most businesses couldn’t pass a dol audit – could yours? presenter october 29, 2015 2015...
TRANSCRIPT
Most Businesses Couldn’t Pass a DOL Audit – Could Yours?
Presenter
October 29, 2015
2015 Education Series
Julia Jennings, RHU, LIASylvia Group Vice President, Paradigm Employee Benefits
Medicare Enrollment for Individuals:Just What the Doctor Ordered
October 29, 2015
CREDIT: mainemedicareoptions.com
Medicare Basics
Medicare is health insurance for people who are:•age 65 or older.•under age 65, after having received SSDI for 24 months (or immediately if receiving SSDI due to ALS).•any age if diagnosed with end-stage renal disease (ESRD).
Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) and enrolled through the Social Security Administration (SSA) or Railroad Retirement Board.
October 29, 2015
Medicare Enrollment• Initial Enrollment Period is 3 months before your 65th birthday, the month
in which you turn 65, and the 3 months after you turn 65.• If you are covered under a group health plan based on current
employment, you have a Special Enrollment Period to sign up for Part A/B anytime, as long as you or your spouse are working and covered by a group health plan based on that work.
• You also have an 8-month Special Enrollment Period that starts the month after employment ends or the group health plan ends, whichever happens first. Note: COBRA is not considered current coverage.
• There is a General Enrollment Period if you do not sign up during the Initial or Special Enrollment period, from January 1-March 31 each year, with coverage commencing on July 1. You may be charged a higher premium if you are a late enrollee to Medicare.
October 29, 2015
Medicare Enrollment
October 29, 2015
Medicare Part A
Hospital Insurance• Automatic Enrollment and free for most• Covers inpatient hospital stays, skilled nursing facility care, hospice
and some home health care• Deductibles (2016)
• $1,260 for hospital stay of 1-60 days per benefit period• $315 per day for days 61-90 of hospital stay per benefit period• $630 per day for each “lifetime reserve day” to 60-day maximum• All costs for each day beyond lifetime reserve days• $157.50 per day co-insurance for days 21-100 of skilled nursing
care in a facility – all costs beyond 100 days
October 29, 2015
Medicare Part BOutpatient Medical Insurance
• You must enroll in Part B insurance and pay a premium* –individuals with higher earnings will pay a higher premium
• Covers an initial “Welcome to Medicare” wellness visit and annual wellness check-ups with your doctor, and certain preventive tests and treatments in full
• Deductible for 2016 is $147*; then the plan covers 80% for medically necessary outpatient services including doctor visits, diagnostic tests, physical therapy, etc.
• Does not cover items such as dental care, routine eye exams, and hearing aids
October 29, 2015
* New Medicare beneficiaries will pay a higher premium and have a higher Part B deductible in 2016 unless Congress passes legislation to maintain the current amounts.
Breaking News!!!
October 29, 2015
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Medicare Supplemental Insurance
Medigap• Supplemental insurance provided by private insurers to fill the “gaps”
in your Medicare Part A and Part B coverage.• There is no HMO/PPO network. Any Medicare provider is eligible.• Covers your Part A and Part B deductibles, copayments and
coinsurance for hospitalization and outpatient services.• Plans do not include outpatient prescription drug coverage. You must
purchase your Part D coverage separately.• Massachusetts only allows two supplemental plans – CORE and
Supplemental 1. (Other states have more choice in supplemental plans.)
October 29, 2015
Medicare Part CMedicare Advantage
• Replaces “Original Medicare” and is a managed health care program (either HMO or PPO type).
• Care is managed and claims are processed by private companies who receive compensation from the federal government.
• Although you “trade in” your Part A & B coverage, you still must enroll and pay for Part B. For some plans, “zero premium” means you pay only the Part B premium and no additional cost.
• Can include Part D prescription drug coverage as part of the plan (MAPD).
• No deductibles as seen in Original Medicare, but there are typically copayments for doctor visits, hospital stays, etc. Also covers more routine care as part of managed care emphasis
• Special enrollment/disenrollment rules apply.
October 29, 2015
Medicare Part D
October 29, 2015
Medicare Part DPrescription Drug Coverage
• Insurance for your prescription drugs. Can be a ‘standalone’ plan, or may be part of a Medicare Advantage Plan (MAPD).
• Though mandated by federal law, there is no federal Part D plan as we have with Parts A and B.
• Some plans have an initial deductible requiring you pay 100% of your prescription costs till the deductible is met. Maximum allowable deductible in 2016 is $360.
• Each plan has a list of eligible prescription drugs or formularies that can differ from one plan to another. Formulary determines what copayment, restrictions and pre-authorizations are required.
• Individuals with higher earnings pay an additional premium directly to Medicare for their prescription coverage.
October 29, 2015
Medicare Part D
October 29, 2015
CREDIT: www.q1medicare.com
Medicare Doesn’t Cover…
October 29, 2015
Open Enrollment for 2016
• Period is from October 15 to December 7, 2015.• Changes in Enrollment will be effective January 1, 2016.• You do not need to enroll annually if you are not making changes to your
Medicare coverage. However, this is a good time to review your options, especially if your medical providers or health status has changed
• If you are in a Medicare Advantage plan, are you spending time outside of the provider network (e.g. snowbirds)?
• You can search for Medicare supplemental plans, Medicare Advantage and Part D plans on the government website www.medicare.gov.
• Sylvia Group is your partner in selecting Medicare coverage for yourself, your family members, your employer group and your employees.
October 29, 2015
Thank you for attending our webinar. This presentation will be available shortly on our agency web site, www.sylviagroup.com.
Follow-up questions or assistance with your Medicare enrollment can be directed to me at [email protected].
Please note, our upcoming Medicare webinar for employers will take place on November 4 at 10 a.m. Register online: https://goo.gl/6IECQG
October 29, 2015
Julie Jennings