MEDICARE WITH EASE WORKBOOK

Transcription

1 MEDICARE WITH EASE WORKBOOK

2

3 Table of Contents Activity 1: My Timing-At-A-Glance Activity 2: My Decision Road Map Activity 3: My Three P s Activity 4: My Needs: What Is Not Covered Activity 5: My Costs Activity 6: My Medicare Choices My Resources

4 Timing-At-A-Glance Timing is everything when it comes to Medicare claiming your benefits, avoid paying more, or worse penalties. As you approach the age of 65, pay attention to the opening windows, how long they re open, and when they might open again. Medicare Part A When can I initially enroll? Once you are 64-years and 9 months old, or otherwise become eligible for Medicare, you can enroll (at your local Social Security office). If you are already collecting Social Security benefits, it s automatic. What if I m late? You may pay a penalty on your premium when you sign up late only if you nor your spouse contributed enough to Social Security and therefore you pay a monthly premium on Part A. Otherwise, there is not a penalty for signing up late. Medicare Part B You have a 7-month window. The three months prior to your eligibility month until three months after. Premiums will be higher unless you qualify for an exception. Contact Medicare to see if you qualify. Medicare Part C Medicare Part D Medicare Supplement (Medicap) Insurance You have a 7-month window. The three months prior to your eligibility month until three months after. You have a 7-month window. The three months prior to your eligibility month until three months after. At age 65, and enroll in Part B, you have a 6-month window for guaranteed right to buy a Medicare supplement policy. (Note: you cannot be denied if you enroll during this period) Unless you qualify for an exception, if you miss your window, you ll need to wait to enroll during the period of October 15 December 7. Premiums could be higher if you enroll later. Unless you qualify for an exception, if you miss your window, you ll need to wait to enroll during the period of October 15 December 7. You can apply later, just be aware you may be charged a higher rate (or possibly denied) if you are considered higher-risk health wise. MY TIMING - 7 MONTH WINDOW Year: 20 3 months prior 3 months after Birthday Month 65! Write Month Write Month Write Month Write Your Birthday Month Write Month Write Month Write Month I enrolled in Part B in: of 20 My guaranteed right to buy, should I choose Medigap (month) (year) insurance is until: of 20. (month) (year) 1

5 Enrollment Calendar Circle the month you turn 65: If enrollment into Medicare is automatic, Medicare card will arrive during the month of: If self-enrolling into Medicare, you can enroll anytime after: (card will arrive in 3-4 weeks) When Medicare enrollment is complete, you can apply for a supplemental plan and drug plan, or an Advantage plan after: January September October 1 October 1 February October November 1 November 1 March November December 1 December 1 April December January 1 January 1 May January February 1 February 1 June February March 1 March 1 July March April 1 April 1 August April May 1 May 1 September May June 1 June 1 October June July 1 July 1 November July August 1 August 1 December August September 1 September 1 *Medicare coverage begins the month you turn 65. However, if your birthday falls on the 1st, coverage will begin the month prior to your birth month and therefore enrollment options are also available one month earlier. 2

6 Your Road Map Choose the option that best fits your needs. 1: Still working and covered under employee group insurance from an employer with at least 20+ employees... OPTION 1 OPTION 2 STAY with employee group insurance. LEAVE employee group insurance. DELAY enrollment in Medicare. No Penalties! No Loss of Options! ENROLL in Medicare. No Penalties! No Loss of Options! SELECT either Medigap or Medicare Advantage. 2: Collecting Social Security... Enrollment in Medicare A & B is usually automatic. Choose one of the following: OPTION 1 Retiree or Employee Group Insurance (Credible Coverage) DELAY Enrollment in Medicare Part B 3: Not Collecting Social Security. Choose one of the following: OPTION 2 (select either) Original Medicare OR Medicare Advantage OPTION 1 OPTION 2 OPTION 3 Call Social Security to schedule an Get Entitlement Document to prove Select Retiree Group Insurance appointment to enroll in Medicare. effective dates and Medicare Claim (Credible Coverage), Call 100 days before your birth month. Number with Letter. Ask for a print Medigap or Medicare Advantage Your Health Map: Understanding these costs can help you save for the future Reducing your risks: Do you get enough sleep? Do you have a balanced healthy diet? Do you consider yourself physically active? Have you been to the dentist in the last year? Do you receive yearly preventive services? Screenings and Vaccinations? None of the above apply Your health risk factors: Claudication (leg pain) Cardiac arrest High Blood Pressure High cholesterol Alcohol/Tobacco Use None of the above apply 3 Genetic Factors/Family History: Increased Risks Stroke High blood pressure High cholesterol Diabetes Cardiovascular (heart) disease Arthritis Depression Asthma Breast Cancer Colon/Colorectal Cancer Prostate Cancer (OTHER: TYPE) Cancer Kidney Disease UNSURE NONE X Direct family OR family on either Mother / Father s side

7 Health History Decision Road Map: Things to consider before you decide NOTE: Medicare coverage is an important decision. Be proactive about investigating what is available in your area and compare the plans. If you have health care coverage now from an employer, talk to your company benefits manager about your options. Taking a look at you: Are you eligible for any health care coverage besides Medicare? You may find that you want to keep some of that coverage. How is your health? Are you in good health generally or do you have Chronic Conditions? Chronic Conditions: (i.e. heart disease/ cancer / diabetes) How often do you see your doctor: (Regularly / Preventative / Emergencies) Do you visit a Specialist? Do you take prescription drugs regularly? How much do you travel? Where Inside or outside the United States? How much did you spend on medical last year? That total can help you estimate next year s costs. How does health care fit into your budget? Will you need financial help to afford Medicare premiums? How much will you be able to spend a year on your share of the costs? Even if you do not need help with premiums, do you want to have a plan that covers as many financial gaps as possible? Are you okay with switching Doctors? Helps determine HMO & PPO. 4

8 Physicians/Prescriptions/Pharmacies PHYSICIAN/Clinic Name Phone Primary Physician or Specialist (what type) Address PRESCRIPTION Name Dosage Quantity Brand or Generic PHARMACY Name Phone Address 5

9 Not Covered What Plans Don t Cover Circle or Highlight any services (in bold print below) you think or you know you might need. A & B C D (Original Medicare) (Medicare Plan C) (Medicare Plan D) Skilled Nursing* or Rehabilitative Care Personal Care Assistance Alternative Medicine Cosmetic Surgery Vision, Hearing, Foot and Dental Care Miscellaneous Hospital Costs Other Excluded Costs Overseas Coverage Long-Term Care There are some exceptions to these exclusions, especially if you are enrolled in a Medicare Advantage plan. In addition, depending on the Medicare coverage you select, you will pay monthly premiums as well as annual deductibles, coinsurance and co-payments. Medicare Advantage plans are required to provide the same services as Medicare Parts A and B, except they don t provide hospice care, which is still covered by Original Medicare. You can keep your Medicare Advantage plan and receive hospice at the same time. Plans that include drug coverage may have restrictions. Two ways to get prescription drug coverage (Medicare Part D): if you have Original Medicare, you purchase a stand-alone plan or you get your selected Medicare Advantage s Prescription Drug plan. Each private insurance company decides which drugs to cover and at what tier (different levels of out-ofpocket costs). Ex. one tier for brand-name drugs, another for generics and even a third tier for preventive drugs used to control certain medical conditions. Generics are usually the least expensive to you. It s a good idea to ask your doctor s office to check your insurance company s formulary of drugs to ensure what he/she is prescribing to you is: 1) covered and 2) at what tier. *This is not the same as a skilled nursing facility, which is covered. 6

10 Costs Overview Medicare Part A: Hospitalization Open Access: No Networks In-patient Hospital Care Skilled Nursing Facility Hospice Home Health Care A Premium: $0 per month (if you qualify) Deductible: $1,288 per benefit period Hospital Co-Pay: Days 1 60: $1,288 deductible Days 61-90: $322 per day Days : $644 per day Skilled Nursing Facility (SNF) Co-Pay: Days 1 20: $0 per day Days : $161 per day Medicare Part B: Medical Open Access: No Networks Out-patient Services Doctors & Specialists Durable Medicare Equipment Home Health Care Preventive Services B Premium: $ $ per month** Deductible: $166 annual Costs: 80/20 Medicare Pays: 80% You Pay: 20% Your 20% is Unlimited. You pay all excess physician charges. **Actual is based upon your Modified Adjusted Gross Income (MAGI) as reported on your tax return two years prior. Medicare Part C: Advantage Open Access: Network C Premium: $0+ (depends on your plan) + your Part B Premium Deductible: $0+ (depends on your plan) Costs: Copayments, coinsurance, or deductibles required by your Medicare Advantage plan. Always be careful to evaluate all costs related to any Medicare Advantage plan you re considering, not just the premium. Medicare Part D: Prescription Drug Plans Must have A &/or B. Network Pharmacies + Drug Formulary D Premium:*** $34.10 base (depends on plan) Stage 1: Deductible: $360 or $0 annual Stage 2: Co-Pays: Tier 1/preferred generic: $0-6 Tier 2/non-preferred generic: $0-12 Tier 3/preferred brand: $20-45 Tier 4/non-preferred brand: $35-95 Tier 5/specialty 25-33% Until TOTAL Retail Rx costs reach: $3,310 Stage 3: Coverage Gap: Generic: 58% of the total cost Brand: 45% of the total cost Until TOTAL out-of-pocket costs reach: $4,850 Stage 4: Catastrophic Coverage: You pay the greater of 5% or Generic: $2.95 Brand: $7.40 ***If your Modified Adjusted Gross Income (MAGI), as reported on your tax return two years prior, exceeds $84,999 (single)/$169,999 (joint), you are subject to an additional cost known as IRMAA (Income Related Monthly Adjustment Amount), ranging from $12.70-$72.90/mo. Medicare Supplement Plans (Medigap) Each carrier has to offer the same coverage within each letter plan as everyone else does. But, the costs range, depending on: How your provider sets their prices A plan s structure. Ex. Plan F high-deductible options If you require medical underwriting (and don t qualify for a guaranteed issue right) Discounts available (for women, non-smokers, married couples, paying annually, paying electronically, multiple policies, etc.) So compare policies, side-by-side, paying particular attention to how they structure their pricing, and fit it to your potential needs to estimate your total costs. 7

11 - Hospital (In-Patient) - Medical (Out-Patient) - Advantage Plans - Drug Plans Part A Premium $ /mo Part B Premium $ /mo Must have Parts A & B Must have A and/or B Networks: Open Access - Networks Open Access - Networks $ Deductible Stage : Annual Deductible $ Co-Pays with $ Deductible (Annual deductible) $ Deductible (Per benefit period) - / $ or $ Annual Maximum Out-of-Pocket Hospital Co-Pays: Days 1-60: $ deductible ADDITIONAL FEATURES: Stage : Initial Coverage T1 - Preferred Generic $ T2 - Non-Pref Generic $ T3 - Preferred Brand $ Medicare pays % You pay % Your 20% is unlimited. You Pay All Physician Excess Charges. Days 61-90: $ / per day Days : $ / per day SNF Co-Pays: Days 1-20: $ / per day Days : $ / per day T4 - Non-Pref Brand $ T5 - Specialty $ % Remain here until TOTAL RETAIL Rx costs reach $ Assignment: Physician Medicare Approved Amounts (MAA). Excess Charges: Physicians can charge up to % above the MAA. Check your Dr: medicare-gov/physician Stage : Coverage Gap (Donut Hole) Medicare Supplement Plans = Medi-Gap Policies Generic: You Pay % of the cost. Brand: You Pay % of the cost. Remain here until TOTAL* Out-of-pocket costs reach $ (*TOTAL also includes mfg. discount) Stage : Catastrophic Coverage You pay greater of 5% or $ / Generics $ / Brands My Costs *Original Medicare doesn t cover long term custodial care, routine eye or dental care, dentures, cosmetic surgery, acupuncture, hearing aids or exams for fitting them. MedicareGRID 8

12 Medicare Choices Medicare Choices Worksheet Original Medicare (Parts A & B): Government-provided Hospital & Medical coverage Prescription Drug Coverage (Part D): A stand-alone drug plan to add to your Medicare coverage Medigap (Medicare Supplements A/B/C/D/F/G/K/L/M/N): Coverage for services not covered by Original Medicare Medicare Advantage (Part C): A plan that combines the coverage of Parts A & B, and may include Part D + extra benefits. Allows you to see any provider who accepts Medicare In- patient hospital care Skilled nursing facility care Nursing home care Hospice care MY NEEDS Original Medicare Parts A & B Prescription Coverage Part D N/A (you can use any pharmacy) Medicare Supplement Insurance (Medigap) Medicare Advantage Part C (specialist referral may be required) N/A (auto- covered in Part A) Home health services Laboratory tests and X- rays Emergency ambulance services Mental health services Durable medical equipment Preventive services (pap tests, flu shots, screenings) Rehabilitative services (physical, speech, etc.) Vision, Dental and other additional benefits 9

13 Medicare Choices (continued) Offers low or $0 monthly premium for prescription drug coverage Limits your out- of- pocket MY NEEDS Original Medicare Parts A & B Prescription Coverage Part D Medicare Supplement Insurance (Medigap) Medicare Advantage Part C (may include) costs Offers low or $0 copays Offers low or $0 deductibles (some services) (some plans) (some plans) Covers prescription drugs (may include) Covers overnight hospital stays Offered through a private company Covers foreign travel emergency ^There are different forms of Medicare Advantage Plans from which to choose. (HMO, PPO, PFFS, SNPs, HMOPOS). Benefits will vary by plan. Each Medicare Advantage Plan offers plan- specific benefits. 10

14 Resources Need a Helping Hand? Every state has their own agency that offers free Medicare counseling to help you find the strategies that are best for you. These are called State Health Insurance Assistance Programs (SHIP). If you d like to somebody, find the number for the SHIP office in your state below. Alabama (TTY) Alaska (TTY) Arizona (TTY) Arkansas California Colorado (Español) Connecticut (TTY) Delaware Florida (TTY) Georgia Guam Hawaii Idaho Illinois Indiana (TTY) Iowa (TTY) Kansas Kentucky Louisiana Maine Maryland (TTY) Massachusetts Michigan Minnesota Mississippi Missouri Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon (TTY) Pennsylvania Puerto Rico Rhode Island (TTY) South Carolina South Dakota (TTY) Tennessee (TTY) Texas Utah y Vermont Virgin Islands (STX) (STT/ STJ) Virginia Washington (TTY) (Español) Washington D.C (TTY) (Español) West Virginia Wisconsin (TTY) Wyoming MORE RESOURCES Medicare Helpline MEDICARE ( ) Medicare.gov Social Security Administration (TTY) SSA.gov Administration on Aging x 711 (TTY) Eldercare.gov 11

15

16 2016 Joshua David Mellberg