insurance options in retirement retiree... · 2017-02-28 · insurance options in retirement...
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INSURANCE OPTIONS IN RETIREMENT PresentedByKurtSwardenski,RHU,REBCAdvantageBenefitsGroup
Re0ree Medical Op0ons – Pre 65 1. COBRAconCnuaConcoverage
2. IndividualCoverage
3. MarketplaceCoverage
PRESENTED BY ADVANTAGE BENEFITS GROUP 2
Pre-65
Re0ree Medical Op0ons
COBRAConCnuaConCoverage◦ Upto18monthsorunClenCtledtoMedicare,whicheverisless
◦ Medical/PrescripConDrugs7/1/2016-6/30/2017Rates
◦ Dental◦ Vision
PRESENTED BY ADVANTAGE BENEFITS GROUP 3
Pre-65
BCBSPPO2 MESSAChoicesSaver
Single:$534.40 Single:$613.67
2-Person:$1,106.21 2-Person:$1,380.78
Family:$1,352.02 Family:$1,718.28
Re0ree Medical Op0ons
IndividualPlan
◦ Availablethroughanumberofcarriers:◦ PriorityHealth◦ BlueCrossBlueShield◦ MolinaHealthcare◦ Humana
◦ Costvariesbasedonsmokerstatus,age,zipcodeandplandesign
PRESENTED BY ADVANTAGE BENEFITS GROUP 4
Pre-65
Re0ree Medical Op0ons
◦ AdvancePremiumCredits(subsidies)basedonhouseholdincomeandage
◦ MetalTierPlans–PlaCnum,Gold,Silver,Bronze
◦ MulCpleCarriersavailable
PRESENTED BY ADVANTAGE BENEFITS GROUP 5
Pre-65
InstrucConstonavigatethewww.healthcare.govsite:
1) Click“SeeTopics”fromthetopribbononthehomepage
2) Click“Seeplansandprices”
SpecialEnrollmentPeriod:◦ Youmayqualifyforaspecialenrollmentperiodifyouleaveajobwhereyouhadhealthcoverage(ie.ReCrement)
◦ Averagemonthlycost(age62,non-smoker,zip:48858,effecCve1/1/17)◦ SilverPlanforSingle:$667(29plansavailable)-$280aeersubsidy
◦ BronzePlanforSingle:$544(61plansavailable)-$157aeersubsidy
◦ Bothplanshaveasubsidyof$387permonthbasedonsinglehouseholdincomeof$36,000(noGoldlevelplanswereavailabletopurchase)
ForPlanandCostEs.matesoutsideofOpenEnrollment,goto:www.healthsherpa.com
MarketplacePlan(www.healthcare.gov)
Re0ree Medical Op0ons
PRESENTED BY ADVANTAGE BENEFITS GROUP 6
Pre-65
Will I Qualify for Lower Costs on Monthly Premiums? – Marketplace Plan
PRESENTED BY ADVANTAGE BENEFITS GROUP 7
SavingsProgramsyoumayqualifyfor:
EsKmated2017HouseholdIncome–basedonnumberofpeopleinyourhousehold*NOTE:Eligibilitydoesvarybasedonageof
applicant.
1 2 3 4 5 6
Freeorlow-costcoveragethroughMedicaidbasedon
incomealone
Below$16,394
Below$22,108
Below$27,821
Below$33,534
Below$39,247
Below$44,960
AMarketplacehealthplanwithlowermonthlypremiumsplussavingsonoutofpocketcosts,
likededucCblesandcopayments
$16,394-$29,700
$22,108-$40,050
$27,821-$50,400
$33,534-$60,750
$39,247-$71,100
$44,960-$81,450
AMarketplacehealthplanwithlowermonthlypremiums
$29,701-$47,520
$40,051-$64,080
$50,401-$80,640
$60,751-$97,200
$71,101-$113,760
$81,451-$130,320
Youwon’tqualifyforsavingsonaMarketplaceinsuranceplan.YoucanbuyinsurancethroughtheMarketplaceatfullprice,or
buyfromothersources
Above$47,520
Above$64,080
Above$80,640
Above$97,200
Above$113,760
Above$130,320
Pre-65
What Does An Average (Silver) Plan Cost? Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium)
MyPriorityHMOHolisCcSilver2500(PriorityHealth)◦ IndividualPremium(age62,zip48858)=$677permonth◦ $2,500SingleDeducCble,$7,150OutofPocketMaximum◦ $30copayaeerdeducCbleforfirsttwoPrimaryCarevisits.Specialist$50aeerdeducCble
◦ $5GenericDrugsBeforeDeducCble◦ $60preferredbrandcopayaeerdeducCble,20%coinsuranceforspecialtymedicaConsaeerdeducCble
◦ 30%membercoinsuranceaeerdeducCbleformostotherservices
MyPriorityHMOHSASilver1500(PriorityHealth)◦ IndividualPremium(age62,zip48858)=$730permonth◦ $1,500SingleDeducCble,$5,250OutofPocketMaximum◦ 30%coinsuranceaeerdeducCbleformostservices◦ $20genericdrugsaeerdeducCble◦ $60preferredbrandcopayaeerdeducCble,20%coinsuranceforspecialtymedicaConsaeerdeducCble
PRESENTED BY ADVANTAGE BENEFITS GROUP 8
Pre-65
Re0ree Medical Op0ons – Post 65
1.Medicare 2.MedicareAdvantagePlan 3.MedicareSupplementalPlan
PRESENTED BY ADVANTAGE BENEFITS GROUP 9
Post-65
Re0ree Medical Op0ons - Medicare
WhorunstheMedicareProgram?◦ TheCentersforMedicare&MedicaidServices(CMS)istheFederalagencythatrunsMedicare.CMSispartoftheU.S.DepartmentofHealthandHumanServices
◦ ImpactofrecentlyenactedhealthreformonMedicare(2012)◦ EnhancedprevenCvecareservices◦ Subsidyanddiscountsfordrugswhileinthedonuthole
◦ Resourcesites:◦ hmp://www.usprevenCveservicestaskforce.org/uspsn/uspsabrecs.htm◦ www.medicare.gov◦ www.medicarerights.org–detailedCmeline◦ www.kff.org–KaiserFamilyFoundaCon
PRESENTED BY ADVANTAGE BENEFITS GROUP 10
Post-65
Medicare MedicareBenefits
PartA:
HospitalCoverage
PartB:
MedicalCoverage
PartD:
PrescripConDrugInsurance
PartC:
CombinesPartA,BandDintoonepackage
PRESENTED BY ADVANTAGE BENEFITS GROUP 11
Post-65
Medicare Coverage Choices Start
OriginalMedicare
PartA(HospitalCoverage)
PartD(PrescripConDrug
Insurance)
Medigap(MedicareSupplementInsurance)
Policy
PartB(MedicalCoverage)
MedicareAdvantagePlan(likeanHMOorPPO)
PartC(IncludesBOTHPartA(HospitalCoverage)andPartB(MedicalCoverage)and
usuallyPartD
PartD(PrescripConDrug
Insurance)
END
PRESENTED BY ADVANTAGE BENEFITS GROUP 12
Step 1: Decide how you want to get your coverage
Step 2: Decide if you want to add drug coverage
Step 3: Decide if you want to add supplemental coverage
If you join a Medicare Advantage Plan, you don’t need and can’t be sold a Medigap policy.
Post-65
Checklist: 5 Things to Do When You Get Medicare
1) FilloutanAuthorizaConFormMedicarecan’tgivepersonalhealthinformaConaboutyoutoanyoneunlessyougivepermissioninwriCngfirst
2) Makea“WelcometoMedicare”PhysicalExamAppointmentThisfree,one-Cmecomprehensiveexamisofferedduringthefirst12monthsyouhaveMedicare
3) SignupforMyMedicare.govMyMedicare.govisasecureonlineservicewhereyoucanaccessyoupersonalMedicareinformaCon24hoursaday,everyday
4) ChooseandJoinaMedicareDrugPlan(PartD)Ifyou’renewtoMedicare,youhave7monthstojoinaMedicaredrugplan
5) DownloadaCopyof“YourMedicareBenefits”Medicare’sofficial“YourMedicareBenefits”publicaConexplainstherulesaboutwhichhealthcareservicesandsuppliesMedicarecovers
PRESENTED BY ADVANTAGE BENEFITS GROUP 13
Post-65
Medicare Part A Helps Pay for: Hospitalstays($1,316deducCble,1st60days/$329perday–61to90days) Skillednursingfacility(SNF)care
Long-termcarehospitals
Homehealthcare
Hospicecare
Blood ForinformaCon,call1-800-MEDICARE
PRESENTED BY ADVANTAGE BENEFITS GROUP 14
Post-65
Paying for Medicare Part A MostpeoplereceivePartApremiumfree
Peoplewithlessthan10yearsofMedicarecoveredemploymentwillpayaPartApremium
ForinformaCon,calltheSocialSecurityAdministraCon(SSA)◦ 1-800-772-1213◦ 1-800-325-0778forTTYusers
PRESENTED BY ADVANTAGE BENEFITS GROUP 15
Post-65
Part B Helps Pay for: Doctors’services OutpaCentmedicalandsurgicalservicesandsupplies
DiagnosCctests OutpaCenttherapy OutpaCentmentalhealthservices
PrevenCvehealthcareservices Othermedicalservices
PRESENTED BY ADVANTAGE BENEFITS GROUP 16
Post-65
Paying for Medicare Part B: MostMedicarePartBbeneficiarieswillpayapremiumamountof$134.00(higherincomeearnersmaypaymore)in2017.
$183peryeardeducCble 20%coinsuranceformostservices
Someprogramsmayhelpcoverthesecosts
AddiConofPrevenCveCareServices◦ Annualwellnessexam◦ Coversallwellnessservices/prevenCvecareservicesasoutlinedbyHealthCareReform
PRESENTED BY ADVANTAGE BENEFITS GROUP 17
Post-65
Medicare Part D helps pay for: PrescripCondrugsprovidedbyMedicareApprovedPrescripConDrugPlans(PDP)orMedicareAdvantagePlans(MA-PD)
TheseplansoffernegoCateddiscountpricesbasedonaformularywithcostsharing
HealthCareReformfilledsomeorallofthedonut-hole◦ 50%manufacturersdiscountonbrandnamedrugs◦ Payonly86%ofplanscostforgenericdrugs
PRESENTED BY ADVANTAGE BENEFITS GROUP 18
Post-65
Paying for Medicare Part D $0orreducedpremium,deducCbleandco-insuranceifonequalifiesfortheLowIncomeSubsidy(LIS)
Mustmeetincomeandassetcriteria
EligibilitydeterminedbySocialSecurityAdministraCon(SSA)
PRESENTED BY ADVANTAGE BENEFITS GROUP
19
Post-65
The Affordable Care Act – Closing the Doughnut Hole BRAND NAME DRUGS
HealthCareReformclosesthePartDDoughnutHole(thegapincoverageduringwhichpeoplewithMedicaremustpaythefullcostoftheirprescripConsoutofpocket). HCRphasesthisoutbydecreasingthebeneficiary’sshareofdrugcostsduringthedoughnutholeunClitreaches25%in2020forbothbrandnameandgenericdrugs
PRESENTED BY ADVANTAGE BENEFITS GROUP 20
Year PharmaceuKcalManufacturerDiscount
PlanResponsibility(gov’tcontribuKon)* ConsumerResponsibility
2010 0 0 100%lessthe$250rebateforbrandnameandgenericdrugs
2011 50% 0 50%
2012 50% 0 50%
2013 50% 2.5% 47.5%
2014 50% 2.5% 47.5%
2015 50% 5% 45%
2016 50% 5% 45%
2017 50% 10% 40%
2018 50% 15% 35%
2019 50% 20% 30%
2020 50% 25% 25%
*Government subsidies to plans will account for the plan share of coverage for drugs.
Post-65
The Affordable Care Act – Closing the Doughnut Hole GENERIC DRUGS
PRESENTED BY ADVANTAGE BENEFITS GROUP 21
Year PlanResponsibility(gov’tcontribuKon)* ConsumerResponsibility
2010 0 100%lessthe$250rebateforbrandnameandgenericdrugs
2011 7% 93%
2012 14% 86%
2013 21% 79%
2014 28% 72%
2015 35% 65%
2016 42% 58%
2017 49% 51%
2018 56% 44%
2019 63% 37%
2020 75% 25%
*Government subsidies to plans will account for the plan share of coverage for drugs.
Post-65
Medicare Advantage MedicareAdvantagePlansarehealthplanopConsthatarepartoftheMedicareprogram.Ifyoujoinoneoftheseplans,yougenerallygetallyourMedicare-coveredhealthcarethroughthatplan(PartsA,B,andD).ThiscoveragecanincludeprescripCondrugcoverage.MedicareAdvantagePlansinclude:◦ MedicareHealthMaintenanceOrganizaCon(HMOs)◦ PreferredProviderOrganizaCons(PPO)◦ PrivateFee-for-ServicePlans◦ MedicareSpecialNeedsPlans
WhenyoujoinaMedicareAdvantagePlan,youusethehealthinsurancecardthatyougetfromtheplanforyourhealthcare.Inmostoftheseplans,generallythereareextrabenefitsandlowercopaymentsthanintheOriginalMedicarePlan.However,youmayhavetoseedoctorsthatbelongtotheplanorgotocertainhospitalstogetservices
PRESENTED BY ADVANTAGE BENEFITS GROUP 22
Post-65
Medicare Advantage TojoinaMedicareAdvantagePlan,youmusthaveMedicarePartAandPartB.YouwillhavetopayyourmonthlyMedicarePartBpremiumtoMedicare.InaddiCon,youmighthavetopayamonthlypremiumtoyourMedicareAdvantagePlanfortheextrabenefitsthattheyoffer. IfyoujoinaMedicareAdvantagePlan,yourMedigappolicywon’twork.Thismeansitwon’tpayanydeducCbles,copayments,orothercost-sharingunderyourMedicareHealthPlan.Therefore,youmaywanttodropyourMedigappolicyifyoujoinaMedicareAdvantagePlan.However,youhavealegalrighttokeeptheMedigappolicy.
PRESENTED BY ADVANTAGE BENEFITS GROUP 23
Post-65
Medicare Advantage
PRESENTED BY ADVANTAGE BENEFITS GROUP 24
Post-65
Medicare Advantage
PRESENTED BY ADVANTAGE BENEFITS GROUP 25
Post-65
Medicare Advantage
PRESENTED BY ADVANTAGE BENEFITS GROUP 26
Post-65
Shopping for Medicare Advantage Plans: www.Medicare.Gov
PRESENTED BY ADVANTAGE BENEFITS GROUP 27
Post-65
Shopping for Medicare Advantage Plans: www.Medicare.Gov
PRESENTED BY ADVANTAGE BENEFITS GROUP 28
Post-65
Re0ree Medical Resources IsabellaCountyCommissiononAging–(989)772-0748
YourPersonalFinancialAdvisor
YourPersonalHomeandAutoInsuranceAgent
AdvantageBenefitsGroup◦ hmp://www.advantageben.com
BlueCrossBlueShieldofMichiganMedicare:1-877-469-2583◦ hmp://www.bcbsm.com/medicare/
PriorityHealthMedicare:1-888-389-6676◦ hmp://www.priorityhealth.com/medicare
CentersforMedicareandMedicaidServices◦ www.cms.hhs.gov
TheOfficialU.S.GovernmentSiteforPeoplewithMedicare◦ www.medicare.gov
HealthSherpa◦ www.healthsherpa.com
“MedicareandYou”◦ hmp://www.medicare.gov/PublicaCons/Pubs/pdf/10050.pdf
AARP◦ hmp://www.aarp.org/health/medicare/
HealthCare.gov◦ hmps://www.healthcare.gov
PRESENTED BY ADVANTAGE BENEFITS GROUP 29