AREA AGENCY ON AGING AND DISABILITYSTATE HEALTH INSURANCE ASSISTANCE

PROGRAM (SHIP)2012

Medicare 101

Welcome to Medicare 101

What is MedicareEnrolling in MedicareYour Medicare BenefitsMedicare Supplemental BenefitsMedicare Advantage PlansPart D Prescription CoverageMedicare With Other Insurances

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

The Medicare Card

Medicare Coverage Basics

Part ASee p. 32 of Medicare and You Handbook

•Inpatient hospital care•Skilled nursing care•Home health care•Hospice care

Part BSee p. 36 of Medicare and You Handbook

•Doctors’ services and outpatient care•Preventive services•Diagnostic tests•Durable medical equipment

Part DSee p. 84 of Medicare and You Handbook

•Outpatient prescription drugs•Shingles vaccination

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

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

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

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

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

Medicare Choices

Original Medicare Plan OR

Original Medicare plus Retiree Coverage Medicare Supplemental Insurance (Medigap) Income-based assistance programs OR

Medicare Advantage Plan

Original Medicare PlanPart A + Part B only

Traditional way of getting Medicare through the federal government

Use any provider that accepts MedicareYou 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

Original Medicare Plan + Medigap

Health insurance sold by private companyUse any provider that accepts Medicare10 standard plans Cover “gaps” in Original Medicare plan

Deductibles, coinsurance, copaymentsMust pay monthly premium to the plan in

addition to your Part B premium ($99.90)

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

Original Medicare Plan + Medigap

Monthly premiums vary according to planPlans are standardizedCosts are different between companiesMost popular plans are C, F, G & NYou have rights and protections

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

Medicare Prescription Drug Coverage

Coverage began January 1, 2006All people with Medicare can join a planProvided through

Medicare Prescription Drug Plans Medicare Advantage Plans

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 benefitsCan get plan information and costs

www.medicare.gov 1-800-MEDICARE (1-800-633-4227) 1-877-801-0044 SHIP

Medicare Drug Coverage Enrollment Periods

Initial Enrollment Period (IEP) 7 months starting 3 months before month eligible for

MedicareAnnual 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)

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)

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)

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

Medicare Advantage Plans

Get all Medicare covered services through plan

May include prescription drug coverageMay have to see certain doctors or go to

certain hospitals to receive careSome plans may include benefits that

Original Medicare does not Vision, dental, hearing

Medicare Advantage Plans

Must continue to pay Part B premium

May pay additional monthly premium

Must pay other out-of-pocket costs

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)

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

Medicare Advantage Plans

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

Original Medicare Plan + Retiree Coverage

Retiree coverage is based on a former jobBased on your own or spouse’s employmentRetiree 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

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

Original Medicare Plan + Other

CobraVATriCare

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

For More Information

If you suspect fraud: Call SMP (Senior Medicare Patrol) at: 1-866-836-7677

www.medicare.govState Health Insurance Assistance Program

(SHIP) at: 1-877-801-00441-800-MEDICARE (1-800-633-4227)

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

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