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

Pre-65 Pr e-65 Re0ree Medical Op0ons – Pre 65 1. COBRA conCnuaCon coverage 2. Individual Coverage 3. Marketplace Coverage 2 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pr Pre-65 e-65 Re0ree Medical Op0ons COBRA ConCnuaCon Coverage ◦ Up to 18 months or unCl enCtled to Medicare, whichever is less ◦ Medical/PrescripCon Drugs 7/1/2016 - 6/30/2017 Rates BCBS PPO2 MESSA Choices Saver Single: $534.40 Single: $613.67 2-Person: $1,106.21 2-Person: $1,380.78 Family: $1,352.02 Family: $1,718.28 ◦ Dental ◦ Vision 3 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pre-65 Pr e-65 Re0ree Medical Op0ons Individual Plan ◦ Available through a number of carriers: ◦ Priority Health ◦ Blue Cross Blue Shield ◦ Molina Healthcare ◦ Humana ◦ Cost varies based on smoker status, age, zip code and plan design 4 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pr Pre-65 e-65 Re0ree Medical Op0ons Marketplace Plan (www.healthcare.gov) ◦ Advance Premium Credits (subsidies) based on InstrucCons to navigate the household income and age www.healthcare.gov site: ◦ Metal Tier Plans – PlaCnum, Gold, Silver, Bronze 1) Click “See Topics” from the top ribbon on the homepage 2) Click “See plans and prices” ◦ MulCple Carriers available Special Enrollment Period: ◦ You may qualify for a special enrollment period if you leave a job where you had health coverage (ie. ReCrement) ◦ Average monthly cost (age 62, non-smoker, zip: 48858, effecCve 1/1/17) ◦ Silver Plan for Single: $667 (29 plans available) - $280 aeer subsidy ◦ Bronze Plan for Single: $544 (61 plans available) - $157 aeer subsidy ◦ Both plans have a subsidy of $387 per month based on single household income of $36,000 (no Gold level plans were available to purchase) For Plan and Cost Es.mates outside of Open Enrollment, go to: www.healthsherpa.com 5 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pre-65 Pr e-65 Re0ree Medical Op0ons 6 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pre-65 Pr e-65 Will I Qualify for Lower Costs on Monthly Premiums? – Marketplace Plan EsKmated 2017 Household Income – based on number of people in your household *NOTE: Eligibility does vary based on age of Savings Programs you may applicant. qualify for: 1 2 3 4 5 6 Free or low-cost coverage Below Below Below Below Below Below through Medicaid based on $16,394 $22,108 $27,821 $33,534 $39,247 $44,960 income alone A Marketplace health plan with lower monthly premiums plus $16,394 - $22,108 - $27,821 - $33,534 - $39,247 - $44,960 - savings on out of pocket costs, $29,700 $40,050 $50,400 $60,750 $71,100 $81,450 like deducCbles and copayments A Marketplace health plan with $29,701 - $40,051 - $50,401 - $60,751 - $71,101 - $81,451 - lower monthly premiums $47,520 $64,080 $80,640 $97,200 $113,760 $130,320 You won’t qualify for savings on a Marketplace insurance plan. Above Above Above Above Above Above You can buy insurance through $47,520 $64,080 $80,640 $97,200 $113,760 $130,320 the Marketplace at full price, or buy from other sources 7 PRESENTED BY ADVANTAGE BENEFITS GROUP

Pre-65 Pr e-65 What Does An Average (Silver) Plan Cost? Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium) MyPriority HMO HolisCc Silver 2500 (Priority Health) ◦ Individual Premium (age 62, zip 48858) = $677 per month ◦ $2,500 Single DeducCble, $7,150 Out of Pocket Maximum ◦ $30 copay aeer deducCble for first two Primary Care visits. Specialist $50 aeer deducCble ◦ $5 Generic Drugs Before DeducCble ◦ $60 preferred brand copay aeer deducCble, 20% coinsurance for specialty medicaCons aeer deducCble ◦ 30% member coinsurance aeer deducCble for most other services MyPriority HMO HSA Silver 1500 (Priority Health) ◦ Individual Premium (age 62, zip 48858) = $730 per month ◦ $1,500 Single DeducCble, $5,250 Out of Pocket Maximum ◦ 30% coinsurance aeer deducCble for most services ◦ $20 generic drugs aeer deducCble ◦ $60 preferred brand copay aeer deducCble, 20% coinsurance for specialty medicaCons aeer deducCble 8 PRESENTED BY ADVANTAGE BENEFITS GROUP

Po Post-65 Re0ree Medical Op0ons – Post 65 1. Medicare 2. Medicare Advantage Plan 3. Medicare Supplemental Plan 9 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po Re0ree Medical Op0ons - 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 ◦ Impact of recently enacted health reform on Medicare (2012) ◦ Enhanced prevenCve care services ◦ Subsidy and discounts for drugs while in the donut hole ◦ Resource sites: ◦ hmp://www.usprevenCveservicestaskforce.org/uspsn/uspsabrecs.htm ◦ www.medicare.gov ◦ www.medicarerights.org – detailed Cmeline ◦ www.kff.org – Kaiser Family FoundaCon 10 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po Medicare Medicare Benefits Part A: Hospital Coverage Part B: Medical Coverage Part D: PrescripCon Drug Insurance Part C: Combines Part A, B and D into one package 11 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po Medicare Coverage Choices Start St Step p 1: 1: De Decide ide ho how w you u wan ant t to get t your ur coverag age 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 Coverage) and Part B (Medical Coverage) and Step St p 2: 2: De Decide ide if if you u wan ant t to add add drug drug coverag age usually Part D Part D (PrescripCon Drug Insurance) Part D (PrescripCon Drug Insurance) Step 3: Decide if you want to add suppleme mental coverage Medigap (Medicare Supplement Insurance) END Policy If you jo join a Medicare Advantage Plan, you don’t need and ca can’t be sold a Medig Medigap ap p policy olicy. 12 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po Checklist: 5 Things to Do When You Get Medicare 1) Fill out an AuthorizaCon Form Medicare can’t give personal health informaCon about you to anyone unless you give permission in wriCng first 2) Make a “Welcome to Medicare” Physical Exam Appointment This free, one-Cme comprehensive exam is offered during the first 12 months you have Medicare 3) Sign up for MyMedicare.gov MyMedicare.gov is a secure online service where you can access you personal Medicare informaCon 24 hours a day, every day 4) Choose and Join a Medicare Drug Plan (Part D) If you’re new to Medicare, you have 7 months to join a Medicare drug plan 5) Download a Copy of “Your Medicare Benefits” Medicare’s official “Your Medicare Benefits” publicaCon explains the rules about which health care services and supplies Medicare covers 13 PRESENTED BY ADVANTAGE BENEFITS GROUP

Po Post-65 Medicare Part A Helps Pay for: Hospital stays ($1,316 deducCble, 1 st 60 days/$329 per day – 61 to 90 days) Skilled nursing facility (SNF) care Long-term care hospitals Home health care Hospice care Blood For informaCon, call 1-800-MEDICARE 14 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po 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 informaCon, call the Social Security AdministraCon (SSA) ◦ 1-800-772-1213 ◦ 1-800-325-0778 for TTY users 15 PRESENTED BY ADVANTAGE BENEFITS GROUP

Po Post-65 Part B Helps Pay for: Doctors’ services OutpaCent medical and surgical services and supplies DiagnosCc tests OutpaCent therapy OutpaCent mental health services PrevenCve health care services Other medical services 16 PRESENTED BY ADVANTAGE BENEFITS GROUP

Po Post-65 Paying for Medicare Part B: Most Medicare Part B beneficiaries will pay a premium amount of $134.00 (higher income earners may pay more) in 2017. $183 per year deducCble 20% coinsurance for most services Some programs may help cover these costs AddiCon of PrevenCve Care Services ◦ Annual wellness exam ◦ Covers all wellness services/prevenCve care services as outlined by Health Care Reform 17 PRESENTED BY ADVANTAGE BENEFITS GROUP

Po Post-65 Medicare Part D helps pay for: PrescripCon drugs provided by Medicare Approved PrescripCon Drug Plans (PDP) or Medicare Advantage Plans (MA-PD) These plans offer negoCated discount prices based on a formulary with cost sharing Health Care Reform filled some or all of the donut-hole ◦ 50% manufacturers discount on brand name drugs ◦ Pay only 86% of plans cost for generic drugs 18 PRESENTED BY ADVANTAGE BENEFITS GROUP

Post-65 Po Paying for Medicare Part D 19 $0 or reduced premium, deducCble and co-insurance if one qualifies for the Low Income Subsidy (LIS) Must meet income and asset criteria Eligibility determined by Social Security AdministraCon (SSA) PRESENTED BY ADVANTAGE BENEFITS GROUP