insurance options in retirement retiree... · 2017-02-28 · insurance options in retirement...

INSURANCE OPTIONS IN RETIREMENT PresentedByKurtSwardenski,RHU,REBCAdvantageBenefitsGroup

Re0ree Medical Op0ons – Pre 65 1.  COBRAconCnuaConcoverage

2.  IndividualCoverage

3.  MarketplaceCoverage

PRESENTED BY ADVANTAGE BENEFITS GROUP 2

Pre-65

Re0ree Medical Op0ons

 COBRAConCnuaConCoverage◦ Upto18monthsorunClenCtledtoMedicare,whicheverisless

◦ Medical/PrescripConDrugs7/1/2016-6/30/2017Rates

◦ Dental◦ Vision

PRESENTED BY ADVANTAGE BENEFITS GROUP 3

Pre-65

BCBSPPO2 MESSAChoicesSaver

Single:$534.40 Single:$613.67

2-Person:$1,106.21 2-Person:$1,380.78

Family:$1,352.02 Family:$1,718.28

Re0ree Medical Op0ons

 IndividualPlan

◦ Availablethroughanumberofcarriers:◦  PriorityHealth◦  BlueCrossBlueShield◦ MolinaHealthcare◦  Humana

◦ Costvariesbasedonsmokerstatus,age,zipcodeandplandesign

PRESENTED BY ADVANTAGE BENEFITS GROUP 4

Pre-65

Re0ree Medical Op0ons

◦  AdvancePremiumCredits(subsidies)basedonhouseholdincomeandage

◦  MetalTierPlans–PlaCnum,Gold,Silver,Bronze

◦  MulCpleCarriersavailable

PRESENTED BY ADVANTAGE BENEFITS GROUP 5

Pre-65

InstrucConstonavigatethewww.healthcare.govsite:

1)  Click“SeeTopics”fromthetopribbononthehomepage

2)  Click“Seeplansandprices”

SpecialEnrollmentPeriod:◦  Youmayqualifyforaspecialenrollmentperiodifyouleaveajobwhereyouhadhealthcoverage(ie.ReCrement)

◦  Averagemonthlycost(age62,non-smoker,zip:48858,effecCve1/1/17)◦  SilverPlanforSingle:$667(29plansavailable)-$280aeersubsidy

◦  BronzePlanforSingle:$544(61plansavailable)-$157aeersubsidy

◦  Bothplanshaveasubsidyof$387permonthbasedonsinglehouseholdincomeof$36,000(noGoldlevelplanswereavailabletopurchase)

  ForPlanandCostEs.matesoutsideofOpenEnrollment,goto:www.healthsherpa.com

MarketplacePlan(www.healthcare.gov)

Re0ree Medical Op0ons

PRESENTED BY ADVANTAGE BENEFITS GROUP 6

Pre-65

Will I Qualify for Lower Costs on Monthly Premiums? – Marketplace Plan

PRESENTED BY ADVANTAGE BENEFITS GROUP 7

SavingsProgramsyoumayqualifyfor:

EsKmated2017HouseholdIncome–basedonnumberofpeopleinyourhousehold*NOTE:Eligibilitydoesvarybasedonageof

applicant.

1 2 3 4 5 6

Freeorlow-costcoveragethroughMedicaidbasedon

incomealone

Below$16,394

Below$22,108

Below$27,821

Below$33,534

Below$39,247

Below$44,960

AMarketplacehealthplanwithlowermonthlypremiumsplussavingsonoutofpocketcosts,

likededucCblesandcopayments

$16,394-$29,700

$22,108-$40,050

$27,821-$50,400

$33,534-$60,750

$39,247-$71,100

$44,960-$81,450

AMarketplacehealthplanwithlowermonthlypremiums

$29,701-$47,520

$40,051-$64,080

$50,401-$80,640

$60,751-$97,200

$71,101-$113,760

$81,451-$130,320

Youwon’tqualifyforsavingsonaMarketplaceinsuranceplan.YoucanbuyinsurancethroughtheMarketplaceatfullprice,or

buyfromothersources

Above$47,520

Above$64,080

Above$80,640

Above$97,200

Above$113,760

Above$130,320

Pre-65

What Does An Average (Silver) Plan Cost? Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium)

 MyPriorityHMOHolisCcSilver2500(PriorityHealth)◦  IndividualPremium(age62,zip48858)=$677permonth◦  $2,500SingleDeducCble,$7,150OutofPocketMaximum◦  $30copayaeerdeducCbleforfirsttwoPrimaryCarevisits.Specialist$50aeerdeducCble

◦  $5GenericDrugsBeforeDeducCble◦  $60preferredbrandcopayaeerdeducCble,20%coinsuranceforspecialtymedicaConsaeerdeducCble

◦  30%membercoinsuranceaeerdeducCbleformostotherservices

 MyPriorityHMOHSASilver1500(PriorityHealth)◦  IndividualPremium(age62,zip48858)=$730permonth◦  $1,500SingleDeducCble,$5,250OutofPocketMaximum◦  30%coinsuranceaeerdeducCbleformostservices◦  $20genericdrugsaeerdeducCble◦  $60preferredbrandcopayaeerdeducCble,20%coinsuranceforspecialtymedicaConsaeerdeducCble

PRESENTED BY ADVANTAGE BENEFITS GROUP 8

Pre-65

Re0ree Medical Op0ons – Post 65

 1.Medicare 2.MedicareAdvantagePlan 3.MedicareSupplementalPlan

PRESENTED BY ADVANTAGE BENEFITS GROUP 9

Post-65

Re0ree Medical Op0ons - Medicare

 WhorunstheMedicareProgram?◦  TheCentersforMedicare&MedicaidServices(CMS)istheFederalagencythatrunsMedicare.CMSispartoftheU.S.DepartmentofHealthandHumanServices

◦  ImpactofrecentlyenactedhealthreformonMedicare(2012)◦  EnhancedprevenCvecareservices◦  Subsidyanddiscountsfordrugswhileinthedonuthole

◦  Resourcesites:◦  hmp://www.usprevenCveservicestaskforce.org/uspsn/uspsabrecs.htm◦  www.medicare.gov◦  www.medicarerights.org–detailedCmeline◦  www.kff.org–KaiserFamilyFoundaCon

PRESENTED BY ADVANTAGE BENEFITS GROUP 10

Post-65

Medicare MedicareBenefits

PartA:

HospitalCoverage

PartB:

MedicalCoverage

PartD:

PrescripConDrugInsurance

PartC:

CombinesPartA,BandDintoonepackage

PRESENTED BY ADVANTAGE BENEFITS GROUP 11

Post-65

Medicare Coverage Choices Start

OriginalMedicare

PartA(HospitalCoverage)

PartD(PrescripConDrug

Insurance)

Medigap(MedicareSupplementInsurance)

Policy

PartB(MedicalCoverage)

MedicareAdvantagePlan(likeanHMOorPPO)

PartC(IncludesBOTHPartA(HospitalCoverage)andPartB(MedicalCoverage)and

usuallyPartD

PartD(PrescripConDrug

Insurance)

END

PRESENTED BY ADVANTAGE BENEFITS GROUP 12

Step 1: Decide how you want to get your coverage

Step 2: Decide if you want to add drug coverage

Step 3: Decide if you want to add supplemental coverage

If you join a Medicare Advantage Plan, you don’t need and can’t be sold a Medigap policy.

Post-65

Checklist: 5 Things to Do When You Get Medicare

1)  FilloutanAuthorizaConFormMedicarecan’tgivepersonalhealthinformaConaboutyoutoanyoneunlessyougivepermissioninwriCngfirst

2)  Makea“WelcometoMedicare”PhysicalExamAppointmentThisfree,one-Cmecomprehensiveexamisofferedduringthefirst12monthsyouhaveMedicare

3)  SignupforMyMedicare.govMyMedicare.govisasecureonlineservicewhereyoucanaccessyoupersonalMedicareinformaCon24hoursaday,everyday

4)  ChooseandJoinaMedicareDrugPlan(PartD)Ifyou’renewtoMedicare,youhave7monthstojoinaMedicaredrugplan

5)  DownloadaCopyof“YourMedicareBenefits”Medicare’sofficial“YourMedicareBenefits”publicaConexplainstherulesaboutwhichhealthcareservicesandsuppliesMedicarecovers

PRESENTED BY ADVANTAGE BENEFITS GROUP 13

Post-65

Medicare Part A Helps Pay for:  Hospitalstays($1,316deducCble,1st60days/$329perday–61to90days) Skillednursingfacility(SNF)care

 Long-termcarehospitals

 Homehealthcare

 Hospicecare

 Blood ForinformaCon,call1-800-MEDICARE

PRESENTED BY ADVANTAGE BENEFITS GROUP 14

Post-65

Paying for Medicare Part A  MostpeoplereceivePartApremiumfree

 Peoplewithlessthan10yearsofMedicarecoveredemploymentwillpayaPartApremium

 ForinformaCon,calltheSocialSecurityAdministraCon(SSA)◦  1-800-772-1213◦  1-800-325-0778forTTYusers

PRESENTED BY ADVANTAGE BENEFITS GROUP 15

Post-65

Part B Helps Pay for:  Doctors’services OutpaCentmedicalandsurgicalservicesandsupplies

 DiagnosCctests OutpaCenttherapy OutpaCentmentalhealthservices

 PrevenCvehealthcareservices Othermedicalservices

PRESENTED BY ADVANTAGE BENEFITS GROUP 16

Post-65

Paying for Medicare Part B:  MostMedicarePartBbeneficiarieswillpayapremiumamountof$134.00(higherincomeearnersmaypaymore)in2017.

 $183peryeardeducCble 20%coinsuranceformostservices

 Someprogramsmayhelpcoverthesecosts

 AddiConofPrevenCveCareServices◦  Annualwellnessexam◦  Coversallwellnessservices/prevenCvecareservicesasoutlinedbyHealthCareReform

PRESENTED BY ADVANTAGE BENEFITS GROUP 17

Post-65

Medicare Part D helps pay for:  PrescripCondrugsprovidedbyMedicareApprovedPrescripConDrugPlans(PDP)orMedicareAdvantagePlans(MA-PD)

 TheseplansoffernegoCateddiscountpricesbasedonaformularywithcostsharing

 HealthCareReformfilledsomeorallofthedonut-hole◦  50%manufacturersdiscountonbrandnamedrugs◦  Payonly86%ofplanscostforgenericdrugs

PRESENTED BY ADVANTAGE BENEFITS GROUP 18

Post-65

Paying for Medicare Part D  $0orreducedpremium,deducCbleandco-insuranceifonequalifiesfortheLowIncomeSubsidy(LIS)

 Mustmeetincomeandassetcriteria

 EligibilitydeterminedbySocialSecurityAdministraCon(SSA)

PRESENTED BY ADVANTAGE BENEFITS GROUP

19

Post-65

The Affordable Care Act – Closing the Doughnut Hole BRAND NAME DRUGS

 HealthCareReformclosesthePartDDoughnutHole(thegapincoverageduringwhichpeoplewithMedicaremustpaythefullcostoftheirprescripConsoutofpocket). HCRphasesthisoutbydecreasingthebeneficiary’sshareofdrugcostsduringthedoughnutholeunClitreaches25%in2020forbothbrandnameandgenericdrugs

PRESENTED BY ADVANTAGE BENEFITS GROUP 20

Year PharmaceuKcalManufacturerDiscount

PlanResponsibility(gov’tcontribuKon)* ConsumerResponsibility

2010 0 0 100%lessthe$250rebateforbrandnameandgenericdrugs

2011 50% 0 50%

2012 50% 0 50%

2013 50% 2.5% 47.5%

2014 50% 2.5% 47.5%

2015 50% 5% 45%

2016 50% 5% 45%

2017 50% 10% 40%

2018 50% 15% 35%

2019 50% 20% 30%

2020 50% 25% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Post-65

The Affordable Care Act – Closing the Doughnut Hole GENERIC DRUGS

PRESENTED BY ADVANTAGE BENEFITS GROUP 21

Year PlanResponsibility(gov’tcontribuKon)* ConsumerResponsibility

2010 0 100%lessthe$250rebateforbrandnameandgenericdrugs

2011 7% 93%

2012 14% 86%

2013 21% 79%

2014 28% 72%

2015 35% 65%

2016 42% 58%

2017 49% 51%

2018 56% 44%

2019 63% 37%

2020 75% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Post-65

Medicare Advantage  MedicareAdvantagePlansarehealthplanopConsthatarepartoftheMedicareprogram.Ifyoujoinoneoftheseplans,yougenerallygetallyourMedicare-coveredhealthcarethroughthatplan(PartsA,B,andD).ThiscoveragecanincludeprescripCondrugcoverage.MedicareAdvantagePlansinclude:◦ MedicareHealthMaintenanceOrganizaCon(HMOs)◦  PreferredProviderOrganizaCons(PPO)◦  PrivateFee-for-ServicePlans◦ MedicareSpecialNeedsPlans

 WhenyoujoinaMedicareAdvantagePlan,youusethehealthinsurancecardthatyougetfromtheplanforyourhealthcare.Inmostoftheseplans,generallythereareextrabenefitsandlowercopaymentsthanintheOriginalMedicarePlan.However,youmayhavetoseedoctorsthatbelongtotheplanorgotocertainhospitalstogetservices

PRESENTED BY ADVANTAGE BENEFITS GROUP 22

Post-65

Medicare Advantage  TojoinaMedicareAdvantagePlan,youmusthaveMedicarePartAandPartB.YouwillhavetopayyourmonthlyMedicarePartBpremiumtoMedicare.InaddiCon,youmighthavetopayamonthlypremiumtoyourMedicareAdvantagePlanfortheextrabenefitsthattheyoffer. IfyoujoinaMedicareAdvantagePlan,yourMedigappolicywon’twork.Thismeansitwon’tpayanydeducCbles,copayments,orothercost-sharingunderyourMedicareHealthPlan.Therefore,youmaywanttodropyourMedigappolicyifyoujoinaMedicareAdvantagePlan.However,youhavealegalrighttokeeptheMedigappolicy.

PRESENTED BY ADVANTAGE BENEFITS GROUP 23

Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP 24

Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP 25

Post-65

Medicare Advantage

PRESENTED BY ADVANTAGE BENEFITS GROUP 26

Post-65

Shopping for Medicare Advantage Plans: www.Medicare.Gov

PRESENTED BY ADVANTAGE BENEFITS GROUP 27

Post-65

Shopping for Medicare Advantage Plans: www.Medicare.Gov

PRESENTED BY ADVANTAGE BENEFITS GROUP 28

Post-65

Re0ree Medical Resources   IsabellaCountyCommissiononAging–(989)772-0748

  YourPersonalFinancialAdvisor

  YourPersonalHomeandAutoInsuranceAgent

  AdvantageBenefitsGroup◦  hmp://www.advantageben.com

  BlueCrossBlueShieldofMichiganMedicare:1-877-469-2583◦  hmp://www.bcbsm.com/medicare/

  PriorityHealthMedicare:1-888-389-6676◦  hmp://www.priorityhealth.com/medicare

  CentersforMedicareandMedicaidServices◦  www.cms.hhs.gov

  TheOfficialU.S.GovernmentSiteforPeoplewithMedicare◦  www.medicare.gov

  HealthSherpa◦  www.healthsherpa.com

  “MedicareandYou”◦  hmp://www.medicare.gov/PublicaCons/Pubs/pdf/10050.pdf

  AARP◦  hmp://www.aarp.org/health/medicare/

  HealthCare.gov◦  hmps://www.healthcare.gov

PRESENTED BY ADVANTAGE BENEFITS GROUP 29