2015 MEDICARE CHANGES Daily Location: - - PowerPoint PPT Presentation

“2015 MEDICARE CHANGES”

Coming Changes & How They Might Affect You!

PURPOSE

Just about every year Medicare changes and adapts. Beneficiary’s costs; including premiums, deductibles, coinsurances, and co-pays can go up, down, or remain the same. Rules and requirements about how to receive services can change and the steps beneficiaries need to take to protect themselves are fluid. How Medicare works with other programs such as Medicaid, LIS, and

• thers can be affected. What works one year might not work the
• next. It is the purpose of this program to shed some light on

Medicare beneficiary’s entitlements, rights, and responsibilities under Medicare. This is not a sales presentation program. No specific insurance plans will be discussed during this program.

Todd Oldfield

Your Cool Insurance Agent, The “Medicare Ninja” Daily Location: ____________________________________ Dates:_____________ Hours: ____________ Date of Presentation: __________ Location of Presentation: _________________ # of Aging In: ____ # of Current: ____

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 1

CLASS FORMAT / MEDIA USED…

In this presentation, I will use two items; the www.Medicare.gov website and the most current version of the “Medicare & You” manual. Each year, in September, Medicare beneficiaries are sent their manuals for the coming year. You should have received your 2015 manual by now. If not, you should inquire.

DISCLAIMERS…

 This is not a sales presentation. No plan specific information can be shared, as required by Medicare’s CMS (Center for Medicare & Medicaid Services – Medicare’s governing body). We will not be talking about specific options for avoiding costs. If you need help, that can only be done in a one-on-one appointment.  No contact information will be collected nor required for participation in this event. Sit back. Relax. No one is here to pester you for the next 100 years.    Speaker’s business cards are NOT distributed at this event. If you would like my assistance, I am happy to help and will be in town for a short time. There is no charge to you for my counsel. I am compensated directly by plan sponsors for enrolling and servicing their members. Your particular case – During and after the presentation, I can take a moment to answer very general questions about Medicare and various options, but for complicated matters, I would highly advise that you meet with an adviser and let them assist you further. “Medicare & You” – “The 2015 Medicare premium and deductible amounts weren’t available at the time of printing. To get the most up-to-date cost information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.” – Page 12

THE “MEDICARE NINJA” - Michael “Todd” Oldfield is a licensed (KY DOI#814418) health insurance agent with the Cool Insurance Group in Lexington,

• Kentucky. He is compensated by health insurance companies to enroll and serve members of their plans. Todd is appointed to Humana, Anthem Blue

Cross/Blue Shield, UnitedHealthcare AARP Plans, Cigna, and United of Omaha and many other Medicare-focused plan companies. He has been certified by AHIP and each plan sponsor, each year of his career. For many beneficiaries, Todd’s job is to be “that guy” they call if they would like to have more personal service or enrollment assistance; rather than an 800# to a nameless, faceless person a long ways away.

I am YOUR Medicare NINJA!

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 2

 SIGN-UP / CHANGE PLANS (BLUE TAB)

 MyMedicare.gov (online account. Top-right)  Apply for Medicare Online – Transfers to Social Security (for new beneficiaries only)  When & How to Sign Up for Medicare Parts A & B  How to Get Drug Coverage  About Medicare Health Plans  Medicare Advantage Plans  Medical Savings Account (MSA) Plans  Other Medicare Health Plans  Signing up for Medicare Part A & B. Page 23-25  Where can I find personalized Medicare information online? Page 135  If I’m not automatically enrolled, when can I sign up? Enrollment Periods - Page 25

• How does Medicare prescription drug

coverage (Part D) work? Page 97  Learn about Medicare Advantage Plans (Part C) & Other Medicare Health Plans – Page 75

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 3

 YOUR MEDICARE COSTS (BLUE TAB)  Get Help Paying For Your Costs  Costs at a Glance  Part A Costs  Part B Costs  Costs for Medicare Drug Coverage  Part A Costs  Late Enrollment Penalty  Costs & Assignment  Part B Costs  Part B Premium Costs by income (2014)  Costs for Medicare Drug Coverage  Monthly Premium for Drug Coverage  Yearly Deductibles for Drug Coverage  Copayments/Coinsurance in Drug Plans  Costs in the Coverage Gap  Catastrophic Coverage  PENALTY – 1% for every month that you do not have part D and should have. Visit Medicare.gov/find-a-plan to compare the costs of plans in your area. You can also call 1-800- MEDICARE (1-800-633-4227). TTY users should call  Section 8 - Get Help Paying Costs – Page 111  How does my other insurance work with Medicare? Which Pays First? - Page 28  Medicaid never pays first for services that Medicare

• covers. - Page 29

 Part A late Enrollment Penalty – Page 32 – 10%  Medicare Part A Costs At a Glance ______________  Some people may pay a higher Part B premium Page 32 – If over $85,000 (individual) or $170,000 (couple)  Part B late enrollment penalty – Page 33 – For each 12 month gap between when you could have had Part B, and you chose not to – 10%  Monthly Premium – Page 100  Yearly Deductible – Page 101  Copayments / Coinsurance – Page 101  Coverage Gap – Page 101-102  Catastrophic Coverage – Page 102  Part D enrollment penalty – 1% penalty any time you go 63 or longer days in a row that you do not have Part D or other “credible coverage”. – Page 104 1-877-486-2048. For help comparing plan costs, contact your State Health Insurance Assistance Program SHIP). See pages 141–144 for the phone number.

2014 2015 Part A Costs

__$0 ___ Premiums ____________ ___$1,216__ Deductibles ____________ Coinsurance _____$0____ Days 1 - 60 __________ __304/day__ Days 61 – 90 __________ _$608/day__ Days 91 - 150 __________ ___100%__ Over 150 Days ___________

After 150 Days, You Pay All Costs

Part B Costs

_$104.90/Mo Premiums ____________ _$147/Annual_ Deductibles _____________ _80%/20% Split Coinsurance ______________

Drug Coverage Costs Monthly / Drug Plan

__$31.20__ Premiums ___________ ___$310___ Annual Deductible __________ Copayments or Coinsurance _$2,850_ Coverage Gap (Donut Hole) Begins _________ Begins once you have spent this amount on deductible and total cost per drugs. Costs in the Coverage Gap _47.5%_ Brand Name _______ _72%_ Generic Drugs ________ _$4,550_ Catastrophic Coverage Begins ________ Getting out of the Donut Hole What Counts? Deductible, Copays, Coinsurance, and Discounts on drugs you purchase. Premiums do not count.

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 4

 Costs for Medicare Health Plans  Premiums – Whether or not you the plan charges a premium.  Deductible – Whether or not the plan has a yearly deductible.  Copayment/Coinsurance – How much you pay for each visit or service.

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 5

 WHAT MEDICARE COVERS (BLUE TAB)

 Part A –Hospital Insurance  Hospital  Skilled Nursing Facilities (SNFs)  Hospice  Part A also covers services like lab tests, surgery, doctor visits, home- health care.  Part B – Medicare Insurance  “Medically Necessary” & “Preventive” Services  Doctor & Other Healthcare Providers’ Services  Outpatient Care  Durable Medical Equipment  Home-Health Care & some Preventative Services.  Long Term Care  Part A – Covered Services – Page 36-39  What does Part B cover? – Page 40-61  What’s Not Covered by Part A and Part B – Most dental, eye exams, dentures, cosmetic surgery, acupuncture, hearing aids and exams, Long-Term Care – Page 62 “Generally above the next and below the ankles.”  Paying for long-term care – Page 63

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 6  What Medicare Health Plans Cover Plans include;  Medicare Advantage Plans  Medicare Medical Savings Accounts (MSAs)  Other Medicare Health Plans  Medicare Cost Plans  Programs for All-Inclusive Care for the Elderly (PACE)  Medication Therapy Management (MTM)  Section 5 – Learn about Medicare Advantage Plans (Part C) & Other Medicare Health Plans – Page 75-77  What else should I know about Medicare Advantage Plans – Page 77-80  What do I pay? - Page 81  Types of Medicare Advantage Plans – Page 82  Health Management Organizations (HMOs) – Page 82  Preferred Provider Plans (PPOs) – Page 83  Preferred Provider Plans (PFFS) – Page 84  Special Needs Plans (SNPs) – Page 85  When can I join, switch, or drop a Medicare Advantage plan – Page 86  Medical Savings Account (MSA) Plans – Page 77  Medicare Cost Plans – Page 88  Demonstrations/Pilot Programs – Page 90  Programs of All-inclusive Care for the Elderly – Page 89  Medication Therapy Management Programs – Pages 107-108

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 7 programs for complex health needs

 Preventative & Screening Services

 Is my Test, Item, Service Covered? Preventive Screenings Summary / Checklist – Page 61

 DRUG COVERAGE (PART D) (BLUE TAB)

 What Drug Plans Cover – Drug Formularies & Tiers



How to Get Drug Coverage



What Drug Plans Cover



Costs for Medicare Drug Coverage



When can I Join a Health or Drug Plan  Section 7 – Get information about Prescription Drug Coverage (Part D) – Page 97  Coverage Gap – Page 101  Special Enrollment Periods – Page 86  Drug Formularies – Page 100  Drug Tiers – Page 106  How much do I pay? – Page 100

 SUPPLEMENTS & OTHER INSURANCE (BLUE TAB)

 Medicare Supplement (Medigap) Insurance  Find a Medigap Policy  When can I buy Medigap?  How to Compare Medigap Policies  Section 6 – What are Medicare Supplement Insurance (Medigap) Policies? – Page 91  Medicare Supplement Insurance (Medigap) Plans – Page 93

 CLAIMS & APPEALS (BLUE TAB)

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 8

 MANAGE YOUR HEALTH (BLUE TAB)  FORMS, HELP, & RESOURCES

(BLUE TAB)

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 9

 GET HELP PAYING COSTS

Under (YOUR MEDICARE COSTS)  MEDICAID

• Medicaid “Spend down” if you are

“medically needy”

• Call the state…

 MEDICARE SAVINGS PROGRAMS – (QMB, SLMB, QI, QDWI, etc.) How to apply for Medicare Savings Programs

If you answer yes to these 3 questions, call the State Medicaid Program to see if you qualify for a Medicare Savings Program in Kentucky.

1. Do you have, or are you eligible for, Part A? 2. Is your income for 2014 at, or below, the income limits below? 3. Do you have limited resources, below the limits below?

It's important to call or fill out an application if you think you could qualify for savings—even if your income or resources are higher than the amounts listed here.

 Medicaid – Description – Page 64  Medicaid – “Dual Eligibles” – Page 116  Medicare Savings Programs – Page 115 - 116

• QMB - Part A and/or Part B premiums,

deductibles, coinsurance, and copayments.

• SLMB – Helps pay Part B Premiums only.
• QI – Helps pay Part B Premiums. Must

reapply every year. Limited number. FC/FS.

• QDWI - Helps pay Part A premiums only.

May qualify if you are disabled and working. For more information on checking your eligibility status under Medicaid, call 1-800- MEDICARE and when asked say “Medicaid” followed by “Kentucky” 2014 Medicare Savings Programs – Must have Part A, income less than, and resource limits of no more than $7,160 if single. $10,750 if married (QDWI is $4,000/$6,000);

• QMB - $993/monthly - if single.

$1,331/monthly - if married living together.

• SLMB - $1,187/monthly if single.

$1,593/monthly - if married living together.

• QI - $1,333/monthly - if single.

$1,790/monthly - if married living together.

• QDWI - $3,975/monthly - if single.

$5,329/monthly if married living together.

“2015 Medicare Changes” Program Agenda

By Michael Todd Oldfield (Licensed Agent, KyDOI # 814418)

THE CLASS: A SIDE BY SIDE COMPARISON OF WWW.MEDICARE.GOV & “MEDICARE & YOU”

Medicare.gov “Medicare & You” Manual 2014 vs. 2015 Comparison

The best source of the most up-to- date information on Medicare. Simply type www.medicare.gov to

• visit. Let’s Discuss Various Pages
• n this site…

The “Medicare & You” manual is sent

• ut to all Medicare beneficiaries in the

month of September. If you would like to download a copy, go to http://www.coolinsurancegroup.com/20 15-medicare-manual/

Use this Column as a Place to Take Notes

• r List Questions You

Wish to Ask… Page 10  PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)  SAVE ON DRUG COSTS

• People that qualified paid no more

than $2.55/generic and $6.35/brand name drugs.

• Others paid only a portion of their

Medicare drug plan premiums and deductibles

• Find Your Level of “Extra Help”

(Part D)  PACE – Page 89  “Extra Help” – “Low income Subsidy”

• Find your level of “extra help”

 2014 – No more than $17,505/annual if single. $23,595 if married, who had no more than $13,440 in resources ($26,860 for marrieds).

2015 - ________ /Generic $ ________ /Brand Name Drugs

R