Navigating Medicare: Your Guide to Enrollment and Coverage Options

1. Medicare and You John Williams SHIP Medicare Specialist

2. What’s Medicare When It Is Available • Federal health insurance available at • Age 65 and older • Under age 65 after 24 months of SS or RR disability benefit entitlement • Under age 65 and entitled to SS or RR disability benefits due to ALS • Any age with ESRD • Administered by • Centers for Medicare & Medicaid Services (CMS) • Isn't the same as Medicaid

3. A-B-C-D • Medicare has four parts • Part A – Hospital Insurance • Part B – Medical Insurance • Part C – Medicare Advantage Plans • Part D – Prescription Drug Coverage

4. Medicare Options • Original Medicare only (Parts A & B) • Original Medicare plus supplemental coverage - from former employer/union, Tricare for Life, for example • Original Medicare plus a Medigap plan • Original Medicare plus a Part D prescription drug plan • Medicare Advantage plan (Part C) with or without drug coverage

5. Original Medicare • Go to any provider that accepts Medicare • Members pay • Part A premium - free for most people • Part B premium- amount generally changes annually • IRMAA Part B & D premium increases for people with high income • Deductibles - amounts generally change annually • Coinsurance or copayments • Program are available to help pay members' costs

6. Initial Enrollment Period • Apply 3 months before age 65 if you want Medicare at age 65 • Do not need to be retired • Benefits through employer/union - active employment plans Might not want to enroll in any or all parts of Medicare while working • Auto Enrollment in Parts A and B • If you already receive SS or RR benefits • Can refuse Part B

7. Part B - Other Enrollment Periods • General Enrollment Period • January 1 through March 31 each year • Coverage effective July 1 • Premium increases 10% for each 12-month period you were eligible but did not enroll • Special Enrollment Period • Sign up within 8 months of the end of employer or union health plan coverage

8. Medigap Policies • Health insurance policies • Sold by private insurance companies, plans are A through N • Follow federal and state protection laws in every state • Policies must say “Medicare Supplement Insurance” • Cover “gaps” in Original Medicare • Costs may vary by state, must purchase a plan where you live

9. Medigap – How It Works • Only works with Original Medicare • Can go to any doctor, hospital, or provider that accepts Medicare • Members pay a monthly premium • All Medigap plans must be approved by the IDOI • A list of all Medigap plans is located on the SHIP website (or via packet in the mail) • IDOI Medigap premium comparison tool at www.idoi.in.gov/medigap

10. Medigap Plans - Enrollment • Guaranteed Issue Period - age 65 or older and Part B just starting - no medical underwriting for first 6 months • Other times when you need coverage - with medical underwriting • Special Enrollment Periods - losing retiree coverage that pays secondary to Medicare - no medical underwriting

11. Advantage Plans - Overview • Health plan options approved by Medicare • Medicare benefits delivered through private companies approved by Medicare • Still in Medicare program • Still have Medicare rights and protections • Still get regular Medicare-covered services • May get extra benefits • Such as vision, hearing, or dental care • May be able to get prescription drug coverage (Part D) • Different Advantage Plans • Health Maintenance Organization (HMO) • Preferred Provider Organization (PPO) • Private Fee-for-Service (PFFS) • Special Needs Plan (SNP)

12. Advantage Plans – How They Work • You may have to stay in a certain network of hospitals and providers • Co-pays and deductible are different than Original Medicare

13. Advantage Plans – Join or Switch Plans • When first eligible for Medicare • 7 monthsbeginning 3 months before first month of Medicare eligibility • Annual Election Period • October 15th – December 7th each year • Coverage starts January first of next year • Annual Disenrollment Period • January 1st – February 14th every year (coverage begins the first of the month after you switch) • May also join a Medicare Part D plan during change

14. Part D Prescription Drug Coverage • Private plans available for all people with Medicare • Approved by Medicare • Requirements: • Have Medicare Part A or Part B, or both • Live in plan service area • Programs are available to help pay members' costs • Medicare Prescription Drug Plans • Medicare Advantage Plans

15. Part D Costs • Costs vary by plan, most people will pay: • Monthly premium - varies by plan • Annual deductible - varies by plan and generally changes annually • Initial coverage phase - members pays 25% of drug costs • Coverage gap (donut hole) - copays increase but drug costs are discounted - discounts increases annually until 2019 when coverage gap disappears • Catastrophic coverage - member pays 5% of drug costs • Programs available to help pay Part D costs

16. Part D - Enrollment and Making Changes • When first eligible for Medicare • 7 months beginning 3 months before first month of Medicare eligibility • During specific enrollment periods • Annual Election Period. -. October 15th- December 7th each year Coverage starts January first of next yeay • Special Enrollment Periods - move out of plan service area; lose creditable drug coverage; enter/reside in/leave a Long Term Care facility; eligible for Extra Help • Some people are enrolled automatically

17. Review If You Are Eligible for Medicare • Decide if you want only Original Medicare; Original Medicare plus a Medigap Plan; or a Medicare Advantage Plan • Decide on a Prescription Drug Plan - Part D • Investigate policies and insurance companies • Choose a reasonable number of the plans and contact insurance companies, brokers or independent agents for personal quotes. • Select coverage and enroll in plan(s) • Review your coverage every Fall during AEP and make needed enrollment changes

18. For More Information • 1-800-MEDICARE (1-800-633-4227) • Medicare publications online • www.medicare.gov • www.cms.hhs.gov • www.socialsecurity.gov • SHIP telephone: 1-800-452-4800 • SHIP: www.medicare.in.gov • SHIP counselors