Medicare Overview October 17, Clay Carroll MMAP Counselor Department on Aging

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1 Medicare Overview October 17, 2018 Clay Carroll MMAP Counselor Department on Aging

2 Who am I Retired Group HR Mgr Eaton Paid Retiree Medical Claims in the 1980 s my first Medicare exposure Became thoroughly frustrated trying to help my mother so I landed here to help others I also fish

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4 Medicare How tough can it be? Well let s see Who is eligible for Medicare? Do I have to take Medicare? How many parts are there? How much do they cost? How do I get a drug plan? What if my drugs change? Is my pharmacy important What is an Advantage plan? What is a Supplemental plan? What is open enrollment and what do I need to enroll in and how often???? When do I get a special enrollment period? When do I do what and how often? Are we confused yet?

5 Medicare Tonight is your lucky night! Sort of We will answer all of these and most other questions you may have Please feel free to ask questions at any time I will get back to you through Kira if I need to research an answer I do not sell insurance or swampland in Florida My goal tonight is to educate and hopefully help you avoid mistakes and save MONEY!

6 Medicare This is the 30 thousand foot view We may defer complicated specific detail/personal questions to after the presentation Have been doing this for 10+ years and learn something new almost every week

7 What is Medicare? Federal Health Insurance established in 1965 for: People 65 years of age or older Some persons with disabilities, after a 24 month waiting period People with End-Stage Renal Disease People with Amyotrophic Lateral Sclerosis (ALS)

8 Medicare Overview How Medicare Works Currently There are currently four parts to Medicare plus an unlettered 5 th part Part A - Hospital Part B Outpatient Everything Part C Medicare Advantage Parts (ABD) Part D Prescription Drug Plans

9 Supplemental Plans ( Unlettered Fifth Part) Supplemental plans supplement the uncovered portion of some or all of the expenses in Medicare Parts A and B (Not D!) They are not considered part of the Medicare system (so have no letter) because you purchase them from private insurance companies unlike drug plans?????? But they are standardized by medicare (10 plans)

10 Original Medicare Medicare Part A covers inpatient hospital services, skilled nursing home care, home health care and hospice care. Medicare Part B helps pay the cost of doctors' services, outpatient hospital services, medical equipment and supplies and other health services. Also some RX s are covered by part B

11 Additions to Original Medicare Part C Optional Medicare Advantage Plans Health Plan (HMO, PPO, PFFS) offered by private health plans You are either in Parts A,B,D or you are in an advantage plan Part C Many employer plans are advantage plans which can be all over the map

12 Additions to Original Medicare Part D- Prescription Insurance Stand alone plan added to Original Medicare around 2006 Coverage is usually included in Med Adv Plan Needs to be reviewed every year during open enrollment, unless part of an advantage plan.

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14 Medicare Sign Ups Part A New to Medicare Age 65 7 Month period 3 months before and after the month of your 65 th Birthday Automatic if drawing Social Security (Get notice) Still Working with Emp coverage at 65? Usually want to sign up for part A but can delay part B if 20 or more employees

15 Medicare Sign Ups Part A Special Enrollment Period (SEP) Lose Coverage Move Etc Open Enrollment for C and D Annual October 15 to December 7

16 Medicare Part A Part A Hospital Coverage Generally No Premium To those eligible for Social Security Has a $1316 deductable Up to five times a year Deductable renews after being out for 60 days Then a new Benefit Period starts

17 Medicare Part A Covers 100 days in a rehabilitation Facility Skilled Nursing care required Covers first 20 days in full Days have a $163 daily co-pay

18 Home Health Care Medicare Part A Medicare pays in full Hospice Medicare pays in full except for $5 copay for palliative medications

19 Part A Questions?

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21 Enrolling in Medicare Part B Initial Enrollment Period 7 months beginning 3 months before age 65 General Enrollment Period January 1 through March 31 each year Coverage effective July 1 Premium increases 10% for each 12-month period you were eligible but did not enroll -

22 Medicare Part B Part B- Medical Insurance Covers Everything else deemed medically necessary except prescriptions, dental, and eye glasses What does it cost???

23 Medicare Part B Costs $ monthly premium in 2019* Annual deductible of $185 20% co-pay for most services with no maximum out of pocket (assumes using Medicare providers) Penalty for not signing up (10%/yr) Pay penalty for twice the amount of time you were late. (1 year late 2 years of penalty) *MAGI less then $85,000 Single $170,000 MFJ

24 Part B Questions?

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26 Medicare Part C Enrollment Medicare Advantage Plans Open enrollment October 15 to December 7 each year Can switch back to original Medicare from January 1 st to Feb 14 If switch have until February 14 to select a drug plan (When you enroll in a drug plan it automatically takes you out of your advantage plan if your advantage plan has an RX component)

27 Medicare Part C Medicare Advantage Plans Private Insurance that combines A,B, and usually D You move out of original Medicare Insurance receives your $135.5 from SS - plus the premium you pay - plus a government subsidy (removed replaced under ACA) These plans are generally more profitable for the insurance company over standard Medigap plans and get more sales push.

28 Medicare Advantage Plans Part C Takes you out of Original Medicare so they may change the structure of benefits Benefits may not be as good as original Medicare in many cases with a MA plan. You can be subjected to many additional co-pays and/or deductables Plans are generally HMO, PPO, or Private Fee For Service and generally limit doctor choice Many don t travel well Must be enrolled in both A & B to purchase When they offer you an advantage plan for 0 premium beware of the fine print Employer Advantage plans may be better then individual

29 Medicare Advantage Plans - Part C They are subject to a yearly Annual Enrollment Period (you do not have to re-enroll) Premiums may go up and benefits may change each year Potential for very expensive eye care, Gym Membership, and dental care They do offer plans with those Your main advantage - One place for all your medical issues The advantage here could be to the Insurance Company Plans vary by state

30 Part C Questions?

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32 Supplemental Plans Enrollment Open enrollment 6 months after enrollment in Part B Guaranteed Issue Rights Cannot use medical underwriting***** Private Insurance so you can opt out or in most any time but.. Pre existing conditions and physical health may apply after the 6 month enrollment window

33 What if I work beyond age 65 If you have employer coverage Medicare becomes secondary to your employer coverage when you turn 65 Generally considered credible coverage Exception Less then 20 emp. Medicare Primary

34 Supplemental Plans ( No Letters Yet but soon) Employer Retiree Medical Medigap Medicaid Income/Asset based These plans help cover the gaps in original Medicare

35 Medigap Plans Sold by private insurance companies Fills some or all of original Medicare gaps (copayments, coinsurance and deductibles) Plans are standardized by state and are labeled with letters Set of core benefits for each standard plan Costs vary by plan and by company Enrollment Disenrollment are voluntary private insurance but may have pre-existing issues

36 Medigap Don t need Medigap if you are In a Medicare Advantage plan Have retiree medical coverage Have full Medicaid Ready for more letters -

37 Medigap There are 10 types of standard Medigap plans that vary by State A B C D F G K L M N Each letter signifies a different level/type of benefits but all plans in one category (A plans for instance) are the same regardless of company you buy from

38 Medigap Vs Medicare PARTS ABCD of Medicare and PLANS ABCDFGKLMN of Medigap are totally different animals The dog gets it the cat not so much

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40 Ok Great Got it Now how much does it Cost? Let s take a minute to look at your sheets

41 Medigap Plans G plan is a G plan but.. Premiums for plans can vary greatly Hundreds a month for the same plan with the exact same benefits! Most all plan premiums will go up with age. If changing companies may have pre-existing condition issues

42 Conclusion Determine how much coverage you want if any - it is not required Medigap plans piggy back and are good where ever your Medicare works. Shop around Get Help if needed United Medicare Advisor may be good place to start.

43 Pre Existing Condition w/supplement No issue if within the first 6 months after you are eligible for part B*** No issue if you involuntarily lose coverage for the first 63 days after you lose the coverage Otherwise you could be subjected to underwriting and they can accept or reject you and charge you according to your conditions if they accept you. (Whew) *** (If you have/had insurance at that time)

44 Supplement Questions?

45 Medicaid Should not be confused with Medicare different levels of help Income/Asset based Some beneficiaries qualify for Medicare Savings Plan in which the state pays their Medicare Part B premium for them. Upper income limits are Single: less than $1,325 month, assets under $7,280; couple: less than $1,792 month and assets under $10,930 Contact Dept On Aging for Specifics

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47 Medicare Part D When should I Enroll 1. New to Medicare 7 month period 2. Annual Election Period October 15 th December 7 th 3. Special Enrollment Period (63 days) Low income, involuntary loss of credible coverage, moved outside of plan s service area, etc.

48 Medicare Part D I affectionately refer to this as No drug company left behind Who is eligible Anyone who has Medicare Part A or Part B and does not have an employer plan Enrollment is voluntary- but

49 Penalty For not Signing Up! If you do not enroll in Medicare Part D when they are first eligible and did not have creditable coverage, you are subject to a penalty Penalty is in the form of higher premiums should you elect to join a Medicare Part D plan later 1% of the National Average Premium (approx $4 per year you did not have a plan) applied monthly forever!

50 Creditable Coverage People who have other drug coverage that is at least as good as Medicare s drug coverage may keep their coverage and incur no penalty (Example VA, employer) If someone involuntarily loses creditable coverage, there is a Special Enrollment Period. The SEP begins upon notification of coverage loss and ends 63 days after coverage ends.

51 Medicare Part D Standard Plan How it is designed or - Who Thought This Up? 400+ Dollar deductable Patient to pay 25% plan 75% When total drug cost reached $3800 You have the DONUT HOLE Used to be zero coverage until total drug cost reached $7500+ Then you pay 5 % the insurance pays 95%

52 Medicare Part D 2019 Senior pays 100% Presc. Plan pays 75% Prescription Plan pays 75% brand name 64% generic Presc.Plan pays 95% (up to $400) Senior pays 25% Senior pays 25%brand 36% generic Sr. Pays 5% Annual Deductible Phase Initial Coverage Phase Coverage Gap Or Doughnut Hole Phase Catastrophic Coverage Phase $0 $400 drug cost $3700 drug cost $7425 drug cost or $4950 out-of-pocket drug cost (includes gap discount)

53 Medicare Part D Coverage Gap is closing with ACA Plans pay 75% for brand name drugs and 64% for generics in 2019 Hole continues to close for the next couple years in 2020 will be 75/25 70 of the 75% of coverage for brand named drugs through the donut hole is being funded by drug companies based on the Affordable Care Act So how hard can it be???

54 Medicare Part D What we got! 29 prescription drug plans in Jackson County Each plan can have different attributes Premiums Deductibles Co pays Covered drugs Tier Levels That s a minimum of over 230 possible options to look at for each drug you take

55 Medicare Part D Premiums can vary from $14.50 to $ (Avg mid 30 s) And if that is not enough to confuse you - they may also have restrictions requiring: Prior Authorizations Step Therapy Quantity Limits Another 87 potential variations 26 Plans have preferred pharmacies! CVS/Kroger 20+ Plans are enhanced

56 Medicare Part D In addition all plans change from year to year Premiums,Deductibles,Drugs Covered Co Pays Drug tier levels 1,2,3,4,5 Prior Authorizations Step Therapy Quantity Limits

57 Medicare Part D What happens if your drugs change during the year? Stuck until open enrollment Possibly get samples Every plan has a drug for every condition - May not be the one your doctor wants You will get a formulary with your plan

58 Medicare Part D You must check each year to see if your plan is still the best for you Medicare.gov is the easiest place to get this information. Easy to do if somewhat knowledgeable about Computers and the Internet Your pharmacy may help you - but beware DOA offers this service Does Training You can save your drug list on line and add or remove drugs at any time to see your cost You can use this list for your annual drug plan search

59 Additional Help for Part D - LIS Extra help program available through Social Security that assists with Part D premiums and copays. 2 levels of assistance based on income and assets Upper limits Single: income less than $1,485 month and assets less than $13,640. Couple: Income less than $2,002 month and assets less than $27,250 Can apply at Social Security or by calling JDOA for help.

60 Medicare D Tips For 2019 use CVS and Kroger as pharmacies initially (only 2 at a time) Do a personalized search Record your drug ID and password date Be prepared to change plans and pharmacies every year Ask your doctor if alternatives exist for very expensive meds Look at needymeds.org for extra help with expensive meds

61 Review Lets look at some of the questions we opened with -

62 Medicare Maybe not so tough now? Well let s see Who is eligible for Medicare? Do I have to take Medicare? How many parts are there? How much do they cost? How do I get a drug plan? What if my drugs change? Is my pharmacy important What is an Advantage plan? What is a Supplemental plan? What is open enrollment and what do I need to enroll in and how often???? When do I get a special enrollment period? When do I do what and how often? Are we less confused yet?

63 Summary A very complex subject Do not be shy about asking for help On your own can cost you money.and AARP or Blue Cross may not be your best bets every time.. DOA services are all donation based You can reach Amy Minnix, or Lisa Rudolph on the MMAP Hotline or call the Department on Aging Leave message You can reach me anytime through Kira unless I am fishing!

64 Any Questions? If you have a question later you can contact Kira and she will advise me or call Amy.