Medicare ABCs

What Is Medicare? Federal health insurance created in 1965 (amendment to Social Security Act) You must be U.S. citizen or legal permanent resident and 65 or older Under 65 and disabled 24+ months on Social Security Disability End-Stage Renal Disease (any age) 123-45-6789-A FEMALE HOSPITAL (PART A) 01-01-1992 MEDICAL (PART B) 01-01-1992 Jane Doe

Components of Medicare Part A Hospital Part B Medical Supplement Part D Drugs Part C Medicare Advantage OR

Part A (Hospital) Part B (Medical) Hospital as Inpatient Skilled nursing facility Home health care Hospice Part B (Medical) Doctor services Hospital as Outpatient/Observation Emergency room Durable medical equipment Other supplies and services

Hospital Status affects what is covered by Part A or B and whether subsequent Skilled Nursing Facility (SNF) is covered. Inpatient – When you’re formally admitted with a doctor’s order. The day before you're discharged is your last inpatient day. SNF covered IF: Inpatient 3 midnights, Admitted to SNF w/in 30 days, Care needed for hospital-treated condition. Outpatient – When the doctor hasn’t written an order to admit you, even if you spend the night. Medicare Outpatient Observation Notice (MOON) – provided when in observation status longer than 24 hours, but before 36th hour

Parts A and B do NOT cover Most prescription drugs Routine dental, vision, hearing, and foot care Long-term care (nursing home custodial care) Non-emergency ambulance Alternative medicine Elective cosmetic surgery Personal care Health care outside the U.S. (except emergency)

Part D covers Part D does NOT cover Prescription drugs Brand name and generic drugs Part D does NOT cover Non-prescription drugs Most vitamins and minerals Weight gain or loss Fertility Cough or cold Hair growth or cosmetics Sexual or erectile dysfunction

So how much does it COST?

Part A costs If you or your spouse paid FICA taxes for at least 40 quarters (10 total years), you pay no premium for Part A 99% pay no premium (can cost up to $422/month) Everyone pays Part A deductible and co-pays 2018 benefit period deductible = $1340 Co-pays based on number of days in hospital

New-to-Medicare in 2018 pay $134 per month Part B costs New-to-Medicare in 2018 pay $134 per month (low income get help /high income pay extra) (if drawing SS, any increase is capped at COLA) Everyone pays Part B deductible and co-pays 2018 Annual deductible = $183 Co-pays = 20% of most medical services

Medicare Savings programs Federal and state-funded help with Medicare costs (premiums, deductibles, co-pays) Low income/asset tests (home & car exempt) Not only Medicaid level (Extra Help, QI1) For more information: DHHS, Social Security, SHIIP, or local Area Agency on Aging

Income Related Monthly Amount Adjustment (IRMAA) –You pay in 2018 --based on 2016 return Individual tax return Joint tax return IRMAA Part B premium $85,000 or less $170,000 or less $0.00 $134.00 Above $85,000 up to $107,000 Above $170,000 up to $214,000 53.50 $187.50 Above $107,000 up to $133,500 Above $214,000 up to $267,000 133.90 $267.90 Above $133,500 up to $160,000 Above $267,000 up to $320,000 214.30 $348.30 Above $160,000 Above $320,000 294.60 $428.60

Part D Costs Premiums range from $20.40 to $100.60 per month (low income get help /high income pay Part D IRMAA) Deductible and co-pays at pharmacy counter Deductibles = $0 to $405 Co-pays = 5% to 44% of full cost of drug, depending on your total annual drug costs

Cap Your Medicare Costs Medicare Parts A and B pay about 80% no cap on your co-pays of about 20%

Cap Your Medicare Costs Two choices for insuring Parts A and B co-pays Option 1: Medicare Supplement (Medigap) and Part D policies (front-end loaded) Option 2: Part C - Medicare Advantage plan (back-end loaded)

Medicare Supplements Supplements help pay A & B co-pays, depending on plan you choose Buy Supplement from private company 6 months from Part B effective date, have one-time “guaranteed issue” right with no medical underwriting Think long term, don’t just shop for price

Medicare Supplements Supplements have front-end premiums, but low out-of-pocket when using medical services 10 Standardized plans available in Nebraska 2018 Monthly non-tobacco premium range for Plan G $91--$226 per month (female) $103--227 (male)

Part D Plans Plans help pay prescription drug costs, depending on plan you choose Buy Part D plan from private company Initial enrollment when you start Medicare Each year open enrollment October 15 – December 7 Good idea to review periodically Think short term, do shop for price

Cap Your Medicare Costs What is the ALTERNATIVE ?

Part C – Medicare Advantage Plans Alternative way to cap your out-of-pocket costs Sold by private insurance companies (they collect per capita from government) Very different rules, restrictions and costs than Original Medicare (A + B + Supplement + D) Wrap hospital, medical and (usually) drug coverage into single plan -- plans are not standardized 33% nationwide / 12% in Nebraska

Part C – medicare Advantage Plans Advantage plans charge low premiums, but higher deductibles & co-pays than Supplements Premiums $0 - $188 per month, in addition to Part B You pay deductible or co-pay for every service HMO/PPO networks of medical providers Out-of-pocket limits (don’t apply if not in-network) You must check with all providers to ensure in-network Travel/residence restrictions (not sold in all NE counties) (if out of region, may only cover emergency care)

When, where to enroll in Medicare?

agencies responsible for Medicare Enrollment, premiums & replacement cards Administration

Medicare Enrollment at 65 If you don’t have work insurance, enroll at age 65 If you delay enrollment to after age 65 and do NOT have work insurance, there are permanent late enrollment premium penalties

Working After Age 65 You can keep work insurance and delay Medicare without penalties (includes spouse who is on your work insurance or you on spouse’s work insurance) If insurance is from your/spouse’s current employer of 20+ people --Small employers can require taking Medicare @ 65 --Retiree health plans are not creditable coverage

Starting Medicare Apply for Parts A & B If starting at 65, online @ www.ssa.gov or local Social Security office (If drawing Social Security, card is sent to you automatically) If working past 65 and have work insurance --O.K. to have Part A at 65 (not w/HSA plan) --Do NOT start Part B at 65 (preserve guaranteed issue for Supplement) --Cannot apply online when stop working (need forms to prove you had creditable insurance)

Starting Medicare 2. Apply for Medicare Supplement policy through mail, phone, or agent/broker 3. Enroll in Part D plan @ medicare.gov, SHIIP, or Aging Partners for plan comparisons & enrollment

Medicare Information and Help Counseling Cost comparisons Enrollment assistance Aging Partners: 402-441-7070 SHIIP: 800-234-7119

Nebraska Department of Insurance Nebraska’s state-wide program to educate older Nebraskans and people with disabilities about health insurance and health care fraud. SHIIP provides presentations and maintains a counseling program for Nebraskans who request one-on-one assistance. Services are free and unbiased. All counseling sessions are completely confidential. Call 1-800-234-7119 DOI.SHIIP@nebraska.gov Nebraska Department of Insurance