MEDICARE: You ve earned It. Make the most of it.

Transcription

1 Cigna Medicare Services MEDICARE: You ve earned It. Make the most of it. A simple guide filled with useful information on Medicare, health and wellness and more. Section 1 MEDICARE. PLAIN AND SIMPLE. Section 2 NOT A MEDICARE EXPERT? NO PROBLEM a UWB 09/13 S5617_14_9883 CMS Accepted

2 SECTION 1 MEDICARE. PLAIN AND SIMPLE. Each person s health is as individual and unique as they are. At Cigna, we get that. That s why we created this handy guide. In it, you ll find answers to all your Medicare questions from understanding the differences between the plans themselves to knowing what to ask yourself when shopping for a plan, when to enroll and where to go for extra financial help. It s all here in plain and simple language so you can easily find the Medicare plan that best fits your unique health care needs. Do you qualify for Medicare? Generally, you re eligible if:* You or your spouse worked for at least 10 years in Medicare-covered employment You re 65 years or older If you re under 65, you can get Part A without having to pay premiums if you have: Received Social Security or Railroad Retirement Board disability benefits for 24 months End-stage renal disease and meet certain requirements * Other eligibility limitations may apply depending on certain situations. For more information, visit medicare.gov. 2 of 11

3 Enrollment There are three types of enrollment periods: 1. Initial Coverage Enrollment Period (ICEP) The initial enrollment period occurs when you turn 65 years of age. Enrollment for the initial period, is from three months before to three months after your 65th birthday. If you are younger and qualify for Medicare due to a disability or other special circumstances, Medicare may work differently for you. Check with your local Social Security Administration offce, or call to confirm your initial enrollment with Medicare. Learn more at 2. Special Enrollment Period (SEP) Due to special situations, you may be able to enroll, switch, or drop out year-round if you: Lose insurance through an employer Move into or out of a plan service area Gain or lose eligibility for Medicaid Qualify for or have a change to, Low Income Subsidy (LIS) Live in a long-term care facility Qualify for a Special Needs Plan (SNP) Are on Medicare Disability and turning 65 Are on a plan that is being removed. 3. Annual Enrollment Period (AEP) ALL Medicare beneficiaries can enroll, switch, or drop out during this time: October 15 December 7. Coverage begins January 1 and will continue for the calendar year. Open enrollment: Tuesday, October 15, 2013 Saturday, December 7, of 11

4 The A, B, C, Ds of Medicare. Original Medicare (Medicare pays 80% and you pay 20%) Part A: Hospital Insurance Hospital stays Skilled nursing facility Hospice care Some home health care Once you turn 65, you re automatically enrolled in Medicare Part A. Most people don t have to pay a premium for Part A because they, or their spouse, paid Medicare taxes while working. Part B: Medical Insurance Medical services Outpatient care Medical items Covered preventive services Medicare pays: 80% of approved charges Beneficiary Pays: 20% of approved charges Part B is optional because you have to pay a monthly premium and satisfy a deductible before Medicare will pay benefits. Part C: Medicare Advantage Plans Combine Part A and Part B in one plan Often also include Part D (prescription drug coverage) These plans are part of the government s Medicare program, but are offered and managed through private insurers and may offer plan extras not found in Original Medicare. You must be enrolled in Medicare Parts A and B to join. Part D: Prescription Drug Coverage Help lower prescription drug costs All plans must offer at least a standard level of coverage set by Medicare Some Medicare Advantage plans offer built-in prescription drug coverage Part D plans are part of the government s Medicare program, but they re offered and managed through approved private insurers. Medigap or Medicare Supplement Insurance A Medigap policy is private health insurance that supplements Original Medicare. It helps pay for the 20% of health care costs (gaps) that Original Medicare doesn t cover. Helps pay some costs (copays, coinsurance and deductibles) that Original Medicare doesn t cover Only works with Original Medicare Medicare Supplement insurance cannot be used with Medicare Advantage plans, but can be used with Prescription Drug plans 4 of 11 To learn more about Medicare, visit medicare.gov.

5 Donut hole coverage The Medicare Part D Prescription Drug Plan Coverage Gap In 2014, if you have a stand-alone Medicare Part D plan, and you and your plan pay more than $2,850 in total prescription drug costs in one year, you fall into the coverage gap, or donut hole. Once you reach this level, you begin paying a larger part of your prescription drug costs until total costs reach $4,550 for the year. After that, the plan pays most of the cost. Over time, the Patient Protection and Affordable Care Act health care reform legislation changes what you pay in the donut hole, and requires drug manufacturers to provide discounts by 2020 Brand-name Generic Brand-name Generic medications medications medications medications you ll pay 47.5% you ll pay 72% you ll pay 25% you ll pay 25% You ll pay only 47.5% of the You ll pay only 25% cost of your brand-name drugs for brand-name and (improved from paying 50% generic drugs. in 2012), while the amount you ll pay for generic medications will also be reduced to 72% of the cost of these drugs. Typically, generic drugs are less expensive than brand-name drugs even after discounts. The amount you pay for brand-name and generic drugs in the coverage gap will be based on your plan. Those who receive Extra Help from the government already have coverage through the coverage gap. $ Why generic drugs make cents. When it comes to your health, only the best will do. Generic drugs are safe and effective alternatives to brand-name drugs. In fact, they have the same active ingredients, dosage and quality as their brand-name counterparts. But, there is one big difference between the two: cost. Typically, generics are less expensive than brand-name drugs; sometimes, much less. According to the U.S. Federal Drug Administration (FDA), generics can be 30% to 80% less expensive than their brand-name versions. The FDA approves new generic drugs each month. For details, go to fda.gov and search for new generic drug approvals. And talk with your doctor to see if there are generic alternatives to the brand-name drugs you currently take. 5 of 11 Source: Krames Staywell, 2012

6 Medicare and staying well. Welcome to Medicare preventive visit Once you enroll in Medicare Part B, you can get this free introductory Welcome to Medicare preventive visit. This visit includes a medical and social history review, routine measurements, vision testing and a plan to help inform you on which screenings, shots and other preventative services you may need. This visit is only available to new Medicare Part B participants and is covered one time (within the first 12 months of signing up for Medicare Part B). You don t need to have this visit to be covered for your annual Wellness visits. Free annual wellness visit and prevention plan If you ve had Medicare Part B for longer than 12 months, you can get a free annual Wellness visit to develop or update your personalized prevention plan to help you stay healthy. This visit includes: a medical and family history review, provider and prescription update, routine measurements, cancer and diabetes screenings and more. This visit is covered once every 12 months (11 full months must have passed since the last visit). Who s eligible? Anyone enrolled in Original Medicare is eligible for the one-time Welcome to Medicare visit and the annual Wellness visits. What s the cost? If you re currently enrolled in Original Medicare, you pay nothing for these visits if your doctor or other qualified health care provider accept assignment.* However, if your doctor or health care provider performs additional tests or services during the same visit that aren t covered under these preventive benefits, you may have to pay coinsurance and your Part B deductible may apply. *Assignment is an agreement by your doctor, health provider, or supplier to be paid directly by Medicare, or accept the amount Medicare approves for the service and not bill you for any more than the Medicare deductibles and coinsurance. For an additional resource to learn more about Medicare, visit ncoa.org, the National Council on Aging website. Located in Washington, D.C., this nonprofit service and advocacy agency has a focused mission to improve the lives of all older Americans. 6 of 11

7 SECTION 2 NOT A MEDICARE EXPERT? NOT A PROBLEM. Just because you re almost 65 or older doesn t mean you re suddenly an expert on Medicare. The fact is, Medicare is complicated. But don t let not knowing every detail stop you from making smart decisions about your future care. Know yourself. Know your options. When comparing the different plans available, be sure to consider what s important to you. There s a lot to think about, so ask yourself the following questions. The answers may help point you in the right direction: How s your health? Are you in good health or do you have chronic conditions? Do you take prescription drugs regularly and if so, which ones? Are they brand name or generic? How much are you spending for them? How does health care fit into your budget? Will you qualify for financial help? How much are you able to spend each year on premiums or copays? What s your level of patience for paperwork? What doctors do you visit? How often do you see them? Would you be willing to see a new doctor, if necessary? Do you travel? Inside the U.S. or internationally? How much did you spend on medical care last year? This can help provide an estimate for what next year s costs might be. 7 of 11

8 Explore your options It s never too early to start shopping for your plan. If you have coverage through your employer, talk with your benefits or human resources manager about your options. There are many other resources available including the Medicare website medicare.gov, the annual Medicare & You handbook, your State Health Insurance Assistance Program (SHIP), the Social Security Administration and more. Nine out of 10 seniors are satisfied with their Medicare prescription 90 % drug coverage (Part D). And 84% report their out-of-pocket drug costs would be much higher without it.* * HRC Research and Medicare Today, October Know where to go for financial help When it comes to choosing the right plan, help is available. But did you know you can also get financial help, if you qualify? Extra financial assistance to help cover the costs of Medicare is available for individuals with lower incomes. If you think you might qualify, apply as soon as possible. It can take several months to process your application. You ll want to find out quickly if you re eligible, and how much help you could receive. Original Medicare (Parts A and B) or Medicare Advantage Plan (Part C) financial help Medicare may help pay Original Medicare (Parts A and B) or Medicare Advantage Plans (Part C): Premium Deductibles Coinsurance Copays Part D Prescription Drug Plan Extra Financial Help Income levels to qualify: Up to <amount> in yearly income (<amount> for a married couple) Up to <amount> in assets (<amount> for a married couple) Medicare Extra Help will help pay for: Premium Deductibles Coinsurance Copays To find out how to apply for financial help, call: MEDICARE ( ), 24 hours a day/7 days a week. TTY users call The Social Security offce at , 7 am to 7 pm, weekdays. TTY users call Your state Medicaid offce. 8 of 11

9 Choosing the right plan for you Medicare offers many choices. You ll need to compare your needs to what s available. The following three scenarios offer examples of the types of plans available and the reasons why they may be a good fit. Remember: costs may vary. Meet John John just turned 65 and retired. He s in good shape, but takes a daily prescription drug to keep his high blood pressure under control. John takes good care of himself and is careful to live within his budget. John s wish list Access to a full range of health care services, including preventive care Coverage that provides a safety net in case of a serious illness Access to specialists if he needs them; he s comfortable with sticking to choices in a plan s network Access to prescription drug coverage, in case he needs to take more drugs later John s choice Medicare Advantage Plan (an HMO type). To qualify for this plan, John must also have Medicare Part A and Part B Features One ID card that covers hospital stays, doctor visits, medications, urgent care clinics and emergency room visits Less paperwork Potential extras, such as a free fitness program Built-in prescription drug benefit Network of local doctors and hospitals No need for a Medigap plan 9 of 11

10 Meet Anne Anne is turning 65 in three months and has started researching Medicare plans. Since she spends a lot of time out of state visiting children and grandchildren, she needs a plan that can travel with her. Anne is fairly healthy, although she takes a drug to keep her bones strong and another drug to keep her cholesterol down. Anne s wish list Access to doctors and hospitals when she s out of state visiting her children Help with paying for her prescription drugs Peace of mind knowing that she ll have significant help paying for her drug costs if they re large Anne s choice Medicare Part A and Part B (Original Medicare) Stand-alone Medicare Part D Prescription Drug Plan Medigap plan (Medicare supplement insurance) through a private insurance company Features Access to doctors and hospitals throughout the United States Medicare Part D coverage for the drugs she takes Help with her Part A and Part B costs through her Medigap plan Meet Rita Rita will be 65 next month. She s been working part-time since her husband passed away several years ago, but her income is limited. Rita has heart disease, so she sees a heart specialist regularly and takes a blood-thinning medicine every day. She does not feel she can afford the premiums for a Medigap (Medicare Supplement insurance) policy. Rita s wish list Health care at an affordable price Access to her trusted doctors Coverage for her prescription drugs Rita s choice Medicare Part A and Part B (Original Medicare) Stand-alone Medicare Part D Prescription Drug Plan Features Access to the doctors and hospitals she uses now The possibility of help with her Part D Prescription Drug Plan premiums and cost sharing if she qualifies for low-income assistance 10 of 11

11 Don t delay. Apply for Medicare as soon as you become eligible. You can enroll in a Medicare plan from three months before to three months after your 65th birthday or Special Enrollment Period, if you qualify. After you enroll, you ll have an opportunity to switch plans once a year during the Annual Enrollment period without penalty. Cigna, Cigna Medicare Services, Cigna Medicare Rx (PDP), the Tree of Life logo and GO YOU are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Cigna Health and Life Insurance Company (CHLIC), and not by Cigna Corporation. Cigna Medicare Rx is a PDP plan with a Medicare contract. Enrollment in Cigna Medicare Rx depends on contract renewal. All models are used for illustrative purposes only. 11 of a UWB 09/ Cigna. Some content provided under license.