Presentation Transcript

1. Sponsored by the SHIBAStatewide Health Insurance Benefits AdvisorsMedicare Open Enrollment PeriodWhat you need to know
2. What is SHIBA? Statewide Health Insurance Benefits Advisors A free program of the Office of the Insurance Commissioner We provide unbiased and confidential information about Medicare and other health insurance We are an educational service We don’t sell anything!
3. Today’s overview Quick overview of Medicare What about the Affordable Care Act? What is Medicare Open Enrollment? Stand-alone prescription drug plans Medicare Advantage plans Do you need help paying for your plan? How to choose a plan
4. Protect yourself! As you research your options: Keep a notebook Write down the names of people you talk to, the date and their contact information Note what was said in the conversation Keep copies of any paperwork Beware of fraud!
5. What is Medicare? Health insurance for people: Age 65 and older Under age 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD)
6. The four parts of Medicare
7. What is Medicare’s Open Enrollment Period to join a drug plan or Medicare Advantage Plan? Every year from Oct. 15 – Dec. 7 People with Medicare can join, switch or leave a Medicare Part D or Medicare Advantage (Part C) plan Changes take effect Jan. 1 of the next year Medicare also calls this the “Annual Enrollment Period”- it means the same thing!
8. Why do a yearly Open Enrollment checkup? Plans change! Coverage changes! Costs change! Your needs change!
9. How Medicare Part D works It’s optional You can choose a plan and enroll Plans have formularies Lists of covered drugs Must include range of drugs in each category You pay the plan a monthly premium You pay deductibles and copayments There is Extra Help to pay Part D costs If you have limited income and resources
10. What do Part D plans cost? For coverage in 2014, you will generally pay: Monthly premium,* varies by plan Possible deductible, no more than $310* Copayments or coinsurance* If costs reach $6,455*, you will only pay a 5% copay for the rest of the year. (Catastrophic Coverage) *These amounts can change each year.
11. What about the Coverage Gap (Donut Hole) ? The Affordable Care Act is phasing out the Donut Hole. In 2014, the Donut Hole will start when your prescription drug costs reach $2,850 for the year. In the Donut Hole, you’ll pay: 47.5% of the retail costs for brand name drugs 72% of the retail costs for generic drugs You will get credit for the full retail cost By 2020, there will be no Donut Hole
12. What about pharmacies? Medicare drug plans work with certain pharmacies You generally must use plan pharmacies Some plans also offer mail mail order Check with the plan Are its pharmacies convenient for you?
13. Who can join Part D? You must have either Part A or Part B or both You must live in the plan’s service area You can’t live outside the U.S. You must actively enroll to join You can only have one plan at a time If you do nothing during annual enrollment, you’ll remain in the same plan you were already in To join a new plan or change plans, you must submit an application to enroll
14. Should I enroll in a Part D plan? Consider: Do you have already have “creditable” drug coverage? Coverage as good as Medicare’s Example: Employer plan through you or your spouse Will that coverage end when you retire? How much do your current drugs cost? What do the premiums cost for Part D plans? Without creditable coverage Late enrollment may mean you pay a penalty
15. For BOTH Medicare Advantage & Part D Plans: You can JOIN or SWITCH When you are first eligible for Medicare During the Open Enrollment Period Oct. 15 – Dec. 7 Coverage starts Jan. 1 During other special times Called Special Enrollment Periods
16. How Medicare Advantage works Plans are Medicare contracted plans with all the rights and protections of Medicare You still get the services provided under Medicare Parts A and B, although you do not use your Medicare card Plan may include prescription drug coverage (Part D) If so, all the rules about drug costs, enrollment, etc. are the same as in a stand-alone Part D plan Plan may include extra benefits Examples: vision, hearing or dental benefits Benefits and cost-sharing may be different Make sure to go over these costs before you join!
17. Do I want to join a Medicare Advantage plan? Consider: Most offer comprehensive coverage Including Part D drug coverage Do your doctors accept it? May require you to use network doctors May require referral to see a specialist Make sure that your doctors accept the plan! Everyone must pay the Part B premium Some plans may also charge a monthly premium, or may have a $0 premium Can only join/leave plan during certain periods Plan does not work with Medigap policies
18. Who can join Medicare Advantage? You must have Medicare Part A andPart B You must live in the plan’s service area You cannot have End Stage Renal Disease Permanent kidney failure requiring dialysis or a transplant You can’t live outside the U.S. You must actively enroll to join
19. When can I enroll in a MA plan? When you are first eligible for Medicare You may Join or Change Plans During the Open Enrollment Period Oct. 15 – Dec. 7 each year May be able to join at other times Special Enrollment Periods Generally, can only leave the plan at the end of a calendar year Contact the plan or Medicare to join
20. Do you need help paying for your plan? Programs are available for people with lower income and assets SHIBA can help you apply!
21. Get help paying for Part D Asset Limits: Individual $13,300 Couple $26,580
22. What other help is there? If you qualify for Extra Help: You might also qualify for help to pay Part B premiums and other Medicare costs This is called the Medicare Savings Program (MSP)
23. Who can qualify for MSP? Asset Limits: Individual $ 7,080 Couple $10,620
24. How do I choose a plan? Step 1: Collect your information Medicare card, any insurance cards Current coverage, drugs and dosages Extra Help info (income/asset information) Step 2: See if you qualify for Extra Help Step 3: Compare plans for upcoming year It’s easy using the Medicare Plan Finder on www.Medicare.gov SHIBA can help with the Plan Finder
25. How do I join a plan? After choosing the plan you are interested in: Step 1: Call plan with any questions Confirm any rules, coverage and exceptions Step 2: Enroll in plan www.medicare.gov Call: 1-800-MEDICARE Call plan directly At any time:Call SHIBA for help at 1-800-562-6900
26. Using your new Rx coverage early in 2014 Take all paperwork to the pharmacy! Picture ID, Medicare card, plan card, plan enrollment confirmation Medicaid card or other coverage information If your new plan denies your drugs: Ask about a “transitional supply” If you pay out of pocket, save receipts and ask your plan to reimburse you
27. Need help with other insurance questions? The Office of the Insurance Commissioner can also help you with questions, information, and complaints about all types of insurance, such as: Call our Insurance Consumer Hotline 1-800-562-6900 Homeowner Auto Life Annuities Health And more!