Medicare Workshop Presented by wwwsenioradvisorscom infosenioradvisorscom 1Q 2019 Justin Lubenow Medicare Specialist Medicare Advisory Board for National Association of Health Underwriters ID: 931159
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Slide1
Avoid the Top 5 Mistakes People Make on Medicare
Medicare Workshop
Presented by:
www.senior-advisors.com
info@senior-advisors.com
- 1Q 2019-
Justin Lubenow
Medicare SpecialistMedicare Advisory Board for National Association of Health Underwriters
908.272.197015 Alden Street, Suite 8Cranford, NJ 07016
Doug Lubenow, RHU, CLTC
PresidentPrior Member of Medicare Advisory Board for National Association of Health Underwriters
856.866.8900
214 W. Main St Suite 101
Moorestown, NJ 08057
Slide22
Parts of Medicare
I
npatient care in hospitals
S
killed nursing facility, hospice, and home health care
Usually, no premiums
Doctors, hospital outpatient care, durable medical equipment and home health care
Preventative services
Usually, $135.50/mo.*
* Income adjusted
Another way to get benefits covered under Part A & B
Most offer prescription drug coverage (part D)
Run by private insurance companies
Varies by plan
Helps cover prescription costs
Run by private insurance companies
Usually
, plan premium
*
* Income adjusted
premium
Slide3Medicare Part B: Monthly Premiums
3
2019 INCOME TIERS
1
& PREMIUMS
Tier
File Ind. Tax Return
File Joint Tax Return
Prem. in 2019
1
<=$85k
<=$170k
$135.50
2
$85,001-$107,000
$170,001-$214,000
$189.60
3
$107,001-$133,500
$214,001-$267,000
$270.90
4
$133,501-$160,000
$267,001-$320,000
$352.20
5
>$160,001-$500,000 $320,001-$750,000$433.406>$500,000>$750,000$460.50
1
Income is based on prior full year tax return (e.g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums)
Slide4Medicare Part D: Monthly Premiums
4
2019 INCOME TIERS
1
& PREMIUMS
Tier
File Ind. Tax Return
File Joint Tax Return
Prem. in 2019
1
<=$85k
<=$170k
Your plan premium
2
$85,001-$107,000
$170,001-$214,000
$12.40 +
your plan premium
3
$107,001-$133,500
$214,001-$267,000
$31.90 +
your plan premium
4
$133,501-$160,000
$267,001-$320,000
$51.40 + your plan premium5>$160,001-$500,000 $320,001-$750,000$70.90 + your plan premium6>$500,000
>$750,000
$77.40 +
your plan premium
1
Income is based on prior full year tax return (e.g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums)
Slide5Medicare B & IRMAA* TOTAL
Monthly Premiums 5
2019 INCOME TIERS
1
& PREMIUMS
Tier
File Ind. Tax Return
File Joint Tax Return
Prem. in 2019
1
<=$85k
<=$170k
$135.50
2
$85,001-$107,000
$170,001-$214,000
$202.00
3
$107,001-$133,500
$214,001-$267,000
$302.80
4
$133,501-$160,000
$267,001-$320,000
$403.60
5
>$160,001-$500,000 $320,001-$750,000$504.306>$500,000>$750,000$537.90
* Income Related Monthly Adjustment Amounts
1
Income is based on prior full year tax return (e.g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums)
Slide6Initial Enrollment Period
7-month Initial Enrollment Period (IEP)Eligible 1st of the month turn 65*
Critical to enroll during the 7-month IEPCan enroll later with penalties (10% per year)
6
* If your birthday is 1st of the month, you are eligible the previous month
IEP Example
1
Slide7Medicare Choices at a glance
7
START
STEP 1: Decide how you want to get your coverage.
ORIGINAL MEDICARE
MEDICARE ADVANTAGE
Part A
Hospital Insurance
Part B
Medical Insurance
Part D
Prescription Drug Coverage
Medicare Supplement Insurance
(
Medigap
) policy
STEP 2: Decide if you need to add drug coverage.
STEP 3: Decide if you need to add supplemental coverage.
END
Part C
Combines Part A, Part B, and usually Part D
Part C (like an HMO or PPO)
ENDIf you join a Medicare Advantage Plan, you can’t use and can’t be sold a Medicare Supplement Insurance (Medigap) policy.
Slide8Original Medicare compared to Advantage
8
Characteristic
Medicare Advantage
(Part C)Original Medicare + Medicare Supplement
Relationship to Medicare
Parts A & B
ReplacesSupplements
Private Network RequiredMost Plans
NoReferrals Required
Some plansNo
Part D Included
Most plans
No
Monthly Premiums
Vary, but generally lower
Vary, but generally higher
Annual Out-of-Pocket Costs
Up to $6,700
Minimal
Guaranteed Renewable for LifeNo
Yes3
Slide9Plan F Example – Part A
9
Services
Medicare Pays
Plan Pays
You Pay
Hospitalization
Semiprivate room and board, general nursing & misc. services & supplies
First 60 Days
61
st
-90
th
day
91
st
and after
While using 60 lifetime reserve days
Once lifetime reserve days are used:
Additional 365 days
Beyond the additional 365 days
All but [$
1,364]All but [$
341
]
a
dayAll but [$682] a day$0$0[$1,364] (Part A deductible)[$341] a day[$682] a day100% Medicare Eligible Expenses$0 $0$0$0$0All costsSkilled Nursing Facility CareYou must meet Medicare’s requirements, including having been in a hospital for at least 3 days & entered a Medicare-Approved facility within 30 days after leaving the hospital
First 20 days
21
st
-100
th day101
st day and after
All approved amounts
All but [$
170.50
]
a day
$0
$0
Up to [
$
170.50
]
a day
$0
$0
$0
All Costs
Blood
First 3 pints
Additional Amounts
$0
100%
3 pints
$0
$0
$0
Hospice Care
You must meet Medicare
’
s requirements, including a doctor
’
s certification of terminal illness
All but very limited co-payment/coinsurance for outpatient drugs & inpatient respite care
Medicare co-payment/ coinsurance
$0
2019
Slide10Plan F Example – Part B
10
Services
Medicare Pays
Plan Pays
You Pay
Medical Expenses
IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician
’
s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical equipment
First [
$
185
]
of Medicare-Approved amounts
Remainder
of Medicare-Approved amounts
$0
Generally 80%
[$
185
]
(Part B deductible)
Generally
20%
$0
$0Part B Excess charges(Above Medicare-Approved amounts)$0100%$0BloodFirst 3 pints
Next [$185
]
of Medicare-Approved amounts
Remainder of Medicare-Approved amounts
$0
$0
80%
All costs
[
$
185
]
(Part B deductible)
20%
$0
$0
$0
Clinical Laboratory Services
TESTS FOR DIAGNOSTIC SERVICES
100%
$0
$0
2019
Slide11Plan F Example – Part A & B
11
Services
Medicare Pays
Plan Pays
You Pay
Home Health Care-
MEDICARE APPROVED SERVICES
Medically necessary skilled care services & medical supplies
Durable medical equipment
First [$
185
] of Medicare-Approved amounts
Remainder of Medicare-Approved amounts
100 %
$0
80%
$0
[$
185
]
(Part B deductible)
20%
$0
$0
$0
Other Benefits-Not Covered by MedicareServicesMedicare PaysPlan PaysYou PayForeign Travel-Not CoveredMedically necessary emergency care services beginning during the first 60 days of each trip outside the USAFirst $250 each calendar yearRemainder of charges$0$0$080% to a lifetime max. benefit of $50,000$25020% & amounts over $50,000 lifetime max.2019
Slide12Plan G Example
Plan G is the same as Plan F, except for the Part B deductible12
Services
Medicare Pays
Plan Pays
You Pay
Medical Expenses
IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician
’
s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical
equipment
First [$
185
]
of Medicare-Approved amounts*
Remainder
of Medicare-Approved amounts
$0
Generally
80%
$0
Generally
20%
$
185
(Part B deductible)
$02019
Slide13Plan N Example
13Plan
N is the same as Plan G, except for
doctor copays and Excess Charges
Services
Medicare Pays
Plan Pays
You Pay
Medical Expenses
IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician
’
s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical equipment
First [
$
185
]
of Medicare-Approved amounts
Remainder
of Medicare-Approved amounts
*ER co-pay waived if admitted to the hospital
$0
Generally 80%
$0
Balance, other than $20 co-pay per office visit and up to $50 per ER visit*
$
185
up to $20 per office visit and up to $50 per ER visit*Part B Excess charges(Above Medicare-Approved amounts)$00%All Costs2019
Slide14Medigap Open Enrollment
146-month Open Enrollment Period*
You may be eligible for Open Enrollment…
*
Guaranteed Issue: Will not need to answer health questions (no medical underwriting)…if you were previously covered under
Medicare (SS Disability) and you turn 65, you have another 6-month open enrollment period
Up to 6 Months after your Medicare Part B effective date
Slide15Medicare Part D: Prescription Coverage
Who Pays What?
Member pays all
Plan pays nothing
Member pays part
Plan pays part
Member pays MOST
Plan pays a little
Member pays a little
Plan pays most
up to…
$
405
$415
LEGEND
<$3,750
<$3,820
*based on retail costs
<
$5,000
<$5,100
*based on Tro-oP>$5,000>$5,100**based on Tro-oPTOTAL COST OF DRUGS Many plans have $0 deducible.COPAYS or COINSURANCE35% 2
5%* of Brand-Name Drugs44% 37% of Generic DrugsMEMBER PAYS:The greater of 5% or $8.35 $8.50 (Brand-Name)$3.35 $3.40 (Generic)Pharma Discount for brand name drugs:50%70%*Strikethrough: 2018 valuesOrange Text
: 2019 Changes
2019
15
* Changes in Bipartisan Budget Act of 2018
Slide16Part D Examples on Medicare.gov
Example 1Zip 08054Drug List ID: 3134985216Date: 10/15/2017
Metformin Example:Zip: 07849Drug List ID: 7790380192Date: 07/07/2017
16
Slide17Avoid the Top 5 Mistakes People Make on Medicare
Medicare Workshop
Presented by:
www.senior-advisors.com
info@senior-advisors.com
- 1Q 2019-
Justin Lubenow
Medicare SpecialistMedicare Advisory Board for National Association of Health Underwriters
908.272.197015 Alden Street, Suite 8Cranford, NJ 07016
Doug Lubenow, RHU, CLTC
PresidentPrior Member of Medicare Advisory Board for National Association of Health Underwriters
856.866.8900
214 W. Main St Suite 101
Moorestown, NJ 08057
Slide18APPENDIX
18
Slide1919
Who
…we are
Our top priority is to
reduce stress for Medicare beneficiaries, by providing education, an overview of the choices available, and making recommendations for each individual's coverage.
https://www.senior-advisors.com/about-
us.html
READ THIS FOR MORE INFO
Founded in 2009Over 20,000 Medicare Clients Nationwide
President is Doug Lubenow; ~30 years in Insurance Industry
Family Owned & OperatedAll 5 star reviews -
https://www.senior-advisors.com/
testimonials.html
Member of the Medicare Advisory Board of National Association of Health Underwriters (NAHU) from 2012-2016
Slide2020
Who
…we are
Our top priority is to
reduce stress for Medicare beneficiaries, by providing education, an overview of the choices available, and making recommendations for each individual's coverage.
https://www.senior-advisors.com/about-
us.html
READ THIS FOR MORE INFO
Rutgers Business School, B.S. Management Science & Information Systems (MSIS)
Master’s Degree, MIS, Stevens Institute of Technology 15 years in “Corporate America”
– Account Director for Several Software Companies managing accounts AT&T, Verizon, Citi, AMEX, and more!Joined Senior Advisors in June 2015 and opened the office in Cranford
Member of the Medicare Advisory Board of National Association of Health Underwriters (NAHU) since 2016
Slide2121
Where
…we are
We have two offices in
NJ, and we are licensed in 25+ states.
Moorestown Office
214 W Main Street Suite 101
Moorestown, NJ 08057
Cranford Office15 Alden Street, Suite 8Cranford, NJ 07016
Slide2222
Where
…we are
We have two offices in
NJ, and we are licensed in 25+ states.
Slide2323
What
…we do
Educate seniors on Medicare, provide options for coverage, and help them enroll.
Educate
Provide Options
Assist with
Enrollment
Part A (Hospital)
Part B (Doctors)
Medigap
Plans (aka Medicare Supplement Plans)
Medicare Advantage
Part D (RX Plans)
And More!
We offer FREE workshops: What Baby Boomers need to know about Medicare.
https://www.senior-advisors.com/watch-workshop-
now.html
Slide24Who Pays First???
There are several situations where knowing who pays first is extremely important, as it may cause employees claims to not be paid or for them to face penalties at a later date.
24
If the member is…
And…
This is who pays first
Over age 65, on group plan/
spouse’s
group plan
Employer has less than 20 employees
Medicare
Over age 65, on group plan/
spouse’s
group plan
Employer has more than 20 employees
Group Health Plan
Disabled & covered by group plan/
spouse’s
group plan
Employer has less than 100 employees
Medicare
Disabled & covered by group plan/
spouse’s
group plan
Employer has more than 100 employees
Group Health Plan
On an Employer Retirement planIs entitled to MedicareMedicareCovered by COBRA*Is entitled to MedicareMedicare
Slide25Part B Enrollment Scenarios
25Turning 65 (already enrolled in SS*)Auto-enrolled in A & B
Turning 65 (not enrolled in SS*)Enroll online at https://secure.ssa.gov/iClaim/rib
Enrolling after age 65 (see next slide)
*Social Security
Slide26Enrolling After Age 65
26
Two forms needed to drop at Social Security
Enroll in Part B
Form https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS40B-E.pdfProof of Coverage Form
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf
Slide27Illustrative Diagram
Medicare Supplement Plans Overview
27
Premium
Level of Coverage
F
G
N
The following examples will focus on plans F, G, & N
~3%
of 2018 policies*
~78%
of 2018 policies*
~13%
of 2018 policies*
* Policies enrolled by Senior Advisors
Slide28H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015
28
Slide29Supplemental Guaranteed Issue
29
When are Supplemental Guaranteed Issue Periods?
No Medical Questions
You have guaranteed issue if…
You can/must apply for a
Medigap
policy
You have Original Medicare & an employer group health plan (including COBRA/retiree) or union coverage that pays after Medicare pays & that plan is ending.
No later than 63 calendar days after…
Date coverage ends
Date on the notice of coverage ending
Date on a claim denial
You are in a Medicare Advantage Plan & your plan is leaving Medicare or stops giving care in your area, or you move out of the plan
’
s service area.
Early as 60 calendar days before the date your health care coverage will end but not later than 63 days after it ends.
Trial Right:
You joined a Medicare Advantage Plan or Programs of All-inclusive Care for Elderly (PACE) when you were first eligible for Medicare Part A at 65, & within the first year of joining, you decide you want to switch to Original Medicare
As early as 60 calendar days
before
the date your coverage will end, but no later than 63 calendar days after your coverage ends
Trial Right:
You dropped a Medigap policy to join a Medicare Advantage Plan for the first time, you have been in the plan less than a year, & you want to switch back
As early as 60 calendar days
before
the date your coverage will end, but no later than 63 calendar days after your coverage endsYour Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.No later than 63 calendar days from the date your coverage ends.You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules or it misled youNo later than 63 calendar days from the date your coverage ends.
Slide30RX Card A Example
30
Monthly Premium:
$98.30
Annual Drug Deductible:
$0
Total Annual Cost:
$4,796.41
Estimated Drug Cost Details at Retail Pharmacy
Full Cost of Drug
Initial Coverage
Coverage Gap
Catastrophic Coverage
Acyclovir 880MG
$42.69
$7.00
$7.00
$2.65
Clonazepam .5MG
$5.07
$5.07
$4.01
$2.65
Exelon Patch 9.5MG/24hr
$304.98
$95.00
$144.87$15.25Gelnique 10% gel$209.64$45.00$99.58$10.48Namenda 5MG
$273.33
$45.00
$129.83
$13.67
Norvasc 5MG
$84.52
$84.52
$40.15
$6.60
Restasis
5%
$153.95
$45.00
$73.13
$7.70
Sinimet
CR 50MG/200MG
$206.03
$95.00
$97.86
$10.30
Zocor 40MG
$172.02
$95.00
$81.71
$8.60
Zoloft 50MG
$217.61
$95.00
$103.36
$10.88
Monthly Totals:
$1669.84
$611.59
$781.50
$88.78
2
Slide31RX Card B Example
31
Monthly Premium:
$39.20
Annual Drug Deductible:
$0
Total Annual Cost:
$12,799.48
Estimated Drug Cost Details at Retail Pharmacy
Full Cost of Drug
Initial Coverage
Coverage Gap
Catastrophic Coverage
Acyclovir 880MG
$42.69
$10.00
$33.73
$2.65
Clonazepam .5MG
$5.07
$5.07
$4.01
$2.65
Exelon Patch 9.5MG/24hr
$304.98
$95.00
$144.87$15.25Gelnique 10% gel$209.64$45.00$99.58$10.48Namenda 5MG
$273.33
$45.00
$129.83
$13.67
Norvasc 5MG
$94.69
$94.69
$94.69
$94.69
Restasis
5%
$153.95
$45.00
$73.13
$7.70
Sinimet
CR 50MG/200MG
$231.05
$231.05
$231.05
$231.05
Zocor 40MG
$204.18
$204.18
$204.18
$204.18
Zoloft 50MG
$244.04
$244.04
$244.04
$244.04
Monthly Totals:
$1763.62
$1019.03
$1259.11
$826.36
*not covered on Formulary
Slide32RX Card C Example
32
Monthly Premium:
$97.00
Annual Drug Deductible:
$325.00
Total Annual Cost:
$16,256.69
Estimated Drug Cost Details at Retail Pharmacy
Full Cost of Drug
Initial Coverage
Coverage Gap
Catastrophic Coverage
Acyclovir 880MG
$46.90
$5.00
$5.00
$2.65
Clonazepam .5MG
$1.62
$1.62
$1.28
$1.62
Exelon Patch 9.5MG/24hr
$304.68
$38.00
$144.72$15.23Gelnique 10% gel$234.80$234.80$234.80$234.80Namenda 5MG
$273.03
$38.00
$129.69
$13.65
Norvasc 5MG
$102.80
$102.80
$102.80
$102.80
Restasis
5%
$153.65
$38.00
$72.98
$7.68
Sinimet
CR 50MG/200MG
$230.75
$230.75
$230.75
$230.75
Zocor 40MG
$203.88
$203.88
$203.88
$203.88
Zoloft 50MG
$263.16
$263.16
$263.16
$263.16
Monthly Totals:
$1815.27
$1156.01
$1389.06
$1076.22
*not covered on Formulary
Slide33RX Comparison
33
Card A*
Card B*
Card C
Monthly Premium
$
98.30
$39.20
$97.00
Total Annual Cost
$4,796.41
$12,592.59
$16,256.69
*Card A and B are the same company
5
Slide34Not enrolling in Part B on-time
34
1
Initial Enrollment Period
10% Penalty/year
COBRA
Retiree Plans
Social Security Disability
Slide35Not analyzing prescription drugs
35
2
Could cost you thousands of $$
30 different drug cards
Formularies are key
Medicare.gov
Annual Enrollment 10/15 to 12/7
Slide36Medicare Advantage
vs Medigap
36
3
Networks & Referrals
Max. Out of Pocket Expense
Changes during Annual Enrollment
Extra Benefits
Overall expenses
Slide37Not analyzing retiree coverage
37
4
Premiums
Co-Pays
Co-Insurance
Compare all-in expenses
Slide38Listening to Friends & Family
38
5
Drug Cards
Advertisements
Analyze entire expense (not just prem.)
Association Plans (not guar. renewable)
Slide3939
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