Medicare 101 and Senior Advantage Group Offering. Conejo Valley Unified School District November 16, 2009

Transcription

1 Medicare 101 and Senior Advantage Group Offering Conejo Valley Unified School District November 16, 2009

2 What is Medicare? Medicare is a federally funded health insurance program Established in 1965 Administered by the Centers for Medicare & Medicaid Services (CMS) 2

3 Who is eligible? Medicare beneficiaries include: Individuals 65 or older If they or their spouses are eligible for Social Security benefits Individuals under 65 who are disabled Must be eligible for Social Security disability benefits Requires two-year waiting period Individuals with end-stage renal (kidney) disease (ESRD) 3

4 Medicare Part A Inpatient insurance Hospital, skilled nursing facility, hospice, home health care Eligibility Cost First day of the month that you turn 65 Two years after becoming disabled After end-stage renal dialysis begins No premium if you or your spouse have worked 40 quarters of Medicare-covered employment If you worked fewer than 40 quarters, there is a monthly premium which is set by a Medicare formula 4

5 Medicare Part B Outpatient insurance Physician services, outpatient surgery, lab, radiology, durable medical equipment (DME), dialysis Enrollment Optional: You are responsible for enrolling with Social Security Administration You can enroll over a seven-month period, which starts three months before your 65th birthday Late enrollment penalty for those who do not enroll in this seven-month window 5

6 Medicare Part B Cost Monthly premium is usually deducted from Social Security check Premium goes up 10 percent for each 12-month period that you decline coverage Known as late enrollment penalty Not imposed if you continue to work for, and receive your health coverage from, an employer group or trust fund plan of 20 or more eligible employees In 2009, Part B premium ranges from $96.40 to $308.30, depending on your income Most beneficiaries pay $

7 Medicare Part B 2009 Monthly Premiums for Medicare Part B You Pay If your yearly income is Single Married Couple $96.40 $85,000 or less $170,000 or less $ $85,001 $107,000 $170,001 $214,000 $ $107,001 $160,000 $214,001 $320,000 $ $160,001 $213,000 $320,001 $426,000 $ Above $213,000 Above $426,000 You Pay If you are married but you file a separate tax return from your spouse and your yearly income is: $96.40 Under $85,000 or less $ $85,001 $128,000 $ Above $128,000 Source: socialsecurity.gov 7

8 When to purchase Medicare Part B Option 1 You can postpone purchasing Part B until you decide to retire. There is no late enrollment penalty if you postpone Part B enrollment due to primary coverage through an employer group or trust fund. 8

9 When to purchase Medicare Part B Option 2 If you are still working, you can purchase Part B. Medicare becomes the secondary payer. You don t assign your Medicare coverage to Kaiser Permanente, but instead use other providers that accept Medicare. This may be more expensive for you. Note: If you are still working, have Medicare Part A, and use non-kaiser Permanente providers, Medicare may deny your claim. 9

10 When to purchase Medicare Part B Option 3 If you are still working, you can purchase Part B. Medicare becomes the secondary payer. In this option, you assign your Medicare coverage to Kaiser Permanente and enroll in the Senior Advantage plan. You get richer benefits, such as $0 copayments. 10

11 Scenario Mary is 64 and will be turning 65 this year in December. She decides that she will continue to work until she is 70. Mary calls Social Security and tells them that she wants to postpone enrolling in Medicare Part B until she turns

12 Scenario Frank is 67, still working, and currently has Medicare Part A only. Frank s medical condition requires him to go to the doctor once a week. He recently started taking several prescription drugs. Frank calculates his financial situation, adding up the copayments for visiting the doctor and for his prescription drugs. Frank decides to purchase Medicare Part B and assign his Medicare coverage to Kaiser Permanente to help reduce his monthly expenses. 12

13 How to enroll in Medicare Part B Fill out an Application for Enrollment in Medicare Part B. Mail it to the nearest Social Security office. or Submit it in person to any Social Security office. Note: Completing the application form and submitting it does not automatically enroll you in Medicare Part B. Social Security must first determine if you are eligible to enroll. 13

14 Medicare Part C Medicare Part C created private plan options for how you receive Medicare coverage Option 1: Original Medicare through the Centers for Medicare & Medicaid Services (CMS). Option 2: Original Medicare through CMS plus Medicare Supplement (Medigap) plans Option 3: Through a private insurer plan, such as an HMO also known as a Medicare Advantage plan 14

15 Senior Advantage The Kaiser Permanente Senior Advantage plan is a Medicare Advantage plan for people with Medicare. Senior Advantage provides services covered by Medicare (including Medicare Part D prescription drug coverage). Senior Advantage members get Medicare benefits through Kaiser Permanente. The Medicare program pays Kaiser Permanente to manage health care for people with Medicare (our Senior Advantage members). 15

16 Medicare Part D Medicare Modernization Act (MMA) created Medicare prescription drug coverage (Part D), effective January 1, Enrollment options Private insurer plan, such as Kaiser Permanente Prescription Drug Plan (PDP): A plan type that offers prescription drugs only Note: Unlike Parts A and B, members enroll in Part D directly with their plan. Part D is not available through Medicare or Social Security. 16

17 Medicare Part D Enrolling in Part D You are eligible for initial enrollment during the seven-month period after you turn 65. Late enrollment penalty (LEP) As with Part B, members must obtain Part D or creditable Part D coverage as soon as they are eligible or they will be charged a penalty. LEP is 1 percent per month that enrollment is deferred. 17

18 Medicare Part D Medicare s extra help program For Medicare beneficiaries with limited income and resources Provides extra help with Part D premiums and outpatient drug copayments Degree of help depends on income and resources Additional facts about extra help Apply at Social Security Administered by the member s plan, for CMS Beneficiaries must be enrolled in a Part D plan to receive assistance 18

19 Senior Advantage Group Offering Conejo Valley USD is offering a self-pay group plan for Medicare-eligible retirees for the very first time. You must have Medicare Parts A and B to join. You must reside in California and in a Kaiser Permanente CMS approved service area. Special enrollment date: Nov. 15 Dec. 18, 2009 Effective date: January 1, 2010 June 30, 2010 Monthly premiums are paid directly to Conejo Valley USD. Senior Advantage covers Medicare Part A and Part B and includes Part D prescription coverage. 19

20 Conejo Valley USD 2010 Senior Advantage Summary of Benefits Services Annual Out-of-Pocket Maximum SENIOR ADVANTAGE HIGH PLAN Monthly Premium $ $1,500 per calendar year $3,000 per c alendar year SENIOR ADVANTAGE LOW PLAN Monthly Premium $ $1,500 per calendar year $3,000 per calendar year Office Visits $10 per visit $20 per visit Lab/X-rays No charge No charge Outpatient Surgery $10 per procedure $50 per procedure Hospitalization Services No charge $200 per admission Emergency Services $50 per visit $50 per visit Ambulance Services $50 per trip $50 per trip Prescription Drugs Generic Brand $5 for up to a 100-day supply $15 for up to a 100-day supply $10 for up to a 100-day supply $25 for up to a 100-day supply Durable Medical Equipment 20 percent coinsurance 20 percent coinsurance Eyewear $150 allowance $125 allowance 20

21 Senior Advantage Election Form Senior Advantage enrollment kits can be picked up today or can be requested through the Conejo Valley USD office Fill out: 1. Group application form 2. Senior Advantage Election Form 3. Mail them in the enclosed envelope 21

22 Already a Senior Advantage Member? Some of you may already be a Senior Advantage Individual Plan Member Fill out: 1. Group application form 2. Short Election Form 3. Mail it in the enclosed envelope. 22

23 Information and Resources Medicare For questions about Medicare, you visit medicare.gov or call MEDICARE ( ) TTY Social Security For assistance with questions about your Medicare eligibility and enrollment or Social Security retirement benefits, visit socialsecurity.gov/mediinfo.htm or call TTY Health Insurance Counseling & Advocacy Program (HICAP) For questions related to buying insurance, choosing a health plan, and your rights under Medicare, call Kaiser Permanente Senior Advantage Conversion Specialist If you are turning 65 soon, retiring, and Medicare eligible, call Kaiser Permanente Senior Advantage Member Services If you have questions about your benefits after you become a Senior Advantage member, call

24 Anyone who has Medicare Parts A and B, including some people under the age of 65 with disabilities, may apply. You must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. You must continue to pay your Medicare Part B premium and any other applicable Medicare premium(s). For more information, please contact Kaiser Permanente. Except for emergency care, urgent care when our network is not available, or out of-area dialysis care, a Kaiser Permanente Plan provider must authorize or provide covered services, including referrals to specialists. If you obtain any other care from non-plan providers, neither Medicare nor Kaiser Permanente will be responsible for the costs. This plan includes Medicare Part D prescription drug coverage that is available only to Kaiser Permanente Senior Advantage members. You may be enrolled in only one Part D plan at a time, which means you will be disenrolled from any other Part D plan when your coverage under our Plan becomes effective. This plan uses a formulary, which lists covered drugs (see kp.org/seniorrx). In most cases, you must obtain covered drugs at one of the pharmacies listed in our pharmacy directory or through our mail order service. You can get a copy of the directory at kp.org/seniorrx or by calling us toll free at (TTY for the hearing/speech impaired), seven days a week, 8 a.m. to 8 p.m. Kaiser Permanente is a Medicare Advantage organization with a Medicare contract, which is renewed annually. Coverage beyond the end of the contract year is not guaranteed. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: Social Security at (toll free) between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call (toll free). Or visit Your State Medicaid office. To obtain general information about extra help, call MEDICARE ( ). TTY/TDD users should call , 24 hours a day, seven days a week. Or visit SKU (10/2009) 24