Medicare Basics Initial Enrollment 1 What is Medicare

Medicare Basics Initial Enrollment 1

What is Medicare? • Health insurance for people – 65 and older, actively working or retired – Under 65 with certain disabilities – Any age with End-Stage Renal Disease (ESRD) • It is Administered by – Centers for Medicare & Medicaid Services (CMS) • Enrollment is done by – Social Security Administration (SSA) for most 2

Enrolling in Medicare • Automatic for those receiving – Social Security benefits • Initial Enrollment Period Package – Mailed by CMS 3 months before citizens turn 65 • For all others—Enroll – Local SS office OR – On-line at www. ssa. gov 3

Your Initial Enrollment Period-7 months 3 months before age 65 3 months to 1 month before you turn 65 The month you turn 65 and up to 3 months after Your birthday month 3 months after your 65 th birthday Sign up early to ensure coverage in the month you turn 65 Waiting could delay your Original Medicare start date 4

The Four Parts of Medicare Part A Hospital Insurance (federal government) Part B Medical Insurance (federal government) Part C Medicare Advantage Plans. Includes Part A & B and sometimes Part D coverage (private Medicare approved insurers) Part D Medicare Prescription Drug Coverage (private Medicare approved insurers) 5

Original Medicare = Parts A & B • Part A – Hospital Insurance (in-patient) – – Hospital Skilled Nursing Facility Home health care Hospice care • Part B – Medical Insurance (out-patient) – – – Doctor’s visits & services (in hospital or in office) Outpatient hospital services Diagnostic tests Durable Medical Equipment Some preventive services Some mental health services 6

Medicare Part A Inpatient / Hospital Insurance • You must be enrolled in Part A to obtain the coverage • Most people receive Part A coverage premium-free because they paid FICA taxes for at least 40 quarters; otherwise you can pay a premium to get Part A • 2015 Part A “Benefit Period” deductible -$1260 -You pay that • Services must be “Medically Necessary” to be covered • Benefit schedule is based on the number of days you receive inpatient treatment/services in a facility

Medicare Part B Outpatient Medical Services • 2015 Part B Annual Deductible - $147 - You pay • Medicare generally pays 80% of Medicare eligible charges • You pay the 20% balance of eligible charges • You must enroll in Part B to obtain the coverage • You pay a monthly premium for Part B once you enroll Y O U MEDICARE

Enrolling in Medicare-Part B • ENROLL if: – – you DON’T have coverage from active employment (yours or your spouses) you have group coverage but there are fewer than 20 employees at the company you have individual health coverage you are on COBRA • If you are covered by a group health plan offered by a company that has 20 or more employees and you will remain eligible to participate – Check with your employer to see how your coverage may change – Depending on your situation you may want to delay Part B enrollment • No federal penalty is assessed if you enroll in Part B while you have group coverage or within 8 months of losing your group coverage 9

Enrolling in Medicare-Part B • Delaying Part B enrollment may mean higher premiums (10% x each 12 month period delayed, permanently) & paying for your medical care out-of-pocket • Monthly premium for Part B is based on your Modified Adjusted Gross Income (MAGI) on line 37 of your 1040 two years previous 10

Your MDA Medicare Advisor will provide more detailed information regarding Medicare, including your coverage options, during your upcoming meeting. If you still need to schedule a meeting, contact Rick Seely or Denise Wyzywany at MDA at 877 -906 -9924. 11