Original Medicare and Medicare Supplement Medigap Insurance July

Original Medicare and Medicare Supplement (Medigap) Insurance July 2020 continuing education Updated June 30, 2020

Today’s agenda • • Learning objectives Troubleshooting and sharing time • • • Original Medicare Medigaps Case sharing and group discussions • • • July learning aids and publications Resources Covid-19 2020 and 2021 continuing education topics Continuing education evaluation Optional training materials: Module 3, quizzes and scenarios SHIBA advisor continuing education | July 2020 2

Learning objectives After completing this training, you should be able to: • Explain how people with Original Medicare (OM) will have costs that could be covered by a Medigap. • Describe three types of providers in the Medicare world and explain what assignment and non-assignment mean. • Describe the implications of going to a doctor who does not accept Medicare assignment. Continued SHIBA advisor continuing education | July 2020 3

Learning objectives (continued) After completing this training, you should be able to: • Explain how you would describe to a client what coverage of excess charges means in a Medigap Plan G. • Demonstrate that you can use the What you need to know about Medigaps booklet to counsel clients about when they can switch plans or about other Medigap rules. • Explain what the columns of the Approved Medigap chart mean. SHIBA advisor continuing education | July 2020 4

Troubleshooting and sharing • Review June topics o Medicare fraud and the Senior Medicare Patrol • Review publications from June training o o Medicare & You SMP Foundations Training Tips to help you recover from scam calls STARS Beneficiary Contacts SMP instructions • Local topic sharing • Other topics SHIBA advisor continuing education | July 2020 5

Original Medicare SHIBA advisor continuing education | July 2020 6

What’s your understanding? Share your understanding of the following topics: • Original Medicare: o Definition and description. o What does a client pay? o What’s assignment? • Medigaps: o Definition and what are they also known as? o How do you compare policies? SHIBA advisor continuing education | July 2020 7

Original Medicare (OM) A quick review: How does OM work? M&Y page 51 • It’s one way to get Medicare. • A client will have OM unless they choose an MA plan or other type of Medicare health plan. • A client will generally have to pay a portion of the cost for each service covered by OM. SHIBA advisor continuing education | July 2020 8

SHIBA advisor continuing education | July 2020 Continued 9

Continued from previous slide SHIBA advisor continuing education | July 2020 10

Original Medicare: Assignment What’s assignment? M&Y pages 53 -54 Doctor, provider or supplier agrees – or is required by law – to accept the Medicare-approved amount as full payment for covered services. Participating and non-participating providers • Limiting charges: For example excess charges. Private contracts and “opt out” • Certain doctors and other health care provides who don’t want to engage with the Medicare program may “opt” out of Medicare. SHIBA advisor continuing education | July 2020 11

Assignment discussion Participating, non-participating and opt-out providers Medicare Interactive has free resources to learn more about Medicare. Spend some time as a group reviewing and summarizing the following web page (also presented on the following three slides): www. medicareinteractive. org/get-answers/medicare-coveredservices/outpatient-provider-services/participating-nonparticipating-and-opt-out-providers Continued SHIBA advisor continuing education | July 2020 12

Participating, non-participating, and opt-out providers: Slide 1 of 3 Continued SHIBA advisor continuing education | July 2020 13

Participating, non-participating, and opt-out providers: Slide 2 of 3 SHIBA advisor continuing education | July 2020 Continued 14

Participating, non-participating, and opt-out providers: Slide 3 of 3 SHIBA advisor continuing education | July 2020 15

Knowledge check Q 1: Does a client need to choose a primary care doctor when on OM? Q 2: What is assignment? Q 3: What are some rules providers must follow if they choose to opt-out? SHIBA advisor continuing education | July 2020 16

Medigaps SHIBA advisor continuing education | July 2020 17

What’s your knowledge? Q 1: What is a Medigap plan and why should a client buy one? Q 2: How does a person get a Medigap policy? Q 3: What do Medigap plans cover? Q 4: When can a client sign up or switch plans? Q 5: How can a client compare Medigap plans? SHIBA advisor continuing education | July 2020 18

Medicare supplement insurance Policies and how to compare M&Y, pages 69 -70 • Also called Medigaps. • Polices are standardized. • Reminder: As of Jan. 1, 2020, Medigap plans sold to people who are new to Medicare do not cover the Part B deductible. M&Y page 69. On the next slide, review how to compare policies. Continued SHIBA advisor continuing education | July 2020 19

Continued from previous slide Continued SHIBA advisor continuing education | July 2020 20

Medigaps: What to know Important facts M&Y, page 71 Go through each of the bullets on this page as a group. • You must have Part A and Part B. • You must pay a monthly premium. • A policy covers one person. • You can’t have prescription drug coverage in both your Medigap policy and a Medicare drug plan. • It’s important to compare. Continued SHIBA advisor continuing education | July 2020 21

Medigaps: What to know (continued) When to buy M&Y, page 71 Go through each of the bullets on M&Y page 71 as a group. • The best time to buy is during what Medicare calls Medigap Open Enrollment. o Carefully review the first bullet under When to Buy on page 71. • If you delay enrolling in Part B due to group health coverage, your Medigap OEP won’t start until you sign up for Part B. • Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. Continued SHIBA advisor continuing education | July 2020 22

Medigaps: What to know (continued) Can a client have a Medigap policy and a Medicare Advantage plan? M&Y, page 72 If a client has an MA plan, it’s illegal for anyone to sell them a Medigap policy unless they are switching back to Original Medicare. For more information: • Medicare. gov. • 1 -800 -MEDICARE. SHIBA advisor continuing education | July 2020 23

Medigaps: What you need to know about Medigap(Medicare Supplement) plans www. insurance. wa. gov/media/8737 10 pages Continued SHIBA advisor continuing education | July 2020 24

Medigaps: What you need to know (cont’d) Group activity Discuss: • When to buy. • What Medigaps cover. • Costs. • Pre-existing conditions. • Snowbirds. • How to enroll. • Switching Medigap plans. Continued SHIBA advisor continuing education | July 2020 25

Medigaps: What you need to know (cont’d) Switching Medigaps What if someone wants to go back and forth between plans? Look at the switching chart on pages 7 -9 in the What you need to know about Medigaps plans booklet and spend some time reviewing and discussing. Pages 7 -9 from the booklet are presented on the next three slides. Continued SHIBA advisor continuing education | July 2020 26

Continued from previous slide What you need to know about Medigap (Medicare Supplement) plans Switching Medigap plans, page 7 Continued SHIBA advisor continuing education | July 2020 27

Continued from previous slide What you need to know about Medigap (Medicare Supplement) plans Switching Medigap plans, page 8 Continued SHIBA advisor continuing education | July 2020 28

Continued from previous slide What you need to know about Medigap (Medicare Supplement) plans Switching Medigap plans, page 9 SHIBA advisor continuing education | July 2020 29

Approved Medicare Supplement plans Approved Medicare Supplement (Medigap) plans SHIBA client publication www. insurance. wa. gov/media/1807 5 pages Continued SHIBA advisor continuing education | July 2020 30

Approved Medicare Supplement plans (cont’d) • This content is VERY dense information. Spend time reviewing and discussing all of this. Being familiar with the information helps you to explain it to clients • The list is updated quarterly. • Read all info on bullets and notes on the first page. • Note there’s a disclaimer that rates can change and to check with the plan. • Grid column notes: • • Company: Includes company name and phone number. Pre X: See footnote on page 4 of the publication. Health Screen: See footnote on page 4 of the publication. Standardized plans: Refer to the chart at end of document. SHIBA advisor continuing education | July 2020 31

Options for people under age 65 Medigaps or similar coverage are very limited. We will talk about each one of these on the next three slides. • Washington State Health Care Authority Premera Plan G. • United American Plan B. • Washington State Health Insurance Pool (WSHIP). Continued SHIBA advisor continuing education | July 2020 32

Options for people under age 65 (cont’d) Premera Blue Cross Washington State Health Care Authority Premera Plan G. Approved Medicare Supplement (Medigap) plans, page 4 Washington State Health Care Authority (HCA) Blue Cross Premera Plans Under age 65 Medicare disability www. insurance. wa. gov/media/1807 SHIBA advisor continuing education | July 2020 33

Options for people under age 65 (cont’d) Premera Blue Cross (continued) Washington State Health Care Authority Premera Plan G. Continued SHIBA advisor continuing education | July 2020 34

Options for under age 65 (continued) United American Plan B Approved Medicare Supplement (Medigap) plans, page 3 United American Insurance Co. Under age 65 Medicare disability www. insurance. wa. gov/media/1807 SHIBA advisor continuing education | July 2020 35

Options for under age 65 (continued) WSHIP is our state's high-risk insurance pool. Created by the state legislature, it originally offered insurance to state residents who were rejected in the individual market due to health issues. www. insurance. wa. gov/washington-state-healthinsurance-pool-wship SHIBA advisor continuing education | July 2020 36

Knowledge check Your trainer may lead a knowledge check. SHIBA advisor continuing education | July 2020 37

July 2020 learning aids Medicare & You 2020 Partner publication Note: this is the national version. www. medicare. gov/Pubs/pdf/10050 -medicare-andyou. pdf What you need to know about Medigap (Medicare Supplement) plans SHIBA publication www. insurance. wa. gov/media/8737 10 pages Note: This publication may be ordered from Fulfillment. SHIBA advisor continuing education | July 2020 38

July 2020 learning aids Approved Medicare Supplement (Medigap) plans SHIBA publication www. insurance. wa. gov/media/1807 5 pages SHIBA advisor continuing education | July 2020 39

COVID-19 resources: Videos The SMP Resource Center is excited to announce two new COVID-19 videos that are available as part of the SMP Consumer Fraud Alert: COVID-19 Fraud Resources. Protect Yourself from COVID-19 Medicare scams video You. Tube: www. youtube. com/watch? v=ylk. EREJc. A-4&t=1 s Facebook: www. facebook. com/SMPNational. Resource. Center/videos/14397928362192 18/ Common COVID-19 Medicare Scam video You. Tube: www. youtube. com/watch? v=37 O 74 z 2 j. Nxw Prevent. Detect. SHIBA advisor continuing education | July 2020 Report. 40

COVID-19: Scams and fraud alerts Scammers are targeting older adults and those with serious long-term health conditions who appear to have a higher risk for serious illness from COVID-19. Fraudsters are attempting to bill Medicare for sham tests or treatments related to the coronavirus and are targeting individuals to illegally obtain money or Medicare numbers. If clients believe they’ve been scammed by a COVID-19 scam, they should contact SHIBA WA state’s Senior Medicare Patrol at 800 -562 -6900. #SMPwatch. COVID 19 Prevent. Detect. SHIBA advisor continuing education | July 2020 Report. 41

2020 continuing education topics Month Topic August No training September Getting ready for Open Enrollment and comparing health and prescription drug plans in your area October Medicare Part D and Medicare Advantage Medicare & You Section 4 Section 6 November No training December No training 2021 January A look at what’s new for 2021 and a broad overview of M&Y 2021 SHIBA advisor continuing education | July 2020 All sections 42

Evaluation Please take some time to send thoughts to shiba@oic. wa. gov, dianas@oic. wa. gov or to your trainer. We appreciate your feedback! SHIBA advisor continuing education | July 2020 43

Optional expanded training materials The materials in this section are optional. They may be added to the slide presentation by the trainer and/or studied separately by the volunteer. SHIBA advisor continuing education | July 2020 44

Check your knowledge: Question 1 If you join an MA plan, you can buy a Medigap policy to pay for out-of-pocket costs. a. True b. False Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 45

Check your knowledge: Question 2 One Medigap policy can cover both you and your spouse. a. True b. False Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 46

Check your knowledge: Question 3 Each standardized Medigap plan identified by the same letter (A-N) must offer the same basic benefits, no matter which insurance company sells it. a. True b. False Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 47

Check your knowledge: Question 4 If you’re 65 or older, your Medigap _____ starts when you enroll in Part B and it can’t be changed or repeated. a. Initial Enrollment Period (IEP) b. General Enrollment Period (GEP) c. Open Enrollment Period (OEP) Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 48

Scenario 1 Ted is 64. He’s had Medicare for four years due to a disability. He lives in a state that requires insurance companies to offer a Medigap policy to people with Medicare who are under age 65 and deemed disabled. He currently has a Medigap policy. What might change when Ted turns 65 next year? Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 49

Scenario 1: Considerations Ted will get a Medigap guaranteed issuance when he turns 65, he’ll have a: • Wider choice of Medigap policies. • Lower Medigap premium. If he signs up during his guaranteed issuance, insurance companies can’t: • Refuse to sell him any Medigap policy due to his disability. • Charge him a higher premium than they charge other people of the same age. He can avoid the pre-existing condition waiting period since he had coverage for more than 6 months before he turned 65. Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 50

Scenario 2 Sophie is 67 and healthy. She retired last month and ended her employer-sponsored health coverage. She was enrolled in Medicare Part A and just enrolled in Part B. She’s interested in buying a Medigap policy to help her with her out-of-pocket costs. What does Sophie need to consider? Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 51

Scenario 2: Considerations • Sophie should consider when she’ll buy a Medigap policy: o The best time is during her 6 -month OEP. o Starts with her Part B effective date. • She’ll have guaranteed issue rights if she enrolls during her Medigap OEP. • If she has guaranteed issue rights: o Insurance companies must sell her a Medigap policy. o All pre-existing conditions must be covered. o Insurance companies can’t charge her more. • If she doesn’t enroll during her Medigap OEP, companies may use medical underwriting or refuse to sell her a policy. Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 52

Scenarios: Key points • You must have both Medicare Part A and Part B to get a Medigap policy. • You still pay the Part B premium. • You pay a monthly premium for Medigap. • Medigap policies cover one person. • Each standardized Medigap policy offers the same basic benefits, no matter which insurance company sells it. • Costs vary by plan and by company. Continued Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 53

Scenarios: Key points (continued) • • • Medigap policies can only cover costs associated with services covered by Original Medicare. Note: EXCEPT foreign travel emergency. Medigap policies don’t work with Medicare Advantage plans. Insurance companies are prohibited from selling standardized Plans C or F to newly eligible people with Medicare: o o Who turned 65 on Jan. 1, 2020, or later. Getting premium-free Part A as of Jan. 1, 2020, or later. Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies SHIBA advisor continuing education | July 2020 Optional expanded learning 54

Resources: SHIP TA course Level 2: Medicare coverage rules Course 4: Medigaps • This course reviews Medigap policies, a type of supplemental insurance that helps pay gaps in Original Medicare costs, like deductibles and coinsurances. In this course, you’ll learn what a Medigap plan is, what Medigap policies cover, and Medigap costs. We’ll also come to understand when someone with Medicare has the right to sign up for a Medigap plan. • shipta. medicareinteractive. org/course/level-2 -medicareadvance/course-4 -medigap-plans-supplementalinsurance. Continued SHIBA advisor continuing education | July 2020 Optional expanded learning 55

Knowledge check Level 2 Course 4: Medigap plans (Supplemental insurance) • shipta. medicareinteractive. org/ ship-certification-tool/exampdf/178 Note: If the link does not open, try copy/paste into the browser. SHIBA advisor continuing education | July 2020 Optional expanded learning 56

Resources Choosing a Medigap Policy: A guide to Health Insurance for People with Medicare Partner publication www. medicare. gov/Pubs/pdf/02110 -medicaremedigap-guide. pdf 50 pages CMS Module 3: Supplemental Insurance (Medigap) Policies cmsnationaltrainingprogram. cms. gov/? q=globalsearch&combine=module Partner publication, Power. Point presentation 55 slides SHIBA advisor continuing education | July 2020 Optional expanded learning 57