1 Turning 65 Webinar June 12, 2018
2 Today s Presenters Grace Pomroy Senior Financial Educator Blake Smith Retirement Advocate
3 Today s Agenda What is Medicare? What health coverage does the ELCA offer? What steps do I need to take to ensure that I have appropriate coverage when I turn 65? 4 things you can do today Next steps Click on the handouts icon to download the presentation Click on the chat icon to submit a question
4 Who is Portico?
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6 What is Medicare? Medicare is the federal health insurance program for: Those age 65 and older Certain younger people with disabilities People with permanent kidney failure (End Stage Renal Disease). Find more information and get an electronic copy of Medicare & You at Medicare.gov Portico Benefit Services does not provide advice regarding your eligibility for Medicare. We provide information of general application to help you understand the way in which we administer our plans. For advice specific to you, contact Medicare or go online at Medicare.gov.
7 How will you receive your Medicare coverage? Original Medicare (through Medicare) Medicare Advantage (through private insurance companies approved by Medicare)
8 What happens if I choose Original Medicare? Medicare Part A Medicare Part B Part A Hospital $$$ Medicare Supp. Medical Part B Medicare Part D Medicare Supplement Medicare Supp. $$$ Part Drugs D $$$ $$$
9 Medicare Part A (Hospital Coverage) What does it cover? Hospital care Skilled nursing facility care (not custodial or long-term care) Hospice Home health services Do I need to enroll? If you ve received Social Security benefits for at least four months prior to turning 65, you ll be enrolled automatically. If not, you ll need to enroll by visiting your local Social Security Office or by applying online at ssa.gov. What is the cost? If you worked and contributed to Social Security, there is no monthly premium. The Part A deductible in 2018 is $1,340 per benefit period. Benefit Period: How Original Medicare measures your use of hospital and skilled nursing facility (SNF) care. Benefit period ends when you haven t received any inpatient hospital or SNF care for 60 days in a row.
10 Medicare Part B (Medical Coverage) What does it cover? Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and meet accepted standards of medical practice. Preventive Services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is likely to be most effective. Do I need to enroll? What is the cost? If you ve received Social Security benefits for at least four months prior to turning 65, you ll be enrolled automatically. If not, you will need to enroll by applying online at ssa.gov or visiting your local Social Security Office. The monthly premium for those enrolling in 2018 is $134 (or higher depending on your income). The annual Part B deductible in 2018 is $183.
11 Services Not Covered by Original Medicare Most dental care Eye examinations related to prescribing glasses Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting them Routine foot care
12 Medicare Part D (Prescription Drug Coverage) What does it cover? Do I need to enroll? What is the cost? Prescription drug costs (some or all) To get Medicare drug coverage, you must join a plan offered by an insurance company, an employer plan, or another private company approved by Medicare. Each plan can vary in cost and drugs covered. The monthly premium ranges anywhere from $0-$100, depending on the plan. Out-of-pocket costs vary. Some plans have a deductible and/or a donut hole. Donut hole (coverage gap): A temporary limit on what the drug plan will cover. You and your plan will pay for your drugs together until you have spent $3,750 on covered drugs. Once you reach this amount, you ll be responsible for a larger portion of your drug costs until you reach your out-of-pocket limit.
13 Medicare Supplement (Medigap) Supplement to Medicare hospital and medical insurance, available through insurance companies Designed to pay for some of your costs, e.g., deductibles and coinsurance Your 6-month open enrollment period to purchase a Medicare Supplement begins the month you turn 65 and are enrolled in Part B After this enrollment period, you may not be able to buy a Medicare Supplement if you are, it may be more expensive Why might you purchase a supplement? Original Medicare is designed to cover only 80% of expenses, after Part A and B deductibles Original Medicare has no out-ofpocket maximum for hospital and/or medical expenses incurred
14 What if I choose Medicare Advantage (Part C)? Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with your Part A and Part B benefits. Most Medicare services are covered through the plan instead of Original Medicare. Many offer prescription drug coverage. May offer additional benefits, such as vision, dental, and hearing. Hospital $$$ Part Drugs C Medical May offer a limited provider network if not associated with a large covered population. Costs vary by plan. Coverage may vary from year to year and state to state if not provided through an employer sponsored plan. Looking to review your options? Use the Medicare Plan Finder at https://www.medicare.gov/find -a-plan/questions/home.aspx
15 Original Medicare vs. Medicare Advantage Original Medicare What is it? Part A (hospital) + Part B (medical) Who provides coverage? How do you choose your providers? How much does it cost? Medicare You can choose any doctor, hospital, and other provider that accepts Medicare Part B premium Deductible and coinsurance for Part A & B services Additional costs for Part D + Medicare Supplement (if you choose to purchase them) Medicare Advantage Part C includes both Part A (hospital) + Part B (medical) Private insurance companies approved by Medicare You may need to use health care providers who participate in the plan s network Part B premium Monthly Medicare Advantage premium (plus Part D premium if drug coverage not included) Possible copayment or coinsurance for covered services
16 Original Medicare vs. Medicare Advantage Prescription drug coverage? Supplemental insurance (vision, dental, hearing)? Out-of-pocket limit? Original Medicare Yes, if you purchase Part D No, but you may be able to purchase additional coverage No, but you can purchase a Medicare Supplement Medicare Advantage Yes, most include it. If not, you can purchase Part D Sometimes included, or you can purchase additional riders (vision, dental, hearing, etc.) Yes
17 Questions to Ask as You Compare Medicare Plans 1. Who will be your advocate? 2. What s the cost? Does it change by age or residency? 3. Is the provider network broad enough for you? 4. Do you want coverage for care received outside the U.S.? 5. What prescription drug coverage do you need? 6. What additional benefits are important to you?
18 What health coverage does the ELCA offer?
19 ELCA Medicare-Primary Health Benefits Who qualifies? ELCA Health Plan members: Age 65 or over and retired or OLFC Age 65 or over and sponsored by an organization with fewer than 20 employees Under age 65, entitled to Medicare due to: Disability and no longer sponsored Permanent kidney failure and have met 30-month Medicare coordination period The plan document of the ELCA Health Plan is the full, legal description of the plan. Your rights under the plan are governed by the plan document. If this summary is found to be inconsistent with the plan document, the plan document will be considered the controlling document.
20 ELCA Medicare-Primary Coverage What benefits are included in ELCA Medicare-Primary coverage? What prescription drug coverage will I have? How does the Medicare supplement benefit work? Medicare supplement Prescription drug benefit Dental benefit ELCA NurseLine SM SilverSneakers fitness program Hearing discount program Retirees: benefit includes the ELCA Part D benefit, administered by Express Scripts. Sponsored: benefit includes same Express Scripts copayments/coinsurance as ELCA-Primary Platinum+ and Gold+ health benefit options. Benefit, administered by Mercer, coordinates with Medicare Part A (hospital) and Part B (medical) to pay a portion of health care costs not covered by Medicare (like copayments, deductibles, and coinsurance) for Medicare-eligible services.
21 ELCA Medicare-Primary Health Benefits: 2018 Medicare Supplement Comparison (administered by Mercer) YOU PAY Economy Option (Comparable to Medigap L) Standard Option (Portico Design) Premium Option (Comparable to Medigap F) Monthly Contribution see materials see materials see materials ELCA Plan Deductible $0 $180 $0 Out-of-Pocket Annual Limit $2,470 $3,500 $0 PLAN PAYS Medicare Part A (Hospital) Part A Deductible* 75% 80%** 100% Part A Coinsurance 100% 80%** 100% Hospice Care or Skilled Nursing Facility 75% 80%** 100% Coinsurance or Copayment Blood (First three pints) 75% 80%** 100% Coinsurance and hospital costs up to an additional 100% $0 100% 365 days after Medicare benefits are exhausted Medicare Part B (Medical) Part B Deductible* $0 80%** 100% Part B Coinsurance 75% 80%** 100% Charges Beyond Medicare Approved Amount $0 $0 100% Care received outside the U.S. and its territories $0 80%** for services 80% after a $250 deductible. Medicare would cover in the U.S.; for services Medicare would $50,000 lifetime maximum cover in the U.S.; $50,000 lifetime maximum 2018 Monthly Rates $376 $393 $445 *See Medicare.gov for 2018 deductible **After plan deductible of $180 is met. NOTE: Monthly rate includes prescription drug benefit, dental benefit, ELCA NurseLine, SilverSneakers, and hearing discount.
22 Medicare Example Mary is enrolled in Medicare Part A, so she pays: $0 Part A premium $1,340 deductible for each benefit period $0 coinsurance for days 1-10 TOTAL: $1,340 to hospital OR Mary is hospitalized for 10 days in 2018 Mary is enrolled in Medicare Part A and the ELCA Medicare-Primary Standard Option, so she pays: $0 Part A premium, ELCA Medicare-Primary monthly contribution $180 ELCA Medicare-Primary deductible 20% of the remaining Part A deductible = $268 (Plan covers the other 80%) $0 coinsurance for days 1-10 TOTAL: $448 to hospital (plus monthly contribution) Hypothetical for illustrative purposes only
23 Medicare Example Economy Option Standard Option Premium Option Part A Premium ELCA Medicare- Primary deductible Part A deductible Part A coinsurance Total $0 $0 $0 $0 $180 $0 25% of the Part A deductible = $335 20% of the remaining Part A deductible after ELCA deductible = $268 $0 $0 $0 $335 to hospital (plus monthly contribution) $448 to hospital (plus monthly contribution) 0% of the Part A deductible = $0 $0 to hospital (plus monthly contribution) Hypothetical for illustrative purposes only
24 What steps do I need to take to ensure that I have appropriate coverage when I turn 65?
25 Three Months Before You (or Your Spouse) Turn 65 1. Read the information you receive from Portico. 2. Sign up for Medicare at this time to ensure your benefits begin the day you turn 65, even if you plan to continue working. 3. Send us a copy of your Medicare card and fill out the forms we send to you.
26 Steps for Those Retired or Planning to Retire at Age 65 1. Contact Portico at 800.352.2876 to let us know you re retiring (if you haven t already). 2. Enroll in Medicare Part A (hospital) and Part B (medical services). 3. Enroll in ELCA Medicare- Primary benefits,* if you choose. *This includes a supplement to Medicare Parts A and B, along with dental and ELCA prescription drug benefits. Accordingly, you won t need to enroll in non-elca Part D prescription drug coverage.
27 ELCA Health Coverage in Retirement Who is eligible? When must I elect to continue or waive ELCA health coverage? Can a new spouse/child be added? Can I get ELCA health coverage in retirement if I waived it while I was employed? If you were eligible for ELCA health benefits at the time of retirement, you can continue coverage at your own expense for yourself and any eligible family members. Act within 60 days of retirement to avoid a 90-day wait for coverage should you want to enroll sometime in the future. Yes, if eligibility requirements are met. Yes, if you filed an eligible waiver.
28 Primary Coverage at Age 65 When Still Working ELCA-Primary Coverage ELCA Medicare- Primary Coverage You work for an employer with 20 or more employees You work for an employer with fewer than 20 employees You re on leave from call and plan to return to work
29 Working at an organization with 20+ employees? 1. Continue with ELCA-Primary benefits, which will serve as primary coverage for your hospital and medical services. 2. Enroll in Medicare Part A, which will act as secondary coverage for your hospital benefits. 3. Contact Medicare to delay Part B for now, but be sure to enroll three months before you retire or prior to changing calls to an employer with fewer than 20 employees. 4. Contact Portico if you have Bronze+ coverage.
30 Does your organization have fewer than 20 employees? 1. Enroll in Medicare Part A (hospital) and Part B (medical services). 2. Tell Portico how much you pay for your Part B premium. 3. Portico will reimburse you for the cost Part B premiums for you and family members with ELCA Medicare-Primary benefits for as long as you continue to be sponsored in the ELCA program. 4. We ll automatically transition you from ELCA-Primary to ELCA-Medicare Primary benefits* and you ll receive a new card from Mercer. 5. Request employer return the Small Employer Exception Form to Portico. *This includes a supplement to Medicare Parts A and B, along with dental and ELCA prescription drug benefits. Accordingly, you won t need to enroll in non-elca Part D prescription drug coverage.
31 ELCA Medicare-Primary Health Benefits: 2018 Medicare Supplement Comparison (administered by Mercer) YOU PAY Economy Option (Comparable to Medigap L) Standard Option (Portico Design) Premium Option (Comparable to Medigap F) Monthly Contribution see materials see materials see materials ELCA Plan Deductible $0 $180 $0 Out-of-Pocket Annual Limit $2,470 $3,500 $0 PLAN PAYS Medicare Part A (Hospital) Part A Deductible* 75% 80%** 100% Part A Coinsurance 100% 80%** 100% Hospice Care or Skilled Nursing Facility 75% 80%** 100% Coinsurance or Copayment Blood (First three pints) 75% 80%** 100% Coinsurance and hospital costs up to an additional 100% $0 100% 365 days after Medicare benefits are exhausted Medicare Part B (Medical) Part B Deductible* $0 80%** 100% Part B Coinsurance 75% 80%** 100% Charges Beyond Medicare Approved Amount $0 $0 100% Care received outside the U.S. and its territories $0 80%** for services 80% after a $250 deductible. Medicare would cover in for services Medicare would the U.S.; $50,000 lifetime maximum cover in the U.S.; $50,000 lifetime maximum 2018 Monthly Rates $376 $393 $445 *See Medicare.gov for 2018 deductible **After plan deductible of $180 is met. NOTE: Monthly rate includes prescription drug benefit, dental benefit, ELCA NurseLine, SilverSneakers, and hearing discount.
32 What next steps should I take if I m on leave from call? 1. Enroll in Medicare Part A (hospital) and Part B (medical services) 2. We ll automatically transition you from ELCA-Primary to ELCA- Medicare Primary benefits.* *This includes a supplement to Medicare Parts A and B, along with dental and ELCA prescription drug benefits. Accordingly, you won t need to enroll in non-elca Part D prescription drug coverage.
33 What if...? My spouse turns 65 first? I m on disability and qualify for Medicare as primary coverage? You could have different coverage based on your ages and employment status. Call Portico Customer Care for more information. You will have ELCA-Medicare Primary health coverage. I still have my FSA and/or HSA? FSA: If you are still sponsored and age 65+, this benefit is still available to you with either ELCA-Medicare Primary or ELCA-Primary coverage. HSA: Once you reach age 65, you can no longer contribute to an HSA. You are still able to spend the money within your HSA account.
34 Most Common Medicare Mistakes People Make 1. Failing to enroll in Part B when you should 2. Thinking you must reach full retirement age before enrolling 3. Failing to read your Annual Notice of Change 4. Not realizing that you may qualify for help to lower your costs 5. Not signing up for Part D because you don t currently take any prescription drugs 6. Misunderstanding enrollment periods 7. Picking a plan based solely on its premium, its name, or because your best friend chose it 8. Waiting until it s too late to buy a Medicare Supplement Source: Our Expert Guides You: Medicare Mistakes by Patricia Barry AARP Bulletin/Real Possibilities April 2016
35 4 Things You Can Do Today
36 4 Things You Can Do Today 1. Learn more about how Medicare works by reading Medicare & You or exploring Medicare.gov 2. Earn all of your wellness dollars by completing the Live Well Challenge before Medicare becomes your primary coverage. 3. If you are retiring, be in conversation with Portico and your bishop at least three months prior to your retirement date. 4. Contact the Portico Customer Care Center at 800.352.2876 with any questions.
37 Next Steps
38 Next Steps Survey Follow-up Email Link to the recording from today s webinar Link to a PDF of the PowerPoint slides Turning 65 Checklist