Medicare Overview September 2016 John Williams SHIP Medicare

+ Medicare Overview - September 2016 John Williams, SHIP Medicare Specialist

+ 2 What Is Medicare & When It Is Available n n Federal health insurance available at n Age 65 and older n Under age 65 after 24 months of SS or RR disability benefit entitlement n Under age 65 and entitled to SS or RR disability benefits due to ALS n Any age with ESRD Administered by n Centers for Medicare & Medicaid Services (CMS) n Isn't the same as Medicaid Understanding Medicare

+ 3 A-B-C-D n Medicare has four parts n Part A – Hospital Insurance n Part B – Medical Insurance n Part C – Medicare Advantage Plans n Part D – Prescription Drug Coverage Understanding Medicare

+ 4 Medicare Options n Original Medicare only (Parts A & B) n Original Medicare plus supplemental coverage - from former employer/union, Tricare for Life, for example n Original Medicare plus a Medigap plan n Original Medicare plus a Part D prescription drug plan n Medicare Advantage plan (Part C) with or without drug coverage Understanding Medicare

+ 6 Original Medicare n n Go to any provider that accepts Medicare Members pay n Part A premium - free for most people n Part B premium- amount generally changes annually n IRMAA Part B & D premium increases for people with high income n Deductibles - amounts generally change annually n Coinsurance or copayments n Program are available to help pay members' costs Understanding Medicare

+ 7 Medicare – Initial Enrollment Period n Apply 3 months before age 65 if you want Medicare at age 65 n n n Do not need to be retired Benefits through employer/union - active employment plans Might not want to enroll in any or all parts of Medicare while working Auto Enrollment in Parts A and B n If you already receive SS or RR benefits n Can refuse Part B Understanding Medicare

+ 15 Part B - Other Enrollment Periods n General Enrollment Period n n January 1 through March 31 each year Coverage effective July 1 Premium increases 10% for each 12 -month period you were eligible but did not enroll Special Enrollment Period n Sign up within 8 months of the end of employer or union health plan coverage Understanding Medicare

+ 16 Medigap Policies n Health insurance policies n n n Sold by private insurance companies, plans are A through N Follow Federal and state protection laws in every state Policies must say “Medicare Supplement Insurance” Cover “gaps” in Original Medicare Costs may vary by state, must purchase a plan where you live Understanding Medicare

+ 17 Medigap – How It Works n Only works with Original Medicare n Can go to any doctor, hospital, or provider that accepts Medicare n Members pay a monthly premium n All Medigap plans must be approved by the IDOI n A list of all Medigap plans is located on the SHIP website (or via packet in the mail) Understanding Medicare

+ 18 Medigap Plans-Enrollment n Guaranteed Issue Period - age 65 or older and Part B just starting - no medical underwriting for first 6 months n When you need coverage - with medical underwriting n Special Enrollment Periods - losing retiree coverage that pays secondary to Medicare - no medical underwriting Understanding Medicare

+ 19 Part D – Prescription Drug Coverage n Private plans available for all people with Medicare n Approved by Medicare n Requirements: n n n Have Medicare Part A or Part B, or both n Live in plan service area n Programs are available to help pay members' costs Medicare Prescription Drug Plans Medicare Advantage Plans Understanding Medicare

+ 20 Part D Costs n Costs vary by plan, most people will pay: n n n Monthly premium - varies by plan Annual deductible - varies by plan and generally changes annually Initial coverage phase - members pays 25% of drug costs Coverage gap (donut hole) - copays increase but drug costs are discounted - discounts increases annually until 2020 when coverage gap disappears Catastrophic coverage - member pays 5% of drug costs Programs available to help pay Part D costs Understanding Medicare

+ 22 Part D - Enrollment and Making Changes n When first eligible for Medicare n n n 7 months beginning 3 months before first month of Medicare eligibility During specific enrollment periods n Annual Election Period. -. October 15 th - December 7 th each year Coverage starts January first of next yeay n Special Enrollment Periods - move out of plan service area; lose creditable drug coverage; enter/reside in/leave a Long Term Care facility; eligible for Extra Help Some people are enrolled automatically Understanding Medicare

+ 24 Medicare Advantage Plans - Overview n Health plan options approved by Medicare n n n n Medicare benefits delivered through private companies approved by Medicare Still in Medicare program Still have Medicare rights and protections Still get regular Medicare-covered services May get extra benefits n Such as vision, hearing, or dental care May be able to get prescription drug coverage (Part D) Different Advantage Plans n n Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs Plan (SNP) Understanding Medicare

+ 25 Advantage Plans – Join or Switch Plans n When first eligible for Medicare n n n 7 months beginning 3 months before first month of Medicare eligibility Annual Election Period n October 15 th – December 7 th each year n Coverage starts January first of next year Annual Disenrollment Period n January 1 st – February 14 th every year (coverage begins the first of the month after you switch) n May also join a Medicare Part D plan during change Understanding Medicare

+ 26 Advantage Plans – How They Work n You may have to stay in a certain network of hospitals and providers n Co-pays and deductible are different than Original Medicare Understanding Medicare

+ 27 Review - If You Are Eligible for Medicare n Decide if you want only Original Medicare; Original Medicare plus a Medigap Plan; or a Medicare Advantage Plan n Decide on a Prescription Drug Plan - Part D n Investigate policies and insurance companies n Choose a reasonable number of the plans and contact nsurance companies, brokers or independent agents for personal quotes. n Select coverage and enroll in plan(s) n Review your coverage every Fall during OEP and make needed enrollment changes Understanding Medicare

+ 28 For More Information n 1 -800 -MEDICARE (1 -800 -633 -4227) n Medicare publications online n www. medicare. gov n www. cms. hhs. gov n www. socialsecurity. gov n SHIP telephone: 1 -800 -452 -4800 n SHIP: www. medicare. in. gov n SHIP counselors Understanding Medicare