MEDICARE 101. Medicare 101. presented by Fairfax County s Virginia Insurance Counseling and Assistance Program (VICAP) Medicare 101 6/9/2015 1

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1 MEDICARE 101 presented by Fairfax County s Virginia Insurance Counseling and Assistance Program (VICAP) /9/2015 1

2 What Is Medicare? A health insurance program for people 65 years of age and older Under age 65 with certain disabilities With End-Stage Renal Disease (ESRD) Lou Gehrig s Disease (ALS- Amyotrophic lateral sclerosis ) Administered by the Centers for Medicare & Medicaid Services (CMS) 6/9/2015 2

3 Medicare Coverage Choices Original Medicare Part A, Part B, Part D and a Supplement, such as an employee retiree plan, a military retiree plan or an individual Medigap plan. OR Medicare Advantage a/k/a Medicare Part C Combines Part A, Part B and usually Part D No supplement plan allowed for uncovered costs! 6/9/2015 3

4 Medicare Coverage Basics 6/9/2015 4

5 Medicare Part A Most people receive Part A premium free due to working for ten years and contributed to system. People with less than 10 years of Medicare- covered employment Can still get Part A but will pay a premium! Less than 30 quarters = $407 monthly Between quarters = $224 monthly More information about Part A entitlement Call SSA at TTY users call Railroad Retirement Board (RRB) 6/9/2015 5

6 Part A Helps Pay for Hospital inpatient care Skilled nursing facility (SNF) care Home health care Hospice care Blood Be Aware of Observation Care Issue! Are you an inpatient or an outpatient? It matters, if you are discharged to a skilled nursing facility (SNF) for post-hospital rehabilitation or if you need any self-administered drugs during your stay. Alert your friends/family now to contact your doctor. 6/9/2015 6

7 Enrolling in Medicare Part B Automatic Enrollment if you receive early SS retirement or Social Security Disability! BUT, you must opt out of Part B if not wanted. Initial Enrollment Period (IEP) 7 months starting 3 months before month of eligibility Special Enrollment Period (SEP) May delay enrolling in Part B with no penalty if: Covered under employer or union group health plan Based on current/active employment Of beneficiary or spouse Sign up within 8 months after coverage ends 6/9/2015 7

8 Enrolling in Medicare Part B General Enrollment Period (GEP) January 1 through March 31 each year Coverage effective July 1 Premium penalty 10% for each 12-month period eligible but not enrolled in Part B. Paid for as long as the person has Part B Limited exceptions to penalty. If uncertain about which enrollment period is best review the rules on the SSA POMS page at: 6/9/2015 8

9 COBRA COVERAGE (Consolidated Omnibus Budget Reconciliation Act) If your employer had 20 or more employees, you may qualify to receive COBRA coverage, which essentially continues your recent employer health insurance for 18 months maybe longer. You pay your portion of the group health plan premium and the employer share, plus a 2% administrative fee. COBRA coverage will end once you become eligible for Medicare, but if you have Medicare prior to COBRA then you can keep your COBRA coverage until it expires. BUT, be aware that if you reach Medicare eligibility while on COBRA you must strongly consider enrolling in Part B when initially eligible or face a late enrollment penalty. COBRA is NOT considered group health insurance based on current employment allowing you to delay Part B without the associated late penalty. 6/9/2015 9

10 Part B Coverage Doctors services Outpatient medical/surgical services Diagnostic tests Outpatient therapy Outpatient mental health services Ambulance Services Getting a second opinion before surgery No cost sharing for most Medicare covered preventative health care services began Durable Medical Equipment: Changed effective July 2013!! 6/9/

11 Paying the Part B Premium Pay monthly Part B premium Most pay $ in 2015 Persons with higher income pay a higher premium You Pay If Your Yearly Income is Part B Single Married Couple $ Under $85,000 Under $170,000 $ $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 6/9/

12 Paying the Part B Premium continued 6/9/

13 Preventive Benefits As of 2011 you can obtain an annual Wellness Exam and most other Part B preventive services free. Review the Medicare handbook for full details. Read the rules very carefully, especially about annual wellness visits it is not an annual physical!! Most preventive services no longer require payment of the Medicare deductible or 20% coinsurance. New in 2014: Abdominal Aortic Aneurysm Screening 6/9/

14 Durable Medical Equipment New competitive bidding program started in 2011 in nine areas of country, saving 42% in 1 st year! Round 2 of program started July 1, 2013 in 91 new areas, including the DC Metro area. Suppliers will submit bids for various equipment that must be lower than current costs. Beneficiaries must generally use such contracted suppliers. Items included in Round 2 include oxygen; walkers; wheelchairs; CPAP devices; hospital beds; support surfaces; enteral nutrients; negative pressure wound therapy pumps; and mail order diabetic supplies. 6/9/

15 Original Medicare Go to any provider that accepts Medicare People are responsible for Part A in 2015 $1,260 deductible for hospital stays up to 60 days Additional costs per day after 60 days: $315/$630 Different costs for other Part A services Part B in 2015 $147 annual deductible 20% coinsurance for most Part B services Works best with a Medicare supplement plan. Some subsidy programs may help with costs. 6/9/

16 Supplemental Insurance Health insurance policy Sold by private insurance companies Costs vary by plan, company and location Must say Medicare Supplement Insurance Covers gaps in Original Medicare It is sometimes called Medigap coverage Covers deductibles, coinsurance & copayments Does not work with Medicare Advantage Plans Up to 10 standardized plans A N Except in Massachusetts, Minnesota, Wisconsin Plan F is best and costs about $135+ month at age 65 in /9/

17 People can buy any Medigap policy Supplemental Insurance Within 6 months of enrolling in Part B, though very costly for those under age 65 and on Medicare due to a disability. It is very expensive if under age 65, but you get a new set of options when you reach age 65 with much lower costs. If they lose certain kinds of health coverage through no fault of their own ie the plan goes bankrupt. If they leave a MA Plan under certain circumstances: For example, you move from their service area. Two 12 Month Trial Periods: One at age 65 and one by dropping Medigap to test drive Medicare Advantage for the 1 st time at any age. 6/9/

18 Supplemental Insurance Other Supplemental Insurance Types Retiree Coverage from a former employer. Government retirees, federal, state or county. Military Coverage, such as Tricare for Life. 6/9/

19 Federal Retiree Options Federal workers and retirees have many good plan options: Can switch plans every open season without underwriting. Retirees with Medicare can change plans once in their lifetime outside of open season per OPM regulations use it wisely! Blue Cross/Blue Shield offers limited 10 day SNF care other plans offer no SNF coverage. SNF = Skilled Nursing Facility. See Checkbook Guide to Health Plans for Federal Employees. The guide costs $9.95 and can be found at most book stores or at Compare federal health plans at 6/9/

20 Federal Retiree Options Part B or Not Part B, That is the Question! Our experience is that 75% of retirees still enroll in Part B. When enrolled in Part B the PPO plans, and a few HMO plans, waive all deductibles and coinsurance or copay amounts. The annual base Medicare premium is about $1,260. Medicare Part B usually does not save you as much money as you may spend on your Part B premiums, per Checkbook, but are you rolling dice in Vegas or planning for health care? Do you have fire insurance and/or LTC insurance? Why? Consider all options and late enrollment costs before deciding. If there were an easy answer the question would not be asked! 6/9/

21 Medicare Advantage (MA) Plans Health Maintenance Organization (HMO) Plans Some have Point-of-Service option Preferred Provider Organization (PPO) Plans Private Fee-for-Service (PFFS) Plans Special Needs Plans (see Medicare handbook) Cost Plans (Kaiser Permanente) Allowed to still use Medicare coverage under Kaiser! Only 5 Star Plan in our locality Can no longer use Inova hospitals except emergencies. 6/9/

22 Eligibility for MA Plans Live in plan s service area Enrolled in Medicare Parts A & B Continue to pay Part B premium May also pay monthly premium to plan, as required Cannot have ESRD at enrollment, but can still remain in such a plan if diagnosed after joining or if your current MA plan ends their participation. 6/9/

23 How MA Plans Work Get all Part A and B services through plan Use providers in plan s network Benefits and cost sharing may differ from Original Medicare Must still pay Part B premium **May get extra benefits Maybe not! Vision, hearing, dental services Prescription drug coverage Does not cover the 20% for some Part B services. Still in Medicare program Get all Part A and Part B services Have Medicare rights and protections 6/9/

24 MA Disenrollment Beginning in 2011 there is a new Medicare Advantage Disenrollment Period (MADP). This period of time, from January 1st to February 14 th, allows a person who is unsatisfied with their Medicare Advantage plan to switch back to Original Medicare. They can also add a Medicare Part D plan at that time, even if their MA plan did not cover medications. The effective date is the 1 st of the following month. 6/9/

25 Medicare Prescription Drug Coverage Medicare Part D Available to all people with Medicare Provided through Medicare Prescription Drug Plans Medicare Advantage Cost Plans, such as Kaiser Special Needs Plans Some employers and unions now switching to MA plans. 6/9/

26 Enrollment Periods Initial Enrollment Period (IEP) 7 months Starts 3 months before month of eligibility Annual Coordinated Election Period (AEP) October 15th through December 7th Can drop or switch coverage Effective January 1 of following year Special Enrollment Period (SEP) When you lose your employer-based coverage (63 days) 6/9/

27 Late Enrollment People who wait to enroll may pay penalty Add 1% of national base premium ($33.15 in 2015) for each month eligible but not enrolled The 1% penalty will equal 33 cents for each month Must pay the penalty as long as enrolled in a Medicare drug plan Unless they have other coverage at least as good as Medicare drug coverage Creditable coverage Penalty is held in suspense if receiving any subsidies 6/9/

28 Prescription Drug Plan Costs Costs vary by plan In 2015 members may pay Monthly premiums averaging $49.60 Annual deductible, no more than $320 Copayments or coinsurance Very little after $4,700 out-of-pocket Plan information and costs available MEDICARE ( ) 6/9/

29 Extra Help With Drug Costs: SSA Low Income Subsidy Program Available for many people with limited income and resources Income limit in 2015 $1,471/month (one person) $1,991/month (married couple) Resource limit in 2015 $13,640 (one person) $27,250 (married couple) Apply at 6/9/

30 Extra Help With Drug Costs People with lowest income and resources Pay no premiums or deductibles Have small or no copayments Those with slightly higher income and resources Pay no or a reduced premium Have a reduced deductible Pay a little more out of pocket 6/9/

31 Eligibility for Extra Help Who may automatically qualify People with Medicare who get Full Medicaid benefits (Duals) Supplemental Security Income (SSI) Help from Medicaid paying Medicare premiums (Medicare Savings Program: QMB, SLMB & QI-1) Others must apply and qualify See Web page. 6/9/

32 Medicaid Joint Federal and state program For some people with limited income and resources If eligible, most health care costs covered Eligibility determined by state Application processes vary Office names vary Social Services Family Services Human Services 6/9/

33 Other Savings Programs Medicare Savings Programs (MSP) Help from Medicaid paying Medicare expenses QMB, SLMB, and QI-1 For people with limited income and resources May also pay deductibles and coinsurance All three help lower out-of-pocket drug costs State-specific programs PACE (Program of All-Inclusive Care for the Elderly) must meet nursing home level of care and are already a dual eligible client. In Fairfax County, only at Olley Glen. 6/9/

34 MSP Programs Qualified Medicare Beneficiary (QMB): Maximum monthly income of $1,001 (1) or $1,348 (2),with assets of no more than $8,660 or $13,750. If eligible, Medicaid pays your secondary Medicare costs such as deductibles and coinsurance. You will likely need to be treated by physicians who accept both Medicare and Medicaid to avoid the 20% coinsurance. QMB may also pay the Medicare A & B premiums. It also provides a drug plan subsidy. 6/9/

35 MSP Programs Specified Low-Income Medicare Beneficiary (SLMB): Pays only Medicare Part B premium. Maximum monthly income of $1,197 (1) or $1,1613 (2). Maximum assets of $8,660 or $13,750. Qualified Individual 1 (QI-1): Pays only Medicare Part B premium. Maximum monthly income of $1,345 (1) or $1,813 (2). Maximum assets of $8,660 or $13,750. Both programs also provide a drug plan subsidy. 6/9/

36 Health Insurance Marketplace Part of the Affordable Care Act (ACA), it provides a one-stop shopping center to explore insurance options. You can compare insurance options based on price, benefits, quality and other features. The initial open season began on November 15, 2014, with plans effective on January 1, Open Enrollment Period is November 15, 2014 February 15, There will be online navigation sites and in-person assisters to help you make an informed decision. Visit or call to learn more about this program. Locally, call or If eligible for Medicare then excluded from ACA plans. 6/9/

37 6/9/

38 MEDICARE APPEALS The following are the five steps of an Original Medicare appeal process: 1. Redetermination.120 days to file the appeal. 2. Reconsideration 180 days to file the appeal. 3. Administrative Law Judge Review 60 days to file the appeal. 4. Medicare Appeals Council 60 days to file the appeal. 5. Judicial Review 60 days to file the appeal. For More Info: 6/9/

39 Senior Medicare Patrol~ FRAUD! Educates persons with Medicare to take an active role in detecting & preventing health care fraud & abuse. In Virginia, contact in Richmond. If you suspect fraud, first contact the medical provider to determine if a mistake was made. You might qualify for a reward if you meet certain conditions. For additional information please go to: 6/9/

40 For More Information MEDICARE ( ) TTY = VA Medigap Premium Charts Medicare & You Handbook or Social Security: or SSA POMS Fairfax County SHIP~VICAP: Medicare For Dummies by Patricia Barry 6/9/

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