Who Qualifies for Medicare? Citizen or U.S. resident and – Age 65 and older, or Under age 65 and disabled*, or Living with end-stage renal disease (ESRD) *Permanently disabled for 24 months or longer.
Initial Enrollment Period (IEP): 3 months before, the month of, and 3 months after your 65 th birth month Annual Enrollment Period (AEP): October 15–December 7 Medicare Advantage Disenrollment Period (MADP): January 1–February 14 Special Election Period (SEP): Example: Loss of employer coverage or moving to new service area Medicare Election Periods
Late Enrollment Penalties Part B Penalty: If you don’t enroll in Part B when you are first eligible, you may have to pay a penalty to get it later. The penalty is an additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Part D Penalty: If you sign up for Medicare Part D after your Initial Enrollment Period, you may be required to pay an additional 1% of the average monthly premium each month, for as long as you are enrolled in a Part D plan.
Part A & Part B Know Your A, B, Cs and D Original Medicare
Know Your A, B, Cs and D Part A does not cover: Physician services or diagnostic tests in the hospital Personal care items Private rooms Custodial care Part A is free for most people There is a $1,260 Part A deductible per benefit period After 60 days in the hospital, you pay: $315 per day copay for 61-90 days $630 per day copay for 91-150 days After day 150, you pay all hospital costs Part A covers: Inpatient hospital care Skilled Nursing Facilities (SNFs) Home health care Hospice care Part A - Hospital Insurance
Part B - Medical Insurance Part B is optional coverage There is a $104.90 standard per month premium There is a $147 annual deductible Original Medicare covers 80% of most Part B costs, leaving you to pay the other 20% for services, like: Most physician services Home health care Outpatient therapies Durable medical equipment Delaying retirement at age 65? You can decline Part B No penalty if you enroll within 8 months of retirement and have a creditable drug coverage plan Know Your A, B, Cs and D
Know Your A, B, Cs and D Part C - Medicare Advantage Plans Medicare Advantage Plans are offered by private companies Cover some of the costs not covered by Medicare Often include extras like fitness and wellness programs Many also offer Part D prescription drug coverage Types of Medicare Advantage Plans: Health Maintenance Organization (HMO) HMOs typically require you to access care from network providers and hospitals, except for an emergency HMO with Point of Service (HMO-POS) Like an HMO, you select a primary care provider from the plan’s network, but you have the ability to see doctors outside the network, usually at a higher cost Preferred Provider Organization (PPO) PPO plans allow you to access care from in and out of network providers, usually for a higher cost Special Needs Plans (SNP) SNPs are for people with chronic illnesses, older adults with limited incomes, and those living in nursing homes.
Voluntary program Run by private companies You pay a monthly premium You pay a portion of the drug cost Plan designs must be equal to or better than standard Medicare benefit designed by CMS Coverage varies from plan to plan Part D - Prescription Drug Coverage Know Your A, B, Cs and D Part D Coverage Options: Medicare Part D Plans Stand-alone Prescription Drug Plans (PDP) Medicare Advantage Prescription Drug Plans (MAPD) Employer Group Plans Plans must be creditable to avoid Part D penalties Military Plan Coverage Provides creditable coverage You may have both the VA and Part D coverage* *VA and Part D benefits not coordinated
4 32 1 $320 $2,960 $4,700 5% COPAY 1 Deductible YOU PLAN 100% 0% 2 Initial CoverageYOU PLAN 3 Coverage GapYOU YOU 4 Catastrophic YOU PLAN 25% 75% 45% 65% 5% 95% YOU pay $2.65/Generic and $6.60/Brand or 5% BRANDGENERIC How Medicare Part D Phases Work Annually This is an example of how Medicare Part D works and is not intended to portray a specific plan. In some instances, these costs will be approximate amounts.
Low Income Subsidy (LIS) is available from the government if you meet certain requirements. Those that qualify may get help paying monthly premiums, copays, coinsurance, and deductibles.* Do you qualify? You don’t know unless you apply. *Premiums, copayments, coinsurance, and deductibles may differ depending upon the level of help for which beneficiaries may qualify. Part D Extra Help
Your Medicare Coverage Options START with Original Medicare DECIDE if you want more coverage Part A (hospital insurance) + Part B (medical insurance) Medicare Advantage Plan Combines Parts A&B Many cover prescription drugs and may include extra benefits Your monthly plan premium could be as low as $0* Medicare Part D Prescription Drug Plan Medicare Supplement Insurance Plan Option 1 Option 2 and / or
Medicare Advantage Eligibility You Must: Have Medicare Parts A & B Continue to pay Part B premium Not have ESRD in most cases Live in plan service area Have a valid election period
Premera is proud to present our 2015 Medicare Advantage Products Premera Blue Cross Medicare Advantage (HMO) Premera Blue Cross Medicare Advantage Plus (HMO) Premera Blue Cross Medicare Advantage (HMO-POS) Premera Blue Cross Medicare Advantage Plus (HMO-POS)
Important Plan Information Premera Blue Cross is an HMO and HMO-POS plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy networks, provider networks, premium, and/or copayments/coinsurance may change on January 1 of each year. You may also refer to the Summary of Benefits or Evidence of Coverage (EOC) for more information. Premera Blue Cross is too new to be rated with a Medicare Star rating. Premera Blue Cross is an Independent Licensee of the Blue Cross and Blue Shield Association. H7245_PBC0357_Approved030426 (02-2015)