Medicare and You John Williams SHIP Medicare Specialist 1

What’s Medicare When It Is Available Federal health insurance available at Age 65 and older Under age 65 after 24 months of SS or RR disability benefit entitlement Under age 65 and entitled to SS or RR disability benefits due to ALS Any age with ESRD Administered by Centers for Medicare & Medicaid Services (CMS) Isn't the same as Medicaid

A-B-C-D Medicare has four parts Part A – Hospital Insurance Part B – Medical Insurance Part C – Medicare Advantage Plans Part D – Prescription Drug Coverage

Medicare Options Original Medicare only (Parts A & B) Original Medicare plus supplemental coverage - from former employer/union, Tricare for Life, for example Original Medicare plus a Medigap plan Original Medicare plus a Part D prescription drug plan Medicare Advantage plan (Part C) with or without drug coverage

Original Medicare Go to any provider that accepts Medicare Members pay Part A premium - free for most people Part B premium- amount generally changes annually IRMAA Part B & D premium increases for people with high income Deductibles - amounts generally change annually Coinsurance or copayments Program are available to help pay members' costs

Initial Enrollment Period Apply 3 months before age 65 if you want Medicare at age 65 Do not need to be retired Benefits through employer/union - active employment plans Might not want to enroll in any or all parts of Medicare while working Auto Enrollment in Parts A and B If you already receive SS or RR benefits Can refuse Part B

Part B - Other Enrollment Periods General Enrollment Period January 1 through March 31 each year Coverage effective July 1 Premium increases 10% for each 12-month period you were eligible but did not enroll Special Enrollment Period Sign up within 8 months of the end of employer or union health plan coverage

Medigap Policies Health insurance policies Sold by private insurance companies, plans are A through N Follow federal and state protection laws in every state Policies must say “Medicare Supplement Insurance” Cover “gaps” in Original Medicare Costs may vary by state, must purchase a plan where you live

Medigap – How It Works Only works with Original Medicare Can go to any doctor, hospital, or provider that accepts Medicare Members pay a monthly premium All Medigap plans must be approved by the IDOI A list of all Medigap plans is located on the SHIP website (or via packet in the mail) IDOI Medigap premium comparison tool at www.idoi.in.gov/medigap

Medigap Plans - Enrollment Guaranteed Issue Period - age 65 or older and Part B just starting - no medical underwriting for first 6 months Other times when you need coverage - with medical underwriting Special Enrollment Periods - losing retiree coverage that pays secondary to Medicare - no medical underwriting

Advantage Plans - Overview Health plan options approved by Medicare Medicare benefits delivered through private companies approved by Medicare Still in Medicare program Still have Medicare rights and protections Still get regular Medicare-covered services May get extra benefits Such as vision, hearing, or dental care May be able to get prescription drug coverage (Part D) Different Advantage Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs Plan (SNP)

Advantage Plans – How They Work You may have to stay in a certain network of hospitals and providers Co-pays and deductible are different than Original Medicare

Advantage Plans – Join or Switch Plans When first eligible for Medicare 7 months beginning 3 months before first month of Medicare eligibility Annual Election Period October 15th – December 7th each year Coverage starts January first of next year Annual Disenrollment Period January 1st – February 14th every year (coverage begins the first of the month after you switch) May also join a Medicare Part D plan during change

Part D Prescription Drug Coverage Private plans available for all people with Medicare Approved by Medicare Requirements: Have Medicare Part A or Part B, or both Live in plan service area Programs are available to help pay members' costs Medicare Prescription Drug Plans Medicare Advantage Plans

Part D Costs Costs vary by plan, most people will pay: Monthly premium - varies by plan Annual deductible - varies by plan and generally changes annually Initial coverage phase - members pays 25% of drug costs Coverage gap (donut hole) - copays increase but drug costs are discounted - discounts increases annually until 2019 when coverage gap disappears Catastrophic coverage - member pays 5% of drug costs Programs available to help pay Part D costs

Part D - Enrollment and Making Changes When first eligible for Medicare 7 months beginning 3 months before first month of Medicare eligibility During specific enrollment periods Annual Election Period. -. October 15th - December 7th each year Coverage starts January first of next yeay Special Enrollment Periods - move out of plan service area; lose creditable drug coverage; enter/reside in/leave a Long Term Care facility; eligible for Extra Help Some people are enrolled automatically

Review If You Are Eligible for Medicare Decide if you want only Original Medicare; Original Medicare plus a Medigap Plan; or a Medicare Advantage Plan Decide on a Prescription Drug Plan - Part D Investigate policies and insurance companies Choose a reasonable number of the plans and contact insurance companies, brokers or independent agents for personal quotes. Select coverage and enroll in plan(s) Review your coverage every Fall during AEP and make needed enrollment changes

For More Information 1-800-MEDICARE (1-800-633-4227) Medicare publications online www.medicare.gov www.cms.hhs.gov www.socialsecurity.gov SHIP telephone: 1-800-452-4800 SHIP: www.medicare.in.gov SHIP counselors