Medicare ABCs: Understanding Your Options and Costs

1. Medicare ABCs

2. What Is Medicare? • Federal health insurance created in 1965 (amendment to Social Security Act) • Must be U.S. citizen or legal permanent resident and • 65 or older • Under 65 and 24+ months on Social Security Disability • End-Stage Renal Disease (any age)

4. OPTIONS 1 and 2 Part A Hospital Part B Medical OR Part CMedicare Advantage Supplement Part D Drugs

5. Part A (Hospital) • Hospital, if Inpatient • Skilled nursing facility • Home health care • Hospice Part B (Medical) • Doctor services • Hospital, if Outpatient/Observation • Emergency room • Durable medical equipment • Other supplies and services

6. SNF covered only if: Inpatient status for 3 midnights, and admitted to SNF w/in 30 days for the hospital-treated condition. Outpatient – When a doctor hasn’t written an order to admit you, even if you spend the night. Hospital Status affects what is covered by Part A or B and whether subsequent Skilled Nursing Facility (SNF) is covered. Inpatient – When you’re formally admitted by a doctor’s order. The day before discharge is your last Inpatient day. Medicare Outpatient Observation Notice (MOON) – provided when observation status longer than 24 hours, before 36th hour.

7. Parts A and B do NOT cover • Most prescription drugs • Routine dental, vision, hearing, and foot care • Long-term care (nursing home custodial care) • Non-emergency ambulance • Alternative medicine • Elective cosmetic surgery • Health care outside the U.S. (a few emergency exceptions)

8. Part D covers • Prescription drugs • Brand name and generic drugs • Part D does NOTcover • Non-prescription drugs • Most vitamins and minerals • Weight gain or loss • Fertility • Hair growth or cosmetics • Sexual or erectile dysfunction

9. So how much does it COST?

10. Part A costs • $0 premium for Part A -- if you or spouse paid FICA taxes at least 40 quarters (10 total years) • Everyone pays Part A deductibleand co-pays • 2019 benefit period deductible = $1364 • Co-pays based on number of days in hospital

11. Part B costs • 2019 monthly premium is $135.50 (low income get help /high income pay extra) (if drawing SS, premium increase capped at COLA) • Part B deductible and co-pays • 2019 deductible = $185 • Co-pays = 20% of most services

12. Medicare Savings programs • Federal and state help with Medicare costs (premiums, deductibles, co-pays) • Low income/asset limits (home & car exempt) • Not only Medicaid level (Extra Help, QI1) • For more information: DHHS, Social Security, SHIIP, or local Area Agency on Aging

13. Income Related Monthly Amount Adjustment (IRMAA) –2019 PART B COST --based on 2017 return

14. Part D Costs • Premiums range from $15 to $94.30 per month • (low income get help / high income pay Part D IRMAA) • Deductibleand co-pays at pharmacy counter • Deductible =$0 to $415 • Co-insurance share =5% to 37%, depending on your total drug costs

15. Insuring your share of Medicare Costs • Parts A and B pay 80% with no cap on your 20% share • Part D medicine shares can be high

16. Cap Your Medicare Costs Choices for insuring your cost shares • Option 1: Part A, Part B, Medicare Supplement and Part D(front-end loaded) • Option 2: Part C - Medicare Advantage (back-end loaded)

17. Medicare Supplements(part of Option 1) Supplements help pay your A & B share (deductibles/co-pays) Buy Supplement from private company • 6 months from Part B effective date, have one-time “guaranteed issue” right -- no medical underwriting • Think long term, don’t just shop for price

18. Medicare Supplements(part of Option 1) Supplements have front-end premiums, but low out-of-pocket when using medical services 10 Standardized plans available in Nebraska 2019 Monthly premiums for Plan G • $92--$226 (female) • $104--242 (male)

20. Part D Plans(part of Option 1) Plans help pay prescription drug costs Buy Part D plan from private company • Initial Enrollment when you start Medicare • Open Enrollment each year Oct. 15 – Dec. 7 • Good idea to review periodically • Think short term, do shop for price

21. Option 1 - overall cost • Part APart B • SupplementPart D

22. Cap Your Medicare Costs What is the ALTERNATIVE ?

23. Part C – Medicare Advantage Plans(Option 2) • Sold by private insurance companies (they collect per capita administrative fees from government) • Must have Parts A + B • Wraps hospital, medical and (usually) drug coverage into single plan • May have additional benefits (dental, gym membership) • Plans are not standardized • Approx. 33% nationwide/approx. 12% in Nebraska

24. Part C – medicare Advantage Plans • Low premiums, but higher deductibles & co-pays • Premiums $0 - $108 per month, in addition to Part B • You pay deductible or co-pay for every service • Network of medical providers (HMO/PPO/PFFS) • Out-of-pocket annual caps (don’t apply if not in-network) • You verify that all providers are in-network • Travel/residence restrictions -- may or may not cover care outside of service area

25. Part C – medicare Advantage Plans • 36 Nebraska counties have no Advantage plan in 2019 Brown Cedar Chase Cherry Clay Custer Deuel Dundy Fillmore Franklin Frontier Furnas Garden Garfield Grant Greeley Harlan Hayes Hitchcock Howard Johnson Kimball Lincoln Nemaha Nuckolls Pawnee Phelps Polk Red Willow Richardson Rock Sioux Thayer Valley Webster York

26. Option 2 - overall cost Part CMedicare Advantage

27. When, where to enroll in Medicare?

28. agencies responsible for MedicareEnrollment, premiums & replacement cardsAdministration

29. Medicare Enrollment • If you don’t have work insurance, enroll at age 65 • If you delay enrollment to after age 65 and do NOThave work insurance(creditable coverage), there can be permanent late enrollment premium penalties

30. Working After Age 65 • You can keep work insurance (creditable coverage) and delay Medicare (includes spouse on your work insurance or you on spouse’s work insurance) So long as work insurance is from your/spouse’s currentemployer of 20+ people • Small employers (under 20 employees) can require taking Medicare @ 65 • Retiree health plans are not creditable coverage

31. Starting Medicare • Apply for Parts A & B • If starting at 65, may apply online @ www.ssa.gov (must have ssa.gov account)or at local Social Security office (If drawing Social Security, card sent to you automatically) • If working past 65 and have work insurance • --O.K. to have Part A (but not with HSA plan) • --Do notstart Part B at 65 (preserve guaranteed issue for Supplement) • --Cannot apply online when stop working (need forms to prove you had creditable insurance)

32. Starting Medicare 2. Choose Option 1 or Option 2 and apply for Medicare Supplement policy or Advantage plan through mail, phone, or agent/broker 3. Enroll in Part D plan (if you choose Option 1) @medicare.gov, agent/broker, or see Aging Partners/ SHIIP for plan comparisons & enrollment

33. Medicare Information and Help • Offers individual appointments • Counsels persons age 60 and over • Serves Lincoln and 8 surrounding counties 1005 O Street Lincoln, NE 68508 402-441-7070 800-247-0938

34. Federally funded program for Medicare education and counseling • Based in Nebraska Department of Insurance • 7 locations, statewide service 800-234-7119 www.doi.nebraska.gov/shiip Nebraska Department of Insurance