Medicare and Its Gaps: Rights and Options You Simply MUST Know THINKING RETIREMENT 1 Agenda Medicare ABCs When to apply Part A Part B Three Pathways to fill the gaps in Medicare Medigap plans Advantage plans Part D plans LTC plans Resources. THINKING RETIREMENT 2 WWW.ANDYLANDIS.BIZ 1
Medicare ABCs THINKING RETIREMENT 3 When to enroll Medicare age is 65 Avoid late fees! Apply at later of: Age 65, or End of employer health insurance from current active work (yours or spouse s) Inquire promptly! Call Social Security 3 months before age 65 Be sure to supplement Medicare. THINKING RETIREMENT 4 WWW.ANDYLANDIS.BIZ 2
Medicare Coverage: Two Parts of Original Medicare Part A: Hospital Insurance Inpatient hospital care plus follow-up care No premium for most Part B: Medical Insurance Doctor, outpatient, and certain other services 2017 monthly base premium: $109-$134 per person, for most. Source: www.medicare.gov/ THINKING RETIREMENT 5 2017 Medicare Part B Variable premiums 2015 Income, Individual filing 2015 Income, Joint filing 2017 Part B premium <= $85,000 <= $170,000 $109-$134 $85k - $107k $170k - $214k $187.50 $107k - $160k $214k - $320k $267.90 $160k - $214k $320k - $428k $348.30 >$214,000 >$428,000 $428.60 Source: www.medicare.gov/ THINKING RETIREMENT 6 WWW.ANDYLANDIS.BIZ 3
Your Medicare card THINKING RETIREMENT 7 Gaps in Medicare THINKING RETIREMENT 8 WWW.ANDYLANDIS.BIZ 4
Identifying gaps in Medicare Before 65: No Medicare Need to reach age 65 After 65: Medicare OK, but... Gaps in Parts A & B Long-Term Care gap Age 65 THINKING RETIREMENT 9 Before Medicare 3 Paths to age 65 & Medicare 1 2 3 Retiree Medical Employer Individual Employer Union COBRA Own work Spouse s work Traditional Fee-For-Service, or HMO/Managed Care Medicaid Uninsured? THINKING RETIREMENT 10 WWW.ANDYLANDIS.BIZ 5
While on Medicare Filling the Gaps in Medicare Retiree Medical Employer Individual Medicare Eligibility? THINKING RETIREMENT 11 While on Medicare Identifying gaps in Medicare Part A Deductibles ($1,316/benefit period of 60 days) Long hospital stays (60-90-150 days) Part B Deductible ($183/year) Dental, eyeglasses, hearing aids, Rx Doctor bill coinsurance & excess fees Long-Term Care gap. THINKING RETIREMENT 12 WWW.ANDYLANDIS.BIZ 6
Example 1: Part B gap Doctor bills Doctor Bill: $115 Medicare Allowable Charge: $100 You Pay $35 80% of Medicare Allowable : $80 Medicare Pays $80 THINKING RETIREMENT 13 So What? THINKING RETIREMENT 14 WWW.ANDYLANDIS.BIZ 7
Example 2: Part B gap Doctor bills Doctor Bill: $230,000 Medicare Allowable Charge: $200,000 You Pay $70,000 80% of Medicare Allowable : $160,000 Medicare Pays $160,000 Medicare has NO Out-Of-Pocket Maximum! THINKING RETIREMENT 15 How to fill the gaps THINKING RETIREMENT 16 WWW.ANDYLANDIS.BIZ 8
While on Medicare 3 Paths to fill the gaps 1 2 3 Retiree Medical Medigap Advantage Medicaid THINKING RETIREMENT 17 While on Medicare Focus: Retiree medical 1 2 3 Retiree Medical Medigap Advantage THINKING RETIREMENT 18 WWW.ANDYLANDIS.BIZ 9
Focus: Retiree medical plans Retiree Medical Private insurance from employer or union Medicare is primary insurance; retiree medical is secondary Cost and coverage vary widely Generally cover prescription drugs If not, you also need Medicare Part D Contact your benefits office. THINKING RETIREMENT 19 While on Medicare Focus: Medigap plans 1 2 3 Retiree Medical Medigap Advantage THINKING RETIREMENT 20 WWW.ANDYLANDIS.BIZ 10
Focus: Medigap plans AKA Medicare Supplement plans Medigap Private insurance to supplement Medicare 10 different plans, standardized nationally Lettered A, B, C, D, F, G, K, L, M, N Coverage from basic to comprehensive Prices: about $60/mo. - $300/mo. Purchase within 6 months of Part B Also consider Medicare Part D Available from major insurance companies. Source: www.insurance.wa.gov/ THINKING RETIREMENT 21 Chart: Medigap plan options 2017 $5,120 $2,560 Source: www.insurance.wa.gov/ THINKING RETIREMENT 22 WWW.ANDYLANDIS.BIZ 11
While on Medicare Focus: Medigap plans 1 2 3 Retiree Medical Medigap Advantage THINKING RETIREMENT 23 Focus: Medicare Advantage AKA Medicare Part C/Health s Advantage Private insurance to replace Medicare Covers Parts A & B, plus additional benefits Typical additional benefits: Many include Rx Wellness care, Dental, Vision, and/or Hearing May be HMO, PPO, or other arrangement Moderate costs ($0 - $270 per month) Chosen by 30% of Medicare beneficiaries Available from insurance companies in select locations. Source: www.insurance.wa.gov/ THINKING RETIREMENT 24 WWW.ANDYLANDIS.BIZ 12
Prescription Drug Coverage THINKING RETIREMENT 25 While on Medicare 3 ways to get Rx coverage 1. Employer/Union retiree plan with creditable Rx coverage 2. Advantage plan including Part D coverage 3. Standalone Medicare Part D plan PDP = Prescription Drug Source: www.medicare.gov/ THINKING RETIREMENT 26 WWW.ANDYLANDIS.BIZ 13
Focus: Medicare Part D Part D Private insurance to cover prescription drugs s not created equal: Varying formularies Varying pharmacy convenience Standard or Enhanced plan designs Costs: $15 - $160 per month Available from insurance companies Chosen by 70% of Medicare beneficiaries Often included in Advantage plan. Source: www.insurance.wa.gov/ THINKING RETIREMENT 27 Variable Part D premiums 2015 Income, Individual filing 2015 Income, Joint filing 2017 Part D premium <= $85,000 <= $170,000 Base Premium (BP) $85k - $107k $170k - $214k BP + $13.30 $107k - $160k $214k - $320k BP + $34.20 $160k - $214k $320k - $428k BP + $55.20 >$214,000 >$428,000 BP + $76.20 Source: www.medicare.gov/ THINKING RETIREMENT 28 WWW.ANDYLANDIS.BIZ 14
Part D coverage 2017 Deductible Period First $400 Initial Coverage Period $400-$3700 Coverage Gap ( Donut Hole ) $3700-$4950 Catastrophic Period Over $4950 You pay 100% You pay 25% You pay 40%-51% You pay ~5% THINKING RETIREMENT 29 While on Medicare 3 Paths with Rx coverage 1 2 Retiree Medical Medigap Including Rx Coverage Part D 3 Advantage Including Part D THINKING RETIREMENT 30 WWW.ANDYLANDIS.BIZ 15
While on Medicare Cost Summary 1 Retiree Medical Including Rx Coverage $109 + $?? 2 Medigap Part D $109 + $60 - $300 $15-$160 3 Advantage Including Part D $109 + $0 - $270 THINKING RETIREMENT 31 Example: Couple with different ages Paul older than Ruth Both under 65 Paul turns 65 Ruth Turns 65 Paul Individual Medicare + Medigap + Part D Medicare + Medigap + Part D Ruth Individual Individual Medicare + Advantage (Includes Part D) Medicare has no family plans, only individual plans. THINKING RETIREMENT 32 WWW.ANDYLANDIS.BIZ 16
Long-Term Care Coverage THINKING RETIREMENT 33 Before Medicare or while on Medicare: Long-Term Care gap (Parts A, B, C, D) Self-Pay Medicaid Long-Term- Care Insurance THINKING RETIREMENT 34 WWW.ANDYLANDIS.BIZ 17
Long Term Care Resources A Shopper's Guide to Long-Term Care Insurance Free PDF at http://www.naic.org/documents/ prod_serv_consumer_ltc_lp.pdf Also contact your state SHIP: www.shiptalk.org THINKING RETIREMENT 35 While on Medicare 3 Paths with Rx & LTC 1 2 3 Retiree Medical Medigap Advantage Including Rx Coverage Part D Including Part D AND LTC Insurance (Optional) THINKING RETIREMENT 36 WWW.ANDYLANDIS.BIZ 18
Medicare Resources THINKING RETIREMENT 37 Medicare Resources www.medicare.gov Information Publications Medicare & You Finders Medigaps, Advantage & Part D s Also contact your state s Senior Health Insurance Program (SHIP) www.shiptalk.org THINKING RETIREMENT 38 WWW.ANDYLANDIS.BIZ 19
98125 THINKING RETIREMENT 39 Your questions? THINKING RETIREMENT 40 WWW.ANDYLANDIS.BIZ 20
Thank you! Andy Landis THINKING RETIREMENT www.andylandis.biz THINKING RETIREMENT 41 WWW.ANDYLANDIS.BIZ 21