2020 Medicare Basics Choosing the Right Medicare Coverage Option Presented by: Darrick Tarvin, License #0B64077 (CA Independent Licensed Insurance Broker/Agent) Tarvin Insurance Services, LLC This event is for educational purposes only. No plan-specific benefits or details will be shared.
Medicare Basics Today’s Program Date: 10/07/2020 I. What is Medicare? II. Enrolling into Medicare III. Two Main Choices for Medicare Plan Coverage: 1. Medicare Advantage Plans (HMO or PPO) 2. Medicare Supplement (Medigap) Plans IV. Medicare Part D Prescription Drug Coverage V. Extra Help VI. Enrollment Timeframes This event is for educational purposes only. No plan specific benefits or details will be shared.
I. What is Medicare? • Medicare (also called Original Medicare) is health insurance for persons: - Age 65 or older - Under age 65 that have received Disability benefits for 24 months - Any age for persons that have end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) • Medicare & You 2018, Pg. 15
Medicare Has Four Different Parts Part A - Inpatient Hospital Coverage* Part B - Medical & Outpatient Coverage* Part C - Medicare Advantage HMO and PPO Plans Part D - Prescription Drug Coverage * Only Medicare Part A and Part B will appear on your red, white and blue Medicare card. • Medicare & You 2018, Pg. 15
Medicare Card
Medicare Part A (In-Patient Hospital Coverage) • Most pay no premium for Medicare Part A. - Was paid for by you or your spouse through payroll taxes while working. • Helps cover inpatient care in hospitals, skilled level of nursing care in nursing facilities (not custodial or long- term care), hospice, limited part-time medically necessary home health care, and more. • Medicare & You 2018, Pg. 26, 29-33
2020 Medicare Part B (Medical & Outpatient Coverage) • You pay $144.60 per month for Medicare Part B, or more, depending on your income. - Premium deducted from your Social Security benefit or you’ll receive a quarterly bill in the mail. • Helps cover medically necessary doctor services, outpatient care, tests, durable medical equipment, limited home health care, preventive services, and more. • Medicare & You 2018, Pgs. 26, 27, 34-59
Higher Income Medicare Beneficiaries Pay More For Medicare Part B • If your filing status and yearly income reported on your tax return 2 years ago (in 2018) was above : $87,000 - Individual tax return $174,000 - Joint tax return - Your Medicare Part B premium will be higher. • Increase based on the “Income -Related Monthly Adjustment Amount” (IRMAA) • Medicare & You 2018, Pg. 26-27
2020 Medicare Part B IRMAA Premiums If your filing status and yearly income reported on your tax return 2 years ago (in 2018) was above : $8,000 up to $109,000 – Individual tax return $174,000 up to $218,000 – Joint tax return You pay $202.40 per month $109,000 up to $136,000 – Individual tax return $218,000 up to $272,000 – Joint tax return You pay $289.20 per month $136,000 up to $163,000 – Individual tax return $272,000 up to $326,000 – Joint tax return You pay $376.00 per month
2020 Medicare Part B IRMAA (cont.) If your filing status and yearly income reported on your tax return 2 years ago (in 2018) was above : $163,000 and less than $500,000 – Individual tax return $326,000 and less than $750,000 – Joint tax return You pay $462.70 per month $500,000 or above – Individual tax return $750,000 and above – Joint tax return You pay $491.60 per month • www.medicare.gov
II. Enrolling Into Medicare • Medicare usually starts on the first day of the month you turn age 65. - If receiving Social Security or Railroad Retirement, you’ll get your Medicare card in the mail 3 months before your 65 th birthday or 25 th month of disability benefits. - If you don’t receive your card in the mail, contact: Social Security: 800-772-1213 (TTY: 800-325-0778) Monday through Friday 7:00 am to 7:00 pm Railroad Retirement: 877-772-5772 (TTY: 312-751-4701) www.medicare.gov • Medicare & You 2018, Pg. 19
Enrolling Into Medicare (cont.) • If not receiving Social Security or Railroad Retirement benefits, you enroll with Social Security to get your Medicare card. • To enroll, contact: Social Security: 800-772-1213 (TTY: 800-325-0778) Monday through Friday 7:00 am to 7:00 pm Railroad Retirement: 877-772-5772 (TTY: 312-751-4701) www.medicare.gov • Medicare & You 2018, Pg. 20
Enrolling Into Medicare (cont.) • INITIAL ENROLLMENT PERIOD You may enroll into Medicare 3 months before the month you turn age 65, your birthday month, and up to 3 months after your birthday month. - If you enroll within 3 months before your birthday month, Medicare will start on the first day of your birthday month. - If you enroll during your birthday month or within 3 months after your birthday month, Medicare will start 1-3 months after signing up. • Medicare & You, 2018, Pg. 21
Enrolling Into Medicare (cont.) • GENERAL ENROLLMENT PERIOD January 1 st to March 31 st - If you didn’t enroll into Medicare during the Initial Enrollment Period, you can enroll between Jan. 1 st to March 31 st every year. - Coverage will start July 1 st - You may incur a late enrollment penalty • Medicare & You 2018, Pg. 22
Covered by Employer Group Plan • If covered by an employer-sponsored group health plan, based on current employment with 20 or more employees , you can delay enrollment for Medicare Parts A and B with no penalty . - However, when employment or group coverage ends, whichever happens first , you have 8-months to enroll for Medicare Parts A and B with no penalty. ✓ Check with your group plan on how Medicare works with your group coverage. • Medicare & You 2018, Pg. 21-22
Covered by Employer Group Plan and have Medicare Part A Only • You may delay enrolling in Medicare Part B with no penalty if group health plan is based on current employment and has 20 or more employees . - However, once employment or group plan ends , you have 8 months to enroll in Part B with no penalty . ✓ Check with your group plan on how Medicare works with your group coverage. • Medicare & You 2017, Pgs. 23, 24
Covered by Employer Group Plan and want to enroll in Medicare Part B • If you have Medicare Part A only and want to enroll in Medicare Part B , you need to complete two Medicare Part B enrollment forms (employer completes one form, you complete the other) and return the two forms to the Social Security office.
Health Savings Accounts • If you have a Health Savings Account (HSA) and group health insurance based on current employment, you may not want to join Medicare Parts A or B. ✓ Check with your group plan on how signing up for Medicare affects your Health Savings Account. • Medicare & You 2018, Pg. 23
Covered by COBRA • If you’re covered by COBRA (Consolidated Omnibus Budget Reconciliation Act) or a Retiree Plan: - After employment ends , you have 8-months to enroll into Medicare Part A or Part B with no penalty. ✓ Check with your plan administrator on how signing up for Medicare affects your Cobra plan. • Medicare & You 2018, Pg. 22
III. Two Main Choices for Medicare Coverage 1. Medicare 2. Medicare Supplement Advantage Plans (Medigap) Plans - HMO or PPO plans - You pay monthly - You pay $0 or low plan premiums monthly plan - Part D drug coverage premiums not included - Includes Part D drug coverage ✓ Must be enrolled in Medicare Parts A & B • Medicare & You 2018, Pg. 4
1. Medicare Advantage Plans (HMO or PPO) • Also known as Medicare Part C - Medicare Advantage Plans combine Medicare Parts A & B and Medicare Part D drug coverage into one plan . - Most plans include extra coverage like vision and hearing. - Dental is usually an optional benefit. • Medicare & You 2018, Pgs. 65-70
Medicare Advantage Plans HMO or PPO (cont.) - Each Medicare Advantage Plan has different costs, copayments, coinsurance, out-of-pocket yearly maximums, and drug coverage. - Prior authorization required for certain procedures. - Plans provide worldwide coverage for emergency and urgently needed services. - Benefits can change every year. • Medicare & You 2018, Pgs. 65-70
HMO Medicare Advantage Plans • You must get your care from the plan’s network of providers and hospitals (except for emergency or urgent situations) . – You select a hospital, medical group, and primary care physician (PCP) from the plan’s network of providers in your service area. – Referrals are required to see specialists. • Medicare & You 2018, Pg. 71
HMO Medicare Advantage Plans (cont.) • HMO plans have $0 or low monthly premiums. • You must pay your Medicare Part B premium. • Pay copayments or coinsurance for authorized services received from in-network or out-of-network providers. • Pay full cost for non-authorized services, except for emergency and urgent care. • Part D drug coverage included in most plans. • Medicare & You 2018, Pg. 71
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