area agency on aging and disability state health insurance assistance program (ship) 2012 medicare...
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AREA AGENCY ON AGING AND DISABILITYSTATE HEALTH INSURANCE ASSISTANCE
PROGRAM (SHIP)2012
Medicare 101
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Welcome to Medicare 101
What is MedicareEnrolling in MedicareYour Medicare BenefitsMedicare Supplemental BenefitsMedicare Advantage PlansPart D Prescription CoverageMedicare With Other Insurances
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What is Medicare?
Health Insurance for People 65 years of age and older People under age 65 with certain disabilities People of all ages with End-Stage Renal Disease
Run by the Centers for Medicare & Medicaid Services (CMS)
Sign up with the Social Security Administration or Railroad Retirement Board
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The Medicare Card
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Medicare Coverage Basics
Part ASee p. 32 of Medicare and You Handbook
•Inpatient hospital care•Skilled nursing care•Home health care•Hospice care
Part BSee p. 36 of Medicare and You Handbook
•Doctors’ services and outpatient care•Preventive services•Diagnostic tests•Durable medical equipment
Part DSee p. 84 of Medicare and You Handbook
•Outpatient prescription drugs•Shingles vaccination
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Applying for Medicare
Apply 3 months before age 65 Don’t have to be retired Contact the Social Security Administration
Enrollment automatic if you get Social Security or Railroad Retirement Benefits
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Medicare Part A
Most people don’t pay a monthly premium for Part A
People with less than 10 years of Medicare-covered work can still get Part A
For more information about Part A eligibility, call Social Security
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Enrolling in Medicare Part B
Initial Enrollment Period (IEP) – 7 months 7 months starting 3 months before month of eligibility
General Enrollment Period (GEP) January 1 – March 31; Coverage starts July 1
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Enrolling in Medicare Part B
Part B premium - $99.90 per month
Higher premiums if income > $85,000 per year Will depend if filing separately or joint Premium can be as high as $319.70/month Social Security determines premium by income tax
records
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Paying the Part B Premium
Taken out of monthly payments Social Security Railroad retirement Federal government retirement May be paid quarterly directly to CMS by check
For more information about premiums, call SSA, RRB or Office of Personnel Management
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Medicare Choices
Original Medicare Plan OR
Original Medicare plus Retiree Coverage Medicare Supplemental Insurance (Medigap) Income-based assistance programs OR
Medicare Advantage Plan
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Original Medicare PlanPart A + Part B only
Traditional way of getting Medicare through the federal government
Use any provider that accepts MedicareYou are responsible for
Part A - $1,156 hospital deductible (1-60 days) Additional costs (coinsurance) after 60 days
Part B $140 annual deductible 20% coinsurance or copayment for most Part B services
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Original Medicare Plan + Medigap
Health insurance sold by private companyUse any provider that accepts Medicare10 standard plans Cover “gaps” in Original Medicare plan
Deductibles, coinsurance, copaymentsMust pay monthly premium to the plan in
addition to your Part B premium ($99.90)
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Original Medicare Plan + Medigap
All Medigap plans include core benefits Hospital coinsurance 365 days full hospital coverage in addition to days
covered by Original Medicare 20% copayment on doctor’s services Cost of first 3 pints of blood each year
Plans may offer additional benefits
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Original Medicare Plan + Medigap
Monthly premiums vary according to planPlans are standardizedCosts are different between companiesMost popular plans are C, F, G & NYou have rights and protections
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Original Medicare Plan + Medigap
Prices of Medigap plans will vary Benefits the same, but pricing is not
Pricing Structure Attained age Issue age Community rated
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Medicare Prescription Drug Coverage
Coverage began January 1, 2006All people with Medicare can join a planProvided through
Medicare Prescription Drug Plans Medicare Advantage Plans
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Medicare Prescription Drug Plans
Must offer standard (minimum) drug benefit In 2012, you may pay:
Monthly premiums Annual Deductibles (no more than $320) Copayments or coinsurance Very little after $4,700 out-of pocket
May offer more benefitsCan get plan information and costs
www.medicare.gov 1-800-MEDICARE (1-800-633-4227) 1-877-801-0044 SHIP
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Medicare Drug Coverage Enrollment Periods
Initial Enrollment Period (IEP) 7 months starting 3 months before month eligible for
MedicareAnnual Coordinated Election Period (AEP)
October 15 through December 7 each year You can join, drop or switch coverage
Change is effective January 1 of the following year
Special Enrollment Period (SEP)
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Minimizing Part D Cost
Look at the total of these costs Monthly premium Annual deductible Monthly copays at pharmacy
Prescription Plan Finder Tool www.medicare.gov
Yourself State Health Insurance Assistance Program (SHIP) 1-800-MEDICARE (1-800-633-4227)
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Extra Help with Drug Costs
For many people with limited income and resources
Income limit $1,361/month (one person) or $1,839/month (married couple)
Resource limit $13,070 (one person) or $26,120 (married couple)
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Medicare Advantage Plans
Health insurance plans purchased from private companies
Part of the Medicare Program Sometimes called Part C
Private company administers your Part A & Part B benefits Not secondary coverage You haven’t “lost” your Medicare
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Medicare Advantage Plans
Get all Medicare covered services through plan
May include prescription drug coverageMay have to see certain doctors or go to
certain hospitals to receive careSome plans may include benefits that
Original Medicare does not Vision, dental, hearing
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Medicare Advantage Plans
Must continue to pay Part B premium
May pay additional monthly premium
Must pay other out-of-pocket costs
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Medicare Advantage Plans
Eligibility requirements
Live in plan service area Enrolled in Medicare Part A & B Most plans will not accept those with End Stage Renal
Disease (ESRD)
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Medicare Advantage Plans
Can join a Medicare Advantage Plan
When first eligible for Medicare
During specific enrollment periods Annual Enrollment Period
October 15-December 7 Special Enrollment Periods
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Medicare Advantage Plans
Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)Private Fee-for-Service (PFFS)Special Needs Plans (SNP)Medical Savings Accounts (MSA)
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Original Medicare Plan + Retiree Coverage
Retiree coverage is based on a former jobBased on your own or spouse’s employmentRetiree Coverage always secondary to
Medicare Current employer coverage not always secondary
Be careful about dropping this coverage You may not be able to get it back
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Original Medicare Plan + Retiree Coverage
Retiree coverage varies from one employer to another
Read coverage information carefully to see how it works with Medicare
Retiree benefits can change from year to year
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Original Medicare Plan + Other
CobraVATriCare
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Medicare Fraud and Abuse
Medicare fraud is purposely billing Medicare for services that were never provided
Billing Medicare for services you never got Billing Medicare for services that are different than
what you received Use of someone else’s Medicare card to get medical
care, supplies or equipment Billing Medicare for home medical equipment after it
has been returned
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For More Information
If you suspect fraud: Call SMP (Senior Medicare Patrol) at: 1-866-836-7677
www.medicare.govState Health Insurance Assistance Program
(SHIP) at: 1-877-801-00441-800-MEDICARE (1-800-633-4227)
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What are Your Next Steps?
More Research?Individual Appointments
Come to our Lifetime Learning Workshops for more detailed info. Registration will be from 1pm-2pm on August 7th at the Conference Center.
Department of Human Services Social Security Administration SHIP Counselor or volunteer Insurance agent
Enrollment – Part D, Medigap, MA Yourself Friend or relative SHIP
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Contact SHIP or SMP
Kristy Adams, SHIP Coordinator 1-877-801-0044 [email protected]
LaNelle Godsey, Statewide SMP Director 1-866-836-7677 [email protected]