Centers for Medicare & Medicaid Services Scott Spilky Health - - PowerPoint PPT Presentation

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Centers for Medicare & Medicaid Services Scott Spilky Health - - PowerPoint PPT Presentation

Mar 03, 2023 29 likes •329 views

Centers for Medicare & Medicaid Services Scott Spilky Health Insurance Specialist CMS-Kansas City Todays Talk Centers for Medicare & Medicaid Services Medicare Coverage & Enrollment Original Medicare Plan Other

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SLIDE 1

Centers for Medicare & Medicaid Services Scott Spilky

Health Insurance Specialist CMS-Kansas City

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SLIDE 2

Today’s Talk

  • Centers for Medicare & Medicaid Services
  • Medicare Coverage & Enrollment
  • Original Medicare Plan
  • Other Medicare Health Plan Choices
  • Medicare Prescription Drug Benefit
  • Learn More About Medicare
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SLIDE 3

Centers for Medicare & Medicaid Services (CMS)

  • Medicare
  • Medicaid
  • State Children’s Health

Insurance Program 1-877-KIDS NOW (1-877-543-7669)

  • Health Insurance Marketplace
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SLIDE 4

What is Medicare?

Medicare is a health insurance program for:

  • People age 65 or older
  • Some people with

disabilities under age 65

  • People with End-Stage

Renal Disease

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SLIDE 5

Enrolling in Medicare

If you are receiving Social Security or Railroad Retirement Board benefits:

  • Automatically enrolled the first day of the

month you turn 65 If you are not receiving Social Security or Railroad Retirement Board benefits:

  • Call Social Security about 3 months before

turning 65 to apply for Medicare

  • You are a US citizen or lawfully present in

the United States

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SLIDE 6

You have a choice

  • Beneficiaries can delay Part B due to

continued work after age 65

  • Beneficiaries can delay Part B due to

coverage under spouses active employer plan

  • COBRA is not considered active employer

coverage

  • Beneficiaries can decline Part B completely

– limited times to enroll later – may suffer penalties

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SLIDE 7

General Enrollment Period (GEP)

  • GEP

– For people who didn’t sign up for Part B (or premium Part A) during Initial Enrollment Period

  • Occurs January 1 through March 31 annually
  • Coverage starts July 1
  • May have to pay a lifetime penalty

– 10% for each 12 months eligible but not enrolled 7

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SLIDE 8

Your Medicare Card

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SLIDE 9

Medicare: Part A Hospital Insurance

  • Inpatient hospital

care

  • Limited skilled

nursing home care

  • Home health care
  • Hospice care
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SLIDE 10

Part A Cost Sharing

  • Benefit period begins first day of an

inpatient hospital stay and ends after discharged for 60 consecutive days

For Each Benefit Period in 2019 You Pay Days 1-60 $1,364 deductible Days 61-90 $341 per day Days 91-150 $682 per day (60 lifetime reserve days) All days after 150 All Costs

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SLIDE 11

Part A Cost Sharing

  • Skilled Nursing Facility Services

–Medicare does not pay beyond 100 days in a benefit period

For Each Benefit Period in 2019 You Pay

Day 1-20 $0 Days 21-100 $170.50 per day All days after 100 All Costs

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SLIDE 12

Part A Cost Sharing

  • Home Health Services

–Medicare pays 100% for all covered services as long as patient meets the criteria and it is medically necessary

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SLIDE 13

Part A Cost Sharing

  • Hospice Services

–Comprehensive benefits with few areas of cost sharing in 2019 –Up to $5 per prescription –Up to 5% of inpatient respite care

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SLIDE 14

Part B Medical Insurance

  • Doctors’ services
  • Outpatient hospital care
  • Lab and x-ray tests
  • Limited ambulance

transportation

  • Medical equipment
  • Other outpatient services
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SLIDE 15

Part B Cost Sharing 2019

  • $135.50 monthly premium

–However, most will continue to pay what they did last year

  • $185 annual deductible
  • 20% of Medicare approved amount
  • Up to 15% above Medicare

approved amount if doctor does not accept assignment

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SLIDE 16

Medicare: Not Covered

  • Annual physical exam
  • Long-term care
  • Dentures
  • Hearing aids
  • Eyeglasses
  • Routine foot care
  • No coverage outside U.S.
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SLIDE 17

Original Medicare Plan

You choose

what doctor to see when to see a specialist what hospital to use

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SLIDE 18

Original Medicare Plan: Supplemental Insurance

  • Medigap
  • Employer group

health plans

  • Union plans
  • Tricare for Life
  • Medicaid
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SLIDE 19

Medicare Coverage Choices

Original Medicare

Part A Hospital Insurance Part B Medical Insurance

You can add

Medicare Supplement Insurance Policy Part D Prescription Drug Coverage

  • r

Medicare Advantage Plan

Part C Combines Part A and Part B

May include, or you may be able to add

Part D Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.)

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SLIDE 20

Medicare Health Plan Choices

  • Medicare managed care plans:
  • HMOs
  • Preferred Provider

Organizations (PPOs)

  • Private Fee For Service Plans
  • Medical Savings Accounts
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SLIDE 21

Other Medicare Health Plan Choices:

  • Work differently
  • Plan covers all Medicare services
  • Primary care doctor coordinates care
  • Co-payments
  • No need for a Medigap or

supplemental policy

  • Often offer extra benefits
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SLIDE 22

Who can join a Medicare Advantage Plan?

If you have Medicare, you can join a plan if:

  • You have both Part A and Part B
  • You live in the service area of the

plan

  • You do not have End-Stage Renal

Disease

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SLIDE 23

Help Paying Drug Costs

Medicare Prescription Drug Program

  • Began January 1, 2006
  • All people with Medicare are eligible to join
  • Most people must choose and enroll in a plan

to get coverage – If you have coverage through an employer

  • r union, check with your benefits

administrator – Many people with limited incomes and resources will get extra help

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SLIDE 24

Medicare Prescription Drug Coverage

  • Join when first eligible, to pay lowest

monthly premium

  • Annual Enrollment Period

– October 15 – December 7 – Election becomes effective January 1

  • Coverage and costs vary
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SLIDE 25

Learn More: Contact Us by Phone

  • 1-800-MEDICARE

(1-800-633-4227) 24 hours a day, 7 days a week

  • English or Spanish
  • Hearing and speech

impaired (1-877-486-2048)

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SLIDE 26

Learn More: One-on-One Help With Your Choices

State Health Insurance Assistance Program Provide free, objective counseling and assistance to Medicare beneficiaries and their family members

State Programs in Missouri (CLAIM): 1-800-390-3330 Kansas (SHICK): 1-800-860-5260

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SLIDE 27

Learn More: Visit Us on the Web

www.medicare.gov

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SLIDE 28

MyMedicare.gov

  • Newest online product available
  • Allows beneficiaries to access

personalized information –Enrollments –Address on file –Preventive services eligibility –Recent claims filed with Medicare

  • Register on website
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SLIDE 29

Resources

  • www.opm.gov/healthcare-

insurance/healthcare/medicare/coordina tion-of-medicare-and-fehb-benefits/

  • www.opm.gov/healthcare-

insurance/healthcare/medicare/

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SLIDE 30

Thank You

Scott Spilky

601 E. 12th Street, Room 355 Kansas City, Missouri 64106 Scott.Spilky@cms.hhs.gov (816) 426-6502