0HGLFDUH - Indiana University Bloomingtonv Z v P o v À Ç Ç µ ] v P ] ( ] ] u ... 10/12/2018 11:21:10 AM

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Medicare 2018Medicare 2018

Understanding MedicareUnderstanding Medicare

+WHAT IS SHIP?

State Health Insurance Assistance Program

Federally Fund

Free service

Unbiased assistance and information on Medicare

No affiliation with any insurance company

Updated 3/7/2017 AMS

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+Medicare – What is it?

Health insurance for people Age 65 and older

Under age 65 with certain disabilities

Any age with End-Stage Renal Disease (ESRD)

Administered by Centers for Medicare & Medicaid Services (CMS)

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+A-B-C-D

Medicare has four parts

Part A – Hospital Insurance

Part B – Medical Insurance

Part C – Medicare Advantage Plans

Part D – Prescription Drug Coverage

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CHOICES



+Original Medicare

Go to any provider that accepts Medicare in USA or US Territories

COSTS: Part A - free for most people

Part B premium in 2018 $134.00 for new beneficiaries, those not collecting Social

Security, dual eligible individuals who’s premium is paid by Medicaid or beneficiaries who pay an additional income-related premium

Deductibles and Coinsurance/copayments for Part A an Part B

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+Medicare – Enrollment

Apply as early as 3 months before age 65 Do not need to be retired-Must have creditable health insurance to deny

Might not want to enroll in all parts of Medicare

See your benefits administrator to see if there are restrictions and/or requirements

Auto Enrollment If you are already receiving Social Security benefits before age 65

OR If receiving Railroad Retirement benefits THEN

Social Security will send you your card in the mail 3 months prior to 65th

birthday month.

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+Medicare Part A –Hospital Coverage

Part A premium is free for most people-Some may choose to pick up Part A only due to no cost.

Less than 10 years/40 quarters of Medicare-covered employment can pay a premium to get Part A ~$232-$422/mo

Coverage Hospital inpatient care, skilled nursing facility (SNF) care, home health care,

hospice care, and blood work.

Charges based on “benefit period” Inpatient hospital care and SNF services Begins day admitted to hospital and ends when no care received in a

hospital or SNF for 60 days in a row. You pay deductible for each benefit period, but there is no limit to number

of benefit periods

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+Paying for Hospital Stays

For inpatient Hospital stays in 2017 you pay

$1,340 total deductible for days 1 – 60 $335 co-payment per day for days 61 – 90

$670 co-payment per day for days 91 – 150(including 60 lifetime reserve days)

Beneficiary pays ALL costs for each day beyond 150 days

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+Medicare Part B - Coverage

Doctors’ services

Outpatient medical and surgical services and supplies

Diagnostic tests

Outpatient therapy

Outpatient mental health services

Some preventive health care services

Advanced Directives Counseling

Other medical services

Clinical laboratory tests

Home health services (not covered under Part A)

Durable medical equipment

Outpatient hospital services

Blood Work

Ambulance service, if other transportation would endanger your health

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+Medicare Part B - Paying the Premium

IRMAA 2018

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Yearly Income FiledIndividual Tax Return (2016)

File Joint Tax Return (2016)

Premium (2018)

$85,000 or less $170,000 or less $134.00

$85,001-$107,000 $170,001-$214,000 $187.50

$107,001-$133,000 $214,001-$267,000 $267.90

$133,001-$160,000 $267,001-$320,000 $348.30

$160,001 or more $320,001 or more $428.60



+Medicare Part B - Enrollment General Enrollment Period (GEP) January 1 through March 31 each year Coverage effective July 1 Premium increases 10% for each 12-month period you were eligible

but did not enroll

Special Enrollment Period You have a Special Enrollment Period to sign up for Part A and/or

Part B any time as long as you or your spouse (or family member if you're disabled) is working, and you're covered by a group health plan through the employer or union based on that work.

This will be an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first. Usually, you don't pay a late enrollment penalty if you sign up during a Special Enrollment Period.

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+Medicare Part B – Cost of Services

In Original Medicare you payYearly deductible $183 in 2018

80% covered by Medicare, 20% co-pays for most services

No cap on 20% beneficiary is responsible for Some co-payments

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Is there way to cover the 20% I am responsible for?

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+Medigap - Overview

Health insurance policies

Sold by private insurance companies, plans are A through N

Plans are Standardized from company to company

All Medigap plans must be approved by the IDOI

Cover “gaps” in Original Medicare

Costs and availability may vary by state, you must purchase a plan where you live

Does not include any drug plan or prescription coverage

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+Medigap – How It Works

Only works with Original Medicare Don’t need Medigap if in MA Plan or other

Medicare plans

Can go to any doctor, hospital, or provider that accepts Medicare

You pay a monthly premium to the insurance company

A list of all Medigap plans is located on the SHIP website (or via packet in the mail)

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+Medigap Plans-

Enrollment

Sign Up during initial enrollment period or special enrollment period (due to you or spouse’s loss of coverage i.e. retirement)

Guaranteed Issue Period

Once beneficiary is 65 AND has Part B, Guaranteed Issue Period Starts

No Additional Underwriting or probationary periods for preexisting conditions, cannot be denied.

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+Medicare Part D –

Rx Coverage Available for all people with Medicare

Requirements:

Have Medicare Part A, Part B, or both

Live in plan service area

Provided through

Medicare Prescription Drug Plans

Medicare Advantage Plans

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+Medicare Part D – Costs in 2018

Costs vary by plan, most people will pay: Monthly premium (national average, $35.63) Annual Deductible, up to: $405 After the deductible for the next $3,750, you will pay 25% and the plan

will cover 75% of your drug costs. When your total drug costs reach $3,750 your initial drug plan

coverage will end, NOW ENTER THE DONUT HOLE Part D enrollees will pay 35% of the total cost of their brand-name

drugs and pay a maximum of 44% co-pay on generic drugs while in the donut hole. The full retail cost of the drugs will still apply to getting out of the donut hole.

Once your total out of pocket drug costs (not including the monthly premiums) reach $5,000 your catastrophic coverage will begin.

Your plan will cover up to 95% of your drug costs. You will pay either $3.35 for generic or $8.35 for brand name drugs or 5% of the cost which ever is greater.

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+Medicare Part D - Enrollment

When first eligible for Medicare 7 months, beginning 3 months before first month

of Medicare eligibility

During specific enrollment periods Annual Coordinated Election Period

October 15th – December 7th each year

Special Enrollment Periods (such as retirement)

Some people are enrolled automatically

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+Late Enrollment Surcharges/Penalties

The late enrollment penalty is calculated by multiplying 1% of the national base beneficiary premium ($35.02 in 2018) times the number of full, uncovered months that you were eligible but didn’t join a Medicare drug plan and went without other creditable prescription drug coverage.

This amount is rounded to the nearest $.10 and added to your monthly premium. You may have to pay this penalty for as long as you have a Medicare drug plan.

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+Medicare Part D Premium

IRMAA 2018

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Yearly Income FiledIndividual Tax Return (2016)

File Joint Tax Return (2016)

Premium (2018)

$85,000 or less $170,000 or less your plan premium

$85,001-$107,000 $170,001-$214,000$13.30 + your plan

premium

$107,001-$133,000 $214,001-$267,000$34.20 + your plan

premium

$133,001-$160,000 $267,001-$320,000$55.20 + your plan

premium

$160,001 or more $320,001 or more$76.20 + your plan

premium



+Medicare Advantage Plans - Overview

Health plan options approved by Medicare A way to get your Medicare benefits delivered through private

companies approved by Medicare Still in Medicare program Still have Medicare rights and protections Still get regular Medicare-covered services May get extra benefits Such as vision, hearing, or dental care

May be able to get prescription drug coverage (Part D) Co-pays and deductible are different than Original Medicare

Federal Government sets Out-of-Pocket spending limits for all Advantage Plan, $6,700 in 2018

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+Medicare Advantage Plans - Overview

Still have to pay Part B Premium

Not to be confused with Medicare Supplements (Medigap)

Different Advantage Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Less Common Plans----PFFS and SNP

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+Advantage Plans – Join and Switch

Initial Coverage Election Period Seven month period begins three months before you turn 65

Annual Election Period October 15th – December 7th each year

Coverage starts January first of next year

Annual Disenrollment Period January 1st – February 14th every year (coverage begins the first of

the month after you switch)

May also join a Medicare Part D plan during change

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+Medicare Advantage vs. Medigap

Advantage Plans: Pay as you go (i.e. $20 for doctors visits, coinsurance for

procedures) Usually higher Out of Pocket costs Stay in smaller network of Doctors and Hospitals Added benefits not covered by traditional Medicare Can change plan every year during specific times Usual candidate: Someone whom comes onto Medicare healthy

and wants to take the risk that they will continue to be healthy OR someone that financially cannot afford to pay high monthly costs.


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+Medicare Advantage vs. Medigap

Medigap Plans: Peace of mind option, Pay more now but little to nothing as you use it Lesser ability to change plans each year, especially as you age Can go to any Medicare provider nationwide Does not include a prescription drug plan Usual candidate: Someone coming into Medicare with preexisting

conditions and high medical costs, someone not wanting to take the risk of high medical costs due to future diagnosis (hereditary conditions)

* provision allows a current Gap insured to try out an Advantage Plan for no more than 12 months, then return to Gap plan. This is a once in a lifetime opportunity called a Trial Right.


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+For More Information

1-800-MEDICARE (1-800-633-4227) TTY users should call 1-877-486-2048

Medicare & You 2017 handbook

Other Medicare publications

www.medicare.gov

www.cms.hhs.gov

SHIP telephone: 1-800-452-4800 TTY users should call 1-800-846-0139

SHIP website: www.medicare.in.gov

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0HGLFDUH - Indiana University Bloomingtonv Z v P o v À Ç Ç µ ] v P ] ( ] ] u ... 10/12/2018 11:21:10 AM