Medicare Madness:Navigating through open enrollment

Joani Shaver, DirectorBlount County Office on Aging

November, 2014

Health insurance for the following people:

◦Those 65 and older◦Those younger than 65 with certain disabilities

◦Those with End-Stage Renal Disease (permanent kidney failure)

What is Medicare?

•Most outpatient prescription drugs•Routine vision care•Long-term care•Routine dental care•Dentures•Hearing aids (exams and fittings)•Routine foot care

What's NOT covered by Original Medicare?

Medicare Part A (Hospital Insurance)◦ Inpatient care in hospitals◦ Skilled nursing facility, hospice, and home health

care

Medicare Part B (Medical Insurance)◦ Doctors’ services, hospital outpatient care and

home health care◦ Some preventive services

Different Parts of Medicare

Medicare Part D◦Prescription drug option run by Medicare-

approved private insurance companies◦Prescription drugs◦May help lower your prescription drug

costs and help protect against higher costs in the future

Different Parts of Medicare

Medicare Part C (Advantage Plan)◦Health plan managed by Medicare-

approved private insurance companies◦Includes all benefits and services

covered under Part A and Part B◦May include extra benefits and services

for an extra cost◦Usually includes Medicare prescription

drug coverage (Part D)

Different Parts of Medicare

TOTAL HEALTHCARE COVERAGE

ORIGINALMEDICARE

Premium remains $104.90 Part B deductible remains $147 Part A hospital inpatient

◦deductible raised to $1260 for each benefit period (was $1216)

◦Days 61-90: $315 per day coinsurance for each benefit period (was $304)

Changes to Medicare in 2015

Annual deductible rises from $310 to $320

Number of plan choices will drop – some are being eliminated

Average monthly premium will be $38.83

Doughnut hole is shrinking

Changes to Part D in 2015

First method

Original Medicare (Parts A & B) Prescription Drug Plan (Part D) Medicare Supplement or Medigap policy (identified by a letter)◦Supplements provide identical coverage,

but vary widely in price

How can I get my Medicare coverage?

Second Method

Medicare Advantage Plan (Part C)◦Includes Part A & B coverage

Prescription Drug Coverage (Part D)◦Some advantage plans include

prescription coverage

If you get retirement benefits from Social Security or the RRB, then you automatically get Parts A & B on 1st day of month you turn 65

If you get disability benefits from Social Security or certain disability from the RRB, then you automatically get Parts A & B on the 1st day of the 25th month after your benefits begin

Medicare Enrollment

If your disability is ALS (Lou Gehrig’s disease), then you automatically get Parts A & B on 1st day of month your disability benefits begin

If you’re still working and not getting Social Security, then you’ll need to talk with your HR department about your choices related to Medicare. You may want to delay enrollment, which you’ll do online through www.ssa.gov.

When you first turn 65, you have 3 months before and after your birthday month

Coverage begins based on your enrollment date

If you don’t sign up for Medicare when you’re first eligible, then you may pay penalty for Part B as long as you receive benefits

Initial Enrollment

Go from Original Medicare to Advantage Plan

Go from Advantage Plan to Original Medicare

Switch Medicare Advantage Plans Join Part D plan Switch Part D plans

What can I do during Open Enrollment from Oct 15 – Dec 7?

Medicare Supplement might make sense if you◦ Want flexibility in choosing your doctors◦ Visit doctors frequently◦ Travel extensively◦ Have a chronic medical condition◦ Don’t mind higher premiums to get lower out-of-

pocket costs (predictability)

11 different plans

What plan is right for me?

Medicare Advantage Plan might make sense if you◦ Are willing to change doctors, if necessary◦ Prefer all benefits from single plan & premium◦ Visit doctors infrequently & don’t mind paying per-

visit copayments and coinsurance◦ Don’t mind researching your options annually◦ Want lower premiums than supplements offer◦ Are informed about your choices and don’t mind

comparison shopping for plans◦ Want options beyond what Medicare provides

19 different plans

Remember all that?

Simple: buy thebest insurance thatyou can afford – after doing yourhomework!

Two ways to get Part D

◦ Purchase Medicare prescription drug policy

◦ Choose a Medicare Advantage Plan that offers prescription drug coverage

Even if you feel it’s not needed in your case, remember that you may pay a late enrollment penalty if you join a Part D plan later.

Medicare Part D

Monthly fee, varies by plan In addition to Part B cost of $104.90 Some Advantage Plans include Part D

coverage in the cost

Avoiding Part D Enrollment penalty◦ Join drug plan when first eligible◦ Don’t go 63 days or more without drug coverage

Penalty = 1% of full uncovered months (pg 105)

Part D Premium

Always be sure that your prescription drugs are in formulary of any plan you’re considering

Check what “tier” drugs are in – each tier has different cost

Do this every year during Open Enrollment!

Call the plan for info or check plan’s website

IMPORTANT!!

Begins when total drug costs reaches $2,960

Includes what you & plan have paid Plan no longer covers drugs for rest of year You pay discounted amounts

◦ 45% on brand name drugs◦ 65% on generic drugs

Once you’ve paid $4,700 out of pocket you pay 5% of cost for covered drugs or copay of $2.65/generic, $6.60 for brand name drugs

The Doughnut Hole

Drug plans may include preferred and non-preferred pharmacies in their network

You may pay less for drugs at preferred pharmacies

IMPORTANT!

Program to help people pay Medicare prescription drug costs

For single person, income less than $1,459 month and resources less than $13,440 per year

For married person living with spouse, income less than $1,966 month and resources less than $26,860 per year

EXTRA HELP

Apply through Social Security www.ssa.gov

Helps with monthly drug plan premium, annual deductible, coinsurance and copayments

Eliminates doughnut hole Switch plans at any time during year Same application used to get help from TN to pay your Medicare costs

EXTRA HELP

Benefit period: begins day you’re admitted to hospital or skilled nursing facility (SNF) and ends when you haven’t received any inpatient hospital care or SNF skilled care for 60 days in a row

Coinsurance: your share of cost for medical service or supply, expressed in percentage

Copayment: set amount you pay as your share of cost for medical service or supply

Glossary

Deductible: amount you pay for health care or prescriptions before Medicare or Advantage Plan or Drug Plan begins to pay

Extra Help: helps those with limited income pay health care costs

Formulary: list of drugs covered by prescription drug plan or other insurance plan

Medically necessary: services or supplies needed to prevent, diagnose or treat illness, injury, condition, disease or its symptoms

Medicare-approved amount: payment accepted by doctor or supplier from Medicare

Preferred Provider: doctor or supplier who is member of network for specific insurer’s HMO or PPO plan

Preventive services: health care to prevent illness or detect at early stage

Primary care doctor: person you see first for most health problems

Referral: written order from primary care doctor for you to see specialist or get some medical services. Required in most HMOs.

Signing up too early or too lateNot understanding difference between Medicare Supplement and Medicare Advantage

Guessing when picking planNot applying for extra helpNot re-evaluating coverage yearly

Five Biggest Mistakes Made When Enrolling in Medicare

www.medicare.govMedicare & You 2015www.mymedicarematters.orgSHIP (1-877-801-0044)www.aonhewittnavigators.comwww.benefitscheckup.org

Best Sources of Information

Joani Shaver, DirectorBlount County Office on AgingBlount County Community Action Agency3509 Tuckaleechee Pike, Maryville 37803(865) 983-8411 x25jshaver@blountcaa.org

Contact Information