How Much Do You Really Know About Medicare? GAIL YOSS Independent - PowerPoint PPT Presentation

How Much Do You Really Know About Medicare? GAIL YOSS Independent Broker- Agent Aetna, Anthem, AARP UnitedHealthcare, Cigna & Humana www.YossInsurance.com Licensed in Virginia #764274 Neither Yoss Ins Agency, LLC nor Gail Yoss is connected with the Federal Medicare Program Since 2010 1

Need for a better understanding Over half of boomers expect to pay less for health care or have no idea of Medicare costs Almost half of Medicare enrollees paid more for health care than expected Over half of boomers say they have a poor understanding or know almost nothing about Medicare SOURCE | Bankers Life and Casualty Company Center for a Secure Retirement, “Retirement Healthcare for Middle-Income Americans,” 2012.

Questions about Medicare What questions do you have? • What does Medicare really cover? • When should I enroll to start my benefits? • Do I have any choices for the types of Medicare coverage I receive? • Does Medicare cost anything? • If I’m still working and have health insurance from my employer, do I still need to enroll? • Is Medicare the only health insurance I need during retirement? • What role will Medicare play in my retirement income plan? • What about dental insurance?

Initial enrollment period Parts A and B Enrollment in Medicare Parts A and B is automatic at age 65 if you’re already receiving Social Security But if you’re delaying Social Security until after age 65 (to increase your Social Security benefits), then you must proactively enroll in Parts A and B as you approach age 65

Enrolling in Medicare 1. Enroll online at www.medicare.gov 2. Call by phone at 1-800-MEDICARE 3. Visit your local Social Security office

Medicare Initial enrollment period Parts A and B Sign up early to avoid a delay in If you wait until the last 4 months of your Initial coverage. To get Part A and/or Part B Enrollment Period to sign up for Part A and/or the month you turn 65, you must sign Part B, your coverage will be delayed. up during the first 3 months before the month you turn 65. Enroll Enroll now! now! SOURCE | “Understanding Medicare Enrollment Periods,” www.medicare.gov/Pubs/pdf/11219.pdf.

General enrollment period If you don’t enroll into Medicare when first eligible Parts A and B January February March April May June July August September October November December If enroll between Coverage begins July January 1 and March 31 1 SOURCE | www.medicare.gov, 2016.

Medicare PARTS A B C D PART A PART B Medicare PART D Advantage Plan Hospital Physician's Prescription 3 in 1 includes Services Drugs Parts A,B, & D Medicare OR Pays 80% Supplement - 20% with Part D -Rx

Original Medicare • Part A ( Hospital) • You Pay Deductible $1,340 Required Yr 2018 Every 60 days ( Benefit Period) COPAY: • $335 per day for days 61-90 • $670 per day for up to 60 lifetime reserve days Copays for skilled nursing facility stays are: • $0 for days 1-20 • $167.50 per day for days 21-100 then YOU pay all costs • Inpatient care in a skilled nursing facility (does not include custodial or long-term care) Coinsurance. Home hospice patients may pay a small coinsurance

Original Medicare • Part B ( Medical) • You Pay 2018 yr $183 Annual Deductible • Due between Jan – Dec • You pay Medicare a monthly premium -$134 • Medicare pays 80% - You pay 20% of costs • No maximum out-of-pocket expenses each year • Some types of drugs may be covered: some antigens,Osteoporosis, Injectables admin in Dr office, oral cancer,oral anti- nausea, Inhalation and Infusion drugs admin through DME • Helps cover medically necessary doctor’s services, outpatient care, home health services, DME and preventive services.

Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. If so, You you'll pay the standard premium amount and an Income Related pay Monthly Adjustment Amount (IRMAA). IRMAA is an extra each charge added to your PART B premium. month File individual tax File joint tax return File married & separate tax return (in return 2018 ) $85,000 or less $170,000 or less $85,000 or less $134 above $85,000 up to above $170,000 up to $187.5 Not applicable $107,000 $214,000 0 above $107,000 up to above $214,000 up to $267.9 Not applicable $133,500 $267,000 0 above $133,500 up to above $267,000 up to $348.3 Not applicable $160,000 $320,000 0 $428.6 above $160,000 above $320,000 above $85,000 0

Medicare Part C Your Options Medicare Advantage Plans Supplement (Medigap) Plans • Combines Parts A , B & usually D Ten (10) plans to choose from in VA • Monthly Premium- $0 - $$ Some plans may pay: • May include a deductible • Deductibles – Parts A & B • Pays 20% coinsurance • Provides Preventive Services • Pays copays • Copays - low • No Network – Freedom of choice of doctors • Some services requires 20% - 30% / hospitals coinsurance • Nation wide coverage- it moves with you • Provider Network – In (HMO) or Out • All plans are “standardized” in all states (PPO) except WIS,MN, MA • PFFS –Private fee for Service-No • Monthly premium to Private Ins Co network . SNP Special Needs Chronic • No Drug Part D – must purchase standalone plan from private insurance • Additional Benefits – or riders $$ company • Part D – Prescriptions ( usually) • Yearly Increases in Supplement ( Medigap) • Maximum out-of-pocket-$6700 Cap Plans ( 4% - 8%) Nat’l Avg • It is illegal to have both plans at the same time

Part D Prescription Drug Plans Obtained through Medicare Advantage Plan or purchase individual drug Plan • Must purchase separate Part D plan through private insurance company OR as part of a Medicare Advantage ( Part C). • Part D plans are offered by private insurance companies approved by Medicare. All drug plans must meet the same basic guidelines created by the federal government but not all plans are the same. • Every Part D plan has a drug list, or formularly that shows all the brand name and generic drugs it covers. Most formularies categorize drugs into tiers. Tiers # 3,4 or 5 may have a deductible

Original Medicare doesn’t cover everything. But..some Medicare Advantage Plans do. But..some Medicare Advantage Plans do. Prescriptions drugs – must have a drug plan Routine eye care Routine hearing exam and hearing aids Routine foot care Routine dental or dentures Acupuncture Cosmetic surgery Custodial care ( help with bathing, dressing and eating)

1 2 How do you want to receive your Medicare 1 coverage? ORIGINAL MEDICARE ADVANTAGE MEDICARE Part A Part B Part C Hospital Medical Comprehensive Insurance Insurance Insurance usually includes A, B and D 2 Do you want to add prescription drug coverage? Part D Part D Prescription Drug Prescription Drug Insurance Insurance Do you want to purchase a Medicare supplement 3 policy? Medigap Supplemental = PREMIUM IS REQUIRED Insurance Policy SOURCE | “Medicare & You,” Centers for Medicare & Medicaid Services, 2016.

Coverage gap -Part D • Part D deductible is $260-$405 for 2018 • Deductible is often covered by beneficiary’s plan, minus a small copayment • Bigger concern is “donut hole” Donut Hole Deductible coverage gap between initial and $3750 - $5000 catastrophic limits ($3,750 to $5000) • Coverage Gap-“Donut Hole” After your total drug costs reach $3750 you will pay no more than 44% coinsurance for generic drugs or 35% coinsurance for brand name drugs, for any drug tier during the coverage gap • Catastrophic coverage stage –After your true out- of- pocket costs reach SOURCE | www.medicare.gov, 2018 $5000 you will then pay the greater of $3.35 copy for generic( including brand drugs treated as generic) and $8.35 for all other drugs or 5%

Late enrollment penalty Part D Part D penalty applies if recipient goes without creditable coverage longer than 63 days Part D penalty 1% of national base beneficiary premium times number of months PERMANENT without coverage SOURCE | www.medicare.gov, 2018

Enrollment periods Part D Same initial enrollment as Parts A and B If you have a Part B you are entitled to Part D !! If qualify for special enrollment period, you have 2 !! months after coverage ends to enroll Ex: Losing or leaving group coverage Annual coordinated election period runs from !! October 15 to December 7 -To change, switch or enroll into a Drug or Medicare Advantage Plan with Jan 1 effective date SOURCE | www.medicare.gov, 2018.

1. Remember enrollment timelines • Proactively enroll in Parts A and B if you’re not collecting Social Security • If qualified for special enrollment, enroll for Parts A and B before group coverage ends • Other special enrollment reminders: • Part C (Medicare Advantage) – 2 months • Part D – 2 months • Medigap – 6 months for a guaranteed issue • Avoid late enrollment penalties • Part D = 1% per month • Part B = 10% every 12 months SOURCE | www.medicar.gov, 2018