1. Medicare Unraveled: What your Employees Need to Know [presentation location] [presentation date] [Insert Regional Office and Phone Number Here]

2. Topics What is Medicare? When should an employee enroll? How does other coverage work with Medicare? Who can help? [Insert Regional Office and Phone Number Here]

3. What is Medicare? Established in 1965, a federal health insurance program –Enroll through SSA –Managed by CMS Who can get Medicare? –People 65 years of age and older –People under 65 with certain disabilities –People with ESRD and other specific diseases [Insert Regional Office and Phone Number Here]

4. Components of Medicare Part A –Inpatient hospital coverage Part B –Outpatient coverage (including doctors’ services, labs, tests, etc.) Part C (Medicare Advantage) –Combines all benefits into a single plan –Similar to an HMO or PPO Part D –Prescription drug coverage [Insert Regional Office and Phone Number Here]

5. For Comprehensive Coverage Medicare has premiums, deductibles, and co- payments To offset these costs, beneficiaries may purchase additional coverage –Retiree coverage –Medigap policies –Medicare Advantage Plans (Part C) –Veterans’ benefits or TRICARE [Insert Regional Office and Phone Number Here]

6. When Should an Employee Enroll? First opportunity approaching 65 th birthday: Birthday July 4 Enrollment Period JanFebMarAprilMayJuneJulyAugSeptOctNovDec If you join during:Three months beforeMonth ofThree months after Medicare starts:July 1Aug 1Oct 1Dec 1Jan 1 [Insert Regional Office and Phone Number Here]

7. What Parts Should an Employee Choose? 65 years old; continuing to work covered by EGHP (through self or spouse) –Part A –Can defer Parts B & D Does not apply to same-sex marriages 65 years or older and retiring –Parts A, B, & D –May have retiree coverage –May purchase additional coverage [Insert Regional Office and Phone Number Here]

8. What if Part B was Deferred? If deferred Part B due to coverage through active employment –8-month enrollment period –Begins at separation or loss of EGHP coverage (whichever is first) –Enrollment beyond 8-month period may result in a lifetime late enrollment penalty and a waiting period for coverage to begin [Insert Regional Office and Phone Number Here]

9. What if Part D was Deferred? If deferred Part D due to creditable coverage –2-month enrollment period Begins after loss of creditable coverage –Beneficiary must provide proof of creditable coverage (provided by employer/EGHP) –Enrollment beyond 2 month period may result in lifetime late enrollment penalty and a waiting period for coverage to begin [Insert Regional Office and Phone Number Here]

10. When Should an Employee NOT Defer? COBRA –Not coverage through active employment Medical Security Program –Health coverage through Department of Unemployment Assistance Active employment coverage through same-sex spouse –Federal programs cannot recognize same-sex marriages [Insert Regional Office and Phone Number Here]

11. How does Medicare work with other coverage? If youSituationPays firstPays second Are 65 or older and covered by a group health plan because you or your spouse is still working Entitled to Medicare Group health planMedicare The employer has 20+ employees The employer has less than 20 employees MedicareGroup health plan Have an employer group health plan after you retire and are 65 or older Entitled to MedicareMedicareRetiree coverage Are disabled and covered by a large group health plan from your work, or from a family member who is working Entitled to Medicare Large group health planMedicare The employer has 100+ employees The employer has less than 100 employees MedicareGroup health plan Are 65 or over OR disabled and covered by Medicare and COBRA Entitled to MedicareMedicareCOBRA Are covered under workers’ compensation because of a job-related illness or injury Entitled to Medicare Workers’ compensation for services related to workers’ compensation claim Usually doesn’t apply. However, Medicare may make a conditional payment. [Insert Regional Office and Phone Number Here]

12. Medicare and HSAs An individual who is entitled to Medicare is no longer able to contribute to a Health Savings Account (HSA) Even if beneficiary only enrolls in Part A and defers Part B If a Medicare beneficiary has an HSA, he/she can still use existing funds in the account –Funds can even be used to pay Medicare premiums, deductibles, or co-payments [Insert Regional Office and Phone Number Here]

13. Who Can Help? Medicare –1-800-MEDICARE –www.medicare.gov Social Security –1-800-772-1213 –www.ssa.gov For questions related to Medicare benefits For questions related to eligibility and Parts A & B enrollment [Insert Regional Office and Phone Number Here]

14. SHINE Funded by Medicare, administered by Massachusetts Executive Office of Elder Affairs in partnership with local agencies 13 Regional Offices and one statewide (Greater Boston Chinese Golden Age Center) 600 certified counselors in almost every city or town in Massachusetts 1-800-AGE-INFO, press 3 (1-800-243-4636) [Insert Regional Office and Phone Number Here]

15. What does a SHINE Counselor Do? Provides free, and unbiased health insurance counseling to Medicare beneficiaries of all ages and their caregivers –At a local site, on the phone, or via email –Home visits are available for homebound clients Assists clients in finding coverage that meets their needs Answers questions regarding Medicare eligibility, enrollment periods, and benefits Assists with Medicare appeals and billing issues Screens for public assistance programs [Insert Regional Office and Phone Number Here]