The A, B, C & D s of Medicare GeorgiaCares

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Daniel Goodwin
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1 The A, B, C & D s of Medicare GeorgiaCares Atlanta Regional Commission, Area Agency on Aging

2 Applying for Medicare Initial Enrollment Period Apply 3 months before age 65, the month of 65 th birthday, or 3 months after month of 65 th birthday *Need not be retired Automatically enrolled if receiving Social Security or Railroad Retirement Benefits Received Social Security Disability Benefits (SSDI) for 24 Months 2

3 Medicare Basics Original Medicare Part A- Hospital Part B - Medical Part C - Medicare Advantage Part D - Prescription 3

4 Medicare Part A Eligibility and Premiums Awarded at age 65 or if a person has received disability payments for 24 months $0 premium for those who have 40 quarters of Medicarecovered Employment (or from a spouse) 4

5 Medicare Part A Hospital Insurance Helps Pay for Hospital stays Skilled nursing facility (SNF) care Home health care Hospice care Drugs that are part of your inpatient care 5

6 Deductibles, Co-Payments For Part A $1,100 hospital deductible Per 60 day benefit period First 20 days of skilled nursing facility stay no cost days $ daily rate 6

7 Paying for Medicare Part B Outpatient Services You pay Monthly Medicare Part B premium $96.40 in 2010 for most people already on Medicare $ for people new to Medicare in 2010 $155 per year deductible in % co-pay for most services 7

8 Medical Services (Part B) Doctor services Outpatient medical and surgical services and supplies Ambulatory surgery center fees for approved procedures Durable Medical Equipment Preventative Services 8

9 Medicare Assignment Agreement between Medicare and physician/supplier Physician/supplier agrees to accept Medicare-approved amount as payment in full You pay coinsurance and deductible If assignment is not accepted: Charges often higher You pay more Can t be charged more than 15% over approved amount 9

10 Medicare Part D: Prescription Drug Coverage Sold by private health insurance companies that contract with Medicare People may receive Part D benefits through a stand alone Medicare Prescription Drug Plan (PDP) or a Medicare Advantage Plan (MAPD) Otherwise people can continue to receive their drug coverage through retiree/union health plans 10

11 Medicare Part D: Prescription Drug Coverage Part D Enrollment: Initial Enrollment Period same 7 month period as Medicare A&B eligibility Annual Election Period-Nov. 15 th -Dec. 31 st Special Enrollment Period 11

12 Part D Costs Monthly Premium varies $0-$310 calendar year deductible Once total drug costs total $2830 hit the donut hole Drug costs range from flat copay amount to percentage of total drug cost Total out of pocket (not including premium) of $

13 Medicare Advantage (Part C) Medicare Pays private plans to provide health coverage the coverage differs from Medicare! Medicare Advantage Plan 13

14 Medicare Advantage (Part C) Replaces the manner in which benefits for Original Medicare are provided Offered through private companies May offer extra benefits including Part D coverage Most require additional premium in additional to annual Medicare premium Coinsurance/Co-pays For enrollment, MUST: Have Medicare Part A and Part B Live in plan s geographical service area 14

15 What are Medicare Advantage Plan Options? Medicare Managed Care Plans (HMOs) Health Maintenance Organizations Medicare Preferred Provider Organization (PPOs) Preferred Provider Organizations Private Fee-for-Service Plans (PFFSs) Special Needs Plans (SNPs) 15

16 Medicare Advantage Plans CANNOT: Ask for personal information (like Social Security, bank account, or credit card numbers) over the telephone Come to the home uninvited to sell or endorse any Medicare-related product Offer cash to join their plan Enroll in a plan over the telephone unless called Ask to send payment over the telephone or web Say that they are Medigap (Medicare Supplement Insurance) 16

17 What is Medigap? Medicare Medigap/ Supplement Insurance Primary Secondary Sold by private insurance companies Fills in the GAPS for Medicare Must have Part A & B Medigap SELECT policies may require use of certain physicians and hospitals 17

18 Additional Information: Financial Assistance for Medicare Health Costs 18

19 Medicaid Medicare Savings Programs (QMB, SLMB, and QI) Pays Medicare premiums and possibly additional coinsurances Savings Program eligibility varies state to state: Georgia 2010 Eligibility Coverage QMB Part B premiums + deductibles and coinsurance Single income limit Single asset limit Married Income limit Married asset limit $903 $6,600 $1,214 $9,910 SLMB Part B premiums $1,083 $6,600 $1,457 $9,910 QI Part B premiums $1,218 $6,600 $1,639 $9,910 Burial Allowance: $10,000 per person: 19

20 Medicaid Enrollment To apply for Medicaid or the Medicare Savings programs: Call or visit local county Department of Family and Children Services (DFCS office) Can complete online application at Call GeorgiaCares at to get the contact information for your local Medicaid office or an application To apply for Supplemental Security Income Benefits call Social Security at or contact your local Social Security office. 20

21 Extra Help for Prescriptions/ Low Income Subsidy Who is eligible? Income < $0-1,354 Single < $0-1,821 Married Assets (Resources) $12,510 Single $25,010 Married What are the benefits? No/low premiums for those with limited incomes No/low deductible Small copayment or coinsurance for each prescription 21

22 Affordable Care Act updates $ 250 rebate check for those who hit the donut hole Last year for November 15-December 31 AEP 2011 Preventative services no cost + addition of yearly wellness exam Jan. 1- Feb 15 MA disenrollment period 22

23 For More Information Call GeorgiaCares MEDICARE ( ) Social Security Administration

Welcome to Medicare! Module 1A

Welcome to Medicare! Module 1A Welcome to Medicare Introduction to Medicare Original Medicare Plan Medicare Supplement Insurance (Medigap) Medicare Advantage and other Medicare plans Medicare prescription