Independent Representatives. 975 Andover Blvd. Alcoa, TN Office: (865)

Transcription

1 Independent Representatives 975 Andover Blvd. Alcoa, TN Office: (865)

2 Understanding Medicare 2019 Medicare Madness: What does it all mean?

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4 What is Medicare? Health insurance for the following people: Those 65 and older Those younger than 65 with certain disabilities Those with End-Stage Renal Disease (permanent kidney failure)

5 Automatic Enrollment: Part A and Part B Automatic enrollment for those receiving Social Security benefits Railroad Retirement Board benefits Initial Enrollment Period Package Mailed 3 months before 65 or 25th month of disability benefits Includes your Medicare card

6 When Enrolling Isn t Automatic If you re not automatically enrolled 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

7 Initial Enrollment Period When you first turn 65, you have 3 months before and after your birthday month Coverage begins based on your enrollment date If you don t sign up for Medicare when you are first eligible, you may have to pay a penalty for Part B as long as you receive benefits

8 Medicare Annual Enrollment Timeline Pre-Enrollment Oct. 1 Oct. 14 Compare and discuss Medicare health plans No applications may be submitted during this time Annual Enrollment Oct. 15 Dec. 7 Enroll or change Medicare Advantage or Prescription Drug plans for the upcoming year = Annual Disenrollment Jan. 1 Feb. 14 May disenroll from Medicare Advantage and return to original medicare and enroll in a standalone drug plan Feb. 15 Oct. 14 No changes except for special circumstances such as moving out of the service area or qualification or loss of Medicaid

9 The 4 Parts of Medicare

10 What's NOT covered by Original Medicare? Most outpatient prescription drugs Long-term care Routine dental care and Dentures Hearing aids (exams and fittings) Routine foot care Cosmetic Surgery Acupuncture

11 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

12 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

13 Medicare Part B Covered Preventive Services "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 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 Colorectal cancer screenings Tobacco use cessation counseling 13

14 Medicare Part D: Prescription Drugs Medicare Part D Prescription drug option operated by Medicare approved private insurance companies Prescription drugs May help lower your prescription drug costs and help protect against higher costs in the future If you don t sign up for a plan that includes prescription drugs when you are first eligible, you may have to pay a permanent penalty for Part D late enrollment.

15 Medicare Advantage Plans Medicare Part C (Advantage Plan) Health plan managed by Medicare approved private insurance companies Includes all benefits and services covered under Part A and Part B May include extra benefits and services for an extra cost Usually includes Medicare prescription drug coverage (Part D)

16 Medicare Costs in 2019 Most people don t pay a Part A premium because they paid Medicare taxes while working. If you don t get premium-free Part A, you pay up to $437 each month. Part A hospital inpatient deductible is $1364 for each benefit period. Part B premium is currently $ Part B deductible $185 Part D deductible is $415. Some prescription drug plans have a lower deductible or no deductible.

17 What are my Medicare coverage options? First method Original Medicare (Parts A & B) Stand-alone Prescription Drug Plan (Part D) Medicare Supplement or Medigap policy Supplements (identified by a letter) provide identical coverage, but vary widely in price

18 Medicare Supplement Choices

19 Second Method Medicare Advantage Plan (Part C) Includes Part A & B coverage Prescription Drug Coverage (Part D) Some advantage plans include prescription drug coverage Prices are the same regardless of age or gender

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22 Which plan is right for me? Medicare Supplement might make sense if you: Want flexibility in choosing your doctors Visit doctors frequently Travel extensively Have a chronic medical condition Don t mind higher premiums to get lower out-of-pocket costs (predictability) Remember to enroll in the first 6 months after you are both 65 years old and enrolled in Medicare Parts A & B to have guaranteed issue. If you do not enroll during this period, you may have to answer health questions to be eligible for the plan later

23 Medicare Advantage Plan might make sense if you: Are willing to change doctors, if necessary Prefer all benefits from a single plan & premium Visit doctors infrequently & don t mind paying per-visit copayments and coinsurance Don t mind researching your options annually Want lower premiums than supplements offer Are informed about your choices and don t mind comparison shopping for plans Want options beyond what Medicare provides Want an out-of-pocket maximum amount which Original Medicare does not provide

24 What can I do during Open Enrollment from Oct 15 Dec 7? Go from Original Medicare to Advantage Plan Go from Advantage Plan to Original Medicare Switch Medicare Advantage Plans Join Part D plan Switch Part D plans

25 Medicare Part D Two ways to get Part D Purchase Medicare prescription drug standalone policy Choose a Medicare Advantage Plan that offers prescription drug coverage If you choose not to enroll in a prescription drug plan, you may pay a late enrollment penalty if you join a Part D plan later

26 Part D Premium Monthly fee, varies by plan In addition to Part B cost Some Advantage Plans include Part D coverage in the cost How to avoid a Part D Enrollment penalty Join plan that includes prescription drugs when first eligible Don t go 63 days or more without drug coverage Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($33.19 in 2019) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

27 IMPORTANT!! Always ensure your prescription drugs are in the formulary of any plan you re considering Check which tier your prescription drugs are in each tier has different cost Do this every year during Open Enrollment!

28 2019 Coverage Gap (Doughnut Hole) Begins when total drug costs reaches $3820 Includes what you & insurance plan have paid During the gap you pay discounted amounts 25% on brand name drugs 37% on generic drugs Once you ve paid $5,100 out of pocket you enter catastrophic coverage and pay 5% of cost for covered drugs.

29 IMPORTANT! Drug plans may include preferred and nonpreferred pharmacies in their network You may pay less for drugs at preferred pharmacies You may pay less using the plans preferred mail order pharmacy

30 EXTRA HELP Program to help people pay Medicare prescription drug costs For single person, income less than $18,210 annually and limited assets For married person living with spouse, income less than $24,690 annually and limited assets

31 EXTRA HELP Apply through Social Security Helps with monthly drug plan premium, annual deductible, coinsurance and copayments Eliminates doughnut hole Switch plans at any time during year Same application used to get help from TN to pay your Medicare costs

32 Five Biggest Mistakes Made When Enrolling in Medicare Not enrolling or making changes during an available enrollment period Not understanding the difference between Medicare Supplement and Medicare Advantage Choosing a plan based entirely on the plan a friend or family member has Not re-evaluating coverage yearly

33 Important to remember! You may not enroll in a Medicare Supplement plan and a Medicare Advantage plan together. You may not enroll in a Medicare Advantage plan and a stand-alone prescription together in most cases.

34 Information Overload?

35 Reasons to Consult with an Independent Agent When Enrolling Objective guidance to help steer you toward a plan to meet your needs and affordability. Trained annually to stay current with changes in the Medicare system. Year around assistance locally No additional cost for expert advice and guidance Don t go through the Medicare Maze alone!

36 Independent Representatives 975 Andover Blvd. Alcoa, TN Office: (865)