INSURANCE OPTIONS IN RETIREMENT Presented By Kurt Swardenski, RHU, - PowerPoint PPT Presentation

INSURANCE OPTIONS IN RETIREMENT Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group

AGENDA ¡ Under Age 65 Options (Pre-65) ¡ Age 65 and Older Options (Post-65) Party Time! ¡ Q&A, Examples throughout

PRE-65 RETIREE MEDICAL OPTIONS – PRE 65 1. COBRA continuation coverage 2. Individual Coverage 3. Marketplace Coverage

PRE-65 RETIREE MEDICAL OPTIONS 1. COBRA CONTINUATION COVERAGE COBRA (rates below reflect costs from 7/1/2017 through 6/30/2018 ¡ Up to 18 months or until entitled to Medicare, whichever is less ¡ Medical/Prescription Drugs PPO 2 ¡ ¡ Single: $560.44 ¡ 2-Person: $1,160.10 ¡ Family: $1,417.90 MESSA Choices Saver ¡ ¡ Single: $632.57 ¡ 2-Person: $1,423.31 ¡ Family: $1,771.21 ¡ Dental ¡ Vision

PRE-65 RETIREE MEDICAL OPTIONS 2. INDIVIDUAL OPTIONS Individual Plan ¡ Number of carriers: ¡ Priority Health ¡ Blue Cross Blue Shield ¡ Molina Healthcare ¡ Humana ¡ Cost varies based on smoker status, age, zip code and plan design

PRE-65 RETIREE MEDICAL OPTIONS 3. MARKETPLACE PLAN Marketplace Plan (www.healthcare.gov) Advance Premium Credits (subsidies) based on household ¡ Instructions to navigate the income and age www.healthcare.gov site: Metal Tier Plans – Platinum, Gold, Silver, Bronze ¡ 1) Click “See Topics” from the top ribbon on the homepage Multiple Carriers available (Blue Cross Blue Shield, Priority 2) Click “See plans and prices” ¡ Health, Blue Care Network) Special Enrollment Period: ◦ You may qualify for a special enrollment period if you leave a job where you had health coverage (ie. Retirement) ◦ Average monthly cost (age 62, non-smoker, zip: 48859, effective 1/1/18) ◦ Silver Plan for Single: $973 (9 plans available) - $285 after subsidy ◦ Bronze Plan for Single: $702 (7 plans available) - $14 after subsidy ◦ Both plans have a subsidy of $688 per month based on single household income of $36,000 For Plan and Cost Estimates outside of Open Enrollment, go to: www.healthsherpa.com

PRE-65 WILL I QUALIFY FOR LOWER COSTS ON MONTHLY PREMIUMS? – MARKETPLACE PLAN Estimated 2018 Household Income – based on number of people in your household *NOTE: Eligibility does vary based on Savings Programs you may age of applicant. qualify for: 1 2 3 4 5 6 Free or low-cost coverage through Below Below Below Below Below Below Medicaid based on income alone $16,643 $22,411 $28,180 $33,948 $39,716 $45,485 A Marketplace health plan with lower monthly premiums plus $16,643 - $22,411 - $28,180 - $33,948 - $39,716 - $45,485 - savings on out of pocket costs, like $30,150 $40,600 $51,050 $61,500 $71,950 $82,400 deductibles and copayments A Marketplace health plan with $30,151 - $40,600 - $51,051 - $61,500 - $71,951 - $82,400 - lower monthly premiums $48,240 $64,960 $81,680 $98,400 $115,120 $131,840 You won’t qualify for savings on a Marketplace insurance plan. You can Above Above Above Above Above Above buy insurance through the $48,240 $64,960 $81,680 $98,400 $115,120 $131,840 Marketplace at full price, or buy from other sources

PRE-65 WHAT DOES AN AVERAGE (SILVER) PLAN COST? COSTS APPLY FOR INDIVIDUAL OR MARKETPLACE (IF ELIGIBLE FOR SUBSIDY, IT WILL REDUCE PREMIUM) Blue Cross Premier PPO Silver ¡ Individual Premium (age 62, zip 48859) = $1,233 per month ¡ $2,000 Single Deductible, $7,350 Out of Pocket Maximum ¡ $30 copay after deductible for Primary Care visits. Specialist $50 after deductible ¡ $15 Generic Drugs After Deductible ¡ 25% coinsurance after deductible for brand copay, 40% coinsurance for specialty medications after ¡ deductible 20% member coinsurance after deductible for most other services ¡ McLaren Silver Standard - HMO ¡ Individual Premium (age 62, zip 48859) = $980 per month ¡ $3,500 Single Deductible, $7,350 Out of Pocket Maximum ¡ $30 copay for Primary Care visits. Specialist $65 copay ¡ $15 Generic Drugs ¡ $50 Brand copay, 40% coinsurance for specialty medications after deductible ¡ 20% member coinsurance after deductible for most other services ¡

POST - 65 RETIREE MEDICAL OPTIONS – POST 65 ¡ 1. Medicare Part A, B and D ¡ 2. Medicare Advantage Plan ¡ 3. Medicare Supplemental Plan

POST - 65 RETIREE MEDICAL OPTIONS - MEDICARE Who runs the Medicare Program? ¡ The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs ¡ Medicare. CMS is part of the U.S. Department of Health and Human Services You enroll in Medicare through the Social Security Department ¡ https://www.ssa.gov/benefits/medicare/ ¡ Resource sites: ¡ http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm ¡ www.medicare.gov ¡ www.medicarerights.org – detailed timeline ¡ www.kff.org – Kaiser Family Foundation ¡

POST - 65 MEDICARE Medicare Benefits Part A: Hospital Coverage Part B: Medical Coverage Part D: Prescription Drug Insurance Part C: Combines Part A, B and D into one package

POST - 65 MEDICARE COVERAGE CHOICES Step 1: Decide how you want to get your coverage START Medicare Advantage Plan Original Medicare (like an HMO or PPO) Part B (Medical Part A (Hospital Coverage) Coverage) Part C (Includes BOTH Part A (Hospital Insurance) and Step 2: Decide if you want to add drug coverage Part B (Medical Insurance) and usually Part D Part D (Prescription Drug Insurance) Part D (Prescription Drug Insurance) Step 3: Decide if you want to add supplemental coverage Medigap (Medicare Supplement Insurance) END Policy If you join a Medicare Advantage Plan, you don’t need and can’t be sold a Medigap policy.

POST - 65 CHECKLIST: 5 THINGS TO DO WHEN YOU GET MEDICARE Fill out an Authorization Form 1) Medicare can’t give personal health information about you to anyone unless you give permission in writing first Make a “Welcome to Medicare” Physical Exam Appointment 2) This free, one-time comprehensive exam is offered during the first 12 months you have Medicare Sign up for MyMedicare.gov 3) MyMedicare.gov is a secure online service where you can access you personal Medicare information 24 hours a day, every day Choose and Join a Medicare Drug Plan (Part D) 4) If you’re new to Medicare, you have 7 months to join a Medicare drug plan Download a Copy of “Your Medicare Benefits” 5) Medicare’s official “Your Medicare Benefits” publication explains the rules about which health care services and supplies Medicare covers

POST - 65 MEDICARE PART A Helps Pay For: Hospital stays ($1,340 deductible, 1 st 60 days/$335 per day – 61 to 90 days) ¡ Skilled nursing facility (SNF) care ¡ Long-term care hospitals ¡ Home health care ¡ Hospice care ¡ Blood ¡ For information, call 1-800-MEDICARE ¡ Paying for Medicare Part A: Most people receive Part A premium free ¡ People with less than 10 years of Medicare covered employment will pay a Part A premium ¡ For information, call the Social Security Administration (SSA) ¡ 1-800-772-1213 ¡ 1-800-325-0778 for TTY users ¡

POST - 65 MEDICARE PART B Helps Pay For: Doctors’ services ¡ Outpatient medical and surgical services and supplies ¡ Diagnostic tests ¡ Outpatient therapy ¡ Outpatient mental health services ¡ Preventive health care services ¡ Other medical services ¡ Paying for Medicare Part B: Most Medicare Part B beneficiaries will pay a premium amount of $134 (higher income earners may pay more) ¡ in 2018. 2018 premium based on 2016 income. $183 per year deductible ¡ 20% coinsurance for most services ¡ Some programs may help cover these costs ¡ Addition of Preventive Care Services ¡ Annual wellness exam ¡ Covers all wellness services/preventive care services as outlined by ¡ the Affordable Care Act

POST - 65 MEDICARE PART D ¡ Prescription drugs provided by Medicare Approved Prescription Drug Plans (PDP) or Medicare Advantage Plans (MA-PD). Not through Medicare – these plans are purchased from insurance companies. ¡ These plans offer negotiated discount prices based on a formulary with cost sharing No more than 35% of cost for brand drugs, what you pay, plus 50% of ¡ discount payment, will count towards your out of pocket costs

POST - 65 THE AFFORDABLE CARE ACT – CLOSING THE DOUGHNUT HOLE - BRAND NAME DRUGS The ACA closes the Part D Doughnut Hole (the gap in coverage during which people with ¡ Medicare must pay the full cost of their prescriptions out of pocket). ACA phases this out by decreasing the beneficiary’s share of drug costs during the ¡ doughnut hole until it reaches 25% in 2020 for both brand name and generic drugs 100% 90% 25% 30% 35% 80% 70% 25% 60% 20% 15% 50% 40% 30% 50% 50% 50% 20% 10% 0% 2018 2019 2020 *Government subsidies to plans will account for the plan share of coverage for drugs. Manufacturer Discount Your Plan Pays You Pay

POST - 65 THE AFFORDABLE CARE ACT – CLOSING THE DOUGHNUT HOLE - GENERIC DRUGS 100% 90% 25% 37% 80% 44% 70% 60% 50% 40% 75% 63% 30% 56% 20% 10% 0% 2018 2019 2020 Your Plan Pays You Pay *Government subsidies to plans will account for the plan share of coverage for drugs.