1 / 60

Medicare

Medicare. Getting Started. SHIBA Statewide Health Insurance Benefits Advisors. A free, unbiased service, sponsored by the Washington State Office of the Insurance Commissioner. What is SHIBA?. Statewide Health Insurance Benefits Advisors

chuong
Download Presentation

Medicare

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Medicare Getting Started SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service, sponsored by the Washington State Office of the Insurance Commissioner

  2. What is SHIBA? • Statewide Health Insurance Benefits Advisors • A free program of the Office of the Insurance Commissioner • We provide unbiased and confidential information about Medicare and other health insurance • We are an educational service • We don’t sell anything!

  3. Today’s overview • Medicare basics: A, B, D or C • How and when to enroll • Medigaps – Medicare Supplement plans • Part D – prescription coverage • Do you need help paying for your plan? • Medicare Advantage plans • Next steps

  4. Protect yourself! • As you research your options: • Keep a notebook • Write down the names of people you talk to, the date and their contact information • Note what was said in the conversation • Keep copies of any paperwork • Beware of fraud!

  5. What is Medicare? • Health insurance for people: • Age 65 and older • Under age 65 with certain disabilities • Any age with End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (also known as ALS)

  6. What is Medicare? • It’s administered by: • Centers for Medicare & Medicaid Services (CMS) • But enrollment is done by: • Social Security Administration (SSA) for most • Railroad Retirement Board (RRB) railroad retirees

  7. The four parts of Medicare OR

  8. Original Medicare Has Part A – Hospital Insurance • Hospital (Inpatient) • Skilled Nursing Facility • Home health care • Hospice care Has Part B – Medical Insurance • Doctor’s visits • Outpatient hospital services • Clinical lab tests • Durable Medical Equipment • Preventive services

  9. Medicare does not cover everything! • Routine eye exams, eyeglasses • Only glasses after cataract surgery • Routine dental care • Cleaning, fillings, crowns, bridges, dentures • Hearing aids • Most “alternative” medicine • Acupuncture, Naturopathy • Long-term care • Only skilled care in certain circumstances

  10. Medicare Part A (Hospital Insurance) • What does Part A cost? • Most people get Part A premium free • You can pay a premium to get Part A • It can cost $234 or $426/mo. depending on work credits

  11. Medicare Part B(Medical insurance) • What does Part B cost? • This year – for most – Part B costs: $104.90/month • Those who have higher incomes will pay more • May have penalty

  12. Paying for Part A&B services • See chart in handouts • In addition to Part B premiums and sometimes Part A premiums • In Original Medicare you pay: • Part A Hospital deductible of $1,216 • Part B yearly deductible of $147 • 20% coinsurance for most services • THERE MAY BE OTHER COSTS! • Programs may help pay these costs • For people with limited income and resources

  13. How to enroll in Medicare • Enrollment is automatic for most • If you get Social Security or RRB benefits • If enrollment is not automatic • For instance, you’re still actively working • You need to enroll with Social Security: • Visit local office • Call 1-800-772-1213 • Online at socialsecurity.gov • If retired from Railroad, enroll with RRB • Call your local RRB office or 1‑877‑772‑5772

  14. Medicare card • Keep it and accept Medicare Parts A and B • Return it to refuse Part B • Follow instructions on back of card Jane Doe Back Front

  15. When can I enroll in Medicare? • The later you enroll, the later coverage starts: • Up to a 3-month wait

  16. Medicare decisions • Original Medicare? • Should I keep/sign up for Part A? • Should I take Part B? When? • What about Part D? • Do I need a Medigap policy? • Do I want a Medicare Advantage Health plan? • Can I get help with Medicare costs? Maybe?

  17. Decide how you want to get your Medicare coverage Source: Page16 of Medicare & You 2014

  18. DecisionShould I keep/sign up for Part A? • Consider • Get it automatically if getting Social Security/RRB • Free for most people • If not free • Can pay for it if not enough work quarters Yes

  19. DecisionShould I keep/sign up for Part B? Consider Is there active work involved? • NO ACTIVE work to consider. • I’m ACTIVELY working and I’m covered by a health insurance plan from my current job. • I’m NOT ACTIVELY working, but my spouse is, and I’m covered under his/her health insurance through their current job. It Depends

  20. DecisionShould I keep/sign up for Part B? • If you don’t have coverage from active employment • Yours or your spouses • Delaying Part B may mean: • Higher premiums • Paying for your health care out-of-pocket • If you do have coverage through active employment • You may want to delay Part B • No penalty if you enroll while you have coverage or within 8 months of losing coverage Probably Maybe Not

  21. DecisionShould I keep/sign up for Part B? • Sometimes you must have Part B • If you want to buy a Medigap policy • If you want to join a Medicare Advantage Plan • If you're eligible for TRICARE • If your employer coverage requires you have it • Talk to your employer’s benefits administrator • Talk to SSA or SHIBA if questions

  22. Medigaps Also called Medicare Supplement insurance

  23. What is a Medigap policy? • Medicare Supplement insurance policies • Sold by private companies • Fill the gaps in Original Medicare • Deductibles, coinsurance, copayments • Standardized plans • All plans with same letter • Have same coverage • Only the costs are different

  24. DecisionDo I need a Medigap policy? • Consider • It only works with Original Medicare • Do you have other supplemental coverage, such as a retiree plan? • You might not need Medigap • Can you afford Medicare deductibles and copayments? • What does the monthly Medigap premium cost? Maybe

  25. DecisionWhen is the best time to buy Medigap? Usually during your Medigap Open Enrollment Period AKA “Guaranteed Issue” • Consider: • Your Medigap Open Enrollment Period starts when you're age 65 or older AND enrolled in Part B • Lasts 6 months • You have protections – plans MUST sell you a plan • You can buy a Medigap policy whenever a company agrees to sell you one

  26. DecisionWhich Medigap policy do I buy? • Consider • The coverage under each standardized plan • The cost of each plan – be sure to shop • Your individual health care needs It Depends

  27. *Plan F has a high-deductible option ** Plans K and L have out-of-pocket limits of $4,800 and $2,400 respectively Source: Page 69 of Medicare & You 2014

  28. DecisionHow do I find the right Medigap policy for me? • By computer or phone • Call SHIBA 1-800-562-6900 • Insurance.wa.gov • Call 1.800.MEDICARE (1-800-633-4227) • TTY users should call 1-877-486-2048

  29. Medicare prescription drug plans • Medicare Part D

  30. Part D – Medicare prescription drug coverage • Available for all people with Medicare • Provided through: • Medicare prescription drug plans • Medicare Advantage plans • Other Medicare plans

  31. How Medicare Part D works • It’s optional • You can choose a plan and join • Plans have formularies • Lists of covered drugs • Must include range of drugs in each category • You pay the plan a monthly premium • You pay deductibles and copayments • There’s Extra Help to pay Part D costs • If you have limited income and resources

  32. Who can join Part D? • You must have Part A and/or Part B • You can’t live outside the U.S. • You must actively enroll to join • In most cases no automatic enrollment

  33. DecisionShould I enroll in a Part D plan? • Consider • Do you have creditable drug coverage? • Coverage as good as Medicare’s • For example through an employer plan • Will that coverage end when you retire? • How much do your current drugs cost? • What do the premiums cost for Part D plans? • Without creditable coverage • Later enrollment may mean you pay a penalty It Depends

  34. Joining a Part D plan • You can join: • During your 7 month Initial Enrollment Period • During the Open Enrollment Period • October 15 – December 7 • Coverage starts January 1 • During other special times • Special Enrollment Period

  35. How do I choose a Part D plan? • Call or by computer • Call SHIBA for help comparing plans • Medicare Plan Finder at:www.medicare.gov/find-a-plan • To join a Part D plan • Enroll on www.medicare.gov • Complete a paper enrollment form • Call the plan • Enroll on the plan’s website • Call 1-800-MEDICARE (1-800-633-4227)

  36. Medicare Advantage plans • Medicare Part C • Also called “Medicare Health plans”

  37. Part C – Medicare Advantage • Run by private companies • Another way to get Medicare coverage • Still part of the Medicare program • Member may have a monthlypremium • Medicare pays amount for each member’s care • May have to use network doctors or hospitals

  38. How Medicare Advantage works • Still in Medicare with all rights and protections • Still get Part A and Part B services • May include prescription drug coverage • May include extra benefits • Like vision, dental, hearing & gym membership • Benefits and cost-sharing may be different per plan

  39. DecisionDo I want to join a Medicare Advantage plan? • Consider • Most offer comprehensive coverage • Including Part D drug coverage • May require you to use a network • You must pay Part B and monthly plan premium • May need a referral to see a specialist • Can only join/leave plan during certain periods • Doesn’t work with Medigap policies • You must have Part A and Part B to join • You must live in the county where the plan is sold • You can’t buy it if you have End Stage Renal Disease It Depends

  40. When can I enroll in an MA plan? • During 7-month Initial Enrollment Period • During the Open Enrollment Period • October 15 – December 7 each year • Coverage starts January 1 • May be able to join at other times • Special Enrollment Period • Contact the plan or Medicare to join • Call their number • Visit their website • Plan information on www.medicare.gov

  41. Paying for Medicare

  42. What do I pay? • Costs vary and change yearly • In Original Medicare • Does the provider accept Medicare Assignment? • In Medicare Advantage • Check with plan • In Medicare prescription drug plans • Check with plan

  43. What help is there for people with limited income and resources? • Medicaid • For people with the lowest incomes, eligible people pay little or nothing for their health care costs • Medicare Savings Programs • Helps pay Part B premiums and sometimes Part A and Part B deductibles and co-insurance • Extra Help • Helps pay Part D costs

  44. What is Medicaid? • Federal-state health insurance program • For people with limited income/resources • Certain people with disabilities • If you have both Medicare and Medicaid, covers most health care costs • Eligibility determined by state • In Washington: DSHS • Apply if you MIGHT qualify

  45. What are Medicare Savings Programs (MSPs)? • Help from Medicaid to pay Medicare costs • Pay Medicare premiums • May pay Medicare deductibles and coinsurance • Income amounts change each year

  46. Who can qualify for MSP? Asset Limits: Individual $ 7,160 Couple $10,750

  47. What is Extra Help (Low Income Subsidy)? • Help paying prescription drug costs • Social Security makes determination • Some groups automatically qualify • Example: If they qualify for Medicare and Medicaid • You or someone on your behalf can apply

  48. Who can qualify for Extra Help? Asset Limits: Individual $13,440 Couple $26,860

  49. DecisionShould I apply for these programs? • Apply if you MIGHT qualify • Social Security for Extra Help • DSHS for Medicaid or Medicare Savings Programs • SHIBA can help you Yes!

  50. Key points to remember • Medicare is a health insurance program • It does not cover all of your health care costs or types of care • You may want to find additional coverage • Or plan to pay out of pocket • Some plans change each year • You may need to review coverage during Open Enrollment in the fall

More Related