Unnamed B/D
What is it? Do I need it? How do I get it? How much does it cost? Medicare What will it cover? Putting the parts together What do my healthcare choices look like? Go relax
What is Medicare? Federal Health Insurance… • Not intended to pay 100% of health care costs; • Designed for US-based healthcare; • Who is eligible? • Age 65 and older • Disabled – any age • Diagnosed with End Stage Renal Disease (ESRD) or ALS
Is Medicare’s Part A mandatory at age 65?
Medicare is not an automatic ‘yes’ as you turn 65
So you are ELIGIBLE for Medic icare … Eligible for retiree coverage? Marketplace/ACA?? COBRA Actively employed? Small employer? I I need Medicare … .
Where do we go for advice?
Medicare PART A • “Room and Board” coverage – covers hospitalization, skilled nursing, hospice, some home health care; • Deductible for 2019 is $1,364 – per 60 day benefit period; • Coinsurance for hospital days 61-90 is $341; • Coinsurance for each day 91-150 is $670; • Does NOT cover long term care expenses
Medicare PART B • Has a monthly premium • Annual deductible of $185 • Covers: • Physician Services; • Outpatient Services; • Durable Medical Equipment; • Pays 80% (YOU are responsible for 20%); • HSA may be used to pay Part B Premiums.
Medicare does NOT cover ○ Most routine Dental Care ○ Routine Eye Care ○ Routine Hearing Tests ○ Custodial Care (Bathing, dressing, eating, etc) ○ Long Term Care ○ Medical evacuation
How much will I pay for Part B?
Sounds easy but … . “seven months” is just part of the story
Example for 65 Year old in Zip Code 48167 Procedure Medigap (Plan G) Medicare Advantage (PPO) Monthly Premium $115/month $14/month Deductible $185 $80 Max out of pocket (MOOP) $185 $6000/$8100 PCP/Specialist Visit $0/$0 $20/$50 Hospitalization (Inpatient) $0 $260/day (days 1-6) Hospitalization (Outpatient) $0 $175 Emergency Care $0 $80 Skilled Nursing (days 21-100) $0* *$160/day Physical Therapy $0 $40/visit Chemotherapy $0 20% Dental Coverage None $0 co-pay for 1 exam and 1 cleaning per year. 50% the cost of 1 bitewing x-ray Vision Coverage None $50/visit Cost of Adding drug plan Approx. $20/month $0/month
Medigap Policy Medicare Advantage Plan • LOW This consists of a Medigap plan • LOW This consists of choosing a MAPD plus a Part D prescription Drug plan plan in your area. • MEDIUM Enrolling into the MAPD plan • MEDIUM This consists of a Medigap plan and adding a hospital indemnity plan to plus a Part D prescription Drug plan and fill in some co- pay “holes” a dental, vision and hearing solution. • • HIGH This consists of a Medigap plan HIGH This consists of enrolling into the plus a Part D prescription Drug plan, a MAPD, adding a hospital indemnity plan dental, vision and hearing solution, plus and also in adding a policy to cover a $10-20,000 cancer policy. cancer, heart attack and stroke concerns (i.e. costs)
Pre-existing conditions and Medicare Source, Costco Connection January 2019
Plan F and Plan C and 2020 Subtitle A — Medicare Reforms Sec. 401. Medigap. Some Medigap plans on the market today provide first-dollar coverage for beneficiaries – which means the plan pays the deductibles and co- payments so that the beneficiary has no out-of- pocket costs. Beginning in 2020 new plans sold would limit coverage to costs above the amount of the Part B deductible (currently $147 a year). Prepared by the Staff of the House Energy and Commerce and Ways and Means Committees, March 24, 2015
Deductible of $185 in 2019
Medigap Medicare Advantage ✓ Choice of physician, hospital, etc. ✓ Can’t afford higher Medigap ✓ Travel within US premiums ✓ Budgeting ✓ VA system users ✓ Low Medical Costs ✓ Just fine with networks ✓ Flexibility ✓ “I’m healthy and staying that way” ✓ Okay with higher monthly ✓ Little travel plans premiums
Part D, Prescription drug plans • Penalties if not secured; • What about a horrible diagnosis; • Least expensive plan today is $14.50; 95% • 29 plans in Michigan.
Timing October December Medicare Advantage and Part D drug plans 15 7 January February M T W T F S S 30 31 1 3 4 5 2 March M T W T F S S 6 7 8 9 10 11 12 30 31 1 3 4 5 2 M T W T F S S 13 14 16 17 18 19 15 6 7 8 9 10 11 12 30 31 1 3 4 5 2 20 21 22 23 24 13 25 14 15 26 16 17 18 19 6 7 8 9 10 11 12 20 21 22 23 24 25 26 27 28 30 31 1 2 13 14 15 16 17 18 19 29 27 28 29 30 31 1 20 2 21 22 23 24 25 26 27 28 29 30 31 1 2 * Medigap – 365 days a year *
Part B premiums 1,626 Medigap policy 1,500 Part B deductible 185 Part D drug plan 300 Drug co-pays 300 Dental and vision - 2 teeth cleaning, 1 eye exam 1,000 $ 4,911 per person
Assumptions • Really good to excellent health; • Not higher income surcharged couple; • Never a crown/root canal/hearing aid for either party; • Never required any form of custodial or long term care; • Zero inflation. $10,000 per couple x 20 years = $200,000 Over 170k MAGI = $220,000 Over 216k MAGI = $265,000
Why the ‘turning 65’ conversation is so important to have at age 64.5 (According to your Boomer Health Group team) Joanne Giardini-Russell Founder, Boomer Health Group
The 64.5 conversation – you can AVOID • Health Savings Account contribution issues; • Under 20 employer size lack of Part B issues; • Comparing workplace insurance to Medicare; • Pre-existing condition protection; • Part B penalty situations; • Cobra coverage issues; • NOT having LTC solutions in place.
Questions?
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