medicare open enrollment community meetingoct 11, 2017 · open enrollment •the doughnut hole is...
TRANSCRIPT
MedicareOpenEnrollmentCommunityMeeting
Presentationby:ChampaignCountyHealthCare
Consumers(CCHCC)
Welcome!
MedicareBasicsByClaudiaLennhoff
• Medicareisafederalhealthinsuranceprogramfor:– peopleage65andolder,
– peopleunderage65withcertaindisabilities(approvedbySocialSecurity),
– andpeopleofanyagewithend-stagerenaldisease.
• YoupayintoMedicarewhileyouworkthroughyourpayroll(FICA)taxes.
WhatisMedicare?
• TheMedicarehealthinsurancecardisthered,whiteandbluecard.
• TherearedifferentcoveragepartstoMedicare.
• BetweenApril2018&2019,Medicarewillbemailingnewcardstoeverybeneficiary.
TheMedicareCard
• PartA:Hospitalinsurance
• PartB:MedicalInsurance
• PartD:PrescriptionDrugPlan(PDP)
We’lltalkaboutPartClater!
MedicareParts
• Free(nopremium)formostpeoplewhoqualifiedbasedondisability,haveworkedandpaidintoMedicareforatleast40quarters,orare/weremarriedtosomeonewhoqualifies.
• IfyoudonotqualifyforfreeMedicarePartA,therearewaystopayin,aswell.
MedicarePartA:HospitalInsurance
• OriginalMedicarePartAhasadeductibleof$1,316(in2017)perhospitalization.
• Covers:– in-hospital(overnight)care,
– skillednursingfacility(SNF)care,
– hospicecare,
– andsomehomehealthcare.
MedicarePartA:HospitalInsurance
• Typicallycosts$134.00permonth,andwillbedeductedfromyourSocialSecuritybenefitseachmonthundermostcircumstances.
• OriginalMedicarePartBhasanannualdeductibleof$183 (in2017).
• ThereisapenaltyifyoudonotsignupforPartBwhenyoubecomeeligibleandifyoudonothaveother“creditable”coverage.
MedicarePartB:MedicalInsurance
• Coversdoctors’services,outpatienthospitalcare,emergencyroomvisits,ambulances,bloodandlabwork,durablemedicalequipment,diabetestestingsupplies,somehomehealthcare,andcoveredpreventiveservices.
• Thisisreallythebulkofyourcoverage!
MedicarePartB:MedicalInsurance
WhatMedicareDoesNotCover
• Vision• Coverscataractsurgeries,andglassesin
betweensurgeries;doesnotcoverglassesorcontactlensesinmostsituations.
• Dental• Hearingaids• Long-TermCare/CustodialCare
• EnrollinginMedicarePartsA&BisthroughtheSocialSecurityAdministration.
• YouwillbeautomaticallyenrolledifyouaredrawingSSAretirementbenefitsorafteryouhavebeenreceivingSSDIdisabilitypaymentsfor24months.
• SocialSecuritywillsendyourMedicarecardinthemail.
MedicarePartA&BEnrollment
• IfyouarenottakingyourSocialSecuritybenefits,youneedtoactivelysignupforMedicarethroughSocialSecurity.
• YourInitialEnrollmentPeriod(IEP)is:– 3monthsbeforeyouturn65
– Themonthofyour65th birthday
– 3monthsafteryouturn65
SigningUpforMedicare
• Ifyoudonothaveinsurance.
• IfyouhaveMedicaid,orhaveaMarketplaceplan,youdo needtoenrollduringyourIEP.
• Adaniisgoingtotalkmoreaboutthistransitioninthenextpresentation.
WhoNeedstoEnrollDuringTheirMedicareIEP?
• IfyoumissyourInitialEnrollmentPeriodanddonothaveaSpecialEnrollment(duetolossofcoverage,etc.),youcanenrollduringtheGeneralEnrollmentPeriod.– January1toMarch31ofeachyearforcoveragestartingJuly1ofthatyear.
GeneralEnrollmentPeriod
• Medicare-approvedprivateinsurancecompaniesofferplanswithvaryingpremiums.
• Helpscoverthecostofprescriptiondrugs.
• Eachplanhasdifferentformulariesandtiers(listofmedicationsthattheyhelpcover)anddifferentpharmacynetworks.
PartD:PrescriptionCoverage
• ThereisapenaltyifyoudonotsignupforPartDwhenyoubecomeeligibleanddonothaveothercreditablecoverage.
• EnrollmentisthroughMedicare,duringyourIEP,whenyoulosecreditablecoverage,aswellastheAnnualOpenEnrollmentPeriod.
PartD:PrescriptionCoverage
CoverageOptions:AdvantagePlansandSupplements
• It’simportantthatyouhavesomeformofhospital,medical,andprescriptioncoveragetoaccessthecareyoumayneed,andtoavoidpenaltieslateron.
• Youhaveoptions!Youcansetupyourcoverageindifferentwaysthatbestmeetyourfinancialandhealthneeds.
CoverageOptions
CoverageOptions
• PartCgivesyoutheoptiontohaveprivatecoverageforyourMedicarebenefitsthroughMedicareAdvantageplans,whichareofferedbyprivateinsurancecompaniesthathaveacontractwithMedicare.
PartC:AdvantagePlans
• WhenyouenrollinanAdvantageplan,theinsurertakescareofyourPartAandPartBbenefits,andtypicallyPartDaswell.
• Advantageplansmayofferadditionalbenefits,notcoveredbyoriginalMedicare,includingsomehearing,vision,and/ordentalbenefits.
PartC:AdvantagePlans
• SupplementorMedigap policiescoverwhatMedicarecoversandgowhereMedicaregoes.
• Theyhelpreducethe20%co-insuranceanddeductibles.
• Theydonotincludeprescriptioncoverage(PartDplan).
Supplement(Medigap)Plans
• SupplementpoliciesareorganizedandsoldbyPlanlevels.ThisishelpfulincomparingplansbecauseaPlanFpolicyfromonecompanyisthesameasaPlanFpolicyfromanothercompany.
• Somecompaniesdonotsellpoliciesatalllevels,buttheymustofferatleastaPlanApolicy.WhilePlanFpoliciestendtobethemostexpensive,PlanFpoliciesalsoprovidethemostcoverage.Seehandoutforchart!
SupplementPolicyLevels
• TheSupplement/Medigap OpenEnrollmentPeriodisaone-timesix-monthperiodwhenaMedicarebeneficiaryfirstenrollsinMedicarePartB.
• Aslongasyouapplyduringthisperiod,youcannotbeturneddownforcoverage(guaranteedissue),regardlessofhealthstatus,claims,ormedicalcondition(s).
SupplementPolicyEnrollment
• Policiesmustbesoldguaranteedrenewable.Theycannotbecancelledduetoincreasingageorchangeinhealth.Theycan,however,becancelledduetolatepaymentorfalsestatementsmadeontheinitialapplication.
• Withthesepolicies,thegoalistogetaplanandstickwithit.Youarenotswitchingtheseplanseveryyear.Afteryourinitialenrollment,therearen’tannualenrollmentperiods.
SupplementPolicyRights
• IfyouarereceivingMedicareduetodisability,youwillpaythehighestpremiumallowedbeforeage65.Whenyouturn65,youhaveasecondopenenrollmentopportunitytoseekoutandreceivethesamepremiumratechargedtopeopleatage65.
SupplementPolicyRights
ComparingSupplements&AdvantagePlans
Supplements AdvantagePlans• SupplementsOriginalMedicare • ReplacesOriginalMedicare
• Samebenefitsacrosscompanies • Benefitsvary
• Generallynonetworklimitations • Generallyhasanetwork
• Medicarepaysfirst,thensupplement,andthenyoupayanyremainingcosts
• OnlycoversexpensescoveredbyMedicare
• Planpays,andthenyoupayremainingco-paysorco-insurances
• Cancoveradditionalservices,includingvision,hearinganddental
• Tendtobemoreexpensive • Tendtobelessexpensive
• Ageandtobaccorating • Noageortobaccoratings
• Mayhavemedicalunderwriting • Nomedicalunderwriting
• WhenyoufirstqualifyforMedicare,duetoturning65,andjoinaMedicareAdvantageplan,youhaveatrialperiod.YoucandropthatAdvantageplanwithinthefirst12monthsandgetaMedicareSupplementwithguaranteedissueandwithnopre-existingwaitperiod.
TrialOptions:AdvantagePlans
• WhenyoufirstpurchaseaSupplementpolicy,youhaveafree-lookperiodof30days.Duringthattime,youcancancelyourpolicyandyouwillberefundedyourfullpremium.
Youcan’thavebothaSupplementandanAdvantageplan.
TrialOptions:Supplements
MedicareAnnualOpenEnrollmentByAdaniSanchez
October15– December7
OpenEnrollment
• October15– December7ofeachyear,forplansforthenextcalendaryear.
• ForAdvantageandPartDprescriptionplans(notSupplementpolicies).
• IfyouhaveExtraHelporfullMedicaid,youcanswitchthroughouttheyear,soyouhavemoreflexibility.
OpenEnrollment
OpenEnrollment
• 2018PartDplans– 24plansavailable
– Premiumsrangefrom$17to$181permonth
– Deductibleis$400formostplans
– Lookatmorethanthepremium:howdoestheplancoveryourmedications?
• CoverageLevels(whatyoupay)1. Deductible
2. Initialcoverage
3. Coveragegap(akathedoughnuthole)
4. Catastrophiccoverage
2018PartDPrescriptionPlans
OpenEnrollment
• Thedoughnutholeisacoveragegapthatsomebeneficiariesencounterduringtheyearoncetheyreach$3,700 (in2017)intotaldrugcosts(betweenwhattheyandtheplanpay).
• Itendswhentheyreach$4,950 (in2017).
• Thecostyoupayduringthecoveragegapiscappedatapercentageofwhattheplanpaysforthatdrug.
• Thedoughnutholeisbeingphasedoutsoitisgettingsmallereachyear,until2020,whenitwillgoaway!
TheDoughnutHole
OpenEnrollment• Thereare11plansofferedfrom3differentcompanies
• Thepremiumsrangefrom$0to$157permonth
• Thingstoconsider:– Doesitcoveryourdoctorsandhospitals?
– Howdoesitcovertheservicesyouuseregularly?
– Doesitcoveryourmedications?
– Lookatmorethanjustthepremiumeachmonth
2018AdvantagePlans
GettingReady&Tips
• ReadyourAnnualNoticeofChanges(ANOC)fromyourcurrentplantoseeaboutplanchangeslikepremiums.• ReviewnoticesfromSocialSecurityandMedicaresentoutinthefallregardingeligibilityfordifferentprograms.• Checkyourplan! Evenifyouloveit,checkit.ThenetworksandcoveredmedicationsCANandDOchangeeveryyear.
HowToReview&SwitchPlans
1. Onlineatwww.medicare.gov• Clickonthisbutton
2. Byphonebycalling1(800)MEDICARE3. InpersonwithaSHIPCounselor
WhatYouNeedforOpenEnrollment
• Whenreviewingyouroptions,youneed:– yourMedicarecard,
– yourlistofdoctors(namesandphonenumbers),
– andyourlistofmedications(Irecommendusingyourpillbottles).
• Ifyouneedhelp,setupanappointmentforin-personassistancewithaSHIPcounselor.
LocalSHIPSites
ChampaignCountyRegionalPlanningCommission(217)819-4097
FamilyServicesSeniorResourceCenter(217)352-5100
PresenceCenterforHealth(nowinsidePresencehospitalatCRC):(217)337-2022
• CompaniesthatsellMedicareAdvantageandPartDplansmustfollowcertainruleswhenpromotingtheirproducts.
• Companiescanmarkettheirplanthroughdirectmailandradio,televisionandprintadvertisements.
• Agentscanevenvisityourhomeundercertaincircumstances,butonlyifyouhaveinvitedthem.
AdvertisingofMedicarePlans
• Somethingsplanscannotdo:– Callyouifyoudidnotaskthemtodoso.
– Sendyouunsolicitede-mails.
– Askforfinancialorpersonalinfoiftheycallyou.
–Markettheirplansateducationaleventsorinhealthcaresettings(exceptincommonareas).
– Comparetheirplantoanotherplansbynameinadvertisingmaterials;
WhatPlansCannotDo
• Somethingsplanscannotdo:– Sellyoulifeinsuranceorothernon-healthrelatedproductsatthesameappointment.Thisiscalledcrosssellinganditisprohibitedunlessyourequestthenon-healthrelatedproductinformation.
– ImplythattheyarecallingonbehalfofMedicare.PlansarenotallowedtogiveyoutheimpressionthatMedicareaskedthemtocallyou.
WhatPlansCannotDo(continued)
TransitioningtoMedicare
• Ifyouhaveemployercoverage,talktoyouremployertofindoutwhatyouneedtodo.SometimesyouneedtosignupforMedicare.
• Youremployercantellyouifyouneedto,andifitwillbeyourprimaryorsecondaryinsurance.
• Makesurethatitiscreditablecoverage!
MedicareandEmployerCoverage
• Typically,iftheemployerhaslessthan20employees,youdo needtosignupforMedicareA&Banditisprimary.
• Afteryoustopworkingoryouremployergroupcoverageends(whicheverisfirst),youhave8monthstosignupforMedicarewithoutpenalty.
MedicareandEmployerCoverage
• Ifyouhaveretireeinsurance,itisimportanttotalktoyourbenefitscoordinatortofindoutwhatyouneedtodoandwhatisoffered.
• Theymayoftenhavedifferentplanoptionsthanwhatwewillbediscussingtoday.
MedicareandRetireeCoverage
• Also,beawarethatifyouchooseanAdvantageplanorsupplementthatisnotpartofyourretireebenefitpackage,youmayjeopardizebenefitsyouarereceivingincludinghealthcoverageorpension/annuitypayments.
• Onceyouoptoutoftheirbenefits,yourarelycangetbackin.
MedicareandRetireeCoverage
• IfyouhaveTRICAREforLife(TFL),youneedMedicarePartsAandB,butrarelyneedadditionalcoverage.ForquestionsregardingTFL,pleasecontact1(866)773-0404.
• IfyouhaveVAbenefits,itcountsascreditableprescriptioncoverage.YouwantMedicaresothatyouarecoveredatnon-VAfacilities.ForquestionsregardingVAbenefits,pleasecall1(877)222-8387.
MedicareandTRICARE/VA
• Youmust terminateyourMarketplacecoveragewhenstartingMedicare.
• CoveragecanbeterminatedonlineatHealthcare.gov orbyphoneat1-800-318-2596.
• Youcanterminateyourplanasearlyas60daysbeforeyourMedicarestarts.
• Ittakes14days,sodonotwaituntilthelastminute.
MarketplacetoMedicare
• YoucanhavebothMedicaidandMedicare,but therequirementschange.– Incomehastobeat100%ofthefederalpovertylevel– Assetsarenowconsideredwhenreviewingeligibility.
MedicaidtoMedicare
DualMedicare+MedicaidRequirementsMonthlyIncome Assets
$1005(1person) $2000
$1354(2people) $3000
• MedicaidwouldbesecondaryandcoverthingsthatMedicaredoesnot,likevisionanddental.• IfyouhavebothMedicareandMedicaid,youstillneedtohaveaPartDplanforprescriptioncoverage.• IfyouqualifyforMedicaid,youdon’treallyneedasupplementoradvantageplan.
MedicaidtoMedicare
Resources:MakingYourMedicareWork
ByChrisGarcia
• MedicareSummaryNotices(MSN)– IfyouhaveoriginalMedicare,keepyourMSNs.TheywilltellyouifaservicewasnotcoveredbyMedicare.ThiswillbeanExplanationofBenefits(EOB)fromanAdvantageplan.
• Appeals&Grievances– IfyouhaveoriginalMedicare:appealthroughMedicare.ForPartDandAdvantageplans:startwithplan’sinternalappealprocess.
KnowYourRights
AssistancePrograms
• PrescriptionAssistance– assistancewithcopaymentwhilesearchingfor
longtermsolution
• DentalReferralProgram– Discountprogramwithparticipatinglocaldentist
• OneSightVisionProgram– Examandglassesfreeoratlowcostatlocal
provider
MedicareSavingsProgram
• MedicareSavingsProgram– tohelpwithPartBpremiumsandMedicareco-
insurances– administeredthroughtheIllinoisDept.ofHuman
Services(abe.illinois.gov)– CCHCCstaffcanprovideinformationoneligibility
andassistwithapplication
ExtraHelpforPartD
• ExtraHelpisanincomeandassetbasedprogramtohelpwithprescriptioncosts,administeredbySocialSecurityAdministration.
• IfyouqualifyforfullExtraHelp,youcanget– $0premium(free!)plans;– Withnodeductible;– Andnodoughnuthole.
Grabahandoutfromourtableformoreinfo!
HospitalFinancialAssistance
• CarleFinancialAssistanceProgram(CommunityCare)– mayreceiveadiscountofupto100%
• Medicare100/PlusDiscountProgramforPresencehospital– memberscanpre-qualifyforadiscountofupto100%off
theirout-of-pocketmedicalcostsatparticipatingPresenceproviders
• CCHCCstaffcanhelpwithcompletingapplications
OtherCCHCCServices
• RedeterminationwithDHS• ChangeofaddresswithDHS• ReportincomechangestoDHS• SNAPbenefits• TerminationofMarketplaceplans• PrescriptionAssistance• Safelink phones• AndMORE!!!
ThankYou!
ChampaignCountyHealthCareConsumers(CCHCC)
(217)352-6533healthcareconsumers.org
facebook.com/healthcareconsumerstwitter.com/cchcc1977