1. Medicare Getting Started SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service, sponsored by the Washington State Office of the Insurance Commissioner 7/24/2015

2. What is SHIBA? 2 Statewide Health Insurance Benefits Advisors  A free program of the Office of the Insurance Commissioner  We provide unbiased and confidential information about Medicare and other health insurance  We are an educational service  We don’t sell anything!

3. 3  Medicare basics: A, B, D or C  How and when to enroll  Medigaps – Medicare Supplement plans  Part D – prescription coverage  Do you need help paying for your plan?  Medicare Advantage plans  Next steps Today’s overview

4. Protect yourself! 4 As you research your options:  Keep a notebook  Write down the names of people you talk to, the date and their contact information  Note what was said in the conversation  Keep copies of any paperwork  Beware of fraud!

5. What is Medicare?  Health insurance for people: Age 65 and older Under age 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (also known as ALS) 5

6. What is Medicare?  It’s administered by: Centers for Medicare & Medicaid Services (CMS)  But enrollment is done by: Social Security Administration (SSA) for most Railroad Retirement Board (RRB) railroad retirees 6

7. The four parts of Medicare 7 Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans (Includes Parts A & B and sometimes Part D) Part D Medicare Prescription Drug Coverage OR

8. Original Medicare Has Part A – Hospital Insurance  Hospital (Inpatient)  Skilled Nursing Facility  Home health care  Hospice care Has Part B – Medical Insurance  Doctor’s visits  Outpatient hospital services  Clinical lab tests  Durable Medical Equipment  Preventive services 8

9. Medicare does not cover everything!  Routine eye exams, eyeglasses Only glasses after cataract surgery  Routine dental care Cleaning, fillings, crowns, bridges, dentures  Hearing aids  Most “alternative” medicine Acupuncture, Naturopathy  Long-term care Only skilled care in certain circumstances 9

10. Medicare Part A (Hospital Insurance)  What does Part A cost? Most people get Part A premium free You can pay a premium to get Part A It can cost $224 or $407/mo. depending on work credits 10

11. Medicare Part B (Medical insurance) 11  What does Part B cost? This year – for most – Part B costs: $104.90/month Those who have higher incomes will pay more  May have penalty

12. Paying for Part A&B services  See chart in handouts  In addition to Part B premiums and sometimes Part A premiums In Original Medicare you pay: o Part A Hospital deductible of $1,260 o Part B yearly deductible of $147 o 20% coinsurance for most services o THERE MAY BE OTHER COSTS!  Programs may help pay these costs For people with limited income and resources 12

13. How to enroll in Medicare  Enrollment is automatic for most If you get Social Security or RRB benefits  If enrollment is not automatic For instance, you’re still actively working You need to enroll with Social Security: o Visit local office o Call 1-800-772-1213 o Online at socialsecurity.gov  If retired from Railroad, enroll with RRB Call your local RRB office or 1 ‑ 877 ‑ 772 ‑ 5772 13

14. Medicare card 14 Jane Doe  Keep it and accept Medicare Parts A and B  Return it to refuse Part B Follow instructions on back of card Front Back

15. When can I enroll in Medicare? 3 months before the month you turn age 65 Medicare starts BD month 2 months before the month you turn age 65 Medicare starts BD month 1 month before the month you turn age 65 Medicare starts BD month Your birthday month Medicare starts next month 1 month after you turn age 65 Medicare starts in 2 months 2 months after you turn 65 Medicare starts in 3 months 3 months after you turn 65 Medicare starts in 3 months 15 The later you enroll, the later coverage starts:  Up to a 3-month wait

16. Medicare decisions 16 Maybe?  Original Medicare?  Should I keep/sign up for Part A?  Should I take Part B? When?  What about Part D?  Do I need a Medigap policy?  Do I want a Medicare Advantage Health plan?  Can I get help with Medicare costs?

17. 17 Decide how you want to get your Medicare coverage

18. Decision Should I keep/sign up for Part A?  Consider Get it automatically if getting Social Security/RRB Free for most people  If not free Can pay for it if not enough work quarters 18

19. Decision Should I keep/sign up for Part B? Consider Is there active work involved?  NO ACTIVE work to consider.  I’m ACTIVELY working and I’m covered by a health insurance plan from my current job.  I’m NOT ACTIVELY working, but my spouse is, and I’m covered under his/her health insurance through their current job. 19

20. Decision Should I keep/sign up for Part B?  If you don’t have coverage from active employment Yours or your spouses Delaying Part B may mean: o Higher premiums o Paying for your health care out-of-pocket  If you do have coverage through active employment You may want to delay Part B No penalty if you enroll while you have coverage or within 8 months of losing coverage 20

21. Decision Should I keep/sign up for Part B?  Sometimes you must have Part B If you want to buy a Medigap policy If you want to join a Medicare Advantage Plan If you're eligible for TRICARE If your employer coverage requires you have it o Talk to your employer’s benefits administrator o Talk to SSA or SHIBA if questions 21

22. Medigaps Also called Medicare Supplement insurance

23. What is a Medigap policy?  Medicare Supplement insurance policies Sold by private companies  Fill the gaps in Original Medicare Deductibles, coinsurance, copayments  Standardized plans  All plans with same letter Have same coverage Only the costs are different 23

24. Decision Do I need a Medigap policy?  Consider It only works with Original Medicare Do you have other supplemental coverage, such as a retiree plan? o You might not need Medigap Can you afford Medicare deductibles and copayments? What does the monthly Medigap premium cost? 24

25. Decision When is the best time to buy Medigap?  Consider: Your Medigap Open Enrollment Period starts when you're age 65 or older AND enrolled in Part B o Lasts 6 months o You have protections – plans MUST sell you a plan You can buy a Medigap policy whenever a company agrees to sell you one 25 Usually during your Medigap Open Enrollment Period AKA “Guaranteed Issue”

26. Decision Which Medigap policy do I buy?  Consider The coverage under each standardized plan The cost of each plan – be sure to shop Your individual health care needs 26

27. Medigap Benefits Medigap Plans ABCDF*GK**L**MN Part A Coinsurance Up to 365 Days Part B Coinsurance 50%75% Blood 50%75% Hospice Care Coinsurance Skilled Nursing Coinsurance 50%75% Part A Deductible 50%75%50% Part B Deductible Part B Excess Charges Foreign Travel Emergency (Up to Plan Limits) 80% 27 *Plan F has a high-deductible option ** Plans K and L have out-of-pocket limits of $4,940 and $2,470 respectively Source: Page 93 of Medicare & You 2015

28. Decision How do I find the right Medigap policy for me?  By computer or phone Call SHIBA 1-800-562-6900 Insurance.wa.gov Call 1.800.MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048 28

29. 29 Medicare prescription drug plans Medicare Part D

30. Part D – Medicare prescription drug coverage  Available for all people with Medicare  Provided through: Medicare prescription drug plans Medicare Advantage plans Other Medicare plans 30

31. How Medicare Part D works  It’s optional You can choose a plan and join  Plans have formularies Lists of covered drugs Must include range of drugs in each category  You pay the plan a monthly premium  You pay deductibles and copayments  There’s Extra Help to pay Part D costs If you have limited income and resources 31

32. Who can join Part D?  You must have Part A and/or Part B  You can’t live outside the U.S.  You must actively enroll to join In most cases no automatic enrollment 32

33. Decision Should I enroll in a Part D plan?  Consider Do you have creditable drug coverage? o Coverage as good as Medicare’s o For example through an employer plan Will that coverage end when you retire? How much do your current drugs cost? What do the premiums cost for Part D plans?  Without creditable coverage Later enrollment may mean you pay a penalty 33

34. Joining a Part D plan  You can join: During your 7 month Initial Enrollment Period During the Open Enrollment Period o October 15 – December 7 o Coverage starts January 1 During other special times o Special Enrollment Period 34

35. How do I choose a Part D plan?  Call or by computer Call SHIBA for help comparing plans Medicare Plan Finder at: www.medicare.gov/find-a-plan  To join a Part D plan Enroll on www.medicare.govwww.medicare.gov Complete a paper enrollment form Call the plan Enroll on the plan’s website Call 1-800-MEDICARE (1-800-633-4227) 35

36. 36 Medicare Advantage plans Medicare Part C Also called “Medicare Health plans”

37. Part C – Medicare Advantage  Run by private companies  Another way to get Medicare coverage  Still part of the Medicare program  Member may have a monthly premium  Medicare pays amount for each member’s care  May have to use network doctors or hospitals 37

38. How Medicare Advantage works  Still in Medicare with all rights and protections  Still get Part A and Part B services  May include prescription drug coverage  May include extra benefits Like vision, dental, hearing & gym membership  Benefits and cost-sharing may be different per plan 38

39. Decision Do I want to join a Medicare Advantage plan?  Consider Most offer comprehensive coverage o Including Part D drug coverage May require you to use a network You must pay Part B and monthly plan premium May need a referral to see a specialist Can only join/leave plan during certain periods Doesn’t work with Medigap policies You must have Part A and Part B to join You must live in the county where the plan is sold You can’t buy it if you have End Stage Renal Disease 39

40. When can I enroll in an MA plan?  During 7-month Initial Enrollment Period  During the Open Enrollment Period October 15 – December 7 each year Coverage starts January 1  May be able to join at other times Special Enrollment Period  Contact the plan or Medicare to join Call their number Visit their website Plan information on www.medicare.gov 40

41. 41 Paying for Medicare

42. What do I pay?  Costs vary and change yearly In Original Medicare o Does the provider accept Medicare Assignment? In Medicare Advantage o Check with plan In Medicare prescription drug plans o Check with plan 42

43. What help is there for people with limited income and resources?  Medicaid For people with the lowest incomes, eligible people pay little or nothing for their health care costs  Medicare Savings Programs Helps pay Part B premiums and sometimes Part A and Part B deductibles and co-insurance  Extra Help Helps pay Part D costs 43

44. What is Medicaid?  Federal-state health insurance program For people with limited income/resources Certain people with disabilities If you have both Medicare and Medicaid, covers most health care costs  Eligibility determined by state  In Washington: DSHS  Apply if you MIGHT qualify 44

45. What are Medicare Savings Programs (MSPs)?  Help from Medicaid to pay Medicare costs Pay Medicare premiums May pay Medicare deductibles and coinsurance  Income amounts change each year 45

46. Who can qualify for MSP? 46 Individual Monthly Income Limit Married Couple Monthly Income Limit Helps Pay Your Medicare Savings Program $1, 324$1,792 Part B premiums, and sometimes Part A premiums, Medicare A & B deductibles and co- insurance Asset Limits:Individual $ 7,280 Couple $10,930

47. What is Extra Help (Low Income Subsidy)?  Help paying prescription drug costs  Social Security makes determination  Some groups automatically qualify Example: If they qualify for Medicare and Medicaid  You or someone on your behalf can apply 47

48. Who can qualify for Extra Help? 48 Individual Monthly Income Limit Married Couple Monthly Income Limit Helps Pay Your Extra Help $1,471$1,991 Part D Premium, Deductibles and Co-pays Asset Limits: Individual $13,640 Couple$27,250

49. Decision Should I apply for these programs?  Apply if you MIGHT qualify  Social Security for Extra Help  DSHS for Medicaid or Medicare Savings Programs  SHIBA can help you 49

50. Key points to remember  Medicare is a health insurance program  It does not cover all of your health care costs or types of care You may want to find additional coverage Or plan to pay out of pocket  Some plans change each year You may need to review coverage during Open Enrollment in the fall 50

51.  There are programs for people with limited income and resources: Medicaid Medicare Savings Programs Extra Help  Important: Make the right decisions Make them at the right times Get help if you need it 51 Key points to remember

52. For more information  SHIBA: 1-800-562-6900  1-800-MEDICARE  www.medicare.gov  Medicare & You Handbook  www.socialsecurity.gov  www.washingtonconnection.org 52

53. 53 Medicare and mental health benefits

54. 54 What Medicare covers Medicare Part A (hospital insurance) helps cover mental health care if you’re a hospital inpatient:  Room  Meals  Nursing care  Other related services and supplies

55. 55 What Medicare covers Medicare Part B (medical insurance) helps cover mental health services you get from a doctor and other services you get outside of a hospital, such as:  Visits with a psychiatrist or other doctor  Visits with a clinical psychologist or clinical social worker  Lab tests ordered by your doctor  May pay for partial hospitalization if you need intensive coordinated outpatient care

56. 56 What Medicare covers Medicare Part D (prescription drug coverage) helps cover  Drugs you may need to treat a mental health condition If you take Rx drugs for a mental health condition, it’s important to find out whether a plan covers your drugs before you enroll. Go to: medicare.gov/find-a-plan to find out which plans cover your drugs.

57. 57 What Medicare does not cover Medicare Part A  Private duty nursing  Phone or TV in your room  Personal items (i.e., socks, razors, etc.  Private room Medicare Part B  Meals  Transportation to and from mental health services  Support groups  Testing/training for job skills that aren’t part of your mental health treatment

58. 58 Medicare and the Affordable Care Act (ACA)

59. 59 How the ACA impacts Medicare  Does not cut Medicare benefits  Does not eliminate Medicare Advantage plans  Does not require people with Medicare to get more or different insurance  Does improve Medicare benefits  Does reduce Medicare costs

60. 60 ACA Medicare benefits already in place  Increased preventive benefits  Many with no copay or deductibles  Discounts in the Part D Donut Hole Brand-name discount now & increasing each year Phasing it out by 2020

61. 61 Key ACA Medicare provisions to control costs  Restructures payments to Medicare Advantage plans to bring costs more in line with Original Medicare plans  Reduces Medicare payments to hospitals with: Too many patient readmissions A high rate of patients who acquire infections while hospitalized  Requires competitive bidding for Durable Medical Equipment  New authority and resources to target waste, fraud and abuse

62. 62 Medicare & the insurance exchange  Medicare-eligible people cannot use the Washington Healthplanfinder.  SHIBA will continue to help Medicare-eligible people with their questions about health benefits under Medicare Parts A, B, D and C.

63. Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Call our Insurance Consumer Hotline 1-800-562-6900 63 Homeowner Auto Life Annuities Health And more!

64. Help your community!  Did some of this make sense to you?  Want to learn more?  Want to make a difference for others?  We would love to have you volunteer with SHIBA! 64

65. More questions?  Please complete and return evaluation form  Let us know if you want us to contact you to: Discuss your personal situation Learn more about becoming a volunteer THANK YOU!! 65