Medicare

1. Medicare Getting Started SHIBA Statewide Health Insurance Benefits Advisors A free, unbiased service, sponsored by the Washington State Office of the Insurance Commissioner

2. What is SHIBA? • Statewide Health Insurance Benefits Advisors • A free program of the Office of the Insurance Commissioner • We provide unbiased and confidential information about Medicare and other health insurance • We are an educational service • We don’t sell anything!

3. Today’s overview • Medicare basics: A, B, D or C • How and when to enroll • Medigaps – Medicare Supplement plans • Part D – prescription coverage • Do you need help paying for your plan? • Medicare Advantage plans • Next steps

4. Protect yourself! • As you research your options: • Keep a notebook • Write down the names of people you talk to, the date and their contact information • Note what was said in the conversation • Keep copies of any paperwork • Beware of fraud!

5. What is Medicare? • Health insurance for people: • Age 65 and older • Under age 65 with certain disabilities • Any age with End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (also known as ALS)

6. What is Medicare? • It’s administered by: • Centers for Medicare & Medicaid Services (CMS) • But enrollment is done by: • Social Security Administration (SSA) for most • Railroad Retirement Board (RRB) railroad retirees

7. The four parts of Medicare OR

8. Original Medicare Has Part A – Hospital Insurance • Hospital (Inpatient) • Skilled Nursing Facility • Home health care • Hospice care Has Part B – Medical Insurance • Doctor’s visits • Outpatient hospital services • Clinical lab tests • Durable Medical Equipment • Preventive services

9. Medicare does not cover everything! • Routine eye exams, eyeglasses • Only glasses after cataract surgery • Routine dental care • Cleaning, fillings, crowns, bridges, dentures • Hearing aids • Most “alternative” medicine • Acupuncture, Naturopathy • Long-term care • Only skilled care in certain circumstances

10. Medicare Part A (Hospital Insurance) • What does Part A cost? • Most people get Part A premium free • You can pay a premium to get Part A • It can cost $234 or $426/mo. depending on work credits

11. Medicare Part B(Medical insurance) • What does Part B cost? • This year – for most – Part B costs: $104.90/month • Those who have higher incomes will pay more • May have penalty

12. Paying for Part A&B services • See chart in handouts • In addition to Part B premiums and sometimes Part A premiums • In Original Medicare you pay: • Part A Hospital deductible of $1,216 • Part B yearly deductible of $147 • 20% coinsurance for most services • THERE MAY BE OTHER COSTS! • Programs may help pay these costs • For people with limited income and resources

13. How to enroll in Medicare • Enrollment is automatic for most • If you get Social Security or RRB benefits • If enrollment is not automatic • For instance, you’re still actively working • You need to enroll with Social Security: • Visit local office • Call 1-800-772-1213 • Online at socialsecurity.gov • If retired from Railroad, enroll with RRB • Call your local RRB office or 1‑877‑772‑5772

14. Medicare card • Keep it and accept Medicare Parts A and B • Return it to refuse Part B • Follow instructions on back of card Jane Doe Back Front

15. When can I enroll in Medicare? • The later you enroll, the later coverage starts: • Up to a 3-month wait

16. Medicare decisions • Original Medicare? • Should I keep/sign up for Part A? • Should I take Part B? When? • What about Part D? • Do I need a Medigap policy? • Do I want a Medicare Advantage Health plan? • Can I get help with Medicare costs? Maybe?

17. Decide how you want to get your Medicare coverage Source: Page16 of Medicare & You 2014

18. DecisionShould I keep/sign up for Part A? • Consider • Get it automatically if getting Social Security/RRB • Free for most people • If not free • Can pay for it if not enough work quarters Yes

19. DecisionShould I keep/sign up for Part B? Consider Is there active work involved? • NO ACTIVE work to consider. • I’m ACTIVELY working and I’m covered by a health insurance plan from my current job. • I’m NOT ACTIVELY working, but my spouse is, and I’m covered under his/her health insurance through their current job. It Depends

20. DecisionShould I keep/sign up for Part B? • If you don’t have coverage from active employment • Yours or your spouses • Delaying Part B may mean: • Higher premiums • Paying for your health care out-of-pocket • If you do have coverage through active employment • You may want to delay Part B • No penalty if you enroll while you have coverage or within 8 months of losing coverage Probably Maybe Not

21. DecisionShould I keep/sign up for Part B? • Sometimes you must have Part B • If you want to buy a Medigap policy • If you want to join a Medicare Advantage Plan • If you're eligible for TRICARE • If your employer coverage requires you have it • Talk to your employer’s benefits administrator • Talk to SSA or SHIBA if questions

22. Medigaps Also called Medicare Supplement insurance

23. What is a Medigap policy? • Medicare Supplement insurance policies • Sold by private companies • Fill the gaps in Original Medicare • Deductibles, coinsurance, copayments • Standardized plans • All plans with same letter • Have same coverage • Only the costs are different

24. DecisionDo I need a Medigap policy? • Consider • It only works with Original Medicare • Do you have other supplemental coverage, such as a retiree plan? • You might not need Medigap • Can you afford Medicare deductibles and copayments? • What does the monthly Medigap premium cost? Maybe

25. DecisionWhen is the best time to buy Medigap? Usually during your Medigap Open Enrollment Period AKA “Guaranteed Issue” • Consider: • Your Medigap Open Enrollment Period starts when you're age 65 or older AND enrolled in Part B • Lasts 6 months • You have protections – plans MUST sell you a plan • You can buy a Medigap policy whenever a company agrees to sell you one

26. DecisionWhich Medigap policy do I buy? • Consider • The coverage under each standardized plan • The cost of each plan – be sure to shop • Your individual health care needs It Depends

27. *Plan F has a high-deductible option ** Plans K and L have out-of-pocket limits of $4,800 and $2,400 respectively Source: Page 69 of Medicare & You 2014

28. DecisionHow do I find the right Medigap policy for me? • By computer or phone • Call SHIBA 1-800-562-6900 • Insurance.wa.gov • Call 1.800.MEDICARE (1-800-633-4227) • TTY users should call 1-877-486-2048

29. Medicare prescription drug plans • Medicare Part D

30. Part D – Medicare prescription drug coverage • Available for all people with Medicare • Provided through: • Medicare prescription drug plans • Medicare Advantage plans • Other Medicare plans

31. How Medicare Part D works • It’s optional • You can choose a plan and join • Plans have formularies • Lists of covered drugs • Must include range of drugs in each category • You pay the plan a monthly premium • You pay deductibles and copayments • There’s Extra Help to pay Part D costs • If you have limited income and resources

32. Who can join Part D? • You must have Part A and/or Part B • You can’t live outside the U.S. • You must actively enroll to join • In most cases no automatic enrollment

33. DecisionShould I enroll in a Part D plan? • Consider • Do you have creditable drug coverage? • Coverage as good as Medicare’s • For example through an employer plan • Will that coverage end when you retire? • How much do your current drugs cost? • What do the premiums cost for Part D plans? • Without creditable coverage • Later enrollment may mean you pay a penalty It Depends

34. Joining a Part D plan • You can join: • During your 7 month Initial Enrollment Period • During the Open Enrollment Period • October 15 – December 7 • Coverage starts January 1 • During other special times • Special Enrollment Period

35. How do I choose a Part D plan? • Call or by computer • Call SHIBA for help comparing plans • Medicare Plan Finder at:www.medicare.gov/find-a-plan • To join a Part D plan • Enroll on www.medicare.gov • Complete a paper enrollment form • Call the plan • Enroll on the plan’s website • Call 1-800-MEDICARE (1-800-633-4227)

36. Medicare Advantage plans • Medicare Part C • Also called “Medicare Health plans”

37. Part C – Medicare Advantage • Run by private companies • Another way to get Medicare coverage • Still part of the Medicare program • Member may have a monthlypremium • Medicare pays amount for each member’s care • May have to use network doctors or hospitals

38. How Medicare Advantage works • Still in Medicare with all rights and protections • Still get Part A and Part B services • May include prescription drug coverage • May include extra benefits • Like vision, dental, hearing & gym membership • Benefits and cost-sharing may be different per plan

39. DecisionDo I want to join a Medicare Advantage plan? • Consider • Most offer comprehensive coverage • Including Part D drug coverage • May require you to use a network • You must pay Part B and monthly plan premium • May need a referral to see a specialist • Can only join/leave plan during certain periods • Doesn’t work with Medigap policies • You must have Part A and Part B to join • You must live in the county where the plan is sold • You can’t buy it if you have End Stage Renal Disease It Depends

40. When can I enroll in an MA plan? • During 7-month Initial Enrollment Period • During the Open Enrollment Period • October 15 – December 7 each year • Coverage starts January 1 • May be able to join at other times • Special Enrollment Period • Contact the plan or Medicare to join • Call their number • Visit their website • Plan information on www.medicare.gov

41. Paying for Medicare

42. What do I pay? • Costs vary and change yearly • In Original Medicare • Does the provider accept Medicare Assignment? • In Medicare Advantage • Check with plan • In Medicare prescription drug plans • Check with plan

43. What help is there for people with limited income and resources? • Medicaid • For people with the lowest incomes, eligible people pay little or nothing for their health care costs • Medicare Savings Programs • Helps pay Part B premiums and sometimes Part A and Part B deductibles and co-insurance • Extra Help • Helps pay Part D costs

44. What is Medicaid? • Federal-state health insurance program • For people with limited income/resources • Certain people with disabilities • If you have both Medicare and Medicaid, covers most health care costs • Eligibility determined by state • In Washington: DSHS • Apply if you MIGHT qualify

45. What are Medicare Savings Programs (MSPs)? • Help from Medicaid to pay Medicare costs • Pay Medicare premiums • May pay Medicare deductibles and coinsurance • Income amounts change each year

46. Who can qualify for MSP? Asset Limits: Individual $ 7,160 Couple $10,750

47. What is Extra Help (Low Income Subsidy)? • Help paying prescription drug costs • Social Security makes determination • Some groups automatically qualify • Example: If they qualify for Medicare and Medicaid • You or someone on your behalf can apply

48. Who can qualify for Extra Help? Asset Limits: Individual $13,440 Couple $26,860

49. DecisionShould I apply for these programs? • Apply if you MIGHT qualify • Social Security for Extra Help • DSHS for Medicaid or Medicare Savings Programs • SHIBA can help you Yes!

50. Key points to remember • Medicare is a health insurance program • It does not cover all of your health care costs or types of care • You may want to find additional coverage • Or plan to pay out of pocket • Some plans change each year • You may need to review coverage during Open Enrollment in the fall