Medicare and Its Gaps: Rights and Options You Simply MUST Know

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1 Medicare and Its Gaps: Rights and Options You Simply MUST Know THINKING RETIREMENT 1 Agenda Medicare ABCs When to apply Part A Part B Three Pathways to fill the gaps in Medicare Medigap plans Advantage plans Part D plans LTC plans Resources. THINKING RETIREMENT 2 1

2 Medicare ABCs THINKING RETIREMENT 3 When to enroll Medicare age is 65 Avoid late fees! Apply at later of: Age 65, or End of employer health insurance from current active work (yours or spouse s) Inquire promptly! Call Social Security 3 months before age 65 Be sure to supplement Medicare. THINKING RETIREMENT 4 2

3 Medicare Coverage: Two Parts of Original Medicare Part A: Hospital Insurance Inpatient hospital care plus follow-up care No premium for most Part B: Medical Insurance Doctor, outpatient, and certain other services 2017 monthly base premium: $109-$134 per person, for most. Source: THINKING RETIREMENT Medicare Part B Variable premiums 2015 Income, Individual filing 2015 Income, Joint filing 2017 Part B premium <= $85,000 <= $170,000 $109-$134 $85k - $107k $170k - $214k $ $107k - $160k $214k - $320k $ $160k - $214k $320k - $428k $ >$214,000 >$428,000 $ Source: THINKING RETIREMENT 6 3

4 Your Medicare card THINKING RETIREMENT 7 Gaps in Medicare THINKING RETIREMENT 8 4

5 Identifying gaps in Medicare Before 65: No Medicare Need to reach age 65 After 65: Medicare OK, but... Gaps in Parts A & B Long-Term Care gap Age 65 THINKING RETIREMENT 9 Before Medicare 3 Paths to age 65 & Medicare Retiree Medical Employer Individual Employer Union COBRA Own work Spouse s work Traditional Fee-For-Service, or HMO/Managed Care Medicaid Uninsured? THINKING RETIREMENT

6 While on Medicare Filling the Gaps in Medicare Retiree Medical Employer Individual Medicare Eligibility? THINKING RETIREMENT 11 While on Medicare Identifying gaps in Medicare Part A Deductibles ($1,316/benefit period of 60 days) Long hospital stays ( days) Part B Deductible ($183/year) Dental, eyeglasses, hearing aids, Rx Doctor bill coinsurance & excess fees Long-Term Care gap. THINKING RETIREMENT

7 Example 1: Part B gap Doctor bills Doctor Bill: $115 Medicare Allowable Charge: $100 You Pay $35 80% of Medicare Allowable : $80 Medicare Pays $80 THINKING RETIREMENT 13 So What? THINKING RETIREMENT

8 Example 2: Part B gap Doctor bills Doctor Bill: $230,000 Medicare Allowable Charge: $200,000 You Pay $70,000 80% of Medicare Allowable : $160,000 Medicare Pays $160,000 Medicare has NO Out-Of-Pocket Maximum! THINKING RETIREMENT 15 How to fill the gaps THINKING RETIREMENT

9 While on Medicare 3 Paths to fill the gaps Retiree Medical Medigap Advantage Medicaid THINKING RETIREMENT 17 While on Medicare Focus: Retiree medical Retiree Medical Medigap Advantage THINKING RETIREMENT

10 Focus: Retiree medical plans Retiree Medical Private insurance from employer or union Medicare is primary insurance; retiree medical is secondary Cost and coverage vary widely Generally cover prescription drugs If not, you also need Medicare Part D Contact your benefits office. THINKING RETIREMENT 19 While on Medicare Focus: Medigap plans Retiree Medical Medigap Advantage THINKING RETIREMENT

11 Focus: Medigap plans AKA Medicare Supplement plans Medigap Private insurance to supplement Medicare 10 different plans, standardized nationally Lettered A, B, C, D, F, G, K, L, M, N Coverage from basic to comprehensive Prices: about $60/mo. - $300/mo. Purchase within 6 months of Part B Also consider Medicare Part D Available from major insurance companies. Source: THINKING RETIREMENT 21 Chart: Medigap plan options 2017 $5,120 $2,560 Source: THINKING RETIREMENT

12 While on Medicare Focus: Medigap plans Retiree Medical Medigap Advantage THINKING RETIREMENT 23 Focus: Medicare Advantage AKA Medicare Part C/Health s Advantage Private insurance to replace Medicare Covers Parts A & B, plus additional benefits Typical additional benefits: Many include Rx Wellness care, Dental, Vision, and/or Hearing May be HMO, PPO, or other arrangement Moderate costs ($0 - $270 per month) Chosen by 30% of Medicare beneficiaries Available from insurance companies in select locations. Source: THINKING RETIREMENT

13 Prescription Drug Coverage THINKING RETIREMENT 25 While on Medicare 3 ways to get Rx coverage 1. Employer/Union retiree plan with creditable Rx coverage 2. Advantage plan including Part D coverage 3. Standalone Medicare Part D plan PDP = Prescription Drug Source: THINKING RETIREMENT

14 Focus: Medicare Part D Part D Private insurance to cover prescription drugs s not created equal: Varying formularies Varying pharmacy convenience Standard or Enhanced plan designs Costs: $15 - $160 per month Available from insurance companies Chosen by 70% of Medicare beneficiaries Often included in Advantage plan. Source: THINKING RETIREMENT 27 Variable Part D premiums 2015 Income, Individual filing 2015 Income, Joint filing 2017 Part D premium <= $85,000 <= $170,000 Base Premium (BP) $85k - $107k $170k - $214k BP + $13.30 $107k - $160k $214k - $320k BP + $34.20 $160k - $214k $320k - $428k BP + $55.20 >$214,000 >$428,000 BP + $76.20 Source: THINKING RETIREMENT

15 Part D coverage 2017 Deductible Period First $400 Initial Coverage Period $400-$3700 Coverage Gap ( Donut Hole ) $3700-$4950 Catastrophic Period Over $4950 You pay 100% You pay 25% You pay 40%-51% You pay ~5% THINKING RETIREMENT 29 While on Medicare 3 Paths with Rx coverage 1 2 Retiree Medical Medigap Including Rx Coverage Part D 3 Advantage Including Part D THINKING RETIREMENT

16 While on Medicare Cost Summary 1 Retiree Medical Including Rx Coverage $109 + $?? 2 Medigap Part D $109 + $60 - $300 $15-$160 3 Advantage Including Part D $109 + $0 - $270 THINKING RETIREMENT 31 Example: Couple with different ages Paul older than Ruth Both under 65 Paul turns 65 Ruth Turns 65 Paul Individual Medicare + Medigap + Part D Medicare + Medigap + Part D Ruth Individual Individual Medicare + Advantage (Includes Part D) Medicare has no family plans, only individual plans. THINKING RETIREMENT

17 Long-Term Care Coverage THINKING RETIREMENT 33 Before Medicare or while on Medicare: Long-Term Care gap (Parts A, B, C, D) Self-Pay Medicaid Long-Term- Care Insurance THINKING RETIREMENT

18 Long Term Care Resources A Shopper's Guide to Long-Term Care Insurance Free PDF at prod_serv_consumer_ltc_lp.pdf Also contact your state SHIP: THINKING RETIREMENT 35 While on Medicare 3 Paths with Rx & LTC Retiree Medical Medigap Advantage Including Rx Coverage Part D Including Part D AND LTC Insurance (Optional) THINKING RETIREMENT

19 Medicare Resources THINKING RETIREMENT 37 Medicare Resources Information Publications Medicare & You Finders Medigaps, Advantage & Part D s Also contact your state s Senior Health Insurance Program (SHIP) THINKING RETIREMENT

20 98125 THINKING RETIREMENT 39 Your questions? THINKING RETIREMENT

21 Thank you! Andy Landis THINKING RETIREMENT THINKING RETIREMENT

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