Welcome to Medicare! Presented by Roger Ward Insurance 2002 2005 - - PowerPoint PPT Presentation

Welcome to Medicare! Presented by

Roger Ward Insurance Ø 2002 – 2005 - Independent Agent Ø 2005 – 2012 - Humana Ø September 2012 - Independent Agent aAer 7 years with Humana Ø 2013 - Cer*fied Senior Advisor Ø Last Century: Ø Late 90’s – 2002 - Business Consultant Ø Prior Corporate America

Medicare Ø Created by Title XVIII of the Social Security Act Ø Administered by CMS Ø Center for Medicare/Medicaid Services Ø Under HHS – Health & Human Services Ø What’s special about Medicare this year?

Happy 50 th !!!

In July 1965, under the leadership of President Johnson, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history .

Medicare Not to be confused with Medicaid From Wikipedia, the free encyclopedia In the United States, Medicare is a naWonal social insurance program, administered by the U.S. federal government since 1966, currently using about 30 private insurance companies across the United States. [1] Medicare provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with disabiliWes, end stage renal disease and amyotrophic lateral sclerosis. In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabiliWes. It was the primary payer for an esWmated 15.3 million inpaWent stays in 2011, represenWng 47.2 percent ($182.7 billion) of total aggregate inpaWent hospital costs in the United States. [2] Medicare serves a large populaWon of elderly and disabled individuals. 55.3 million in 2015 (46.3 + 9.0) On average, Medicare covers about half (48 percent) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Out-of-pocket costs can vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and the supplemental insurance. [3]

Medicare Card

Part A: No premium for most people Part B: $104.90 per month 2016 Newbies: $121.80 per month DeducWbles: Part A: $1,288 per Benefit Period Part B: $166 per year Medicare pays 80%, your cost share is 20% Part D Premiums: $18 per month to $100+/mth DeducWbles, CoPays, Coinsurance, Drug Tiers, Coverage Gap/Donut hole! Medicare Supplements pick up some or all of the DeducWbles and the 20%

Medicare Supplements aka “Medigap” plans since they fill-in the gaps Ø Pick up some or all of the DeducWbles and 20% cost sharing that Medicare does not pay Ø Popular plans include Plan F, G, N, High DeducWble F Ø Supplements do not include Drug Coverage! Must get a PDP Ø Plans are “Standardized”, so coverage is same with each company Ø Key differences are iniWal premiums and annual rate increases Ø UnderwriWng requirements – BCBS and AARP/UHC easy to change Ø Extra Benefits e.g., Vision Discounts, etc, Silver Sneakers Ø Popular carriers: BCBS, AARP/UHC, Mutual of Omaha, Aetna, Humana

Plans A thru N Plan F most comprehensive Plan F Most expensive Plan F @ age 65 Male: $135 per month Female: $118 per month Plan G: Male: $102 Female: $90 Plan N: Male: $85 Female: $81 High DeducWble F: Male: $26 Female: $26 DeducWble is $2,180 Medicare paying 80%, you pay 20%

Important Points about Medicare Supplements 1. You have a guaranteed right to enroll, regardless of your health, for 6 months (extended to 12 months if you enroll first in Medicare Advantage plan) 2. You can change plans any Wme of year (not part of/funded by Medicare) 3. AAer 6 months, you are subject to health quesWons, so could be turned down 4. Plans are “standardized”, so coverage is same, a Plan F is a Plan F 5. Difference is primarily premiums and other benefits, e.g., Silver Sneakers 6. Supplements widely accepted! 7. Premiums generally increase every year! By age 75, over $200 per month!

PrescripWon Drug Plans, aka Part D Ø Created by the Medicare Improvement & ModernizaWon Act 2003 Ø Coverage began January 2006 Ø Medicare contracts with Insurance Companies Ø Medicare determines which drugs are covered Ø Plans can have co-pays, or coinsurance, and DeducWbles Ø Plans use Drug Tiers, e.g., 1,2,3,4,5 Ø Tiers ARE NOT Standardized, so very important to check!! Ø All plans have the Donut Hole aka Coverage Gap! $3310 in 2016 Ø Recommend Medicare.gov to check drugs Ø 23 plans in Rockingham County

Medicare Advantage Plans, aka Part C Ø First began in 1990’s as Medicare Plus Choice Ø Medicare contracts with Insurance Companies Ø Popularity grew in 2006 with Medicare Rx plans Ø Today, 32% of Beneficiaries have Part C - MA plans Ø Plan types include HMO, PPO, PFFS

Medicare Advantage Plan Carriers: Ø Aetna/Coventry Ø Blue Cross Ø Humana Ø United Healthcare/AARP Ø Cone’s Health Team Advantage Medicare Advantage Plan Premiums $0 to over $100 per month, Copays, Max Out of Pocket Most include Drug Coverage Annual ElecWon Period October 15 – December 7 If it’s covered under Medicare , it’s covered under the plan!

Important Points about Medicare Advantage Plans 1. Plans usually have Networks, especially PPO and HMO plans. Check your Doctors! 2. Plans have Copayments: OV: $10-$50; ER: $75; Hospital: $265-430/day, 1-4,5,6,7; Copays or Co-ins for Labs, Xrays, MRI’s; and Annual Max Out of Pocket $3,400-$6,700 3. May offer extra benefits not covered by Medicare, e.g., Dental, Vision, Silver Sneakers 4. Only 1 health quesWon: ESRD. No other quesWons 5. Plans may require referrals, e.g., HMO, and prior authorizaWon for certain services 6. Can only change during Annual ElecWon Period (Oct 15 – Dec 7) 7. Drug Formulary – check your drugs! Some generics in Tier 3 and 4!

How Do Costs Compare? Medicare Supplements: Medicare Advantage: • Plan G: 65 year old • $0 Premium • Male: $102; Female $90 • 4 OV-PCP, 2 Specialists $60 + $180 = $240 • Rx Plan: $30 • Labs & X-rays: $100 ($340 total) • Total $132/$120 per month • CT/MRI: $250 ($590 total) • Annually: $1,584/$1,440 • OutpaWent Surgery: $250 ($840 total) • Part B DeducWble: $166 (2017 ???) • Hospital Stay $300/3=$900 ($1,740) • Total $1,750/$1,606 • Supplement looking beyer! Lower premiums on Plans N and High F

So which strategy is best? Medicare Supplements Medicare Advantage • Cost more, but…… • Low or no monthly premiums • No Networks • Great if good health • Freedom to choose doctors, • No Health UnderwriWng hospitals, providers • AddiWonal benefits beyond original • Predictable Costs, i.e. premium Medicare, e.g., safety nets, i.e., Dollar limits and extra’s, • Beyer if serious health issues • Dental, Vision, Silver Sneakers Depends on your circumstances, your Health, your Budget, your feelings about risk

How do I decide? Ø What’s your current coverage? Ø ACA or other Individual Plan? Ø Employer/Group Plan? Ø Monthly premium? DeducWbles? Max? Copays? Ø Drug Coverage? Usually No Donut Hole! Ø Schedule Ø an appointment Ø with Roger!

QuesWons????

• Thank you for coming!!