medicare - pehp...medicare part a cost 2019 • no cost for most. if you or your spouse paid...
TRANSCRIPT
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Clients
MEDICAREOpen Enrollment Meetings
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Clients
Medicare
Medicare is a National Health Insurance Program
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Clients
Who is Eligible?
• Age 65+
• Certain disabilities
• End stage renal disease
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Clients
Medicare Alphabet
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Clients
Initial Enrollment
3 months before age 65
The month you turn 65
3 months after age 65
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General Enrollment
• Every year
• January – March
• Effective July 1st EFFECTIVE JULY 1
January
February
March
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Clients
Automatic Enrollment
• Social Security Benefits
• Railroad Retirement Board
• Under 65 and disabled
• If you have ALS
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Clients
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Clients
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Clients
Working Past Age 65
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Clients
What You Need to Consider
• Type of health plan
• Coordination of benefits
• Length of employment
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Clients
Special Enrollment
You may be able to delay enrollment in Medicare Part A and Part B:
• If you’re covered by an employer’s group health plan WITH 20 OR
MORE EMPLOYEES as an actively employed employee
• If you’re the spouse of actively employed employee
• Or, if you’re disabled dependent of actively employed employee
(must have a 100 or more employees)
Any time you’re
still covered by an
active group
health plan
During the 8 months
from coverage ending or
employment ending
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Clients
Late Enrollment PENALTIES
If you’re not eligible for premium-free Part A,
and did not purchase Part A when eligible,
your premium may go up 10% for twice the
number of years you could have had Part A.
10% added to the premium for each full 12-
month period if you were eligible and did not
enroll. You may pay a penalty for as long as
you have Part B.
A
B
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Clients
What Does Medicare Cost?
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Clients
Medicare Part A Cost 2019
• No cost for most. If you or your spouse paid Medicare
taxes while working 40 quarters or more.
• There is a cost if you or your spouse paid Medicare
taxes while working less than 40 quarters.
• $437.00 per month for less than 30 quarters
• $240.00 per month for 30 to 39 quarters.
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Clients
Medicare Part B Cost 2019
• The standard Part B premium is $135. 50 or higher
• Based on your modified adjusted gross income as
reported on your income tax return from two years ago
• Income for 2017 = What you pay for 2019
• Income for 2016 = What you pay for 2018
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Clients
Medicare Part B Cost 2019
File Individual File Joint Tax File Married & separate return
2019 Cost for Part BPer person per month
$85,000 or less $170,000 or less $85,000 or less $135.50
above $85,000 up to $107,000
above $170,000 up to $214,000
Not applicable $189.60
above $107,000 upto $133,500
above $214,000 up to $267,000
Not applicable $270.90
above $133,500up to $160,000
above $267,000 up to $320,000
Not applicable $352.20
above $160,000less than $500,00
above $320,000less than $750,000
Above $85,000 andless than $415,000
$433.40
$500,000 or above $750,000 and above $415,000 and above $460.50
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Clients
Medicare Doesn’t Cover
A• $1,364 deductible per benefit period
• Days 61 to 90 $341 per day
• Days 91 & beyond $682 per day
(using 60 lifetime reserve days)
• Nothing after 150 days
Inpatient Hospital 2019
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Clients
Medicare Doesn’t Cover
A • Days 21 – 100 $170.50 per day
(Benefit Period)
• Nothing after 100 days
Skilled Nursing Facility 2019
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Clients
Medicare Doesn’t Cover
BPhysician & Out Patient Services
• $185 deductible per calendar year
• 20% after deductible
• Part B Excess Fees
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Medicare Supplement
Do you need additional
coverage?
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Directions Please
THIS WAY
THAT WAY
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Medicare Choices
Original Medicare Medicare ADVANTAGE
PART BPART A
MEDICARE SUPPLEMENT
PART D
PART C COMBINES PART A AND PART B
MOST INCLUDE PART D
ADD PART DIF NOT
INCLUDED
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What Works for You?
• Medicare Supplement
• Medicare Advantage
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Medigap Plans
• Medicare Providers and Facilities in the U.S.www.medicare.gov/physician
www.medicare.gov/supplier
• Rates based on age
• One time six month Open- Enrollment Periodwww.medicare.gov/publications
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Medicare Advantage
• Reside and live in the service area
• May not have out-of-country coverage
• May need a referral to see specialist
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Do I need a prescription drug plan?
YES IF YOU HAVE A MEDIGAP PLAN
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Part D Initial Enrollment
3 months before age 65
The month you turn 65
3 months after age 65
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Part D General Enrollment
• Every year
• April 1 – June 30
• Effective – July 1st
January
February
March
ONLY IF ENROLLING IN PART B FOR THE FIRST TIME
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Part D Special Enrollment
• Move
• Qualify or lose extra help
• Move into a nursing home
• Lose creditable coverage
• Have or lose Medicaid
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Medicare Part D & CMS
• $415 Deductible
• $415.01- $3,820 – Member pays 25% co-pay
• $3,820.01- $5,100 – Member pays MOST OF THE COST (Coverage Gap)
• $5,100.01 and greater (Catastrophic Coverage) Member pays 5% or $3.40 generic/$8.50 Brand whichever is greater
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Creditable Coverage
• Prescription drug coverage that’s expected to pay on average at least as much as Medicare’s standard prescription drug coverage
• Your drug coverage is as good or better…
• If NOT or you have a break in coverage of 63 days or more you could pay a 1% monthly penalty for each month you were eligible but did not enroll.
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Part D Open Enrollment
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How Does Part D Work?
CATASTOPHIC STAGE $5,100.01
The deductible plus your co-pays = $5,100
COVERAGE GAP STAGE $3,820.01 to $5,100
The deductible + your co-pays + what your Part D Plan paid = $3,820
CO-PAY STAGE $415.01 to $3,820
You pay applicable co-pay
DEDUCTIBLE
You pay the first $415
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Medicare Part D Cost 2019
File Individual File Joint Tax File Married & separate
2019 Cost for Part DPer person per month
$85,000 or less $170,000 or less $85,000 or less Your plan premium.
above $85,000 up to $107,000
above $170,000 up to $214,000
Not applicable $12.40 + your plan premium
above $107,000 up to $133,500
above $214,000 up to $267,000
Not applicable $31.90 + your plan premium
above $133,500 up to $160,000
above $267,000 up to $320.000
Not applicable $51.40 + your plan premium
above $160,000 less than $500,000
above $320,000less than $750,000
Above $85,000less than $415,000
$70.90 + your plan premium
$500,000 or above $750,000 and above $415,000 and above $77.40 + your plan premium
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Medicare Says
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PEHP Medicare Plans
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PEHP Medicare Plans
Who is Eligible?
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PEHP Medicare Plans
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PEHP Open Enrollment
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PEHP Medicare Plans
1. Plan 100
2. Plan 75
3. Plan 50
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PEHP Medicare Plans
• NO Medical underwriting
• NO rate increases during the year
• SELECT a new plan at open enrollment
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PEHP Medicare Plans
1. Basic Rx
2. Basic Plus Rx
3. Enhanced Rx
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BENEFIT STAGE BASIC PLAN BASIC PLUS PLAN ENHANCED PLAN
DEDUCTIBLE $415 $415 $415
C0-PAY$415.01 to $3,820
Pay applicable Co-pay
Pay applicable Co-pay
Pay applicable Co-pay
COVERAGE GAP$3,820.01 to $5,100
37% of cost covered generics25% for Brand100% for all other drugs
Co-pay Tier 1 generics 37% for other covered generics25% for Brand100% for all other drugs
Continue to pay Co-pay. No coverage gap
CATASTROPIC$5,100.01
$3.40 generic$8.50 Brand or 5% of Cost whichever is more
$3.40 generic$8.50 Brand or 5% of Cost whichever is more
$3.40 generic$8.50 Brand or 5% of Cost whichever is more
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PEHP Part D Plans
CATASTOPHIC STAGE $5,100.01
The deductible plus your co-pays = $5,100
COVERAGE GAP STAGE $3,820.01 to $5,100
The deductible + your co-pays + what PEHP’s Plan paid = $3,820
CO-PAY STAGE $415.01 to $3,820
You pay applicable co-pay
DEDUCTIBLE
You pay the first $415
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PEHP Medicare Dental
Two Dental plans• Affordable cost
• Use PEHP contracted dentists
NO COST Discount Dental Plan• Included in Medicare Medical
Plans
• Use PEHP contracted dentists
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PEHP Medicare Dental
BENEFIT Plan 1500 PLAN 1000
Deductible NONE $50
Annual Maximum $1,500 $1,000
Preventive No Charge 20%
Restorative 20% 20%
Prosthodontics 50% 50%
Monthly Rate $43.04 $32.80
6-month waiting period implants & prosthodontics
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PEHP Medicare Vision Plans
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PEHP Vision Plans
• Plans offered through Opticare of Utah and EyeMed
• Options for exams plus hardware or just Hardware
• LASIK options available
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What to Consider?
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What to Consider?
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What to Consider?
• Creditable Coverage
• Are my prescriptions covered?
• Costs vary by plan
• Higher income pay more
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What to Consider?
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What to Consider?
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Helpful Hints
• Create a MyMedicare.gov account
• Remove SSN from your Medicare Card
• Medicare Outpatient Observation Notice (MOON)
• Always ask - Inpatient or outpatient?
• Know or ask if the service is Medicare eligible
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Consider PEHP
• Mix and match plans
• Select plans that meet your individual needs
• Enroll during open enrollment or qualifying event
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Resources
• Your County Aging Services
• More Medicare – 1-800-MEDICARE
• Information online: www.Medicare.gov
• State Health Insurance Assistance Programs
• Centers for Medicare & Medicaid Services
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References
•Department of Health and Human services,
Initials. Centers for Medicare and Medicaid
Services, (2019). Medicare and you 2019
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Thank You