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Medicare 101

Medicare 101

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Medicare 101

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  1. Medicare 101 Area Agency on Aging and Disability State Health Insurance Assistance Program (SHIP) 2012

  2. Welcome to Medicare 101 What is Medicare Enrolling in Medicare Your Medicare Benefits Medicare Supplemental Benefits Medicare Advantage Plans Part D Prescription Coverage Medicare With Other Insurances

  3. What is Medicare? • Health Insurance for • People 65 years of age and older • People under age 65 with certain disabilities • People of all ages with End-Stage Renal Disease • Run by the Centers for Medicare & Medicaid Services (CMS) • Sign up with the Social Security Administration or Railroad Retirement Board

  4. The Medicare Card

  5. Medicare Coverage Basics

  6. Applying for Medicare • Apply 3 months before age 65 • Don’t have to be retired • Contact the Social Security Administration • Enrollment automatic if you get Social Security or Railroad Retirement Benefits

  7. Medicare Part A Most people don’t pay a monthly premium for Part A People with less than 10 years of Medicare-covered work can still get Part A For more information about Part A eligibility, call Social Security

  8. Enrolling in Medicare Part B • Initial Enrollment Period (IEP) – 7 months • 7 months starting 3 months before month of eligibility • General Enrollment Period (GEP) • January 1 – March 31; Coverage starts July 1

  9. Enrolling in Medicare Part B • Part B premium - $99.90 per month • Higher premiums if income > $85,000 per year • Will depend if filing separately or joint • Premium can be as high as $319.70/month • Social Security determines premium by income tax records

  10. Paying the Part B Premium • Taken out of monthly payments • Social Security • Railroad retirement • Federal government retirement • May be paid quarterly directly to CMS by check • For more information about premiums, call • SSA, RRB or Office of Personnel Management

  11. Medicare Choices • Original Medicare Plan OR • Original Medicare plus • Retiree Coverage • Medicare Supplemental Insurance (Medigap) • Income-based assistance programs OR • Medicare Advantage Plan

  12. Original Medicare PlanPart A + Part B only • Traditional way of getting Medicare through the federal government • Use any provider that accepts Medicare • You are responsible for • Part A - $1,156 hospital deductible (1-60 days) • Additional costs (coinsurance) after 60 days • Part B • $140 annual deductible • 20% coinsurance or copayment for most Part B services

  13. Original Medicare Plan + Medigap • Health insurance sold by private company • Use any provider that accepts Medicare • 10 standard plans • Cover “gaps” in Original Medicare plan • Deductibles, coinsurance, copayments • Must pay monthly premium to the plan in addition to your Part B premium ($99.90)

  14. Original Medicare Plan + Medigap • All Medigap plans include core benefits • Hospital coinsurance • 365 days full hospital coverage in addition to days covered by Original Medicare • 20% copayment on doctor’s services • Cost of first 3 pints of blood each year • Plans may offer additional benefits

  15. Original Medicare Plan + Medigap Monthly premiums vary according to plan Plans are standardized Costs are different between companies Most popular plans are C,F, G & N You have rights and protections

  16. Original Medicare Plan + Medigap • Prices of Medigap plans will vary • Benefits the same, but pricing is not • Pricing Structure • Attained age • Issue age • Community rated

  17. Medicare Prescription Drug Coverage • Coverage began January 1, 2006 • All people with Medicare can join a plan • Provided through • Medicare Prescription Drug Plans • Medicare Advantage Plans

  18. Medicare Prescription Drug Plans • Must offer standard (minimum) drug benefit • In 2012, you may pay: • Monthly premiums • Annual Deductibles (no more than $320) • Copayments or coinsurance • Very little after $4,700 out-of pocket • May offer more benefits • Can get plan information and costs • www.medicare.gov • 1-800-MEDICARE (1-800-633-4227) • 1-877-801-0044 SHIP

  19. Medicare Drug Coverage Enrollment Periods • Initial Enrollment Period (IEP) • 7 months starting 3 months before month eligible for Medicare • Annual Coordinated Election Period (AEP) • October 15 through December 7 each year • You can join, drop or switch coverage • Change is effective January 1 of the following year • Special Enrollment Period (SEP)

  20. Minimizing Part D Cost • Look at the total of these costs • Monthly premium • Annual deductible • Monthly copays at pharmacy • Prescription Plan Finder Tool • www.medicare.gov • Yourself • State Health Insurance Assistance Program (SHIP) • 1-800-MEDICARE (1-800-633-4227)

  21. Extra Help with Drug Costs • For many people with limited income and resources • Income limit $1,361/month (one person) or $1,839/month (married couple) • Resource limit $13,070 (one person) or $26,120 (married couple)

  22. Medicare Advantage Plans • Health insurance plans purchased from private companies • Part of the Medicare Program • Sometimes called Part C • Private company administers your Part A & Part B benefits • Not secondary coverage • You haven’t “lost” your Medicare

  23. Medicare Advantage Plans • Get all Medicare covered services through plan • May include prescription drug coverage • May have to see certain doctors or go to certain hospitals to receive care • Some plans may include benefits that Original Medicare does not • Vision, dental, hearing

  24. Medicare Advantage Plans • Must continue to pay Part B premium • May pay additional monthly premium • Must pay other out-of-pocket costs

  25. Medicare Advantage Plans • Eligibility requirements • Live in plan service area • Enrolled in Medicare Part A & B • Most plans will not accept those with End Stage Renal Disease (ESRD)

  26. Medicare Advantage Plans • Can join a Medicare Advantage Plan • When first eligible for Medicare • During specific enrollment periods • Annual Enrollment Period • October 15-December 7 • Special Enrollment Periods

  27. Medicare Advantage Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs Plans (SNP) Medical Savings Accounts (MSA)

  28. Original Medicare Plan + Retiree Coverage • Retiree coverage is based on a former job • Based on your own or spouse’s employment • Retiree Coverage always secondary to Medicare • Current employer coverage not always secondary • Be careful about dropping this coverage • You may not be able to get it back

  29. Original Medicare Plan + Retiree Coverage Retiree coverage varies from one employer to another Read coverage information carefully to see how it works with Medicare Retiree benefits can change from year to year

  30. Original Medicare Plan + Other Cobra VA TriCare

  31. Medicare Fraud and Abuse • Medicare fraud is purposely billing Medicare for services that were never provided • Billing Medicare for services you never got • Billing Medicare for services that are different than what you received • Use of someone else’s Medicare card to get medical care, supplies or equipment • Billing Medicare for home medical equipment after it has been returned

  32. For More Information If you suspect fraud: Call SMP (Senior Medicare Patrol) at: 1-866-836-7677 www.medicare.gov State Health Insurance Assistance Program (SHIP) at: 1-877-801-0044 1-800-MEDICARE (1-800-633-4227)

  33. What are Your Next Steps? • More Research? • Individual Appointments • Come to our Lifetime Learning Workshops for more detailed info. Registration will be from 1pm-2pm on August 7th at the Conference Center. • Department of Human Services • Social Security Administration • SHIP Counselor or volunteer • Insurance agent • Enrollment – Part D, Medigap, MA • Yourself • Friend or relative • SHIP

  34. Contact SHIP or SMP • Kristy Adams, SHIP Coordinator • 1-877-801-0044 • kadams@ucdd.org • LaNelle Godsey, Statewide SMP Director • 1-866-836-7677 • lgodsey@ucdd.org