Independent Representatives 975 Andover Blvd. Alcoa, TN 37701 - - PowerPoint PPT Presentation

Independent Representatives 975 Andover Blvd. Alcoa, TN 37701 www.wmgalcoa.com Office: (865)258-9642

Understanding Me g Medicare re 2 2018

Medicare Madness:

What does it all mean?

What is Medicare?

Health insurance for the following people:

 Those 65 and older  Those younger than 65 with certain

disabilities

 Those with End-Stage Renal Disease

(permanent kidney failure)

Automatic Enrollment: Part A and Part B

 Automatic enrollment for those receiving

 Social Security benefits  Railroad Retirement Board benefits

 Initial Enrollment Period Package

 Mailed 3 months before

○ 65 or ○ 25th month of disability benefits

 Includes your Medicare card

When Enrolling Isn’t Automatic

 If you’re not automatically enrolled

 You need to enroll with Social Security

○ Visit socialsecurity.gov, or ○ Call 1-800-772-1213, or ○ Visit your local office

 If retired from the Railroad, enroll with the

Railroad Retirement Board (RRB)

○ Call your local RRB office or 1-877-772-5772

 Apply 3 months before you turn 65

 Don’t have to be retired to get Medicare

Initial Enrollment Period

 When you first turn 65, you have 3 months

before and after your birthday month

 Coverage begins based on your enrollment

date

 If you don’t sign up for Medicare when you

are first eligible, you may have to pay a penalty for Part B as long as you receive benefits

Medicare Annual Enrollment Timeline

=

Pre-Enrollment

• Oct. 1 – Oct. 14

Compare and discuss Medicare health plans No applications may be submitted during this time

Annual Enrollment

• Oct. 15 –Dec. 7

Enroll or change Medicare Advantage or Prescription Drug plans for the upcoming year

Annual Disenrollment

• Jan. 1 – Feb. 14

May disenroll from Medicare Advantage and return to original medicare and enroll in a stand- alone drug plan

• Feb. 15 –
• Oct. 14

No changes except for special circumstances such as moving

• ut of the

service area or qualification or loss of Medicaid

The 4 Parts of Medicare

What's NOT covered by Original Medicare?

• Most outpatient prescription drugs
• Long-term care
• Routine dental care and Dentures
• Hearing aids (exams and fittings)
• Routine foot care
• Cosmetic Surgery
• Acupuncture

Medicare Part A : Hospital Insurance Coverage

 Part A–Hospital Insurance helps cover

 Inpatient hospital care  Inpatient skilled nursing facility (SNF) care  Blood (inpatient)  Home health care  Hospice care

Medicare Part B: Medical Insurance Coverage

 Part B—Medical Insurance helps cover

 Doctors’ services  Outpatient medical and surgical services,

supplies

 Clinical lab tests  Durable medical equipment  Diabetic testing supplies  Preventive services

Medicare Part B–Covered Preventive Services



"Welcome to Medicare" preventive visit



Yearly “Wellness” visit



Abdominal aortic aneurysm screening



Alcohol misuse screening and counseling



Bone mass measurement



Breast cancer screening (mammogram)



Cardiovascular disease (CVD) Risk Reduction Visit



Cardiovascular disease screenings



Cervical and vaginal cancer screening



Colorectal cancer screenings



Depression screening



Diabetes screenings



Diabetes self-management training



Flu shots (Vaccine)



Glaucoma tests



Hepatitis B shots (Vaccine)



Hepatitis C screening test



HIV screening



Lung Cancer Screening



Medical nutrition therapy services



Obesity screening and counseling



Pneumococcal shots



Prostate cancer screening



Tobacco use cessation counseling

13

Medicare Part D: Prescription Drugs

 Medicare Part D  Prescription drug option operated by Medicare

approved private insurance companies

 Prescription drugs  May help lower your prescription drug costs

and help protect against higher costs in the future

 If you don’t sign up for a plan that includes

prescription drugs when you are first eligible, you may have to pay a permanent penalty for Part D late enrollment.

Medicare Advantage Plans

 Medicare Part C (Advantage Plan)  Health plan managed by Medicare approved

private insurance companies

 Includes all benefits and services covered

under Part A and Part B

 May include extra benefits and services for an

extra cost

 Usually includes Medicare prescription drug

coverage (Part D)

Medicare Costs in 2018

 Most people don’t pay a Part A premium because

they paid Medicare taxes while working. If you don’t get premium-free Part A, you pay up to $413 each month.

 Part A hospital inpatient deductible is $1340 for each

benefit period.

 Part B premium is currently $134  Part B deductible $183  Part D deductible is $405. Some prescription drug

plans have a lower deductible or no deductible.

What are my Medicare coverage options? First method

 Original Medicare (Parts A & B)

 Stand-alone Prescription Drug Plan (Part D)  Medicare Supplement or Medigap policy  Supplements (identified by a letter) provide

identical coverage, but vary widely in price

Medicare Supplement Choices

Second Method

 Medicare Advantage Plan (Part C)  Includes Part A & B coverage  Prescription Drug Coverage (Part D)

Some advantage plans include prescription

drug coverage

 Prices are the same regardless of age or

gender

Which plan is right for me?

 Medicare Supplement might make sense if you:

 Want flexibility in choosing your doctors  Visit doctors frequently  Travel extensively  Have a chronic medical condition  Don’t mind higher premiums to get lower out-of-pocket

costs (predictability)

 Remember to enroll in the first 6 months after you are

both 65 years old and enrolled in Medicare Parts A & B to have guaranteed issue. If you do not enroll during this period, you may have to answer health questions to be eligible for the plan later

 Medicare Advantage Plan might make sense if you:

 Are willing to change doctors, if necessary  Prefer all benefits from a single plan & premium  Visit doctors infrequently & don’t mind paying

per-visit copayments and coinsurance

 Don’t mind researching your options annually  Want lower premiums than supplements offer  Are informed about your choices and don’t mind

comparison shopping for plans

 Want options beyond what Medicare provides  Want an out-of-pocket maximum amount which

Original Medicare does not provide

What can I do during Open Enrollment from Oct 15 – Dec 7?

 Go from Original Medicare to Advantage

Plan

 Go from Advantage Plan to Original

Medicare

 Switch Medicare Advantage Plans  Join Part D plan  Switch Part D plans

Medicare Part D

Two ways to get Part D

 Purchase Medicare prescription drug stand-

alone policy

 Choose a Medicare Advantage Plan that

• ffers prescription drug coverage

If you choose not to enroll in a prescription drug plan, you may pay a late enrollment penalty if you join a Part D plan later

Part D Premium

 Monthly fee, varies by plan  In addition to Part B cost  Some Advantage Plans include Part D coverage in the cost  How to avoid a Part D Enrollment penalty

 Join plan that includes prescription drugs when first

eligible

 Don’t go 63 days or more without drug coverage

 Medicare calculates the penalty by multiplying 1% of

the "national base beneficiary premium" ($35.02 in 2018) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

IMPORTANT!!

 Always ensure your prescription drugs

are in the formulary of any plan you’re considering

 Check which “tier” your prescription drugs

are in – each tier has different cost

 Do this every year during Open

Enrollment!

2018 Coverage Gap (Doughnut Hole)

 Begins when total drug costs reaches $3750  Includes what you & insurance plan have paid  During the gap you pay discounted amounts

 35% on brand name drugs  44% on generic drugs

 Once you’ve paid $5,000 out of pocket you

enter catastrophic coverage and pay 5% of cost for covered drugs or a copay of $3.35 for generic and $8.35 for brand name drugs

IMPORTANT!

 Drug plans may include preferred and non-

preferred pharmacies in their network

 You may pay less for drugs at preferred

pharmacies

 You may pay less using the plans preferred

mail order pharmacy

EXTRA HELP

 Program to help people pay Medicare

prescription drug costs

 For single person, income less than

$18,090 annually and limited assets

 For married person living with spouse,

income less than $24,360 annually and limited assets

EXTRA HELP

 Apply through Social Security www.ssa.gov  Helps with monthly drug plan premium,

annual deductible, coinsurance and copayments

 Eliminates doughnut hole  Switch plans at any time during year  Same application used to get help from TN

to pay your Medicare costs

Five Biggest Mistakes Made When Enrolling in Medicare

Not enrolling or making changes during

an available enrollment period

Not understanding the difference

between Medicare Supplement and Medicare Advantage

Choosing a plan based entirely on the

plan a friend or family member has

Not re-evaluating coverage yearly

Important to remember!

 You may not enroll in a

Medicare Supplement plan and a Medicare Advantage plan together.

 You may not enroll in a

Medicare Advantage plan and a stand-alone prescription together in most cases.

Information Overload?

Reasons to Consult with an Independent Agent When Enrolling

 Objective guidance to help steer you

toward a plan to meet your needs and affordability.

 Trained annually to stay current with

changes in the Medicare system.

 Year around assistance locally  No additional cost for expert advice

and guidance Don’t go through the Medicare Maze alone!

Independent Representatives 975 Andover Blvd. Alcoa, TN 37701 www.wmgalcoa.com Office: (865)258-9642