Making the most of Medicare

Transcription

1 & BCBS Nebraska Sponsor Making the most of Medicare NOT FDIC INSURED ı MAY LOSE VALUE ı NO BANK GUARANTEE NOT A DEPOSIT ı NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY First Westroads Bank, Inc. is not affiliated with Lincoln Financial Advisors Corp. Mike Beacom & Brian Kelly are registered representatives of Lincoln Financial Advisors Corp. > Securities and investment advisory services offered through Lincoln Financial Advisors Corp., a broker/dealer (member SIPC) and a registered investment advisor. Insurance offered through Lincoln affiliates and other fine companies. CRN > You may want to consult a legal or tax advisor regarding this information as it relates to your personal circumstances. Neither Lincoln Financial Advisors nor its representatives offer legal or tax advice. 2

2 Making the most of Medicare

3 Today s Presenter Matthew Leonard Manager, Consumer Sales Blue Cross and Blue Shield of Nebraska 4

4 Today s topics: >What is Medicare? >Who s eligible? >Medicare coverage >Options to fill coverage gaps >When you can enroll >Finding the right plan >Additional help and resources 5

5 What is Medicare >Enacted by Congress in 1965, Original Medicare is a health insurance program >Original Medicare has two parts Medicare Part A and Medicare Part B >The Medicare Modernization Act of 2003 added prescription drug coverage known as Medicare Part D >Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) 6

6 Who s eligible > Must be United States citizen or permanent legal resident who has resided in the United States for five continuous years and are: Age 65 or older and eligible to receive Social Security OR Under age 65, permanently disabled and have received Social Security disability benefits for at least two years Diagnosed with end-stage renal disease (ESRD) 7

7 Medicare coverage choices Medical + Prescription Drugs Original Medicare Medicare Advantage Prescription Drug Plan Medicare Supplement Medicare Cost Plans Medicare Advantage + Prescription Drugs 8

8 Original Medicare Benefits: Part A > Coverage for: Inpatient hospital care and services Skilled nursing facility care Home health care Hospice care > Premium: Generally, no cost to beneficiary > Hospital deductible: $1,216 (per benefit period-2014) Days 1-60 covered in full after deductible You pay $304 per day for days You pay $608 per day for additional 60 lifetime reserve days 9

9 Original Medicare Benefits: Part A (continued) > Skilled nursing covered up to 100 days after a 3-day hospital stay Days 1-20 covered in full, no deductible You pay $ per day for days > Hospice care covered if provided in Medicare-certified facility > Medicare-approved home health care covered in full 10

10 Original Medicare Benefits: Part B > Coverage for outpatient care and services as well as durable medical equipment > Premium: $ $ per month > Annual deductible: $ > After you pay the deductible, you pay 20% and Medicare pays 80% for most covered services > Preventive care: Medicare will cover a one-time routine physical exam within the first 12 months that you are enrolled in Part B coverage ( Welcome to Medicare ) An annual physical exam including lab tests Certain screenings and immunizations at $0 cost 11

11 Original Medicare Benefits: Part B (continued) >Doctor services, including hospital, clinic, office or home visits >Diagnostic X-rays, lab tests, radiation therapy >Medical supplies and services including durable medical equipment >Outpatient diagnosis or treatment services, including ambulatory surgical centers 12

12 Original Medicare Benefits: Part B (covered) >Ambulance transportation >Outpatient rehabilitation including physical, speech and occupational therapy >Unlimited home health visits when ordered by a doctor 13

13 What Original Medicare doesn t pay for: > Deductibles and coinsurance > Most outpatient prescription drugs > Charges for inpatient hospital and skilled nursing days beyond Medicare s limits > Services deemed not medically necessary or not allowed by Medicare > Most care received outside of the U.S. 14

14 Medicare plan options >Medicare supplement plans (Medigap) >Medicare Advantage plans >Medicare Cost plans >Generally, you will pay an additional monthly plan premium for these products 15

15 Options to fill coverage gaps: Medicare supplement plans > Medicare supplement or Medigap plans help pay for some of the gaps that Medicare doesn t cover > Different Medicare supplement plans are offered in different states 16

16 Options to fill coverage gaps: Medicare supplement plans (continued) > Premiums may change each year > Benefits usually don t change each year > No longer cover outpatient prescription drugs > Regulated by each state, not Medicare > Must have both Medicare Part A and Part B coverage to be eligible to enroll in a Medigap policy 17

17 Options to fill coverage gaps: Medicare supplement plans (continued) > Best time to buy is during initial Medicare supplement plan open enrollment period First six months of Part B enrollment After open enrollment, may have medical underwriting > If in a Medigap plan, can try a Medicare Advantage plan for first time and return to Medigap plan within 12 months without providing health history 18

18 This information is effective January 1 through December 31,

19 Dental Essentials 20

20 When you can enroll > Age 65 and/or when you apply for Social Security benefits > Enrollment in Part A is usually automatic when you apply for Social Security > You must choose to enroll in Part B and Part D enrollment is not automatic > If you re under 65 and have received Social Security or Railroad Retirement disability benefits for 24 months 21

21 When you can enroll (continued) > Medicare Advantage Disenrollment Period (MADP) or Annual Disenrollment Period (ADP) Held each year from January 1-February 14 Specific opportunity to switch coverage from Medicare Advantage to Original Medicare and a Prescription Drug Plan > Medigap Open Enrollment No health history required if you enroll within the first 6 months of your enrollment in Part B > Special Election Period (SEP) Offered to beneficiaries who meet specific eligibility criteria 22

22 Finding the right plan >How much are you comfortable paying in premiums each month? >How much do you want to share in the cost of services? >Do you want additional health coverage and/or a prescription drug plan? Or is Original Medicare enough coverage? 23

23 Finding the right plan (continued) >Do you plan to move out of state? >Is it important that your benefits remain the same each year? >Are you familiar with the companies who offer the product(s) you want? Choose a company you have faith in. 24

24 Finding the right plan (continued) >Do you want to continue seeing your current doctor? Do other providers you use accept the plan? >What about access to doctors and hospitals? Some provider networks are extensive and include providers in nearby states or across the country. 25

25 Finding the right plan (continued) > Do you travel? Plans vary in their travel benefits and the length of time you ll be covered. How often you travel and for how long should be considered. 26

26 Additional help and resources > Social Security Monday-Friday, 7 a.m to 7 p.m TTY > Medicare Helpline 7 days a week, 24 hours TTY or 27

27 Additional help and resources (continued) > For more information about Medicare benefits and services: MEDICARE ( ) TTY hearing impaired users call hours a day, seven days a week > State Health Insurance Assistance Program for Nebraska (SHIP):

28 Additional help and resources (continued) > Visit For Medigap policies in your area, select Health and Drug Plans, and then select Compare Medigap Policies. For updated phone numbers, select Help and Support, and then select Useful Phone Numbers and Websites. 29

29 Questions? 30