Your Source for Senior Planning

Transcription

1 Your Source for Senior Planning

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3 YOUR SOURCE FOR SENIOR PLANNING Y0044_2018_401 Accepted Date: 9/25/2017 What We Will Cover Today Martin s Point Health Care Medicare Parts A & B: Original Medicare Medicare Part C: Medicare Advantage Plans Medicare Part D: Prescription Drug Program Medicare Supplement Medigap Plans

4 Martin s Point Health Care Who is Martin s Point Health Care? Physician-led Not-for-profit Organization Based in Maine Since 1981 Seven Health Care Centers Two Health Plans We care passionately for the well-being of the people we serve, each other, our families, and our communities. What is Medicare? Medicare is a federal program that was established in 1965 to provide health insurance to: Individuals age 65 years of age or older Individuals under age 65 with certain disabilities that qualify under Social Security Disability provisions Individuals with end-stage renal disease (ESRD)

5 Medicare Card Keep it to accept Medicare Parts A and B or return it to refuse Part B. Follow instructions on the back of the card. Different Parts of Medicare A + B + MORE! Part A Part B Part C Part D Hospital Insurance Medical Insurance Medicare Advantage Plans Prescription Drug Coverage Original Medicare

6 Medicare Part A Hospital Insurance PART A: Hospital Insurance Inpatient hospital stay Skilled nursing facility (SNF) care Some home health care Hospice care Inpatient hospital stays have a benefit period deductible of $1,316 with the potential to refresh every 60 days. Most Medicare beneficiaries do not pay a monthly premium for Part A. Medicare Part B Medical Insurance PART B: Medical Insurance Doctor office visits Diagnostic tests, lab work Durable medical equipment (wheelchairs, oxygen, walkers, etc.) Outpatient/day surgery Select preventive services Outpatient rehabilitative therapy (physical, occupational, speech, cardiac rehab, etc).

7 Covered Preventive Services Annual Wellness Exam (conversation with PCP no physical) Vaccinations (flu and pneumonia shots) Screenings:! Diabetes! Pap test/pelvic exam! Mammogram! Bone density! Prostate cancer! Glaucoma! Cardiovascular! Colorectal cancer screenings (does not include polyp removal, 20% coinsurance may apply) What Doesn t Original Medicare Cover? Worldwide emergency care services (only covers health care in the United States and its territories) Routine physical exam Routine vision exam Routine hearing exam Hearing aids Massage therapy Acupuncture Cosmetic surgery Most dental care and dentures Prescription drugs

8 Paying for Part B If you are NEW to Medicare in 2016 or 2017, your monthly Part B premium is $134* Premium is deducted from retirement check (Social Security Benefit, Railroad Retirement, Civil Service Retirement) or billed by Medicare each quarter Annual Deductible is $183 80/20 Split You pay 20% coinsurance for most services after deductible is met *For incomes above $85,000 (single) or $170,000 (couple) monthly premiums may be higher. Key Features of Original Medicare Part A Part B Choice of doctors, hospitals, and health care providers that accept Medicare payment Medicare Services can be used anywhere in the US and its territories Covers all medically necessary care and preventive screenings Certain restrictions apply to Medicare: Ex: Length of stay in hospitals, skilled nursing facilities, etc.

9 Late Enrollment Penalties: Parts A & B Part A and B PENALTY: If a beneficiary does not sign up for Part A (if you have to buy it) and/or Part B when first eligible, and does not have creditable coverage from an Employer Group Health Plan, a penalty may be imposed if he/she enrolls later. Medicare Part D Prescription Drug: PART D: Prescription Drug First major benefit addition to Medicare since 1965 instituted in 2006 Administered by private companies contracted with Medicare either as stand-alone plans or as part of a Medicare Advantage plan Maine has approximately 23 different stand-alone Part D plans to choose from the national average monthly premium for 2017 is $35.63

10 Key Features of Medicare Part D Part D is voluntary NOT part of original Medicare or through the government Medicare beneficiaries must have creditable prescription drug coverage (coverage that is as good as the standard Medicare benefits) to avoid penalty Beneficiaries may not need to join if they have creditable coverage through another source (ex: VA or employersponsored plans) Medicare Advantage plans MAY include Part D benefits however, not always Late Enrollment Penalty (LEP): Part D Part D PENALTY: If a beneficiary does not enroll in a Part D plan when first eligible, and does not have creditable coverage for 63 continuous days or more, they may have to pay an LEP* when they do sign up for Part D prescription coverage later. *Penalty continues monthly as long as enrolled in a prescription plan.

11 Late Enrollment Penalties: Part D Calculating Part D Penalties 1 % x # = $ One percent of the average monthly prescription drug premium Number of months you were late The amount of your penalty Part D Coverage: Initial Phase

12 Coverage Gap Phase Note: Member cost shares in the Coverage Gap may vary by plan. The drug manufacturer pays 50% of the total cost of your brand name medications. Catastrophic Coverage Phase

13 Financial Aid/Extra Help Different types of help available for those who qualify (based on income & assets) Programs that can help pay for premiums, copays and coinsurances: LIS Low Income Subsidy (Federal Medicare Assistance) Part D Medicare Savings Program QMB/SLMB/QI (members are automatically deemed LIS eligible) MaineCare/Medicaid (State Assistance) Medicare Advantage Plans: Part C Part A Part B MORE! Provided by insurance companies which contract with Medicare. Medicare Advantage plans must cover everything Original Medicare covers Combines Part A, B, and D into ONE plan (if you choose a plan that includes prescription coverage) May include coverage beyond Original Medicare (Parts A and B) Ex: Dental, prescription coverage etc.

14 How Medicare Advantage Plans Work Medicare Advantage plans do not replace Original Medicare. Members still have Original Medicare, with all of its benefits, rights, and privileges. Medicare Advantage plans are simply a different way to receive your Original Medicare benefits. Unlike Original Medicare, Medicare Advantage plans Include an outof-pocket maximum (OOPM) Only present your Medicare Advantage ID card at hospital, doctor s office, and pharmacy. Medicare Part C Rules Beneficiaries must: Be enrolled in both Part A and B* to enroll in a Medicare Advantage (MA) plan Not have end stage renal disease (ESRD) Have a primary residence in the plan s service area Enroll during a valid election period Medicare Advantage plans must cover everything Original Medicare covers there is a great deal of oversight by Medicare over these plans to protect beneficiaries. * Members continue to pay their Part B premium to Medicare.

15 Medicare Advantage Plans Most Common Types of Plans: Health Maintenance Organization (HMO) Health Maintenance Organization with Point of Service benefit (HMO-POS) Preferred Provider Organization (PPO) Provided by private insurance companies such as: Martin s Point United Health Care (AARP) Humana Anthem Harvard Pilgrim Aetna Initial Election Period (IEP) One-time event when individuals are newly eligible for Medicare If beneficiary is eligible for both Part A and Part B, enrollment period is seven months long If beneficiary is only enrolling in Part B, enrollment period is three months long

16 Annual Election Period (AEP) Any Medicare beneficiary can join, switch, or leave a Medicare Advantage plan as many times as he/she wants to. Enrollment Period October 15 December 7 EVERY year Plan effective January 1 the start of the next calendar year. OCT NOV DEC JAN October 15 through December 7 Coverage begins January 1 Special Election Periods (SEPs) At any time during the year, if a qualifying event occurs, a beneficiary can enroll during an SEP. Moving into or out of the coverage area Losing employer or union group coverage (voluntarily/ involuntarily) Receive Low Income Subsidy Receive Medicaid Current Medicare Advantage plan no longer available Timeframes for SEPs are variable (most are three months)

17 Annual Disenrollment Period (ADP) During the Annual Disenrollment Period a beneficiary has one election available and may disenroll from his/her Medicare Advantage plan and go back to Original Medicare. Beneficiaries cannot join or switch Medicare Advantage plans during this time. Disenrollment period runs from January 1 February 14 Medicare Supplement Plans Insurance policies that pay all or some of Medicare beneficiary cost-shares for Part A and B* services Provided by private insurance companies such as:! Anthem Blue Cross! Harvard Pilgrim! United Health Care (AARP)! Bankers Life Regulated by state and federal laws NOT Medicare 10 modernized policies: Plans A through N Monthly premiums can range from $78 $200+ per month (depending on plan) * Members continue to pay their Part B premium to Medicare.

18 Key Features of Supplement Plans Only work with Original Medicare Can cover all or most of Medicare s out-of-pocket costs (deductibles, coinsurance) Do NOT include prescription drug coverage Can ask Medical Qualifying Questions prior to enrollment and annually adjust premium. Choice of any provider that accepts Medicare assignment. Two Different Paths for Medicare Coverage Part D Prescription Drug Plan Medicare Supplement Plan Original Medicare (Parts A and B) Martin s Point Generations Advantage (Parts A and B plus more, Part D included with most plans) Medicare Supplement Plans Medicare Advantage Plans If you join a Medicare Advantage or Medicare Supplement plan you must continue to pay your Medicare Part B premium.

19 Have Additional Medicare Questions? Resources for Additional Information: Local Area Agency on Aging Social Security Administration: (TTY: ) or MEDICARE ( ) (TTY: ) or Thank you for your time. Any questions?