Navigating Your Benefits and Healthcare System

1. Navigating Your Benefits and Healthcare System

2. What we will cover today: • Medicare Overview • Enrolling in Medicare • Managing Your Medicare • Resources to Help pay Medicare Premiums and Co-insurance • Resources to Help with Medication Costs • Long Term Care and Tools to Help You Plan for Long Term Care

3. www.agewiseconnection.com

4. Qualifying for Medicare US citizens or resident VISA holders who have lived in the US for five consecutive years and • 65 years or older; eligible for Social Security or Railroad Retirement Benefits • 65 or older; married to someone eligible for Social Security/Railroad retirement • Have received Social Security Disability income for at least 24 months • Have ESRD (kidney failure) or ALS (Amyotrophic Lateral Sclerosis)

5. Applying for Medicare Initial Enrollment Period Apply 3 months before age 65, the month of 65th birthday, or 3 months after month of 65th birthday *Need not be retired Automatically enrolled if receiving Social Security or Railroad Retirement Benefits Received Social Security Disability Benefits (SSDI) for 24 Months Apply through the Social Security Administration (SSA)or Railroad Retirement Board (RRB) 5

6. Medicare Part C Medicare Advantage Medicare Health Plans (PPO, HMO, PFFS, SNP) Part A Hospital Part B Medical Part D Prescription Medicare Basics Known as Original Medicare

7. The Original Medicare Plan Part A and/or Part B Go to any provider that accepts Medicare Pay Medicare Part B premium Pay deductibles Pay co-insurance 7

8. Medicare Part AOverview

9. Medicare Part A – Eligibility and Premiums • Awarded at age 65 or if a person has received disability payments for 24 months • $0 premium for those who have 40 quarters of Medicare-covered Employment (or from a spouse)

10. Medicare Part A – Hospital Insurance – Helps Pay for Hospital stays Skilled nursing facility (SNF) care Home health care Hospice care Blood 10

11. Deductibles, Co-Payments For Part A (Hospitalization) • $1,068 deductible Per Benefit Period • $267 Per day for days 61-90 • $534 Per day for 91-150 (Lifetime Reserve Days) • All costs for each day beyond 150 days

12. Medicare Part BOverview

13. Part B - MedicalOut-patient/Physician Insurance Helps Pay for: • Doctor Services • Outpatient therapy • Outpatient mental health services • Some preventive health care services • Clinical laboratory services • Durable medical equipment (DME) • Outpatient hospital services • Blood • Ambulance service • If other transportation would endanger health

14. Enrolling in Medicare Part B Initial Enrollment Period • 7 months beginning 3 months before age 65 • Enrollment after 24 months of Social Security disability

15. Paying for Medicare Part B – Outpatient Services $96.40 monthly premium $135 per year deductible in 2009 20% co-insurance for most services 15

16. Medicare Prescription Drug Coverage

17. Medicare Part D: Prescription Drug Coverage • Medicare drug coverage • Must enroll in Part D within 90 days of Medicare eligibility – else a penalty will apply • Penalty – 1% of the national average premium times as many months you could have been enrolled • Penalty waived if you have “creditable” coverage by another insurance – Part D enrollment needs to be within 63 days of loss of creditable coverage • People to receive Part D benefits through stand alone PDP plan or Medicare Advantage Plan (MAPD)

18. Part D Eligibility Requirements • Medicare Part A and/or Part B • Part A and Part B to join Medicare Advantage plan with drug coverage • Live in plan’s service area • Enroll in a plan

19. Enrolling in Part D Enrollment Periods for PDP • Initial Enrollment Period (7 mos. surrounding Medicare effective date) • Annual Coordinated Election Period (AEP Nov. 15th-Dec. 31st)-Can choose PDP or MA-PD • Special Enrollment Period (SEP) Open enrollment period for MA-PD (OEP Jan. 1st-Mar. 31st)

20. What is the Medicare prescription “donut hole” or “gap?” • Getting into the gap: • You pay copays or coinsurance for each prescription filled; the plan pays the remainder until drug costs (retail) reach $2,700 • The gap: • You pay 100% of drug costs until out of pocket for the calendar year equal $4,350 • After the Gap (Catastrophic Coverage) • Small coinsurance charged for each drug until end of year • *Note: excluded drugs do not help contribute towards out of pocket costs to be out of the gap

21. Choosing a Part D Plan • For assistance choosing a Part D plan visit www.medicare.gov • The following information is needed to compare plans: -Name -Date of birth -Medicare card -Zip code -County -List of medications

22. www.medicare.govPrescription Drug Plan Finder

23. Part C -Medicare AdvantagePrivate Health Plans Pays plan to provide Part A and B coverage Pays company $$ per person enrolled

24. Medicare Advantage (Part C) • Replaces the manner in which benefits for Original Medicare are provided • Offered through private companies • May offer extra benefits including Part D coverage • Most require additional premium in additional to annual Medicare premium • Coinsurance/Co-pays • May offer some vision or basic dental benefits • For enrollment, MUST: • Have Medicare Part A and Part B • Live in plan’s geographical service area

25. What are Medicare Advantage Plan Options? • Medicare Managed Care Plans (HMOs) – Health Maintenance Organizations • Medicare Preferred Provider Organization (PPOs) – Preferred Provider Organizations • Private Fee-for-Service Plans (PFFSs) • Special Needs Plans (SNPs)

26. Why choose an Advantage Plan? • Generally includes Physical Exam annually • May include some Dental, Vision or Hearing Coverage • Often, fixed copay for doctor services • Sometimes, lower hospitalization costs • Often, a lower monthly premium than Medigap

27. What’s the Advantage? • Can result in cost savings for medical care for some people • Can offer additional services not covered by Original Medicare • Any Medicare beneficiary can enroll and receive benefits – no pre-existing condition exclusion or waiting period for coverage

28. Is Medicare Advantage right for you? • A Medicare Advantage Plan is NOT a replacement for your Medigap policy. • Before you enroll in a Medicare Advantage Plan, answer the following questions: • 1. Are my doctors and hospitals covered by the plan? That is, do they accept the plan’s terms and conditions? • 2. Do I need a referral to see a specialist? • 3. Can I get care outside the plan's service area or network? If so, how? • 4. What costs are involved in the plan (premium, deductible, copayments)? • 5. Are my prescriptions covered by the plan? • 6. What are copayment requirements for lab tests, diagnostic tests, x-rays, MRI scans, or CT scans?

29. Medicare Advantage Enrollment:General Periods • When first eligible for Medicare • Open Enrollment Period January – March • If plan has Part D coverage, additional period: November 15th - December 31st

30. What card do I use?

31. Medicare Advantage Enrollment • You can use the Medicare Plan Comparison tool on Medicare.gov to find and compare plans • You can enroll online

32. Medicare Advantage Enrollment To enroll, call: • Medicare • Private Insurance Company Or, online: www.medicare.gov

33. Financial Assistance for Medicare Health Costs

34. Medicaid – Medicare Savings Programs (QMB, SLMB, and QI) • Pays Medicare premiums and possibly additional coinsurances • Savings Program eligibility varies state to state: • Georgia 2009 Eligibility Burial Allowance: $10,000 per person:

35. Georgia Compasshttps://compass.ga.gov/selfservice/

36. Extra Help for Prescriptions/ Low Income Subsidy • Who is eligible? Income < $0-1,354 Single < $0-1,821 Married Assets (Resources) $12,510 Single $25,010 Married • What are the benefits? • No/low premiums for those with limited incomes • No/low deductible • Small copayment or coinsurance for each prescription

37. To Apply for the Extra Help Visitwww.ssa.gov

38. Resources for Bridging the Coverage Gap http://www.medicare.gov/bridging-the-gap.asp

39. Resources for Bridging the Coverage Gap • Needy Medswww.needymeds.org • Partnership For Prescription Assistancewww.pparx.org • RxAssistwww.rxassist.org

40. Benefits CheckUpwww.benefitscheckup.org Find Benefits Programs For: • Prescription drugs • Nutrition (SNAP/Food Stamps) • Energy assistance • Financial • Legal • Health care • Social Security • Housing • In-home services • Tax relief • Transportation • Educational assistance • Employment • Volunteer services

41. What is Medigap ? • Sold by private insurance companies • Fills in the “GAPS” for Medicare • 12 standardized plans (A through L) • Must have Part A & B • Medigap SELECT policies may require use of certain physicians and hospitals

42. Enrolling in a MedigapOpen Enrollment Period 6 months following enrollment in Medicare Part B Cannot be turned down for any reason Cannot charge more because of health problem Cannot make beneficiary wait for all coverage to start May wait for coverage of pre-existing conditions – unless creditable coverage

43. How Medigap Works Only works with Original Medicare Won’t work with Medicare Advantage Plans Other Medicare plans Can go to any doctor, hospital, or provider that accepts Medicare Unless have Medigap SELECT policy

44. Medigap Is Not • Medicare Advantage Plans • Medicare Part B • Medicare Prescription Drug Plans • Medicaid • Employer or union plan • TRICARE • Veterans’ benefits

45. Who Can Buy Medigap? • Must have Medicare Parts A and B • May not be able to buy Medigap under 65 • People with a disability • People with End-Stage Renal Disease • Guaranteed right to buy a Medigap policy • In your Medigap open enrollment period • Covered under a Medigap protection

46. Why Buy Medigap? • Original Medicare does not pay all costs • Medigap policy may help • Lower out-of-pocket costs • Get more health insurance coverage

47. Medigap Toolwww.medicare.gov Provides: • Information on different types of Medigap policies by area • Contact information on the companies that offer them

48. Once you are enrolled in Medicare, you can use www.mymedicare.gov to: • View claim status (excluding Part D claims) • Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card • View eligibility, entitlement and preventive services information • View enrollment information including prescription drug plans • View or modify your drug list and pharmacy information • View address of record with Medicare and Part B deductible status • Access online forms, publications and messages sent to you by CMS

49. www.mymedicare.gov

50. Mymedicare.gov Virtual Tourhttp://www.mymedicare.gov/WBTMain.asp