Medicare and How Drew University’s Plan Works for You

What is Medicare? Health insurance for people It is Administered by 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) It is Administered by Centers for Medicare & Medicaid Services (CMS) Enrollment is done by Social Security Administration (SSA) for most

What is Medicare? The Social Security Act established both the Medicare and Medicaid programs in 1965. Original Medicare is a “fee-for-service” system, where a Medicare beneficiary is charged a fee for each health care service/supply received. Beneficiaries can see any provider that is approved by the Medicare program.

Enrollment Automatic for those receiving Social Security benefits Railroad Retirement Board benefits Initial Enrollment Period Package Mailed 3 months before Age 65 25th month of disability benefits

When to Enroll in Medicare You don’t have to be retired Your Initial Enrollment Period lasts 7 months Begins 3 months before your 65th birthday Includes the month you turn 65 Ends 3 months after you turn 65 There are other times you may enroll But you may pay a penalty if you delay

Enrolling in Medicare Part A Get it automatically if getting Social Security Free for most people Can pay if work history is not sufficient There may be a penalty if you delay If you/your spouse is actively working and covered by employer plan Contact Social Security to sign up

Enrolling in Medicare Part B Automatic if getting Social Security Most people pay a monthly premium Usually deducted from SSA benefits Amount depends on income If you don’t sign up on time, you will pay a penalty

Enrolling in Part B If you do have coverage through active employment You may want to delay Part B No penalty if you enroll while you have coverage or within 8 months of losing coverage If you don’t have coverage from active employment Yours or your spouses Delaying Part B may mean Higher premiums Paying for your health care out-of-pocket

Enrollment Periods Initial Enrollment Period (IEP) Begins 3 months prior to the month of turning age 65 and continues through the end of the third month after General Enrollment Period (GEP) Allows individuals who did not enroll in Part B during the IEP to enroll between January 1 – March 31 of each year for a July 1 effective date Special Enrollment Period (SEP) Allows individuals who delayed enrolling in Part B because they were receiving benefits through an employer as an active employee (or dependent of someone who is); SEP runs eight months from the time of retirement or loss of coverage

Medicare Card Keep it and accept Medicare Parts A and B Return it and refuse Part B Follow instructions on back of card FRONT BACK

The Four Parts of Medicare Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans (like HMOs and PPOs). Includes Part A & B and sometimes Part D coverage Part D Medicare Prescription Drug Coverage

Original Medicare Part A – Hospital Insurance (in-patient) Skilled Nursing Facility Home health care Hospice care Part B – Medical Insurance (out-patient) Doctor’s visits Outpatient hospital services Clinical lab tests Durable Medical Equipment Preventive services

Not Covered by Medicare Acupuncture Dental care/dentures Cosmetic surgery Custodial care Health care while traveling outside the U.S. Hearing aids Orthopedic shoes Outpatient prescription drugs (covered under Part D) Routine foot care Routine eye care and eyeglasses

Medicare Part B Outpatient Medical Services Part B Annual Deductible - $166 Medicare generally pays 80% of Medicare eligible charges You pay 20% Balance You must enroll in Part B to obtain the coverage You pay a monthly premium for Part B once you enroll YOU MEDICARE

If your Yearly Income in 2014 was Monthly Part B Premium If your Yearly Income in 2014 was You Pay File Individual Tax Return File Joint Tax Return $85,000 or below $170,000 or below $121.80 $85,001–$107,000 $170,001–$214,000 $170.50 $107,001–$160,000 $214,001–$320,000 $243.60 $160,001–$214,000 $320,001–$428,000 $316.70 above $214,000 above $428,000 $389.80 Note: Premiums are usually deducted from your Social Security benefit payment.

What is a Medigap policy? Medicare Supplement Insurance Policies Sold by private companies Fill the gaps in Original Medicare Deductibles, coinsurance, copayments Standardized plans in all but three states Minnesota, Massachusetts, Wisconsin All plans with same letter Have same coverage Only the costs are different

Your (Drew University) Medicare Supplement Plan Part B Deductible: $166.00 Part B Co-Insurance: 10% Part B Out-of-Pocket Max: $1,500.00 (Includes Part B Deductible) Lifetime Maximum: Unlimited Office Visit Copay: $20.00*** ER Visit Copay: $100.00***

100% of Medicare Eligible Expenses Part A Coverage Services Medicare Pays Plan Pays You Pay HOSPITAL CONFINEMENT BENEFIT* Semiprivate room and board, general nursing and miscellaneous services and supplies: First 60 days All but $1,288 $1,288 (Part A Deductible) $0 61st through 90th day All but $322 per day $322 per day 91st through 150th day (While using 60 lifetime reserve days) All but $644 per day $644 per day Once Lifetime Reserve days are used:   Additional 365 days: 100% of Medicare Eligible Expenses Beyond the Additional 365 days All costs SKILLED NURSING FACILITY CARE* You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital: First 20 days All approved amounts 21st through 100th day All but $161 a day Up to $161 a day 101st day and after BLOOD DEDUCTIBLE – Hospital Confinement and Out-Patient Medical Expense When furnished by a hospital or skilled nursing facility during a covered stay. First 3 pints 3 pints Additional amounts 100% HOSPICE CARE Available as long as your doctor certifies you are terminally ill and you elect to receive these services. All but very limited coinsurance for outpatient drugs and inpatient respite care Balance

Part B Coverage Services Medicare Pays Plan Pays You Pay OUT-PATIENT MEDICAL EXPENSES - - In or Out of the Hospital and Out-Patient Hospital Treatment, such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment: Medicare Part B Deductible: First $166 of Medicare-approved amounts** $0 Part B Deductible Remainder of Medicare-approved amounts Generally 80% 10% until Out-of-Pocket Max is met, then 20%*** 10% until Out-of-Pocket Max is met, then 0%*** Part B Excess Charges (Above Medicare Approve Amounts) 100% 0% BLOOD First 3 pints All costs Next $166 of Medicare Approved Amounts** CLINICAL LABORATORY SERVICES Blood tests for Diagnostic Services

Part B- Continued Services Medicare Pays Plan Pays You Pay HOME HEALTH CARE – Medicare Approved Services: Medically necessary skilled care services and medical supplies 100% $0 DURABLE MEDICAL EQUIPMENT First $166 of Medicare Approved Amounts** Part B Deductible Remainder of Medicare-approved amounts Generally 80% 10% until Out-of-Pocket Max is met, then 20%*** 10% until Out-of-Pocket Max is met, then 0%*** FOREIGN TRAVEL - Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA: First $250 each calendar year $0 $250 Remainder of charges 80% to a lifetime maximum of $50,000 20% and amounts over the $50,000 lifetime max

Part D – Medicare Prescription Drug Coverage Available for all people with Medicare Provided through Medicare Prescription Drug Plans Medicare Advantage Plans Other Medicare plans

How Medicare Part D Works? Plans have formularies Lists of covered drugs Must include range of drugs in each category You pay a monthly premium You pay deductibles and copayments There is Extra Help to pay Part D costs If you have limited income and resources

How Medicare Part D Works? You must have Part A and/or Part B You must live in the plan’s service area You can’t live outside the U.S. You must actively enroll to join In most cases no automatic enrollment You must fill out an application

Enrolling in a Part D plan You can join During your 7 month Initial Enrollment Period During the Open Enrollment Period October 15 – December 7 Coverage starts January 1 During other special times Special Enrollment Period

Part D Prescription Drug Plan 5-Tier Rx Member Pays: (30 Day Retail) (90 Day Retail) (90 Day Mail Order) Annual Deductible: $0.00 Initial Coverage Limit: Tier 1:  Preferred Generic $10 $30 $20 Tier 2: Non-Preferred Generic Tier 3: Preferred Brand $25 $75 $50 Tier 4:  Non-Preferred Brand $40 $120 $80 Tier 5:  Specialty Coverage Gap: * Same as above Catastrophic Coverage Greater of 5% or $2.95 for generic and multi-source drugs, up to a maximum of the copays listed above. Greater of 5% or $7.40 for all other covered drugs, up to a maximum of the copays listed above. *After your total yearly drug costs reach $3,310, you will pay the same copay schedule as noted above. The co-payments shown already include the manufacturer discounts on brand name drugs by the Medicare Coverage Gap Discount Program.

Premium Rates Drew University 2016 Medical Conventional Equivalent Costs Retired on or after 1/1/2011   <65 Base Total Rate Drew Contrib Total Contribution Retiree Contribution Medicare Split Contract Dep Contribution Non-Medicare Split Contract Dep Contribution Single-Retiree under 65 $650.14 $455.10 $195.04 n/a Retiree + Spouse - both under 65 $1,300.72 $650.27 $650.45 Retiree + Spouse - Retiree under 65/spouse over 65 $987.58 $556.33 $431.25 $236.21 Retiree + Child(ren) - Retiree under 65 and Non-Medicare Child(ren) $975.54 $552.72 $422.82 Retiree + Child(ren) - Retiree under 65 and Medicare Child $987.14 $556.20 $430.94 $235.90 Family - all under 65 $1,951.07 $845.38 $1,105.69 Family - Retiree under 65/1 Medicare Dependent (spouse or child) $1,637.49 $751.30 $886.19 $650.29 Family - Retiree under 65/2 Medicare Dependents (spouse and child) $1,324.35 $657.36 $666.99 $195.19 $471.80 65+ Medicare Supplement Single Medicare $337.00 $101.10 Retiree + Spouse - both over 65 $674.00 Retiree + Spouse - Retiree over 65/spouse under 65 $431.07 $556.51 $455.41 Retiree + Child(ren) - Retiree over 65 and Non-Medicare Child(ren) $662.40 $333.52 $328.88 $227.78 Retiree + Child(ren) - Retiree over 65 and Medicare Child $202.20 Family - Retiree over 65/Family under 65 $626.05 $1,011.44 $910.34 Family - Retiree over 65/1 Medicare Dependent (spouse or child) $532.10 $792.25 $455.25 Family - Retiree over 65/2 Medicare Dependents (spouse and child) $1,011.00 $438.10 $572.90 Assumes pre-2011 retirees pay 30% of the cost. Post-2010 retirees pay 30% towards single coverage and 70% towards dependent coverage.

Additional Features AmWINS Contact Center Support Manage My Health For assistance with getting prescriptions filled Claims or billing questions General questions Call 888-883-3757, 8 am to 8 pm EST Manage My Health 1-800MD services GlobalMedID.com- Create your own online personal health record Senior Care Resources- Solutions for caregiver stress and estate settlement services Hear in America- Discount Hearing Offering MyEWellmess.com- Online tips and tricks for an active lifestyle

Key Points to Remember Medicare is a health insurance program It does not cover all of your health care costs Be sure you enroll on time Consider your options for supplementing you Medicare Coverage Employer Retiree Program Individual Medigap Medicare Part D Rx Government resources www.medicare.gov Medicare & You Handbook 1-800-MEDICARE www.healthcare.gov

Questions?