Understanding Your Medicare Coverage Options

Transcription

1 Understanding Your Medicare Coverage Options With information on how to increase your coverage with a Medicare Supplement insurance policy Medicaresupplement.com is a website operated by TZ Insurance Solutions LLC, a licensed insurance producer. We are not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained in this document. This is not a complete listing of plans available in your service area. For a complete listing please contact MEDICARE or consult (TTY users should call ), 24 hours a day/7 days a week or consult MS-eBook

2 2015 TZ Insurance Solutions LLC. All rights reserved. TZ Insurance Solutions LLC is not an underwriting insurance carrier. Not all companies and insurance plans are available in all states. This is a solicitation for insurance and you may be contacted by an individual insurance agent. Some states require that all Medicare Supplement standardized insurance plans be offered to Medicare qualified individuals due to disability. In Ohio, you may contact the Department of Insurance to verify the information pertaining to TZ Insurance Solutions LLC.

3 If your 65 th birthday is on the horizon, you, like many other Americans, may be thinking about Medicare. This pamphlet gives you a basic introduction to Medicare and your coverage options. First, we look at Medicare s essential parts. Then, we explain why and how you can get additional coverage. Finally, we examine some of the finer details of Medicare (like how to enroll) and some details about Medicare Supplement insurance (Medigap). If you re looking for more detailed information, visit our website: MedicareSupplement.com Get quotes and learn more about your Medicare options Visit MedicareSupplement.com or call

4 Table of Contents

5 Table of Contents 3 Getting Started with Medicare... 4 The Cost of Medicare Parts A & B... 5 Coverage Options Side By Side... 6 More About Medicare... 7 More About Medigap... 9 Frequently Asked Questions References... 13

6 4 Getting Started with Medicare Getting Started with Medicare What is Medicare? Medicare is a federal program that ensures senior citizens and citizens with disabilities have affordable health care options. In its Fast Facts report, the Centers for Medicare & Medicaid Services (CMS) states that 53.8 million people were enrolled in Medicare in million people were enrolled in Medicare in Parts A & B The two core parts of Medicare are Parts A & B. When combined, they re often referred to as Original Medicare. Original Medicare provides the hospital and medical coverage that is the backbone of the Medicare system. If you decide to get Medicare coverage, you first must sign up for Medicare Part A. Part A is Medicareprovided hospital insurance that covers services such as inpatient hospital stays, hospice care, and skilled nursing facility care. Some people are enrolled in Part A automatically and get it for free. If you re enrolled in Part A automatically, you will get your Medicare card in the mail 3 months before your 65 th birthday. Part B is the second element of Original Medicare. It s medical insurance that covers services such as outpatient hospital care and doctor s services. Part B is optional and if you want it, you must pay a monthly premium. If you re enrolled in Original Medicare automatically and want to reject Part B, you need to follow the instructions on the back of the Medicare card that was sent to you in the mail. Next, let s look at costs associated with Medicare Parts A & B. Getting Parts A & B Some people are enrolled in Parts A & B automatically. If you re not enrolled automatically, you need to enroll during one of three enrollment periods: 1. Initial Enrollment Period (IEP) 2. Special Enrollment Period (SEP) 3. General Enrollment Period (GEP) For more information on enrollment periods, see page 7.

7 The Cost of Medicare Parts A&B 5 The Cost of Medicare Parts A & B Parts A & B provide many benefits, but there are out-of-pocket costs to use those benefits. These costs include monthly premiums, deductibles, co-payments, and/or co-insurance. The following table outlines some common Medicare costs in 2015: Part A Premium Part A Inpatient Hospital Stay Costs Most people don t have to pay for this if they or their spouse paid Medicare taxes while working. If you do, it costs up to $407 per month. $1,260 deductible each benefit period. Co-insurance: Days 0-60: $0 in each benefit period Days 61-90: $315 per day in each benefit period Days 91+: $630 for each lifetime reserve day after day 90 of each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: All costs Part A Hospice Care Costs Part A Skilled Nursing Facility Costs $5 co-payment for each prescription drug and other similar products for pain relief. You may need to pay 5% of the Medicare-approved amount for inpatient respite care. Medicare doesn t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home). Days 1 20: $0 for each benefit period. Days : $ co-insurance per day of each benefit period Days 101+: All costs Part B Premium Part B Coverage Costs $ $ per month, depending on your income in previous years. $147 deductible each year. 20% of the Medicare-approved amount for most covered medical services. Source: Medicare.gov 3 In addition to out-of-pocket costs, there are other services not covered by Parts A & B including prescription drugs, routine dental or vision care, or most foreign travel emergencies. In the next section, we ll look at how you can get additional coverage for these costs.

8 6 Coverage Options Side By Side Coverage Options Side By Side Many Americans rely solely on Medicare Parts A & B for their medical needs, but millions also add coverage to be better protected. While the federal government provides core Medicare benefits through Parts A & B, private insurance companies offer extra coverage for out-of-pocket costs and other services. A common way to get additional coverage is to buy a Medicare Supplement insurance (Medigap) policy. The following table compares how coverage works when you have Medicare only and when you have Medicare with a Medigap policy. Summary Original Medicare Only You get basic hospital & medical coverage from the government.you pay the deductibles, co-payments & extra costs that come with that coverage yourself. Original Medicare + Medigap You get basic hospital & medical coverage from the government. You pay a private insurer to cover the deductibles, copayments & extra costs that come with that coverage. Premiums Part A is usually free if you or your spouse paid Medicare taxes while working. If not, it costs up to $407 each month. For most people the part B premium is $104.90, but it can be higher based on prior years income. Original Medicare premium + Medigap policy premium. Providers Benefits are paid by the Federal government. Original Medicare benefits are paid by the Federal government. Medigap benefits are paid by private insurance companies. Plan Parts Medicare Parts A & B. Medicare Parts A & B + 1 of up to 10 Medigap plan options. Different plans are available in MA, MN and WI. Who Accepts It? Any doctor or hospital that accepts Original Medicare. Any doctor or hospital that accepts Original Medicare, unless you choose a Medicare SELECT policy. Prescription Coverage You must add Medicare Part D to get drug coverage. You must add Medicare Part D to get drug coverage.

9 More About Medicare 7 More About Medicare Three Things to Know About Medicare 1. Some people are enrolled in Parts A & B automatically when they turn If you re not enrolled automatically, there are 3 periods when you can enroll. 3. There are 4 parts of Medicare (A, B, C, and D). Part A is the only part that s free for most enrollees when they or their spouse paid Medicare taxes while working. Enrolling In Parts A & B If you need to manually enroll in Medicare, you need to do so during an enrollment period. The following table breaks down the three types of enrollment periods: Enrollment Period Initial Enrollment Period (IEP) Timing Start: 3 full months before the month you turn 65. End: 3 full months after the month you turn 65. Notes Example: If your birthday is June 5th, your IEP starts on March 1st (3 months before June) and ends on September 30th (3 months after June). Special Enrollment Period (SEP) Usually any time after your IEP, if you re either still covered by a group health plan or are within 8 months of your employment or group coverage ending. Other Special Enrollment Periods may apply. SEPs are mainly for people transitioning from an employment-based group health plan to Medicare. General Enrollment Period (GEP) Start: January 1 st of each year End: March 31 st of each year If you sign up during the GEP, you could pay a higher premium than if you enrolled during your IEP, and you will not receive Medicare coverage until July 1 of that year.

10 8 More About Medicare What Medicare Parts A & B Cover In general, Medicare Part A covers hospital care, and Part B covers medically necessary and preventive services as defined by CMS. The following lists give more details on what these services include: Part A Covered Services Inpatient hospital care Hospice care At-home part-time skilled nursing care At-home physical therapy Inpatient care at a religious non-medical health care facility Blood transfusions after the first 3 pints Part B Covered Services Initial physical exam Yearly wellness exam Doctor services Nursing care Ambulance services Chemotherapy Diagnostic tests and screenings Durable medical equipment Certain pap smear and mammography screenings Pneumonia and flu vaccinations

11 More About Medigap 9 More About Medigap Three Things to Know About Medicare Supplement Insurance 1. It s also known as Medigap. 2. Medigap plans cover up to 9 different types of expenses. Those specific expenses include deductibles, co-insurance, co-payments, and other costs not covered by Original Medicare. 3. There are 10 standardized Medigap plan options. Each plan option has different benefits and costs. Plan options in Minnesota, Massachusetts, and Wisconsin differ from the 10 standardized plan options. Medicare Supplement insurance, commonly referred to as Medigap, is a private form of medical insurance that helps cover costs that Original Medicare doesn t cover. You can buy a Medigap policy to help pay for Original Medicare deductibles, co-payments, co-insurance, and other costs million people had Medigap coverage in Plan options are regulated by federal and state governments. In most states, there are 10 standardized plans, each named with a different letter. Since they re standardized (other than Massachusetts, Minnesota and Wisconsin), Plan A will always cover the same set of benefits, no matter which company you buy it from. Note: Medigap policies are not compatible with Medicare Advantage plans. You can only have one or the other. How to Get a Medigap Policy You can buy a Medigap policy at any time, but the best time to buy is during your Medigap open enrollment period. This period is a 6-month window that starts the day that you are both 1) 65 years old and 2) enrolled in Medicare Parts A & B. During this period, insurance companies cannot deny you coverage or increase prices due to health issues.

12 10 More About Medigap 13 Medigap Plan Options In most states, there are 10 standardized Medicare Supplement Insurance plans to choose from: A, B, C, D, F, G, K, L, M, and N. Each has a different combination of up to 9 benefits. Plan F is the most popular and is the only plan that includes all 9 benefits. Plan A is the most basic plan and offers the fewest benefits. For more information about each plan and its benefits, review the chart below: A B C D F 1 G K 2 L 3 M N 4 Medicare Part A Co-insurance & Hospital Costs Medicare Part B Co-insurance & Hospital Costs 50% 75% First 3 Pints of Blood 50% 75% Part A Hospice Care, Co-insurance or Co-payment 50% 75% Co-insurance for Skilled Nursing Facility 50% 75% Medicare Part A Deductible 50% 75% 50% Medicare Part B Deductible Medicare Part B Excess Charges Foreign Travel Emergency Source: Medicare.gov 5 1. Plan F offers a high-deductible option. It requires you to pay a $2,180 deductible before it covers anything (in 2015). 2. Plan K has an Out-of-Pocket yearly limit of $4,940 (in 2015). 3. Plan L has an Out-of-Pocket yearly limit of $2,470 (in 2015). 4. Plan N pays 100% of the Part B co-insurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don t result in an inpatient admission.

13 13 Frequently Asked Questions 11 Frequently Asked Questions Get quotes and learn more about your Medicare options Visit MedicareSupplement.com or call Q: Can I visit any doctor or hospital with Medicare? A: You can visit any doctor or hospital with Medicare, but you might not be covered. After you enroll in Medicare, you must check to see if your preferred medical practitioner and facility accept Medicare. Similar to the qualification standards with private insurance, each practitioner and facility has a choice as to what insurance they accept. If you do not check before your treatment, you could be responsible for part or all of the medical costs. Q: When should I buy a Medigap policy? A: You should buy a Medigap policy during the open enrollment period. Your Medigap open enrollment period starts the day you are both 1) 65 years old and 2) enrolled in Medicare Parts A & B. The open enrollment period lasts for 6 months. If you only enrolled in Part A when you turned 65, the 6-month period starts the day you add on Part B coverage. Continued on the next page

14 12 Frequently Asked Questions Continued from the previous page. During this open enrollment period you have a guaranteed right to access a Medicare Supplement insurance policy. Insurance companies cannot deny you coverage or increase prices due to health issues. If you buy a policy after the open enrollment period, you can be denied coverage or face higher premiums. Q: Do I need multiple Medicare Supplement insurance plans? A: You do not need multiple Medicare Supplement insurance plans. In fact, you cannot buy more than one Medigap policy. Q: Can I get Medicare Supplement insurance if I have a pre-existing condition? A: You have guaranteed access to a Medicare Supplement insurance policy, even with a preexisting condition, if you buy during your open enrollment period. During the open enrollment period, insurers cannot use underwriting, which means they cannot deny you coverage or force you to pay a higher premium because of a past or current health condition. Your insurance company may enforce a waiting period that lasts for up to 6 months. During this period, your insurer will provide health care coverage, but it can refuse to cover out-of-pocket costs related to treatment of the pre-existing condition. Once the waiting period ends, these costs will be covered. After the open enrollment period, it is more difficult to get approved for a Medicare Supplement insurance plan with a pre-existing condition. It is possible to get approved, but it depends on each insurance company s rules. Unless you have a guaranteed issue right, insurance companies can legally deny you coverage. Q: Can I change my Medicare Supplement insurance plan? A: You can change your Medicare Supplement insurance plan at any time of the year. If you do change plans or providers, you should switch during the open enrollment period. If you change plans outside of the open enrollment period, the insurance company could charge higher premiums or refuse to insure you based on your health conditions. The only way to switch plans outside of your open enrollment period without facing medical underwriting is if you have a guaranteed issue right.

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