more about medicare and changes in 2010 provided by copyright© 2009, 2010
TRANSCRIPT
Agenda Common misconceptions Differences among Medicare Parts A,
B, C and D; Medigap Enrollment Medicare: 2010 changes Valuable resources
Common Misconceptions “Medicare is free and covers everything.”
“Medicare Part A with a Medigap policy is enough.”
“I can enroll in Medicare whenever I want to.”
My doctor will tell me what I need for Medicare coverage.”
“Medicare will cover my long-term care.”
What Seniors Are Saying . . .
“I turn 65 next year and I’m counting on my Medicare to replace my current insurance.”
“There are so many moving parts to Medicare, I’m confused.”
“Where would I find information to help me understand my Medicare insurance benefits?”
“Help, I need somebody, help, not just anybody…” -- The Beatles
Benefits ofUnderstanding Medicare
Make better decisions for your health care, short- and long-term
Have information and resources to address future needs
Potential to avoid or reduce stress on the family
Medicare - Since 1965…
Changes in coverage Increasing premiums More out-of-pocket expenses New plan - prescription drugs
Do you think things might keep changing?
What is Medicare?
Medicare is health insurance for people:
• Age 65 or older
• Under age 65 with certain disabilities
• Any age with End-Stage Renal Disease (ESRD) -- permanent kidney failure requiring dialysis or a kidney transplant
Medicare’s Goal
To make it easy for you to get the highest quality health care at the most affordable price.
To transform itself from a program which simply pays the bills to a program which actively supports a high quality health care system.
Medicare and Medigap: A Family of Coverage
Part A = Oldest child Part B = Next oldest Part C = Middle child Part D = Next child Medigap = Last child
Part A – Oldest Child Part A is hospital insurance for
inpatient careRehabilitation facilitiesSome skilled nursing facility careHospice careSome skilled home health care
Medically necessary and reasonable treatments
Part A continued Must show significant improvement Outpatient therapy ordered by doctor and
provided by Medicare-certified home health agencyPart time or intermittent skilled nursingSpeech-languageOccupational and physical
Entitlement program; majority of beneficiaries do not pay premiums
Part A + Employer Plan
For seniors who continue to work: Comprehensive Both plans pay; one is primary
provider Employer plan covers Part A co-pays
and deductibles, regardless of who the primary provider is
Which Plan Pays First?
At the time the claim is submitted --
Employer plan administrator
Health care provider
Medicare
Determine which plan is the primarycoverage based on Medicare rules
Part B – Next Oldest Child
Medically necessary services Doctor Outpatient care Some preventive services Variety of medical services
Voluntary plan; monthly premium paidby deduction from Social Security check
Part C – Middle Child
Called Medicare Advantage Plans Cover Parts A and B plus provide
additional coverage Offered by private companies
Voluntary program; Part C premiums (if any) are paid directly to the plan provider; senior must still pay Part B premiums, too
Part C Medicare Advantage continued
More coverage than Parts A and B, especially preventive services
Vision exams and eyeglasses Dental Health and wellness programs Rx (most include Medicare drug
prescriptions)
Part D – Next Child
Prescription Drug Plan – 2004
Must have Part A or Part B to enroll – or if you have a Medicare Advantage Plan, both Parts A and B
Private companies sell plans
Must live in plan’s service area
Part D Costs
Plans vary in cost and drugs covered Co-pays or coinsurance Deductibles Monthly premiums Drug costs
Voluntary program; senior pays premiums out-of-pocket or premiums are included in Part C Medicare Advantage Plan
Medigap - Last Child Also called Medicare Supplement Plans Sold by private insurance agents MUST have Parts A and B to buy Covers only 1 person Helps pay costs that Parts A and B don’t:
Co-pays Coinsurance Deductibles
Voluntary program; senior pays for it
Medigap Plans continued Standardized plans – A through L
A is basic coverage; more in B – L; some offer out-of-country coverage
June 1, 2010: New plans M and N; and E, H, I and J no longer available for purchase
Cost variesDon’t need if you have a Part C Medicare Advantage plan
When to Enroll or Change Your Medicare, Medigap Plans
Part A and Part B enrollments Automatic Initial General Special
Part C Medicare Advantage Plans Part D Prescription Drug Medigap Supplemental Plans
Handout: Medicare Enrollment Overview
Annual Changes in Medicare All parts of Medicare
New premiumsNew limits
New plans added
Where to learn more: www.medicare.gov
Part A – 2010
Premium $0 if senior paid at least 40 credits
to Social Security during working years
$461 per month if less than 40 credits paid
Part A 2010 continued
For each benefit period in a year: Deductible: $1,100 for each hospital stay of 1-60 days Coinsurance - hospital:
$275 per day - days 61-90 $550 per day - days 91-150 (60 Lifetime Reserve Days
Skilled Nursing Facility (SNF): $0 - days 1-20 $137.50 per day - days 21-100
Part B – 2010
Premium is based on income
Individual: $110.50 per month for adjusted gross income equal to or under $85,000
Joint tax return: Up to $353.60 per month for highest adjusted gross income above $428,000
Part B 2010 continued
Deductible is $155 annually
Co-pay or coinsurance Senior pays these amounts for most doctor services, durable medical equipment, and outpatient mental health care
Co-pay (cash out-of-pocket) or coinsurance (another carrier)
Part C – 2010
Premiums vary depending on provider and plan – some are $0
Pays out-of-pocket costs for:Co-paysCoinsuranceDeductibles
Don’t need a Medigap Plan
Part D - 2010
Premium Averages about $35 per month Can go up to $121 or more per
month State-specific
Handout: Medicare Part D Coverage
Future of Medicare
“Absent fundamental reforms, over the next two decades the average American household’s health-care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23% to 41% of average household income.
Medicare Future continued
By curtailing revenues, today’s recession will bring closer the projected exhaustion of the Medicare Part A trust fund from early 2019 to perhaps 2016.”
-- Michael Levitt
Former Secretary of Health and Human Services
Last Thoughts… In 1965 America’s median age was 28.4,
now it is 36.6
The average life expectancy is age 80
Ratio of workers to seniors has steadily declined; number of seniors living long enough to have 5 or more chronic conditions -- 23% of Medicare beneficiaries -- has increased
Source: George Will, The Washington Post
Long-Term Care -- Does Medicare Cover It? Part A – Partially; only skilled, not
custodial care Part B – No Part C – No Part D – No Medigap Supplement Plans - No