(Talk about years of experience Premera has and the years of training and experience we have as Medicare Representatives.)

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Shannon Roberts
5 years ago
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1 Facilitator: Thank you for joining us! We are going to be together for about 45 minutes this morning / afternoon. During that time I m going to give you an overview of Medicare so you have a better understanding of what Medicare covers and what it doesn t cover. We ll also talk about the types of additional coverage options available to you that provide more coverage than Original Medicare. (Talk about years of experience Premera has and the years of training and experience we have as Medicare Representatives.) I ll be available to answer any questions you may have during and after the presentation. 1

2 Review agenda with participants 2

3 Medicare is a federal health insurance program that pays for hospital and medical care. To qualify for Medicare you need to be: A U.S. citizen or resident, and Age 65 or over, who have worked more than 40 quarters or their spouse has worked more than 40 quarters or Under 65 and permanently disabled for at least 24 months, or Be living with End-Stage Renal Disease 3

4 Let s discuss your Medicare card: For those of you who haven t already done so enrolling in Medicare is easy. If you don t already receive Social Security, you may apply for Medicare at any Social Security office or by calling or visiting their website at In this case, your Medicare card will arrive after you re enrolled. If you re already receiving Social Security benefits before you turn 65, you won t need to file a Medicare application; you ll automatically receive your Medicare card three months before your 65 th birthday. 4

5 There are several Medicare Enrollment Periods that you should know about: The first is your Initial Enrollment Period that begins 3 months prior to, the month of, and 3 months after your 65 th birthday. This is when you are first eligible to enroll in Medicare. The Annual Enrollment Period takes place between October 15 and December 7 of each year. This is the only time you can sign up for a plan or change plans for the following year, unless you are eligible for one of these other enrollment periods. You may also qualify for a Special Enrollment Period. Some examples of a special enrollment period are when you move to a new service area or lose your employer group coverage. Starting in 2019, there will be a new window for enrollment. It s called the Open Enrollment Period. It runs from January 1 to March 31. It allows people enrolled in a Medicare Advantage plan to make a one-time change to move to another Medicare Advantage plan or move to Original Medicare only. 5

6 The federal Medicare program is made up of four parts that help cover specific services. Let s start with Parts A & B. 6

7 Things to consider. Look at your current situation Do you have coverage through your employer? Do you have coverage through a union? Do you have coverage through your spouse? If you fall within one of these categories, no need to enroll in Medicare Part B until you or your spouse are ready to retire or lose coverage. Are you retired, planning to retire or retiring late? Let Premera help you enroll in the plan that s right for you. 7

8 Medicare Part A is hospital insurance. It helps pay for inpatient care in hospitals and skilled nursing facilities, for hospice care and for home healthcare. Part A does not cover physician services or diagnostic tests in the hospital, personal care items, private rooms, and custodial care. Part A is free for most people because you have contributed to the cost of Part A during your working lifetime. However, there is a $1,340 deductible per benefit period. So one stay in the hospital could cost you more than $1,000. After a 60-day period stay in the hospital, you are responsible to pay a $335 copay per day for any stays between 61 and 90 days. After 90 days, Medicare allows an additional 69 days in the hospital. These are called life-time reserve days. You will pay $670 per day. Once these days are used, they are gone. Any hospital stay after 150 days will require you to pay all hospital costs. 8

9 Medicare Part B is medical insurance. This is optional coverage that helps pay for doctors services and other medical services. There is a premium for Part B. The Part B premium is $134; however, it does vary for higher-income consumers. For most items, Medicare covers 80% of the cost. You pay the other 20%, after the $183 annual deductible is met. Examples of Part B covered services include, home health care, most physician services, outpatient therapies, and durable medical equipment. For those that may be delaying retirement beyond age 65 years old, you can decline Part B. There is no penalty for postponing Part B enrollment if you enroll within 2 months of retirement and have a drug coverage plan equivalent to a Part D prescription drug plan. NOTE: Point out that the figures are for

10 Part B (medical insurance) Penalty If you don t enroll in Part B when you are first eligible, you may have to pay a penalty to get it later. The penalty is an additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Not planning to retire at age 65? You can decline Part B without a penalty if you or your spouse have group insurance from an employer. If you don t sign up for Medicare during your Initial Enrollment Period, you have a General Enrollment Period, which is a grace period that runs between January 1 and March 31 st with an effective date of July 1 st of the same year. You may still get a penalty if you enroll during your General Enrollment Period. There are some important late enrollment penalties you should know about. Two of the more common late enrollment penalties are the Part B and Part D penalty for late enrollment. 10

11 Medicare Part D plans help cover the cost of prescription drugs. 11

12 Which brings us to Medicare Part D Medicare Part D plans help cover the cost of prescription drugs. Let s take a closer look Part D is prescription drug coverage with a unique product design. The federal government designed Part D to serve as insurance to help Medicare participants with the cost of their prescription drugs. Part D enrollment is a voluntary benefit and is not required. It serves as catastrophic coverage for those who have high prescription costs and it helps to keep costs manageable for those with lower prescription expenses. Even more will be done between now and 2020 to provide opportunities to save by reducing the coverage gap. Before we get into too many details, let s talk about how you can get Part D. The government sets a standard benefit plan that has four steps or phases, which we will cover in a moment. Private insurance companies offer a variety of Part D plans. How much you pay and how much the plan pays varies based on the plan you join and how many drugs you use during the year. Plans also vary based on monthly premiums and types of drugs that are covered. Lastly, as a Medicare beneficiary, you have a number of ways to get your Part D coverage. Let s take a look at the basic Part D model that Medicare designed and all health plans use as a base design. Read Part D Coverage options on slide. 12

13 Deductible Phase: You ll start the year in the Deductible phase. The deductible is the amount you pay before your insurance kicks in. The deductible is set by Medicare and can change from year to year. During this phase, you pay the full cost of your prescription drugs included in the formulary until your costs reach your yearly deductible amount. The 2018 deductible is $405. Step 1 ends when you reach your deductible. As a reminder, this is the basic model Medicare designed as a starting point; some plans don t have deductibles. Initial Coverage Phase: Once you ve met your deductible, you move into the Initial Coverage Phase. During this phase, you and the Plan each pay a portion of the cost for each prescription included in the formulary (drug list). Keep in mind that some plans may have fixed copays for each prescription rather than a percentage. You re in this phase until your year-to-date drug costs (paid by you, including your deductible from Step 1, and the Plan combined) reach the Initial Coverage Limit. For 2018, the Initial Coverage Limit is $3,750. Once you reach your Initial Coverage Limit, welcome to the gap! Coverage Gap Phase: The coverage gap or donut hole as some call it is the next phase. In the past, you would have had to pay all costs at this phase out of your own pocket. For 2018, you pay 35% of brand-name drug costs and 44% of generic drug costs. If you reach your coverage gap limit of $5,000, Step 3 ends and you move into the final phase. Catastrophic Phase: If your total out-of-pocket spending on prescriptions reaches a set amount $5,000 for 2018 and the year s not over, you move into the catastrophic coverage phase for the rest of the year. You pay very little for your prescriptions either 5% or $3.35 per generic and $8.35 per brand, whichever is higher. The plan pays the rest unlimited to the end of the calendar year. 13

14 People with limited incomes may qualify for help to pay for their prescription drug costs through the federal and/or state government. If you qualify, you may receive help with drug costs including monthly prescription drug premiums, copays, coinsurance and deductibles. Keep in mind that any extra help you receive will only apply to the Part D prescription drug portion of your premium, and not the Part C medical portion. Those that receive Extra Help are also not subject to the Part D Coverage Gap. The income limits and the amount of help you receive may differ depending on your yearly income. So you may qualify, but you won t know unless you apply. You can complete an application for Extra Help by going to calling or visiting your local Social Security office. I am also happy to help you apply if you think you may be eligible. 14

Now that we ve given you a basic understanding and overview of the different parts of Medicare, let s talk about the different coverage options you have as a Medicare beneficiary.

15 Now that we ve given you a basic understanding and overview of the different parts of Medicare, let s talk about the different coverage options you have as a Medicare beneficiary. The Medicare program is good and benefits lots of people, but it was never meant to cover 100% of your healthcare expenses. Deductibles, copayments and coinsurance are your responsibility. Many people want and need more coverage than Original Medicare provides. There are two main choices for getting your Medicare coverage. Let s look at these options to help you decide which option is right for you. 15

16 16

17 Read the types of Medicare plans from the slide. 17

18 If you start with Medicare Parts A & B, you can then decide what option is best for you. In Option 1, you can add a Medicare Part D plan for prescription coverage or a Medicare Supplement plan to help pay your share of hospital and medical costs... or both. Both types of plans are sold through private insurance companies, and you pay a monthly premium for each plan. In Option 2, you can join a Medicare Advantage plan and get hospital, medical and Part D drug coverage combined into a single plan. Some plans may have premiums as low as $0, and many Medicare Advantage plans include extra benefits you don t get with Medicare like a fitness membership. Medicare Advantage plans are offered through private health insurers like Premera Blue Cross. 18

19 Enrolling in a Medicare Supplement plan: Supplement plans are standardized plans A through N. Ongoing enrollment in some states including Washington (underwriting may be required depending on when you enroll [explain what underwriting is]) You can enroll in MS without underwriting up to 6 months after turning 65 - Longer than 6 months: could be refused, get charged higher premium, acceptance based on health, may have waiting period) Supplement plans help pay healthcare costs Original Medicare doesn t cover: Copays Coinsurance Deductibles Supplement plans are guaranteed renewable as long as you pay your premium. 19

20 You might be wondering why you would need insurance if you already have Medicare. Good question! Original Medicare was never meant to cover all your healthcare expenses, so many people enroll in a Part C or a Part D plan to help pay for some of the costs and benefits that aren t paid by Original Medicare. Medicare Advantage plans combine hospital care, doctor visits and outpatient care in a single plan. If you enroll in a Medicare Advantage Plan, your Medicare benefits are managed by the plan you join. These plans provide all Part A and Part B benefits and help off-set costs like the Part A hospital deductible and the 20% of costs that Medicare does not cover. Members copays and coinsurances vary by plan. Many Medicare Advantage plans also include prescription drug coverage. This means you have one plan and one card for your medical and prescription coverage. Our market is predominately HMO plans. With an HMO plan, you generally have to get your care and services from doctors and other healthcare providers in the Medicare Advantage network. There are exceptions, such as when you are traveling outside the service area or you need emergency care. 20

21 To qualify for a Medicare Advantage plan, you must meet the eligibility requirements: Have Medicare Parts A & B Continue to pay your Part B premium Not have end-stage renal disease (in most cases) Have a valid enrollment period Live in plan service area 21

22 Facilitator Notes: Resources available Local agent Medicare 101 educational meetings and sales meetings In-home appointments Website: premera.com/ma Premera guidebook Medicare Helpline Medicare & You Social Security Administration 22

23 Let s take a final few moments to talk about what you can expect as a new member of Premera Blue Cross. Any additional questions? 23

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