1. The Maze of Medicare
Presented by:
Larry Ulvila

2. Presentation Overview
This Presentation provides a brief overview of Medicare components as well as Supplemental plans.
This information is for educational purposes only.
Please refer to the “Resources” slide for a listing of helpful contacts to learn about specific details for enrolling in Medicare and available Supplemental Plans.
Presented by Albers & Company June 5, 2007

3. Presentation Agenda Medicare 101 Medicare Part D
Medicare Part A and B
Medicare Eligibility
Medicare Part C and other types of Medicare complimentary plans
Medicare Part D
How does Medicare Part D work?
Medicare Resources
Presented by Albers & Company June 5, 2007

4. Medicare 101
Medicare Part A – Hospital Insurance Medical Part B – Medical Insurance
Presented by Albers & Company June 5, 2007

5. Medicare Part A
Funded through payroll deductions and taxes - You and AAMC have already paid for these benefits
No monthly premium cost if beneficiary worked 40 quarters
Benefits in 2017:
Covers inpatient care, limited skilled nursing, hospice and some home health care
You pay: $ 1,316 deductible and applicable coinsurances
Presented by Albers & Company June 5, 2007

6. Medicare Part B
Medicare Part B premiums are based on the year in which you enroll and your annual income
The 2017 standard premium is $ (or higher depending on your income), if:
You enroll in Part B for the first time in 2017
You are not receiving Social Security benefits
You are directly billed for your Part B premiums
Your modified adjusted gross income is under $85,000/year (single or married filing separate returns) or under $170,000/year (married filing joint tax return) – higher premiums apply if your income exceeds these limits

7. Medicare Part B Benefits in 2017:
Covers doctor visits, diagnostic services, therapy, outpatient care (non-hospital services)
You pay: $183 yearly deductible plus 20% coinsurance for Medicare covered expenses.

8. Medicare Eligibility: If Retired
At age 65 if retired or retiring
Contact Social Security
3 months prior/post 65th birthday
Enroll in Medicare Parts A & B
Can decline Part B
10% penalty for each year failed to apply
Unless employee or spouse is working and covered by group insurance (not a plan for retirees)
Presented by Albers & Company June 5, 2007

9. Medicare Eligibility: If Still Working
If you are still working, do not plan to retire at age 65, and have group medical coverage:
Contact Social Security
3 months prior/post 65th birthday (for example, if your date of birth is January 1, 1950, your initial election period (IEP) will end on March 31, 2017)
Consider enrolling in Part A, there is no premium cost. (You cannot contribute to an HSA if you are enrolled in Part A)
You can decline Part B
No penalty applies if employee or spouse is working and covered under creditable group insurance (not a plan for retirees)
Apply for Medicare within 8 months of retirement to avoid penalty
Presented by Albers & Company June 5, 2007

10. Medicare Eligibility: Under Age 65
If you are under 65
Before age 65, you may eligible for Medicare Part A if you:
Have been a Social Security Disability beneficiary for 24 months
Part B can be purchased
Presented by Albers & Company June 5, 2007

11. Other Types of Medicare Plans
Supplemental Plans (aka Medigap)
Medicare Advantage Part C
Medicare Part D (most often elected when enrolling in a supplemental plan)
Presented by Albers & Company June 5, 2007

12. Supplemental Plans: Medigap
Medicare provides Parts A & B
You purchase an additional policy that “supplements” what Medicare does not cover, e.g. deductibles, coinsurance
Payments based on Medicare allowable charges; may be additional out of pocket costs in excess of 20% coinsurance
Supplemental benefits depend on plan elected
Presented by Albers & Company June 5, 2007

13. Medicare Supplemental Plans

14. Medicare Supplemental Plans

15. Medicare Supplemental Plans

16. Medicare Part C Medicare Advantage Plans
Must be enrolled in Medicare Part A & B to be eligible
Pays providers for services instead of Medicare (whereas Medicare supplemental plan pays after Medicare)
HMO & PPO private health insurance plans regulated by the Centers for Medicare and Medicaid Services (CMS)
Often includes prescription drug coverage as well as benefits such as routine eye exams, dental and hearing services
Presented by Albers & Company June 5, 2007

17. Medicare Part C – PPO Plan

18. Medicare Part C – Plus PPO Plan
Johns Hopkins Advantage MD (PPO) Plus
Monthly Plan Premium
$78
Out-of-Pocket Annual Maximum
$6,700/$10,000 Combined In and Out-of-Network
Office Visit Copay – PCP
$5 copay
Office Visit Copay - Specialist
$40 copay
Inpatient Hospital Stay
$250/day copay for days 1-7
Outpatient Surgery
$200 copay
Emergency Care
$75 copay
Annual Routine Vision Exam
$0 copay; up to $150 every other year for eyewear
Prescription Drugs
Preferred Generic
Non-Preferred Generic
Preferred Brand
Non-Preferred Brand
Specialty
$4 Copay
$12 Copay
$42 Copay
$92 Copay
33% of the cost
Presented by Albers & Company June 5, 2007

19. Medicare Part D - Overview
Open enrollment: Annually every October 15th through December 7th
Enroll through a private carrier, not through Medicare
Voluntary enrollment, but penalties apply
1%/month delay
Waived if employer coverage creditable
Presented by Albers & Company June 5, 2007

20. Medicare Part D Overview
Sample Medicare Prescription Drug Basic Plan Coverage
Plan Coverage
You Pay
Deductible
100% of first $400
Initial Coverage Stage: Copay/Coinsurance you pay (at Standard Network Pharmacy)
$3 Copay Preferred Generic; $8 Generic; $33 Preferred Brand; 40% Non-Preferred; 25% Specialty
Coverage Gap: Amount you pay until your Out-of-Pocket expenses reach $4,950 for the calendar year
58% of Generic drugs
45% of Brand drugs
Catastrophic Coverage: Amount you pay after your Out-of-Pocket expenses reach $4,950 for the calendar year
Whichever is Greater:
$2.95 Generic; $7.40 Other Covered Drugs; OR, 5% of the Drug’s Cost
Presented by Albers & Company June 5, 2007

21. Medicare Part D – Other Thoughts
Plans can be flexible in benefit design
Plans may have different formularies, but Medicare has some formulary requirements
Pharmacy networks vary by plan
Higher income individuals will be charged additional surcharge for Part D plans
Presented by Albers & Company June 5, 2007

22. Next Steps – When You Retire
Age 65+, retired and no longer covered by a group health plan
Make sure you’re enrolled in Medicare Parts A and B; contact Social Security if unsure
Analyze options – Medicare Supplement or Medicare Advantage Plan. If you are not already enrolled, decide on a plan and enroll
Assess the need for Plan D
Analyze plan options online via
Presented by Albers & Company June 5, 2007

23. Resources: Medicare
Numerous resources available through the Medicare website or by contacting Medicare directly
Visit:
Click on: “Forms, Help and Resources” OR
Call: MEDICARE
( )
Presented by Albers & Company June 5, 2007

24. Senior Health Insurance & Assistance Program (SHIP)
Resources: SHIP
Senior Health Insurance & Assistance Program (SHIP)
Counselors provide assistance with Medicare, Supplemental Plans, Medicaid, Long Term Care coverage.
Free service available in every State
In Anne Arundel County, visit:
Presented by Albers & Company June 5, 2007

25. Additional Resources Medicare & You Handbook
Visit: select the “Forms, Help and Resources” tab, then click on the “Medicare and You” Handbook
Medicare Part D Options
In Maryland, visit:
See “Compare Drug and Health Plans” (click on “Find Health & Drug Plans” on left side of home page)
Presented by Albers & Company June 5, 2007

26. Additional Resources Medicare Helpline 1-800-MEDICARE (1-800-633-4227)
Social Security Administration
Senior Health Insurance & Assistance Program (SHIP)
Presented by Albers & Company June 5, 2007

27. Questions?