Medicare 101 - Tennessee Medicare Assistance

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					      Medicare 101

AREA AGENCY ON AGING AND DISABILITY
 STATE HEALTH INSURANCE ASSISTANCE
          PROGRAM (SHIP)
                2012
          Welcome to Medicare 101

 What is Medicare
 Enrolling in Medicare
 Your Medicare Benefits
 Medicare Supplemental Benefits
 Medicare Advantage Plans
 Part D Prescription Coverage
 Medicare With Other Insurances
                   What is Medicare?

 Health Insurance for
   People 65 years of age and older

   People under age 65 with certain disabilities

   People of all ages with End-Stage Renal Disease

 Run by the Centers for Medicare & Medicaid Services
  (CMS)
 Sign up with the Social Security Administration or
  Railroad Retirement Board
The Medicare Card
                     Medicare Coverage Basics

                                            •Inpatient hospital care
          Part A                            •Skilled nursing care
                                            •Home health care
See p. 32 of Medicare and You Handbook
                                            •Hospice care


                                            •Doctors’ services and outpatient care
          Part B                            •Preventive services
                                            •Diagnostic tests
   See p. 36 of Medicare and You Handbook   •Durable medical equipment


                                            •Outpatient prescription drugs
          Part D                            •Shingles vaccination

   See p. 84 of Medicare and You Handbook
                Applying for Medicare

 Apply 3 months before age 65
   Don’t have to be retired

   Contact the Social Security Administration



 Enrollment automatic if you get Social Security or
  Railroad Retirement Benefits
                  Medicare Part A


 Most people don’t pay a monthly premium for Part A
 People with less than 10 years of Medicare-covered
  work can still get Part A
 For more information about Part A eligibility, call
  Social Security
            Enrolling in Medicare Part B


 Initial Enrollment Period (IEP) – 7 months
   7 months starting 3 months before month of eligibility



 General Enrollment Period (GEP)
   January 1 – March 31; Coverage starts July 1
           Enrolling in Medicare Part B

 Part B premium - $99.90 per month


 Higher premiums if income > $85,000 per year
   Will depend if filing separately or joint

   Premium can be as high as $319.70/month

   Social Security determines premium by income tax records
             Paying the Part B Premium

 Taken out of monthly payments
   Social Security

   Railroad retirement

   Federal government retirement

   May be paid quarterly directly to CMS by check



 For more information about premiums, call
   SSA, RRB or Office of Personnel Management
                  Medicare Choices

 Original Medicare Plan OR


 Original Medicare plus
   Retiree Coverage

   Medicare Supplemental Insurance (Medigap)

   Income-based assistance programs OR



 Medicare Advantage Plan
                     Original Medicare Plan
                      Part A + Part B only

 Traditional way of getting Medicare through the
  federal government
 Use any provider that accepts Medicare
 You are responsible for
    Part A - $1,156 hospital deductible (1-60 days)
        Additional costs (coinsurance) after 60 days
    Part B
      $140 annual deductible
      20% coinsurance or copayment for most Part B services
      Original Medicare Plan + Medigap


 Health insurance sold by private company
 Use any provider that accepts Medicare
 10 standard plans
 Cover “gaps” in Original Medicare plan
   Deductibles, coinsurance, copayments

 Must pay monthly premium to the plan in addition
 to your Part B premium ($99.90)
        Original Medicare Plan + Medigap


 All Medigap plans include core benefits
   Hospital coinsurance

   365 days full hospital coverage in addition to days covered by
    Original Medicare
   20% copayment on doctor’s services

   Cost of first 3 pints of blood each year



 Plans may offer additional benefits
      Original Medicare Plan + Medigap

 Monthly premiums vary according to plan
 Plans are standardized
 Costs are different between companies
 Most popular plans are C, F, G & N
 You have rights and protections
       Original Medicare Plan + Medigap


 Prices of Medigap plans will vary
   Benefits the same, but pricing is not



 Pricing Structure
   Attained age

   Issue age

   Community rated
     Medicare Prescription Drug Coverage


 Coverage began January 1, 2006
 All people with Medicare can join a plan
 Provided through
   Medicare Prescription Drug Plans

   Medicare Advantage Plans
       Medicare Prescription Drug Plans

 Must offer standard (minimum) drug benefit
   In 2012, you may pay:
    Monthly premiums
    Annual Deductibles (no more than $320)
    Copayments or coinsurance
    Very little after $4,700 out-of pocket

 May offer more benefits
 Can get plan information and costs
   www.medicare.gov

   1-800-MEDICARE (1-800-633-4227)

   1-877-801-0044 SHIP
Medicare Drug Coverage Enrollment Periods


 Initial Enrollment Period (IEP)
   7 months starting 3 months before month eligible for Medicare

 Annual Coordinated Election Period (AEP)
   October 15 through December 7 each year

   You can join, drop or switch coverage
       Change is effective January 1 of the following year
 Special Enrollment Period (SEP)
               Minimizing Part D Cost

 Look at the total of these costs
   Monthly premium

   Annual deductible

   Monthly copays at pharmacy

 Prescription Plan Finder Tool
   www.medicare.gov
     Yourself
     State Health Insurance Assistance Program (SHIP)
     1-800-MEDICARE (1-800-633-4227)
             Extra Help with Drug Costs


 For many people with limited income and resources


    Income limit $1,361/month (one person) or $1,839/month
     (married couple)
    Resource limit $13,070 (one person) or $26,120 (married
     couple)
              Medicare Advantage Plans

 Health insurance plans purchased from private
  companies
 Part of the Medicare Program
    Sometimes called Part C
 Private company administers your Part A & Part B
 benefits
    Not secondary coverage
    You haven’t “lost” your Medicare
              Medicare Advantage Plans

 Get all Medicare covered services through plan
 May include prescription drug coverage
 May have to see certain doctors or go to certain
  hospitals to receive care
 Some plans may include benefits that Original
  Medicare does not
    Vision, dental, hearing
           Medicare Advantage Plans


 Must continue to pay Part B premium


 May pay additional monthly premium


 Must pay other out-of-pocket costs
              Medicare Advantage Plans


 Eligibility requirements


    Live in plan service area
    Enrolled in Medicare Part A & B
    Most plans will not accept those with End Stage Renal Disease
     (ESRD)
              Medicare Advantage Plans

 Can join a Medicare Advantage Plan


    When first eligible for Medicare

    During specific enrollment periods
      Annual Enrollment Period
        October 15-December 7

      Special Enrollment Periods
           Medicare Advantage Plans


 Health Maintenance Organization (HMO)
 Preferred Provider Organization (PPO)
 Private Fee-for-Service (PFFS)
 Special Needs Plans (SNP)
 Medical Savings Accounts (MSA)
 Original Medicare Plan + Retiree Coverage


 Retiree coverage is based on a former job
 Based on your own or spouse’s employment
 Retiree Coverage always secondary to Medicare
   Current employer coverage not always secondary

 Be careful about dropping this coverage
   You may not be able to get it back
 Original Medicare Plan + Retiree Coverage


 Retiree coverage varies from one employer to
  another
 Read coverage information carefully to see how it
  works with Medicare
 Retiree benefits can change from year to year
          Original Medicare Plan + Other


 Cobra
 VA
 TriCare
              Medicare Fraud and Abuse

 Medicare fraud is purposely billing Medicare for
 services that were never provided

    Billing Medicare for services you never got
    Billing Medicare for services that are different than what you
     received
    Use of someone else’s Medicare card to get medical care,
     supplies or equipment
    Billing Medicare for home medical equipment after it has been
     returned
             For More Information

 If you suspect fraud: Call SMP (Senior Medicare
  Patrol) at: 1-866-836-7677
 www.medicare.gov
 State Health Insurance Assistance Program (SHIP)
  at: 1-877-801-0044
 1-800-MEDICARE (1-800-633-4227)
               What are Your Next Steps?

 More Research?
 Individual Appointments
    Come to our Lifetime Learning Workshops for more detailed info.
     Registration will be from 1pm-2pm on August 7th at the Conference
     Center.
    Department of Human Services
    Social Security Administration
    SHIP Counselor or volunteer
    Insurance agent
 Enrollment – Part D, Medigap, MA
    Yourself
    Friend or relative
    SHIP
             Contact SHIP or SMP

 Kristy Adams, SHIP Coordinator
   1-877-801-0044

   kadams@ucdd.org



 LaNelle Godsey, Statewide SMP Director
   1-866-836-7677

   lgodsey@ucdd.org

				
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