medicare eligible and still working - benefits€¦ · 24 healthcare benefits benefits office will...
TRANSCRIPT
Medicare Eligible and Still Working
August 2, 2018
Liza Hahlbeck , Benefits CounselorSHRM Benefits Office
2
Maximize Benefits
Reduce Cost
Ensure Compliance
3
Main Points to Cover
1. Medicare Basics
2. Medicare While Working
3. Medicare at Retirement
4. Enrollment Process
5. Resources
4
Main Points to Cover
1. Medicare Basics
5
Only Social Security Administration determines eligibility
▪ Normally first eligible at age 65
▪ May be eligible under age 65 if disabled
―After 24-month period if receiving SS Disability benefits
―No waiting period if Lou Gehrig’s disease or End Stage Renal disease (kidney failure)
Eligibility for Medicare
May qualify under spouse or former spouse (if married 10 or more years)
6
Medicare’s Four Parts
Part A
Hospital Insurance
Part B
Medical Insurance
Part C
Medicare Advantage
Part D
Medicare Prescription
Drug Coverage
7
Medicare Part A
Part A
Hospital Insurance
Costs:Premium▪ Part A - $0 if paid into Social Security for 40 quarters (10 yrs.)
Deductible▪ Hospital Inpatient: $1,340 per benefit period
Copays▪ Hospital: $0 per day (days 1-60)
$335 per day (days 61-90)$670 per day (days 91-150)100% per day (151+ days)
Services:1. Inpatient Hospital Care2. Skilled Nursing3. Home Health Care4. Hospice
8
Medicare Part B
Part B
Medical Insurance
Services:1. Physicians2. Diagnostic Tests3. Rehabilitation Services4. Ambulance5. Preventive Health Exams/Screenings6. Durable Medical Equipment
CostsPremium▪ Standard premium is $134
Deductible▪ $183
Copay▪ 20% after deductible
9
Medicare Part B
Part B
Medical Insurance
10
Medicare Part C
Part C
Medicare Advantage
Medicare Advantage Plans
A type of plan offered by private company contracting with Medicare
▪ Provides all Part A and Part B benefits.
▪ Most Medicare services are covered through the plan and aren’t paid for under Original Medicare.
▪ Most Medicare Advantage Plans offer prescription drug coverage.
11
Medicare Part D
Part D
Medicare Prescription
Drug Coverage
Two ways to enroll:1. Prescription Drug Plan – offered through private
insurance companies2. Medicare Advantage Plan with drug benefits
Costs:Premium
▪ Each plan sets premium▪ Additional income-related premium adjustment
amounts
Deductible▪ $400 maximum
Copay▪ Each plan sets copays
12
▪ Medigap Plans (Medicare Supplement Plans)
▪ Medicare Advantage Plans
▪ Tri-Care for Life
▪ VA Benefits
▪ Medi-Cal
Ways to Supplement Medicare
13
Your Medicare Choices
14
Your Medicare Choices
15
▪ Both Medicare Part A and B required
▪ You pay Part B & Medigap plan premiums
▪ Medigap policies cover one person only
▪ Benefits are standardized, —but costs vary by plan and by company
▪ Costs covered only if approved by Original Medicare
—Service must be medically necessary and reasonable
Key Points regarding Medigap Plans
D
Supplement
Part A & B
16
Main Points to Cover
1. Medicare Basics
2. Medicare While Working
17
• Are you already 65 or when will you become 65?
1
AGE?
• Will you be retiring soon?2
RETIRING?
• Are you enrolled in a HSA Plan? (Anthem Blue Cross Core Value or HDHP)
3
MEDICAL PLAN?
Three questions to consider
18
Should you enroll in Medicare now?
No
< 65
Will continue to work
Why?
▪ Not Eligible if under age 65 (unless disabled)
▪ Reduce your costs— Part B costs minimum $134/month— Still pay full LLNS medical plan cost
▪ LLNS medical remains primary plan while working
19
Should you enroll in Medicare now?
>= 65
Yes
Will be retiring
soonMake sure to see a Benefits Counselor at least 3 months
before you retire.
20
Enrolling in Part A
If your answer is NO: You may want to enroll in Part A.
• Part A may be free to you
• May reduce hospital out-of-pocket costs
• Present both your LLNS medical card and your Medicare card if hospitalized
If your answer is YES: Do not enroll in Part A.
• You may want to postpone your enrollment in Part A.
• Will not be eligible for the HSA.
21
Main Points to Cover
1. Medicare Basics
2. Medicare While Working
3. Medicare at Retirement
22
Regardless of whether you are eligible for Medicare or not when you retire, please note the following:
General Retirement Process
▪ Start 3 months before retiring
▪ Call the Benefits Office (2-9955) for an appointment
▪ Your Benefit Counselor will provide you with direction on who to contact
23
All Credited Service counts
towards eligibility
Service frozen on 10/2007 counted
for eligibility*
Eligible for
Access Only
Eligible for Retiree Benefits?
TCP1 TCP2 TCP2 after 10/2007
1. Minimum 10 years of
credited service
a. Or Rule of 75 (age +
service)
2. Must elect pension
within 120 days of
termination
3. Must be at least age 50
4. Must be enrolled in a
LLNS medical plan prior
to retirement
1. Minimum 10 years of
credited service
a. Or Rule of 75 (age
+ service)
2. Must elect pension
within 120 days of
termination
3. Must be at least age 50
4. Lump sum payment not
eligible (Access Only)
5. Must be enrolled in a
LLNS medical plan
prior to retirement
1. Must have at least 10
years of service
2. TCP2 (UCRS) with
less than 10 years
service frozen can
qualify for Access Only
by adding LLNS
service
3. Those who elect lump
sum payments are
eligible for Access Only
24
Healthcare Benefits
Benefits Office will send your eligibility to Empyrean(after you retire)
Empyrean is the record keeper:
▪ Medical
— Non-Medicare medical
— Medicare: Kaiser Permanente Senior Advantage (KPSA)
▪ Dental
▪ Vision
▪ Legal
Maintains the eligibility files for Via Benefits (formerly OneExchange) by Towers Watson for other Medicare plans
Remember: Employee coverage terminates at the end of the month
25
Electing Medicare Plans
Empyrean
▪ Only Medicare option is Kaiser Permanente Senior Advantage
▪ Must call and confirm enrollment and complete enrollment form
▪ Group policy
▪ Single price
Via Benefits
▪ Multiple options based upon zip code
▪ Must call and speak with a Benefit Advisor (make telephonic enrollment)
▪ Individual policies
▪ Prices vary on plan elected and age of participant
26
LLNS Contributions to Healthcare
Amount of contribution is based upon your years of service
▪ Non-Medicare medical and dental plans:
— contributions go directly to reduce monthly premium
▪ Medicare plans:
— HRA
— Special Protection Payment for Prescriptions, aka “Donut Hole”
LLNS continues to contribute to your medical and dental benefits
# of Years
Maximum
Employer
Contribution
20> 100%
19 95%
18 90%
17 85%
16 80%
15 75%
14 70%
13 65%
12 60%
11 55%
10 50%
<10 0%
27
If enrolled in a Medicare plan, you will be eligible for the HRA.
▪ A special, tax-free, employer-funded account
▪ Current maximum amount is $2450 annually per Medicare eligible person
— HRA is prorated based on years of service— Must enroll in a Medicare plan through
OneExchange or with Kaiser Senior Advantage — Unused balance rolls over
HRA – Healthcare Reimbursement Account
28
HRA – Healthcare Reimbursement Account
The HRA monies can be used to reimburse you for eligible health care expenses on a tax-free basis.
▪ Expenses eligible for reimbursement:
‒ Medicare supplemental insurance premiums
‒ Prescription Drug plans premiums
‒ Deductibles and co-pays
‒ Medicare Part B premiums
▪ Proof of expense will need to be provided per IRS requirements.
▪ May have to file a claim or set up auto-reimbursement
29
LLNS provides a separate fund for Prescription Drug gap.
▪ The gap covers drug costs from $3700 to $5000.
▪ Maximum lump sum payment is $2500 (50% of the $5000), prorated based upon month in which donut hole gap is reached
▪ This special payment is taxable income
▪ Kaiser does not have a Medicare Prescription Drug Plan Gap
“Donut Hole” Special Payment
30
“Donut Hole” Special Payment
31
Main Points to Cover
1. Medicare Basics
2. Medicare While Working
3. Medicare at Retirement
4. Enrollment Process
32
Already receiving Social Security benefits?
▪ SSA will automatically enroll you in both Parts A and B
▪ SSN will mail you a Medicare card 90 days prior to 65th birthday.
If not, you must initiate process.
Role of Social Security
Only Social Security can determine your eligibility
33
3 Ways to Enroll in Medicare
2 - By Phone
• Call SSA
800-772-1213
3 - In Person
• Call SSA
800-772-1213
1 - On-Line
• www.ssa.govIf not yet enrolled
in Part A
34
Avoiding a Late Penalty
I’ve heard that if you do not enroll when you turn 65 that you will be charged a penalty. Is that true?
If you are enrolled in a group health plan
through your employer (or through your
spouse’s employer, you can postpone
enrollment and avoid a penalty until you
retire or lose employer coverage.
The Benefits Office will complete a form to confirm your enrollment.
35
Main Points to Cover
1. Medicare Basics
2. Medicare While Working
3. Medicare at Retirement
4. Enrollment Process
5. Resources
36
Resources – Health Care
OrganizationPhone
NumberWebsite
Social Security Administration
(800)772-1213
www.ssa.gov
LLNS BenefitsOffice
(925)422-9955
https://benefits.llnl.gov/
Empyrean* www.llnsretireebenefits.com
Via Benefitshttps://my.viabenefits.com/
DO NOT LOG IN OR REGISTER
* Available upon retirement only.
37
Resources – Pension
OrganizationPhone
NumberWebsite
LLNS Pension Center (TCP1)
(866)655-9587
www.pension.hewitt.com/livermore
University of California
(UCRP)
(800)888-8267
http://ucnet.universityofcalifornia.edu
CalPERS(888)
225-7377www.calpers.ca.gov
38
▪ While this presentation and the verbal statements of Plan representatives are meant to be accurate, the actual Plan documents and Medicare rules and regulations, and other relevant laws and contract requirements will govern at all times.
▪ LLNS reserves the right to amend or terminate benefits at any time.
▪ Company policies on hiring, discharge, layoff and discipline are in no way affected by the plans and programs described herein.
▪ The Medicare rules stated herein are current as of this presentation date. They may change in the future, which may affect your Medicare coverage.
Legal Disclosures
39
Resources – Benefits Office
