Understanding Medicare and Open Enrollment

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1 Understanding Medicare and Open Enrollment Presented by: Stephanie Fajuri, Esq. Supervising Attorney, CLRC Presented by: Jamie Ledezma, Esq. Phone 866.THE.CLRC TDD Fax This publication is designed to provide general information on the topics presented. It is provided with the understanding that the author is not engaged in rendering any legal or professional services by its publication or distribution. Although these materials were reviewed by a professional, they should not be used as a substitute for professional services. 1

2 Overview of the CLRC Joint program Education Model English & Spanish or language line Confidential services

3 National Telephone Assistance Line 1. Phone Calls 2. s 3. Letters 4. Faxes 5. Online Intake Form Disability Rights Legal Center

4 Today s goals: giving an overview of 1) Medicare 2) Medicare Open Enrollment 3) Open Enrollment in Health Care Exchanges 4

5 Medicare vs. Medicaid Medicare Age 65+ and entitled to SS retirement benefits Or under 65 & have received SSDI for 24 months 5

6 Medicare vs. Medicaid Medicaid Limited income and limited resources Aged, blind, and disabled program Share of Cost or Medicaid Buy-In Program Medicaid expansion 6

7 Medicare Has 4 Parts Part A: Hospital Insurance ho 7

8 Medicare Has 4 Parts Part B: Medical Insurance 8

9 Part C: Medicare Advantage Plans Medicare HMOs & PPOs 9

10 Medicare Has 4 Parts Part D: Prescription Drug Benefit 10

11 Medicare Coverage Choices at a Glance Step 1: Decide how you want to get your coverage Original Medicare Medicare Advantage Plan (like an HMO or PPO) Part C Combines Part A (Hospital Part A (Hospital Insurance) and Insurance) and Part B (Medical Presented by: Part Jane B (Medical Doe, Esq. Insurance) Insurance), and usually Part D Step 2: Decide if you want to add prescription drug coverage Part D Prescription Drug Coverage Step 3: Decide If You Want Supplemental Coverage Medigap (Medicare Supplement Insurance) policy from a private company. Part D Prescription Drug Coverage (if not already included) End Note: If you join a Medicare Advantage Plan, you don't need and can t get a Medigap policy. 11

12 How Much Does Medicare Cost? Staff Part Attorney, A: Cancer Premiums Legal Resource Center are Free Unless you have insufficient/no Social Security work history. 12

13 How Much Does Medicare Cost? Part B: For those who earn <$85K (single) or <$170K (married): Premiums cost - $ Annual deductible is $147 Part C: Varies on the type of plan chosen Part D: Varies by plan but average premium is ~$30/month 13

14 How to Apply for Medicare You will be automatically enrolled in Medicare Part A effective the month you are 65 Example: If you turned 65 on October 25, 2014, your Medicare effective date would be October 1,

15 How to Apply for Medicare If you are under 65 and receiving SSDI You should enroll during the 7- month period that starts 3 months before your 25th month of getting Social Security disability benefits and ends 3 months after your 25th month of getting disability benefits. 15

16 Medicare Advantage Open Enrollment October 15-December 7,

17 Medicare Part B Medicare Enrollment Periods Initial Enrollment General Enrollment Special Enrollment 17

18 Medicare Penalties for Late Enrollment Part B If enrolled late: 10% for each late year, in effect for life 18

19 Medicare Part B Group Health Plan Coverage from an Employer Special enrollment period for Medicare Part B without paying a penalty if you enroll while covered under group plan, or during the 8-month period beginning with the month your group plan ends, or the month employment ends, whichever comes first 19

20 Medicare Penalties for Late Enrollment Part D: 1% of the national premium Staff the Attorney, year Cancer you join Legal Resource x number Center of months you waited to join. 20

21 Medicare Part D How to Choose a Plan? Determine what matters most to you: Cost Coverage Convenience 21

22 Medigap Policies Medicare supplemental insurance 22

23 Where to go for Help! 1. Call your plan first! 2. Read your Medicare & You 2015 Book 3. Call your state Health Insurance Assistance Program. 4. Centers for Medicare & Medicaid Services (800) MEDICARE or 23

24 Healthcare.gov Insurance for anyone who can afford it including people with pre-existing conditions Disability Rights Legal Center

25 Open Enrollment November 15, 2014 February 15,

26 Plan Options in Exchanges Bronze = plan covers 60%; you pay 40% Silver = plan covers 70%; you pay 30% Gold = plan covers 80%; you pay 20% Platinum = plan covers 90%; you pay 10% Catastrophic = covers essential benefits but has high deductible 26

27 Tax Credits/Premium Subsidies Income under 400% FPL 400% = $46,680 individual; $95,400 family of 4 (2015) No employer sponsored health insurance, No Medicare/Medicaid 27

28 Qualifying for Lower Costs

29 If you signed up for coverage in 2014: Automatic enrollment in same or similar plan OR Enrollment in different plan 29

30 IMPORTANT: You must report changes to the information you provided on your 2014 application Includes changes in: Income; Household; Permanent address; Eligibility for other coverage; etc. 30

31 Other Options for Buying a Health Plan Directly from an insurance company Through an insurance agent or broker From an online health insurance seller

32 For more information: THE-CLRC 32 Disability Rights Legal Center 2014

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