1. Medicare and You John Williams SHIP Medicare Specialist1

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. For More Information 1-800-MEDICARE (1-800-633-4227)
Medicare publications online
SHIP telephone:
SHIP:
SHIP counselors