what employers and employees need to know about medicare legislation and eligibility
DESCRIPTION
What Employers and Employees Need to Know About Medicare Legislation and Eligibility. Presented by, Jeff Johnson RHU, CEBS Brown and Brown Insurance. WHY?. Longer Life Span Reduced Savings Increasing Health Insurance Costs Enjoy Working. A Brief History. A Brief History. - PowerPoint PPT PresentationTRANSCRIPT
What Employers and Employees Need to Know About Medicare Legislation and Eligibility
Presented by,Jeff Johnson RHU, CEBSBrown and Brown Insurance
WHY?
Longer Life Span Reduced Savings Increasing Health Insurance Costs Enjoy Working
A Brief History
A Brief History
1945 Truman introduced a national health insurance plan.
1965 Johnson signed legislation. Truman is the first to enroll. Part B premium is $3 per month.
1972 eligibility for disabled and ESRD. Payments to HMOs Authorized.
A Brief History
1983 DRGs, payment to hospitals established. Civilian federal employees eligible.
1984 remaining federal employees eligible.
1988 Major overhaul of Medicare. Catastrophic and prescription benefits added.
A Brief History
1989 Major overhaul repealed. 1992 payments to physicians
established 2003 MMA
A Brief History
MMA, The bill passed 220-215, 5:30AM Added D Removed Rx from Medigap plans Added Inflation Adjustments to B ded. Added Initial Preventive care to B B premium based on income Added HSA Survey - Health Care for All Americans
Benefits
Benefits
Original Medicare Part A Hospital Part B Physicians Part D Prescription Drug (Medigap Policy)
Benefits
Part C - Medicare Advantage Former name - Medicare + Choice
HMO PPO PFFS MSA
Part D Prescription Drug Enrollment 15% WA, 23% OR, 29% CA
Benefits
New Premiums for Medicare B based on Income!
If your income is above $80,000 (single) or $160,000 (married couple), then your Medicare Part B premium may be higher than $93.50 per month
Benefits
MMA Inflation Adjustment - Deductibles
2005 2006 2007 A $912 $952 $992 B $110* $124 $131 C D $250 $265*
*first inflation adjustment
Medicare's Future
Medicare's Future
Budget Busting Currently comprises 13 percent of
federal spending By 2030, the Congressional Budget
Office projects it will consume nearly a quarter of the budget.
Medicare Unfunded Liability 4 Times greater than SS Unfunded Liability
Fiscal Wake up tour David Walker, Comptroller General of the
United States and Director of the Government Accountability Office,
Robert L. Bixby of The Concord Coalition Diane Lim Rogers of The Brookings
Institution Alison A. Fraser of The Heritage
Foundation Bi-partisan discussion
Fiscal Wake up tour
Seattle November 29, 2006 Noon-1:30, Westin Hotel www.seattlecityclub.org
Eligibility&Enrollment
Entitled = eligible and enrolled
Eligibility
Age 65 Disease
ESRD (enacted 1972) ALS (enacted in 2001)
Disability (enacted 1972) SS Elimination period of 5 months On SS Disability for 24 months
Eligibility Federal Retirement timeline
59.5 Can Start Withdrawal IRA, 401(k) 62 Can Start SS Early 65 Medicare (Today-80% males retired) 67 SS Normal 70 SS Max 70.5 Must Start Withdrawal Traditional
IRA, 401(k)
Enrollment
Enrollment time line for Employees Initial, General, Special Covered in next segment
Medicare Supplement (timing) Traditional Medicare Covered in next segment
What Employers Need to Know
What Employers Need to Know
TEFRA-Tax Equity and Fiscal Responsibility Act of 1982
Employers must offer their age 65+ employees with a current employment status, or the spouses of their employees, the same primary health care coverage as their younger employees
What Employers Need to Know
TEFRA Applies to Employers with 20 FT or PT
employees
What Employers Need to Know
TEFRA Coordination of Medicare and
Employer provided medical benefits
Employers plan pays FIRST* Medicare plans pays SECOND Medigap plan pays THIRD
What Employers Need to Know Coordination of Medicare and Employer
provided medical benefits
*Some exceptions Less then 20 employees Medicare pays first ESRD Employers plan pays first for 30 months
then Medicare pays first after 30 months of Medicare eligibility or entitlement
Group plan pays first for Multi-Employer plans that request an exception
What Employers Need to Know
Medicare Secondary Payer (MSP) demand letters.
Such a letter is usually sent because Medicare may have made primary payments for services furnished to Medicare beneficiaries that it believes should have been the primary payment responsibility of the group health plan.
What Employers Need to Know
Medicare and COBRA If you already have group health
coverage under COBRA when you enroll in Medicare, COBRA ends.
If you elect COBRA coverage after you enroll in Medicare, you can keep your COBRA continuation coverage
What Employers Need to Know
Creditable Coverage Annual Notice to Medicare eligible
employees Notice to all employees
Disclosure to CMS Internet
Resources
“Who Pays First” CMS Publication # 02179 40 pages
http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf
Resources
“Enrolling in Medicare” CMS Publication # 11036 60 pages Look up - The Special Enrollment Period
for Medicare Part B, Medicare and Group Health Plan Coverage.
http://www.medicare.gov/Publications/Pubs/pdf/11036.pdf
Resources
“Choosing a Medigap Policy” CMS publication # 02110 100 pages Look up – I am over age 65 and still
working (or covered under my spouse’s health plan)
http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf
Resources
Washington State Office of the Insurance Commissioner has a great publication:
“Retirement and your Health Insurance” Review the section on retiring after age 65.
http://www.insurance.wa.gov/publications/consumer/RetireGuide.pdf