Medicare 101. Decluttering the Medicare Confusion. Richard W. Feder

Transcription

1 Medicare 101 Decluttering the Medicare Confusion Richard W. Feder May 3, 2018

2 Today s Presentation What is Medicare Enrollment timing Medicare Insurance Medicare vs. Group/Employer Healthcare Coverage Gap ( Donut Hole )

3 Medicare Facts 78 million reaching age 65 in next 20 years Currently 58.5 million receiving Medicare, incl. 9 million < age 65 Administered by the Centers for Medicare and Medicaid Services (CMS) Established in 1965

4 What is Medicare Part A Part C Part B Part D

5 Medicare Part A Part A Hospitalization ( In Patient Care) Hospital Stays Cost of room Physicians, Nurses, Medications Food Skilled Nursing Facility Home Health Care Services Hospice Care

6 Medicare Part A Part A Hospitalization Medicare pays... Days 0 60 All but $1,316 deductible Days All but $329/day Days 91+ All but $658/day Skilled Nursing Facility Days 0 20 All Days All but $164.50/day Days 101+ $0

7 Medicare Part B Part B Medical Care ( Out Patient ) Doctor (Medical) & Other Services Clinical Lab Services Outpatient Services (Surgeries) Durable Medical Equipment (wheelchairs, oxygen tanks, medical beds, etc) Home Health Care Services

8 Medicare Part B Part B Medicare pays... 80% of Medical Costs (after $183 annual deductible 100% of Clinical Lab Services 100% of Home Health Care 80% of Durable Medical Equipment

9 Medical Part B Part B You pay... $183 annual deductible 20% of Medicare approved amounts Excess charges (Non-assigned to Medicare) 20% of durable medical equipment

10 Medicare Parts A & B What is Not Covered? Prescriptions Dental Vision Hearing Long-term Care Care outside US

11 Medical Part D Part D Prescription Drug Plans Offered by private insurers Plans vary as to deductibles, premiums, benefits & change annually Preferred, network & out of network Access information at:

12 Medical Part C Part C Medicare Advantage Plans Part A + Part B + Part D + +

13 How & When Do I Enroll?

14 Medicare Enrollment Part A + Part B = Traditional Medicare Before age 65, may be contacted if receiving Social Security benefits If not, you must contact Social Security Part B is elective Other creditable health insurance

15 Medicare A & B Enrollment Age 65 3 months Birth Month 3 months Losing Employer health insurance Group coverage I 8 Months I General Enrollment Period Jan 1 Enrollment March 31 Effective Date July 1

16 Medicare Cost Part A + Part B = Traditional Medicare Part A Hospitalization No Cost - (must have worked 12 quarters) Part B Medical Services Cost $ per month paid to US Govt. Can be higher based on MAGI Elective

17 Medicare Cost Part B Part B Monthly Premium You pay a Part B premium each month to Social Security. Most people will pay the standard premium amount. However if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more. If your yearly income in 2015 was File Individual Tax Return File Joint Tax Return You Pay $85,000 or less $170,000 or less $ above $85,000 up to $107,000 above $170,000 up to $214,000 $ above $107,000 up to $160,000 above $214,000 up to $320,000 $ above $160,000 up to $214,000 above $320,000 up to $428,000 $ above $214,000 above $428,000 $428.60

18 Medicare Cost Part D Part D Monthly Premium The chart below shows your estimated prescription drug plan monthly premium based on your income. If your income is above a certain limit, you will pay an income related monthly adjustment ('IRMA') amount to Social Security in addition to paying your monthly Rx plan premium to your insurance company. If your yearly income in 2015 was File Individual Tax Return File Joint Tax Return You Pay $85,000 or less $170,000 or less Your Rx plan premium above $85,000 up to $107,000 above $170,000 up to $214,000 $ your plan premium above $107,000 up to $160,000 above $214,000 up to $320,000 $ your plan premium above $160,000 up to $214,000 above $320,000 up to $428,000 $ your plan premium $ your plan above $214,000 above $428,000 premium

19 Medicare Insurance

20 Medicare Supplement (Medigap) Part A + Part B + Med Supp Fills the Gaps - Pays out of pocket Medicare costs Deductibles Co-pays Plans A,B,C,D,F,G,K,L,M,N Cost - varies by sex, age, smoker, plan Guaranteed Renewal

21 Medicare Supplement (Medigap) Part A + Part B + Med Supp When is Guaranteed Enrollment? Reaching Age 65 First enrolling in Medicare Part B Losing Employer Group Health Insurance Newly residing in Skilled Nursing Facility Moving out of or into service area Otherwise underwritten

22 Med Supp

23 Medicare Part C (Medicare Advantage) Part A + Part B + Part D = Coverage through private Insurance Cos. Combine Hospitalization & Medical Drug Plan usually included May include limited dental, vision, hearing Must have Part A and Part B

24 Medicare Part C (Medicare Advantage) Pros Premium attractive Rx coverage Additional benefits No refusals Annual selection Cons Networks (HMO) & Coordinated Care Service Areas Deds/Copays/Coins Not available in all NJ counties

25 Medicare vs. Group Health Under 20 Groups Medicare is primary Plan is secondary Must have Part B Groups 20+ Medicare is secondary Part B optional can defer w/o penalty Upon Retirement & COBRA, Medicare is primary

26 Medicare Part D 2018 Donut Hole Part D Initial Coverage Coverage Gap Catastrophic Coverage During this stage you pay a flat fee (copay) or a percentage of a drug's total cost (coinsurance) for each prescription you fill. During this stage you pay 35% of the total cost for brand name drugs and 44% of the total cost for generic drugs. In this stage you pay only a small copay or coinsurance amount for each filled prescription The plan pays the rest until your total drug costs (paid by you and the plan) reach $3,750. Once your out of pocket costs reach $5,000 you move to catastrophic coverage. The plan and Medicare pay the rest until the end of the calendar year. Up to $3,750 Up to $5,000 Through end of year $0 $3,750 $3,750 $5,000 $5,000

27 Medicare: Key Points Medicare enrollment periods Must have Parts A & B for Medicare Supplement or Advantage Plan Star Ratings for MA and PDP Network considerations

28 Medicare: Key Points for CFPs No Cost for Part A, Can you defer Part B? 65 and Retired, on COBRA, or a <20 Group Need Part B, Medicare is primary Yes, can Opt-out of EGHI HSAs and Medicare (can no longer contribute) Medicare deductibility

29 Medicare: Key Points for CFPs EGHI Medicare Monthly Costs Premium $1,500 Part B & IRMA $ Med Supp Premium G $ Rx Premium $ Total $1,500 $ Deductible $2,500 $183 Coinsurance 30% 0% Provider Network Yes No Pre-Authorizations Yes No

30 Medicare: Biggest Mistakes Thinking Medicare enrollment is automatic at age 65 Failing to enroll in Part B when required Relying on HR or Doctor s office for Medicare guidance Believing all Rx plans are the same COBRA Clock > Part B / Med Supp/ Rx

31 Thank You Presentation By: Richard Feder