Most Businesses Couldn’t Pass a DOL Audit – Could Yours? Presenter October 29, Education Series Julia Jennings, RHU, LIA Sylvia Group Vice President, Paradigm Employee Benefits Medicare Enrollment for Individuals: Just What the Doctor Ordered

October 29, 2015 CREDIT: mainemedicareoptions.com

Medicare Basics Medicare is health insurance for people who are: age 65 or older. under age 65, after having received SSDI for 24 months (or immediately if receiving SSDI due to ALS). any age if diagnosed with end-stage renal disease (ESRD). Medicare is administered by the Centers for Medicare and Medicaid Services (CMS) and enrolled through the Social Security Administration (SSA) or Railroad Retirement Board. October 29, 2015

Medicare Enrollment Initial Enrollment Period is 3 months before your 65 th birthday, the month in which you turn 65, and the 3 months after you turn 65. If you are covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A/B anytime, as long as you or your spouse are working and covered by a group health plan based on that work. You also have an 8-month Special Enrollment Period that starts the month after employment ends or the group health plan ends, whichever happens first. Note: COBRA is not considered current coverage. There is a General Enrollment Period if you do not sign up during the Initial or Special Enrollment period, from January 1-March 31 each year, with coverage commencing on July 1. You may be charged a higher premium if you are a late enrollee to Medicare. October 29, 2015

Medicare Enrollment October 29, 2015

Medicare Part A Hospital Insurance Automatic Enrollment and free for most Covers inpatient hospital stays, skilled nursing facility care, hospice and some home health care Deductibles (2016) $1,260 for hospital stay of 1-60 days per benefit period $315 per day for days of hospital stay per benefit period $630 per day for each “lifetime reserve day” to 60-day maximum All costs for each day beyond lifetime reserve days $ per day co-insurance for days of skilled nursing care in a facility – all costs beyond 100 days October 29, 2015

Medicare Part B Outpatient Medical Insurance You must enroll in Part B insurance and pay a premium* –individuals with higher earnings will pay a higher premium Covers an initial “Welcome to Medicare” wellness visit and annual wellness check-ups with your doctor, and certain preventive tests and treatments in full Deductible for 2016 is $147*; then the plan covers 80% for medically necessary outpatient services including doctor visits, diagnostic tests, physical therapy, etc. Does not cover items such as dental care, routine eye exams, and hearing aids October 29, 2015 * New Medicare beneficiaries will pay a higher premium and have a higher Part B deductible in 2016 unless Congress passes legislation to maintain the current amounts.

Breaking News!!! October 29, 2015.

Medicare Supplemental Insurance Medigap Supplemental insurance provided by private insurers to fill the “gaps” in your Medicare Part A and Part B coverage. There is no HMO/PPO network. Any Medicare provider is eligible. Covers your Part A and Part B deductibles, copayments and coinsurance for hospitalization and outpatient services. Plans do not include outpatient prescription drug coverage. You must purchase your Part D coverage separately. Massachusetts only allows two supplemental plans – CORE and Supplemental 1. (Other states have more choice in supplemental plans.) October 29, 2015

Medicare Part C Medicare Advantage Replaces “Original Medicare” and is a managed health care program (either HMO or PPO type). Care is managed and claims are processed by private companies who receive compensation from the federal government. Although you “trade in” your Part A & B coverage, you still must enroll and pay for Part B. For some plans, “zero premium” means you pay only the Part B premium and no additional cost. Can include Part D prescription drug coverage as part of the plan (MAPD). No deductibles as seen in Original Medicare, but there are typically copayments for doctor visits, hospital stays, etc. Also covers more routine care as part of managed care emphasis Special enrollment/disenrollment rules apply. October 29, 2015

Medicare Part D October 29, 2015

Medicare Part D Prescription Drug Coverage Insurance for your prescription drugs. Can be a ‘standalone’ plan, or may be part of a Medicare Advantage Plan (MAPD). Though mandated by federal law, there is no federal Part D plan as we have with Parts A and B. Some plans have an initial deductible requiring you pay 100% of your prescription costs till the deductible is met. Maximum allowable deductible in 2016 is $360. Each plan has a list of eligible prescription drugs or formularies that can differ from one plan to another. Formulary determines what copayment, restrictions and pre-authorizations are required. Individuals with higher earnings pay an additional premium directly to Medicare for their prescription coverage. October 29, 2015

Medicare Part D October 29, 2015 CREDIT:

Medicare Doesn’t Cover… October 29, 2015

Open Enrollment for 2016 Period is from October 15 to December 7, Changes in Enrollment will be effective January 1, You do not need to enroll annually if you are not making changes to your Medicare coverage. However, this is a good time to review your options, especially if your medical providers or health status has changed If you are in a Medicare Advantage plan, are you spending time outside of the provider network (e.g. snowbirds)? You can search for Medicare supplemental plans, Medicare Advantage and Part D plans on the government website Sylvia Group is your partner in selecting Medicare coverage for yourself, your family members, your employer group and your employees. October 29, 2015

Thank you for attending our webinar. This presentation will be available shortly on our agency web site, Follow-up questions or assistance with your Medicare enrollment can be directed to me at Please note, our upcoming Medicare webinar for employers will take place on November 4 at 10 a.m. Register online: October 29, 2015 Julie Jennings

Employer Health Plan Coverage Generally, an employer health plan will be considered primary coverage for active employees and their dependents who are over age 65. This is referred to as Medicare Secondary Payer under federal law. Medicare will be secondary to the group health plan (GHP) for employers with 20 or more employees for 20 or more calendar weeks in the current or prior calendar year. Medicare also will be secondary to the GHP for 65 disabled individuals under age 65 if the employer has 100 or more employees. October 29, 2015

Medicare Primary/Secondary Rules October 29, 2015

Employer Disclosure Requirements Employers must notify the CMS of their Part D Medicare status each year, within 60 days of their plan anniversary dateor within 60 days of any change in their Part D creditable coverage. The form can be found online: Employers must notify their Medicare-eligible health plan members (both active and retired) of the Part D creditable status annually prior October 15, before a Medicare eligible individual enrolls in the employer’s plan and when the plan’s prescription coverage ends or creditable status changes, as well as upon individual member request. For standard notice requirements and wording see: October 29, 2015

Annual Disclosure to CMS October 29, 2015

We’ve come a long way since 1965! October 29, 2015