Medicare ABC s

1. Medicare ABCs

2. 123-45-6789-A FEMALE HOSPITAL (PART A) 01-01-1992MEDICAL (PART B) 01-01-1992 What Is Medicare? • Federal health insurance created in 1965 (amendment to Social Security Act) • You must be U.S. citizen or legal permanent resident and • 65 or older • Under 65 and disabled 24+ months on Social Security Disability • End-Stage Renal Disease (any age) Jane Doe

3. Components of Medicare Part A Hospital Part B Medical OR Part CMedicare Advantage Supplement Part D Drugs

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

5. SNF covered IF: Inpatient 3 midnights, Admitted to SNF w/in 30 days, Care needed for hospital-treated condition. Outpatient – When the 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 with a doctor’s order. The day before you're discharged is your last inpatient day. Medicare Outpatient Observation Notice (MOON) – provided when in observation status longer than 24 hours, but before 36th hour

6. 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 • Personal care • Health care outside the U.S. (except emergency)

7. 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 • Cough or cold • Hair growth or cosmetics • Sexual or erectile dysfunction

8. So how much does it COST?

9. Part A costs • If you or your spouse paid FICA taxes for at least 40 quarters (10 total years), you pay no premium for Part A • 99% pay no premium (can cost up to $422/month) • Everyone pays Part A deductible and co-pays 2018 benefit period deductible = $1340 Co-pays based on number of days in hospital

10. Part B costs • New-to-Medicare in 2018 pay $134 permonth (low income get help /high income pay extra) (if drawing SS, any increase is capped at COLA) • Everyone pays Part B deductible and co-pays 2018 Annual deductible = $183 Co-pays = 20% of most medical services

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

12. Income Related Monthly Amount Adjustment (IRMAA) –You pay in 2018--based on 2016 return

13. Part D Costs • Premiums range from $20.40 to $100.60 per month • (low income get help /high income pay Part D IRMAA) • Deductibleand co-pays at pharmacy counter • Deductibles = $0 to $405 • Co-pays = 5% to 44% of full cost of drug, depending on your total annual drug costs

15. Cap Your Medicare Costs • Medicare Parts A and B pay about 80% • no cap on your co-pays of about 20%

16. Cap Your Medicare Costs Two choices for insuring Parts A and B co-pays • Option 1:Medicare Supplement (Medigap) and Part D policies (front-end loaded) • Option 2:Part C - Medicare Advantage plan (back-end loaded)

17. Medicare Supplements • Supplements help pay A & B co-pays, depending on plan you choose • Buy Supplement from private company • 6 months from Part B effective date, have one-time “guaranteed issue” right with no medical underwriting • Think long term, don’t just shop for price

18. Medicare Supplements Supplements have front-end premiums, but low out-of-pocket when using medical services 10 Standardized plans available in Nebraska 2018 Monthly non-tobacco premium range for Plan G • $91--$226 per month (female) • $103--227 (male)

20. Part D Plans • Plans help pay prescription drug costs, depending on plan you choose • Buy Part D plan from private company • Initial enrollment when you start Medicare • Each year open enrollment October 15 – December 7 • Good idea to review periodically • Think short term, do shop for price

21. Cap Your Medicare Costs What is the ALTERNATIVE ?

22. Part C – Medicare Advantage Plans • Alternative way to cap your out-of-pocket costs • Sold by private insurance companies (they collect per capita from government) • Very different rules, restrictions and costs than Original Medicare (A + B + Supplement + D) • Wrap hospital, medical and (usually) drug coverage into single plan -- plans are not standardized • 33% nationwide / 12% in Nebraska

23. Part C – medicare Advantage Plans • Advantage plans charge low premiums, but higher deductibles & co-pays than Supplements • Premiums $0 - $188 per month, in addition to Part B • You pay deductible or co-pay for every service • HMO/PPO networks of medical providers • Out-of-pocket limits (don’t apply if not in-network) • You must check with all providers to ensure in-network • Travel/residence restrictions (not sold in all NE counties) • (if out of region, may only cover emergency care)

24. When, where to enroll in Medicare?

25. agencies responsible for MedicareEnrollment, premiums & replacement cards Administration

26. Medicare Enrollment at 65 • If you don’t have work insurance, enroll at age 65 • If you delay enrollment to after age 65 and do NOThave work insurance, there are permanent late enrollment premium penalties

27. Working After Age 65 • You can keep work insurance and delay Medicare without penalties (includes spouse who is on your work insurance or you on spouse’s work insurance) If insurance is from your/spouse’s current employer of 20+ people --Small employers can require taking Medicare @ 65 --Retiree health plans are not creditable coverage

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

29. Starting Medicare 2. Apply for Medicare Supplement policy through mail, phone, or agent/broker 3. Enroll in Part D plan @medicare.gov, SHIIP, or Aging Partners for plan comparisons & enrollment

30. Medicare Information and Help • Counseling • Cost comparisons • Enrollment assistance Aging Partners: 402-441-7070 SHIIP: 800-234-7119

31. Nebraska’s state-wide program to educate older Nebraskans and people with disabilities about health insurance and health care fraud. SHIIP provides presentations and maintains a counseling program for Nebraskans who request one-on-one assistance. Services are free and unbiased. All counseling sessions are completely confidential. Call 1-800-234-7119 DOI.SHIIP@nebraska.gov Nebraska Department of Insurance