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Get the facts about the confusing world of Medicare. Invite Erin Hart to speak to your group about Medicare 101.
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Senior Health Care: Medicare 101Erin Hart
Business Development, American HealthCare Group
Email: [email protected]
Ph: (412) 563-7807
Erin
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HISTORY OF MEDICARE• 1965: Medicare (Part A & B)
• 1996: Medicare Advantage (Part C)
• 2006: Prescription Drug Program (Part D)
• 2010: Patient Protection and Affordable Care Act (PPACA)
• Centers for Medicare & Medicaid Services (CMS)
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Erin
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Health Care Reform: Impact on MedicareMedicare
• Added coverage for annual physical exams and other preventive services
• Eventual elimination of donut hole affecting 14% Brand Name Drugs –
47.5% in donut hole
Medicaid
• Varies State by State
• Expand Medicaid to 133% of the federal poverty level.
Erin
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@am
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Medicare Considerations• 65 years old
• Under 65 with certain disabilities – after 24 months
• End stage renal disease, Lou Gehrig’s, others
• Who Pays First? Medicare as secondary
• Medicare Savings
Erin
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hart
@am
eric
an-h
ealth
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Parts A & B• Part A
Generally free (or up to $441/month) 65+, self/spouse worked 10 years/40
quarters Hospital/Inpatient care/Home
health/hospice/skilled nursing 100 days/year
• Part B 2014 - $104.90/month
5% of enrollees pay higher premium – next slide
Physicians/Outpatient care/lab/x-ray/DME
Erin
Har
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hart
@am
eric
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ealth
care
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Medicare Part B Premiums
If your yearly income in 2011 was:
Filing Individual Return
Filling Married Return
You pay (in 2013)
Old Rates 2012
(Based on 2010 income)
$85k or less $170k or less $104.90 $99.90
above $85,000 up to $107,000
above $170,000 up to $214,000 $146.90 $139.90
above $107,000 up to $160,000
above $214,000 up to $320,000 $209.80 $199.80
above $160,000 up to $214,000
above $320,000 up to $428,000 $272.70 $259.70
above $214,000 above $428,000 $335.70*
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
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Coverage Details: Traditional Medicare – 80/20Cost Sharing for 2014
Hospital Stays
1-60 days $1,216
61-90 days $304/day
91-150 days $608/day
150+ days All Costs
SNF
$152/day for days 21 – 100 for each benefit period – covered after 3 day hospital stay
Medicare Part B
$147 deductible, then 20%
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
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12-5
63-7
807
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Part C: Medicare Advantage• From private insurers
• Medicare Advantage and Medicare Advantage Prescription Drug plans
• Live in plan’s service area
• Entitled to Part A & enrolled in Part B
• Premiums range from $0 – over $250.
• Copays for services
• Becomes only insurance
• Most include RX benefit
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
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Part C cont’d…
• Services covered that original Medicare doesn’t cover Lower cost sharing Vision, Hearing, Dental Podiatrist & Chiropratic Gym Membership
• Combine benefit coverage for hospitals and doctors
• Types: HMO, PPO, SNP, POS
• Considerations: Formulary, Network
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
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12-5
63-7
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Part D Prescription Drug Coverage Available from private insurers Uses a formulary & tiers 2014 Coverage Gap: $2,970; $4,750 – 28% discount on generic; 52.5% discount on brand name
2014 Base Premium: $32.42
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
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PACE/PACENET InformationIncome Individual Married
Percentage of FPL 133% 120%
Yearly $14,500 $17,700
Monthly $1,208 $1,470
Income Individual Married
Yearly $23,500 $31,500
Monthly $1,958 $2,625
PACE PACENET
RX Benefit$6.00 & $9.00, potentially lower based on income level
$8.00 & $15.00
Premium BenefitCovers the premium if RX plan is a partner plan
No premium benefit
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
- 4
12-5
63-7
807
Important Dates• Timing
Initial enrollment – 3 months before & after 65 October 15 – December 7 in 2014 for January 1, 2015
effective date January 1 – February 14 – disenrollment Anytime throughout the year
Dual eligible Move out of service area Institutionalized Lose employer coverage Low Income Subsidy
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ContactErin HartDirector, Health Benefit Services
American HealthCare Group
(412)563-7807
Erin
Har
t - e
hart
@am
eric
an-h
ealth
care
.net
- 4
12-5
63-7
807
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