Medicare 101 Module 1 B Medicare 101 n

Medicare 101 Module 1 B

Medicare 101 n Introduction to Medicare n Original Medicare Plan n Medicare Supplement Insurance (Medigap) n Medicare Advantage and other Medicare plans n Medicare prescription drug coverage n Medicaid and Medicare Savings Programs 06 -07 -07 2

Introduction What Is Medicare? n A health insurance program for People 65 years of age and older People under age 65 with certain disabilities People with End-Stage Renal Disease (ESRD) n Administered by Centers for Medicare & Medicaid Services (CMS) n Enrollment by Social Security Administration (SSA) or Railroad Retirement Board (RRB) 06 -07 -07 3

Introduction Applying for Medicare n Apply 3 months before age 65 Don’t have to be retired Contact the Social Security Administration n Enrollment automatic if receiving Social Security or Railroad Retirement benefits 06 -07 -07 4

Introduction Medicare Basics Part A Hospital Insurance Part B Medical Insurance Prescription Drug Coverage (Part D) 06 -07 -07 5

Introduction Medicare Coverage Basics Part A Part B Part D 06 -07 -07 n n Inpatient hospital care Skilled nursing care Home health care Hospice care n n n Doctors’ services and outpatient care Preventive services Diagnostic tests Some therapies Durable medical equipment Outpatient prescription drugs 6

Introduction Medicare Part A n Most people receive Part A premium free n People with less than 10 years of Medicarecovered employment Can still get Part A • Will pay a premium n For information about Part A entitlement Call SSA • 1 -800 -772 -1213 • TTY users call 1 -800 -325 -0778 06 -07 -07 7

Introduction Enrolling in Medicare Part B n Pay monthly Part B premium $93. 50 in 2007 n Initial Enrollment Period (IEP) 7 months starting 3 months before month of eligibility n General Enrollment Period (GEP) January 1 through March 31 each year Coverage effective July 1 Premium penalty • 10% for each 12 -month period eligible but not enrolled • Paid for as long as the person has Part B • Limited exceptions 06 -07 -07 8

Introduction Enrolling in Medicare Part B n Some people can delay enrolling in Part B with no penalty If covered under employer or union group health plan • Based on current employment – Person or spouse • Will get a Special Enrollment Period (SEP) – Sign up within 8 months after coverage ends 06 -07 -07 9

Introduction Part B Enrollment Periods Example n Marie turned 65 on June 25, 2007. She will have group health coverage from her employer until she stops working on December 31, 2007. n Part B enrollment opportunities … Enrollment period Begins Ends IEP 3/1/07 9/30/07 SEP 10/1/07 8/31/08 1/1 3/31 GEP (each year) 06 -07 -07 10

Introduction Paying the Part B Premium n Taken out of monthly payments Social Security Railroad retirement Federal government retirement n For information about premiums Call SSA, RRB, or Office of Personnel Management n If no monthly payments Billed every 3 months Medicare Easy Pay 06 -07 -07 11

Introduction Medicare Choices n Original Medicare Plan n Medicare Advantage Plans n Other Medicare Plans n Medicare Prescription Drug Plans 06 -07 -07 12

Original Medicare Plan n Go to any health care provider that accepts Medicare n People are responsible for Part A • $992 deductible in 2007 for hospital stays up to 60 days – Additional costs after 60 days • Different costs for other Part A services Part B • $131 annual deductible in 2007 • 20% coinsurance or copayment for most Part B services n Some programs may help with costs 06 -07 -07 13

Original Medicare The Medicare Card Jane Doe 06 -07 -07 14

Medigap n Health insurance policy Sold by private insurance companies Must say “Medicare Supplement Insurance” Covers “gaps” in the Original Medicare Plan • Deductibles, coinsurance, copayments • Does not work with Medicare Advantage Plans Up to 12 standardized plans A – L • Except in Massachusetts, Minnesota, Wisconsin • So people can compare easily 06 -07 -07 15

Medigap How Medigap Works n People can buy a Medigap policy Within 6 months of enrolling in Part B • Must be age 65 or older If they lose certain kinds of health coverage • Through no fault of their own If they leave MA Plan under certain circumstances Whenever the company will sell them one n Monthly premium n Generally go to any doctor or specialist 06 -07 -07 16

Medicare Advantage and Other Medicare Plans Medicare Advantage Plans n Health Maintenance Organization (HMO) Plans Some have Point-of-Service option n Preferred Provider Organization (PPO) Plans Regional PPOs new in 2006 n Private Fee-for-Service (PFFS) Plans n Special Needs Plans n Medicare Medical Savings Account (MSA) Plans New in 2007 06 -07 -07 17

Medicare Advantage and Other Medicare Plans n Medicare Cost Plans n Demonstrations/Pilot Programs n Programs of All-inclusive Care for the Elderly (PACE) 06 -07 -07 18

Medicare Advantage and Other Medicare Plans Eligibility for MA Plans n Live in plan’s service area n Entitled to Medicare Part A n Enrolled in Medicare Part B Continue to pay Part B premium May also pay monthly premium to plan n Don’t have ESRD at enrollment Some exceptions 06 -07 -07 19

Medicare Advantage and Other Medicare Plans How MA Plans Work n Usually get all Part A and B services through plan May have to use providers in plan’s network Generally must still pay Part B premium • Some plans may pay all or part n May get extra benefits Vision, hearing, dental services Prescription drug coverage n Still in Medicare program Get all Part A and Part B services Have Medicare rights and protections 06 -07 -07 20

Medicare Drug Coverage Medicare Prescription Drug Coverage n Coverage began January 1, 2006 n Available to all people with Medicare n Provided through Medicare Prescription Drug Plans Medicare Advantage and other Medicare plans Some employers and unions 06 -07 -07 21

Medicare Drug Coverage Enrollment Periods n Initial Enrollment Period (IEP) 7 months Starts 3 months before month of eligibility n Annual Coordinated Election Period (AEP) November 15 through December 31 each year Can join, drop, or switch coverage • Effective January 1 of following year n Special Enrollment Period (SEP) 06 -07 -07 22

Medicare Drug Coverage Late Enrollment n People who wait to enroll may penalty Additional 1% of national base premium for every month eligible but not enrolled Must pay the penalty as long as enrolled in a Medicare drug plan n Unless they have other coverage at least as good as Medicare drug coverage “Creditable coverage” 06 -07 -07 23

Medicare Drug Coverage Prescription Drug Plans n At a minimum, must offer standard benefit In 2007 members may pay • • Monthly premiums Annual deductible, no more than $265 Copayments or coinsurance Very little after $3, 850 out-of-pocket n May offer supplemental benefits n Plan information and costs available www. medicare. gov 1 -800 -MEDICARE (1 -800 -633 -4227) 06 -07 -07 24

Medicare Drug Coverage Extra Help With Drug Costs n Available for many people with limited income and resources Income limit in 2007 • $1, 276/month individual) • $1, 711/month (married couple) Resource limit • $11, 710 (individual) • $23, 410 (married couple) 06 -07 -07 25

Medicare Drug Coverage Extra Help With Drug Costs n People with lowest income and resources Pay no premiums or deductibles Have small or no copayments n Those with slightly higher income and resources Pay no or a reduced premium Have a reduced deductible Pay a little more out of pocket 06 -07 -07 26

Medicare Drug Coverage Eligibility for Extra Help n Some people may automatically qualify People with Medicare who • Get full Medicaid benefits • Get Supplemental Security Income (SSI) • Get help from Medicaid paying Medicare premiums n Others must apply and qualify 06 -07 -07 27

Medicaid and Medicare Savings Programs Medicaid n Joint Federal and state program For some people with limited income and resources n If eligible, most health care costs covered n Eligibility determined by state n Application processes vary n Office names vary Social Services Public Assistance Human Services 06 -07 -07 28

Medicaid and Medicare Savings Programs Other Savings Programs n Medicare Savings Programs Help from Medicaid paying Medicare expenses For people with limited income and resources May also pay deductibles and coinsurance n State-specific programs n PACE 06 -07 -07 29

For More Information n 1 -800 -MEDICARE (1 -800 -633 -4227) TTY users call 1 -877 -486 -2048 n www. medicare. gov n www. cms. hhs. gov n State Health Insurance Assistance Program (SHIP) n Medicare & You handbook Other publications 06 -07 -07 30

Summary n Medicare coverage n Original Medicare Plan n Medicare Supplement Insurance (Medigap) n Medicare Advantage and other Medicare plans n Medicare prescription drug coverage n Medicaid and Medicare Savings Programs 06 -07 -07 31

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