SLIDE 1 The ABCD s of Medicare Welcome to Health First s presentation of The ABCDs of Medicare. This is not a sales presentation it s for educational purposes and no plan specific benefits or details will be shared. SLIDE 2 Agenda In the next few minutes, we ll explain Original Medicare which has Parts A & B, Medicare Advantage plans known as Part C, and prescription drug plans or Part D. We ll also discuss Medicare Supplement Plans. Then we ll talk about your enrollment period and the various ways you can enroll in Medicare and give you a number of resources to help you learn more and choose a Medicare plan. Finally, we ll share with you ways to get extra help with your Medicare costs, if you qualify. So let s get started. SLIDE 3 Original Medicare: What is Original Medicare Original Medicare, which we will also refer to as Medicare, is a federal health insurance program for people age 65 and older, or those under age 65 with certain disabilities, and anyone with End Stage Renal Disease. SLIDE 4: Part A and B [CHART] Original Medicare covers certain medical services and items in hospitals and other settings. Some are covered under Part A and others are covered under Part B. SLIDE 5: Important Terms: Deductible and Benefit Period Before we discuss the differences between Part A and Part B, there are two terms that are important to understand: deductible and benefit period. A deductible is the amount you must pay for health care or prescriptions, before Original Medicare, your prescription drug plan, or other insurance begins to pay. For example, in Original Medicare, you pay a new deductible for each benefit period for Part A, and each year for Part B. These amounts can change every year. A benefit period is used to determine coverage for inpatient stays in hospitals and skilled nursing facilities. A benefit period begins on the first day you go to a Medicare covered inpatient hospital or a skilled nursing facility. The benefit period ends when you haven t been an inpatient at any hospital or skilled nursing facility for 60 days in a row. If you go to the hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have, and there is no maximum out of pocket protection with Original Medicare. This is an example of how a deductible and a benefit period work for Original Medicare Part A. In 2013, you would have a $1,184 deductible for each benefit period. For an inpatient hospital stay in 2013, you would pay a coinsurance amount of $0 per day for days one to sixty, $296 per day for days sixty one to ninety, and $592 per lifetime reserve day, for days ninety one to one hundred and fifty. Medicare allows up to sixty lifetime reserve days over your lifetime.
SLIDE 6 Part A: Overview Part A helps cover your inpatient care in hospitals. Part A also covers skilled nursing rehabilitative care, home health care and hospice care. Part A does not cover personal or custodial care. SLIDE 7: Part A: Out of Pocket Costs Most people automatically get Part A coverage without having to pay a monthly payment, called a premium because they or a spouse paid taxes while working (10 years or 40 quarters). Note: The 2013 premium amount for people who buy Part A is $441. If you don t automatically get Part A, you may be able to buy it. If you choose to buy Part A, you must also have Part B and pay monthly premiums for both. And, if you choose to buy Part A, you will always get a bill for your premium. You may be eligible to buy Part A if you or your spouse aren t entitled to Social Security because you didn t work or didn t pay enough taxes while you worked and you are age 65 Or You are disabled but no longer get premium free Part A because you returned to work. Part A also has a deductible for each benefit period along with copayments or coinsurance requirements for certain covered services. There is no maximum out of pocket protection. SLIDE 8: Part B: Some Covered Services While most people automatically get Part A coverage, you can choose when you sign up for Part B. Part B covers other medical services that Part A doesn t cover. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventative services. It covers 2 types of physical exams Welcome to Medicare a 1 time physical exam, and a wellness yearly exam. SLIDE 9: Part B: Services Not Covered Medicare Part B does not cover items such as long term care, dental care or dentures, hearing aids or eyeglasses. But, glasses after cataract surgery are covered. Medicare Part B also does not cover foreign travel health care, routine foot care, chiropractic services, cosmetic surgery or convenience items such as chair lifts or bathroom grab bars. SLIDE 10: Part B: Out of Pocket Costs Part B has a monthly premium. Part B has a monthly premium. In 2013, the Part B monthly premium is $104.90 and a maximum of $335.70. In some cases, this amount may be higher based on your income, or if you didn't sign up for Part B
when you became eligible. If you are covered by other insurance, you may not need to pay the Part B premium while on your company plan. You will also pay a Part B deductible. In 2013, the annual Part B deductible is $147 before Original Medicare starts to pay its share. If you qualify for financial assistance through the Medicare Savings Program, which we will cover later in this presentation, you may be able to get help to pay this premium and deductible." If you get Social Security, Railroad Retirement Board, or Civil Service benefit payments, your Part B premium will be automatically deducted from your monthly benefit check. If you don t get Social Security, Railroad Retirement Board, or Civil Service benefit payments and choose to sign up for Part B, you will get a bill. SLIDE 11: Part B: Out of Pocket Costs Some Part B Medicare approved services are covered in full while other services may require a copayment or coinsurance amount be paid. Doctor visits, for instance, require a 20% coinsurance payment. If providers do not accept assignment, you may pay an additional 15% over the Medicare approved amount. SLIDE 12: Part B: Premiums So how can you estimate what your Medicare Part B premium will be once you are no longer on a company plan? These are the 2013 Part B monthly premium rates for beneficiaries who file an individual tax return or joint tax return. The premium is based on your modified adjusted gross income as reported on your IRS tax return from two years ago, the most recent tax return information provided to Social Security by the IRS. Each year, Social Security will notify you if you have to pay more than the standard premium. The amount you pay can change each year depending on your income. SLIDE 13: Original Medicare [PHOTO OF CARD] Once you are enrolled in Original Medicare, you can look at your red, white and blue Original Medicare card and it will tell you if you have Part A, Part B or both. SLIDE 14: Reminders about Original Medicare Here are some things to remember in regards to Original Medicare. When you are eligible to enroll into Part A and Part B, you are in Original Medicare unless you join a Medicare Advantage Plan. You may go to any provider that accepts Original Medicare. And, you will have a deductible plus coinsurance for most services. SLIDE 15: Medicare Part C [CHART] Medicare Part C includes several types of Medicare Advantage plans such as Health Maintenance Organizations, or HMOs; Preferred Provider Organizations, or PPOs; Private Fee for Service plans or PFFS; and Special Needs Plans, or SNPs.
SLIDE 16: What is Part C? If you are enrolled in a Medicare Advantage plan, Medicare services are covered through the plan and are not paid under Original Medicare. You still have Original Medicare with a Medicare Advantage plan, and still have to pay your Part A premium and Part B premium, if applicable. Monthly Medicare Advantage premiums vary by plan. There are advantages to this type of coverage. Medicare Advantage Plans eliminate Part A and Part B deductibles and often have no deductible of their own, with low to no additional monthly premiums. Medicare Advantage Plans also feature an out of pocket maximum to give you more financial protection than Original Medicare. SLIDE 17: Medicare Advantage Plans Medicare Advantage plans may include prescription drug coverage and offer extra benefits for vision or dental care. Some plans even include gym memberships. And there is little paperwork. The limitations to this type of coverage are that you often have networks and you must live in the service area of the plan. You can generally join a Medicare Advantage Plan if you are entitled to Part A, are enrolled in Part B and you don t have End Stage Renal Disease. In most cases, you can join a Medicare Advantage Plan only at certain times during the year, which we will discuss shortly. SLIDE 18: Medicare Supplements Medicare supplemental plans, also known as Medigap, are sold by private companies to fill gaps in Original Medicare coverage. Medicare supplements have standardized benefits but their premiums will vary by carrier. You cannot be enrolled in a Medigap plan and a Medicare Advantage Plan. If you want more coverage than Original Medicare offers, you will have to choose between these two plan types. Although some Medigap policies sold in the past covered prescription drugs, no Medigap policies include prescription drug coverage today. You do have the option to add drug coverage by joining a stand alone Prescription Drug Plan or Part D. SLIDE 19 [PART D CHART] If you have only Original Medicare, or Original Medicare plus a Medigap policy, you can add drug coverage by joining a stand alone Medicare Prescription Drug Plan or PDP. These prescription drug plans are called Part D. Or, you can have Part D coverage when you enroll in to a Medicare Advantage Prescription Drug Plan, also known as a MAPD plan, that offers medical and drug benefits. SLIDE 20 Part D: Overview Prescription drug plans are offered by private companies to cover generic and brand medications. They can be part of a Medicare Advantage Plan or a stand alone Prescription Drug Plan. So if prescription coverage is important to you, be sure to look for a plan with Part D built in or enroll in a stand alone plan.
If you choose to buy a stand alone Prescription Drug Plan, you will pay a separate monthly premium for those benefits. Premiums vary by plan, and you must follow the formulary list of covered drugs. It is important to remember that you can t buy a separate Part D policy if you belong to a Medicare Advantage Plan. If you join a stand alone prescription drug plan, you will automatically be disenrolled from the Medicare Advantage Plan, and you will revert to Original Medicare. SLIDE 21: Part D: Out of pocket costs The amount you pay for Part D coverage could be based on your 2011 IRS tax return income. This includes Part D coverage you get from a stand alone plan or a Medicare Advantage Plan that includes Medicare prescription drug coverage whether you buy the plan on your own or get it through an employer group plan. If your income is above a certain limit, you will pay an extra amount in addition to your plan premium. This is an example of what your 2013 Medicare Part D premium would be, based on a 2011 IRS tax return. If your income look back, or modified adjusted gross income as reported on your IRS tax return from two years ago, indicates you must pay the Part D monthly premium adjustment, it will be deducted from your monthly Social Security check or included in a quarterly invoice if you re not collecting Social Security yet. SLIDE 22: Part D: Standard benefit There are three stages to the standard benefit of Medicare Part D. Some plans have a yearly deductible, however if they do, it is no more than $325. Stage One the initial coverage period, covers up to $2,970 total drug cost. During this period you pay the defined copayments based on the plan you chose. At Stage 2, or what is referred to as the doughnut hole or coverage gap, you pay 47.5% of your brand name drugs and 79% of generic drugs, until you reach a total out of pocket cost limit of $4,750. Your premium payments are not counted toward the $4,750 out of pocket cost limit. At Stage 3, referred to as catastrophic coverage, Original Medicare pays all but about 5% of your prescription costs for the remainder of the year. SLIDE 23: Medicare Enrollment Period When Can You Sign Up for Part A and Part B? If you collect benefits from Social Security or the Railroad Retirement Board, you will automatically get Part A and Part B, effective the first of the month you turn 65 or the first of the previous month if your birthday falls on the first. If you don t collect benefits from Social Security or the Railroad Retirement Board, you can sign up for Part A & B during your Initial Enrollment Period. This is a 7 month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. You do not need to be retired to sign up for Original Medicare. If you wait until the last four months of your Initial Enrollment Period to sign up for Part B, your date for coverage will be delayed up to 3 months after you sign up if you wait until the last month or your Initial Enrollment Period.
SLIDE 24: Enrollment Period: Medicare Advantage or Medicare Supplement Plan The time to enroll in a Medicare Advantage plan is the same period of time you can enroll in Original Medicare the 3 months before the month you turn 65, the month you turn 65, and the 3 months after the month you turn 65. The best time to buy a Medicare supplement plan is during your Medigap open enrollment period. This period last for 6 months and begins on the first day of the month in which you re both 65 or older and enrolled in Medicare Part B. SLIDE 25: Medicare Annual Enrollment Periods If you have chosen to enroll in a Medicare Advantage Plan or a Prescription Drug Plan, you will have an opportunity every year to switch to a different plan. The time in which you can do this is called the Annual Election Period (AEP). It is currently slated between October 15 th and December 7 th with your new plan selection taking effect on January 1 st. If you initially enroll in a Medicare Supplement Plan you are free to switch to a different Medicare Supplement Plan at any time throughout the year. There is also a Medicare Advantage Disenrollment Period (MADP) that lasts from January 1 st through February 14 th. In this period of time, you can disenroll from your Medicare Advantage Plan and switch to Original Medicare. You can also join a Prescription Drug Plan during this time. SLIDE 26: Choosing a Plan There are three steps you should take before you choose your Medicare coverage. Step 1: Decide if you only want Original Medicare, a Medicare Advantage Plan, or a Medicare Supplement Plan. Step 2: Decide if you want prescription drug coverage. And, step 3: Make sure you enroll on time according to your choice of plans. SLIDE 27: Medicare Enrollment If you decide you want Original Medicare, The Social Security Administration handles enrollment. You can contact them at 1 800 772 1213. TDD/TTY relay users should call 1 800 325 0778. If you worked for a railroad, contact the Railroad Retirement Board to sign up. Once again, it s important that you contact Social Security three months before you turn 65 or before the 25 th month of disability. SLIDE 28: Resources And remember, as you decide on your Medicare coverage, there are several resources for you to get the information you need. You can always contact the Centers for Medicare and Medicaid Services online or toll free 1 800 633 4227 24 hours a day, 7 days a week. TDD/TTY relay users should call 1 877 486 2048. Also, the State Health Insurance Assistance Program is a government program with trained counselors in every state. You can reach them toll free at 1 800 963 5337. TDD/TTY relay users should call 1 800 955 8770.
And don t forget Health First can also help you with any questions you have regarding your Medicare coverage. Feel free to call or drop by our headquarters Monday through Friday from 8 am to 5 pm. You can reach us toll free at 1 800 716 7737; TDD/TTY relay users should call 1 800 955 8771. We re available weekdays from 8 am to 8 pm and Saturdays from 8 am to noon. From October 1 through February 14, we re available seven days a week from 8 a.m. to 8 p.m. If you call after hours, you may leave a message and we ll return your call the next business day. SLIDE 29: Extra Help As you learn about and consider your Medicare options, you may feel that it will be difficult to afford your medical costs. Keep in mind, there are several resources available to you. Programs are available such as Low Income Subsidy, which is a federal program to help reduce Prescription Drug Plan costs for limited income beneficiaries. You can apply online, by phone or in person at a Social Security office. If you qualify for full Low Income Subsidy, you will not pay Part D premiums or deductibles. You will not be subject to the coverage gap. Drug costs, for most people who qualify, are currently no more than $2.65 for generics, $6.60 for brand name. The Medicare Savings Program is a Federal State program that pays Part B premiums, coinsurance and deductibles for limited income Medicare beneficiaries. You can apply at the local Office of Family Resources, Medicaid, or initiate the application when you apply for Low Income Subsidy. Health First partners with Social Service Coordinators to assist our members in applying for Extra Help. If you qualify, you could reduce your monthly plan premium. You can call the number shown here for Social Service Coordinators, and they will help you determine if you may be eligible for Extra Help. SLIDE 30: Thank you Thank you for watching this educational presentation on the ABCD s of Medicare. We hope this presentation made things a little clearer for you and answered your questions as you take the steps to find the Medicare coverage that is right for you. Remember, if you still have questions, or you re ready to make a decision, just refer to the resources in this presentation. SLIDE 31: Disclaimers Health First Health Plans is a Medicare Advantage organization with a Medicare contract. Medicare Supplement products are not connected with or endorsed by the US Government or the Federal Medicare Program. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1.800.MEDICARE (1.800.633.4227) 24 hours a day, 7 days a week (TDD/TTY relay users should call 1.877.486.2048); the Social Security Office at 1.800.772.1213 between 7 am and 7 pm, Monday through Friday (TDD/TTY relay users should call 1.800.325.0778); or your Medicaid office. Y0089_MP3247 CMS Approved 01182013