Medicare 101 Christian Reformed Church Medicare 101

Medicare 101 Christian Reformed Church

Medicare 101 n Introduction to Medicare n Original Medicare Plan n Medicare Supplement Insurance (Medigap) n Medicare Advantage and other Medicare plans n Medicare prescription drug coverage n Medicaid n Question and Answers June, 2012 2

Introduction What Is Medicare? n A health insurance program for People 65 years of age and older People under age 65 with certain disabilities People with End-Stage Renal Disease (ESRD) n Administered by Centers for Medicare & Medicaid Services (CMS) n Enrollment by Social Security Administration (SSA) or Railroad Retirement Board (RRB) June, 2012 3

Introduction Applying for Medicare n Apply 3 months before age 65 Don’t have to be retired Contact the Social Security Administration n Enrollment automatic if receiving Social Security or Railroad Retirement benefits June, 2012 4

Introduction Medicare Basics Part A Hospital Insurance Part B Medical Insurance Prescription Drug Coverage (Part D) June, 2012 5

Introduction Medicare Coverage Basics Part A Part B Part D June, 2012 n n Inpatient hospital care Skilled nursing care Home health care Hospice care n n n Doctors’ services and outpatient care Preventive services Diagnostic tests Some therapies Durable medical equipment Outpatient prescription drugs 6

Introduction Medicare Part A n Most people receive Part A premium free n People with less than 10 years of Medicarecovered employment or anyone not paying Medicare Tax (i. e. clergy) Can still get Part A, but will pay premium ($451/month in 2012) n If over 65 (on Part A) actively working and on employer’s group medical plan May receive some Part A benefit to supplement covered services not paid by active plan June, 2012 7

Introduction Enrolling in Medicare Part B n Pay monthly Part B premium $99. 90 in 2012 – higher income consumers pay more n Initial Enrollment Period (IEP) 7 months starting 3 months before month of eligibility n General Enrollment Period (GEP) January 1 to March 31 each year - Coverage effective July 1 Premium penalty • 10% for each 12 -month period eligible but not enrolled June, 2012 8

Introduction Enrolling in Medicare Part B n Some people can delay enrolling in Part B with no penalty If covered under employer group health plan that is considered “creditable coverage” • Based on current employment – Person or spouse • Will get a Special Enrollment Period (SEP) when employer group coverage ends – Sign up within 8 months after coverage ends June, 2012 9

Introduction Part B Enrollment Periods Example n Marie turned 65 on June 2, 2012. She will have group health coverage from her employer until she stops working on December 31, 2012. n Part B enrollment opportunities … Enrollment period Begins Ends IEP 3/1/12 9/30/12 SEP 10/1/12 8/31/13 1/1 3/31 GEP (each year) June, 2012 10

Introduction Paying the Part B Premium n Taken out of monthly Social Security payments n If no monthly payments Billed every 3 months Medicare Easy Pay June, 2012 11

Introduction Medicare Choices n Original Medicare Plan n Medicare Advantage Plans n Other Medicare Plans n Medicare Prescription Drug Plans June, 2012 12

Original Medicare Plan n Can access any health care provider that accepts Medicare n People are responsible for: Part A • In 2012, $1, 156 deductible per benefit period for hospital stays up to 60 days – Additional costs after 60 days • Different costs for other Part A services Part B • $140 annual deductible in 2012 • 20% coinsurance or copayment for most Part B services n Some programs may help with costs June, 2012 13

Original Medicare The Medicare Card Jane Doe June, 2012 14

Medicare Coverage Outside U. S. n For most situations, Basic Medicare won’t pay for health care or Rx outside U. S. n Must have either: Medicare Supplement plan that covers foreign travel Some Medicare Advantage plans include it International Travel Insurance n Visit www. medicare. gov/Coverage/ to learn more about what Medicare covers. June, 2012 15

Medigap n Health insurance policy Sold by private insurance companies Must say “Medicare Supplement Insurance” Covers “gaps” in the Original Medicare Plan • Deductibles, coinsurance, copayments • Does not work with Medicare Advantage Plans Up to 12 standardized plans A – L • Except in Massachusetts, Minnesota, Wisconsin • So people can compare easily June, 2012 16

Medigap How Medigap Works n People can buy a Medigap policy Within 6 months of enrolling in Part B • Only some plans are guarantee-issue If they lose certain kinds of health coverage • Through no fault of their own If they leave MA Plan under certain circumstances Whenever insurance company will sell them one n Monthly premium n Generally go to any doctor or specialist June, 2012 17

Medicare Advantage and Other Medicare Plans Medicare Advantage Plans n Health Maintenance Organization (HMO) Plans Some have Point-of-Service option n Preferred Provider Organization (PPO) Plans Regional PPOs n Private Fee-for-Service (PFFS) Plans n Special Needs Plans n Medicare Medical Savings Account (MSA) Plans Not very common June, 2012 18

Medicare Advantage and Other Medicare Plans Eligibility for MA Plans n Live in plan’s service area n Entitled to and Enrolled in Medicare Part A n Enrolled in Medicare Part B Continue to pay Part B premium May also pay monthly premium to plan n Don’t have ESRD at enrollment Some exceptions June, 2012 19

Medicare Advantage and Other Medicare Plans How MA Plans Work n Usually get all Part A and B services through plan May have to use providers in plan’s network Generally must still pay Part B premium • Some plans may pay all or part n May get extra benefits Vision, hearing, dental services Prescription drug coverage n Still in Medicare program Get all Part A and Part B services Have Medicare rights and protections June, 2012 20

Medicare Drug Coverage Medicare Prescription Drug Coverage n Medicare “D” program began Jan 1, 2006 n Available to all people with Medicare n Provided through Medicare Prescription Drug Plans Medicare Advantage and other Medicare plans Some employers and unions June, 2012 21

Medicare Drug Coverage Enrollment Periods n Initial Enrollment Period (IEP) 7 months Starts 3 months before month of eligibility n Annual Coordinated Election Period (AEP) November 15 through December 31 each year Can join, drop, or switch coverage • Effective January 1 of following year n Special Enrollment Period (SEP) June, 2012 22

Medicare Drug Coverage Late Enrollment n People who wait to enroll may penalty Additional 1% of national base premium for every month eligible but not enrolled Must pay the penalty as long as enrolled in a Medicare drug plan n Unless they have other coverage at least as good as Medicare drug coverage “Creditable coverage” June, 2012 23

Medicare Drug Coverage Prescription Drug Plans n At a minimum, must offer standard benefit In 2012 members may pay • Monthly premiums • Annual deductible, no more than $320 • Copayments or coinsurance n Coverage Gap (donut hole) Begins when reach coverage limit ($2, 930 in 2012) and ends when you spend $4, 700 TROOP (True Out-of. Pocket costs). In “donut hole”, 50% manufacturer-paid discount on covered brand-name drugs. 14% discount for generic After TROOP max, minimal cost sharing (5%) June, 2012 24

Medicaid and Medicare Savings Programs Medicaid n Joint Federal and state program For some people with limited income and resources n If eligible, most health care costs covered n Eligibility determined by state n Application processes vary n Office names vary Social Services Public Assistance Human Services June, 2012 25

For More Information n 1 -800 -MEDICARE (1 -800 -633 -4227) TTY users call 1 -877 -486 -2048 n www. medicare. gov n Social Security Administration (1 -800 -772 -1213) n www. cms. hhs. gov n State Health Insurance Assistance Program (SHIP) n Medicare & You handbook Other publications June, 2012 26

Summary n Medicare coverage n Original Medicare Plan n Medicare Supplement Insurance (Medigap) n Medicare Advantage and other Medicare plans n Medicare prescription drug coverage n Medicaid June, 2012 27

Questions? n Thanks for your time! n Presented by: Kevin Cumings Vice-President of Benefits Buiten & Associates, LLC 5738 Foremost Dr. Grand Rapids, MI 49546 616 -956 -0040 Kevin. Cumings@buiteninsurance. com June, 2012 28