medicare open enrollment community meetingoct 11, 2017  · open enrollment •the doughnut hole is...

MedicareOpenEnrollmentCommunityMeeting

Presentationby:ChampaignCountyHealthCare

Consumers(CCHCC)

Welcome!

MedicareBasicsByClaudiaLennhoff

• Medicareisafederalhealthinsuranceprogramfor:– peopleage65andolder,

– peopleunderage65withcertaindisabilities(approvedbySocialSecurity),

– andpeopleofanyagewithend-stagerenaldisease.

• YoupayintoMedicarewhileyouworkthroughyourpayroll(FICA)taxes.

WhatisMedicare?

• TheMedicarehealthinsurancecardisthered,whiteandbluecard.

• TherearedifferentcoveragepartstoMedicare.

• BetweenApril2018&2019,Medicarewillbemailingnewcardstoeverybeneficiary.

TheMedicareCard

• PartA:Hospitalinsurance

• PartB:MedicalInsurance

• PartD:PrescriptionDrugPlan(PDP)

We’lltalkaboutPartClater!

MedicareParts

• Free(nopremium)formostpeoplewhoqualifiedbasedondisability,haveworkedandpaidintoMedicareforatleast40quarters,orare/weremarriedtosomeonewhoqualifies.

• IfyoudonotqualifyforfreeMedicarePartA,therearewaystopayin,aswell.

MedicarePartA:HospitalInsurance

• OriginalMedicarePartAhasadeductibleof$1,316(in2017)perhospitalization.

• Covers:– in-hospital(overnight)care,

– skillednursingfacility(SNF)care,

– hospicecare,

– andsomehomehealthcare.

MedicarePartA:HospitalInsurance

• Typicallycosts$134.00permonth,andwillbedeductedfromyourSocialSecuritybenefitseachmonthundermostcircumstances.

• OriginalMedicarePartBhasanannualdeductibleof$183 (in2017).

• ThereisapenaltyifyoudonotsignupforPartBwhenyoubecomeeligibleandifyoudonothaveother“creditable”coverage.

MedicarePartB:MedicalInsurance

• Coversdoctors’services,outpatienthospitalcare,emergencyroomvisits,ambulances,bloodandlabwork,durablemedicalequipment,diabetestestingsupplies,somehomehealthcare,andcoveredpreventiveservices.

• Thisisreallythebulkofyourcoverage!

MedicarePartB:MedicalInsurance

WhatMedicareDoesNotCover

• Vision• Coverscataractsurgeries,andglassesin

betweensurgeries;doesnotcoverglassesorcontactlensesinmostsituations.

• Dental• Hearingaids• Long-TermCare/CustodialCare

• EnrollinginMedicarePartsA&BisthroughtheSocialSecurityAdministration.

• YouwillbeautomaticallyenrolledifyouaredrawingSSAretirementbenefitsorafteryouhavebeenreceivingSSDIdisabilitypaymentsfor24months.

• SocialSecuritywillsendyourMedicarecardinthemail.

MedicarePartA&BEnrollment

• IfyouarenottakingyourSocialSecuritybenefits,youneedtoactivelysignupforMedicarethroughSocialSecurity.

• YourInitialEnrollmentPeriod(IEP)is:– 3monthsbeforeyouturn65

– Themonthofyour65th birthday

– 3monthsafteryouturn65

SigningUpforMedicare

• Ifyoudonothaveinsurance.

• IfyouhaveMedicaid,orhaveaMarketplaceplan,youdo needtoenrollduringyourIEP.

• Adaniisgoingtotalkmoreaboutthistransitioninthenextpresentation.

WhoNeedstoEnrollDuringTheirMedicareIEP?

• IfyoumissyourInitialEnrollmentPeriodanddonothaveaSpecialEnrollment(duetolossofcoverage,etc.),youcanenrollduringtheGeneralEnrollmentPeriod.– January1toMarch31ofeachyearforcoveragestartingJuly1ofthatyear.

GeneralEnrollmentPeriod

• Medicare-approvedprivateinsurancecompaniesofferplanswithvaryingpremiums.

• Helpscoverthecostofprescriptiondrugs.

• Eachplanhasdifferentformulariesandtiers(listofmedicationsthattheyhelpcover)anddifferentpharmacynetworks.

PartD:PrescriptionCoverage

• ThereisapenaltyifyoudonotsignupforPartDwhenyoubecomeeligibleanddonothaveothercreditablecoverage.

• EnrollmentisthroughMedicare,duringyourIEP,whenyoulosecreditablecoverage,aswellastheAnnualOpenEnrollmentPeriod.

PartD:PrescriptionCoverage

CoverageOptions:AdvantagePlansandSupplements

• It’simportantthatyouhavesomeformofhospital,medical,andprescriptioncoveragetoaccessthecareyoumayneed,andtoavoidpenaltieslateron.

• Youhaveoptions!Youcansetupyourcoverageindifferentwaysthatbestmeetyourfinancialandhealthneeds.

CoverageOptions

CoverageOptions

• PartCgivesyoutheoptiontohaveprivatecoverageforyourMedicarebenefitsthroughMedicareAdvantageplans,whichareofferedbyprivateinsurancecompaniesthathaveacontractwithMedicare.

PartC:AdvantagePlans

• WhenyouenrollinanAdvantageplan,theinsurertakescareofyourPartAandPartBbenefits,andtypicallyPartDaswell.

• Advantageplansmayofferadditionalbenefits,notcoveredbyoriginalMedicare,includingsomehearing,vision,and/ordentalbenefits.

PartC:AdvantagePlans

• SupplementorMedigap policiescoverwhatMedicarecoversandgowhereMedicaregoes.

• Theyhelpreducethe20%co-insuranceanddeductibles.

• Theydonotincludeprescriptioncoverage(PartDplan).

Supplement(Medigap)Plans

• SupplementpoliciesareorganizedandsoldbyPlanlevels.ThisishelpfulincomparingplansbecauseaPlanFpolicyfromonecompanyisthesameasaPlanFpolicyfromanothercompany.

• Somecompaniesdonotsellpoliciesatalllevels,buttheymustofferatleastaPlanApolicy.WhilePlanFpoliciestendtobethemostexpensive,PlanFpoliciesalsoprovidethemostcoverage.Seehandoutforchart!

SupplementPolicyLevels

• TheSupplement/Medigap OpenEnrollmentPeriodisaone-timesix-monthperiodwhenaMedicarebeneficiaryfirstenrollsinMedicarePartB.

• Aslongasyouapplyduringthisperiod,youcannotbeturneddownforcoverage(guaranteedissue),regardlessofhealthstatus,claims,ormedicalcondition(s).

SupplementPolicyEnrollment

• Policiesmustbesoldguaranteedrenewable.Theycannotbecancelledduetoincreasingageorchangeinhealth.Theycan,however,becancelledduetolatepaymentorfalsestatementsmadeontheinitialapplication.

• Withthesepolicies,thegoalistogetaplanandstickwithit.Youarenotswitchingtheseplanseveryyear.Afteryourinitialenrollment,therearen’tannualenrollmentperiods.

SupplementPolicyRights

• IfyouarereceivingMedicareduetodisability,youwillpaythehighestpremiumallowedbeforeage65.Whenyouturn65,youhaveasecondopenenrollmentopportunitytoseekoutandreceivethesamepremiumratechargedtopeopleatage65.

SupplementPolicyRights

ComparingSupplements&AdvantagePlans

Supplements AdvantagePlans• SupplementsOriginalMedicare • ReplacesOriginalMedicare

• Samebenefitsacrosscompanies • Benefitsvary

• Generallynonetworklimitations • Generallyhasanetwork

• Medicarepaysfirst,thensupplement,andthenyoupayanyremainingcosts

• OnlycoversexpensescoveredbyMedicare

• Planpays,andthenyoupayremainingco-paysorco-insurances

• Cancoveradditionalservices,includingvision,hearinganddental

• Tendtobemoreexpensive • Tendtobelessexpensive

• Ageandtobaccorating • Noageortobaccoratings

• Mayhavemedicalunderwriting • Nomedicalunderwriting

• WhenyoufirstqualifyforMedicare,duetoturning65,andjoinaMedicareAdvantageplan,youhaveatrialperiod.YoucandropthatAdvantageplanwithinthefirst12monthsandgetaMedicareSupplementwithguaranteedissueandwithnopre-existingwaitperiod.

TrialOptions:AdvantagePlans

• WhenyoufirstpurchaseaSupplementpolicy,youhaveafree-lookperiodof30days.Duringthattime,youcancancelyourpolicyandyouwillberefundedyourfullpremium.

Youcan’thavebothaSupplementandanAdvantageplan.

TrialOptions:Supplements

MedicareAnnualOpenEnrollmentByAdaniSanchez

October15– December7

OpenEnrollment

• October15– December7ofeachyear,forplansforthenextcalendaryear.

• ForAdvantageandPartDprescriptionplans(notSupplementpolicies).

• IfyouhaveExtraHelporfullMedicaid,youcanswitchthroughouttheyear,soyouhavemoreflexibility.

OpenEnrollment

OpenEnrollment

• 2018PartDplans– 24plansavailable

– Premiumsrangefrom$17to$181permonth

– Deductibleis$400formostplans

– Lookatmorethanthepremium:howdoestheplancoveryourmedications?

• CoverageLevels(whatyoupay)1. Deductible

2. Initialcoverage

3. Coveragegap(akathedoughnuthole)

4. Catastrophiccoverage

2018PartDPrescriptionPlans

OpenEnrollment

• Thedoughnutholeisacoveragegapthatsomebeneficiariesencounterduringtheyearoncetheyreach$3,700 (in2017)intotaldrugcosts(betweenwhattheyandtheplanpay).

• Itendswhentheyreach$4,950 (in2017).

• Thecostyoupayduringthecoveragegapiscappedatapercentageofwhattheplanpaysforthatdrug.

• Thedoughnutholeisbeingphasedoutsoitisgettingsmallereachyear,until2020,whenitwillgoaway!

TheDoughnutHole

OpenEnrollment• Thereare11plansofferedfrom3differentcompanies

• Thepremiumsrangefrom$0to$157permonth

• Thingstoconsider:– Doesitcoveryourdoctorsandhospitals?

– Howdoesitcovertheservicesyouuseregularly?

– Doesitcoveryourmedications?

– Lookatmorethanjustthepremiumeachmonth

2018AdvantagePlans

GettingReady&Tips

• ReadyourAnnualNoticeofChanges(ANOC)fromyourcurrentplantoseeaboutplanchangeslikepremiums.• ReviewnoticesfromSocialSecurityandMedicaresentoutinthefallregardingeligibilityfordifferentprograms.• Checkyourplan! Evenifyouloveit,checkit.ThenetworksandcoveredmedicationsCANandDOchangeeveryyear.

HowToReview&SwitchPlans

1. Onlineatwww.medicare.gov• Clickonthisbutton

2. Byphonebycalling1(800)MEDICARE3. InpersonwithaSHIPCounselor

WhatYouNeedforOpenEnrollment

• Whenreviewingyouroptions,youneed:– yourMedicarecard,

– yourlistofdoctors(namesandphonenumbers),

– andyourlistofmedications(Irecommendusingyourpillbottles).

• Ifyouneedhelp,setupanappointmentforin-personassistancewithaSHIPcounselor.

LocalSHIPSites

ChampaignCountyRegionalPlanningCommission(217)819-4097

FamilyServicesSeniorResourceCenter(217)352-5100

PresenceCenterforHealth(nowinsidePresencehospitalatCRC):(217)337-2022

• CompaniesthatsellMedicareAdvantageandPartDplansmustfollowcertainruleswhenpromotingtheirproducts.

• Companiescanmarkettheirplanthroughdirectmailandradio,televisionandprintadvertisements.

• Agentscanevenvisityourhomeundercertaincircumstances,butonlyifyouhaveinvitedthem.

AdvertisingofMedicarePlans

• Somethingsplanscannotdo:– Callyouifyoudidnotaskthemtodoso.

– Sendyouunsolicitede-mails.

– Askforfinancialorpersonalinfoiftheycallyou.

–Markettheirplansateducationaleventsorinhealthcaresettings(exceptincommonareas).

– Comparetheirplantoanotherplansbynameinadvertisingmaterials;

WhatPlansCannotDo

• Somethingsplanscannotdo:– Sellyoulifeinsuranceorothernon-healthrelatedproductsatthesameappointment.Thisiscalledcrosssellinganditisprohibitedunlessyourequestthenon-healthrelatedproductinformation.

– ImplythattheyarecallingonbehalfofMedicare.PlansarenotallowedtogiveyoutheimpressionthatMedicareaskedthemtocallyou.

WhatPlansCannotDo(continued)

TransitioningtoMedicare

• Ifyouhaveemployercoverage,talktoyouremployertofindoutwhatyouneedtodo.SometimesyouneedtosignupforMedicare.

• Youremployercantellyouifyouneedto,andifitwillbeyourprimaryorsecondaryinsurance.

• Makesurethatitiscreditablecoverage!

MedicareandEmployerCoverage

• Typically,iftheemployerhaslessthan20employees,youdo needtosignupforMedicareA&Banditisprimary.

• Afteryoustopworkingoryouremployergroupcoverageends(whicheverisfirst),youhave8monthstosignupforMedicarewithoutpenalty.

MedicareandEmployerCoverage

• Ifyouhaveretireeinsurance,itisimportanttotalktoyourbenefitscoordinatortofindoutwhatyouneedtodoandwhatisoffered.

• Theymayoftenhavedifferentplanoptionsthanwhatwewillbediscussingtoday.

MedicareandRetireeCoverage

• Also,beawarethatifyouchooseanAdvantageplanorsupplementthatisnotpartofyourretireebenefitpackage,youmayjeopardizebenefitsyouarereceivingincludinghealthcoverageorpension/annuitypayments.

• Onceyouoptoutoftheirbenefits,yourarelycangetbackin.

MedicareandRetireeCoverage

• IfyouhaveTRICAREforLife(TFL),youneedMedicarePartsAandB,butrarelyneedadditionalcoverage.ForquestionsregardingTFL,pleasecontact1(866)773-0404.

• IfyouhaveVAbenefits,itcountsascreditableprescriptioncoverage.YouwantMedicaresothatyouarecoveredatnon-VAfacilities.ForquestionsregardingVAbenefits,pleasecall1(877)222-8387.

MedicareandTRICARE/VA

• Youmust terminateyourMarketplacecoveragewhenstartingMedicare.

• CoveragecanbeterminatedonlineatHealthcare.gov orbyphoneat1-800-318-2596.

• Youcanterminateyourplanasearlyas60daysbeforeyourMedicarestarts.

• Ittakes14days,sodonotwaituntilthelastminute.

MarketplacetoMedicare

• YoucanhavebothMedicaidandMedicare,but therequirementschange.– Incomehastobeat100%ofthefederalpovertylevel– Assetsarenowconsideredwhenreviewingeligibility.

MedicaidtoMedicare

DualMedicare+MedicaidRequirementsMonthlyIncome Assets

$1005(1person) $2000

$1354(2people) $3000

• MedicaidwouldbesecondaryandcoverthingsthatMedicaredoesnot,likevisionanddental.• IfyouhavebothMedicareandMedicaid,youstillneedtohaveaPartDplanforprescriptioncoverage.• IfyouqualifyforMedicaid,youdon’treallyneedasupplementoradvantageplan.

MedicaidtoMedicare

Resources:MakingYourMedicareWork

ByChrisGarcia

• MedicareSummaryNotices(MSN)– IfyouhaveoriginalMedicare,keepyourMSNs.TheywilltellyouifaservicewasnotcoveredbyMedicare.ThiswillbeanExplanationofBenefits(EOB)fromanAdvantageplan.

• Appeals&Grievances– IfyouhaveoriginalMedicare:appealthroughMedicare.ForPartDandAdvantageplans:startwithplan’sinternalappealprocess.

KnowYourRights

AssistancePrograms

• PrescriptionAssistance– assistancewithcopaymentwhilesearchingfor

longtermsolution

• DentalReferralProgram– Discountprogramwithparticipatinglocaldentist

• OneSightVisionProgram– Examandglassesfreeoratlowcostatlocal

provider

MedicareSavingsProgram

• MedicareSavingsProgram– tohelpwithPartBpremiumsandMedicareco-

insurances– administeredthroughtheIllinoisDept.ofHuman

Services(abe.illinois.gov)– CCHCCstaffcanprovideinformationoneligibility

andassistwithapplication

ExtraHelpforPartD

• ExtraHelpisanincomeandassetbasedprogramtohelpwithprescriptioncosts,administeredbySocialSecurityAdministration.

• IfyouqualifyforfullExtraHelp,youcanget– $0premium(free!)plans;– Withnodeductible;– Andnodoughnuthole.

Grabahandoutfromourtableformoreinfo!

HospitalFinancialAssistance

• CarleFinancialAssistanceProgram(CommunityCare)– mayreceiveadiscountofupto100%

• Medicare100/PlusDiscountProgramforPresencehospital– memberscanpre-qualifyforadiscountofupto100%off

theirout-of-pocketmedicalcostsatparticipatingPresenceproviders

• CCHCCstaffcanhelpwithcompletingapplications

OtherCCHCCServices

• RedeterminationwithDHS• ChangeofaddresswithDHS• ReportincomechangestoDHS• SNAPbenefits• TerminationofMarketplaceplans• PrescriptionAssistance• Safelink phones• AndMORE!!!

ThankYou!

ChampaignCountyHealthCareConsumers(CCHCC)

(217)352-6533healthcareconsumers.org

facebook.com/healthcareconsumerstwitter.com/cchcc1977