MEDICAL PLAN OPTIONS Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group
Medical Options after CMU 1. Spouse Plan 2. COBRA continuation coverage 3. Marketplace Coverage 4. Individual Coverage 5. Medicaid Coverage 6. Post 65 Options PRESENTED BY ADVANTAGE BENEFITS GROUP 2
Pre 65 Medical Options 1. Spouse Coverage Check now to see if your spouse is offered coverage under his/her employer o If so: Check to see when they allow special event enrollments Event date (when employment ends) Coverage end date (when CMU sponsored benefits end, may or may not include COBRA period) PRESENTED BY ADVANTAGE BENEFITS GROUP 3
Pre 65 Medical Options 2. COBRA Continuation Coverage Continue healthcare coverage up to 18 months or until entitled to Medicare, whichever is less COBRA Healthcare Coverage Options o o o Medical / Prescription Dental Vision PRESENTED BY ADVANTAGE BENEFITS GROUP 4
Pre 65 A few notes on COBRA CMU will pay the Employer Premium Cost Share for the first three months of COBRA coverage. The Employee will be required to pay their premium cost share. If you elect COBRA you will NOT be able to sign up on the Marketplace or on an Individual health plan until you exhaust COBRA continuation coverage or until the Marketplace Open Enrollment. If you elect COBRA, you MAY not be allowed to join your spouse s employer plan. Check with your spouse s employer to see what they considered a qualifying status change qualifying event o May use: Event Date as qualifying event date (generally must enroll within 30 calendar days) Coverage end date as qualifying event (may allow you to take 3 months of COBRA coverage) PRESENTED BY ADVANTAGE BENEFITS GROUP 5
Pre 65 Medical Options 3. Marketplace Plan (www.healthcare.gov) Advance Premium Credits (subsidies) based on household income and age Metal Tier Plans Platinum, Gold, Silver, Bronze Multiple Carriers available (Blue Cross Blue Shield, Priority Health, Blue Care Network) Instructions to navigate the www.healthcare.gov site: 1) Click See Topics from the top ribbon on the homepage 2) Click See plans and prices Marketplace Open Enrollment Period: November 1 December 15 Average monthly cost example (age 40, non smoker, zip: 48804, assumes no subsidies, BCBS Plans) o Bronze Plan for Single: $299, $7,150 deductible o Silver Plan for Single: $429, $1,800 deductible o Gold Plan for Single: $530, $250 deductible For Marketplace plan and cost estimates outside of open enrollment, go to: ww.healthsherpa.com PRESENTED BY ADVANTAGE BENEFITS GROUP 6
Pre 65 Medical Options PRESENTED BY ADVANTAGE BENEFITS GROUP 7
Pre 65 Will I Qualify for Lower Costs on Monthly Premiums? Marketplace Plan Savings Programs you may qualify for: Free or low cost coverage through Medicaid based on income alone A Marketplace health plan with lower monthly premiums plus savings on out of pocket costs, like deductibles and copayments A Marketplace health plan with lower monthly premiums You won t qualify for savings on a Marketplace insurance plan. You can buy insurance through the Marketplace at full price, or buy from other sources Estimated 2017 Household Income based on number of people in your household *NOTE: Eligibility does vary based on age of applicant. 1 2 3 4 5 6 Below $16,643 $16,644 $29,700 $29,701 $47,520 Above $47,520 Below $22,411 $22,411 $40,050 $40,051 $64,080 Above $64,080 Below $28,180 $28,180 $50,400 $50,401 $80,640 Above $80,640 Below $33,948 $33,948 $60,750 $60,751 $97,200 Above $97,200 Below $39,716 $39,716 $71,100 $71,101 $113,760 Above $113,760 Below $45,485 $45,485 $81,450 $81,451 $130,320 Above $130,320 PRESENTED BY ADVANTAGE BENEFITS GROUP 8
Pre 65 Medical Options 4. Individual Plan Available through a number of carriers: o Priority Health o Blue Cross Blue Shield o Molina Healthcare o Humana Cost varies based on smoker status, age, zip code and plan design PRESENTED BY ADVANTAGE BENEFITS GROUP 9
Pre 65 Medical Options 5. Medicaid General Eligibility Rules Individuals who are 19 64 years of age Income at or below 133% of federal poverty level ($15,800 for one person) Do not qualify for or are not enrolled in Medicare Do not qualify for or are not enrolled in other Medicaid programs Not pregnant at time of application A resident of Michigan To Apply for Medicaid or Check Eligibility: Visit: www.michigan.gov/mibridges Call: 1 855 789 5610 Stop in: Your location Department of Human Services office 1919 Parkland Drive Mt. Pleasant, MI 48858 PRESENTED BY ADVANTAGE BENEFITS GROUP 10
Post 65 Medical Options Post 65 1. Medicare 2. Medicare Advantage Plan 3. Medicare Supplemental Plan PRESENTED BY ADVANTAGE BENEFITS GROUP 11
Post 65 Medical Options Medicare Who runs the Medicare Program? The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs Medicare. CMS is part of the U.S. Department of Health and Human Services Impact of recently enacted health reform on Medicare (2012) o o Enhanced preventive care services Subsidy and discounts for drugs while in the donut hole Resource sites: o http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm o www.medicare.gov o www.medicarerights.org detailed timeline o www.kff.org Kaiser Family Foundation PRESENTED BY ADVANTAGE BENEFITS GROUP 12
Post 65 Medicare Part A: Hospital Coverage Medicare Benefits Part B: Medical Coverage Part D: Prescription Drug Insurance Part C: Combines Part A, B and D into one package PRESENTED BY ADVANTAGE BENEFITS GROUP 13
Post 65 Medicare Coverage Choices Step 1: Decide how you want to get your coverage Start Part A (Hospital Coverage) Original Medicare Step 2: Decide if you want to add drug coverage Part D (Prescription Drug Insurance) Part B (Medical Coverage) Step 3: Decide if you want to add supplemental coverage Medigap (Medicare Supplement Insurance) Policy Medicare Advantage Plan (like an HMO or PPO) Part C (Includes BOTH Part A (Hospital Coverage) and Part B (Medical Coverage) and usually Part D Part D (Prescription Drug Insurance) END If you join a Medicare Advantage Plan, you don t need and can t be sold a Medigap policy. PRESENTED BY ADVANTAGE BENEFITS GROUP 14
Post 65 Medicare Advantage Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare covered health care through that plan (Parts A, B, and D). This coverage can include prescription drug coverage. Medicare Advantage Plans include: Medicare Health Maintenance Organization (HMOs) Preferred Provider Organizations (PPO) Private Fee for Service Plans Medicare Special Needs Plans When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services PRESENTED BY ADVANTAGE BENEFITS GROUP 15
Post 65 Medicare Advantage PRESENTED BY ADVANTAGE BENEFITS GROUP 16
Post 65 Shopping for Medicare Advantage Plans: www.medicare.gov PRESENTED BY ADVANTAGE BENEFITS GROUP 17
Resources Your Personal Financial Advisor Your Personal Home and Auto Insurance Agent Marketplace https://www.healthcare.gov/ Advantage Benefits Group: 616 458 3597 or www.advantageben.com Blue Cross Blue Shield of Michigan http://www.bcbsm.com Priority Health http://www.priorityhealth.com Centers for Medicare and Medicaid Services www.cms.hhs.gov Medicare and You http://www.medicare.gov/publications/pubs/pdf/10050.pdf AARP http://www.aarp.org/health/medicare/ PRESENTED BY ADVANTAGE BENEFITS GROUP 18