medicare & university of iowa retiree benefits · cost of enrolling in medicare part b people...
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Medicare & University of Iowa Retiree Benefits
Presentation of Iowa City/Johnson County
Senior Center SHIIP Program
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What Is SHIIP?
• Objective Information Source
• Part of the State of Iowa Insurance Division
• Answers questions and provides assistance
• Doesn’t recommend or endorse specific companies, products or agents
• Free & Confidential
Senior Health Insurance Information Program
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What Will We Cover?
What should I do? High level overview of Medicare How can a SHIIP counselor help?
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What Should An Employee Do?
See your University Benefits Representative
Enroll in Medicare Parts A and B Understand options inside and
outside the University system and choose one
I’m Turning 65 and Retiring:
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What Should An Employee Do?
See your University Benefits Representative
Contact Social Security to verify Medicare A & B enrollment requirements
Visit the Social Security Administration Coralville Office
Do Nothing Further Or Enroll in Part A (no penalty for waiting if
you have 40 quarters)
I’m Turning 65, but will Continue to Work:
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What Should An Employee Do?
See your University Benefits Representative
Contact Social Security to verify Medicare A & B enrollment requirements
If your spouse can cover you on his or her policy, evaluate that coverage against one of your other options
Remember: If you leave the University system, you can’t come back!
I’m Turning 65 and Retiring, but My Spouse will Continue to Work:
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What Should An Employee Do?
See your University Benefits Representative
Enroll in Medicare Part B, and Part A if not previously done
Choose one of the 3 sets of options available
Enroll in the appropriate plan(s)
I Have Continued to Work Past 65, My Spouse has Retired, Now I Plan to Retire:
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MEDICARE - Who Is Eligible?
Must be a U.S. citizen or permanent resident for 5 years
MEDICARE
Age 65and older Disability ALS
End-Stage Renal
Disease
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Your Medicare Coverage Choices
Original Medicare Medicare AdvantagePart C
Part A Hospital InsurancePart B Medical Insurance
Supplemental Coverage
Prescription Drug Coverage – Part D
Combines Part A & Part B
May include Prescription Drug Coverage – Part D
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Medicare Part A
Home Health Care
Hospital Insurance
SkilledNursing Facility
Inpatient Hospital Hospice
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Part A Inpatient - What You Pay
Days 1-60 Days 61-90 60 Lifetime Reserve Days You
pay all costs
Deductible $1,364
Daily Coinsurance
$341
Daily Coinsurance
$682
Renewable Days
Renewable days
Each day available only
once
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Skilled Nursing Facility Care - What You Pay
Requirements:• 3-day inpatient hospital stay• Need daily skilled care• Use a Medicare-certified skilled nursing facility (SNF)
Days 1-20
Days 21-100
You pay
all costs
Medicare pays 100%
Daily Coinsurance
$170.50
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Home Health Care – What You Pay
Covered Services – no cost• Part-time skilled nursing care• Therapy—occupational, physical,
speech-language• Some home health aid services
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Hospice Services –What You Pay
• You pay nothing for hospice care from a Medicare-certified Hospice provider.
• You may pay part of the cost of medications and respite care
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Part A Premium
• Free for those who have paid into Social Security for 40 quarters
• $232/month in 2019 for those who have paid into Social Security for 30-39 quarters
• $422/month in 2019 for those who have paid into Social Security less than 30 quarters
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Medicare Part B
OtherServices &Supplies
DoctorServices
OutpatientHospital & Emergency
Room
Home Health Care
Medical Insurance
DurableMedical
Equipment
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Medicare Part B - Payments For Services
You pay $185 annual deductible in 2019.
Medicare pays 80%.
You pay 20%.
You may pay excess of 15% (or more for equipment).
Approved Amount
No annual or lifetime limit
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Medicare Part B - Claims
If provider accepts “assignment”• Agree to accept Medicare’s “approved” amount as full payment• You only pay deductibles & coinsurance• Medicare sends its payment directly to the provider
If provider does not accept “assignment”• May charge up to 15% more than the “approved” amount• May ask you to pay entire charge at time of service• Medicare sends its payment to you and you pay the provider
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Cost Of Enrolling In Medicare Part B
People new to Medicare in 2019 pay $135.50 per month for Part B. People with higher incomes pay more if their income is above: • $85,000 individual • $170,000 couple filing joint return
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Original Medicare Medicare AdvantagePart C
Part A Hospital InsurancePart B Medical Insurance
Prescription Drug Coverage – Part D
Combines Part A & Part B
May include Prescription Drug Coverage – Part D
Supplemental coverage
Same Options Available to Everyone
Options for University Employees
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Options For Filling Medicare’s Gaps
• Medicare Supplement insurance• Retiree health plan from employer• Medicare Savings Program – QMB• Medicaid• TRICARE/TRICARE for Life• Indian Health Services/tribal medical benefits
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Medicare Supplement Insurance
• Health insurance policies sold by private insurance companies
• Also called “Medigap”• Cover “gaps” in Original Medicare Plan • 10 standardized policies • Plans A, B, C, D, F, G, K, L, M, N• Guaranteed renewable
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Standard Plans -- 10 Benefit Packages
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Medicare Supplement Plans – Cost
• Iowa Medicare Supplement & Premium Comparison Guide
• 2019 projected costs at age 65:
• Plan A – From $869 per year• Plan F – From $1,530 • Plan G – From $1,157• Plan N – From $956
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Guaranteed Access - Open Enrollment
• Available at age 65 or older
• Triggered when Medicare Part B starts
• Lasts six months from Part B effective date
• Can’t be turned down
• Pay “preferred” premium
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Starting in 2020 “Newly eligible” beneficiaries will be required to pay out-of-pocket for the Medicare Part B deductible. Cannot purchase Plan C or F
“Newly eligible” is anyone who on or after January 1, 2020: Attains age 65 OR Becomes eligible for Medicare due to age, disability or
ESRD
Medicare Supplement InsuranceChanges Coming in 2020
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1. Plan C and F will go away in 2020
2. You must get rid of your C or F plan3. Premiums will sky rocket out of
control
2020 Medicare Supplement Myths
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Prescription Drug Coverage Choices
Original Medicare Medicare AdvantagePart C
Part A Hospital InsurancePart B Medical Insurance
Supplemental coverage
Combines Part A & Part B
May include Prescription Drug Coverage – Part D
Prescription Drug Coverage – Part D
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Medicare Part D
Available for all people with Medicare • Enrolled in Part A and/or Part B• Includes those on Medicare due to
disability, ALS or ESRD
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Part D PremiumsEach plan has a monthly premium, set by the
individual plan.• Premium can change from year to year • 2019: $15.00 to $94.30
Some people receive assistance paying the premium.
Some people pay more than the plan’s usual monthly premium if their income is above:
$85,000 individual$170,000 couple filing a joint return
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Comparing Part D Plans
• Premium
• Deductible
• Formulary – the drugs that are covered
• Restrictions on your medications
• Out of pocket costs at pharmacy
• Coverage in the Gap
• Pharmacy network (national availability?)
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Creditable Coverage Notice
Individuals receiving their prescription drug coverage from an employer, retiree or pre-standard Medicare supplement plan will receive a notice by October 15 each year telling them if their coverage is “as good as or better than Medicare coverage”.
Keep this notice.
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What Is “Creditable Coverage”?
Drug coverage that is as good as or better than a Medicare prescription drug plan
Includes: • VA drug benefits• Tricare for Life• Some employer or retiree coverage • Indian Health Services
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What Is The Late Enrollment Penalty?
• Assessed 1% of base premium* for every month you were eligible to enroll in Medicare’s prescription drug coverage and did not enroll
• Pay penalty for life
Example: Did not enroll in 2006-your penalty would be 151 months X 1% or 151% X $33.19 or $50.12 per month in penalty
* $33.19 in 2019
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Open Enrollment Period
Can choose new planMedicare Advantage PlanMedicare Prescription Drug PlanOriginal Medicare
New plan starts January 1
October 15 – December 7
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Your Medicare Coverage Choices
Original Medicare Medicare AdvantagePart C
Part A Hospital InsurancePart B Medical Insurance
Supplemental coverage
Prescription Drug Coverage – Part D
Combines Part A & Part B
May include Prescription Drug Coverage – Part D
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Medicare Advantage - A Private Solution
• Medicare contracts with a private company on an annual basis.
• Contracts require that plans provide Medicare Part A & B services; they usually include Part D, Drugs.
• The plan handles claims. • You receive services and make payments based
on the private plan’s rules. • The plan may offer extra coverages – dental,
vision, health club membership
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Medicare Advantage - Eligibility
Have Medicare Parts A & B Do not have end-stage renal disease Live in service area (county-specific) Covers people on Medicare because of disability
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Medicare Advantage - Types of Plans
• HMO-Health Maintenance Organization
• PPO-Preferred Provider Organization
• Private Fee-For-Service
• Cost Plan
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Medicare Advantage - Out-of-Pocket Costs
• Must still pay Part B premium
• May pay additional monthly premium
• Pay other out-of-pocket costs• Different from Original Medicare Plan• Vary from plan to plan
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Questions to Ask About MA Plans• Do I live in the service area for the plan?
• Will my doctors, hospital and other medical providers accept payment from the MA plan?
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Questions to Ask About MA Plans
• What is the monthly premium?
• What is the annual out-of-pocket maximum for medical expenses?
• What are the deductibles, co-payments or coinsurance for the benefits I’m most likely to use?
• Does the plan include prescription drug coverage
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Plan Finder
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Three University Options
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Contacting SHIIP
Statewide: 1-800-351-4664(TTY 1-800-735-2942)
Website: www.therightcalliowa.gov
E-mail: [email protected]
Local: Iowa City Senior Center, 319-356-5220Mercy Iowa City, 319-339-3658
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Protect Yourself & Medicare
PROTECT– Protect your personal information. Treat your Medicare and Social Security numbers like your credit cards. Never give these numbers to a stranger.
DETECT-- Review your Medicare statements for mistakes by comparing them to your personal records.
REPORT--If you think you have been a target of fraud, report it
800-351-4664 or your local SHIIP