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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

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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