1. Medicare Made Easy

2. What is Medicare? A health insurance for beneficiaries meeting certain criteria: –65 and older –Under 65 with certain disabilities –Any age with End-Stage Renal Disease (ESRD) Administration –Centers for Medicare & Medicaid Services (CMS) Enrollment –Social Security Administration for most seniors –Railroad Retirement Board (RRB)

3. Part – B Part – A Part – D Part – C Ways to receive Medicare Original Medicare

4. Review of Medicare

5. Enrollment Periods at a glance Initial Enrollment Period (IEP) –3 months before, month of, 3months after Person’s 65 th birthday 30 th month for Medicare due to disability General Enrollment Period (GEP) –January 1 st through March 31 st of each year –Medicare coverage begins July 1 st of same year Penalties will usually apply Special Enrollment Period (SEP) –Working or covered by a working spouse Medicare Part B – 8 months from when retirement begins Medicare Part D – 63days from when retirement begins –Only if already enrolled into Medicare Part A

6. Enrollment Periods

7. Enrollment Periods (cont’d)

8. You’re eligible to join Medicare if this describes you: Eligibility Here are some things to know about the “age 65” rule.

9. Medicare Card (front) Jane Doe

10. Social Security Administration Responsible for eligibility and enrollment –People aged 65 yrs or older Contributed into FICA 40 quarters (10yrs) Married and receiving benefits under a spouse’s work record Must have been married a minimum of 10yrs to receive benefits under a former spouse –Under age 65yrs Receiving disability benefits under SSA or Railroad retirement systems for 24 months –Any Age Receiving regular dialysis Amyotrophic Lateral Sclerosis (ALS) –a.k.a Lou Gehrig’s Disease

11. Medicare for Disabled Individuals Disability Defined: –Inability to work –Expected to last for 1 year or result in death Can be the result of blindness –Visual acuity 20/200 or less with correcting lens in better eye OR –Visual field of 20 degrees or less Note: SSA is responsible for disability determination

12. Qualifying for Disability Benefits Meet requirements –Definition of disability –Work credits Or relationship to someone with work credits 5-month waiting period –Exceptions People eligible for childhood disability benefits Some people previously entitled to disability benefits

13. Qualifying for Medicare due to Disability 24-month waiting period –Exceptions for people with ALS No additional waiting period Medicare starts with first month of benefits Medicare usually begins 30 th month after disability began o 5 months + 24 months = 29 month wait

14. ESRD Disability For Medicare Coverage begins: –Fourth month of dialysis First month if certain conditions are met –Month you receive kidney transplant –Month you are admitted to approved hospital For transplant of procedures preliminary to transplant –2 months before month of transplant If transplant is delayed more than 2 months

15. Original Medicare Go to any provider that accepts Medicare Enrolled into Medicare Part A –Premium free for most people Paid 40 quarters (10yrs) into FICA –Others may be able to purchase If a U.S. citizen; or Legal U.S. resident of 5 continuous years or more Enroll into Medicare Part B –Pay monthly premium Starting in 2007 some individuals have their premiums based on their taxable income Pay Part A and Part B –Deductible –Coinsurance or co-payment

16. Advantages Most people do not pay a monthly premium Only pay first $1,260 (2015) of costs – your deductible – for a hospital stay of less than 60 days You can go to any hospital in the U.S. that’s qualified Enrollment is easy. You cannot be denied coverage due to medical history or current health conditions Disadvantages Hospital stays of more than 60 days require a daily co-payment. Long hospitalizations can be expensive Multiple stays may mean multiple deductibles Generally, hospital care outside the US isn’t covered Provides help with the cost of hospital stays and skilled nursing services after a hospital stay, plus some other skilled care A Closer Look at Part A

17. Medicare Part A - Covered Services Inpatient Hospital Care Skilled Nursing Facility Home Healthcare Hospice Care Semi-private room and board, general nursing, meals, and the other hospital services and supplies Full-time inpatient nursing and rehabilitative services (Custodial Care not covered) Part-time skilled nursing care, home health aids, physical and occupational therapy, speech and language pathology Support services from a Medicare- approved hospice, includes drugs for system control and pain relief

18. Benefit Period Part A (Hospital Insurance) charges are based on “benefit period” –Inpatient hospital care and skilled nursing facility (SNF) services –Begins first day of inpatient hospital care –Ends when you have been out of a hospital or SNF for 60 days in a row –Benefit period is not based on a calendar year –You pay deductible for each benefit period –No limit to number of benefit periods

19. Advantages Part B works the same way throughout the U.S. You can get care wherever you are You can receive care from any participating physician Enrollment is easy. Your history or pre-existing conditions don’t matter Disadvantages If you wait to join, you may have to pay a higher premium Limited preventive care You usually pay 20% of the Medicare- approved amount and there is no ceiling on your total spent Generally, care outside of the U.S. is not covered Monthly premium of $104.90 (2015) to be paid by Medicare beneficiary Part B deductible of $147 per year (2015) Help with the cost of doctor visits and other medical services that do not require an inpatient hospital stay A Closer Look at Part B

20. Medicare Part B- Covered Services Medical Expenses Home Healthcare Outpatient Hospital Services Durable Medical Equipment (DME) Physician services, some diagnostic test, physical and speech therapy, ambulance, observation stay in the hospital…etc. Part-time skilled nursing care, home health aids, physical and occupational therapy, speech and language pathology Outpatient surgery, diagnostic procedures, emergency room, partial hospitalization…etc. Walkers, wheelchairs, hospital beds, insulin pump, some medication associated with a DME…etc.

21. Paying the Part B Premium Taken out of one of the following monthly payments: –Social Security –Railroad Retirement –Federal Government Retirement For information about premiums –Call SSA or RRB Office of Personnel Management if a retired Federal employee Will be billed every 3 months –If not receiving SSA or RRB benefits

22. Medicare Penalties Part A –Penalty will only apply if a beneficiary has to purchase Medicare Part A 10% a year for twice the number of years Part B –If a person delayed enrollment into Part B, their penalty will be 10% for each year and will remain with them for as long as they are on Medicare

23. Medicare Supplement Insurance

24. What is a MedSup Policy? Health insurance policy –Provided by private insurance companies Used with “Original Medicare” only –Must have both Medicare Part A and Part B –Covers the major gaps in Medicare Medicare-approved charges All policies are standardized –Each policy will be identical from company to company Except in Massachusetts, Minnesota, and Wisconsin

25. Advantages Depending on the plan, some or all of your out-of-pocket costs for care under Medicare A & B are covered You are guaranteed the right to buy a Medigap plan during your open enrollment period You get help budgeting because you have predictable monthly premiums instead of cost sharing that is hard to anticipate Disadvantages Plan premiums can change from year to year Prices for the same coverage can vary sharply. In some plans, premiums rise as your age increases. You can be denied coverage based on your health if you apply for coverage after your open enrollment period Private insurance that helps pay your part of cost sharing in traditional Medicare Parts A & B. Also known as Medigap plans. Medicare Supplement Plans

26. 2015’s MedSup Policy – Core Benefit Core Benefits for Plans A, B, C, D, F, G, M, N include: All Part A coinsurance expenses for : $315 per day for 61st through 90th day; $630 per day for 91st through 150th day; Part A Hospice coinsurance Upon exhaustion of Part A hospitalization benefits, full coverage of an additional 365 days per lifetime; Part B coinsurance or copayment; including Part B Preventive Services First three pints of blood each calendar year *Core benefits for Plan K and L are the same as listed above with the exception of 50% (Plan K) and 75% (Plan L) payment for the Part A deductible, Part B coinsurance, the blood deductible, hospice care coinsurance and Skilled Nursing Facility coinsurance.

27. 2014’s Medicare Supplement Policies Benefits Included Plan A Plan B Plan C Plan D Plan F Plan G Plan K Plan L Plan M Plan N Core Benefits √√√√√√√* √ Skilled Nursing Facility √√√√ √* (50%) √* (75%) √√ Part A Deductible √ √ √√√ √* (50%) √* (75%) √* (50%) √ Part B Deductible √√ Part B Excess (100%) √√ Foreign Travel √√√√√√ 2014 Out-of Pocket Maximum $4940$2470

28. Medicare Supplement Open Enrollment One-time 6-month window –Have or enrolling into Part A –Enrolling into Part B for first time Including those enrolling due to disability Cannot be denied a policy –Join any plan from any company May require a pre-existing condition waiting period –No more than 6 months

29. Rights and Guarantees Loss of Medicare Supplement –Company pulls out of the market Must be provided with another policy Loss of other coverage –Employer group health plan 63-day Guaranteed Issue May purchase Plan A, B, C, F, K or L Medicare Advantage (MA) –Leave MA plan within first 12 months of first enrollment –Plan is pulled from the market

30. High Deductible Option Another variation of a Medicare Supplement Policy offered is a “high- deductible option” Offered only with a standardize Plan F Plan will not pay it’s portion of benefits until deductible has been met –$2,180 in 2015 Deductible is adjusted each year

31. Advantages You get help with the cost of your prescription drugs You’ll save money when your plan negotiates lower drug costs and passes the savings along to you Catastrophic coverage protects you from very high drug costs Disadvantages Plan benefits – including premium, deductible and copayments can change each year Total costs of a plan can vary significantly from plan to plan Each plan has a list of drugs that it covers. Lists can be different Provides help with the cost of prescription drugs through private companies A Closer Look at Part D

32. Two Important Concepts: 1.Formulary List of drugs that the insurance plan covers Medicare provides guidelines about the type of drugs to be covered but not the specific drug Each plan has its own formulary Medicare has excluded some types of drugs but some plans may include them as part of an enhanced formulary A Closer Look at Part D

33. 2.Cost sharing Your level of cost sharing will change depending on the total cost of drugs you use Total cost = what you pay + what the plan pays Use of generic drugs can be an effective way to lower your costs and avoid or delay hitting the coverage gap A Closer Look at Part D TIP

34. Resources Medicare 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2049 24 hours/day, 7 days/week www.medicare.gov Social Security Administration 1-800-772-1213 TTY 1-800-325-0778 www.ssa.gov

35. Where graphics and information came from www.thefinancialteam.com/MedicareMadeClear.pptwww.thefinancialteam.com/MedicareMadeClear.ppt http://insurance.illinois.gov/ship/medicare/medicarebasics2.ppthttp://insurance.illinois.gov/ship/medicare/medicarebasics2.ppt