Retiree Considerations Medicare 101. June 26, 2012

Transcription

1 Retiree Considerations Medicare 101 June 26, 2012

2 Agenda Goal: Present information regarding Medicare and related products to assist you in evaluating options Key Topics: Eligibility Rules Enrollment Rules Coordination with COBRA Medicare Part A, Part B, Part D Supplement Plans (Medi Gap or Advantage Plans) 2

3 Medicare Versus Social Security Eligibility for Social Security cash benefits and eligibility for Medicare may differ. Eligibility for cash benefits generally depends upon when you elect to receive the benefit. You are generally eligible for Medicare at age 65. Medicare Part A (In-patient Services): No cost if you or your spouse worked and paid Medicare taxes for at least 10 years Medicare Part B (Physician Services): Cost to recipient Medicare Part D (Prescription Drug): Cost to recipient 3

4 Medicare Eligibility Persons less than age 65 with a total disability Persons with End Stage Renal Disease Persons who are age 65 and older 4

5 Medicare Eligibility Persons who are age 65 and older Initial Enrollment Period period of time that you can sign up for Part A, Part B and Part D when you are first eligible At age 65 you can sign up during a 7 month period which begins 3 months before your birthday, includes your birthday month and 3 months after your birthday. You can delay enrollment without a penalty if you are covered under a group health plan based on you or your spouse s current employment. NOTE: COBRA and Retiree health plans are not coverage based on current employment. 5

6 Medicare Eligibility During Active Employment Waive Employer plan and enroll in Medicare only Employers are not allowed to sponsor a group plan to cover or supplement Medicare for active employees. There is usually no financial incentive for an active employee to opt out of an employer plan because he/ she will lose any employer subsidy for benefits. Keep Employer plan and delay Medicare Keep Employer plan and enroll in Medicare Plans for active employees and their covered spouses must pay first, Medicare is secondary (employer plans with 20 or more employees.) 6

7 Medicare Eligibility During Retirement Once your employment ends You have 8 months to enroll in Part B without a penalty this applies whether or not you choose COBRA. If you choose Medicare after you have COBRA, then your COBRA coverage will end. If you have any part of Medicare (A, B or D) prior to electing COBRA, your are still eligible to elect COBRA. - COBRA will always be secondary to Medicare (unless you are end stage renal) Part B Late Enrollment Penalty Penalty applies for as long as you are purchasing Medicare Penalty could increase premium as much as 10% for each full 12 month period you could have had Medicare 7

8 Medicare COBRA or Not? If you can select between COBRA and a Medicare Supplement plan for the first 18 months, the best choice for you depends on your health status and the overall costs of the two choices. When you elect COBRA, most COBRA plans will require you to elect Part B immediately. Dependents may elect COBRA even if you do not. (18 months) 8

9 Medicare COBRA or Not? If an employer offers a retiree medical plan, you typically have to choose between the retiree plan or COBRA. Since the retiree plan is usually available for more than 18 months, it is the most common selection. 9

10 Medicare Part A Inpatient services piece of Medicare

11 Benefits Under Medicare Part A Part A covers inpatient services 2012 Hospital Inpatient Stay: You pay $1,156 for the first 60 days of a hospital stay You pay $289 per day for days 61 to 90 You pay $578 per day for days 91 to 150 (lifetime reserve days) You pay all costs once lifetime reserve days are exhausted. 11

12 Benefits Under Medicare Part A 2012 Skilled Nursing Facility: You pay $0 for Medicare approved amounts for the first 20 days. You pay $ per day for days 21 to 100 days. You pay all costs for each day beyond 100 days. You must have a hospital stay of at least 3 days and enter the SNF within 30 days. 12

13 Medicare Part B Outpatient services and doctor visit portion of Medicare

14 Benefits Under Medicare Part B Medicare Part B pays for outpatient services EXCEPT prescription drugs, dental, vision and hearing. Pays for inpatient professional services. Annual per person deductible in 2012 is $140 You pay 20% of most Medicare-approved charges after the deductible (45% of mental health care). 14

15 Benefits Under Medicare Part B Examples of covered services: Doctor office visits and inpatient services Physical therapy X-ray and laboratory testing Blood after first 3 pints Certain preventive care Outpatient/Ambulatory surgery 15

16 Other Coverage Considerations Home health care is covered at 100% if medically necessary/non-custodial Foreign Travel - Most care outside of the US is not covered. Exceptions are if you are in Canada traveling between Alaska and another state, limited care aboard a ship or US hospital is more than 50 miles, but a foreign hospital is closer. 16

17 Cost For Medicare Part B Is based on annual income from 2 years prior If your income has changed, you may appeal to base price on current income. 17

18 Summary Part A covers inpatient care and most people are automatically enrolled at no cost. Part B covers outpatient care and most people enroll after quitting full-time employment monthly cost varies with income. Now for what is not covered.. Long term care Dental Hearing aids Prescription Drugs 18

19 Medicare Part D The prescription drug part of Medicare

20 Enrollment in Medicare Part D You may enroll for Part D Between October 15 and Dec 7 of each year for the following year Within 63 days of involuntary loss of coverage This means within 63 days of when you lose your group coverage due to retirement or job termination You must be enrolled in Part A or Part B to join a Medicare Prescription Drug Plan. 20

21 Enrollment in Medicare Part D If you do not enroll when first eligible, there is a cumulative 1% penalty per month ****UNLESS**** No penalty applies for any month in which you had creditable coverage (i.e., coverage as good as or better than the baseline Part D plan) Currently, most employers (but not all) offer creditable coverage. You should receive annual notification as to status of your plan 21

22 In General Under Part D Deductible: applies to most plans. The maximum deductible for 2012 is $320. Copays apply after deductible until prescription drugs costs including deductible reach a certain amount in total costs. ($2,930 in 2012) Coverage Gap: temporary limit on what drug plan covers until you and plan have spent a certain amount for prescriptions ($4,700 in 2012) During gap: 50% discount on brand drugs and you pay 86% of generic drug costs Beyond 2012: additional savings in coverage gap until full coverage in 2020 Catastrophic coverage: coverage after the coverage gap is reached. Coverage includes copayments until end of the plan year. 22

23 In Practice Under Part D Pharmacy vendors sell Part D not the government Pharmacy vendors are given a subsidy by the government and charge the enrollee a monthly fee based on what they need to make a reasonable profit. Plan designs and drugs covered vary by pharmacy vendo. 23

24 In Practice Under Part D Most plans use a closed formulary (Formulary drugs included on the vendors preferred list) Even plans with an open formulary do not cover drugs prohibited by Part D (weight loss, fertility, barbiturates, benzodiazepines) Prior authorization, step therapy and quantity limits may apply and application varies by pharmacy vendor. 24

25 Costs for Medicare Part D Costs vary by plan selected and range from $30 to $180 per month. Medicare Advantage Plans (HMO or PPO) typically include the Medicare prescription coverage in the premium for the plan. Income based premium adjustment: Your Part D premium could be higher based on your income. This includes Part D coverage from a stand-alone plan or a Medicare Advantage Plan 25

26 Plan Options for Retirement Original Medicare (Part A and Part B) Plan D is what you purchase no supplements Medicare Supplement Plans Designed to fill in the gaps of Part A & Part B Medicare Advantage Plans Stand alone plan to replace Parts A and B Must purchase Part B and this plan 26

27 Medicare Supplement (Medigap) Must be approved by each state and meet defined coverage criteria. Plans are identified by letters in most states. For the most part plan only covers items that Medicare covers. Will cover an extra 365 reserve lifetime days of inpatient hospitalization at 100%. 27

28 Medicare Supplement (Medigap) Plan designs are established by Medicare Not all carriers sell all plan designs Plans A to G cover more progressively Plans K, L, M and N offer limited coverage Some plans cover foreign travel 28

29 Medicare Supplement (Medigap) Costs are approved by each state. Some states have a flat cost, some vary by age and/or zip code, some have a prompt enrollment discount. If you enroll when you are first eligible for Medicare Part B, coverage is guarantee issue, but there may be medical underwriting for pricing purposes You can enroll within 63 days of when you enroll in Part B. If you enroll in a Medicare Supplement plan late, they may decline coverage for certain medical conditions. 29

30 Medicare Supplement (Medigap) Many insurance companies sell Medicare Supplement plans. An internet search shows: AARP (United Healthcare) Many BlueCross BlueShield companies Humana Aetna Kaiser Permanente Many others 30

31 Medicare Advantage Plans Sometimes called Part C C is for Choice Replaces Part A and B and includes Part D in most cases Includes HMOs, PPOs, or Traditional Fee for Service 31

32 Medicare Advantage Plans Insurance companies sell Medicare Advantage plans not the government. You still pay the government for Part B. Insurance companies are given a subsidy by the government and charge the enrollee a monthly fee based on what they need to make a reasonable profit. Plan designs vary by insurer. 32

33 Summary Medicare Part A and B cover in patient and outpatient but not all costs. Medicare Part D covers prescription drugs. Medicare Supplement or Medi Gap Plans fill in some or all of the holes in Medicare Part A and B. Medicare Advantage plans replace Part A and B with a comprehensive plan and usually include Part D. 33

34 The Medicare web site has more information than you can imagine. Comparison tools are available for: Medicare Supplement Plans Medicare Advantage Plans Medicare Part D Prescription Drug Plans Medicare & You Booklet (updated annually) 34

35 Want to Know More? If you have further questions, please contact your Charon Planning Consultant. 35