Medicare2016 revised Aug 2016 - Indiana · Understanding,Medicare + Medicare Part D – Costs in 2016! Costs vary by plan, most people will pay: ! Monthly premium! Annual Deductible,

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Medicare 2016

Understanding Medicare

+Medicare – What is it?

n Health insurance for peoplen Age 65 and older

n Under age 65 with certain disabilities

n Any age with End-Stage Renal Disease (ESRD)

n Administered byn Centers for Medicare & Medicaid Services (CMS)

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Updated 11/13/15 AMS


+A-B-C-D

n Medicare has four parts

n Part A – Hospital Insurance

n Part B – Medical Insurance

n Part C – Medicare Advantage Plans

n Part D – Prescription Drug Coverage

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nOriginal Medicare

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CHOICES



+Original Medicare

n Go to any provider that accepts Medicare

n You pay

n Part A - free for most people

n Part B premium in 2016

n $104.90 for those “held-harmless”

n $121.80 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

n Deductibles

n Coinsurance or copayments

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+Medicare – Enrollment

n Apply 3 months before age 65n Do not need to be retired*

n *Benefits through employer or retirement plans?

n Social Security Administration (SSA) will enroll you in Medicare starting the first day of the month (upon meeting requirements)

n Might not want to enroll in all parts of Medicare

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

n Auto Enrollmentn If you are already receiving Social Security benefit

n If receiving Railroad Retirement benefits

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+Medicare Part A – Hospital Coverage

n Part A premium is free for most people

n People with less than 10 years of Medicare-covered employment can pay a premium to get Part A

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

hospice care, and blood work.

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

hospital or SNF for 60 days in a row.n 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

n For inpatient Hospital stays in 2016 you payn $1,288 total deductible for days 1 – 60

n $322 co-payment per day for days 61 – 90

n $644 co-payment per day for days 91 – 150(60 lifetime reserve days)

n All costs for each day beyond 150 days

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+Medicare Part B - Medical Coverage

Enrollment in Part B is your choice

n Initial Enrollment Period (IEP)n 7 months beginning 3 months before age 65

n Enrolled automatically if receiving Social Securityn To keep Part B, keep the card

n If you don’t want Part B, follow instructions with card

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+Medicare Part B - Enrollmentn General Enrollment Period (GEP)

n January 1 through March 31 each yearn Coverage effective July 1n Premium increases 10% for each 12-month period you were eligible

but did not enroll

n Special Enrollment Periodn 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.

n You also have 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 - Paying the Premium

n Taken out of your monthly paymentn Social Securityn Railroad Retirementn Federal Government retirement

n OR May be billed every 3 months

n Programs available to help

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+Medicare Part B - Paying the Premium

IRMAA 2016

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Yearly Income FiledIndividual Tax Return (2014)

File Joint Tax Return (2014)

Premium (2016)

$85,000 or less $170,000 or less $121.80

$85,001-$107,000 $170,001-$214,000 $170.50

$107,001-$160,000 $214,001-$320,000 $243.60

$160,001-$214,000 $320,001-$428,000 $316.70

$214,001 or more $428,001 or more $389.80



+Medicare Part B 2017

Projected

� 2017 Projected Part B Costs¡ As of June 2016, Social Security projects a Cost of Living

Adjustment (“COLA”) of .2%¡ Those who are not “held harmless” i.e. those who are new to

Medicare, not having Part B premiums taken directly from Social Security check, or those effected by IRMAA may expect Part B premiums to be $149.00/month ($27.20 more than 2016)

¡ Those who are “held harmless” may expect to pay $107.60/month ($2.70 more than 2016)

¡ Part B Deductible may be $204 ($38.00 more than 2016)¡ Final numbers should be available in November


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+Medicare Part B - Coverage

n Doctors’ services

n Outpatient medical and surgical services and supplies

n Diagnostic tests

n Outpatient therapy

n Outpatient mental health services

n Some preventive health care services

n Advanced Directives Counseling (new in 2016)

n Other medical services

n Clinical laboratory tests

n Home health services (not covered under Part A)

n Durable medical equipment

n Outpatient hospital services

n Blood Work

n Ambulance service, if other transportation would endanger your health

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+Medicare Part B – Cost of Services

n In Original Medicare you payn Yearly deductible

n $166 in 2016n 80% covered by Medicare, 20% co-pays for most services

n Some co-payments

n Programs available to help pay Part B costs

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+Medigap - Overview

n Health insurance policies

n Sold by private insurance companies, plans are A through N

n Plans are Standardized from company to company

n Follow Federal and State laws that protect you in every state

n Must say “Medicare Supplement Insurance”

n Cover “gaps” in Original Medicare

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

n Does not include a drug plan benefit

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+Medigap – How It Works

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

Medicare plans

n Can go to any doctor, hospital, or provider that accepts Medicaren Except with a Medicare SELECT policy

n You pay a monthly premium to the insurance company

n All Medigap plans must be approved by the IDOI

n 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

n When you need coverage

n Guaranteed Issue Period

n Other Enrollment Possibilities

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+Medicare Part D – Rx Coverage

n Available for all people with Medicare

n Requirements:

n Have Medicare Part A, Part B, or both

n Live in plan service area

n Enroll in a Medicare prescription drug plan

n Provided through

n Medicare Prescription Drug Plans

n Medicare Advantage Plans

n Assistance Plans

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+Medicare Part D – Costs in 2016

n Costs vary by plan, most people will pay: n Monthly premiumn Annual Deductible, $360 in 2016n After the deductible for the next $3,310, you will pay 25% and the plan

will cover 75% of your drug costs. n When your total drug costs reach $3,310, your initial drug plan

coverage will end. n Part D enrollees will pay 45% of the total cost of their brand-name

drugs and pay a maximum of 58% 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.

n Once your total out of pocket drug costs (not including the monthly premiums) reach $4,850 your catastrophic coverage will begin.

n Your plan will cover up to 95% of your drug costs. You will pay either $2.95 for generic or $7.40 for brand name drugs or 5% of the cost which ever is greater.

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+Part D Costs

Projected

� Part D expenses ¡ 2017 Part D Premium [National Average]- $35.63

÷ This means: This is the national average premium for a standard Part D policy. This will be used to calculate a late penalty, if applicable

¡ 2017 Deductible-$400 ($40 more than 2016)÷ This means: If you enroll in a Medicare Part D plan with a standard

initial deductible, you will pay $400 before your drug plan will begin sharing costs

¡ 2017 Initial Coverage Limit- $3,700 ($390 more than 2016)÷ Initial Coverage Limit is the amount of money beneficiaries and their

Part D plan will pay before the beneficiary reaches the Donut Hole÷ This means: Beneficiaries will be able to buy slightly more medications

before reaching the 2017 Donut Hole.÷ Note: If a beneficiary pays less than $309/month for medications, that

beneficiary will not enter the Donut Hole


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+Part D Cost Continued

� Part D expenses ¡ 2017 Total Out-of-Pocket Costs (TrOOP)- $4,950 ($100 more than

2016)÷ This means: A beneficiary will have to spend $4,950 to get out of

the Donut Hole¡ 2017 Generic Drug Discount- 49% (7% more than 2016)

÷ This means: If a beneficiary reaches the Donut Hole and has a generic medication has a retail cost of $100, the beneficiary will pay $51

¡ 2017 Brand Name Drug Discount- 60% (5% more than 2016)÷ This means: If a beneficiary reaches the Donut Hole and has a

brand name medication that has a retail cost of $100, the beneficiary will pay $40


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+Medicare Part D – Making Changes

n Annual Election Period

n Special Enrollment Periodsn Permanently move out of plan service arean Lose creditable prescription drug coverage n Enter, reside in, or leave a long-term care facility

n Like a nursing homen Qualify for Extra Helpn Have other exceptional circumstances

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+Medicare Part D - Enrollment

n When first eligible for Medicaren 7 months beginning 3 months before first month

of Medicare eligibility

n During specific enrollment periodsn Annual Coordinated Election Period

n October 15th – December 7th each year

n Special Enrollment Periods

n Some people are enrolled automatically

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+Late Enrollment Surcharges/Penalties

n The late enrollment penalty is calculated by multiplying 1% of the national base beneficiary premium ($34.10 in 2016) 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.

n 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 2016

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Yearly Income FiledIndividual Tax Return (2014)

File Joint Tax Return (2014)

Premium (2016)

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

$85,001-$107,000 $170,001-$214,000$12.70 + your plan

premium

$107,001-$160,000 $214,001-$320,000$32.80 + your plan

premium

$160,001-$214,000 $320,001-$428,000$52.80 + your plan

premium

$214,001 or more $428,001 or more$72.90 + your plan

premium



+Medicare Advantage Plans - Overview

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

companies approved by Medicare n Still in Medicare programn Still have Medicare rights and protectionsn Still get regular Medicare-covered servicesn May get extra benefits

n Such as vision, hearing, or dental caren May be able to get prescription drug coverage (Part D)

n Different Advantage Plansn Health Maintenance Organization (HMO)n Preferred Provider Organization (PPO)n Private Fee-for-Service (PFFS)n Special Needs Plan (SNP)

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+Part D Prescriber Enrollment

New for 2016

n Effective June 1, 2016

n All physicians and other eligible professionals who prescribe Part D drugs are required to be validly enrolled in the Medicare program.

n Part D plans will deny a pharmacy claim at point of sale for drugs prescribed by physicians or other eligible professionals who are not enrolled in Medicare.

n Applies to all physicians, dentist and other eligible professionals that write Part D prescriptions.


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+Advantage Plans – Join and Switch

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

n Includes the month you turn 65

n Ends 3 months after you turn 65

n Annual Election Periodn October 15th – December 7th each year

n Coverage starts January first of next year

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

the month after you switch)

n May also join a Medicare Part D plan during change

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+Advantage Plans – How They Work

n Get Medicare-covered services through the plan, all of Part A and Part B covered services

n Some Plans may provide additional benefits

n Can include a prescription drug coverage

n You may have to stay in a certain network of hospitals and providers

n Co-pays and deductible are different than Original Medicare

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+Medicare & HSAs

n The Social Security Administration (SSA) determines the month your Medicare begins. If you apply for Medicare Part A or Social Security benefits after you attain age 65, your Medicare Part A coverage will begin retroactively up to six months prior to your application month, but not before the month you attained the age of 65.

n You cannot contribute to your HSA once your Medicare coverage begins. If you contribute to your HSA after your Medicare coverage starts, you may have to pay a tax penalty and repay employer contributions. If you’d like to continue contributing to your HSA, you should not apply for Medicare, Social Security, or Railroad Retirement Board benefits.

n You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).

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+THE RECAP

n If you want and are eligible for Medicare:Ø Decide if you want only Original Medicare OR

Original Medicare plus a Supplement/Gap Plan OR a Medicare Advantage Plan

Ø Decide on a Prescription Drug Plan

Ø Investigate Policies and CompaniesØ Choose a reasonable number of the above and

contact companies for personal quotes.

Ø ENROLL!Ø Receive the benefits for which you’ve paid!

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+For More Information

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

n Medicare & You 2016 handbook

n Other Medicare publications

n www.medicare.gov

n www.cms.hhs.gov

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

n SHIP website: www.medicare.in.gov

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Documents

Medicare2016 revised Aug 2016 - Indiana · Understanding,Medicare + Medicare Part D – Costs in 2016! Costs vary by plan, most people will pay: ! Monthly premium! Annual Deductible,