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Medicare Unraveled: What your Employees Need to Know

Medicare Unraveled: What your Employees Need to Know. [presentation location] [presentation date]. Topics. What is Medicare? When should an employee enroll? How does other coverage work with Medicare? Who can help?. What is Medicare?.

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Medicare Unraveled: What your Employees Need to Know

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  1. Medicare Unraveled:What your Employees Need to Know [presentation location] [presentation date] [Insert Regional Office and Phone Number Here]

  2. Topics • What is Medicare? • When should an employee enroll? • How does other coverage work with Medicare? • Who can help? [Insert Regional Office and Phone Number Here]

  3. What is Medicare? • Established in 1965, a federal health insurance program • Enroll through SSA • Managed by CMS • Who can get Medicare? • People 65 years of age and older • People under 65 with certain disabilities • People with ESRD and other specific diseases [Insert Regional Office and Phone Number Here]

  4. Components of Medicare • Part A • Inpatient hospital coverage • Part B • Outpatient coverage (including doctors’ services, labs, tests, etc.) • Part C (Medicare Advantage) • Combines all benefits into a single plan • Similar to an HMO or PPO • Part D • Prescription drug coverage [Insert Regional Office and Phone Number Here]

  5. For Comprehensive Coverage • Medicare has premiums, deductibles, and co-payments • To offset these costs, beneficiaries may purchase additional coverage • Retiree coverage • Medigap policies • Medicare Advantage Plans (Part C) • Veterans’ benefits or TRICARE [Insert Regional Office and Phone Number Here]

  6. When Should an Employee Enroll? • First opportunity approaching 65th birthday: [Insert Regional Office and Phone Number Here]

  7. What Parts Should an Employee Choose? • 65 years old; continuing to work covered by EGHP (through self or spouse) • Part A • Can defer Parts B & D • Does not apply to same-sex marriages • 65 years or older and retiring • Parts A, B, & D • May have retiree coverage • May purchase additional coverage [Insert Regional Office and Phone Number Here]

  8. What if Part B was Deferred? • If deferred Part B due to coverage through active employment • 8-month enrollment period • Begins at separation or loss of EGHP coverage (whichever is first) • Enrollment beyond 8-month period may result in a lifetime late enrollment penalty and a waiting period for coverage to begin [Insert Regional Office and Phone Number Here]

  9. What if Part D was Deferred? • If deferred Part D due to creditable coverage • 2-month enrollment period • Begins after loss of creditable coverage • Beneficiary must provide proof of creditable coverage (provided by employer/EGHP) • Enrollment beyond 2 month period may result in lifetime late enrollment penalty and a waiting period for coverage to begin [Insert Regional Office and Phone Number Here]

  10. When Should an Employee NOT Defer? • COBRA • Not coverage through active employment • Medical Security Program • Health coverage through Department of Unemployment Assistance • Active employment coverage through same-sex spouse • Federal programs cannot recognize same-sex marriages Will not prevent a late enrollment penalty! [Insert Regional Office and Phone Number Here]

  11. How does Medicare work with other coverage? [Insert Regional Office and Phone Number Here]

  12. Medicare and HSAs • An individual who is entitled to Medicare is no longer able to contribute to a Health Savings Account (HSA) • Even if beneficiary only enrolls in Part A and defers Part B • If a Medicare beneficiary has an HSA, he/she can still use existing funds in the account • Funds can even be used to pay Medicare premiums, deductibles, or co-payments [Insert Regional Office and Phone Number Here]

  13. Who Can Help? • Medicare • 1-800-MEDICARE • www.medicare.gov • Social Security • 1-800-772-1213 • www.ssa.gov For questions related to Medicare benefits For questions related to eligibility and Parts A & B enrollment [Insert Regional Office and Phone Number Here]

  14. SHINE • Funded by Medicare, administered by Massachusetts Executive Office of Elder Affairs in partnership with local agencies • 13 Regional Offices and one statewide (Greater Boston Chinese Golden Age Center) • 600 certified counselors in almost every city or town in Massachusetts • 1-800-AGE-INFO, press 3 (1-800-243-4636) [Insert Regional Office and Phone Number Here]

  15. What does a SHINE Counselor Do? • Provides free, and unbiased health insurance counseling to Medicare beneficiaries of all ages and their caregivers • At a local site, on the phone, or via email • Home visits are available for homebound clients • Assists clients in finding coverage that meets their needs • Answers questions regarding Medicare eligibility, enrollment periods, and benefits • Assists with Medicare appeals and billing issues • Screens for public assistance programs [Insert Regional Office and Phone Number Here]

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