2. Welcome to Medicare: A,B,C and D Rhonda Whitenack, Public Affairs Specialist, Social Security Administration Robert Grams, Health Insurance Counselor Metropolitan Area Agency on Aging and MN SHIP

3. What is Medicare? Health Insurance Program for: –People age 65 and older –People under 65 with a certified disability –People of any age with End-Stage Renal Disease (ESRD) Permanent kidney failure or kidney transplant –People of any age with ALS (Lou Gehrig’s Disease)

4. Medicare Parts A thru D Part A: Hospital Insurance Part B: Medical Insurance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Part C: Medicare Advantage –Option that replaces Original Medicare (Parts A and B) Part D: Prescription Drug Coverage –Through a Medicare Advantage plan or a Stand Alone Prescription Drug Plan (PDP )

5. Medicare Card (Front)

6. Medicare Card (Back)

7. Medicare Eligibility Age 65 and Older May receive Part A premium-free if: –Worked 40+ quarters (at least 10 years) –Spouse of someone with 40 work quarters May purchase Medicare: –U.S. citizens who have not worked 40 quarters –Legal aliens admitted for permanent residence who have lived in the U.S. for 5+ consecutive years –Also known as “voluntary enrollees”

8. Other types of Medicare Eligibility Person under 65 who has received 24+ months of Social Security Disability benefits Person of any age with End Stage Renal Disease who has had a kidney transplant or who receives regular dialysis Person of any age with ALS (Lou Gehrig’s Disease)

9. Types of Medicare Enrollment Initial Enrollment Special Enrollment General Enrollment

10. Initial Enrollment Period 7 Month Period –3 months before you are eligible –The month you are eligible The month you turn 65 OR The 25 th month you are certified disabled –3 months after you are eligible

11. How do I enroll? If you already receive Social Security or RR Benefits : –Entitled to Medicare the first of the month you turn 65 –Do not need to do anything to enroll A card will be mailed three months before you turn 65 If you are not receiving Social Security or RR Benefits: –Apply online or visit your local Social Security Office

12. When to Waive Part B You can delay enrolling into Part B and avoid paying the monthly premium until you need it if you are age 65 or older and have health coverage through your or your spouse’s employer or union –Must contact Social Security and inform of your decision –Have a clear understanding of employer’s plan coverage before making this decision –Must be actively employed

13. Special Enrollment Period for Part B Can enroll in Part B anytime while covered under the group plan OR During the 8 month period that begins the month active employment ends or when the group health coverage ends, whichever comes first

14. General Enrollment Period January 1 st through March 31 st of every year Coverage will begin the following July 1 st Part A Penalty: 10% for voluntary enrollee who does not elect Part A during initial or Special Enrollment Period Part B Penalty: 10% of the Part B premium charged for every 12 months one was late enrolling

15. Medicare Part A In-patient hospital care Skilled nursing facility (SNF) care Home health care Hospice Care

16. Medicare Part A Premium Most receive Part A premium-free because they have at least 40 quarters or work credits of Medicare- covered employment Voluntary enrollees pay: –$248/month if have 30 – 39 quarters of employment –$450/month if have less than 30 quarters of employment –2012 cost sharing to be announced

17. Medicare Part A Cost of Coverage Hospital Coverage –Deductible for days 1 – 60: $1,132 –Days 61 – 90: $283 co-payment per day –Days 90 – 150: $566 co-payment per day Skilled Nursing Facility Coverage –No costs for days 1 – 20 –Days 21 – 100: $141.50 per day Home Health Care Coverage and Hospice Coverage –No cost for covered services (2012 cost sharing to be announced)

18. Medicare Part B Physician Services Outpatient Services Ambulance Services Durable Medical Equipment (DME)

19. Medicare Part B Cost Sharing Premium: $115.40 –Those on Medicare before 2010 who had their premium deducted from the Social Security check continue to pay $96.50, unless income is greater than $85,000. 2010 enrollees continue to pay $110.50 unless income is greater than $85,000. Deductible: $162 Co-insurance: 20% for most services –45% for mental health services (2012 cost sharing to be announced)

20. Medicare Part B Premium Income ThresholdPart B Individual Monthly Premium Less than or equal to $85,000 ($170,000 couples) and did have Social Security withhold Medicare Part B premiums in 2010 $96.50 Less than or equal to $85,000 ($170,000 couples) and did not have Social Security withhold Medicare Part B premiums in 20 $115.40 Greater than $85,000 and less than or equal to $107,000 ($170,000 to $214,000 couples) $161.50 Greater than $107,000 and less than or equal to $160,000 ($214,000 to $320,000 couples) $230.70 Greater than $160,000 and less than or equal to $214,000 ($320,000 to $428,000 couples) $299.90 Greater than $214,000 ($428,000 couples)$369.10

21. Medicare Covered Preventative Services NEW Annual Medicare Wellness Visit Welcome to Medicare physical Bone Mass Measurements Cardiovascular Screening Colorectal Cancer Screening Diabetes Screening Immunizations: Flu, Hepatitis B, Pneumococcal Mammograms Pap Test and Pelvic Exam Prostate Cancer Screening

22. Medicare Covered Items and Services Listing limited to frequently asked about items and services Ambulance Services –when medically necessary Diabetic Supplies –glucose testing monitors, test strips, etc. Durable Medical Equipment –walkers, wheelchairs, oxygen Emergency Room Services Eyeglasses –After special cataract surgery

23. Medicare Covered Items and Services Listing limited to frequently asked about items and services cont. Foot Exams/Treatment –If diabetes related & meet certain conditions Kidney Dialysis Services Prescription Drugs –A limited number of drugs are covered under Part B Prosthetic/Orthotic Items Second Surgical Opinions Tests –X-rays, MRIs, CT Scans, EKGs

24. Services Not Covered by Medicare Dental Care and Dentures Health care outside the U.S. Hearing Aids and Hearing Exams Orthopedic Shoes Routine foot care, eye care and physical exams Long-term Care Shots – except those for prevention

25. Medicare Summary Notice (MSN) In Original Medicare, an MSN is issued every 3 months if Part A or Part B services were provided It is not a bill Shows the amount that will be owed to the provider after Medicare has paid –“You may be billed” field Includes instructions on how to file an appeal

26. Medicare Summary Notice and Medicare Fraud Review MSN when received for: –Procedure/services provided –Amount you may owe the provider –Provider name –Dates of Service You may appeal discrepancies within 120 days If you feel you have been a victim of fraud and intentionally billed incorrectly: –Call the provider to discuss issue –Call the Senior LinkAge Line® to file a report

27. Original Medicare Medicare Part A and B –Fee-for-service plan managed by Federal Government –Use your red, white and blue card when receiving services –Can go to any doctor or hospital that accepts Medicare –Must pay deductibles and co-insurance or co-payment amounts

28. Medigap Insurance Supplements Original Medicare Must have Parts A and B to buy a Medigap policy Sold by private insurance companies Minimum benefit levels are mandated by Minnesota law Covers costs or “gaps in coverage” that Medicare does not pay Must pay a monthly premium

29. Standardized Medigap Plans in Minnesota Basic Plan Coverage : –Medicare Part A co-insurance –Part B co-insurance –Blood – 1 st three pints/year –80% of emergency foreign travel –45% of most outpatient mental health services –20% of physical therapy –State mandated benefits

30. Standardized Medigap Plans in Minnesota Optional Riders: –Medicare Part A deductible – Part B annual deductible –Excess Rider – Preventive Care Rider Additional Medigap Policies: –Extended Basic – Plan N –Plan K – High Deductible Plan F –Plan L –Plan M

31. When to Buy a Medigap Policy Open Enrollment Period –Starts the month you are 65 or the 25 th month of certified disability and enrolled in Part B –Lasts 6 months During the Open Enrollment Period the company cannot : –Deny you any Medigap policy it sells –Make you wait for coverage to start, with some exceptions –Charge you more for a policy because of existing health problems

32. Cost Plans Available in limited areas May be able to join even if you only have Medicare Part B Can join anytime plan is accepting new members Can leave and return to Original Medicare at any time May see a non-network provider –Services are then covered under Original Medicare Can get Medicare prescription drug coverage

33. Medicare Part C: Medicare Advantage Provided by private insurance companies approved by Medicare –May only receive coverage through the Medicare Advantage plan Most charge a monthly premium –Must still pay your Medicare Part B premium May include Part D May include extra benefits, such as hearing and vision

34. Medicare Advantage Plans cont. In some cases, you must take the drug coverage that is included with the plan –You may not choose a Stand Alone Part D plan Cannot have a Medigap policy Are responsible for the co-pays and co-insurance set by the plan May have a network of doctors you must use

35. Enrollment in a Medicare Advantage Plan Must live in the service area of the plan you would like to join Must have Medicare Part A and B Cannot have End-Stage Renal Disease NEW – Beginning Fall 2011, the Annual Open Enrollment Period will change to October 15 – December 7 (plan effective date January 1, 2012)

36. Medicare Advantage Disenrollment Period January 1, 2012 – February 15, 2012 During this new Medicare Advantage Disenrollment period: –Beneficiaries can disenroll from a Medicare Advantage plan and switch to Original Medicare –Beneficiaries can enroll in a Stand Alone PDP plan when returning to Original Medicare –Beneficiaries enrolled in a Medicare Advantage plan cannot switch to another Medicare Advantage plan –Beneficiaries in Original Medicare cannot enroll in a Medicare Advantage plan

37. Medicare Advantage Plan Options in Minnesota Health Maintenance Organizations (HMO) Preferred Provider Organization Plans (PPO) Private Fee-for-Service Plans (PFFS) Special Needs Plans (SNPs)

38. Things to Consider When Choosing a Plan Cost Benefits Doctor & Hospital Choice Travel Prescription Drugs Pharmacy Choice Quality of Care

39. Medicare Part D – Prescription Drug Coverage Began January 1, 2006 Coverage is through a Stand Alone prescription drug coverage or as part of a Medicare Advantage Plan –Plans are offered by private insurance companies approved by Medicare Separate monthly premium for most plans Must have Medicare Part A, Part B or both Is a voluntary benefit –However, if you do not enroll when first eligible you may face a penalty later

40. Medicare Part D Enrollment Periods Initial Enrollment Period (IEP) –7 month period starting 3 months before the month of 65 th birthday or 25 th month of certified disability Annual Open Enrollment Period (OEP) –November 15 though December 31 –Coverage is effective January 1 of following year –Beneficiaries may join, drop or switch coverage –NEW! Beginning Fall 2011, Annual Election Period will change to October 15 – December 7 Special Enrollment Period (SEP) –Moving, plan leaves the market, dual eligible, loss of creditable coverage

41. Late Enrollment Penalty People who do not join a Part D plan when they are eligible may pay a penalty –Add 1% of the national base premium for each month you should have had a plan, but did not enroll –Must pay the penalty as long as you are enrolled in a Part D plan Penalty does not apply to those who have creditable coverage or if you have dual eligibility –You are a dual eligible if you receive Medicare and are on Medical Assistance or a Medicare Savings Program

42. 2012 Standard Benefit for Medicare Part D: You Pay Monthly Premium Deductible: $320 Initial Coverage Limit: 25% co-insurance per prescription drug Donut Hole: 100% of prescription drugs once you and the plan both pay $2,930.01. 50% discount on brand name and 14% discount on generic drugs purchased while the beneficiary is in the donut hole. Catastrophic Coverage: 5% co-insurance per drug after you pay $4,700 out of pocket *Plans may have a lower deductible or set their own co-pays/co- insurance. It is important to compare plans when deciding.

43. Medicare Part D Premiums Higher income beneficiaries will pay higher Medicare Part D monthly premiums –$85,000 individuals –$170,000 couples –Not indexed for inflation Waiting for additional information from CMS

44. 2011 Part D Standard Benefit No Extra Help (LIS) 75% 5% 95% Catastrophic Benefit 100% 25% $310 Deductible Beneficiary Costs Part D Plan Donut Hole 50% discount on Brand Name drugs 7% discount on co- insurance for generic drugs

45. 5% 95% Catastrophic Benefit 100% with discounts 75%25% $320 Deductible Monthly Premium $2,930.01 - $6,657.50 $320.01 - $2,930 $.01 - $320 Over $6,657.50 (copays of $2.60/$6.50 or 5%) Drug Costs Beneficiary Costs Part D Plan 2012 Part D Standard Benefit No Extra Help (LIS) Donut Hole 50% discount on Brand Name drugs 14% discount on co-insurance for generic drugs

47. Extra Help Paying for Part D Costs Administered by Social Security Administration Helps pay for Medicare Part D cost sharing Full and Partial LIS are available Must complete application and send to SSA or complete online application at www.ssa.govwww.ssa.gov Income must be below 150% of FPG or $1,362/single or $1,839/couple Assets must be below $12,640 for single and $25,260 for a couple

48. Additional Extra Help is Available Medicare Savings Programs –QMB –SLMB –QI-1 Medical Assistance Send completed application to your county –Application assistance is available through Senior LinkAge Line®

49. MinnesotaHelp Network™ is here to help you Senior LinkAge Line® 1-800-333-2433 Disability Linkage Line ® 1-866-333-2466 Veterans Linkage Line ™ 1-888-LinkVet www.MinnesotaHelp.info ® http://longtermcarechoices.minnesotahelp.info/ Local community based sites throughout Minnesota

50. Questions or Comments?