INSURANCE OPTIONS IN RETIREMENT Presented By Kurt Swardenski, RHU, - - PowerPoint PPT Presentation

INSURANCE OPTIONS IN RETIREMENT

Presented By Kurt Swardenski, RHU, REBC Advantage Benefits Group

Re0ree Medical Op0ons – Pre 65

1. COBRA conCnuaCon coverage 2. Individual Coverage 3. Marketplace Coverage

PRESENTED BY ADVANTAGE BENEFITS GROUP

2

Pr Pre-65 e-65

Re0ree Medical Op0ons

COBRA ConCnuaCon Coverage

• Up to 18 months or unCl enCtled to Medicare,

whichever is less

• Medical/PrescripCon Drugs

7/1/2016 - 6/30/2017 Rates

• Dental
• Vision

PRESENTED BY ADVANTAGE BENEFITS GROUP

3

Pr Pre-65 e-65

BCBS PPO2 MESSA Choices Saver Single: $534.40 Single: $613.67 2-Person: $1,106.21 2-Person: $1,380.78 Family: $1,352.02 Family: $1,718.28

Re0ree Medical Op0ons

Individual Plan

• Available through a number of carriers:
• Priority Health
• Blue Cross Blue Shield
• Molina Healthcare
• Humana
• Cost varies based on smoker status, age, zip code and

plan design

PRESENTED BY ADVANTAGE BENEFITS GROUP

4

Pr Pre-65 e-65

Re0ree Medical Op0ons

• Advance Premium Credits (subsidies) based on

household income and age

• Metal Tier Plans – PlaCnum, Gold, Silver, Bronze
• MulCple Carriers available

PRESENTED BY ADVANTAGE BENEFITS GROUP

5

Pr Pre-65 e-65

InstrucCons to navigate the www.healthcare.gov site:

1) Click “See Topics” from the top ribbon

• n the homepage

2) Click “See plans and prices”

Special Enrollment Period:

• You may qualify for a special enrollment period if you leave a job where you had health coverage (ie. ReCrement)
• Average monthly cost (age 62, non-smoker, zip: 48858, effecCve 1/1/17)
• Silver Plan for Single: $667 (29 plans available) - $280 aeer subsidy
• Bronze Plan for Single: $544 (61 plans available) - $157 aeer subsidy
• Both plans have a subsidy of $387 per month based on single household income of $36,000 (no Gold level plans

were available to purchase)

For Plan and Cost Es.mates outside of Open Enrollment, go to: www.healthsherpa.com

Marketplace Plan (www.healthcare.gov)

Re0ree Medical Op0ons

PRESENTED BY ADVANTAGE BENEFITS GROUP

6

Pr Pre-65 e-65

Will I Qualify for Lower Costs on Monthly Premiums? – Marketplace Plan

PRESENTED BY ADVANTAGE BENEFITS GROUP

7

Savings Programs you may qualify for: EsKmated 2017 Household Income – based on number of people in your household *NOTE: Eligibility does vary based on age of applicant. 1 2 3 4 5 6 Free or low-cost coverage through Medicaid based on income alone Below $16,394 Below $22,108 Below $27,821 Below $33,534 Below $39,247 Below $44,960 A Marketplace health plan with lower monthly premiums plus savings on out of pocket costs, like deducCbles and copayments $16,394 - $29,700 $22,108 - $40,050 $27,821 - $50,400 $33,534 - $60,750 $39,247 - $71,100 $44,960 - $81,450 A Marketplace health plan with lower monthly premiums $29,701 - $47,520 $40,051 - $64,080 $50,401 - $80,640 $60,751 - $97,200 $71,101 - $113,760 $81,451 - $130,320 You won’t qualify for savings on a Marketplace insurance plan. You can buy insurance through the Marketplace at full price, or buy from other sources Above $47,520 Above $64,080 Above $80,640 Above $97,200 Above $113,760 Above $130,320

Pr Pre-65 e-65

What Does An Average (Silver) Plan Cost?

Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium)

MyPriority HMO HolisCc Silver 2500 (Priority Health)

• Individual Premium (age 62, zip 48858) = $677 per month
• $2,500 Single DeducCble, $7,150 Out of Pocket Maximum
• $30 copay aeer deducCble for first two Primary Care visits. Specialist $50 aeer

deducCble

• $5 Generic Drugs Before DeducCble
• $60 preferred brand copay aeer deducCble, 20% coinsurance for specialty medicaCons

aeer deducCble

• 30% member coinsurance aeer deducCble for most other services

MyPriority HMO HSA Silver 1500 (Priority Health)

• Individual Premium (age 62, zip 48858) = $730 per month
• $1,500 Single DeducCble, $5,250 Out of Pocket Maximum
• 30% coinsurance aeer deducCble for most services
• $20 generic drugs aeer deducCble
• $60 preferred brand copay aeer deducCble, 20% coinsurance for specialty medicaCons

aeer deducCble

PRESENTED BY ADVANTAGE BENEFITS GROUP

8

Pr Pre-65 e-65

Re0ree Medical Op0ons – Post 65

• 1. Medicare
• 2. Medicare Advantage Plan
• 3. Medicare Supplemental Plan

PRESENTED BY ADVANTAGE BENEFITS GROUP

9

Po Post-65

Re0ree Medical Op0ons - Medicare

Who runs the Medicare Program?

• The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs
• Medicare. CMS is part of the U.S. Department of Health and Human Services
• Impact of recently enacted health reform on Medicare (2012)
• Enhanced prevenCve care services
• Subsidy and discounts for drugs while in the donut hole
• Resource sites:
• hmp://www.usprevenCveservicestaskforce.org/uspsn/uspsabrecs.htm
• www.medicare.gov
• www.medicarerights.org – detailed Cmeline
• www.kff.org – Kaiser Family FoundaCon

PRESENTED BY ADVANTAGE BENEFITS GROUP

10

Po Post-65

Medicare

Medicare Benefits Part A: Hospital Coverage Part B: Medical Coverage Part D: PrescripCon Drug Insurance Part C: Combines Part A, B and D into one package

PRESENTED BY ADVANTAGE BENEFITS GROUP

11

Po Post-65

Medicare Coverage Choices

Start Original Medicare Part A (Hospital Coverage) Part D (PrescripCon Drug Insurance) Medigap (Medicare Supplement Insurance) Policy Part B (Medical Coverage) Medicare Advantage Plan (like an HMO or PPO) Part C (Includes BOTH Part A (Hospital Coverage) and Part B (Medical Coverage) and usually Part D Part D (PrescripCon Drug Insurance) END

PRESENTED BY ADVANTAGE BENEFITS GROUP

12

St Step p 1: 1: De Decide ide ho how w you u wan ant t to get t your ur coverag age St Step p 2: 2: De Decide ide if if you u wan ant t to add add drug drug coverag age Step 3: Decide if you want to add suppleme mental coverage

If you jo join a Medicare Advantage Plan, you don’t need and ca can’t be sold a Medig Medigap ap p policy

• licy.

Po Post-65

Checklist: 5 Things to Do When You Get Medicare

1) Fill out an AuthorizaCon Form

Medicare can’t give personal health informaCon about you to anyone unless you give permission in wriCng first

2) Make a “Welcome to Medicare” Physical Exam Appointment

This free, one-Cme comprehensive exam is offered during the first 12 months you have Medicare

3) Sign up for MyMedicare.gov

MyMedicare.gov is a secure online service where you can access you personal Medicare informaCon 24 hours a day, every day

4) Choose and Join a Medicare Drug Plan (Part D)

If you’re new to Medicare, you have 7 months to join a Medicare drug plan

5) Download a Copy of “Your Medicare Benefits”

Medicare’s official “Your Medicare Benefits” publicaCon explains the rules about which health care services and supplies Medicare covers

PRESENTED BY ADVANTAGE BENEFITS GROUP

13

Po Post-65

Medicare Part A Helps Pay for:

Hospital stays ($1,316 deducCble, 1st 60 days/$329 per day – 61 to 90 days) Skilled nursing facility (SNF) care Long-term care hospitals Home health care Hospice care Blood For informaCon, call 1-800-MEDICARE

PRESENTED BY ADVANTAGE BENEFITS GROUP

14

Po Post-65

Paying for Medicare Part A

Most people receive Part A premium free People with less than 10 years of Medicare covered employment will pay a Part A premium For informaCon, call the Social Security AdministraCon (SSA)

• 1-800-772-1213
• 1-800-325-0778 for TTY users

PRESENTED BY ADVANTAGE BENEFITS GROUP

15

Po Post-65

Part B Helps Pay for:

Doctors’ services OutpaCent medical and surgical services and supplies DiagnosCc tests OutpaCent therapy OutpaCent mental health services PrevenCve health care services Other medical services

PRESENTED BY ADVANTAGE BENEFITS GROUP

16

Po Post-65

Paying for Medicare Part B:

Most Medicare Part B beneficiaries will pay a premium amount of $134.00 (higher income earners may pay more) in 2017. $183 per year deducCble 20% coinsurance for most services Some programs may help cover these costs AddiCon of PrevenCve Care Services

• Annual wellness exam
• Covers all wellness services/prevenCve care services as outlined by Health

Care Reform

PRESENTED BY ADVANTAGE BENEFITS GROUP

17

Po Post-65

Medicare Part D helps pay for:

PrescripCon drugs provided by Medicare Approved PrescripCon Drug Plans (PDP) or Medicare Advantage Plans (MA-PD) These plans offer negoCated discount prices based on a formulary with cost sharing Health Care Reform filled some or all of the donut-hole

• 50% manufacturers discount on brand name drugs
• Pay only 86% of plans cost for generic drugs

PRESENTED BY ADVANTAGE BENEFITS GROUP

18

Po Post-65

Paying for Medicare Part D

$0 or reduced premium, deducCble and co-insurance if one qualifies for the Low Income Subsidy (LIS) Must meet income and asset criteria Eligibility determined by Social Security AdministraCon (SSA)

PRESENTED BY ADVANTAGE BENEFITS GROUP

19

Po Post-65

The Affordable Care Act – Closing the Doughnut Hole BRAND NAME DRUGS

Health Care Reform closes the Part D Doughnut Hole (the gap in coverage during which people with Medicare must pay the full cost of their prescripCons out of pocket). HCR phases this out by decreasing the beneficiary’s share of drug costs during the doughnut hole unCl it reaches 25% in 2020 for both brand name and generic drugs

PRESENTED BY ADVANTAGE BENEFITS GROUP

20

Year PharmaceuKcal Manufacturer Discount Plan Responsibility (gov’t contribuKon)* Consumer Responsibility 2010

100% less the $250 rebate for brand name and generic drugs

2011 50% 50% 2012 50% 50% 2013 50% 2.5% 47.5% 2014 50% 2.5% 47.5% 2015 50% 5% 45% 2016 50% 5% 45% 2017 50% 10% 40% 2018 50% 15% 35% 2019 50% 20% 30% 2020 50% 25% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Po Post-65

The Affordable Care Act – Closing the Doughnut Hole GENERIC DRUGS

PRESENTED BY ADVANTAGE BENEFITS GROUP

21

Year Plan Responsibility (gov’t contribuKon)* Consumer Responsibility 2010 100% less the $250 rebate for brand name and generic drugs 2011 7% 93% 2012 14% 86% 2013 21% 79% 2014 28% 72% 2015 35% 65% 2016 42% 58% 2017 49% 51% 2018 56% 44% 2019 63% 37% 2020 75% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Po Post-65

Medicare Advantage

Medicare Advantage Plans are health plan opCons that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan (Parts A, B, and D). This coverage can include prescripCon drug coverage. Medicare Advantage Plans include:

• Medicare Health Maintenance OrganizaCon (HMOs)
• Preferred Provider OrganizaCons (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most

• f these plans, generally there are extra benefits and lower copayments

than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services

PRESENTED BY ADVANTAGE BENEFITS GROUP

22

Po Post-65

Medicare Advantage

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addiCon, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they

• ffer.

If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deducCbles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.

PRESENTED BY ADVANTAGE BENEFITS GROUP

23

Po Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP

24

Po Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP

25

Po Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP

26

Po Post-65

Shopping for Medicare Advantage Plans: www.Medicare.Gov

PRESENTED BY ADVANTAGE BENEFITS GROUP

27

Po Post-65

Shopping for Medicare Advantage Plans: www.Medicare.Gov

PRESENTED BY ADVANTAGE BENEFITS GROUP

28

Po Post-65

Re0ree Medical Resources

Isabella County Commission on Aging – (989) 772-0748 Your Personal Financial Advisor Your Personal Home and Auto Insurance Agent Advantage Benefits Group

• hmp://www.advantageben.com

Blue Cross Blue Shield of Michigan Medicare: 1-877-469-2583

• hmp://www.bcbsm.com/medicare/

Priority Health Medicare: 1-888-389-6676

• hmp://www.priorityhealth.com/medicare

Centers for Medicare and Medicaid Services

• www.cms.hhs.gov

The Official U.S. Government Site for People with Medicare

• www.medicare.gov

HealthSherpa

• www.healthsherpa.com

“Medicare and You”

• hmp://www.medicare.gov/PublicaCons/Pubs/pdf/10050.pdf

AARP

• hmp://www.aarp.org/health/medicare/

HealthCare.gov

• hmps://www.healthcare.gov

PRESENTED BY ADVANTAGE BENEFITS GROUP

29