SHICK Senior Health Insurance Counseling For Kansas. Medicare Options

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1 SHICK Senior Health Insurance Counseling For Kansas Medicare Options What is Medicare? Federal health insurance that covers some medical costs if you: Are age 65 or over Are under age 65 with some disabilities Receiving Social Security Disability End Stage Renal Disease Amyotrophic Lateral Sclerosis (ALS)/Lou Gehrig s Disease 1 of 13

2 Original Medicare Medicare basics Original Medicare (administered by the federal government) Part A: Hospital Part B: Medical Part D: Prescription Drug (run by private insurance companies) Medicare Advantage Plans (Private Insurance) Part C: HMO s, PPO s and PFFS Plans 2 of 13

3 What does Original Medicare cost? Part A is free if: My spouse or I earned enough work credits My spouse is age 62+ Part B costs most people a premium In 2015: Most people will pay $104.90/month $147 deductible *Premiums may change each year in January When can I join Medicare? Enrollment Periods Initial: Seven months around your 65 th birthday or Medicare eligibility date Special: Up to eight months after your jobbased plan ends not COBRA!!! General: Every year from January March (coverage starts July 1) 3 of 13

4 How do I sign up? Go to your local Social Security office Call Social Security at Go online to How does Original Medicare pay? Medicare (Parts A & B) pay: Part of the total amount Medicare approves for covered services (often 80%) If you have Original Medicare, you pay: Medicare premiums and deductibles Copays and coinsurance (often 20%) 15% more if provider won t accept assignment Medicare doesn t cover (dental, routine vision, etc.) 4 of 13

5 Medigap/Supplemental Plans Run by private insurance companies Plans A-N (not the same as Medicare Parts A-D) Fill gaps in Original Medicare May pay copays, coinsurance, deductibles Does Not cover prescription drugs Medigap or Supplemental Insurance Federal government sets benefits Each plan letter must cover the same benefits Example: Jones Company sells Plan F for $150/month. Smith Company sells Plan F for $450/month. Both plans provide the same benefit, no matter how much you pay for the premium. 5 of 13

6 Purchasing a Medigap You have guaranteed issue if you buy your Medigap: In your first six months with Medicare Part B at any age Within 63 days of losing creditable Medical coverage Guaranteed issue means the plan must: Accept you with no health screening Charge you the same rate they charge other customers 6 of 13

7 Prescription Drug Coverage Part D Optional (run by private insurance companies) Must have Part A, B, or both Must live in the plan s service area May buy regardless of health status May have only one Part D plan at a time May not combine with creditable retiree drug coverage Will cost more for those with higher incomes Part D Prescription Drug Plan Medicare drug plans vary by: Cost How much you pay Coverage What drugs they cover Convenience Which pharmacies they use 7 of 13

8 Do I need Part D? Enrollment is optional. Do I have other creditable drug coverage? If yes, I may keep my current drug coverage with no penalty If no, and I join Part D later than my initial enrollment period, I may pay a penalty Will joining Part D end other coverage I have? When can I join Part D? Initial Enrollment Period for Medicare (seven months around your 65 th birthday or Medicare eligibility date) Every year in the fall: October 15 December 7 January 1 effective date 8 of 13

9 Medicare Part C Medicare Advantage Plans (run by private insurance companies) Optional replaces Original Medicare (A&B) while you have the plan May contain prescription drug coverage Medicare Advantage Plans Health Maintenance Organizations (HMOs) Preferred Provider Organization (PPOs) Private Fee For Service (PFFS) 9 of 13

10 Medicare Advantage Costs I pay: My Medicare Part B premium My Medicare Part A premium (if any) Medicare Advantage (MA) plan monthly premium. Deductible and copays or coinsurance. See to estimate costs Who Can Join? People: With both Medicare Parts A and B Who live in the plan s service area With any health conditions except End Stage Renal Disease (ESRD) 10 of 13

11 What s My Situation? COBRA Retired Medicaid Indian Health Insurance Help Paying for Medicare Costs Extra Help Medicare Part D Social Security Administration Online: Medicaid Part A and B Call Kansas Dept. of Children and Families of 13

12 Protect Yourself Guard your Medicare number Review your Medicare Summary Notice Don t do business with door to door, phone sales, or online solicitors. Report any discrepancies or fraudulent activity Protect documents that contain personal information Protect Yourself Senior Medicare Patrol To report fraud, call of 13

13 Next steps What are your next steps? Do you need personal help with your situation? Contact SHICK for an appointment! Local number: or We Need Volunteers Did some of this make sense to you? Do you want to learn more? Would you like to make a difference for others? We would love to have you volunteer with SHICK 13 of 13

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