How Much Do You Really Know About Medicare? GAIL YOSS Independent - - PowerPoint PPT Presentation

How Much Do You Really Know About Medicare? GAIL YOSS

Independent Broker- Agent

Aetna, Anthem, AARP UnitedHealthcare, Cigna & Humana www.YossInsurance.com

Licensed in Virginia #764274

Neither Yoss Ins Agency, LLC nor Gail Yoss is connected with the Federal Medicare Program

1 Since 2010

Over half of boomers expect to pay less for health care or have no idea of Medicare costs Almost half of Medicare enrollees paid more for health care than expected Over half of boomers say they have a poor understanding or know almost nothing about Medicare

SOURCE | Bankers Life and Casualty Company Center for a Secure Retirement, “Retirement Healthcare for Middle-Income Americans,” 2012.

Need for a better understanding

What questions do you have?

• What does Medicare really cover?
• When should I enroll to start my benefits?
• Do I have any choices for the types of Medicare

coverage I receive?

• Does Medicare cost anything?
• If I’m still working and have health insurance from

my employer, do I still need to enroll?

• Is Medicare the only health insurance I need during

retirement?

• What role will Medicare play in my retirement

income plan?

• What about dental insurance?

Questions about Medicare

Initial enrollment period

Parts A and B

Enrollment in Medicare Parts A and B is automatic at age 65 if you’re already receiving Social Security But if you’re delaying Social Security until after age 65 (to increase your Social Security benefits), then you must proactively enroll in Parts A and B as you approach age 65

• 1. Enroll online at www.medicare.gov
• 2. Call by phone at 1-800-MEDICARE
• 3. Visit your local Social Security office

Enrolling in Medicare

SOURCE | “Understanding Medicare Enrollment Periods,” www.medicare.gov/Pubs/pdf/11219.pdf.

Medicare Initial enrollment period

Parts A and B

If you wait until the last 4 months of your Initial Enrollment Period to sign up for Part A and/or Part B, your coverage will be delayed.

Enroll Enroll now! now!

Sign up early to avoid a delay in

• coverage. To get Part A and/or Part B

the month you turn 65, you must sign up during the first 3 months before the month you turn 65.

General enrollment period

If you don’t enroll into Medicare when first eligible

Parts A and B

January February March April May June July August September October November December

If enroll between January 1 and March 31 Coverage begins July 1

SOURCE | www.medicare.gov, 2016.

B A C D

PART A Hospital PART B Physician's Services Medicare Pays 80%

Medicare Advantage Plan 3 in 1 includes Parts A,B, & D OR Supplement - 20% with Part D

• Rx

PART D Prescription Drugs

Medicare PARTS

Original Medicare

• Part A ( Hospital)
• You Pay Deductible $1,340 Required Yr 2018

Every 60 days ( Benefit Period) COPAY:

• $335 per day for days 61-90
• $670 per day for up to 60 lifetime reserve days

Copays for skilled nursing facility stays are:

• $0 for days 1-20
• $167.50 per day for days 21-100 then YOU pay all

costs

• Inpatient care in a skilled nursing facility (does not include custodial
• r long-term care)
• Coinsurance. Home hospice patients may pay a small coinsurance

Original Medicare

• Part B ( Medical)
• You Pay 2018 yr $183 Annual Deductible
• Due between Jan – Dec
• You pay Medicare a monthly premium -$134
• Medicare pays 80% - You pay 20% of costs
• No maximum out-of-pocket expenses each

year

• Some types of drugs may be covered: some

antigens,Osteoporosis, Injectables admin in Dr office, oral cancer,oral anti- nausea, Inhalation and Infusion drugs admin through DME

• Helps cover medically necessary doctor’s services, outpatient care, home

health services, DME and preventive services.

You pay each month (in 2018) File individual tax return File joint tax return File married & separate tax return $85,000 or less $170,000 or less $85,000 or less $134 above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $187.5 above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $267.9 above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $348.3 above $160,000 above $320,000 above $85,000 $428.6

Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. If so, you'll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your PART B premium.

Medicare Part C Your Options

Medicare Advantage Plans

• Combines Parts A , B & usually D
• Monthly Premium- $0 - $$
• May include a deductible
• Provides Preventive Services
• Copays - low
• Some services requires 20% - 30%

coinsurance

• Provider Network – In (HMO) or Out

(PPO)

• PFFS –Private fee for Service-No

network . SNP Special Needs Chronic

• Additional Benefits – or riders $$
• Part D – Prescriptions ( usually)
• Maximum out-of-pocket-$6700 Cap

Supplement (Medigap) Plans

Ten (10) plans to choose from in VA Some plans may pay:

• Deductibles – Parts A & B
• Pays 20% coinsurance
• Pays copays
• No Network – Freedom of choice of doctors

/ hospitals

• Nation wide coverage- it moves with you
• All plans are “standardized” in all states

except WIS,MN, MA

• Monthly premium to Private Ins Co
• No Drug Part D – must purchase

standalone plan from private insurance company

• Yearly Increases in Supplement ( Medigap)

Plans ( 4% - 8%) Nat’l Avg

• It is illegal to have both plans at the same

time

Part D Prescription Drug Plans

Obtained through Medicare Advantage Plan or purchase individual drug Plan

• Must purchase separate Part D plan through

private insurance company OR as part of a Medicare Advantage( Part C).

• Part D plans are offered by private insurance

companies approved by Medicare. All drug plans must meet the same basic guidelines created by the federal government but not all plans are the same.

• Every Part D plan has a drug list, or formularly

that shows all the brand name and generic drugs it covers. Most formularies categorize drugs into

• tiers. Tiers # 3,4 or 5 may have a deductible

Original Medicare doesn’t cover everything.

But..some Medicare Advantage Plans do. But..some Medicare Advantage Plans do.

Prescriptions drugs – must have a drug plan Routine eye care Routine hearing exam and hearing aids Routine foot care Routine dental or dentures Acupuncture Cosmetic surgery Custodial care ( help with bathing, dressing and eating)

ORIGINAL MEDICARE MEDICARE ADVANTAGE

How do you want to receive your Medicare coverage?

1

Part A

Hospital Insurance

Part B

Medical Insurance

Part C

Comprehensive Insurance usually includes A, B and D Do you want to add prescription drug coverage?

2

Do you want to purchase a Medicare supplement policy?

3

Part D

Prescription Drug Insurance

Part D

Prescription Drug Insurance

Medigap

Supplemental Insurance Policy

1 2

= PREMIUM IS REQUIRED SOURCE | “Medicare & You,” Centers for Medicare & Medicaid Services, 2016.

Deductible Donut Hole $3750 - $5000

• Part D deductible is $260-$405 for

2018

• Deductible is often covered by

beneficiary’s plan, minus a small copayment

• Bigger concern is “donut hole”

coverage gap between initial and catastrophic limits ($3,750 to $5000)

• Coverage Gap-“Donut Hole” After

your total drug costs reach $3750 you will pay no more than 44% coinsurance for generic drugs or 35% coinsurance for brand name drugs, for any drug tier during the coverage gap

• Catastrophic coverage stage –After

your true out- of- pocket costs reach $5000 you will then pay the greater of $3.35 copy for generic( including brand drugs treated as generic) and $8.35 for all other drugs or 5%

Coverage gap -Part D

SOURCE | www.medicare.gov, 2018

1% of national base beneficiary premium times number of months without coverage

Part D penalty

PERMANENT

Late enrollment penalty

Part D

Part D penalty applies if recipient goes without creditable coverage longer than 63 days

SOURCE | www.medicare.gov, 2018

Enrollment periods

Part D

Same initial enrollment as Parts A and B If you have a Part B you are entitled to Part D

!!

If qualify for special enrollment period, you have 2 months after coverage ends to enroll Ex: Losing or leaving group coverage

!!

Annual coordinated election period runs from October 15 to December 7

• To change, switch or enroll into a Drug or

Medicare Advantage Plan with Jan 1 effective date

!!

SOURCE | www.medicare.gov, 2018.

• Proactively enroll in Parts A and B if

you’re not collecting Social Security

• If qualified for special enrollment, enroll

for Parts A and B before group coverage ends

• Other special enrollment reminders:
• Part C (Medicare Advantage) – 2 months
• Part D – 2 months
• Medigap – 6 months for a guaranteed issue
• Avoid late enrollment penalties
• Part D = 1% per month
• Part B = 10% every 12 months
• 1. Remember enrollment timelines

SOURCE | www.medicar.gov, 2018

• Starts month you turn 65 and have Part B
• Open enrollment extends for 6 months
• Insurers must accept all applicants during this enrollment

period with a guaranteed issue right

• CAUTION – the clock starts regardless of other

coverage Medicare Supplement Ins Policies are also called Medigap policies

Open Enrollment

SOURCE | www.medicare.gov,. 2018

Long-term care

65-year-old has a 40% chance of entering a nursing facility But Medicare and Medigap insurance typically cover only 100 days of skilled nursing care Custodial care is not covered by Medicare or Medigap

SOURCE | www.medicare.gov, 2018

DENTAL PLANS

Some Medicare Advantage Plans Medicare Advantage Plans offer the basic dental coverage in their

• plans. Others may offer optional benefit riders for dental & vision at

additional costs. AARP United Healthcare and Anthem supplemental insurance plans also

• ffer dental plans for a monthly premium.

www.deltadentalcoversme.com 1-844-764-5301 Plans by state & zip code. Plans are; Premium, Enhanced and Classic – PPO

THANK YOU ! QUESTIONS ?