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2/26/2018
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Welcome to Medicare
Presented by: Nebraska SHIIP
Welcome to Medicare
Mary LoftisNebraska Extension Associate
and SHIIP Counselor
mloftis2@unl.edu
402‐374‐2929
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Nebraska SHIIPNebraska Senior Health Insurance Information Program Federally FundedNebraska Department of Insurance
Seven locations statewide350 Certified Counselors Served over 30,000 Nebraskans in 20171‐800‐234‐7119www.doi.nebraska.gov/shiip
Nebraska SHIIPMedicare education & counseling FreeConfidentialUnbiased
Does not sell insurance
Does not do market research
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Nebraska SHIIPPlease note today’s presentation addresses the average individual and that Medicare is individual insurance.
If you have specific questions about: Certain disabilities ALS (Lou Gehrig’s Disease) ESRD (End Stage Renal Disease)
Certain insurance or other coverage ACA (Affordable Care Act) Tricare or VA COBRA
Please feel free to ask the counselor or call Nebraska SHIIP
What is Medicare?
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What is Medicare?Federal Health Insurance created in 1965
Must meet one criteria to qualify:65 or overQualifying DisabilityEnd‐Stage Renal Disease (ESRD)
Part A Hospital Part B Medical
Supplement Part D Drugs
Part CMedicare Advantage
What is Medicare?
OR
Option 1
Option 2
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Part A Hospital Part B Medical
Supplement Part D Drugs
Part CMedicare Advantage
Option 1 ‐ Part A and Part B
OR
Part A – Hospital InsurancePays for: Inpatient Hospital Skilled Nursing FacilityHome HealthcareHospice
Premium free for most
$1340 deductible pays for first 60 daysAdditional copay for days 61 – 150Unlimited Benefit Periods
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Part B – Medical Insurance Pays for:Medical Expenses Physician Services Mental Health Services
Medical Supplies
Clinical Laboratory ExpensesOutpatient Hospital Treatment
Durable Medical Equipment
Part B – Medical Insurance $134 monthly premiumHigher wage earners pay more IRMAA
$183 annual deductible
Copay 20% ‐ no maximum cap
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Part B ‐ IRMAA * Income Related Monthly Adjustment Amount
2016 individual tax return with income
2016 joint tax return with income
2018 monthly premium
Less than $85,000 Less than $170,000 $134
$85,001 to $107,000 $170,001 to $214,000 $187.50
$107,001 to $133,500 $214,001 to $267,000 $267.90
$133,501 to $160,000 $267,001 to $320,000 $348.30
Over $160,000 Over $320,000 $428.60
Part B – Medical Insurance Lower income earners can receive assistance paying for Part B premiums Single Income < $16,524/annually Assets* < $7,280Married Income < $22,164/annually Assets* < $10,930
Apply at ACCESS Nebraska 1‐855‐632‐7633www.ACCESSNebraska.ne.gov
*Assets do not include car or home
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Part A Hospital Part B Medical
Supplement Part D Drugs
Part CMedicare Advantage
Option 1 ‐ Medicare Supplements
OR
Medicare SupplementsOptional extra insurance
Works with Original Medicare & pays for some or allDeductiblesCopays
Purchased from private insurance company Standardized plansGuaranteed renewable
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Medicare SupplementsOne time “guarantee issue” Six month window
At age 65 or overWhen Part B begins for the first time
After “guarantee issue” underwriting will determineOffer/refusal of policyPremiums
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Medicare SupplementsPremiums$40 ‐ $400 per month
Supplement plan with fewer benefits cost lessCompany X ‐ $97 for Plan A (fewest benefits)
Company X ‐ $141 for Plan G (most benefits)
65 year old premiums for same supplement varyCompany Y ‐ $103 for Plan G
Company Z ‐ $282 for Plan G
Medicare SupplementsOut‐of‐pocket determined by which plan you choose
ServiceMedicare Part A & B
only
Medicare Part A & B + Supplement
Plan A
Medicare Part A & B + Supplement
Plan G
65‐day inpatient hospital*
$3,015 $1,340 $0
$100 doctorvisit
$20 $0 $0
*Daily copay for hospitalization days 61 – 90 is $335/day
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Part A Hospital Part B Medical
Supplement Part D Drugs
Part CMedicare Advantage
Option 1 ‐ Medicare Part D
OR
Part D – Drug InsuranceBrand name & generic prescriptions
Monthly Premiums$20.40 ‐ $100.60 IRMAA on higher wages
Deductible$0 ‐ $405
Copay5% ‐ 44%
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Part D – Drug Insurance
Deductible Beneficiary
pays
•Up to $405
Initial C
overage Beneficiary
pays
•Average 25% of cost
Coverage Gap Total drug cost
reaches $3,750
Beneficiary pays
• 35% ‐ Brand
• 44% ‐Generic
Catastrophic Coverage True out of
pocket reaches $5,000
Beneficiary pays greater of
• 5% of cost OR
• $8.35 –Brand
• $3.35 –Generic
Part D – Drug Insurance IRMAA*Income Related Monthly Adjustment Amount
2016 individual tax return with income
2016 joint tax return with income
2018 monthly premium
Less than $85,000 Less than $170,000 Plan Premium
$85,001 to $107,000 $170,001 to $214,000 Plan Premium + $13.00
$107,001 to $133,500 $214,001 to $267,000 Plan Premium + $33.60
$133,501 to $160,000 $267,001 to $320,000 Plan Premium + $54.20
Over $160,000 Over $320,000 Plan Premium + $74.80
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Part D – Drug InsuranceExtra Help (Low Income Subsidy) helps pay Part D cost Single Income < $1,507/month
Assets* < $13,820
Married Income < $2,030/month
Assets* < $27,600
Apply at www.ssa.gov or at Nebraska SHIIP
*Assets do not include car or home
Option 1 – Overall Cost
Part A Hospital Part B Medical
Supplement Part D Drugs
Medicare Part A $0.00
Medicare Part B $134.00
Medicare Supplement* $130.00
Medicare Part D* $36.00
Total $300.00
*Values are examples of average cost per individual
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Part A Hospital Part B Medical
Supplement Part D Drugs
Part CMedicare Advantage
Option 2 ‐ Medicare Part C
OR
Part C – Advantage PlansAlternative to Original Medicare Purchased from private insurance companiesMust be enrolled in Part A & B
Blends Part A, Part B and usually Part DMust offer equal/better coverage than Original MedicareMay offer extra benefits Dental Vision Hearing Availability varies by county Network restrictions HMO/PPO/PFFS
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Part C – Advantage PlansPremiums $0 ‐ $108 per month Continue to pay Part B premium
Deductibles Up to $1,000 for health Up to $405 for prescriptions
Copays Set dollar amounts Percentage of total
Out‐of‐pocket maximum HMOs/PFFSs up to $6,700 PPOs up to $10,000
Part C – Advantage PlansOriginal Medicare vs. Advantage Plans
Service
Original Medicare Only
(with NO Supplement)
Original Medicare + Supplement
Plan G
Sample Medicare Advantage
Primary doctor visit 20%/visit $0 $15/visit
Physical Therapy 20%/visit $0 $45/visit
5‐day inpatient hospital stay
$1,340 $0 $1,815
25‐day skilled nursing facility
$837.50 $0 $837.50
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Part C – Advantage Plans34 Counties with no Part C MA plan in 2018
AntelopeBoydBrownChaseCherryClayCusterDeuelDundyFillmoreFranklinFrontier
FurnasGardenGrantGreeleyHarlanHitchcockHoltHowardKimballNemahaPawneePhelps
PiercePolkRed WillowRichardsonRockSiouxThayerValleyWebsterYork
Option 2 – Overall Cost
Medicare Part A $0.00
Medicare Part B $134.00
Medicare Part C* $44.00
Total $174.00
*Values are examples of average cost per individual
Part CMedicare Advantage
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When and where do I sign up?Age 65 – Initial enrollment Self‐employed or retiredThree months before birthday month Coverage begins the first of the birthday month
Up to three months after birthday month Coverage delayed
Three ways to sign up: Social Security Administration1‐800‐772‐1213www.socialsecurity.gov or www.ssa.gov
I’m still working. Do I need to enroll?If you/your spouse are currently working and you receive your healthcare coverage from active employment:You are NOT required to enroll into Medicare at age 65
Most enroll into Part A Generally premium free
Those with HSAs may not want to enroll
Special enrollment period after retirementAnytime while still coverage by group health plan
Up to eight months after loss of insurance or employment
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What should I consider?Is my work coverage cheaper than Medicare?
*Values are examples of average cost per individual
Medicare Part A/B $134.00
Medicare Supplement* $130.00
Medicare Part D* $36.00
Total $300.00
Medicare Part A/B $134.00
Medicare Part C* $44.00
Total $178.00
What should I consider?Is my work coverage better than Medicare?Medicare Part A/B with a Plan G supplement $183 deductible then 100% coverage for hospital and doctors You will still pay copays for prescriptions
Medicare Part CWill always have deductibles/copays
Similar to work insurance
How do deductibles compare?
Do I need coverage for my spouse or dependent?
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What about Medicaid?Medicaid is a totally income based program.
Nebraska Department of Health and Human Resources
oversee this state program.
Apply online through ACCESSNebraska
IIncome guidelines are varied but General Requirements are:
Household Size*Maximum Income Level (Per Year)
1 $15,800
2 $21,307
What about Medicaid?
Medicaid resource guidelines are approximately:
$4,000 for one individual
$6,000 for two individuals
Does not count their home or one vehicle.
Go to: http://dhhs.ne.gov/medicaid/Pages/Medicaid‐Eligibility.aspx
for more details on the Nebraska Medicaid Program.
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Medicare Fraud & AbuseCosts Medicare $60 billion annuallyProviders billing for services not received Providers ordering unnecessary tests/procedures Compromised Medicare information
You can help protect your Medicare benefitsProtectDetect Report
Medicare Fraud & AbuseProtect Social Security number/Medicare number Shred letters with personal information Medicare does not call or visit
Detect Review Medicare Summary Notice (MSN) Review Explanation of Benefits (EOB) Keep records/Healthcare Journal
Report Ask questions Call Nebraska SHIIP 1‐800‐234‐7119
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Good News!Medicare to issue NEW Medicare cards
Cards will be mailed between April 2018 and April 2019
What do you need to do to get your new card?Make sure your address is current with Social Security
Nothing else. Cards will be sent automatically
Shred your old card as soon as you get your new card
Good News!
Current Medicare Cards NEW Medicare Cards
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Nebraska SHIIPMedicare information by phone, in‐person or via WebEx
Cost comparisons for Part C, D & Supplements
Medicare enrollment help
Medicare problem solving
Low Income Subsidy applications
Presentations for your group
1‐800‐234‐7119
www.doi.nebraska.gov/shiip
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