Medicare unraveled what your employees need to know
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Medicare Unraveled: What your Employees Need to Know PowerPoint PPT Presentation


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Medicare Unraveled: What your Employees Need to Know. [presentation location] [presentation date]. Topics. What is Medicare? When should an employee enroll? How does other coverage work with Medicare? Who can help?. What is Medicare?.

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Medicare Unraveled: What your Employees Need to Know

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Medicare unraveled what your employees need to know

Medicare Unraveled:What your Employees Need to Know

[presentation location]

[presentation date]

[Insert Regional Office and Phone Number Here]


Topics

Topics

  • What is Medicare?

  • When should an employee enroll?

  • How does other coverage work with Medicare?

  • Who can help?

[Insert Regional Office and Phone Number Here]


What is medicare

What is Medicare?

  • Established in 1965, a federal health insurance program

    • Enroll through SSA

    • Managed by CMS

  • Who can get Medicare?

    • People 65 years of age and older

    • People under 65 with certain disabilities

    • People with ESRD and other specific diseases

[Insert Regional Office and Phone Number Here]


Components of medicare

Components of Medicare

  • Part A

    • Inpatient hospital coverage

  • Part B

    • Outpatient coverage (including doctors’ services, labs, tests, etc.)

  • Part C (Medicare Advantage)

    • Combines all benefits into a single plan

    • Similar to an HMO or PPO

  • Part D

    • Prescription drug coverage

[Insert Regional Office and Phone Number Here]


For comprehensive coverage

For Comprehensive Coverage

  • Medicare has premiums, deductibles, and co-payments

  • To offset these costs, beneficiaries may purchase additional coverage

    • Retiree coverage

    • Medigap policies

    • Medicare Advantage Plans (Part C)

    • Veterans’ benefits or TRICARE

[Insert Regional Office and Phone Number Here]


When should an employee enroll

When Should an Employee Enroll?

  • First opportunity approaching 65th birthday:

[Insert Regional Office and Phone Number Here]


What parts should an employee choose

What Parts Should an Employee Choose?

  • 65 years old; continuing to work covered by EGHP (through self or spouse)

    • Part A

    • Can defer Parts B & D

      • Does not apply to same-sex marriages

  • 65 years or older and retiring

    • Parts A, B, & D

    • May have retiree coverage

    • May purchase additional coverage

[Insert Regional Office and Phone Number Here]


What if part b was deferred

What if Part B was Deferred?

  • If deferred Part B due to coverage through active employment

    • 8-month enrollment period

    • Begins at separation or loss of EGHP coverage (whichever is first)

    • Enrollment beyond 8-month period may result in a lifetime late enrollment penalty and a waiting period for coverage to begin

[Insert Regional Office and Phone Number Here]


What if part d was deferred

What if Part D was Deferred?

  • If deferred Part D due to creditable coverage

    • 2-month enrollment period

      • Begins after loss of creditable coverage

    • Beneficiary must provide proof of creditable coverage (provided by employer/EGHP)

    • Enrollment beyond 2 month period may result in lifetime late enrollment penalty and a waiting period for coverage to begin

[Insert Regional Office and Phone Number Here]


When should an employee not defer

When Should an Employee NOT Defer?

  • COBRA

    • Not coverage through active employment

  • Medical Security Program

    • Health coverage through Department of Unemployment Assistance

  • Active employment coverage through same-sex spouse

    • Federal programs cannot recognize same-sex marriages

Will not

prevent

a late enrollment

penalty!

[Insert Regional Office and Phone Number Here]


How does medicare work with other coverage

How does Medicare work with other coverage?

[Insert Regional Office and Phone Number Here]


Medicare and hsas

Medicare and HSAs

  • An individual who is entitled to Medicare is no longer able to contribute to a Health Savings Account (HSA)

  • Even if beneficiary only enrolls in Part A and defers Part B

  • If a Medicare beneficiary has an HSA, he/she can still use existing funds in the account

    • Funds can even be used to pay Medicare premiums, deductibles, or co-payments

[Insert Regional Office and Phone Number Here]


Who can help

Who Can Help?

  • Medicare

    • 1-800-MEDICARE

    • www.medicare.gov

  • Social Security

    • 1-800-772-1213

    • www.ssa.gov

For questions related to Medicare

benefits

For questions related to eligibility and Parts A & B enrollment

[Insert Regional Office and Phone Number Here]


Shine

SHINE

  • Funded by Medicare, administered by Massachusetts Executive Office of Elder Affairs in partnership with local agencies

  • 13 Regional Offices and one statewide

    (Greater Boston Chinese Golden Age Center)

  • 600 certified counselors in almost every city or town in Massachusetts

  • 1-800-AGE-INFO, press 3

    (1-800-243-4636)

[Insert Regional Office and Phone Number Here]


What does a shine counselor do

What does a SHINE Counselor Do?

  • Provides free, and unbiased health insurance counseling to Medicare beneficiaries of all ages and their caregivers

    • At a local site, on the phone, or via email

    • Home visits are available for homebound clients

  • Assists clients in finding coverage that meets their needs

  • Answers questions regarding Medicare eligibility, enrollment periods, and benefits

  • Assists with Medicare appeals and billing issues

  • Screens for public assistance programs

[Insert Regional Office and Phone Number Here]


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