enrollment Joani Shaver Director Blount County Office on Aging November 2014 Health insurance for the following people Those 65 and older Those younger than 65 with certain disabilities Those with EndStage Renal Disease permanent kidney failure ID: 931125
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Slide1
Medicare Madness:Navigating through open enrollment
Joani Shaver, Director
Blount County Office on Aging
November, 2014
Slide2Slide3Health insurance for the following people:Those 65 and olderThose younger than 65 with certain disabilitiesThose with End-Stage Renal Disease (permanent kidney failure)
What is Medicare?
Slide4Most
outpatient prescription drugs
Routine vision care
Long-term care
Routine dental care
DenturesHearing aids (exams and fittings)Routine foot care
What's NOT covered by Original Medicare
?
Slide5Medicare Part A (Hospital Insurance)Inpatient care in hospitalsSkilled nursing facility, hospice, and home health careMedicare Part B (Medical Insurance)Doctors’ services, hospital outpatient care and home health careSome preventive services
Different Parts of Medicare
Slide6Medicare Part DPrescription drug option run by Medicare-approved private insurance companiesPrescription drugsMay help lower your prescription drug costs and help protect against higher costs in the future
Different Parts of Medicare
Slide7Medicare Part C (Advantage Plan)Health plan managed by Medicare-approved private insurance companiesIncludes all benefits and services covered under Part A and Part BMay include extra benefits and services for an extra costUsually includes Medicare prescription drug coverage (Part D)
Different Parts of Medicare
Slide8TOTAL HEALTHCARE COVERAGE
ORIGINAL
MEDICARE
Slide9Premium remains $104.90Part B deductible remains $147Part A hospital inpatient deductible raised to $1260 for each benefit period (was $1216)Days 61-90: $315 per day coinsurance for each benefit period (was $304)
Changes to Medicare in 2015
Slide10Annual deductible rises from $310 to $320Number of plan choices will drop – some are being eliminatedAverage monthly premium will be $38.83Doughnut hole is shrinking
Changes to Part D in 2015
Slide11First methodOriginal Medicare (Parts A & B)
Prescription Drug Plan
(Part D)
Medicare Supplement or
Medigap
policy (identified by a letter)Supplements provide identical coverage, but vary widely in priceHow can I get my Medicare coverage?
Slide12Second MethodMedicare Advantage Plan (Part C)Includes Part A & B coverage Prescription Drug Coverage
(Part D)
Some advantage plans
include prescription
coverage
Slide13If you get retirement benefits from Social Security or the RRB, then you automatically get Parts A & B on 1st day of month you turn 65
If
you get disability benefits from Social Security or certain disability from the RRB,
then
you
automatically get Parts A & B on the 1st day of the 25th month after your benefits beginMedicare Enrollment
Slide14If your disability is ALS (Lou Gehrig’s disease), then you automatically get Parts A & B on 1
st
day of month your disability benefits begin
If
you’re still working and not getting Social Security,
then you’ll need to talk with your HR department about your choices related to Medicare. You may want to delay enrollment, which you’ll do online through www.ssa.gov.
Slide15When you first turn 65, you have 3 months before and after your birthday monthCoverage begins based on your enrollment dateIf you don’t sign up for Medicare when you’re first eligible,
then
you may pay penalty for Part B as long as you receive benefits
Initial Enrollment
Slide16Go from Original Medicare to Advantage PlanGo from Advantage Plan to Original MedicareSwitch Medicare Advantage PlansJoin Part D planSwitch Part D plans
What can I do during Open Enrollment from Oct 15 – Dec 7?
Slide17Medicare Supplement might make sense if youWant flexibility in choosing your doctorsVisit doctors frequentlyTravel extensivelyHave a chronic medical condition
Don’t mind higher premiums to get lower out-of-pocket costs (predictability)
11 different plans
What plan is right for me?
Slide18Medicare Advantage Plan might make sense if youAre willing to change doctors, if necessaryPrefer all benefits from single plan & premiumVisit doctors infrequently & don’t mind paying per-visit copayments and coinsurance
Don’t mind researching your options annually
Want lower premiums than supplements offer
Are informed about your choices and don’t mind comparison shopping for plans
Want options beyond what Medicare provides
19 different plans
Slide19Remember all that?
Simple: buy the
best insurance that
you can afford –
after doing your
homework!
Slide20Two ways to get Part DPurchase Medicare prescription drug policyChoose a Medicare Advantage Plan that offers prescription drug coverage
Even if you feel it’s not needed in your case, remember that you may pay a late enrollment penalty if you join a Part D plan later.
Medicare Part D
Slide21Monthly fee, varies by planIn addition to Part B cost of $104.90Some Advantage Plans include Part D coverage in the costAvoiding Part D Enrollment penaltyJoin drug plan when first eligibleDon’t go 63 days or more without drug coverage
Penalty = 1% of full uncovered months
(
pg
105)
Part D Premium
Slide22Always be sure that your prescription drugs are in formulary of any plan you’re consideringCheck what “tier” drugs are in – each tier has different costDo this every year during Open Enrollment!Call the plan for info or check plan’s website
IMPORTANT!!
Slide23Begins when total drug costs reaches $2,960Includes what you & plan have paidPlan no longer covers drugs for rest of yearYou pay discounted amounts45% on brand name drugs65% on generic drugsOnce you’ve paid $4,700 out of pocket you pay 5% of cost for covered drugs or copay of $2.65/generic, $6.60 for brand name drugs
The Doughnut Hole
Slide24Drug plans may include preferred and non-preferred pharmacies in their networkYou may pay less for drugs at
preferred pharmacies
IMPORTANT!
Slide25Program to help people pay Medicare prescription drug costsFor single person, income less than $1,459 month and resources less than $13,440 per year
For
married person living with spouse, income less than $
1,966
month and resources less than $26,860 per year
EXTRA HELP
Slide26Apply through Social Security www.ssa.govHelps with monthly drug plan premium, annual deductible, coinsurance and copaymentsEliminates doughnut holeSwitch plans at any time during year
Same application used to get help from TN to pay your Medicare costs
EXTRA HELP
Slide27Benefit period: begins day you’re admitted to hospital or skilled nursing facility (SNF) and ends when you haven’t received any inpatient hospital care or SNF skilled care for 60 days in a rowCoinsurance: your share of cost for medical service or supply, expressed in percentageCopayment:
set amount you pay as your share of cost for medical service or supply
Glossary
Slide28Deductible: amount you pay for health care or prescriptions before Medicare or Advantage Plan or Drug Plan begins to payExtra Help: helps those with limited income pay health care costsFormulary:
list of drugs covered by prescription drug plan or other insurance plan
Medically necessary:
services or supplies needed to prevent, diagnose or treat illness, injury, condition, disease or its symptoms
Slide29Medicare-approved amount: payment accepted by doctor or supplier from MedicarePreferred Provider: doctor or supplier who is member of network for specific insurer’s HMO or PPO planPreventive services:
health care to prevent illness or detect at early stage
Primary care doctor:
person you see first for most health problems
Referral:
written order from primary care doctor for you to see specialist or get some medical services. Required in most HMOs.
Slide30Signing up too early or too lateNot understanding difference between Medicare Supplement and Medicare AdvantageGuessing when picking planNot applying for extra helpNot re-evaluating coverage yearly
Five
Biggest Mistakes
Made
When Enrolling in Medicare
Slide31www.medicare.govMedicare & You 2015www.mymedicarematters.orgSHIP (1-877-801-0044)
www.aonhewittnavigators.com
www.benefitscheckup.org
Best Sources of Information
Slide32Joani Shaver, DirectorBlount County Office on AgingBlount County Community Action Agency3509 Tuckaleechee Pike, Maryville 37803
(865) 983-8411 x25
jshaver@blountcaa.org
Contact Information