John R. Kasich, Governor Mary Taylor, Lt. Governor/Director. Medicare Supplement Vs. Medicare Advantage
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1 John R. Kasich, Governor Mary Taylor, Lt. Governor/Director Medicare Supplement Vs. Medicare Advantage
2 Medicare Supplement vs Medicare Advantage? Option 1 Option 2 Original Medicare Part A and Part B + Secondary Insurance GHI, MedSup, or Medicaid + Rx Coverage Part D or GHI Medicare Advantage (Part C) 1. Hospitalization, 2. Medical 3. Rx (MA-PD) 2
3 Gaps in Original Medicare Coverage Original Medicare doesn t cover everything Original Medicare pays a share You pay a share If you buy a Medigap policy The policy pays all or part of your share Coverage depends on Medigap plan you buy 3/18/2015 3
4 What is a Medigap policy? (continued) A Medigap policy may help you Lower your out-of-pocket costs Get more health insurance coverage Considerations include Your other coverage and health needs If your doctor accepts assignment 3/18/2015 4
5 What are Standardized Plans? Standardized plans in most states Identified by a letter Plans currently sold A, B, C, D, F, G, K, L, M, N Companies don t have to sell all plans Plans existing but no longer sold E, H, I, J Non-standardized plans (waiver states) Massachusetts, Minnesota, Wisconsin 3/18/2015 5
6 Who Can Buy Medigap? Generally must have Medicare Parts A and B May not be able to buy Medigap under 65 People with a disability People with End-Stage Renal Disease Guaranteed right to buy a Medigap policy In your Medigap open enrollment period Covered under a guaranteed issue right 3/18/2015 6
7 When to Buy a Medigap Policy May be able to buy a Medigap policy any time 6-month Medigap open enrollment period Begins when you Are both age 65 and Enrolled in Part B Can t be changed or repeated 3/18/2015 7
8 Buying a Medigap Policy Under Age 65 People with Medicare under age 65 May not be able to buy Medigap People with a disability People with End-Stage Renal Disease If available, may cost more New Medigap open enrollment period at age 65 3/18/2015 8
9 Open Enrollment Examples Mary is turning 65 in January. She plans to go on Part B at the same time. She would have January through June to get any Medicare Supplement plan with no health questions Fred is 70 but is still working, so he delayed Part B. He is retiring in July and picking up Part B then. He would have July through December to take advantage of his Medicare Supplement Open Enrollment period. 3/18/2015 9
10 Guaranteed Rights to Buy a MedSup Policy Called guaranteed issue rights Situations with special rights to buy MedSup After MedSup open enrollment period Companies must sell you a Medigap policy within 63 days of the date your coverage ends Must cover all pre-existing conditions Can t charge more These are Federal protections 3/18/
11 Medicare Options Option 1 Option 2 Original Medicare Part A and Part B + Secondary Insurance GHI, MedSup, or Medicaid + RX Coverage Part D or GHI Medicare Advantage (Part C) 1. Hospitalization, 2. Medical 3. Rx (MA-PD) 11
12 What are Medicare Advantage (MA) Plans? Health plan options approved by Medicare Run by private companies Part of the Medicare program Sometimes called Part C Available in many areas of the country Provide Medicare-covered benefits May cover extra benefits, e.g.; vision or dental
13 Who Can Join? Eligibility requirements Live in plan s service area Entitled to Medicare Part A Enrolled in Medicare Part B Do not have End-Stage Renal Disease (ESRD) at enrollment To join an MA plan, a person must also Agree to provide the necessary information to the plan Agree to follow the plan s rules Belong to only one Medicare Advantage plan at a time
14 When to Join Open Enrollment October 15 th - December 7 th Coverage begins January 1 Other enrollment times based on circumstances MA Annual Disenrollment Period January 1 st - February 14 th (first 45 calendar days of the year) May disenroll from a MA plan and return to Original Medicare and enroll in a stand alone prescription drug plan 5 Star rated plans (MA, MAPD or PDP) may allow an enrollment at anytime during the year 14
15 How MA Plans Work You get Medicare-covered services through the plan All Part A and Part B covered services Some plans may provide additional benefits Most plans include prescription drug coverage Part D You may have to go to network doctors or hospitals MA may be different than Original Medicare Benefits and cost-sharing
16 MA Costs Must still pay Part B premium May pay an additional monthly premium to plan You pay deductibles, coinsurance and copayments Different from Original Medicare Varies from plan to plan Costs may be higher if you go out-ofnetwork Plans have Out of Pocket Maximums
17 Switching Medigap to Medicare Advantage Guaranteed Issue anytime enrollment is open Medigap to Medigap Not guaranteed Issue Unless in other GIO situation Medicare Advantage to Medicare Advantage Guarantee Issue (Unless ESRD) Medicare Advantage to Medigap Not Guaranteed Issue Unless in other GIO situation 12 month trial right Plan terminating
18 At a Glance Medicare Supplement Cost Part B Premium ($104.90) Higher Plan Premium $150-$200+ monthly Little or no out of pocket cost when used Provider Choice Any provider that accepts Medicare Is this Right for Me? Frequent traveler Important to keep open doctor network Use lots of health services Can afford premiums Drug Coverage Included? No Need to purchase separate Part D Plan Medicare Advantage Part B Premium ($104.90) Lower Plan Premium $0-$100/month Charged copays as plan is used Plan will have a provider network Cost will be higher if out of network Infrequent traveler Comfortable with narrower provider choice Fewer medical conditions and provider visits Want to save on a premium Yes Some plans available without Drug Coverage
19 Know Your Options Option 1 Option 2 Original Medicare Part A and Part B + Secondary Insurance GHI, MedSup, or Medicaid + RX Coverage Part D or GHI Medicare Advantage (Part C) 1. Hospitalization, 2. Medical 3. Rx (MA-PD) 19
20 Thank you for your time and attention. Questions?
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