The Maze of Medicare Presented by: Larry Ulvila

Presentation Overview This Presentation provides a brief overview of Medicare components as well as Supplemental plans. This information is for educational purposes only. Please refer to the “Resources” slide for a listing of helpful contacts to learn about specific details for enrolling in Medicare and available Supplemental Plans. Presented by Albers & Company June 5, 2007

Presentation Agenda Medicare 101 Medicare Part D Medicare Part A and B Medicare Eligibility Medicare Part C and other types of Medicare complimentary plans Medicare Part D How does Medicare Part D work? Medicare Resources Presented by Albers & Company June 5, 2007

Medicare 101 Medicare Part A – Hospital Insurance Medical Part B – Medical Insurance Presented by Albers & Company June 5, 2007

Medicare Part A Funded through payroll deductions and taxes - You and AAMC have already paid for these benefits No monthly premium cost if beneficiary worked 40 quarters Benefits in 2017: Covers inpatient care, limited skilled nursing, hospice and some home health care You pay: $ 1,316 deductible and applicable coinsurances Presented by Albers & Company June 5, 2007

Medicare Part B Medicare Part B premiums are based on the year in which you enroll and your annual income The 2017 standard premium is $134.00 (or higher depending on your income), if: You enroll in Part B for the first time in 2017 You are not receiving Social Security benefits You are directly billed for your Part B premiums Your modified adjusted gross income is under $85,000/year (single or married filing separate returns) or under $170,000/year (married filing joint tax return) – higher premiums apply if your income exceeds these limits

Medicare Part B Benefits in 2017: Covers doctor visits, diagnostic services, therapy, outpatient care (non-hospital services) You pay: $183 yearly deductible plus 20% coinsurance for Medicare covered expenses.

Medicare Eligibility: If Retired At age 65 if retired or retiring Contact Social Security 3 months prior/post 65th birthday Enroll in Medicare Parts A & B Can decline Part B 10% penalty for each year failed to apply Unless employee or spouse is working and covered by group insurance (not a plan for retirees) Presented by Albers & Company June 5, 2007

Medicare Eligibility: If Still Working If you are still working, do not plan to retire at age 65, and have group medical coverage: Contact Social Security 3 months prior/post 65th birthday (for example, if your date of birth is January 1, 1950, your initial election period (IEP) will end on March 31, 2017) Consider enrolling in Part A, there is no premium cost. (You cannot contribute to an HSA if you are enrolled in Part A) You can decline Part B No penalty applies if employee or spouse is working and covered under creditable group insurance (not a plan for retirees) Apply for Medicare within 8 months of retirement to avoid penalty Presented by Albers & Company June 5, 2007

Medicare Eligibility: Under Age 65 If you are under 65 Before age 65, you may eligible for Medicare Part A if you: Have been a Social Security Disability beneficiary for 24 months Part B can be purchased Presented by Albers & Company June 5, 2007

Other Types of Medicare Plans Supplemental Plans (aka Medigap) Medicare Advantage Part C Medicare Part D (most often elected when enrolling in a supplemental plan) Presented by Albers & Company June 5, 2007

Supplemental Plans: Medigap Medicare provides Parts A & B You purchase an additional policy that “supplements” what Medicare does not cover, e.g. deductibles, coinsurance Payments based on Medicare allowable charges; may be additional out of pocket costs in excess of 20% coinsurance Supplemental benefits depend on plan elected Presented by Albers & Company June 5, 2007

Medicare Supplemental Plans

Medicare Supplemental Plans

Medicare Supplemental Plans

Medicare Part C Medicare Advantage Plans Must be enrolled in Medicare Part A & B to be eligible Pays providers for services instead of Medicare (whereas Medicare supplemental plan pays after Medicare) HMO & PPO private health insurance plans regulated by the Centers for Medicare and Medicaid Services (CMS) Often includes prescription drug coverage as well as benefits such as routine eye exams, dental and hearing services Presented by Albers & Company June 5, 2007

Medicare Part C – PPO Plan

Medicare Part C – Plus PPO Plan Johns Hopkins Advantage MD (PPO) Plus Monthly Plan Premium $78 Out-of-Pocket Annual Maximum $6,700/$10,000 Combined In and Out-of-Network Office Visit Copay – PCP $5 copay Office Visit Copay - Specialist $40 copay Inpatient Hospital Stay $250/day copay for days 1-7 Outpatient Surgery $200 copay Emergency Care $75 copay Annual Routine Vision Exam $0 copay; up to $150 every other year for eyewear Prescription Drugs Preferred Generic Non-Preferred Generic Preferred Brand Non-Preferred Brand Specialty $4 Copay $12 Copay $42 Copay $92 Copay 33% of the cost Presented by Albers & Company June 5, 2007

Medicare Part D - Overview Open enrollment: Annually every October 15th through December 7th Enroll through a private carrier, not through Medicare Voluntary enrollment, but penalties apply 1%/month delay Waived if employer coverage creditable Presented by Albers & Company June 5, 2007

Medicare Part D Overview Sample Medicare Prescription Drug Basic Plan Coverage Plan Coverage You Pay Deductible 100% of first $400 Initial Coverage Stage: Copay/Coinsurance you pay (at Standard Network Pharmacy) $3 Copay Preferred Generic; $8 Generic; $33 Preferred Brand; 40% Non-Preferred; 25% Specialty Coverage Gap: Amount you pay until your Out-of-Pocket expenses reach $4,950 for the calendar year 58% of Generic drugs 45% of Brand drugs Catastrophic Coverage: Amount you pay after your Out-of-Pocket expenses reach $4,950 for the calendar year Whichever is Greater: $2.95 Generic; $7.40 Other Covered Drugs; OR, 5% of the Drug’s Cost Presented by Albers & Company June 5, 2007

Medicare Part D – Other Thoughts Plans can be flexible in benefit design Plans may have different formularies, but Medicare has some formulary requirements Pharmacy networks vary by plan Higher income individuals will be charged additional surcharge for Part D plans Presented by Albers & Company June 5, 2007

Next Steps – When You Retire Age 65+, retired and no longer covered by a group health plan Make sure you’re enrolled in Medicare Parts A and B; contact Social Security if unsure Analyze options – Medicare Supplement or Medicare Advantage Plan. If you are not already enrolled, decide on a plan and enroll Assess the need for Plan D Analyze plan options online via www.medicare.gov Presented by Albers & Company June 5, 2007

Resources: Medicare Numerous resources available through the Medicare website or by contacting Medicare directly Visit: www.medicare.gov Click on: “Forms, Help and Resources” OR Call: 1-800-MEDICARE (1-800-633-4227) Presented by Albers & Company June 5, 2007

Senior Health Insurance & Assistance Program (SHIP) Resources: SHIP Senior Health Insurance & Assistance Program (SHIP) Counselors provide assistance with Medicare, Supplemental Plans, Medicaid, Long Term Care coverage. Free service available in every State In Anne Arundel County, visit: www.aacounty.org Presented by Albers & Company June 5, 2007

Additional Resources Medicare & You Handbook Visit: www.medicare.gov; select the “Forms, Help and Resources” tab, then click on the “Medicare and You” Handbook Medicare Part D Options In Maryland, visit: www.medicare.gov See “Compare Drug and Health Plans” (click on “Find Health & Drug Plans” on left side of home page) Presented by Albers & Company June 5, 2007

Additional Resources Medicare Helpline 1-800-MEDICARE (1-800-633-4227) Social Security Administration 1-800-772-1213 Senior Health Insurance & Assistance Program (SHIP) 410-222-4464 Presented by Albers & Company June 5, 2007

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