Medicare Educational Video. Presented by: Medicare Simplified Medicare Simplified. All rights reserved.

Transcription

1 Medicare Educational Video Presented by: Medicare Simplified Copyright 2014 Medicare Simplified. All rights reserved.

2 TABLE OF CONTENTS SUBJECT TIME ON CLOCK(HR/MIN/SEC) INTRODUCTION 00:00:00 YOUR MEDICARE CHOICES 00:05:25 ENROLLMENT PERIODS 00:07:40 PENALTIES FOR LATE ENROLLMENT 00:18:41 MORE ABOUT YOUR OPTIONS AND EMPLOYER PLANS 00:22:27 PART A DETAILS 00:38:49 PART B DETAILS AND MEANS TESTING 00:43:39 SUPPLEMENT PLAN DETAILS (MEDIGAP) 00:48:23 PRESCRIPTION DRUG PLAN DETAILS (PART D) 00:57:00 MEDICARE ADVANTAGE PLAN DETAILS (PART C) 01:07:57 IMPACT OF HEALTHCARE REFORM ON ADVANTAGE PLANS 01:13:18 MEDICARE COSTS 01:17:08 CHANGES AFTER YOU ARE ON MEDICARE 01:20:29 HOW DO MOST INDIVIDUALS MAKE THEIR DECISIONS 01:24:54 MEDICARE SIMPLIFIED PERSONAL CONSULTING SERVICES 01:27:21 (THE VIDEO IS ABOUT 1 HOUR AND 32 MINUTES)

3 Your choices Original Medicare Part A: Hospital Insurance Part B: Medical Insurance Medicare Supplement (Medigap) Plans Medicare Prescription Drug Plans (Part D) Medicare Advantage Plans (Part C)

4 Important Enrollment Periods Part A and Part B Initial Enrollment Period 7 month window 3 months prior to your birth month Birth month 3 months after your birth month Collecting Social Security automatically enrolled Not collecting Social Security Call In person Website

5 Special Enrollment Period If you or a spouse is currently working, and you are covered by a group plan based on that work, you can sign up anytime you have the group coverage or 8 months after the employment or coverage ends (whichever happens first). If you have COBRA, you must sign up during the 8 month period that begins the month after the employment ends. General Enrollment Period January 1 March 31 every year. When you sign up during this period your coverage will begin July 1 st. Note: May have penalties.

6

7 Medicare Supplement (Medigap) Plans Open Enrollment Period - This period lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Part B (some states have additional open enrollment periods). There may be some exceptions if you miss the open enrollment period.

8 Medicare Prescription Drug Plan Part D When you first become eligible for Medicare Initial Enrollment Period as described earlier. Within 63 days of not having creditable drug coverage. Between October 15 December 7 (dates may change each year). Your coverage will begin January 1 st of the following year. Note: May have penalties.

9 Medicare Advantage Plans Part C When you first become eligible for Medicare Initial Enrollment Period as described earlier. If you are loosing health coverage from your (or your spouse) employer plan. This Special Enrollment Period is if you or a spouse is currently working, and you are covered by a group plan based on that work, you can sign up anytime you have the group coverage or 8 months after the employment or coverage ends (whichever happens first). If you have COBRA, you must sign up during the 8 month period that begins the month after the employment ends. Note: If you want prescription drug coverage included with your Advantage Plan, you must enroll within 63 days of not having creditable drug coverage. Between October 15 December 7 (dates may change each year). Your coverage will begin January 1 st of the following year. Note: May have penalties.

10 Financial Penalties For Late Enrollment Part A Hospital Insurance The cost will increase 10% if you do not enroll within the first 12 months of being eligible. You pay this penalty for twice the time you could have had Part A, but did not sign up for it. You avoid this penalty if you qualify for the special enrollment period or if your Part A is free. Part B Medical Insurance The cost will increase 10% for each full 12-month period you could have had Part B but did not sign up for it, unless you qualify for the special enrollment period. You may have to pay this penalty as long as you have Part B.

11 Financial Penalties For Late Enrollment Part D Drug Coverage The cost will increase 1% for every full month you did not have creditable drug coverage after you were first eligible to join a Medicare Drug Plan. This percentage is multiplied by the current year Part D national base beneficiary premium. You may pay this penalty as long as you have Part D. This penalty also applies to Part C (Medicare Advantage Plans) if drug coverage is included.

12 Underwriting Concerns Medicare Supplement (Medigap) Plans If you do not enroll in a Medicare Supplement Plan in a timely manner, you may be subject to delays for pre-existing conditions, higher premiums or possibly denied coverage.

13 Option 1 Option 2 Option 3 Part A and B (Original Medicare) + Medicare Supplement (Medigap) + Medicare Prescription Drug Plan Part D Medicare Advantage Plan (PPO, HMO, PFFS or MSA) (Must have Part A and Part B) Cannot buy a Supplement Plan Drug coverage is normally included Other Coverage Current or previous employer of yours or your spouse, a Pension Plan, a Union or the Military

14 Option 1 Original Medicare Part A Hospital and Part B Medical Through the government Out of pocket exposure Supplement Plans Offered by private insurance companies Helps pay some (or most) of costs of Medicare covered services not paid by Part A and Part B Prescription Drug Coverage Offered by private insurance companies Helps pay for some of the cost of prescription medications

15 Option 2 Medicare Advantage Plans Offered by private insurance companies Must have Part A and Part B Many include prescription drug coverage HMO, PPO, PFFS, MSA, SNP Cannot have Advantage Plan and Supplement Plan

16 Option 3 Other coverage Current / previous employer (of you or your spouse), a Pension Plan, a Union or the Military Full coverage Drug Coverage Creditable May need nothing Through Medicare Supplement and Drug Coverage Drug Coverage Drug Coverage Creditable Drug Coverage Creditable Need Part A and B Need Part A and B + Supplement/Drugs or + Advantage Plan

17 Part A (Hospital Insurance) Part A helps cover Medicare eligible inpatient care in hospitals, inpatient care in a skilled nursing facility, home health care services and hospice care services. Free to most people. Could cost up to $446/month in Benefit Period This is the way Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go into a hospital or SNF and ends when you have not received any hospital or SNF care for 60 days in a row. If you go into a hospital or SNF after one benefit period has ended, a new benefit period begins. Lifetime Reserve Days These are additional days Medicare will cover when you are in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily co-pay.

18 Part A (Hospital Insurance) Deductibles, co-pays and/or coinsurance in 2014 (Assumes no Supplement Plan or Advantage Plan) Hospital Stays you pay $1,216 deductible for days 1-60 each benefit period $304 per day for days each benefit period $608 per day for days (lifetime reserve days) All costs after lifetime reserve days Skilled Nursing Facility Stays you pay No deductible $0 for days 1-20 each benefit period $152 per day for days each benefit period All costs after day 100 each benefit period

19 Part A (Hospital Insurance) Deductibles, co-pays and/or coinsurance in 2014 (Assumes no Supplement Plan or Advantage Plan) Home Health Care you pay $0 for home health care services and 20% coinsurance for durable medical equipment Hospice Care you pay $0 for hospice care, $5 per outpatient prescription drug for pain and system management, and 5% for inpatient respite care. Room and board are not covered when you get hospice care in your home or another facility where you live.

20 Part B (Medical Insurance) Part B helps cover Medicare eligible physician services, outpatient care, home health services and other medical services. Part B also covers some preventative services. The premium for Part B in 2014 is $104.90/month. However it is means tested based on your modified adjusted gross income you could pay more than $104.90/month. Premium will come out of your Social Security check. If not collecting Social Security, you will be billed quarterly.

21 Means Testing for Part B and Part D in 2014 Monthly Premium Add On* Individual Return Joint Return Part B Part D $85,000 or below $170,000 or below $0 $0 $85,001 - $107,000 $170,001 - $214,000 $42.00 $12.10 $107,001 - $160,000 $214,001 - $320,000 $ $31.10 $160,001 $214,000 $320,001 - $428,000 $ $50.20 Above $214,000 Above $428,000 $ $69.30 Married Filing a Separate Return $85,000 or below $0 $0 $85,001 - $129,000 $ $50.20 Above $129,000 $ $69.30 *The monthly premium add on amount is in addition to the standard Part B premium of $ per month in The Part D add on amount is in addition to the premium for your specific drug plan.

22 Part B (Medical Insurance) Part B helps cover Medicare eligible physician services, outpatient care, home health services and other medical services. Part B also covers some preventative services. The premium for Part B in 2014 is $104.90/month. However it is means tested based on your modified adjusted gross income you could pay more than $104.90/month. Premium will come out of your Social Security check. If not collecting, call Social Security, you will be billed quarterly.

23 Part B (Medical Insurance) Deductibles, co-pays and/or coinsurance in 2014 (Assumes no Supplement Plan or Advantage Plan) You pay the first $147 for Part B covered services. You pay 20% of the Medicare approved amount for most doctor services (including most doctor services while in the hospital), outpatient therapy (may be limits) and durable medical equipment. You pay $0 for Medicare approved clinical laboratory services. You pay $0 for home health care and 20% of the Medicare approved amount for durable medical equipment. You pay 40% for most outpatient mental health care. You pay coinsurance and co-pay amounts that vary for hospital outpatient services.

24 Medicare Supplement (Medigap) Plans Available through private insurance companies. Pays for some (or most) of the costs ( gaps ) of Medicare covered services Part A and Part B do not pay (i.e. deductibles, co-pays and coinsurance). Generally you must have Part A and Part B to purchase this coverage. There are 10 Supplement Plans. All plans are standardized. Some Supplement Plans have a Select option.

25 Supplement Plan Options Supplement Benefits A B C D F* G K L M N Medicare Part A Coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up X X X X X X X X X X Medicare Part B Coinsurance or Copayment X X X X X X 50% 75% X X*** Blood (First 3 pints) X X X X X X 50% 75% X X Part A Hospice Care Coinsurance or Copayment X X X X X X 50% 75% X X Skilled Nursing Facility Care Coinsurance X X X X 50% 75% X X Medicare Part A Deductible X X X X X 50% 75% 50% X Medicare Part B Deductible X X Medicare Part B Excess Charges X X Foreign Travel Emergency (Up to Plan Limits) X X X X X X Medicare Preventive Care Part B Coinsurance X X X X X X X X X X Out of Pocket Limit ** $4,940 $2,470 * Plan F also offers a high deductible option. This means you must pay for Medicare covered costs up to the deductible amount of $2,140 in 2014 before your Supplement Plan pays anything. ** After you meet your out of pocket yearly limit (for Plan K or L) and your yearly Part B deductible ($147 in 2014), the Supplement Plan pays 100% of covered services for the rest of the calendar year. Out of pocket limit is the maximum amount you would pay for coinsurance and copayments. *** Plan N pays 100 % of the Part B coinsurance except up to $20 copayment for office visits and up to $50 for emergency department visits.

26 How Medicare Supplement Plans are Priced Community rated You pay the same premium as everyone else who has the policy in a specific area, regardless of your age. Once you buy the policy, the premiums may go up because of inflation and other factors, but not based on your age. Issue-age rated The premium is based on your age when you buy (are issued ) the policy. Once you buy the policy, premiums may go up because of inflation and other factors, but not based on your age. Attained-age rated The premium is based on your current age (the age you have attained ). Once you buy the policy, the premiums may go up as you get older and may go up because of inflation and other factors.

27 Medicare Prescription Drug Coverage (Part D) Part D is available through private insurance companies. May be purchased as a stand alone plan or as part of an Advantage Plan. There are numerous plans available in every state. Each plan may have a different premium (can vary dramatically), deductible, co-pays and coinsurance schedule. The premium for Part D is means tested based on your modified adjusted gross income.

28 Medicare Prescription Drug Coverage (Part D) Coverage rules Prior authorization Quantity limits Step therapy Tier Structure Formulary Pharmacy / Mail Order

29 Medicare Prescription Drug Coverage (Part D) Standard Drug Plan Details for 2014 Annual Deductible - $310 maximum in 2014 Initial Coverage you pay co-pays or coinsurance and the plan pays its share of covered drugs until the total is $2,850 (includes deductible, but not your premiums) Doughnut Hole or Coverage Gap Once you and the plan have spent $2,850 for covered drugs, you enter the doughnut hole. You now pay 47.5% of the costs for brand name drugs and 72% for generics until you have spent $4,550. Catastrophic Coverage Once you have spent $4,550 out-ofpocket for the year, you pay a small (compared to the initial coverage above) co-pay or coinsurance for each covered drug until the end of the year.

30 Doughnut Hole Phase Out Brand Name Drugs Generic Drugs Year Discount Subsidy You Pay Subsidy You Pay % 0% 50% 7% 93% % 0% 50% 14% 86% % 2.5% 47.50% 21% 79% % 2.5% 47.50% 28% 72% % 5% 45% 35% 65% % 5% 45% 42% 58% % 10% 40% 49% 51% % 15% 35% 56% 44% % 20% 30% 63% 37% % 25% 25% 75% 25%

31 Medicare Prescription Drug Coverage (Part D) Standard Drug Plan Details for 2014 Annual Deductible - $310 maximum in 2014 Initial Coverage you pay co-pays or coinsurance and the plan pays its share of covered drugs until the total is $2,850 (includes deductible, but not your premiums) Doughnut Hole or Coverage Gap Once you and the plan have spent $2,850 for covered drugs, you enter the doughnut hole. You now pay 47.5% of the costs for brand name drugs and 72% for generics until you have spent $4,550. Catastrophic Coverage Once you have spent $4,550 out-of-pocket for the year, you pay a small (compared to the initial coverage above) co-pay or coinsurance for each covered drug until the end of the year.

32 Medicare Prescription Drug Coverage Strategies Do not just look at premiums and deductible. Remember coverage rules. If you take expensive medications, discuss alternatives with your doctor. Maybe buy some medications off the plan. Review on an annual basis.

33 Medicare Advantage Plans Part C Offered by private insurance companies. To purchase you must be enrolled in Part A and Part B, live within the service area of the plan and do not have End-Staged Renal Disease. Types of Advantage Plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-For- Service (PFFS), Medical Savings Account (MSA) and Special Needs Plans (SNP). Must cover at least all services Part A and Part B cover but may have different out of pocket costs. You will be responsible for some of the costs of Medicare covered services through deductibles, co-pays or coinsurance. You can not add a Supplement Plan to an Advantage Plan.

34 Medicare Advantage Plans Prescription drug coverage may be included in the Advantage Plan (same standard coverage as a stand alone Part D Plan). If the Advantage Plan does not include prescription drug coverage, you may be able to purchase a stand alone Drug Plan (Part D). Doctors and hospitals need to be in the network or accept the plan to avoid a lower (or no) reimbursement. Some Advantage Plans offer extra coverage such as preventive care, vision, hearing, dental and/or health and wellness programs.

35

36

37

38 Premiums for Medicare (All premiums are per month and per person) Option 1 ORIGINAL MEDICARE Part A: FREE Part B: $ SUPPLEMENT PLANS National Range Normal Range $25 - $1,200 $50 - $200 DRUG PLANS National Range National Average $13 - $175 $31 Social Security :

39 Premiums for Medicare (All premiums are per month and per person) Option 1 ORIGINAL MEDICARE Part A: FREE Part B: $ SUPPLEMENT PLANS National Range Normal Range $25 - $1200 $50 - $200 DRUG PLANS National Range National Average $13 - $175 $31 Option 2 ADVANTAGE PLAN Part A: FREE Part B: $ ADVANTAGE PLAN ADDITIONAL PREMIUM RANGE Normal Range $0 - $250

40 Making Changes

41 Changes you want to make

42

43

44

45 Factors for Decisions Your Health Your Doctors Your Travel Habits Your Finances Your Medications Where You Live Your Risk Tolerance

46

47 Personalized Medicare Study with One on One Consulting through Medicare Simplified Cost All pricing is subject to change. $225 This covers all written reports and phone calls for an individual. $50 additional charge If you are married and we review both spouses at the same time. If we review a spouse s situation in a different year, the cost for the spouse will be half of the current price. The pricing varies for any future services through Medicare Simplified based on the service. We are up front before any services are performed.

48 How to sign up for the Personalized Medicare Study with One on One Consulting Go to Contact Us on our website: Call Note: Please provide your name and phone number. Copyright 2014 Medicare Simplified. All rights reserved.

49 Produced by Medicare Simplified Copyright 2014 Medicare Simplified. All rights reserved.