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MedicareOpenEnrollmentCommunityMeeting
Presentationby:ChampaignCountyHealthCare
Consumers(CCHCC)
Welcome!
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MedicareBasicsByClaudiaLennhoff
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• Medicareisafederalhealthinsuranceprogramfor:– peopleage65andolder,
– peopleunderage65withcertaindisabilities(approvedbySocialSecurity),
– andpeopleofanyagewithend-stagerenaldisease.
• YoupayintoMedicarewhileyouworkthroughyourpayroll(FICA)taxes.
WhatisMedicare?
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• TheMedicarehealthinsurancecardisthered,whiteandbluecard.
• TherearedifferentcoveragepartstoMedicare.
• BetweenApril2018&2019,Medicarewillbemailingnewcardstoeverybeneficiary.
TheMedicareCard
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• PartA:Hospitalinsurance
• PartB:MedicalInsurance
• PartD:PrescriptionDrugPlan(PDP)
We’lltalkaboutPartClater!
MedicareParts
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• Free(nopremium)formostpeoplewhoqualifiedbasedondisability,haveworkedandpaidintoMedicareforatleast40quarters,orare/weremarriedtosomeonewhoqualifies.
• IfyoudonotqualifyforfreeMedicarePartA,therearewaystopayin,aswell.
MedicarePartA:HospitalInsurance
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• OriginalMedicarePartAhasadeductibleof$1,316(in2017)perhospitalization.
• Covers:– in-hospital(overnight)care,
– skillednursingfacility(SNF)care,
– hospicecare,
– andsomehomehealthcare.
MedicarePartA:HospitalInsurance
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• Typicallycosts$134.00permonth,andwillbedeductedfromyourSocialSecuritybenefitseachmonthundermostcircumstances.
• OriginalMedicarePartBhasanannualdeductibleof$183 (in2017).
• ThereisapenaltyifyoudonotsignupforPartBwhenyoubecomeeligibleandifyoudonothaveother“creditable”coverage.
MedicarePartB:MedicalInsurance
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• Coversdoctors’services,outpatienthospitalcare,emergencyroomvisits,ambulances,bloodandlabwork,durablemedicalequipment,diabetestestingsupplies,somehomehealthcare,andcoveredpreventiveservices.
• Thisisreallythebulkofyourcoverage!
MedicarePartB:MedicalInsurance
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WhatMedicareDoesNotCover
• Vision• Coverscataractsurgeries,andglassesin
betweensurgeries;doesnotcoverglassesorcontactlensesinmostsituations.
• Dental• Hearingaids• Long-TermCare/CustodialCare
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• EnrollinginMedicarePartsA&BisthroughtheSocialSecurityAdministration.
• YouwillbeautomaticallyenrolledifyouaredrawingSSAretirementbenefitsorafteryouhavebeenreceivingSSDIdisabilitypaymentsfor24months.
• SocialSecuritywillsendyourMedicarecardinthemail.
MedicarePartA&BEnrollment
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• IfyouarenottakingyourSocialSecuritybenefits,youneedtoactivelysignupforMedicarethroughSocialSecurity.
• YourInitialEnrollmentPeriod(IEP)is:– 3monthsbeforeyouturn65
– Themonthofyour65th birthday
– 3monthsafteryouturn65
SigningUpforMedicare
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• Ifyoudonothaveinsurance.
• IfyouhaveMedicaid,orhaveaMarketplaceplan,youdo needtoenrollduringyourIEP.
• Adaniisgoingtotalkmoreaboutthistransitioninthenextpresentation.
WhoNeedstoEnrollDuringTheirMedicareIEP?
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• IfyoumissyourInitialEnrollmentPeriodanddonothaveaSpecialEnrollment(duetolossofcoverage,etc.),youcanenrollduringtheGeneralEnrollmentPeriod.– January1toMarch31ofeachyearforcoveragestartingJuly1ofthatyear.
GeneralEnrollmentPeriod
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• Medicare-approvedprivateinsurancecompaniesofferplanswithvaryingpremiums.
• Helpscoverthecostofprescriptiondrugs.
• Eachplanhasdifferentformulariesandtiers(listofmedicationsthattheyhelpcover)anddifferentpharmacynetworks.
PartD:PrescriptionCoverage
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• ThereisapenaltyifyoudonotsignupforPartDwhenyoubecomeeligibleanddonothaveothercreditablecoverage.
• EnrollmentisthroughMedicare,duringyourIEP,whenyoulosecreditablecoverage,aswellastheAnnualOpenEnrollmentPeriod.
PartD:PrescriptionCoverage
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CoverageOptions:AdvantagePlansandSupplements
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• It’simportantthatyouhavesomeformofhospital,medical,andprescriptioncoveragetoaccessthecareyoumayneed,andtoavoidpenaltieslateron.
• Youhaveoptions!Youcansetupyourcoverageindifferentwaysthatbestmeetyourfinancialandhealthneeds.
CoverageOptions
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CoverageOptions
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• PartCgivesyoutheoptiontohaveprivatecoverageforyourMedicarebenefitsthroughMedicareAdvantageplans,whichareofferedbyprivateinsurancecompaniesthathaveacontractwithMedicare.
PartC:AdvantagePlans
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• WhenyouenrollinanAdvantageplan,theinsurertakescareofyourPartAandPartBbenefits,andtypicallyPartDaswell.
• Advantageplansmayofferadditionalbenefits,notcoveredbyoriginalMedicare,includingsomehearing,vision,and/ordentalbenefits.
PartC:AdvantagePlans
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• SupplementorMedigap policiescoverwhatMedicarecoversandgowhereMedicaregoes.
• Theyhelpreducethe20%co-insuranceanddeductibles.
• Theydonotincludeprescriptioncoverage(PartDplan).
Supplement(Medigap)Plans
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• SupplementpoliciesareorganizedandsoldbyPlanlevels.ThisishelpfulincomparingplansbecauseaPlanFpolicyfromonecompanyisthesameasaPlanFpolicyfromanothercompany.
• Somecompaniesdonotsellpoliciesatalllevels,buttheymustofferatleastaPlanApolicy.WhilePlanFpoliciestendtobethemostexpensive,PlanFpoliciesalsoprovidethemostcoverage.Seehandoutforchart!
SupplementPolicyLevels
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• TheSupplement/Medigap OpenEnrollmentPeriodisaone-timesix-monthperiodwhenaMedicarebeneficiaryfirstenrollsinMedicarePartB.
• Aslongasyouapplyduringthisperiod,youcannotbeturneddownforcoverage(guaranteedissue),regardlessofhealthstatus,claims,ormedicalcondition(s).
SupplementPolicyEnrollment
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• Policiesmustbesoldguaranteedrenewable.Theycannotbecancelledduetoincreasingageorchangeinhealth.Theycan,however,becancelledduetolatepaymentorfalsestatementsmadeontheinitialapplication.
• Withthesepolicies,thegoalistogetaplanandstickwithit.Youarenotswitchingtheseplanseveryyear.Afteryourinitialenrollment,therearen’tannualenrollmentperiods.
SupplementPolicyRights
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• IfyouarereceivingMedicareduetodisability,youwillpaythehighestpremiumallowedbeforeage65.Whenyouturn65,youhaveasecondopenenrollmentopportunitytoseekoutandreceivethesamepremiumratechargedtopeopleatage65.
SupplementPolicyRights
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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
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• WhenyoufirstqualifyforMedicare,duetoturning65,andjoinaMedicareAdvantageplan,youhaveatrialperiod.YoucandropthatAdvantageplanwithinthefirst12monthsandgetaMedicareSupplementwithguaranteedissueandwithnopre-existingwaitperiod.
TrialOptions:AdvantagePlans
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• WhenyoufirstpurchaseaSupplementpolicy,youhaveafree-lookperiodof30days.Duringthattime,youcancancelyourpolicyandyouwillberefundedyourfullpremium.
Youcan’thavebothaSupplementandanAdvantageplan.
TrialOptions:Supplements
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MedicareAnnualOpenEnrollmentByAdaniSanchez
October15– December7
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OpenEnrollment
• October15– December7ofeachyear,forplansforthenextcalendaryear.
• ForAdvantageandPartDprescriptionplans(notSupplementpolicies).
• IfyouhaveExtraHelporfullMedicaid,youcanswitchthroughouttheyear,soyouhavemoreflexibility.
OpenEnrollment
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OpenEnrollment
• 2018PartDplans– 24plansavailable
– Premiumsrangefrom$17to$181permonth
– Deductibleis$400formostplans
– Lookatmorethanthepremium:howdoestheplancoveryourmedications?
• CoverageLevels(whatyoupay)1. Deductible
2. Initialcoverage
3. Coveragegap(akathedoughnuthole)
4. Catastrophiccoverage
2018PartDPrescriptionPlans
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OpenEnrollment
• Thedoughnutholeisacoveragegapthatsomebeneficiariesencounterduringtheyearoncetheyreach$3,700 (in2017)intotaldrugcosts(betweenwhattheyandtheplanpay).
• Itendswhentheyreach$4,950 (in2017).
• Thecostyoupayduringthecoveragegapiscappedatapercentageofwhattheplanpaysforthatdrug.
• Thedoughnutholeisbeingphasedoutsoitisgettingsmallereachyear,until2020,whenitwillgoaway!
TheDoughnutHole
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OpenEnrollment• Thereare11plansofferedfrom3differentcompanies
• Thepremiumsrangefrom$0to$157permonth
• Thingstoconsider:– Doesitcoveryourdoctorsandhospitals?
– Howdoesitcovertheservicesyouuseregularly?
– Doesitcoveryourmedications?
– Lookatmorethanjustthepremiumeachmonth
2018AdvantagePlans
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GettingReady&Tips
• ReadyourAnnualNoticeofChanges(ANOC)fromyourcurrentplantoseeaboutplanchangeslikepremiums.• ReviewnoticesfromSocialSecurityandMedicaresentoutinthefallregardingeligibilityfordifferentprograms.• Checkyourplan! Evenifyouloveit,checkit.ThenetworksandcoveredmedicationsCANandDOchangeeveryyear.
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HowToReview&SwitchPlans
1. Onlineatwww.medicare.gov• Clickonthisbutton
2. Byphonebycalling1(800)MEDICARE3. InpersonwithaSHIPCounselor
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WhatYouNeedforOpenEnrollment
• Whenreviewingyouroptions,youneed:– yourMedicarecard,
– yourlistofdoctors(namesandphonenumbers),
– andyourlistofmedications(Irecommendusingyourpillbottles).
• Ifyouneedhelp,setupanappointmentforin-personassistancewithaSHIPcounselor.
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LocalSHIPSites
ChampaignCountyRegionalPlanningCommission(217)819-4097
FamilyServicesSeniorResourceCenter(217)352-5100
PresenceCenterforHealth(nowinsidePresencehospitalatCRC):(217)337-2022
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• CompaniesthatsellMedicareAdvantageandPartDplansmustfollowcertainruleswhenpromotingtheirproducts.
• Companiescanmarkettheirplanthroughdirectmailandradio,televisionandprintadvertisements.
• Agentscanevenvisityourhomeundercertaincircumstances,butonlyifyouhaveinvitedthem.
AdvertisingofMedicarePlans
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• Somethingsplanscannotdo:– Callyouifyoudidnotaskthemtodoso.
– Sendyouunsolicitede-mails.
– Askforfinancialorpersonalinfoiftheycallyou.
–Markettheirplansateducationaleventsorinhealthcaresettings(exceptincommonareas).
– Comparetheirplantoanotherplansbynameinadvertisingmaterials;
WhatPlansCannotDo
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• Somethingsplanscannotdo:– Sellyoulifeinsuranceorothernon-healthrelatedproductsatthesameappointment.Thisiscalledcrosssellinganditisprohibitedunlessyourequestthenon-healthrelatedproductinformation.
– ImplythattheyarecallingonbehalfofMedicare.PlansarenotallowedtogiveyoutheimpressionthatMedicareaskedthemtocallyou.
WhatPlansCannotDo(continued)
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TransitioningtoMedicare
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• Ifyouhaveemployercoverage,talktoyouremployertofindoutwhatyouneedtodo.SometimesyouneedtosignupforMedicare.
• Youremployercantellyouifyouneedto,andifitwillbeyourprimaryorsecondaryinsurance.
• Makesurethatitiscreditablecoverage!
MedicareandEmployerCoverage
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• Typically,iftheemployerhaslessthan20employees,youdo needtosignupforMedicareA&Banditisprimary.
• Afteryoustopworkingoryouremployergroupcoverageends(whicheverisfirst),youhave8monthstosignupforMedicarewithoutpenalty.
MedicareandEmployerCoverage
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• Ifyouhaveretireeinsurance,itisimportanttotalktoyourbenefitscoordinatortofindoutwhatyouneedtodoandwhatisoffered.
• Theymayoftenhavedifferentplanoptionsthanwhatwewillbediscussingtoday.
MedicareandRetireeCoverage
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• Also,beawarethatifyouchooseanAdvantageplanorsupplementthatisnotpartofyourretireebenefitpackage,youmayjeopardizebenefitsyouarereceivingincludinghealthcoverageorpension/annuitypayments.
• Onceyouoptoutoftheirbenefits,yourarelycangetbackin.
MedicareandRetireeCoverage
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• IfyouhaveTRICAREforLife(TFL),youneedMedicarePartsAandB,butrarelyneedadditionalcoverage.ForquestionsregardingTFL,pleasecontact1(866)773-0404.
• IfyouhaveVAbenefits,itcountsascreditableprescriptioncoverage.YouwantMedicaresothatyouarecoveredatnon-VAfacilities.ForquestionsregardingVAbenefits,pleasecall1(877)222-8387.
MedicareandTRICARE/VA
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• Youmust terminateyourMarketplacecoveragewhenstartingMedicare.
• CoveragecanbeterminatedonlineatHealthcare.gov orbyphoneat1-800-318-2596.
• Youcanterminateyourplanasearlyas60daysbeforeyourMedicarestarts.
• Ittakes14days,sodonotwaituntilthelastminute.
MarketplacetoMedicare
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• YoucanhavebothMedicaidandMedicare,but therequirementschange.– Incomehastobeat100%ofthefederalpovertylevel– Assetsarenowconsideredwhenreviewingeligibility.
MedicaidtoMedicare
DualMedicare+MedicaidRequirementsMonthlyIncome Assets
$1005(1person) $2000
$1354(2people) $3000
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• MedicaidwouldbesecondaryandcoverthingsthatMedicaredoesnot,likevisionanddental.• IfyouhavebothMedicareandMedicaid,youstillneedtohaveaPartDplanforprescriptioncoverage.• IfyouqualifyforMedicaid,youdon’treallyneedasupplementoradvantageplan.
MedicaidtoMedicare
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Resources:MakingYourMedicareWork
ByChrisGarcia
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• MedicareSummaryNotices(MSN)– IfyouhaveoriginalMedicare,keepyourMSNs.TheywilltellyouifaservicewasnotcoveredbyMedicare.ThiswillbeanExplanationofBenefits(EOB)fromanAdvantageplan.
• Appeals&Grievances– IfyouhaveoriginalMedicare:appealthroughMedicare.ForPartDandAdvantageplans:startwithplan’sinternalappealprocess.
KnowYourRights
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AssistancePrograms
• PrescriptionAssistance– assistancewithcopaymentwhilesearchingfor
longtermsolution
• DentalReferralProgram– Discountprogramwithparticipatinglocaldentist
• OneSightVisionProgram– Examandglassesfreeoratlowcostatlocal
provider
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MedicareSavingsProgram
• MedicareSavingsProgram– tohelpwithPartBpremiumsandMedicareco-
insurances– administeredthroughtheIllinoisDept.ofHuman
Services(abe.illinois.gov)– CCHCCstaffcanprovideinformationoneligibility
andassistwithapplication
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ExtraHelpforPartD
• ExtraHelpisanincomeandassetbasedprogramtohelpwithprescriptioncosts,administeredbySocialSecurityAdministration.
• IfyouqualifyforfullExtraHelp,youcanget– $0premium(free!)plans;– Withnodeductible;– Andnodoughnuthole.
Grabahandoutfromourtableformoreinfo!
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HospitalFinancialAssistance
• CarleFinancialAssistanceProgram(CommunityCare)– mayreceiveadiscountofupto100%
• Medicare100/PlusDiscountProgramforPresencehospital– memberscanpre-qualifyforadiscountofupto100%off
theirout-of-pocketmedicalcostsatparticipatingPresenceproviders
• CCHCCstaffcanhelpwithcompletingapplications
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OtherCCHCCServices
• RedeterminationwithDHS• ChangeofaddresswithDHS• ReportincomechangestoDHS• SNAPbenefits• TerminationofMarketplaceplans• PrescriptionAssistance• Safelink phones• AndMORE!!!
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ThankYou!
ChampaignCountyHealthCareConsumers(CCHCC)
(217)352-6533healthcareconsumers.org
facebook.com/healthcareconsumerstwitter.com/cchcc1977