Retirement Considerations for Employees Sandy Ruffo, RN

Statewide Health Insurance Benefits Advisors (SHIBA) Role of SHIBA Handouts Key concepts to be discussed Common terminology Critical timelines and rules Employee choices Employer advise to employees

The Terminology “Hospital Benefit” No cost Eligible age 65 Disabled X 2 years Medicare Part A

“Medical Benefit” Monthly premium: $93.50 in 2007 Premium higher for incomes over $80,000/$160,000 The Terminology Medicare Part B

Drug Coverage (57 plans Pierce) – offered for Original Medicare only Varies by plan Formulary and price Deductibles and co-pays Coverage in gap period varies by plan Contracted pharmacies Untimely enrollment = penalties Three parts (A-B-D) referred to as Original Medicare Plans Part C is not considered “Original Medicare” The Terminology Medicare Part D

Medicare Advantage Plans – Medicare Health Plans – MC + Choice Plans (16 Pierce) Part B required In Medicare program – have MC rights and protections Includes Medicare A and B benefits + may have extras Drug coverage varies by plan; OOP costs vary by plan The Terminology Medicare Part C

The Terminology Insurance supplements for Original Medicare benefits – not MedAdvantage Plans OIC approved carriers (22) 12 Standardized Plans (A though J) Hospital/outpatient co-insurance/co-payments SNF co-insurance Part A and B deductibles Medicare Supplements/Medigap

The Terminology Government Sources DSHS Medicare Savings (Part B costs) Extra Help (Part D prescription) Non-Government Sources Foundations for chronic disease Pharmacy Assistance Programs Charities Limited Income/Resource Programs

Drug Plan Employer drug plan: as good or better than Medicare Employer to provide employee with letter Medigap Plan Health coverage employee had before applying to Medicare √ Not discount cards, specific disease insurance, LTC insurance The Terminology Credible Coverage

Timelines to Watch Part A Enrollment 3 Months Before Birthday Month 3 Months After Birthday Not tied to obtaining Social Security benefits SSA sends info packet Employee not auto enrolled (unless getting SS) Rules: If working after age 65, not mandatory If to retiree plan, required to enroll Unsolicited advice

Timelines to Watch Part B Enrollment Critical: What is employer plan requirement? When employer plan pays – before or after Medicare? Employee can delay Employer coverage primary Under spouses insurance Rules: If working after age 65, not mandatory If to retiree plan, required to enroll Critical: If enrolls Triggers open enrollment period for Medigap If delays due to employer coverage, has 8 months

Or 63 days after employer coverage ends Penalty of 1% of national average premium (2007: $27.35) per month Enrollment limited to Open Enrollment period (11/15 to 12/31) Effective January 1st HR change plan prescription drug parameters Ensure coverage credible; if not employee penalized Timelines to Watch Part D Enrollment 3 Months Before Birthday Month 3 Months After Birthday Not keeping any employer coverage:

Initiate Part A and B enrollment, then Enroll in MedAdvantage Plan Miss this period = only during Open Enrollment period Timelines to Watch Part C Enrollment 3 Months Before Birthday Month 3 Months After Birthday Not keeping any employer coverage:

Part B triggers – 6 months to enroll Guarantees Pre-existing conditions Late enrollment Higher premium potential Annual Open Enrollment period Reminder: employer plan requires Part B = impacts Medigap Medigap Protections Have employer coverage Move in and out of MedAdvantage Plans Leave Medigap protections – 63 days to enroll Timelines to Watch Medigap Enrollment

Employee Choices On Retirement Employer Retirement Plan Consider benefit parameter changes; decrease Price Spouse coverage COBRA an option Drug coverage credible Obtain benefit book

Employee Choices On Retirement Original Medicare Plans Plus Supplement Part A, B and D Medigap Supplement Monthly average 2007: $254

Employee Choices On Retirement Medicare Advantage Plans (Part C) Purchase Part B Plan premium (with and without drugs) Medigap insurance not needed Monthly average 2007: $231 (for plan which offer above Medicare)

Advising Your Employees Retirement before age 65 (not Medicare eligible) Spouse coverage needed Employer plan cost versus individual insurance Disability a factor Limited income/resource programs Assistance with drug prescriptions

Advising Your Employees Retirement at age 65 Employer health plan offered Remind: enroll Medicare Part A Decisions made on Part B – trigger Medigap Open Enrollment period Drug coverage credible

Advising Your Employees Retirement over age 65 Timely enrollment in Part B Decide Original Medicare or MedAdvantage Plan

Q & A? SHIBA Hotline