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 Annual Enrollment Annual Feb. 15 – Disenrollment Oct. 1 – Oct. 14 Oct. 15 –Dec. 7 Oct. 14 Jan. 1 – Feb. 14 Compare and Enroll or change No changes May disenroll discuss Medicare Medicare except for from Medicare health plans Advantage or special Advantage and Prescription Drug circumstances No applications return to original plans for the may be submitted such as moving medicare and upcoming year during this time out of the enroll in a stand- service area or alone drug plan 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 Depression screening  Yearly “Wellness” visit  Diabetes screenings  Abdominal aortic aneurysm  Diabetes self-management training  screening Flu shots (Vaccine)  Alcohol misuse screening and  Glaucoma tests  counseling Hepatitis B shots (Vaccine)  Bone mass measurement  Hepatitis C screening test  Breast cancer screening  HIV screening  (mammogram) Lung Cancer Screening  Cardiovascular disease (CVD) Risk  Medical nutrition therapy services  Reduction Visit Obesity screening and counseling  Cardiovascular disease screenings  Pneumococcal shots  Cervical and vaginal cancer  screening Prostate cancer screening  Colorectal cancer screenings 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 offers 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