Medicare Quick Reference 2016 Income Investment Estate Retirement Social Security NOT FDIC INSURED NO BANK GUARANTEE MAY LOSE VALUE This guide provides general Medicare information.
Part A Part C (Medicare Advantage) Medigap/ Medicare Supplement Medicare Parts and Plans Covers hospital, skilled nursing facility, home health and hospice care. Part of Original Medicare. Covers physician services, preventative care, durable medical equipment, hospital outpatient, mental health and ambulance services. Part of Original Medicare. Commonly called Medicare Advantage (MA), Part C is a private insurance alternative to Original Medicare. MA plans generally incorporate Parts A, B and D into a single insurance plan option. Covers prescription medications through plans issued by private insurance companies. Coverage can be obtained as a stand-alone plan under Original Medicare or as part of a Medicare Advantage offering. Supplemental coverage for certain expenses not covered by Original Medicare. Covered expenses may include deductibles, copays, coinsurance and foreign travel emergency care. These plans are issued by private insurance companies. Medicare Costs Part A Base Premiums None (up to $411 for those without sufficient work credits or spousal eligibility) $1,288/benefit period. A benefit period begins on the day Deductible you are admitted to the hospital or skilled nursing facility and ends after 60 consecutive days of no inpatient or skilled nursing care. Copayments Hospital stays: Days 1-60: $0 after deductible Days 61-90: $322/day Days 91+: $644 coinsurance per available reserve day (up to 60 days over lifetime) or full cost Skilled nursing facility: Days 1-20: none Days 21-100: $161/day Days 100+: Full cost Base Premiums High Income Surcharge Deductible Annual: $166 $104.90 hold harmless * ; $121.80 standard Varies by income and tax filing status. See High Income Premium Surcharge table. Coinsurance 20% for most other services. None for most preventative services. * Hold harmless applies for most Social Security recipients Part C Medicare Advantage MA plans are a private alternative to Original Medicare. Plan s vary, but will not be less than the cost of $104.90 (hold harmless) or $121.80 (standard ) Issued by private insurance companies generally under HMO or PPO structure. May include dental, hearing or vision coverage. Plan availability and provider networks vary by geographic region.
Base Premiums High Income Surcharge Deductible Annual: $360 Copayments/ coinsurance Coverage Phases Varies by plan and location. National base : $34.10 Varies by income and tax filing status. See High Income Premium Surcharge table. Depends on plan and phase of coverage Standard: $0-3,310 in prescription costs Donut Hole: $3,310-7,062.50 in prescription costs Catastrophic: >$7,062.50 in prescription costs Donut Hole The Donut Hole is a gap in full coverage once total prescription medication costs exceed the annually adjusted threshold. Under the Affordable Care Act legislation, the Donut Hole will close by 2020. Under standard guidelines, a participant is responsible for expenses in 2016 as follows Participant pays an initial deductible up to $360. Medicare covers 75% of the next $2,950 in prescription drug costs. Once all and participant out of pocket expenses total $3,310, the participant enters the Donut Hole coverage phase. While in the Donut Hole, the participant pays 58% of generic medication costs and 45% of brand name costs. Once total creditable payments exceed $7,062.50, the participant enters the Catastrophic coverage phase. Donut Hole Out of Pocket Costs Limits % Paid by Participant Creditable Payments Catastrophic (5%) (5%) $7,062.50 of additional expenses Donut Hole Up to $3,752.50 Generic Brands depending on generic (58%) (45%) vs. brand choice $3,310 $360 Initial Coverage (25%) Deductible (100%) $737.50 Medigap Must be enrolled in Part A & B in order to purchase. Only available under Original Medicare. Premiums vary by plan type and insurer selected. Most recent report (2010) lists average monthly as $177. Supplemental plans are typically available in 10 variations depending on desired coverage. Plans may cover all or portions of copays, deductibles, coinsurance, excess charges and foreign travel emergency coverage.
Eligibility Requirements Part A 65 years old Citizen or resident or Sufferer of end stage renal disease or ALS or Social Security disability insurance recipient 65 years old Citizen or resident or Sufferer of end stage renal disease or ALS or Social Security disability insurance recipient Part C & Medigap Enrolled in A and Enrolled in B Enrolled in A/B Enrollment Periods Initial Enrollment -3 months Age 65 +3 months +6 months Parts A, B, D and MA Medigap Annual Election Period October 15 November December 7 General Enrollment January February March MA Disenrollment January 1 February 14 Enrollment Period Definitions Initial Enrollment: Begins 3 months prior to 65th birthday and ends 3 months after. Annual Election Period: Opportunity to make changes to selected coverage. May change MA or plan, move from Original Medicare to MA or vice versa. General Enrollment: Opportunity to enroll if you did not enroll when first eligible. Coverage will begin on July 1st and enrollment penalties may apply. See Penalties for Late Enrollment Medicare Advantage Disenrollment: Ability to switch back to Original Medicare if you did not do so during your annual election period.
Penalties for Late Enrollment Part A* (if applicable) Amount 10% flat penalty 10% incremental penalty 1% incremental penalty, based on National Base Premium of $34.10 Rate of increase Does not increase Increases 10% for each 12 mo period participant was eligible for Part B but was not enrolled Increases 1% for each full month participant was eligible for coverage but was not enrolled Duration Twice as long as participant was eligible for Part A, but was not enrolled As long as participant has Medicare As long as participant has Medicare Initiation As soon as initial or special enrollment period ends As soon as initial or special enrollment period ends After 63 continuous days without creditable prescription drug coverage *Only applies to individuals who do not qualify for free Part A coverage. High Income Premium Surcharges Taxable income in 2014 (determines what you pay in 2016) Monthly File individual File married & joint File married & separate $85,000 or less $170,000 or less $85,000 or less $121.80 * Plan $85,001 to $107,000 $170,001 to $214,000 Not applicable $170.50 $12.70 + $107,001 to $160,000 $214,001 to $320,000 Not applicable $243.60 $32.80 + $160,001 to $214,000 $320,001 to $428,000 above $85,000 to $129,000 $316.70 $52.80 + above $214,000 above $428,000 above $129,000 $389.80 $72.90 + * $104.90 if held harmless
KEY ENROLLMENT CONSIDERATIONS Signing up at the proper time: In order to avoid penalties, participant must either sign up for Medicare during the initial enrollment period or be eligible to delay coverage. Delaying coverage past age 65: Medicare can be delayed without penalty, if participant has creditable health care coverage through an employer or spouse s employer. Transitioning from employer coverage to delayed Medicare coverage: Participants who delayed coverage can sign up for Medicare through a Special Enrollment Period (SEP). Participant may sign up while covered by another plan or up to eight months after other coverage ends. Combining Medicare and group plan coverage: If participant has both Medicare and plan coverage, payments will depend on the size of the employer providing the coverage. The group plan will be the primary payer if the plan is offered by a firm with 20 or more employees. For plans through firms with 20 or fewer employees, which coverage is primary will depend on the plan. Participants should consult with plan provider to determine how the plan will integrate with Medicare. Medicare and health savings accounts (HSAs): Upon enrollment in any part of Medicare (including Part A), participant may no longer contribute to an HSA. However, participant may use remaining HSA funds to pay for medical services while enrolled in Medicare. All information is sourced from Medicare.gov. The statements contained herein are the opinions of Nuveen Investments Wealth Management Services. All opinions and views constitute our judgments as of the date of writing and are subject to change at any time without notice. Hypothetical examples are shown for illustrative and educational purposes only. Information was obtained from third party sources, which we believe to be reliable but not guaranteed for accuracy or completeness. The information provided is not intended to be relied upon as investment advice or recommendations, does not constitute a solicitation to buy or sell securities and should not be considered specific legal, investment or tax advice. The information provided does not take into account the specific objectives, financial situation, or particular needs of any specific person. 2016 Nuveen Investments, Inc.
Nuveen Investments 333 West Wacker Drive Chicago, IL 60606 312.917.7700 nuveen.com WFS-MD2016-0116D 12078-INV-Y-12/16