Medicare www medicare gov This presentation produced at

Medicare www. medicare. gov This presentation produced at U. S. taxpayer expense.

Who Can Get Medicare ? 65 & older -or 24 months after entitlement to Social Security disability benefits -or. Amyotrophic Lateral Sclerosis –Medicare coverage begins first month entitled to SSDI -or. Permanent kidney failure and receive maintenance dialysis. Medicare coverage begins 4 th month of dialysis or if kidney transplant Medicare coverage begins immediately 2

Who Else Can Get Medicare? • Disabled adult children • Spouses or widows/widowers of deceased workers at age 65 • Railroad retirement beneficiaries who are at least 65 • Dependent parents of a fully insured deceased worker 3

Disabled Adult Child • A person whose disability began before age 22 can receive benefits under their parent • Parent must be deceased or getting Social Security disability or retirement benefits • Benefit starts at age 18 or afterwards • Beneficiary must be unmarried and found to be disabled before age 22 by Social Security • This is called SSDI (Social Security Disability Insurance) not SSI (Supplemental Security Income) 4

How Does a Person Enroll in Medicare? • Enrollment in Medicare A and B is through SSA • Go to : Socialsecurity. gov or ssa. gov • Enrollment in Parts C and D is by contacting the plan or going to: medicare. gov or by calling 1 800 MEDICARE (1 800 6334227)www. medicare. gov 5

Medicare-Automatic Enrollment • If a person is receiving SS benefits prior to age 65, SSA will automatically enroll them in Parts A and B at 65 • Medicare card usually arrives 3 months before 65 th birthday • Persons who receive Social Security disability benefits (SSDI) are automatically enrolled in Medicare A and B the 25 th month of disability benefits 6

When Can I Enroll In Medicare ? Medicare Enrollment Periods: Ø Initial – at age 65 Ø Special – if still working Ø General – January-March 7 7

Initial Enrollment Period (IEP) • Lasts 7 months • Begins 3 months before you turns 65 and ends 3 months after you reach 65 • For those who are not working or who do not have employer health coverage through a working spouse • If you enroll during the first 3 months of your IEP, your coverage begins the month you reach 65 8

Initial Enrollment Period • If you enroll in Medicare Part B the month you reach 65, your coverage begins the following month • If you enroll the month after you turn 65, your coverage starts 2 months after enrollment • If you enroll 2 or 3 months after age 65, your coverage begins 3 months after your enrollment 9

Special Enrollment Period (SEP) • If a person has group health coverage from their own or their spouse’s current employer, they have 8 months to apply for Medicare Part B whenever they or their spouse stops working • SEP starts the month AFTER a person or their spouse stops working • This is called the Special Enrollment Period (SEP) • If a person does not apply for Medicare Part B during the SEP, they can only enroll during the General Enrollment Period (GEP) which is January-March of each year • Employer must verify that person was covered under a group health plan while they were employed (or their spouse if insured through them) 10

General Enrollment Period (GEP) • January to March of each year for late enrollees • Coverage for Medicare Part B does not begin until July of the year that they enroll • Medicare Part B premium is 10% higher for each 12 month period a person was eligible to enroll but did not • Premium penalty for late enrollment never goes away 11

Medicare Has Four Parts Part A - Hospital Insurance Ø Covers most inpatient hospital expenses Ø 2020 deductible $1, 408 Ø Free for “fully insured” individuals, their spouses, widow/ers and/or disabled adult children Ø If not fully insured, they can pay for Part A depending on how many work credits they have Part B - Medical Insurance Ø Covers 80% doctor bills & other outpatient medical expenses after 1 st $198 in approved charges Ø 2020 standard monthly premium $144. 60 12

Medicare Has Four Parts Part C – Medicare Advantage Plans Ø Health plan options offered by Medicare-approved private insurance companies Ø When you join a Medicare advantage plan, you can get the benefits and services covered under Part A, Part B, and in most plans, Part D – Medicare Prescription Drug Coverage Ø Covers a major portion of your prescription drug costs Ø Your out-of-pocket costs—monthly premiums, annual deductible and prescription co-payments—will vary by plan Ø You enroll with a Medicare-approved prescription drug provider not Social Security 13

Medicare Part A • You don’t have to enroll in Medicare Part A or B at 65 if you are employed and have health insurance through your employer • The same is true if your spouse is employed and you are on her employer health plan • If you enroll in Medicare Part A only and you have a Health Savings Account, you can’t put any more money into your HSA or IRS will assess a tax penalty 14

Medicare Part A • Medicare Part A is always 6 months retroactive but not earlier than age 65 • If you enroll in Medicare Part A after age 65 ½ and you contributed to your employer HSA during the 6 months prior to your enrollment, you may have to pay a tax penalty to IRS • While you are working Medicare is secondary payer 15

Medicare Part A • If you or your spouse has 40 work credits (quarters), Part A is premium free • If you have 30 -39 work credits, Part A monthly premium is $252 • If you have less than 30 work credits or none at all, your monthly premium for Part A is $458 16

Medicare Part B • Part B- Medical Insurance Ø SSA uses Modified Adjusted Gross Income (MAGI) to determine premium amount Ø Some may pay higher premiums due to higher income Ø If MAGI exceeds $87, 000 for persons filing individually or $174, 000 if filing tax returns as “married, filing jointly”, Part B premiums will be higher Ø SSA uses most recent federal tax return (For 2020, this would have been tax return for 2018 filed in 2019) Ø If a person enrolls late in Part B, their premiums will incur a penalty which never goes away 17

Medicare for Military • Members of the military, active or retired and their families should enroll in Medicare A and B when first eligible in order to keep their TRICARE • If you have VA health coverage and don’t enroll in Medicare Part B in a timely manner, your part B premium may be higher and you may have to wait to enroll during the General Enrollment Period (GEP) 18

What is Medigap? • Medicare supplemental insurance policies • Covers deductibles, coinsurance and copayments • Sold by private insurance companies • Plans with the same letter offer the same benefits • Costs vary according to company rates 19

When to Buy a Medigap Policy • Open enrollment begins the month you turn 65 or older • Must be enrolled in Medicare Part B • Can purchase a policy whenever company agrees to sell you one • Go to: Medicare. gov/find-a-plan for the Medigap comparison tool 20

Do You Need Medigap? • Only works if you have Original Medicare • May not be needed if you have supplemental coverage • Can you afford the premiums, deductibles and copays of your Medigap plan? • Does not cover Medicare Part D • Some companies offer Medigap only to seniors not to people getting SSDI 21

Medicare Part D • Must have Medicare Parts A and B in order to enroll in Medicare Part D • Administered through private plans • Will only cover drugs which appear on the company’s formulary • Premiums, copays and deductibles with Medicare Part D 22

Medicare Part D • Medicare Part D also has a premium penalty for late enrollees. • Your Part D premium will be 1% higher for each month you could have enrolled in Part D and did not • You should enroll in Part D during your IEP or within 63 days of not having Part D or creditable drug coverage • Your Part D premium could be higher depending on your MAGI 23

Medicare Part D – Enroll in Medicare Part D by calling 1 -800 MEDICARE (1 -800 -633 -4227) or by contacting private plans – You can get “Extra Help” in paying for Part D if your resources are below $14, 390 (individual) or $28, 720 (couple) – Income must be below $18, 735 (individual) or $25, 365 (couple) – If you have a Medicare Advantage Plan (Part C), in most cases drug coverage is included 24 –

Medicare Part C • Also called Medicare Advantage Plans (MA) or MA-PD (Medicare Advantage with Prescription Drug coverage) • Managed by private companies approved by Medicare • Medicare Parts A and B are included and most include drug coverage • May have to use doctors in network • Must pay Part B premium • Does not work with Medigap policies 25

Medicare Parts C and D • You can join, switch or drop your Part C or Part D Plan or return to original Medicare during Open Enrollment Period (OEP) • OEP is from October 15 -December 07 of each year • Coverage begins January 1 st of the following year • If you enroll in Medicare during the General Enrollment Period (GEP) you can then enroll in Medicare C (if you have Medicare A and B) and/or Medicare D (if you have Medicare A and/or B) from April 01 -June 30 26

Medicare Parts C and D • If you are enrolled in a Medicare Advantage Plan (Part C) you can switch from a MA (No prescription drug coverage) to a MA-PD (Prescription drug) plan or from a MA-PD plan to a MA plan • You can drop Medicare Part C and return to Original Medicare • You will need to enroll in a Part D plan if you go back to Original Medicare • You can do this from January-March • You must be in an MA plan to use this enrollment period 27

Medicare • Remember that Medicare does not cover hospitalization, prescription drugs or doctor costs while you are living or vacationing outside of the United States • If you are on vacation, check with your carrier for vacationers’ insurance. It is not expensive. • If you move outside of the United States, get health insurance coverage from the country where you reside

For More Medicare Information 1 -800 -MEDICARE (1 -800 -633 -4227) TTY 1 -877 -486 -2048 www. medicare. gov 29