Understanding Your Medicare Options Medicare Made Clear
1. Eligibility 2. Coverage Options 3. Enrollment 4. Next Steps 5. Resources Agenda 2
ELIGIBILITY Medicare Made Clear
ELIGIBILITY Original Medicare (Parts A and B) 65 year old U.S. citizen and resident (at least five consecutive years) Special situation For example, people of any age with End-Stage Renal Disease (ESRD) 4
ELIGIBILITY You may qualify if you re under 65 and have: A disability and have been receiving Social Security Disability Insurance for more than 24 months End-stage renal disease Amyotrophic lateral sclerosis (ALS) 5
COVERAGE OPTIONS Medicare Made Clear
Coverage options 7
Original Medicare + 8
Hospital visits Inpatient hospital care Inpatient mental health care Skilled nursing services Hospice care Some blood for transfusions 9
Fast facts Costs: Most people don t pay a monthly premium You only pay your deductible for a hospital stay of fewer than 60 days Enrollment: You can t be turned down because of your medical history or pre-existing condition Coverage: Stays of more than 60 days require a daily copayment Multiple stays may mean multiple deductibles You can go to any qualified hospital in the U.S. that accepts new Medicare patients Hospital care outside the U.S. isn t usually covered 10
Doctor and outpatient visits Physician services Outpatient hospital services Ambulance Outpatient mental health Laboratory services Durable medical equipment (wheelchairs, oxygen, etc.) Outpatient physical, occupational and speech-language therapy Some preventive care 11
Fast facts Costs: No maximum out-of-pocket For coinsurance, you pay 20% of Medicare-approved cost Part B has a monthly premium that is determined based on your income May have higher premiums if you join after your initial enrollment period Enrollment: You can t be turned down because of your medical history or pre-existing condition Coverage: You can get care throughout the U.S., but generally not outside the country Participating physicians who accept new Medicare patients Some preventive health care is provided 12
What s not covered Medicare Part A and Part B deductibles and coinsurance premiums Medicare Part B excess charges (amount billed over what Medicare agrees to pay) Prescription drug coverage Additional items such as hearing and dental 13
Medicare Advantage plan 14
Medicare Advantage plan Combines Part A and Part B and, in many cases, prescription drug coverage Offered by private insurance companies like UnitedHealthcare Often includes additional benefits like eye care, hearing, wellness services and nurse phone line support 15
Eligibility Must be enrolled in Medicare Parts A and B Must live in plan service area Must not have end-stage renal disease (ESRD)* *People with ESRD may be able to join a Medicare Special Needs Plan (SNP) if one is available in their area 16
Fast facts Costs: Plan premiums and terms can change from year to year Must continue to pay your Part B monthly premium Enrollment: Eligibility is not affected by health or financial status There are special rules for ESRD Coverage: Convenience of one single plan Many plans may include prescription drug coverage (Part D) Coverage is often limited to a service area unless it s an emergency May be required to see doctors and hospitals that are included in the plan s network May offer additional benefits not covered by Medicare like dental, vision, hearing and preventive care 17
Types of Part C plans Coordinated care plans Health Maintenance Organization (HMO) plans Preferred Provider Organization (PPO) plans Special Needs Plans (SNP) Health Maintenance Organization Point of Service (HMOPOS) plans Other plans Private Fee-For-Service (PFFS) plans Medical Savings Account (MSA) plans 18
What is an HMO? Health Maintenance Organization Plan with a network of physicians, hospitals and other health care professionals Routine care is provided by an approved network of doctors and hospitals Primary care physician may refer you to specialists Out-of-network generally not covered, unless it s in an emergency Many plans include prescription drug coverage and additional benefits 19
What is a PPO? Preferred Partner Organization Hospital costs, doctor and outpatient care in one plan No referral needed to see a specialist More freedom to choose your doctor or hospital Can choose to use doctors and hospitals inside the network and receive the maximum benefit Can go outside the network, but usually at a higher cost Many plans include prescription drug coverage and additional benefits 20
What is a SNP? Special Needs Plan Designed for people with special or complex health care needs Residents of nursing homes People eligible for both Medicare and Medicaid People with certain chronic diseases such as diabetes or heart disease Focus on helping members receive well-coordinated care Holistic, proactive approach Specialized care team Enhanced education and communication 21
What is a PFFS? Private Fee-for-Service Offered by private insurance companies Many plans may offer prescription drug coverage Many plans may offer additional benefits beyond Original Medicare (Parts A and B) No restrictions on which doctors or hospitals you can use 22
Prescription drug plan 23
Helps with the cost of prescription drugs Only offered through private insurance Must continue to pay Part B premium 24
Fast Facts Costs: Prescription drug coverage varies from plan to plan Catastrophic coverage protects you from very high drug costs Benefits can change each year Enrollment: Coverage is not automatic Penalties may apply if you enroll late Coverage: Each plan has a list of drugs that it covers Make sure your drugs are covered before you enroll in a plan The list of drugs can change each year 25
Part D Formulary drug list Formulary: List of drugs that the insurance plan covers Many drug plans have a tiered formulary. That means the plan divides drugs into groups called tiers. Generally, the lower the tier, the lower your copay. 26
Understanding drug payment stages If your plan has a deductible, you pay the total cost of your drugs until you reach the deductible amount set by your plan. Then you move to the initial coverage stage. Up to $2,970 Up to $4,750 Through the end of the year Note: On January 1 of each year, the coverage cycle starts over and the dollar limits can change. Amounts listed above reflect the 2013 plan year. 27
Standardized Medicare supplement insurance plan 28
Medicare supplement insurance plan Helps cover some of what Medicare Parts A and B don t pay such as portions of coinsurance, copayments and deductibles Offered by private insurance companies Plans are named A, B, C, D, F, G, K, L, M, N and a high-deductible plan F Benefits vary by plan and by state Generally, the more comprehensive the coverage, the higher the premium Regulated by federal and state laws 29
Medicare supplement insurance plan Eligibility Generally must be enrolled in Medicare Parts A and B Resident of the state in which you are applying for coverage Age 65+ (or under age 65 with certain disabilities in some states) People of any age with End-Stage Renal Disease 30
Fast facts Costs: Helps with some of the out-of-pocket costs not paid by Medicare Premiums vary based on the plan and insurance carrier Enrollment: Guaranteed the right to enroll during your Open Enrollment Period (OEP) This period begins the first day of the month that you are enrolled in Medicare Part B, and in most states it lasts for six months Coverage can be denied if you enroll late Coverage: Goes with you anywhere in the U.S. Guaranteed to continue as long as you pay your premium on time and have not made any material misrepresentation on the application for insurance 31
Bringing it all together Step 1 Step 2 32
ENROLLMENT Medicare Made Clear
ENROLLMENT When can I enroll? Part A After you turn 64 years and nine months Enrollment is automatic if you are already receiving Social Security Benefits What if I m late? Usually no penalties (unless you didn t pay enough into Social Security) 34
ENROLLMENT When can I enroll? Part B YOUR ELIGIBILITY MONTH THREE MONTHS BEFORE THREE MONTHS AFTER 65 Initial Enrollment Period What if I m late? Your premiums may go up 35
ENROLLMENT When can I enroll? Part C and D YOUR ELIGIBILITY MONTH THREE MONTHS BEFORE THREE MONTHS AFTER 65 Initial Enrollment Period What if I m late? Wait until the Open Enrollment Period (OEP), Oct. 15 Dec. 7 36
ENROLLMENT Medicare Open Enrollment Period (OEP) For Parts A, B, C and D Current Year Upcoming Year Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. Jul. Aug. OEP Open Enrollment Period (OEP) October 15 December 7 Special Election Period (SEP) 37
ENROLLMENT Medicare supplement insurance plans When can I enroll? In most states, there is a six-month guaranteed window starts when you turn 65 and enroll in Part B MONTH YOU QUALIFY FIVE MONTHS AFTER What if I m late? 65 Open Enrollment Period You can apply later but may be charged a higher premium due to existing health problems or rejected depending on your health history 38
NEXT STEPS Medicare Made Clear
NEXT STEPS 1. Review enrollment periods 2. Research 3. Ask questions 4. Get answers 5. Find financial help 6. Enroll 7. Yearly review 40
QUESTIONS?
ADDITIONAL RESOURCES Medicare Made Clear
RESOURCES Questions? MedicareMadeClear.com 43
RESOURCES Additional information resources: Visit Medicare.gov Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day/7 days a week Call your State Health Insurance Assistance Program (SHIP) to see if you qualify for any financial assistance 44
Copyright 2013 United HealthCare Services, Inc. All rights reserved. No portion of this work may be reproduced or used without express written permission of United HealthCare Services, Inc., regardless of commercial or non-commercial nature of the use. The family of UnitedHealthcare Medicare Solutions plans are insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. 13_13 BAXNAEN000_UHSP13187 IR_130613_143100 45