Retiree Medicare Solutions With a Personal Touch. Ted O Connor Borislow Insurance (781)

Transcription

1 Retiree Medicare Solutions With a Personal Touch Ted O Connor Borislow Insurance ted@borislow.com (781)

2 Various Parts of Medicare Which Parts work together? Part A Inpatient Hospital Care Part B Outpatient and Medical Care Medi-Gap / Supplement Plans Part D Prescription Drug Plans Part C Medicare Advantage Plans "2

3 Find a Personal Touch "3

4 Formula for Success for Medicare-Eligible Receive Proper Medicare Education What is Part A & Part B and how do you sign up? Do Research on Insurance Carriers What is available in your area of residence? Develop Scale of Importance What plan element is most important to you? Properly Plan For Your Effective Date Prevent any gaps of coverage Year Round Advocate Find support for Annual Enrollment Period "4

5 What to expect when you enroll "5

6 Insurance Carriers Choice Matters What is available to you in your area? "6

7 Original Medicare Part A Details Inpatient Hospital Coverage Medicare Part A (Inpatient Hospital Insurance) Room, Food, Services and any Medications provided while inpatient $1340 Deductible with 60 day benefit period Not Annual Deductible Days co-pay per day Lifetime Reserve: Days co-pay per day Medicare Part A (Skilled Nursing Facility Care) Recovery stay after a 3 day Inpatient stay in the hospital Days 1-20 at no cost: Days $ per day co-pay Additional Part A Coverage Hospice Care for those terminally ill with services at home Home Health Care for short term skilled care for those recovering at home Blood in hospital after you pay for first three pints * No Premium if you or spouse paid FICA taxes for 40 quarters/10 years in a job Medicare.Gov *2017 "7

8 Original Medicare Part B Details Doctor Fees X-Rays Outpatient Surgery Medicare Part B (Medical & Outpatient Services) Provides coverage for services such as: Outpatient medical care Doctor visits Ambulance services Diagnostic tests Laboratory and Radiology tests Some medications for outpatient visits Some durable medical equipment Preventive Services Medicare Part B (Your Responsibility) Annual $183 Part B deductible* 20% Co-Insurance Medicare assumes 80% Unlimited 20% Co-Insurance: No out of pocket spending limit $ Standard monthly 2018 premium (see next slide for rates) Premiums deducted out of your social security check unless you are not collecting social security and then direct pay established *2018 Medicare.Gov "8

9 Part B Premiums 1 st Step in determining your overall Medicare costs 2018 Part B Premiums Based on Modified Adjusted Gross Income reported on federal tax return two years earlier: Premiums can fluctuate each year, based on income $ Standard Premium: $85,000 or less for individual or up to $170,000 for married couple. Part D Standard Premium $ Premium: $85,000 up to $107,000 for individual, and $170,000 up to $214,000 for married couple. Part D + $13.00 per month $ Premium: $107,000 up to $133,000 for individual, and $214,000 up to $267,000 for married couple. Part D + $33.60 per month $ Premium: $133,000 up to $160,000 for individual, and $267,000 up to $320,000 for married couple. Part D + $54.20 per month $ Premium: above $160,000 for individual, and above $320,000 for married couple. Part D + $74.80 per month *If new to Part B in 2018 *2018 Medicare.Gov "9

10 Two Road Paths in Medicare Decision Medi-Gap & Part D In Addition Medi-Gap is portable throughout country Can see any doctor or hospital that accepts Medicare Higher Premiums but pays the gaps in Medicare A/B with little or no out of pocket expenses Plans labeled by Letters A-N in 47 states. Plan F highest coverage plan In MA, Core & Supplement 1 plan are the only plans. Each plan has one rate for entire MA population with Guaranteed Issue Need to have Part A & B Enroll in separate Part D Rx plan Medicare Advantage - Part C Replacement Managed Plans such as HMO, PPO, POS and PFFS Need to follow doctor/hospital network directory Localized Plans Plans available to you in your zip code Some plans have low premiums but all services have co-pays and coinsurances to satisfy until you reach Out of Pocket Spending limit One plan rate for entire region and guaranteed issue Most include Part D (Rx) and some have vision/dental Need to have Part A & B

11 Medi-Gap Plans Path 1 In Addition to Original Medicare A & B Medi-Gap Plans (Medicare Supplement) Purchased through private insurance companies Plans fill the gaps in Original Medicare Part A/B by paying the deductibles coinsurances and co-pays Portable plans throughout country Doctor or Hospital just has to accept Medicare to use any Medi-Gap plan Not a managed plan (HMO or PPO) nor referrals required Original Medicare A & B pay first and then the Medi-Gap pays second Opportunity for first dollar coverage (Plan F) - 100% coverage as long as doctors/hospitals accept Medicare and services are Medicare approved Various Plan Designs by State Plans A-N in 47 states, only two plans in MA Plan F has most coverage, known as Supplement 1 Plan in MA Coverage per plan is identical, but premiums are different Need to have Part A and B and does not include Part D Rx coverage "11

12 Part D Rx plans Path 1 In Addition to Original Medicare A & B Medicare Part D (Prescription Drug Coverage) Offered by private insurance companies and approved by CMS (Center for Medicare Services) annually What is available to you is based on your primary residence zip code Numerous plans offered per region You can t just pick any drug plan You need to find what plan covers your overall medications with the lowest co-pays. Specific pharmacy costs vary per plan with designated preferred pharmacies Four Important Factors to Consider What is the Premium? ($12.60/month to $140.00) Does the Plan have a Deductible? ($0 plans and up to $400) What Plan gives you the Best Value/Co-Pay for your specific medications Choice of Pharmacy: Would you be open and able to go to another pharmacy (Walmart, CVS, Walgreens) if the costs were less? "12

13 Part D Rx plans Path 1 In Addition to Original Medicare A & B Medicare Part D (Three Coverage Levels) Initial Coverage Level (by calendar year) Co-Payments from $0-$ % coverage on average $0 generics on many plans Coverage Gap Donut Hole Begins when your total costs (you and insurance company) reaches $3700 $3750-$5050 range you pay 35% of brand drugs and 44% of generics Costs go up *Some plans have additional coverage during the gap, with high premiums Costs lowering every year until gap closes in 2020 Catastrophic Coverage Begins when you reach $5000 true out-of-pocket costs Plan assumes 95% and you pay 5% or no more than $6.35 per covered drug On 1/1 of every year, Initial Coverage Level begins again at $0 *2018 Medicare & You "13

14 Medicare Advantage Part C Managed Localized Plan Path 2 Replacement Plan to Original Medicare A & B One Plan.One Card Offers all the benefits of Part A & B and adds Part D Managed Plans such as HMO PPO POS and PFFS Localized plans based on your zip code Need to follow doctor/hospital network directory Referrals needed in most HMO plans Lower premiums but out of pocket costs incur and vary by plan Out of Pocket Spending limits have Maximums $6700 HMO and $10,000 PPO Guaranteed Issue during Election Periods (Initial, Annual or Special Election) Not Portable except Emergency Room and Urgent Care in HMO Purchased through Private Insurance Companies Plan structures vary per plan (deductibles, coinsurances, co-pays) One plan rate per region Some plans include dental, vision, hearing and wellness programs Enroll and change plans annually during the Medicare Open Enrollment period (Oct 15 th through Dec 7 th ) "14

15 Massachusetts Sample Premiums Doing the Math at Home Medi-Gap & Part D 1) Part B Standard Premium = $ month 2) Harvard Pilgrim Supplement 1 Plan = $ if new to Medicare Portable - First Dollar coverage 3) Envision Rx Plus Part D Plan = $12.60 month, $300 Deductible then Co-Pays Total $ per month Part C Medicare Advantage (20 plans in 02184) 1) Part B Standard Premium = $ month 2) Aetna Value Plan HMO = $0.00 month Co-pays & Co-Insurances for Doctors/Hospitals up to: $6700 In- Network Out of Pocket Spending Limit 3) Part D Coverage within the plan, $0 Deductible with Co-Pays Total $ per month and pay as you go up to $6700 "15

16 Lifestyle and Budget: What Plan Best Fits You? Items to Consider Locality of Plan Coverage Do you have two homes? Do you travel out of country? Do your doctors accept Medicare? What Part C plans do your doctors accept? Plan Designs Do you want portability? Are you familiar with managed plans? Do you want to avoid referrals? Total Cost Consideration Monthly premiums Out of pocket expenses Prescription Drug costs Donut Hole Candidate? "16

17 Two Road Paths in Medicare Decision Medi-Gap & Part D In Addition Medi-Gap is portable throughout country Can see any doctor or hospital that accepts Medicare Higher Premiums but pays the gaps in Medicare A/B with little or no out of pocket expenses Plans labeled by Letters A-N in 47 states. Plan F highest coverage plan In MA, Core & Supplement 1 plan are the only plans. Each plan has one rate for entire MA population with Guaranteed Issue Need to have Part A & B Enroll in separate Part D Rx plan Medicare Advantage - Part C Replacement Managed Plans such as HMO, PPO, POS and PFFS Need to follow doctor/hospital network directory Localized Plans Plans available to you in your zip code Some plans have low premiums but all services have co-pays and coinsurances to satisfy until you reach Out of Pocket Spending limit One plan rate for entire region and guaranteed issue Most include Part D (Rx) and some have vision/dental Need to have Part A & B

18 Signing up for Part A & B Signing up for Part A & B If you're covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse are working, and you're covered by a group health plan through the employer or union based on that work If one just has Part A and applying for Part B, Social Security will need proof of employer credible coverage since your Part A effective date Apply online at Social Security Visit your local Social Security office ********* Call Social Security If you turn 65 and are collecting Social Security, you are automatically signed up for Part A & B, where you can defer Part B, if on active group plan or spouse of active employee. Typically, people will keep Part A (no cost) and defer Part B. If contributing to HSA, you will need to stop contributing as you can t have any part of Medicare and contribute to HSA. If you turn 65 and are not collecting Social Security and actively employed (or spouse of active employee), you don t need to sign up for Part A & B and will need to enroll yourself when needed. When you enroll you for Part A & B, you will not be penalized as you have employer creditable coverage and can sign up automatically. Social Security will need a form filled out by your employer to prove you had employer creditable coverage *2018 Medicare & You "18

19 Questions? "19

20 Next Steps: Contact Info Borislow Insurance Ted O Connor ted@borislow.com (781) Provide your medication list - Gather your Medicare card information - Set Appointment! "20