INSURANCE OPTIONS IN RETIREMENT. Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group

Transcription

1 INSURANCE OPTIONS IN RETIREMENT Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group

2 Pre-65 Re0ree Medical Op0ons Pre COBRA concnuacon coverage 2. Individual Coverage 3. Marketplace Coverage PRESENTED BY ADVANTAGE BENEFITS GROUP 2

3 Pre-65 Re0ree Medical Op0ons COBRA ConCnuaCon Coverage Up to 18 months or uncl enctled to Medicare, whichever is less Medical/PrescripCon Drugs 7/1/2016-6/30/2017 Rates Dental Vision BCBS PPO2 MESSA Choices Saver Single: $ Single: $ Person: $1, Person: $1, Family: $1, Family: $1, PRESENTED BY ADVANTAGE BENEFITS GROUP 3

4 Pre-65 Re0ree Medical Op0ons Individual Plan Available through a number of carriers: Priority Health Blue Cross Blue Shield Molina Healthcare Humana Cost varies based on smoker status, age, zip code and plan design PRESENTED BY ADVANTAGE BENEFITS GROUP 4

5 Pre-65 Re0ree Medical Op0ons Marketplace Plan ( Advance Premium Credits (subsidies) based on household income and age Metal Tier Plans PlaCnum, Gold, Silver, Bronze MulCple Carriers available InstrucCons to navigate the site: 1) Click See Topics from the top ribbon on the homepage 2) Click See plans and prices Special Enrollment Period: You may qualify for a special enrollment period if you leave a job where you had health coverage (ie. ReCrement) Average monthly cost (age 62, non-smoker, zip: 48858, effeccve 1/1/17) Silver Plan for Single: $667 (29 plans available) - $280 aeer subsidy Bronze Plan for Single: $544 (61 plans available) - $157 aeer subsidy Both plans have a subsidy of $387 per month based on single household income of $36,000 (no Gold level plans were available to purchase) For Plan and Cost Es.mates outside of Open Enrollment, go to: PRESENTED BY ADVANTAGE BENEFITS GROUP 5

6 Pre-65 Re0ree Medical Op0ons PRESENTED BY ADVANTAGE BENEFITS GROUP 6

7 Pre-65 Will I Qualify for Lower Costs on Monthly Premiums? Marketplace Plan Savings Programs you may qualify for: Free or low-cost coverage through Medicaid based on income alone A Marketplace health plan with lower monthly premiums plus savings on out of pocket costs, like deduccbles and copayments A Marketplace health plan with lower monthly premiums You won t qualify for savings on a Marketplace insurance plan. You can buy insurance through the Marketplace at full price, or buy from other sources EsKmated 2017 Household Income based on number of people in your household *NOTE: Eligibility does vary based on age of applicant Below $16,394 $16,394 - $29,700 $29,701 - $47,520 Above $47,520 Below $22,108 $22,108 - $40,050 $40,051 - $64,080 Above $64,080 Below $27,821 $27,821 - $50,400 $50,401 - $80,640 Above $80,640 Below $33,534 $33,534 - $60,750 $60,751 - $97,200 Above $97,200 Below $39,247 $39,247 - $71,100 $71,101 - $113,760 Above $113,760 Below $44,960 $44,960 - $81,450 $81,451 - $130,320 Above $130,320 PRESENTED BY ADVANTAGE BENEFITS GROUP 7

8 Pre-65 What Does An Average (Silver) Plan Cost? Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium) MyPriority HMO HolisCc Silver 2500 (Priority Health) Individual Premium (age 62, zip 48858) = $677 per month $2,500 Single DeducCble, $7,150 Out of Pocket Maximum $30 copay aeer deduccble for first two Primary Care visits. Specialist $50 aeer deduccble $5 Generic Drugs Before DeducCble $60 preferred brand copay aeer deduccble, 20% coinsurance for specialty medicacons aeer deduccble 30% member coinsurance aeer deduccble for most other services MyPriority HMO HSA Silver 1500 (Priority Health) Individual Premium (age 62, zip 48858) = $730 per month $1,500 Single DeducCble, $5,250 Out of Pocket Maximum 30% coinsurance aeer deduccble for most services $20 generic drugs aeer deduccble $60 preferred brand copay aeer deduccble, 20% coinsurance for specialty medicacons aeer deduccble PRESENTED BY ADVANTAGE BENEFITS GROUP 8

9 Re0ree Medical Op0ons Post Medicare 2. Medicare Advantage Plan 3. Medicare Supplemental Plan PRESENTED BY ADVANTAGE BENEFITS GROUP 9

10 Re0ree Medical Op0ons - Medicare Who runs the Medicare Program? The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs Medicare. CMS is part of the U.S. Department of Health and Human Services Impact of recently enacted health reform on Medicare (2012) Enhanced prevencve care services Subsidy and discounts for drugs while in the donut hole Resource sites: hmp:// detailed Cmeline Kaiser Family FoundaCon PRESENTED BY ADVANTAGE BENEFITS GROUP 10

11 Medicare Medicare Benefits Part A: Hospital Coverage Part B: Medical Coverage Part D: PrescripCon Drug Insurance Part C: Combines Part A, B and D into one package PRESENTED BY ADVANTAGE BENEFITS GROUP 11

12 Medicare Coverage Choices Step 1: Decide how you want to get your coverage Start Part A (Hospital Coverage) Original Medicare Step 2: Decide if you want to add drug coverage Part D (PrescripCon Drug Insurance) Part B (Medical Coverage) Step 3: Decide if you want to add supplemental coverage Medigap (Medicare Supplement Insurance) Policy Medicare Advantage Plan (like an HMO or PPO) Part C (Includes BOTH Part A (Hospital Coverage) and Part B (Medical Coverage) and usually Part D Part D (PrescripCon Drug Insurance) END If you join a Medicare Advantage Plan, you don t need and can t be sold a Medigap policy. PRESENTED BY ADVANTAGE BENEFITS GROUP 12

13 Checklist: 5 Things to Do When You Get Medicare 1) Fill out an AuthorizaCon Form Medicare can t give personal health informacon about you to anyone unless you give permission in wricng first 2) Make a Welcome to Medicare Physical Exam Appointment This free, one-cme comprehensive exam is offered during the first 12 months you have Medicare 3) Sign up for MyMedicare.gov MyMedicare.gov is a secure online service where you can access you personal Medicare informacon 24 hours a day, every day 4) Choose and Join a Medicare Drug Plan (Part D) If you re new to Medicare, you have 7 months to join a Medicare drug plan 5) Download a Copy of Your Medicare Benefits Medicare s official Your Medicare Benefits publicacon explains the rules about which health care services and supplies Medicare covers PRESENTED BY ADVANTAGE BENEFITS GROUP 13

14 Medicare Part A Helps Pay for: Hospital stays ($1,316 deduccble, 1 st 60 days/$329 per day 61 to 90 days) Skilled nursing facility (SNF) care Long-term care hospitals Home health care Hospice care Blood For informacon, call MEDICARE PRESENTED BY ADVANTAGE BENEFITS GROUP 14

15 Paying for Medicare Part A Most people receive Part A premium free People with less than 10 years of Medicare covered employment will pay a Part A premium For informacon, call the Social Security AdministraCon (SSA) for TTY users PRESENTED BY ADVANTAGE BENEFITS GROUP 15

16 Part B Helps Pay for: Doctors services OutpaCent medical and surgical services and supplies DiagnosCc tests OutpaCent therapy OutpaCent mental health services PrevenCve health care services Other medical services PRESENTED BY ADVANTAGE BENEFITS GROUP 16

17 Paying for Medicare Part B: Most Medicare Part B beneficiaries will pay a premium amount of $ (higher income earners may pay more) in $183 per year deduccble 20% coinsurance for most services Some programs may help cover these costs AddiCon of PrevenCve Care Services Annual wellness exam Covers all wellness services/prevencve care services as outlined by Health Care Reform PRESENTED BY ADVANTAGE BENEFITS GROUP 17

18 Medicare Part D helps pay for: PrescripCon drugs provided by Medicare Approved PrescripCon Drug Plans (PDP) or Medicare Advantage Plans (MA-PD) These plans offer negocated discount prices based on a formulary with cost sharing Health Care Reform filled some or all of the donut-hole 50% manufacturers discount on brand name drugs Pay only 86% of plans cost for generic drugs PRESENTED BY ADVANTAGE BENEFITS GROUP 18

19 Paying for Medicare Part D $0 or reduced premium, deduccble and co-insurance if one qualifies for the Low Income Subsidy (LIS) Must meet income and asset criteria Eligibility determined by Social Security AdministraCon (SSA) 19 PRESENTED BY ADVANTAGE BENEFITS GROUP

20 The Affordable Care Act Closing the Doughnut Hole BRAND NAME DRUGS Health Care Reform closes the Part D Doughnut Hole (the gap in coverage during which people with Medicare must pay the full cost of their prescripcons out of pocket). HCR phases this out by decreasing the beneficiary s share of drug costs during the doughnut hole uncl it reaches 25% in 2020 for both brand name and generic drugs Year PharmaceuKcal Manufacturer Discount Plan Responsibility (gov t contribukon)* Consumer Responsibility 100% less the $250 rebate for brand name and generic drugs % 0 50% % 0 50% % 2.5% 47.5% % 2.5% 47.5% % 5% 45% % 5% 45% % 10% 40% % 15% 35% % 20% 30% % 25% 25% *Government subsidies to plans will account for the plan share of coverage for drugs. PRESENTED BY ADVANTAGE BENEFITS GROUP 20

21 The Affordable Care Act Closing the Doughnut Hole GENERIC DRUGS Year Plan Responsibility (gov t contribukon)* Consumer Responsibility % less the $250 rebate for brand name and generic drugs % 93% % 86% % 79% % 72% % 65% % 58% % 51% % 44% % 37% % 25% *Government subsidies to plans will account for the plan share of coverage for drugs. PRESENTED BY ADVANTAGE BENEFITS GROUP 21

22 Medicare Advantage Medicare Advantage Plans are health plan opcons that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan (Parts A, B, and D). This coverage can include prescripcon drug coverage. Medicare Advantage Plans include: Medicare Health Maintenance OrganizaCon (HMOs) Preferred Provider OrganizaCons (PPO) Private Fee-for-Service Plans Medicare Special Needs Plans When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services PRESENTED BY ADVANTAGE BENEFITS GROUP 22

23 Medicare Advantage To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addicon, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. If you join a Medicare Advantage Plan, your Medigap policy won t work. This means it won t pay any deduccbles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy. PRESENTED BY ADVANTAGE BENEFITS GROUP 23

24 Post-65 Medicare Advantage PRESENTED BY ADVANTAGE BENEFITS GROUP 24

25 Medicare Advantage PRESENTED BY ADVANTAGE BENEFITS GROUP 25

26 Medicare Advantage PRESENTED BY ADVANTAGE BENEFITS GROUP 26

27 Shopping for Medicare Advantage Plans: PRESENTED BY ADVANTAGE BENEFITS GROUP 27

28 Shopping for Medicare Advantage Plans: PRESENTED BY ADVANTAGE BENEFITS GROUP 28

29 Re0ree Medical Resources Isabella County Commission on Aging (989) Your Personal Financial Advisor Your Personal Home and Auto Insurance Agent Advantage Benefits Group hmp:// Blue Cross Blue Shield of Michigan Medicare: hmp:// Priority Health Medicare: hmp:// Centers for Medicare and Medicaid Services The Official U.S. Government Site for People with Medicare HealthSherpa Medicare and You hmp:// AARP hmp:// HealthCare.gov hmps:// PRESENTED BY ADVANTAGE BENEFITS GROUP 29