Understanding Medicare MARCIA MEEKS, BA, INSURANCE COMPLAINT SPECIALIST, WV OFFICES OF THE INSURANCE COMMISSIONER, AND REBECCA GOUTY, BSW, SHIP/SMP

Transcription

1 Understanding Medicare MARCIA MEEKS, BA, INSURANCE COMPLAINT SPECIALIST, WV OFFICES OF THE INSURANCE COMMISSIONER, AND REBECCA GOUTY, BSW, SHIP/SMP DIRECTOR, WV BUREAU OF SENIOR SERVICES, CHARLESTON.

2 What Is Medicare? Health insurance for people 65 and older Under 65 with certain disabilities Amyotrophic Lateral Sclerosis known as Lou Gehrig s disease (without waiting period) Any age with End-Stage Renal Disease Administered by Centers for Medicare & Medicaid Services 4/27/2018 2

3 Automatic Enrollment Part A and B Automatic for those receiving Social Security benefits Railroad Retirement Board benefits Initial Enrollment Period package Mailed 3 months before Age 65 25th month of disability benefits Others must enroll themselves 4/27/2018 3

4 When Enrolling Isn t Automatic If you re not automatically enrolled For example, if not getting SS or RRB benefits You need to enroll with Social Security Visit socialsecurity.gov, or Call , or Visit your local office If retired from the Railroad, enroll with the Railroad Retirement Board (RRB) Call your local RRB office or Apply 3 months before you turn 65 Don t have to be retired to get Medicare 4/27/2018 4

5 If you enroll in Part B If Not Automatically Enrolled Your 7-Month Initial Enrollment Period No Delay 3 months before the month you turn 65 2 months before the month you turn 65 1 month before the month you turn 65 The month you turn 65 (1 month delay) Delayed Start 1 month after you turn 65 (2 month delay) 2 months after you turn 65 (3 month delay) 3 months after you turn 65 (3 month delay) Sign up early to avoid a delay in getting coverage for Part B services. To get Part B coverage the month you turn 65, you must sign up during the first three months before the month you turn 65. 4/27/2018 If you wait until the last four months of your Initial Enrollment Period to sign up for Part B, your start date for coverage will be delayed. 5

6 Medicare Card Keep it and accept Medicare Parts A and B Return it to refuse Part B Follow instructions on back of card Front Back OLD NEW 4/27/2018 6

7 General Enrollment Period (GEP) For people who didn t sign up for Part B (or premium Part A) during their Initial Enrollment Period January 1 March 31 annually Coverage starts July 1 May have to pay a penalty 10% for each 12 months eligible, but not enrolled in Part B for as long as you have Part B Limited exceptions 4/27/2018 7

8 Decision Should I keep/sign up for Part B? If you don t have coverage from active employment Yours or your spouses Delaying Part B may mean Higher premiums Paying for your health care out-of-pocket If you do have coverage through active employment (yours or spouse) You may want to delay Part B No penalty if you enroll while you have active employer coverage or within 8 months of losing coverage (SEP) COBRA not is not considered active employer insurance 4/27/2018 8

9 Your Medicare Coverage Choices Original Medicare Medicare Advantage Plan Part A Hospital Insurance Part B Medical Insurance or Part C Combines Part A and Part B Medicare Supplement Insurance (Medigap) Policy You can add Part D Prescription Drug Coverage May include, or you may be able to add Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.) 4/27/2018 9

10 Original Medicare Health care option run by the federal government Provides your Part A and/or Part B coverage See any doctor or hospital that accepts Medicare You pay Part B premium (Part A is usually premium free) Deductibles, coinsurance, or copayments Get Medicare Summary Notice Can join a Part D plan to add drug coverage 4/27/

11 Paying for Medicare Part A Most people don t pay a premium for Part A If you or your spouse paid Federal Insurance Contributions Act (FICA) taxes at least 10 years If you paid FICA less than 10 years you can pay a premium to get Part A May have a penalty if you don t enroll when first eligible for premium Part A Your monthly premium may go up 10% You'll have to pay the higher premium for twice the number of years you could ve had Part A, but didn't sign up 4/27/

12 Original Medicare Part A Hospital Insurance Coverage Part A Hospital Insurance helps cover Inpatient hospital care Inpatient skilled nursing facility (SNF) care Blood (inpatient) Home health care Hospice care 4/27/

13 Benefit Periods Measures use of inpatient hospital and skilled nursing facility (SNF) services Begins the day you first receive inpatient care In hospital or SNF Ends when not in hospital/snf 60 days in a row Pay Part A deductible for each benefit period No limit to the number of benefit periods you can have 4/27/

14 Paying for Inpatient Hospital Stays For Each Benefit Period in 2018 Days 1-60 Days Days All days after 150 You Pay $1,340 deductible $335 per day $670 per day (60 lifetime reserve days) All Costs 4/27/

15 Skilled Nursing Facility (SNF) Care Required Conditions for Coverage Require daily skilled services Not just long-term or custodial care Hospital inpatient 3 consecutive days or longer Admitted to SNF within specific time frame Generally 30 days after leaving hospital SNF care must be for a hospital-treated condition Or condition that arose while receiving care in the SNF for hospitaltreated condition Must be a Medicare-participating SNF 4/27/

16 Paying for Skilled Nursing Facility Care For Each Benefit Period in 2018 You Pay Days 1-20 $0 Days All days after 100 $ per day All Costs 4/27/

17 Medicare Part B Medical Insurance Coverage Part B Medical Insurance helps cover Doctors services Outpatient medical and surgical services, supplies Clinical lab tests Durable medical equipment Diabetic testing supplies Preventive services 4/27/

18 What Are Medicare Part B Covered Services? Doctors Services Services that are medically necessary (includes outpatient and some doctor services you get when you re a hospital inpatient) or covered preventive services. You pay 20% of the Medicare-approved amount (if the doctor accepts assignment), and the Part B deductible applies. Outpatient Medical and Surgical Services and Supplies For approved procedures like X-rays, casts, or stitches. You pay the doctor 20% of the Medicare-approved amount for the doctor s services if the doctor accepts assignment. You also pay the hospital a copayment for each service. The Part B deductible applies. 4/27/

19 Medicare Part B Covered Services Continued Durable Medical Equipment (DME) Items such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds for use in the home. Some items must be rented. Medicare has a program called competitive bidding. If you live in a competitive bidding area, you must use specific suppliers, or Medicare won t pay for the item and you ll likely pay full price. Includes national mail-order program for diabetic self-testing supplies. Visit Medicare.gov/supplier to find Medicare-approved suppliers in your area. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 4/27/

20 More Medicare Part B Covered Services Home Health Services Medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy, some home health aide services, medical social services, and medical supplies. You pay nothing for covered services. Other (including but not limited to) Medically necessary medical services and supplies, such as clinical laboratory services, diabetes supplies, kidney dialysis services and supplies, mental health care, limited outpatient prescription drugs, diagnostic X-rays, MRIs, CT scans, and EKGs, transplants and other services are covered. Costs vary. 4/27/

21 Medicare Part B Covered Preventive Services (available at little or no cost) "Welcome to Medicare" preventive visit Yearly Wellness visit Abdominal aortic aneurysm screening Alcohol misuse screening and counseling Bone mass measurement Breast cancer screening (mammogram) Cardiovascular disease (CVD) Risk Reduction Visit Cardiovascular disease screenings Cervical and vaginal cancer screening Human Papillomavirus (HPV) Testing Colorectal cancer screenings Screening fecal occult blood test Screening flexible sigmoidoscopy Screening colonoscopy Screening barium enema Multi-target stool DNA test Depression screening Diabetes screenings Diabetes self-management training Flu shots (Vaccine) Glaucoma tests Hepatitis B shots (Vaccine) Hepatitis C screening test HIV screening Lung Cancer Screening Medical nutrition therapy services Obesity screening and counseling Pneumococcal shots Prostate cancer screening Sexually-transmitted infections screening and counseling Tobacco use cessation counseling 4/27/

22 Medicare Part B Costs Yearly Deductible Coinsurance for Part B Services $ % coinsurance for most covered services, like doctor s services and some preventive services, if provider accepts assignment $0 for some preventive services 20% coinsurance for outpatient mental health services, and copayments for hospital outpatient services 4/27/

23 What You Pay Part B Premiums 2018 Premiums Standard premium $134 (or higher depending on your income) Deducted monthly from Social Security benefit payments Railroad retirement benefit payments Federal retirement benefit payments If not deducted Billed every 3 months Medicare Easy Pay to deduct from bank account Contact Social Security, the Railroad Retirement Board, or the Office of Personnel Management about premiums 4/27/

24 Monthly Part B Standard Premium Income-Related Medicare Adjustment Amount for 2018 Chart is based on your yearly income in 2016 (for what you pay in 2018) was File Individual Tax Return File Joint Tax Return File Married & Separate Tax Return In 2018 You Pay $85,000 or less $170,000 or less $85,000 or less $ $85, $107,000 $170, $214,000 Not applicable $ $107, $133,500 $214, $267,000 Not applicable $ $133, $160,000 $267, $320,000 Not applicable $ Above $160,000 Above $320,000 Above $85,000 $ NOTE: You may pay more if you have a Part B late enrollment penalty. 4/27/

25 Part B Late Enrollment Penalty See how your insurance works with Medicare Contact your employer/union benefits administrator Penalty for not signing up when first eligible 10% more for each full 12-month period May have a penalty as long as you have Part B Sign up during a Special Enrollment Period Usually no penalty if you sign up within 8 months of employer coverage ending 4/27/

26 Medicare Supplement Insurance (Medigap) Policies Medigap policies are private health insurance that Supplement Original Medicare You must have both Medicare Part A and Part B to get a Medigap policy You pay a monthly premium to the insurer and also pay the Part B monthly premium Medicare will pay its share of the Medicare-approved amounts for covered health care costs Then your Medigap policy pays its share A Medigap policy covers one person Sold by private companies 4/27/

27 Medigap Plan Types Medicare Supplement Insurance (Medigap) Plans Benefits A B C D F* G K L M N Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Medicare Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%* ** Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A hospice care coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Skilled nursing facility care coinsurance 100% 100% 100% 100% 50% 75% 50% 100% Part A deductible 100% 100% 100% 100% 100% 50% 75% 100% 100% Part B deductible 100% 100% Part B excess charges 100% 100% Foreign travel emergency (up to plan limits) 80% 80% 80% 80% 80% 80% Out-of-Pocket Limit in 2018** $5,240 $2,620 *Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicarecovered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,240 in 2018 before your policy pays anything. **For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($183 in 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission. 4/27/

28 Medigap Policies You pay a monthly premium Costs vary by plan, company, your age, and location Medigap Open Enrollment Period Starts when you're both 65 or older AND enrolled in Part B Lasts 6 months (some states may have longer period) Once started, it can t be delayed or repeated You have protections plans MUST sell you a plan Doesn t work with Medicare Advantage No networks except with a Medicare SELECT policy You can buy a Medigap policy whenever a company agrees to sell you one If later, there may be restrictions Certain Guaranteed Issue Situations 4/27/

29 Delayed Medigap Open Enrollment Period (OEP) If you delay enrolling in Medicare Part B Because you or your spouse is still working, and You have group health coverage Medigap OEP is delayed Until you re 65 or older and enrolled in Part B No late enrollment penalty Notify Social Security to delay Part B 4/27/

30 What s a Medicare Advantage Plan? Health plan options Approved by Medicare Run by private companies Sometimes called Part C You still pay the Part B premium State assistance for some people with limited income and resources You may pay plan an additional monthly premium You pay deductibles, coinsurance, and copayments Different from Original Medicare Varies from plan to plan May be higher if out of network 4/27/

31 How Medicare Advantage Plans Work Receive services through the plan All Part A- and Part B-covered services Have their own deductibles and copayments/coinsurance that differ from Original Medicare Some plans may provide additional benefits Most plans include prescription drug coverage You re still in the Medicare program Medicare pays the plan every month for your care You still have Medicare rights and protections You may have to use network doctors/hospitals If the plan leaves Medicare, you can Join another MA Plan, or Return to Original Medicare 4/27/

32 Who Can Join a Medicare Advantage Plan? Eligibility requirements you must Be enrolled in Medicare Part A (Hospital Insurance) Be enrolled in Medicare Part B (Medical Insurance) Live in the plan s service area Be a United States (U.S.) citizen or lawfully present in the U.S. Not be incarcerated To join you must also Provide necessary information to the plan Follow the plan s rules Can only belong to one plan at a time 4/27/

33 When You Can Join or Switch Medicare Advantage (MA) Plans Initial Enrollment Period 7-month period begins 3 months before the month your Medicare starts Includes the month your Medicare starts Ends 3 months after the month your Medicare Starts If delay Part B, can enroll the month before Part B starts when you do enroll into Part B Open Enrollment October 15 December 7 Coverage begins January 1 4/27/

34 When You Can Join or Switch Plans Special Enrollment Periods (SEP) Move out of your plan s service area You have Medicaid Plan leaves Medicare program or reduces its service area Leaving or losing employer or union coverage You enter, live at, or leave a long-term care facility You have a continuous SEP if you qualify for Extra Help Losing your Extra Help status You join or switch to a plan that has a 5-star rating Retroactive notice of Medicare entitlement Other exceptional circumstances 4/27/

35 When You Can Leave Medicare Advantage (MA) Plans January 1 February 14 You can leave an MA Plan Switch to Original Medicare Coverage begins first day of month after switch May join Part D Plan Drug coverage begins first day of month after plan gets enrollment May not join another MA Plan during this period May be able to buy a Medicare Supplement Insurance (Medigap) policy 4/27/

36 What s Medicare Prescription Drug Coverage (Part D)? Medicare drug plans Part D Approved by Medicare Run by private companies Available to everyone with Medicare You usually must join a plan to get coverage It s optional Late Enrollment Penalty Plans have formularies Lists of covered drugs Must include range of drugs in each category There are 2 ways to get Medicare drug coverage Medicare Prescription Drug Plans Medicare health plans with prescription drug coverage 4/27/

37 Medicare Part D Costs Most people will pay A monthly premium A yearly deductible (if applicable) Copayments or coinsurance Costs in the coverage gap Costs vary by Plan Late enrollment penalty Extra Help Must offer at least a standard level of coverage Benefits and costs may change each year 4/27/

38 Part D Standard Benefit Ms. Smith joins a Medicare Prescription Drug Plan. Her coverage begins on January 1. She doesn t get Extra Help and uses her Medicare drug plan membership card when she buys prescriptions. She pays a monthly premium throughout the year. 1. Yearly deductible 2. Copayment or coinsurance (what you pay at the pharmacy) 3. Coverage gap 4. Catastrophic coverage Ms. Smith pays the first $405 of her drug costs before her plan starts to pay its share. Ms. Smith pays a copayment, and her plan pays its share for each covered drug until their combined amount (plus the deductible) reaches $3,750. Once Ms. Smith and her plan have spent $3,750 for covered drugs, she s in the coverage gap. In 2018, she pays 35% of the plan s cost for her covered brand-name prescription drugs and 44% of the plan s cost for covered generic drugs. What she pays (and the discount paid by the drug company) counts as out-of-pocket spending, and helps her get out of the coverage gap. Once Ms. Smith has spent $5,000 out of pocket for the year, her coverage gap ends. Now she only pays a small coinsurance or copayment for each covered drug until the end of the year. 4/27/

39 Part D Eligibility Requirements You must Have Medicare Part A and/or Part B to join a Medicare Prescription Drug Plan Have Medicare Part A and Part B to join a Medicare Advantage Plan with drug coverage Have Medicare Part A and Part B or only Part B to join a Medicare Cost Plan with Part D coverage Live in the plan s service area Not be incarcerated Not be unlawfully present in the U.S. Not live outside the U.S. You must join a plan to get drug coverage 4/27/

40 When You Can Join or Switch Medicare Prescription Drug Plans Initial Enrollment Period (IEP) Medicare s Open Enrollment Period January 1 February 14 7 month period Starts 3 months before month of eligibility October 15 December 7 each year Coverage begins January 1 During this period, you can leave an MA plan and switch to Original Medicare. If you make this change, you may also join a Part D plan to add drug coverage. Coverage begins the first of the month after the plan gets the enrollment form. 4/27/

41 Special Enrollment Period (SEP) Life events that allow an SEP include if you Permanently move out of your plan s service area Lose other creditable prescription coverage Weren t properly told that your other coverage wasn t creditable, or your other coverage was reduced and is no longer creditable Enter, live at, or leave a long-term care facility Have a continuous SEP if you qualify for Extra Help Belong to a State Pharmaceutical Assistance Program Join or switch to a plan that has a 5-star rating Have other exceptional circumstances 4/27/

42 Creditable Drug Coverage Current or prior prescription drug coverage Creditable if it meets or exceeds Medicare s minimum standards With creditable coverage May not have to pay a late enrollment penalty Plans inform yearly about whether creditable For example, employer group health plans (EGHPs), retiree plans, VA, TRICARE and FEHB 4/27/

43 Part D Late Enrollment Penalty Higher premium if you wait to enroll Exceptions if you have Creditable coverage Extra Help Pay penalty for as long as you have coverage 1% of base beneficiary premium - $35.02 for 2018, may change each year For each full month eligible and not enrolled For as long as you have Medicare drug coverage 4/27/

44 Medicare Prescription Drug Coverage Premium A small group may pay a higher premium Based on income above a certain limit Fewer than 5% of all people with Medicare Uses same thresholds used to compute income-related adjustments to Part B premium As reported on your IRS tax return from 2 years ago Required to pay if you have Part D coverage 4/27/

45 Income-Related Monthly Adjustment Amount (IRMAA) Your Yearly Income in 2016 Filing an Individual Tax Return Your Yearly Income in 2016 Filing a Joint Tax Return In 2018 You Pay Monthly $85,000 or less $170,000 or less Your Plan Premium (YPP) Above $85,000 Up to $107,000 Above $170,000 Up to $214,000 YPP + $13.00* Above $107,000 Up to $133,500 Above $133,500 Up to $160,000 Above $214,000 Up to $267,000 Above $267,000 Up to $320,000 YPP + $33.60* YPP + $54.20* Above $160,000 Above $320,000 YPP + $74.80* *IRMAA is adjusted each year, as it s calculated from the annual beneficiary base premium. 4/27/

46 Programs to help with Medicare costs Extra Help Social Security Program to help people pay for Medicare prescription drug costs No coverage gap or late enrollment penalty if you qualify for Extra Help Below 150% of the Federal poverty level (FPL) Resource/assets limits Medicare Savings Programs - Medicaid Help from Medicaid paying Medicare costs For people with limited income and resources Programs include Qualified Medicare Beneficiary (QMB) Specified Low-income Medicare Beneficiary (SLMB) Qualifying Individual (QI) 4/27/

47 Guidelines for Extra Help and Medicare Savings Programs Extra Help Part D Guidelines 2018 Income Guidelines Below 150% of the Federal poverty level (FPL) $1,518 per month for an individual*, or $2,058 per month for a married couple* Based on family size 2018 Resources Up to $14,100 for an individual, or Up to $28,150 for a married couple Includes $1,500/person for funeral or burial expenses Counts savings and investments Doesn t count home you live in Medicare Savings Program Individual Monthly Income Limit* Married Couple Monthly Income Limit* Helps Pay Your Qualified Medicare Beneficiary (QMB) Specified Low-Income Medicare Beneficiary (SLMB) $1032 $1,392 Part A and Part B premiums, and other cost-sharing (like deductibles, coinsurance, and copayments) $1,244 $1,680 Part B premiums only Qualifying Individual (QI) $1,386 $1,872 Part B premiums only Asset Limits: $7,560 for individual $11,340 for Married Couple 4/27/

48 Medicare and Other Health Insurance 4/27/

49 When Medicare Is the Primary Payer If Medicare is your only insurance, or Your other source of coverage is A Medicare Supplement Insurance (Medigap) policy Medicaid Retiree benefits The Indian Health Service Veterans benefits TRICARE for Life Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage Except 30-month coordination period for people with End-Stage Renal Disease 4/27/

50 Employer Group Health Plans (EGHP) If You Are 65 or older and have retiree coverage 65 or older with EGHP coverage through current employment (yours or your spouse s) Under 65 with a disability and have EGHP coverage through current employment (yours or a family member s) Medicare Pays First Yes If the employer has less than 20 employees If the employer has less than 100 employees 4/27/

51 PEIA Medicare Retiree benefits The year you retire (or turn 65 if retired prior to 65) Medicare becomes primary and PEIA is secondary. Have the option to immediately go onto Humana PEIA plan instead All PEIA Medicare retirees are switched onto Humana PEIA plan January 1 of following year Humana PEIA plan has different costs and network than other Humana plans available to public Humana PEIA plan premium depends on years of service/how long you worked for state; receive discounts on premium for tobacco free 4/27/

52 PEIA Cont d PEIA offers Benefit and Premium assistance program to some retirees depending on years of service and income. If you dropped retiree PEIA coverage, you may be able to pick it back up in certain situations. Open Enrollment for Medicare PEIA retirees October 1 st October 31 st ; plan year January 1 st December 31 st 4/27/

53 Federal Employee Health Benefits (FEHB) Administered by OPM Office of Personnel Management Open Enrollment November 1 st November 30 th If still working, may not need Part B/D because FEHB coverage will be primary payer If you are retiring or retired, you may want to get Medicare Part B if you have a fee for service FEHB plan such as the basic or standard plan with Blue Cross Blue Shield. These FEHB plans pays secondary to Medicare and there are little out-of-pocket costs when you have both Medicare A and B and this type of FEHB plan. 4/27/

54 FEHB Cont d If you do not sign up for Medicare Part B when you are first eligible and not actively employed, you may have to pay a penalty for Medicare Part B. You may sign up for Part B during the General Enrollment Period January 1 st March 31 st The FEHB s drug coverage is creditable (as good as or better than Medicare Part D). You do not have to get Part D, unless you qualify for low-income assistance with drug costs. If you want to get a Part D plan after your initial enrollment, you can enroll during Medicare s Open Enrollment between October 15 th and December 7 th with no penalty. 4/27/

55 If You Have a Marketplace Plan First and Then Get Medicare Coverage You lose eligibility for any premium tax credits and/or reduced cost sharing for your Marketplace plan If you choose to drop your Marketplace plan, pay special attention to the timing If a consumer is the only member of their household enrolled on their Marketplace plan, they should visit the Marketplace at least 15 days before the date they want their Marketplace coverage to end If a consumer is enrolled in the same Marketplace plan with other members of their household, in most cases, their coverage will end immediately when they request termination of their coverage for only some people on their application 4/27/

56 Other Types Of Insurances 4/27/

57 COBRA - Continuation Coverage If you purchase Insurance coverage through your employer and your employer has 20 or more employees, You are eligible for continuation coverage to be offered by the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) WV requires continuation coverage to be offered by smaller employers typically those with less than 20. Mini-COBRA 4/27/

58 Eligibility Requirements You must have had 18 months of continuous creditable coverage with at least the last day having been under a group health policy You must have used up any COBRA group continuation coverage for which you were eligible. You must not be eligible for Medicare, Medicaid, or a group health policy You must not have any other major medical health insurance. You must apply for health insurance for which you are deemed eligible individual within 63 days of losing your prior coverage. Office of Employee Benefits Security Administration Federal Department of Labor WV Regional Director number /27/

59 Discount Plans and Risk-Sharing Plans Discount plans and risk-sharing plans are not insurance plans! Before signing up, be sure to understand how the program works. Discount Plans You might receive advertisements from plans offering discounts on health care for a monthly fee. These are not Affordable Care Act approved health insurance plans and participants do not have the same protections as under ACA. Insurance commissioners strongly recommend that you thoroughly investigate any plan promising deep discounts for a low monthly fee and weigh the benefits against the cost carefully. 4/27/

60 Health Insurance Marketplace To be eligible to enroll in health coverage through the Marketplace, you: Must live in the United States Must be a U.S. citizen or national (or be lawfully present). Can't be incarcerated. If you have Medicare coverage, you re not eligible to use the Marketplace to buy a health or dental plan. Financial help is available for eligible families and individuals, including Premium tax credits to lower the monthly premiums you pay Reduced cost sharing to lower out-of-pocket spending for health care costs Eligibility for the premium tax credit is based on Household income and family size Household income between 100% to 400% FPL Must not be eligible for government-sponsored coverage, affordable employersponsored insurance, or certain other minimum essential coverage 4/27/

61 Contact Information Medicare: WV SHIP (Medicare counseling) WV SMP (Medicare fraud and abuse) or West Virginia Bureau of Senior Services WV Bureau of Senior Services 1900 Kanawha Blvd East, Charleston, WV (Mailing) 3 rd Floor Charleston Town Center Mall (Physical) Health Insurance Questions or Need to File an Insurance Complaint: WV Offices of the Insurance Commissioner Pennsylvania Avenue, Charleston, WV /27/