Welcome to Medicare: A,B,C and D

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Welcome to MedicareA,B,C and D

• Rhonda Whitenack, Public Affairs Specialist,
• Social Security Administration
• Robert Grams, Health Insurance Counselor
• Metropolitan Area Agency on Aging and MN SHIP

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What is Medicare?

• Health Insurance Program for
• People age 65 and older
• People under 65 with a certified disability
• People of any age with End-Stage Renal Disease
  (ESRD)
• Permanent kidney failure or kidney transplant
• People of any age with ALS (Lou Gehrigs Disease)
  

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Medicare Parts A thru D

• Part A Hospital Insurance
• Part B Medical Insurance
• Part C Medicare Advantage
• Option that replaces Original Medicare (Parts A
  and B)
• Part D Prescription Drug Coverage
• Through a Medicare Advantage plan or a Stand
  Alone Prescription Drug Plan (PDP)

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Medicare Card (Front)
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Medicare Card (Back)
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Medicare Eligibility Age 65 and Older

• May receive Part A premium-free if
• Worked 40 quarters (at least 10 years)
• Spouse of someone with 40 work quarters
• May purchase Medicare
• U.S. citizens who have not worked 40 quarters
• Legal aliens admitted for permanent residence who
  have lived in the U.S. for 5 consecutive years
• Also known as voluntary enrollees

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Other types of Medicare Eligibility

• Person under 65 who has received 24 months of
  Social Security Disability benefits
• Person of any age with End Stage Renal Disease
  who has had a kidney transplant or who receives
  regular dialysis
• Person of any age with ALS (Lou Gehrigs Disease)

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Types of Medicare Enrollment

• Initial Enrollment
• Special Enrollment
• General Enrollment

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Initial Enrollment Period

• 7 Month Period
• 3 months before you are eligible
• The month you are eligible
• The month you turn 65 OR
• The 25th month you are certified disabled
• 3 months after you are eligible

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How do I enroll?

• If you already receive Social Security or RR
  Benefits
• Entitled to Medicare the first of the month you
  turn 65
• Do not need to do anything to enroll
• A card will be mailed three months before you
  turn 65
• If you are not receiving Social Security or RR
  Benefits
• Apply online or visit your local Social Security
  Office

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When to Waive Part B

• You can delay enrolling into Part B and avoid
  paying the monthly premium until you need it if
  you are age 65 or older and have health coverage
  through your or your spouses employer or union
• Must contact Social Security and inform of your
  decision
• Have a clear understanding of employers plan
  coverage before making this decision
• Must be actively employed

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Special Enrollment Period for Part B

• Can enroll in Part B anytime while covered under
  the group plan
• OR
• During the 8 month period that begins the month
  active employment ends or when the group health
  coverage ends, whichever comes first

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General Enrollment Period

• January 1st through March 31st of every year
• Coverage will begin the following July 1st
• Part A Penalty 10 for voluntary enrollee who
  does not elect Part A during initial or Special
  Enrollment Period
• Part B Penalty 10 of the Part B premium charged
  for every 12 months one was late enrolling

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Medicare Part A

• In-patient hospital care
• Skilled nursing facility (SNF) care
• Home health care
• Hospice Care

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Medicare Part A Premium

• Most receive Part A premium-free because they
  have at least 40 quarters or work credits of
  Medicare-covered employment
• Voluntary enrollees pay
• 248/month if have 30 39 quarters of employment
• 450/month if have less than 30 quarters of
  employment
• 2012 cost sharing to be announced

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Medicare Part A Cost of Coverage

• Hospital Coverage
• Deductible for days 1 60 1,132
• Days 61 90 283 co-payment per day
• Days 90 150 566 co-payment per day
• Skilled Nursing Facility Coverage
• No costs for days 1 20
• Days 21 100 141.50 per day
• Home Health Care Coverage and Hospice Coverage
• No cost for covered services
• (2012
  cost sharing to be announced)

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Medicare Part B

• Physician Services
• Outpatient Services
• Ambulance Services
• Durable Medical Equipment (DME)

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Medicare Part B Cost Sharing

• Premium 115.40
• Those on Medicare before 2010 who had their
  premium deducted from the Social Security check
  continue to pay 96.50, unless income is greater
  than 85,000. 2010 enrollees continue to pay
  110.50 unless income is greater than 85,000.
• Deductible 162
• Co-insurance 20 for most services
• 45 for mental health services
• (2012 cost sharing to be announced)

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Medicare Part B Premium
Income Threshold Part B Individual Monthly Premium
Less than or equal to 85,000 (170,000 couples) and did have Social Security withhold Medicare Part B premiums in 2010 96.50
Less than or equal to 85,000 (170,000 couples) and did not have Social Security withhold Medicare Part B premiums in 20 115.40
Greater than 85,000 and less than or equal to 107,000 (170,000 to 214,000 couples) 161.50
Greater than 107,000 and less than or equal to 160,000 (214,000 to 320,000 couples) 230.70
Greater than 160,000 and less than or equal to 214,000 (320,000 to 428,000 couples) 299.90
Greater than 214,000 (428,000 couples) 369.10
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Medicare Covered Preventative Services

• NEW Annual Medicare Wellness Visit
• Welcome to Medicare physical
• Bone Mass Measurements
• Cardiovascular Screening
• Colorectal Cancer Screening
• Diabetes Screening
• Immunizations Flu, Hepatitis B, Pneumococcal
• Mammograms
• Pap Test and Pelvic Exam
• Prostate Cancer Screening

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Medicare Covered Items and ServicesListing
limited to frequently asked about items and
services

• Ambulance Services
• when medically necessary
• Diabetic Supplies
• glucose testing monitors, test strips, etc.
• Durable Medical Equipment
• walkers, wheelchairs, oxygen
• Emergency Room Services
• Eyeglasses
• After special cataract surgery

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Medicare Covered Items and ServicesListing
limited to frequently asked about items and
services cont.

• Foot Exams/Treatment
• If diabetes related meet certain conditions
• Kidney Dialysis Services
• Prescription Drugs
• A limited number of drugs are covered under Part
  B
• Prosthetic/Orthotic Items
• Second Surgical Opinions
• Tests
• X-rays, MRIs, CT Scans, EKGs

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Services Not Covered by Medicare

• Dental Care and Dentures
• Health care outside the U.S.
• Hearing Aids and Hearing Exams
• Orthopedic Shoes
• Routine foot care, eye care and physical exams
• Long-term Care
• Shots except those for prevention

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Medicare Summary Notice (MSN)

• In Original Medicare, an MSN is issued every 3
  months if Part A or Part B services were provided
• It is not a bill
• Shows the amount that will be owed to the
  provider after Medicare has paid
• You may be billed field
• Includes instructions on how to file an appeal

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Medicare Summary Notice and Medicare Fraud

• Review MSN when received for
• Procedure/services provided
• Amount you may owe the provider
• Provider name
• Dates of Service
• You may appeal discrepancies within 120 days
• If you feel you have been a victim of fraud and
  intentionally billed incorrectly
• Call the provider to discuss issue
• Call the Senior LinkAge Line to file a report

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Original Medicare

• Medicare Part A and B
• Fee-for-service plan managed by Federal
  Government
• Use your red, white and blue card when receiving
  services
• Can go to any doctor or hospital that accepts
  Medicare
• Must pay deductibles and co-insurance or
  co-payment amounts

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Medigap Insurance

• Supplements Original Medicare
• Must have Parts A and B to buy a Medigap policy
• Sold by private insurance companies
• Minimum benefit levels are mandated by Minnesota
  law
• Covers costs or gaps in coverage that Medicare
  does not pay
• Must pay a monthly premium

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Standardized Medigap Plans in Minnesota

• Basic Plan Coverage
• Medicare Part A co-insurance
• Part B co-insurance
• Blood 1st three pints/year
• 80 of emergency foreign travel
• 45 of most outpatient mental health services
• 20 of physical therapy
• State mandated benefits

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Standardized Medigap Plans in Minnesota

• Optional Riders
• Medicare Part A deductible Part B annual
  deductible
• Excess Rider Preventive Care Rider
• Additional Medigap Policies
• Extended Basic Plan N
• Plan K High Deductible Plan F
• Plan L
• Plan M

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When to Buy a Medigap Policy

• Open Enrollment Period
• Starts the month you are 65 or the 25th month of
  certified disability and enrolled in Part B
• Lasts 6 months
• During the Open Enrollment Period the company
  cannot
• Deny you any Medigap policy it sells
• Make you wait for coverage to start, with some
  exceptions
• Charge you more for a policy because of existing
  health problems

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Cost Plans

• Available in limited areas
• May be able to join even if you only have
  Medicare Part B
• Can join anytime plan is accepting new members
• Can leave and return to Original Medicare at any
  time
• May see a non-network provider
• Services are then covered under Original Medicare
• Can get Medicare prescription drug coverage

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Medicare Part C Medicare Advantage

• Provided by private insurance companies approved
  by Medicare
• May only receive coverage through the Medicare
  Advantage plan
• Most charge a monthly premium
• Must still pay your Medicare Part B premium
• May include Part D
• May include extra benefits, such as hearing and
  vision

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Medicare Advantage Plans cont.

• In some cases, you must take the drug coverage
  that is included with the plan
• You may not choose a Stand Alone Part D plan
• Cannot have a Medigap policy
• Are responsible for the co-pays and co-insurance
  set by the plan
• May have a network of doctors you must use

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Enrollment in a Medicare Advantage Plan

• Must live in the service area of the plan you
  would like to join
• Must have Medicare Part A and B
• Cannot have End-Stage Renal Disease
• NEW Beginning Fall 2011, the Annual Open
  Enrollment Period will change to October 15
  December 7
• (plan effective date January 1, 2012)

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Medicare Advantage Disenrollment Period

• January 1, 2012 February 15, 2012
• During this new Medicare Advantage Disenrollment
  period
• Beneficiaries can disenroll from a Medicare
  Advantage plan and switch to Original Medicare
• Beneficiaries can enroll in a Stand Alone PDP
  plan when returning to Original Medicare
• Beneficiaries enrolled in a Medicare Advantage
  plan cannot switch to another Medicare Advantage
  plan
• Beneficiaries in Original Medicare cannot enroll
  in a Medicare Advantage plan

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Medicare Advantage Plan Options in Minnesota

• Health Maintenance Organizations (HMO)
• Preferred Provider Organization Plans (PPO)
• Private Fee-for-Service Plans (PFFS)
• Special Needs Plans (SNPs)

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Things to Consider When Choosing a Plan

• Cost
• Benefits
• Doctor Hospital Choice
• Travel
• Prescription Drugs
• Pharmacy Choice
• Quality of Care

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Medicare Part D Prescription Drug Coverage

• Began January 1, 2006
• Coverage is through a Stand Alone prescription
  drug coverage or as part of a Medicare Advantage
  Plan
• Plans are offered by private insurance companies
  approved by Medicare
• Separate monthly premium for most plans
• Must have Medicare Part A, Part B or both
• Is a voluntary benefit
• However, if you do not enroll when first eligible
  you may face a penalty later

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Medicare Part D Enrollment Periods

• Initial Enrollment Period (IEP)
• 7 month period starting 3 months before the month
  of 65th birthday or 25th month of certified
  disability
• Annual Open Enrollment Period (OEP)
• November 15 though December 31
• Coverage is effective January 1 of following year
• Beneficiaries may join, drop or switch coverage
• NEW! Beginning Fall 2011, Annual Election Period
  will change to October 15 December 7
• Special Enrollment Period (SEP)
• Moving, plan leaves the market, dual eligible,
  loss of creditable coverage

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Late Enrollment Penalty

• People who do not join a Part D plan when they
  are eligible may pay a penalty
• Add 1 of the national base premium for each
  month you should have had a plan, but did not
  enroll
• Must pay the penalty as long as you are enrolled
  in a Part D plan
• Penalty does not apply to those who have
  creditable coverage or if you have dual
  eligibility
• You are a dual eligible if you receive Medicare
  and are on Medical Assistance or a Medicare
  Savings Program

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2012 Standard Benefit for Medicare Part D You Pay

• Monthly Premium
• Deductible 320
• Initial Coverage Limit 25 co-insurance per
  prescription drug
• Donut Hole 100 of prescription drugs once you
  and the plan both pay 2,930.01. 50 discount on
  brand name and 14 discount on generic drugs
  purchased while the beneficiary is in the donut
  hole.
• Catastrophic Coverage 5 co-insurance per drug
  after you pay 4,700 out of pocket
• Plans may have a lower deductible or set their
  own co-pays/co-insurance. It is important to
  compare plans when deciding.

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Medicare Part D Premiums

• Higher income beneficiaries will pay higher
  Medicare Part D monthly premiums
• 85,000 individuals
• 170,000 couples
• Not indexed for inflation
• Waiting for additional information from CMS

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2011Part D Standard BenefitNo Extra Help (LIS)
Beneficiary Costs
Part D Plan
Donut Hole 50 discount on Brand Name drugs 7
discount on co-insurance for generic drugs
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2012 Part D Standard Benefit No Extra Help (LIS)
Beneficiary Costs
Part D Plan
100 with discounts
Donut Hole 50 discount on Brand Name drugs 14
discount on co-insurance for generic drugs
75
25
320 Deductible
Monthly Premium
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Extra Help Paying for Part D Costs

• Administered by Social Security Administration
• Helps pay for Medicare Part D cost sharing
• Full and Partial LIS are available
• Must complete application and send to SSA or
  complete online application at www.ssa.gov
• Income must be below 150 of FPG or 1,362/single
  or 1,839/couple
• Assets must be below 12,640 for single and
  25,260 for a couple

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Additional Extra Help is Available

• Medicare Savings Programs
• QMB
• SLMB
• QI-1
• Medical Assistance
• Send completed application to your county
• Application assistance is available through
  Senior LinkAge Line

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MinnesotaHelp Network is here to help you

• Senior LinkAge Line 1-800-333-2433
• Disability Linkage Line 1-866-333-2466
• Veterans Linkage Line 1-888-LinkVet
• www.MinnesotaHelp.info
• http//longtermcarechoices.minnesotahelp.info/
• Local community based sites throughout Minnesota

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Questions or Comments?