MEDICARE OVERVIEW

1. MEDICARE OVERVIEW 402- 444-6617 800-234-7119 Pam Roberts Program Manager

2. VOLUNTEERS ASSISTING SENIORS • Non-Profit Agency • Created in 1977 • Programs: • Insurance Counseling and Assistance- SHIIP • Legal Assistance • Homestead Exemption Assistance • Conservator Program • Consumer Issues/Scams/Fraud

3. What is Medicare & Who Runs the Medicare Program? • Medicare is the federal health insurance program for people age 65 or older. It also covers persons under age 65 with disabilities and people with End-Stage Renal Disease (ESRD) • The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs Medicare. CMS is part of the U.S. Department of Health and Human Services (HHS)

4. Today’s Medicare is about CHOICE. • Original Medicare Plan • Fee-For-Service (pay-per-visit) health plan that lets people go to any doctor, hospital or other health care provider who accepts Medicare. • Medigap policies are Medicare supplement insurance sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. • Medicare Advantage Plans • Health Plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program and sometimes called “Part C”. • Prescription Drug Coverage • Open to everyone with Medicare, but you must join a drug plan to get this coverage.

5. Medicare has three parts Part A Hospital Insurance Most people do not have to pay for Part A. Part B Medical Insurance Most people pay monthly for Part B. Part D Prescription Drug Insurance Provided through private insurance companies

6. D5 Part A • Inpatient Hospital Stays • Skilled Nursing Facility (SNF) Care • Home Health Care • Hospice Care

7. D7 Original MedicarePart A Beneficiary Costs in 2007 • In-Patient Hospitalization: • $992. deductible for a hospital stay of 1-60 days • $248. per day copayment for days 61-90 • $496. per day copayment for days 91-150 • All costs for each day beyond 150 days • Blood deductible -- first three pints • Skilled Nursing Facility Costs: • Days 1-20: Medicare pays 100 (approved) • Days 21-100: $124. copayment per day • Beyond 100 days: Beneficiary pays all costs

8. D16 Original MedicarePart A Beneficiary Costs in 2007 • Home Health Care: • Medicare pays 100% for Home Health Care covered services – You pay 0%. • 20% of the Medicare-approved amount for covered Durable Medical Equipment • Hospice Care: • Medicare pays 100% for services – You pay 0% • Beneficiary pays: • No more than $5 for each prescription drug and other similar products • 5% of Medicare approved amount for inpatient respite care

9. E5 Part B Monthly Premium – Generally, $93.50 in 2007 • Doctors Services • Outpatient Hospital & Emergency Room • Durable Medical Equipment • Clinical Lab Services • Other Services & Supplies

10. E6 Original Medicare - Part BBeneficiary Liability • Yearly Deductible - $131.00 in 2007 • Coinsurance Amounts • 20% of Medicare approved amount for physician services; 50% of Medicare approved amount for outpatient mental health services; Set co-payment amount for hospital outpatient services • Excess Charges • generally limited to 15% over Medicare approved amount; exceptions include durable medical equipment, flu shots, & some drugs • Noncovered Items

11. “Welcome to Medicare” physical exam Bone mass measurement Cardiovascular screening Colorectal cancer screening Diabetes screening, services, and supplies Glaucoma screening Pap test and pelvic exam with clinical breast exam Prostate cancer screening Screening mammogram Smoking cessation counseling Vaccinations (shots) Part B Preventive Services Available to Help you Stay Healthy

12. Medicare Supplement Insurance • Sometimes referred to as a “Medigap” Policy, this is health insurance sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. • Medigap policies help pay your share (coinsurance, copayments, or deductibles) of the costs of Medicare-covered services • Medigap policies DO NOT work with Medicare Advantage plans • Insurance companies in NE can sell you a policy from 12 “standardized” Medigap policies (Medigap A through L). These Medigap policies must all have specific benefits. • Costs vary by policy and company. • An employer/union/retiree plan may offer similar coverage

13. Medicare Advantage Basics • A unique alternative to Original Medicare • Sometimes referred to as Medicare + Choice or Part C • Approved by Medicare and administered by private companies, so MA Plans provide ALL of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. • You must have Medicare Parts A & B to join • Operates under an annual contract with Medicare • Usually includes coverage for prescription drugs (MAPD) • May offer extra benefits, i.e. vision, hearing or dental care • Must accept all Medicare beneficiaries, even those on Medicare due to disability, and cannot have a waiting period for pre-existing conditions. • The exception are those with End-Stage Renal Disease (ESRD)

14. N6 In a Medicare Advantage Plan, be aware that…. • You must continue to pay Part A (if necessary) and Part B premiums • Some Medicare Advantage Plans charge a monthly premium in addition to your Part A/Part B premium. Costs vary by plan and the services you use. • You must live in area where plan is offered • You are responsible for the co-payments • Plans determine their own rates & charges.Co-pays vary according to plan • Medigap (supplement) Plans do not work with Medicare Advantage Plans • Your current provider may or may not accept the plan you choose as these plans often have networks • Doctors or hospitals are not required to accept payment from MA plans. If the provider does NOT accept the plan, you may be responsible for the entire payment!

15. Important MA Considerations: • Does your provider accept the plan? • You may have to see doctors who accept the plan or go to certain hospitals to get covered services—are you willing to change? • In most Medicare Advantage Plans, if your plan offers Medicare prescription drug coverage and you want drug coverage, you must get it from your plan. • Are your prescriptions covered under this plan? • Can you cover the maximum out of pocket? • i.e. in-patient hospital co-pays • Rules for enrollment and disenrollment • Annual Co-ordinated Election Period (AEP) • November 15 through December 31—Coverage begins January 1 • Medicare Advantage open enrollment period • January 1 through March 31 each year—lateral move only

16. Twelve Month Trial Run • Can leave the MA plan at any point during first 12 months • If enrolled when turned 65: • Can go to Original Medicare and buy any Medigap plan A-L (OR) • If left Medigap and original Medicare: • Can return to Original Medicare and get their Medigap policy back, if still available, or pick another one (A,B,C,F,K or L) from any issuer

17. Medicare Prescription Drug Coverage--Part D-- • Began January 1, 2006 • Offered by private plans approved by Medicare • Available for all people with Medicare • Part A, Part B, or both • Must join a Medicare drug plan to get coverage

18. Part D Enrollment & Penalties • Initial Enrollment Period (IEP) • 7 months • Starts 3 months before month of eligibility • Annual Coordinated Election Period (AEP) • Special Enrollment Period (SEP) • People who wait to enroll may pay penalty • Additional 1% of national base premium for every month eligible but not enrolled

19. Annual Coordinated Election Period (AEP) • November 15 – December 31 every year • People who don’t have a Medicare drug plan can enroll • People who currently have a Medicare drug plan can switch • Changes are effective January 1, 2008 • Special Enrollment Period (SEP) may apply in special circumstances

20. Annual Notice of Change • All Part D plans send to all members • By October 31, 2007 • Will include information for 2008 • Summary of Benefits • Formulary • Any changes • Premium • Copayment/coinsurance

21. 2008 BASIC STANDARD COVERAGE Your Drug Costs You Pay Medicare Pays Your Total Out-Of-Pocket Costs Per Year* Deductible $0- $275 100% ($275) $0 $275 Coinsurance $276-$2,510 25% ($558.75) 75% ($1,676.25) $833.75 GAP or Doughnut Hole $2,511-$5,726.25 100% ($3,216.25) $0 $4050. Catastrophic Benefit Over $5,726.25 5% 95% $4050. + 5% of costs above $5,726.25 Basic Standard Coverage *Does not include premium cost

22. Part D Plan Finder Tool and MyMedicare.gov • Both available at: • www.medicare.gov • Part D Plan Finder Tool • Allows beneficiaries to personalize their search for prescription drug coverage that best meets their needs • Compare plans • Use preferences to narrow results • Provides information on Prescription Drug Plans & Medicare Advantage Prescription Plans • MyMedicare.gov • Secure online service for accessing your personal Medicare information

24. Limited Income and Resources? • What is Medicaid? • What is the Medicare Savings Program? • What is Medicare’s Extra Help? • Low Income Subsidy

25. Reevaluation and Enrollment Events • Begin November 16th, 2007 • Call VAS office for list of events close to you • Can come into VAS office for one-on-one • 1941 South 42nd Street, Suite 502 • The Center • 444-6617