Medicare Insurance Guide. Help You Can Count On.

Transcription

1 Medicare Insurance Guide Help You Can Count On.

2 Help You Can Count On. For many people, Medicare alone does not provide a comprehensive safety net for health care expenses. While Medicare Parts A and B help to provide coverage for some hospital and medical costs, the fact remains: for many people, it s often not enough. The reality is that Medicare Parts A and B place no limit on the amount of money you could be responsible to pay annually, including: No limit on expenses for medical services No coverage for the mounting costs of prescription drugs (with a few exceptions) Because of these significant gaps in coverage, most people purchase Medicare insurance to help build complete coverage and provide a more comprehensive safety net. With so many insurance options how do you find the plan that is right for you? Aon Hewitt Navigators Insurance Services Inc. offers help you can count on. A certified and licensed benefit advisor will provide free, impartial guidance and will help you navigate your available options, find an insurance plan that fits your needs and budget, and build the comprehensive financial protection you deserve. Building complete coverage Medicare Parts A and B Medicare Insurance (2 options) Medigap & Medicare Part D Prescription Drug OR Medicare Advantage Complete coverage and financial protection In this Guide Medicare Parts A and B... 2 Medicare Insurance... 5 Medigap and Medicare Part D... 6 Medicare Advantage Making the Right Choice: Medigap or Medicare Advantage? Ongoing, Free Help You Can Count On... 16

3 Aon Hewitt Navigators has more than 70 years experience helping millions of people with their insurance and benefits needs. Here s what you can expect from us: Knowledgeable guidance and impartial recommendations Simple explanations of your Medicare insurance options One-on-one assistance as you enroll in the insurance plan of your choice 100% free service; you pay only for the insurance coverage in which you enroll Getting started The personalized letter accompanying this guide provides you with: 1. Actions you may need to take to avoid a lapse in coverage 2. A special phone number and log-on information for our website that can help you contact us Contact us today Whether you learned about us through an employer, were referred to us by a friend, or found us on your own, we re happy to hear from you! Contact us today and take the first step toward finding the coverage, financial protection, and peace of mind you deserve. Be sure you have the following information in hand before you contact us: Your Medicare card List of your key prescription medications List of your primary doctors and their phone numbers Medicare card 1

4 Medicare Parts A and B Your Step-by-Step Guide to Building Complete Coverage Step 1: Understand and enroll in Medicare Parts A and B Medicare is the nation s largest health insurance program. It s designed to provide coverage for people age 65 and older, people under age 65 who have permanent disabilities, and people of any age with end-stage renal disease permanent kidney failure requiring dialysis. What do Medicare Parts A and B cover? Coverage Medical Services Prescription Drugs Financial Protection Part A Inpatient care in hospitals Limited skilled-nursing care Hospice care services Home health services Limited Limited Part B Doctors fees Outpatient hospital care Medical equipment and supplies None* Limited * With a few exceptions, most prescriptions are not covered. What s not covered by Medicare Parts A and B? The simple truth is that Medicare Parts A and B do not cover everything. If you need certain services that are not covered by Medicare Parts A and B, you will have to pay for them yourself unless you have other insurance to help cover those costs. Even if Medicare Part A or Part B covers a service or item, you ll still generally have to pay deductibles, coinsurance, and copayments without any annual limit on those costs. Generally, services and items not covered by Medicare Parts A and B include: Most outpatient prescription drugs Routine vision care Long-term care Routine dental care Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting hearing aids 2

5 Medicare Parts A and B Medicare Part A How does Medicare Part A work? If you are admitted to a hospital for between 1 and 60 days, you will be responsible for paying all daily out-of-pocket costs up to your deductible ($1,132 for 2011). After you reach your deductible, Medicare Part A will cover your expenses. If you are required to stay in the hospital for 60 to 150 days, you will be responsible for paying additional out-of-pocket costs (approximately $283 to $566 per day for 2011). For each day after 150 days of hospitalization, you will be responsible for paying all costs. Most other services, including blood infusions and skilled-nursing facilities, require a copayment before Medicare covers eligible expenses. How much does Medicare Part A cost? Most people don t have to pay a premium for Medicare Part A because they or their spouse paid Medicare taxes while working. This is referred to as premium-free Medicare Part A. If you or your spouse worked and paid Medicare taxes for at least 10 years, you are eligible for premium-free Medicare Part A. If you and your spouse worked less than 10 years, you ll pay a premium of between $248 and $450 per month based on your work history. Medicare Part B How does Medicare Part B work? When you visit the doctor, you ll pay all costs out-of-pocket until you reach your annual deductible ($162 for 2011). Then Medicare Part B will begin to cover your expenses. Once you reach your deductible, you ll pay 20% of the Medicare-approved amount for services. This is called your coinsurance share. How much does Medicare Part B cost? Typically, you will pay a monthly premium of around $100 for Medicare Part B coverage. The premium depends on a number of factors, including when you enroll and your income level. Visit or call MEDICARE ( ) or contact Aon Hewitt Navigators for more information on Medicare. 3

6 Medicare Parts A and B When can you enroll in Medicare Parts A and B? You can sign up for Medicare Parts A and B any time during an initial seven-month enrollment period, which begins three months before the month of your 65th birthday and ends three months after your 65th birthday. If you don t sign up for Medicare Parts A and/or B during that time, you may still sign up from January 1 to March 31 each calendar year however, you may have to pay a higher premium for late enrollment, and your coverage won t start until July 1. Special enrollment periods If you didn t sign up for Medicare Parts A and B when you were first eligible because you were working and were covered by your employer s group health plan, you can sign up while you are covered under the employer s group health plan or during the eight months following the month after your employment or employer group health plan ends (whichever comes first). How can you enroll in Medicare Parts A and B? To enroll in Medicare Parts A and B, contact the Social Security Administration online at or by phone at Be aware There is no out-of-pocket cap for Medicare Part A and Part B costs. This means there is no limit to the amount of money you could potentially pay annually for hospital costs and medical services. Consider a Medicare insurance plan that can help you manage these outof-pocket costs. Aon Hewitt Navigators can help you understand your Medicare Parts A and B coverage, explore your insurance options, and find a solution that provides you with the protection you need. 4

7 Medicare Insurance Step 2: Choosing and enrolling in a Medicare insurance option After enrolling in Medicare Parts A and B, most people purchase Medicare insurance to obtain complete coverage and the greatest financial protection. Aon Hewitt Navigators can help you control out-of-pocket expenses by helping you find an insurance plan that fits your needs and budget. Generally, there are two options for Medicare insurance: Option 1 Medigap plans (also known as Medicare Supplement ), which are designed to fill the gaps by covering a wide range of medical expenses not covered by Medicare Parts A and B. However, Medigap plans do not cover prescription drugs. Plus separate Medicare Part D Prescription Drug coverage, which helps to pay for the prescription drugs you may need. Coverage Medical Services Prescription Drugs Financial Protection Medigap Helps pay for services and supplies not fully covered by Medicare Parts A and B and may cover other items None Complete Medicare Part D Prescription Drug None Complete Complete Option 2 Medicare Advantage plans, which provide medical benefits as good as those covered by Medicare Parts A and B, with greater financial protection. Most Medicare Advantage plans also include Medicare Part D Prescription Drug coverage, although there are many plans available without that coverage (if desired). Coverage Medical Services Prescription Drugs Financial Protection Medicare Advantage At least the same services as Medicare Parts A and B, and may cover additional services or supplies Complete (many plans) Complete (many plans) Before you can purchase Medicare insurance that includes medical coverage, you must enroll in Medicare Parts A and B. To do so, contact the Social Security Administration online at or by phone at

8 Medigap + Medicare Part D Medicare Insurance Option 1: Medigap + Medicare Part D Prescription Drug Medigap As the name suggests, Medigap insurance is designed to fill gaps in Medicare Parts A and B coverage by assuming responsibility for various costs not covered by original Medicare. While there are a number of different Medigap plans, their benefits are standardized in each state. This means that within your state, the benefits of each plan offered by one insurance company will be the same as the benefits for the same plan offered by any other insurance company. The difference among the Medigap plans within your state lies in the details of how much coverage they offer and which gaps they fill. Aon Hewitt Navigators can help you sort through these details to determine which plan best meets your needs. How much does a Medigap plan cost? You pay a monthly premium for your Medigap policy in addition to your monthly Medicare Part B premium. Premiums vary based on the plan you choose. Insurance companies may charge different premiums for exactly the same coverage. Be aware Medigap plans do not cover prescription drugs. If you choose a Medigap plan, consider enrolling in a Medicare Part D Prescription Drug plan as well. Contact Aon Hewitt Navigators for guidance in selecting a plan that s right for you. 6

9 Medigap + Medicare Part D Standard Medigap plans and their benefits: All states except Massachusetts, Minnesota, and Wisconsin The table below is a summary of what each standardized Medigap plan (A to N) covers. As a rule, most people who work with Aon Hewitt Navigators consider Plan F the gold standard. With Plan F, you only pay the monthly premium, and pay nothing additional when you see a doctor or go to the hospital if they are approved by Medicare. (A checkmark (3) indicates areas where the plan pays 100% of the benefit cost.) Medigap Benefits Medicare Part A Coinsurance and Hospital Costs (up to 365 days after Medicare benefits are used up) Medigap Plans A B C D F* G K** L** M N Medicare Part A Hospital Deductible % 75% 50% 3 Skilled-Nursing Facility Care Copay/Coinsurance % 75% 3 Medicare Part B Deductible 3 3 Medicare Part B Coinsurance (generally 20%) % 75% 3 3 *** Medicare Part B Excess Charges 3 3 Blood (first 3 pints) % 75% 3 3 Foreign Travel Emergencies (up to plan limits) * Some insurance companies offer a high deductible version of Plan F, which requires you to pay a deductible before these costs are covered. ** Maximum out-of-pocket expenses of around $5,000 for Plan K and $2,500 for Plan L apply. *** 20% is covered, with the exception of a $20 copayment to see a physician and a $50 copayment for emergency room visits that don t result in an inpatient admission. 7

10 Medicare Medigap + Medicare InsurancePart D Medicare Insurance (continued) Standard Medigap plans and their benefits: Massachusetts, Minnesota, and Wisconsin In these three states, standard Medigap benefits work a bit differently. The table below details what is covered by standard Medigap plans in Massachusetts, Minnesota, and Wisconsin. Medigap Benefits Massachusetts Minnesota* Wisconsin** Core Plan Supplement 1 Plan Basic Plan Extended Basic Plan (or Riders) Basic Plan Hospital Copays/Coinsurance extra days extra days Medicare Part A Hospital Deductible Skilled-Nursing Copay/Coinsurance days 3120 days 3 3 Medicare Part B Deductible Medicare Part B Coinsurance (generally 20%) Medicare Part B Excess Charges 80% 3 Optional Riders Available Blood (first 3 pints) Foreign Travel Emergencies (up to plan limits) 3 380% 380% *** 3 Inpatient Days in Mental Health Hospitals 60/benefit year 120/calendar year 175 lifetime days Preventive Care and Other State Benefits * Plans K, L, M, N, and high-deductible F are also available. ** Plans similar to K and L, and a high-deductible plan, are also available. *** 100% after you spend $1,000 in out-of-pocket costs for a calendar year. 8

11 Medigap + Medicare Part D Important considerations for plans in all states: To enroll in a Medigap plan, you must be enrolled in Medicare Parts A and B. Although most Medigap plans cover expenses from any health care provider that accepts Medicare, some Medigap companies also offer a Medigap SELECT plan. Medigap SELECT plans provide coverage only within a defined network of providers. Before you purchase a Medigap SELECT plan, check to make sure that your doctor or hospital is included in that particular plan s network. Most Medigap plans don t require a copayment or coinsurance for hospital charges. If you buy coverage when you first become eligible at age 65, or if your company stops providing a group retiree health plan, you are guaranteed to qualify to obtain Medigap coverage and will not be required to pass any health screening by the Medigap insurer. At all other times, however, it is likely that you will be required to pass a health screening in order to obtain coverage. 9

12 Medigap + Medicare Part D Medicare Insurance (continued) Medicare Part D Prescription Drug Medicare Part D Prescription Drug coverage helps you pay for prescription drugs that are not covered by Medicare Parts A and B. Medicare Part D Prescription Drug coverage is insurance available from an insurance company or other private company that is approved by Medicare. There are two ways in which you can obtain the prescription drug coverage you need: Medicare Part D Prescription Drug plans (sometimes called PDPs) can be added to Medicare Parts A and B and to Medigap plans. Medicare Advantage Prescription Drug plans are Medicare Advantage plans (see page 12 for details) that also provide prescription drug coverage. If you enroll in a Medicare Advantage Prescription Drug plan, you will not need to enroll in a separate PDP. How much does Medicare Part D Prescription Drug coverage cost? The cost of Medicare Part D Prescription Drug coverage varies with the plan you choose. As with most other insurance plans, you must pay a monthly premium for your Medicare Part D Prescription Drug plan, then coverage works like this: Expense Description Your Costs (varies by plan; 2011 ranges) Premium Deductible Coinsurance Copayment Catastrophic Coverage This is the monthly cost of your Medicare Part D Prescription Drug plan coverage. Regardless of whether you use your plan to purchase drugs, you will be responsible for paying this premium. This is the amount you pay out-of-pocket for your prescription drugs each year before your plan begins to pay. Many plans don t have a deductible. Once you ve satisfied your deductible (if required), you and the Medicare Part D Prescription Drug plan share the cost of your prescription drugs. This is typically a percentage of the total cost of the prescription, although that amount may vary depending on whether you require a brand-name or generic prescription. Some plans require that you pay a set dollar amount for each prescription, as opposed to a percentage of its cost (see Coinsurance above). This amount may vary depending on whether you require a brand-name or generic prescription. Coinsurance and copayments are often either/or, so you ll rarely have to pay for both. If, over the course of a calendar year, your spending on covered prescription drugs exceeds a preset limit, your plan s catastrophic coverage will begin to provide a safety net for you. Once that happens, the Medicare Part D Prescription Drug plan will cover about 95% of the cost of your prescriptions. The exact amount you need to spend before catastrophic coverage begins depends on the type of prescriptions you require. $0 $100 per month $0 $310 per year After you and the plan have spent $2,840 in drug costs, you pay 50% of the brand-name drug costs. Depends on plan After your out-of-pocket costs reach $4,550 in a given year (prior to any rebate for brandname drugs for purchases in the coverage gap), you only pay about 5% of your prescription costs. 10

13 Medigap + Medicare Part D Important considerations for plans: You must be enrolled in Medicare Part A and/or B before you can enroll in a Medicare Part D Prescription Drug plan. Unless you have coverage from another source that is considered as good as Medicare s (known as creditable coverage), you may pay a penalty if you don t enroll in Medicare Part D Prescription Drug coverage when you are first eligible. Each Medicare Part D Prescription Drug plan has a formulary, which is a list of approved drugs. Only specific drugs listed on your plan s formulary will be covered by the plan. The good news is that, by law, all Medicare Part D Prescription Drug plans must cover medications that treat almost every medical condition. If you have limited income and assets, you may be eligible for the Extra Help program to pay your premiums and drug costs. Contact the Social Security Administration online at or by phone at for more information. 11

14 Medicare Advantage Medicare Insurance (continued) Option 2: Medicare Advantage Medicare Advantage plans are Medicare-approved health insurance plans offered by private insurance companies. They generally provide all your Medicare Parts A and B coverage, and often provide extra coverage for vision, hearing, dental, and health/wellness programs. Most Medicare Advantage plans include Medicare Part D Prescription Drug coverage within the quoted monthly premium. How much does a Medicare Advantage plan cost? In addition to your Medicare Part B premium, you will usually pay a monthly premium for your Medicare Advantage plan. This premium may vary, depending on the services covered. In most cases there are no deductibles, and for most medical services you will pay a copayment instead of coinsurance. Each plan is different, so you need to understand the specifics before enrolling in any plan. Most Medicare Advantage plans also have an out-of-pocket maximum, which provides you with financial protection by setting a cap on how much you ll have to pay in a given year for health services. This protection does not come at the cost of less coverage, however; by law, Medicare Advantage plans must cover all the services that Medicare Parts A and B cover, with the exception of hospice care (which remains covered under Medicare Part A). Be aware Need prescription drug coverage? Be sure it s included! If you choose a Medicare Advantage HMO or PPO plan, you will not be able to enroll in a stand-alone Medicare Part D Prescription Drug plan. Be sure that your approach to Medicare insurance coverage includes prescription drug coverage before you enroll. Contact your Aon Hewitt Navigators benefit advisor for help in finding the coverage you need. 12

15 Medicare Advantage Medicare Advantage Plan Comparison Chart Type Doctors and Hospitals Referrals Prescription Drugs Notes Premiums Health Maintenance Organization Plans (HMOs) HMOs only provide coverage for services performed through a designated network of physicians and hospitals. You will be required to select a primary care physician (PCP), who will manage your health care. Your PCP must provide referrals for hospital and specialized care. HMO members cannot enroll in a stand-alone Medicare Part D Prescription Drug plan. Be sure the HMO plan you select includes prescription drug coverage before you enroll. These plans are often the least expensive, and provide the best value in areas where there are strong HMO plans with an extensive network of providers. $ Preferred Provider Organization Plans (PPOs) PPOs provide coverage through a network of physicians and hospitals, but allow you to choose out-of-network providers. However, the plan pays a higher benefit when you use a network provider. (The cost of services may also be higher for out-ofnetwork providers.) Typically, you don t need a referral. However, you may need plan-approval for certain services. Check with your plan provider for full details. PPO members cannot enroll in a stand-alone Medicare Part D Prescription Drug plan. Be sure the PPO plan you select includes prescription drug coverage before you enroll. PPO plans offer flexibility often for an affordable price. $$ Private Feefor-Service Plans (PFFS) In rural areas, you can see any willing doctor or hospital as long as the provider accepts Medicare s fee schedule. In urban areas, PFFS plans work like PPOs. No referrals are needed for hospital or specialized care. However, you may need plan-approval for certain services. Check with your plan provider for full details. You can elect a PFFS plan that has prescription drug coverage, or enroll in a stand-alone Medicare Part D Prescription Drug plan. Some health care providers do not accept PFFS plans. Check with your doctors to make sure they accept PFFS plans before enrolling. $$ Medicare Cost Plans (MC) MC plans are available only in certain areas. They work like HMOs, with the added feature of coverage of out-of-network services covered by Medicare Parts A and B (and are subject to Medicare deductibles and copayments). No referrals are needed for hospital or specialized care. However, you may need plan-approval for certain services. Check with your plan provider for full details. You can elect an MC plan that has prescription drug coverage, or enroll in a stand-alone Medicare Part D Prescription Drug plan. $$ Medical Savings Account Plans (MSA) You re covered no matter what Medicare provider you use. Typically, no referrals are needed for hospital or specialized care. You must enroll in a stand-alone Medicare Part D Prescription Drug plan if you want drug coverage. Your MSA will be funded up to a preset dollar amount each year. You use these funds to pay for services (excluding prescriptions) until you meet your deductible, which is usually higher than in other plans. Once you reach the deductible, you re responsible for paying coinsurance (a % of the costs) until you reach the out-of-pocket maximum, after which your insurer pays 100%. Any money remaining in your account at the end of the year carries over into subsequent years. $ 13

16 Medicare Advantage Medicare Insurance (continued) Option 2: Medicare Advantage Important considerations for plans: To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Parts A and B. To receive maximum benefits from a Medicare Advantage plan, you will generally need to receive care from the doctors and health care providers who participate in the plan s network (if the plan includes network limitations). If you travel and have a medical emergency, you can see any doctor or visit any hospital and your Medicare Advantage plan will cover it. However, some plans may not cover non-emergency services outside your home area. The design and specifications of Medicare Advantage plans including premiums, copayments, deductibles, and covered services change each year. To ensure that your needs are met, set up an annual appointment with your Aon Hewitt Navigators benefit advisor to re-evaluate your plan selection. 14

17 Making the Right Choice: Medigap or Medicare Advantage? Finding the right Medicare insurance can be challenging. Your Aon Hewitt Navigators benefit advisor is ready to help you explore your options and understand the differences between individual plans, and will offer free, impartial guidance on which plan may be best for you. We are dedicated to working with you as you choose and enroll in a plan that fits your needs, protects you against the rising cost of health care services and prescriptions, and offers you peace of mind. The following chart offers a quick comparison of your Medicare insurance options: Medigap + Medicare Part D Prescription Drug plan Medicare Advantage (with prescription drug coverage) Typical Monthly Premium $150 $300 About $50 on average (2011) Copayments/Coinsurance $0 for standard Plan F Varies by plan Annual Maximum Out-of-Pocket Expense $0 for standard Plan F $3,000 $5,000 Health Care Provider See any Medicare provider Varies by plan; some restrictions or discounts to see certain providers may apply Prescription Drug Coverage Yes (via enrollment in a stand-alone Medicare Part D Prescription Drug plan) Yes (often included or available via enrollment in a stand-alone Medicare Part D Prescription Drug plan) Other Considerations Generally best value if you have chronic medical conditions Plans standardized and stable Covers Medicare services only Good value for many retirees, since they are less expensive than Medigap plans Plans change every year Some plans have extra benefits Might make sense if you Enjoy the flexibility of choosing your doctors, since Medigap is accepted by all doctors that accept Medicare Visit your doctors frequently, since copayments and coinsurance for visits are covered by your monthly premium Travel extensively, since Medigap is widely accepted Are open to changing your doctors, since the network is defined Visit your doctors rarely and don t mind paying per-visit copayments and coinsurance Would prefer all your benefits from a single plan and premium 15

18 Ongoing, Free Help You Can Count On. At Aon Hewitt Navigators, our services don t stop after you enroll. If you have questions about your plan or problems resolving an issue with your insurance company, help is just a phone call away. If you enrolled in a Medicare insurance plan through Aon Hewitt Navigators, our advocacy services are available to you free of charge. Our advocates are experts on Medicare insurance plans, billing procedures, claims and appeals, and solving access-to-care problems. Beyond their professional expertise, they are also people who understand that problems can be frustrating and stressful to you and every day they are dedicated to transforming their expert guidance and assurance into solutions that offer lasting peace of mind. What to do if you have a problem: 1. Start by contacting your insurance plan carrier. If you are having a problem with a bill or have a question about your coverage, you should always try to call your insurance carrier first to attempt to resolve the issue. 2. Contact Aon Hewitt Navigators. Your benefit advisor will be your primary contact for Medicarerelated questions, but you will also have access to our dedicated team of professional advocates. Advocates are experts who can help you resolve your issue whether that means finding the solution themselves, or connecting you with someone who can. What our advocates can do for you: Help resolve Medicare insurance claims, billing disputes, and other problems. Research and resolve tough health care and benefits issues, including access to care, eligibility, claims, and Medicare questions. Use comprehensive understanding of your benefits plan to help research, identify, and implement solutions to your challenge. Aon Hewitt Navigators offers help you can count on. Your personalized letter includes a special phone number and log-on information for our website. You can also contact us at: Phone: , Monday Friday, 8 a.m. 8 p.m., Central time. Closed on holidays. Web: aonhewittnavigators.com 16

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20 About Aon Hewitt Navigators Insurance Services Inc. Aon Hewitt Navigators Insurance Services Inc. is an Aon Hewitt company. Aon Hewitt is the global leader in human capital consulting and outsourcing solutions. The company partners with organizations to solve their most complex benefits, talent and related financial challenges, and improve business performance. Aon Hewitt designs, implements, communicates and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies. With more than 29,000 professionals in 90 countries, Aon Hewitt makes the world a better place to work for clients and their employees. For more information on Aon Hewitt, please visit Copyright 2011 Aon Hewitt Navigators Insurance Services Inc. Aon Hewitt Navigators Insurance Services Inc. (Aon Hewitt Navigators) is an Aon Hewitt company. Aon Hewitt Navigators and Aon Hewitt Navigators Insurance Services Inc. are trademarks of Aon Corporation. The material in this booklet is intended to be informative and educational. It is also meant to be used as a reference for you to select and purchase one of the health insurance plans and options presented. It is not complete, in that it summarizes information for clarity and ease of use. It should not in any way be construed as a substitute for thoroughly and completely reading plan descriptions and policies from the respective insurance companies represented here. While every attempt is made to keep this information correct and up-to-date, nothing contained herein is to be construed as a guarantee that it is. We take no responsibility or liability for any actions taken as a result of using the information presented in this booklet. We will not be liable as a company or as individuals for damages, losses, or other expenses incurred as a result of reading this material or for any other reason. California License: 0E97576 AH