Those under 65 with certain disabilities, or. Those of any age with End Stage Renal Disease (ESRD).

Transcription

1 Medicare 101

2 Medicare Basics

3 WHAT IS MEDICARE? Medicare is health insurance for: Individuals age 65 and older, Those under 65 with certain disabilities, or Those of any age with End Stage Renal Disease (ESRD). 3

4 WHO IS ELIGIBLE FOR MEDICARE? You or your spouse must have worked at least 10 years in Medicare-covered employment You must be age 65 or older You must be a citizen or permanent resident of the United States Special rules apply for the disabled and those with ESRD 4

5 WHAT ARE THE PARTS OF MEDICARE? Medicare Parts A and B make up what s known as Original Medicare Part A typically has $0 monthly premium, while Part B premium is $99.90 per month (can be higher based on income). 5

6 WHAT ARE THE PARTS OF MEDICARE? In addition, there are Parts C and D 6

7 Choosing a Plan

8 WHAT ARE MY COVERAGE CHOICES? 8

9 HOW DO I CHOOSE A PLAN? There are several factors you should consider when deciding between Original Medicare with a Medigap plan, or a Medicare Advantage plan. These include: Cost Benefits Provider Choice Travel Prescription Drugs Pharmacy Choice Other Coverage 9

10 TYPES OF MEDIGAP PLANS 10

11 HOW ARE MEDIGAP PREMIUMS CALCULATED? 11

12 LOCAL CARRIERS AND PREMIUMS Most policies are available based on geographic area. In Miami-Dade County, Medigap premiums range from $90 to $465 per month. In Miami-Dade County, Medicare Advantage premiums range from $0 to $99 per month (Note UHealth does not accept most Advantage plans) These premiums are in addition to Medicare Part B premiums, and Part D (Rx) premiums (if elected). Examples of insurers offering Medigap and/or Advantage plans in Miami-Dade: AARP Aetna American Pioneer BCBS of Florida Colonial Penn Humana Mutual of Omaha State Farm State Mutual Sterling Transamerica United American 12

13 MEDICARE AND UM COVERAGE If you plan to retire before you are eligible for Medicare (age 65), UM Early Retiree Coverage may be an option You must be at least age 55 with 10 years of service, or meet the rule of 70 Coverage is the same as UM active coverage, but premiums are not subsidized by UM Coverage ends at age 65 If the employee beyond age 65 but the spouse is under age 65, the spouse can elect Early Retiree coverage until the spouse turns 65 Dependents under age 26 are also eligible to continue coverage to age 26 even if the employee is beyond age 65 13

14 MEDICARE AND UM COVERAGE cont d While you are working at UM beyond age 65 you may: Keep UM coverage, forego Medicare You will not be penalized for delaying enrollment in Medicare while you have UM coverage (see slide 16) Once you retire, you will need to enroll in Medicare Elect UM coverage plus Original Medicare (A, or A&B) Your UM coverage will pay first, before any Medicare coverage Since Part B requires monthly premium payments, it may be best to delay enrollment in Part B in many cases Please note that Part D will not coordinate with UM Rx plan Drop UM coverage altogether and elect Medicare 14

15 Enrollment

16 WHEN TO ENROLL IN MEDICARE There are three types of Original Medicare enrollment periods: Initial Enrollment Period Begins 3 months before you turn 65 and lasts for 7 months General Enrollment Period January 1 through March 31 each year for July 1 coverage Special Enrollment Period At any time after age 65 while you are covered by an employer plan, or within 8 months of the of loss of employment or loss of coverage (whichever is first) If you enroll when you are first eligible (Initial Enrollment Period) or when your UM coverage ends (Special Enrollment Period), no late enrollment penalty will be applied to your Part B premium. If you wait to elect Part B outside of the Initial or Special Enrollment periods, the 10% permanent late enrollment penalty will apply. 16

17 HOW TO ENROLL IN ORIGINAL MEDICARE Online at Call Visit Social Security Office at 6101 Blue Lagoon Drive Can apply for Medicare and Social Security together, or just Medicare alone Medicare A & B enrollment is automatic if you re already receiving Social Security benefits 17

18 WHAT YOU LL NEED TO ENROLL IN ORIGINAL MEDICARE CMS form signed by UM Benefits showing your dates of UM coverage Social Security Number, Place and Date of Birth Earnings for last year and current year Name/Address of Employer Beginning and end dates of military service Name, SSN and DOB of current and former spouses Birth Certificate US Military Papers W-2 18

19 WHEN TO ENROLL IN MEDICARE ADVANTAGE AND/OR PART D If you are over age 65 and currently enrolled in coverage at UM, when your UM coverage ends you have: Special Enrollment Period of 2 months to enroll in a Medicare Advantage Plan. Special Enrollment Period of 2 months to enroll in a Medicare Part D Rx Plan Contact the Medicare Advantage or Part D carrier directly to enroll. Remember, you will need to have Medicare Parts A and B in order to elect a Medicare Advantage Plan. 19

20 WHEN TO ENROLL IN MEDIGAP Medigap Open Enrollment is the period during which you have a guaranteed right to purchase a Medigap plan regardless of your health status. Medigap Open Enrollment Period is the first 6 months you are enrolled in Part B after age 65. Medigap Open Enrollment is once per lifetime and begins as soon as you enroll in Part B for the first time. It cannot be delayed or replaced. If you enroll in Medicare Part B while you were still covered by the UM plan, your Medigap Open Enrollment Period will occur while you are covered by the UM plan. 20

21 WHEN TO ENROLL IN MEDIGAP cont d If you buy a policy during your Medigap Open Enrollment period, the insurance company must shorten the waiting period for pre-existing conditions by the amount of previous health coverage (creditable coverage) that you have. UM coverage is creditable coverage. If you apply for a policy after your Medigap Open Enrollment period has ended: The insurer may be allowed to use medical underwriting to decide whether to accept your application The insurer may also be allowed to use medical underwriting to decide how much to charge you for the policy. Medigap protections may apply (see slide 24). To enroll in a Medigap plan, contact the carrier directly. 21

22 Changing Plans

23 CHANGING YOUR MEDICARE ADVANTAGE/PART D PLAN Medicare Open Enrollment is October 15-December 7 for January 1 coverage You can enroll/change/drop coverage in a Medicare Advantage and/or Part D plan In addition, from January 1-February 14 each year you may still drop your Medicare Advantage Plan and return to Original Medicare If doing this, you may also enroll in a Part D plan during this time 23

24 CHANGING TO A MEDIGAP PLAN (MEDIGAP PROTECTIONS) If you buy a Medigap plan outside of Medigap Open Enrollment, the insurer may deny you, place conditions or charge you more based on your health status. In certain situations, Medigap protections (aka guaranteed issue rights and trial rights) apply which enable you to buy a Medigap policy without these concerns. Examples include: You are in a Medicare Advantage plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan s service area You joined a Medicare Advantage plan when you first became eligible at age 65 and within the first year of joining you want to switch to Original Medicare You drop a Medigap policy to join a Medicare Advantage plan for the first time, you have been in the plan less than a year, and you want to switch back 24

25 FOR MORE INFORMATION Medicare Call MEDICARE Call the Miami Social Security Office at SHINE (Serving Health Insurance Needs of Elders) Call ELDER Local ext 256 Seniority Matters Call UM Benefits Administration