Unnamed B/D What is it? Do I need it? How do I get it? How much - - PowerPoint PPT Presentation

Unnamed B/D

What is it? Do I need it? How do I get it? How much does it cost? What will it cover? Putting the parts together What do my healthcare choices look like? Go relax

Medicare

What is Medicare? Federal Health Insurance…

• Not intended to pay 100% of health care costs;
• Designed for US-based healthcare;
• Who is eligible?
• Age 65 and older
• Disabled – any age
• Diagnosed with End Stage Renal Disease (ESRD) or ALS

Is Medicare’s Part A mandatory at age 65?

Medicare is not an automatic ‘yes’ as you turn 65

So you are ELIGIBLE for Medic icare…

Eligible for retiree coverage?

Actively employed? Small employer? Marketplace/ACA??

I I need Medicare….

COBRA

Where do we go for advice?

Medicare PART A

• “Room and Board” coverage – covers

hospitalization, skilled nursing, hospice, some home health care;

• Deductible for 2019 is $1,364 – per 60

day benefit period;

• Coinsurance for hospital days 61-90 is

$341;

• Coinsurance for each day 91-150 is $670;
• Does NOT cover long term care expenses

Medicare PART B

• Has a monthly premium
• Annual deductible of $185
• Covers:
• Physician Services;
• Outpatient Services;
• Durable Medical Equipment;
• Pays 80% (YOU are responsible

for 20%);

• HSA may be used to pay Part B

Premiums.

○ Most routine Dental Care ○ Routine Eye Care ○ Routine Hearing Tests ○ Custodial Care (Bathing, dressing, eating, etc)

○ Long Term Care

○ Medical evacuation

Medicare does NOT cover

How much will I pay for Part B?

Sounds easy but….

“seven months” is just part of the story

Procedure Medigap (Plan G) Medicare Advantage (PPO) Monthly Premium $115/month $14/month Deductible $185 $80 Max out of pocket (MOOP) $185 $6000/$8100 PCP/Specialist Visit $0/$0 $20/$50 Hospitalization (Inpatient) $0 $260/day (days 1-6) Hospitalization (Outpatient) $0 $175 Emergency Care $0 $80 Skilled Nursing (days 21-100) $0* *$160/day Physical Therapy $0 $40/visit Chemotherapy $0 20% Dental Coverage None $0 co-pay for 1 exam and 1 cleaning per year. 50% the cost

• f 1 bitewing x-ray

Vision Coverage None $50/visit Cost of Adding drug plan

• Approx. $20/month

$0/month

Example for 65 Year old in Zip Code 48167

Medigap Policy Medicare Advantage Plan

• LOW This consists of a Medigap plan

plus a Part D prescription Drug plan

• MEDIUM This consists of a Medigap plan

plus a Part D prescription Drug plan and a dental, vision and hearing solution.

• HIGH This consists of a Medigap plan

plus a Part D prescription Drug plan, a dental, vision and hearing solution, plus a $10-20,000 cancer policy.

• LOW This consists of choosing a MAPD

plan in your area.

• MEDIUM Enrolling into the MAPD plan

and adding a hospital indemnity plan to fill in some co-pay “holes”

• HIGH This consists of enrolling into the

MAPD, adding a hospital indemnity plan and also in adding a policy to cover cancer, heart attack and stroke concerns (i.e. costs)

Pre-existing conditions and Medicare

Source, Costco Connection January 2019

Subtitle A—Medicare Reforms Sec. 401. Medigap. Some Medigap plans on the market today provide first-dollar coverage for beneficiaries – which means the plan pays the deductibles and co- payments so that the beneficiary has no out-of- pocket costs. Beginning in 2020 new plans sold would limit coverage to costs above the amount

• f the Part B deductible (currently $147 a year).

Prepared by the Staff of the House Energy and Commerce and Ways and Means Committees, March 24, 2015

Plan F and Plan C and 2020

Deductible of $185 in 2019

Medigap

Medicare Advantage

✓ Choice of physician, hospital, etc. ✓ Travel within US ✓ Budgeting ✓ Low Medical Costs ✓ Flexibility ✓ Okay with higher monthly premiums ✓ Can’t afford higher Medigap premiums ✓ VA system users ✓ Just fine with networks ✓ “I’m healthy and staying that way” ✓ Little travel plans

Part D, Prescription drug plans

• Penalties if not secured;
• What about a horrible diagnosis;
• Least expensive plan today is

$14.50;

• 29 plans in Michigan.

95%

Timing

1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 30 M T W T F S S 2 15 29

January

31 1 2 30 31

October

15

December

7

Medicare Advantage and Part D drug plans

* * Medigap – 365 days a year

1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 30 M T W T F S S 2 15 29

February

31 1 2 30 31 1 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 30 M T W T F S S 2 15 29

March

31 1 2 30 31

Part B premiums 1,626 Medigap policy 1,500 Part B deductible 185 Part D drug plan 300 Drug co-pays 300 Dental and vision - 2 teeth cleaning, 1 eye exam 1,000 $ 4,911 per person

Assumptions

• Really good to excellent health;
• Not higher income surcharged couple;
• Never a crown/root canal/hearing aid for either

party;

• Never required any form of custodial or long term

care;

• Zero inflation.

$10,000 per couple x 20 years = $200,000 Over 170k MAGI = $220,000 Over 216k MAGI = $265,000

Why the ‘turning 65’ conversation is so important to have at age 64.5

(According to your Boomer Health Group team)

Joanne Giardini-Russell

Founder, Boomer Health Group

The 64.5 conversation – you can AVOID

• Health Savings Account contribution issues;
• Under 20 employer size lack of Part B issues;
• Comparing workplace insurance to Medicare;
• Pre-existing condition protection;
• Part B penalty situations;
• Cobra coverage issues;
• NOT having LTC solutions in place.

Questions?