MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente

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1 MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente Sylvia Weathers Service Consultant Keenan & Associates Nancy C. Voltero Retiree Programs Consultant Kaiser Permanente License No Innovative Solutions. Enduring Principles.

2 Medicare 101 KEENAN AND ASSOCIATES October 17, 2012 Nancy Voltero Retiree Programs Consultant

3 Basics of Medicare 3

4 What is Medicare? Medicare is a federally funded health insurance program for eligible beneficiaries. Medicare was established in Medicare is administered by the Centers for Medicare & Medicaid id Services (CMS). 4

5 Who is eligible? Medicare beneficiaries include: Individuals 65 or older if they or their spouses are eligible for Social Security. Individuals under 65 who are disabled. Must be eligible for Social Security disability Requires 2-year waiting period Individuals with end-stage renal (kidney) disease (ESRD). 5

6 Medicare Part A Inpatient insurance Hospital, skilled nursing facility, hospice, home health care Eligibility First day of the month that you turn 65 2 years after becoming disabled After end-stage renal dialysis begins Cost No premium if you or your spouse has worked 40 quarters of Medicare-covered employment If you worked fewer than 40 quarters, there is a monthly premium which is set by a Medicare formula. 6

7 Medicare Part B Outpatient insurance Physician services, outpatient surgery, lab, radiology, durable medical equipment (DME), dialysis Enrollment Optional: You are responsible for enrolling with Social Security Administration. You can enroll over a 7-month period, which starts 3 months before your 65th birthday. Late enrollment penalty will apply if you do not enroll in this 7-month window. 7

8 Medicare Part B Cost Monthly premium is usually deducted from your Social Security check. Premium goes up 10 percent for each 12-month period that you decline coverage. Known as late enrollment penalty.* Not imposed if you continue to work for and receive your health coverage from an employer group or trust fund plan of 20 or more eligible. * This amount is not a one-time penalty, but continues throughout enrollment. 8

9 2012 Monthly Premiums for Medicare Part B You Pay If Your Yearly Income is Single Married Couple $ $85,000 or less $170, or less $ $85,001-$107,000 $170,001-$214,000 $ $107,001-$160,000 $214,001-$320,000 $ $160,001-$214,000 $320,001-$428,000 $ Above $214,000 Above $428,000 You Pay If You Are Married but You File a Separate Tax Return From Your Spouse and Your Yearly Income is $99.90 Under $85,000 or less $ $85,001-$129,000 $ Above $129,000 If you have questions about your Part B premium, call Social Security at TTY users should call

10 How to Enroll in Medicare Part B Fill out an Application for Enrollment in Medicare Part B. Mail it to the nearest Social Security office, or Submit it in person to any Social Security office. Note: Completing the application form and submitting it does not automatically enroll you in Medicare Part B. Social Security must first determine if you are eligible to enroll. 10

11 Medicare Plan Options Plan options for how you receive Medicare coverage: Option 1: Original Medicare Plan through the Centers for Medicare & Medicaid Services (CMS). Option 2: Medicare Advantage Plans (Part C) such as: A Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Medical Savings Account Plans (MSA) 11

12 Medicare Part D Medicare Modernization Act (MMA) created Medicare prescription p drug coverage (Part D), effective January 1, Provides outpatient prescription drug coverage. Enrollment options for Part D Private insurer plan, such as Kaiser Permanente. Prescription Drug Plan (PDP): A plan type that offers prescription drugs only. Note: Unlike Parts A and B, Part D is enrolled directly with the plan. Part D is not available through Medicare or Social Security. 12

13 Medicare Part D Enrolling in Part D You are eligible for initial enrollment during the 7-month period, which starts 3 months before your 65th birthday. Late enrollment penalty (LEP) As with Part B, you must obtain Part D or creditable Part D coverage as soon as you are eligible or you will be charged a penalty. LEP is 1 percent per month that enrollment is deferred. 13

14 Medicare Part D Medicare s extra help program: Low Income Subsidy (LIS) For Medicare beneficiaries with limited income and resources. Provides extra help with Part D premiums and outpatient drug copayments. Degree of help depends on income and resources. Additional facts about extra help: Apply at Social Security or state Medicaid office. Administered by the member s plan, for CMS. Beneficiaries must be enrolled in a Part D plan to receive assistance. 14

15 Part D higher- income Premium 2012 You pay If your yearly income is Single Married couple $11.60 $85, ,000 $170, ,000 $29.90 $107, ,000 $214, ,000 $48.10 $160, ,000 $320, ,000 $66.40 Above $214,000 Above $428,000 The Part D premium is determined according to formulas set by federal law, not by the health plan. 15

16 Kaiser Permanente Senior Advantage (HMO) 16

17 Excellent Performance in 2012 Medicare ratings Kaiser Permanente region California Colorado Georgia Hawaii Mid-Atlantic States (MD, VA, D.C.) Northwest (OR, WA) Ohio Star rating Plan performance summary star ratings are assessed each year and may change from one year to the next. Kaiser Permanente is a health plan with a Medicare contract. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings Kaiser Permanente contract #s H0524, H0630_A, H0630_B, H1170, H1230, H2150, H9003, and H

18 Star Ratings Kaiser Permanente performance in CA 5 Star Rating Kaiser Permanente is the highest rated Medicare Advantage plan in California. 100% of 5-star Medicare beneficiaries in California are Kaiser Permanente members. There are no other 4.5 or 5 star plans in California According to CMS*, only nine Medicare plans in the country earned 5 stars for the overall 2012 Medicare star quality rating. 18

19 Five Categories Make Up the Star Quality Ratings Staying Healthy - 13 Measures Managing Chronic Conditions 10 Measures Member Satisfaction 10 Measures Customer Service 3 Measures Pharmacy Measures 17 Measures Individual Star Quality Ratings are assigned to 53 Measures Overall rating is the weighted average of the Individual items 19

20 Contact Information Kaiser Permanente Member Services: (TTY ), 1370) Monday through Friday, 7 a.m. to 7 p.m., Saturday and Sunday, 7 a.m. to 3 p.m. Social Security: (TTY ), Monday through Friday, 7 a.m. to 7 p.m. Medicare: MEDICARE ( ) TTY , 24 hours a day, seven days a week. 20

21 Questions? Disclaimer Keenan & Associates is an insurance brokerage and consulting firm. It is not a law firm or an accounting firm. We do not give legal advice or tax advice and neither this presentation, the answers provided during the Question Innovative and Answer period, Solutions. nor the documents accompanying Enduring this presentation constitutes or should be construed as legal l or tax advice. You are advised to follow up with your Principles. own legal counsel and/or tax advisor to discuss how this information affects you. License No Innovative Solutions. Enduring Principles.

22 Thank you for your participation! Join us for our next Medicare Webinar Wednesday, d October :00am -10:00am 00 National Medicare Group Member Termination: Understanding the Impacts Register online at License No Innovative Solutions. Enduring Principles.

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