REACH National Medicare Training Program Speaker Name Group Name Date

2 Welcome to Medicare

3 CMS (Centers for Medicare & Medicaid Services) Federal agency within HHS Administers Medicare, Medicaid, SCHIP Spends over $360 billion a year Establishes policies for paying health care providers Conducts research Assesses quality

4 Medicare A health insurance program for –People 65 years of age and older –Some people with disabilities –People with ESRD Administered by CMS Enrollment handled by SSA or RRB Prescription drug coverage

5 Applying for Medicare Apply 3 months before age 65 –Need not be retired Automatically enrolled if receiving Social Security or Railroad Retirement Benefits

6 Some Interesting Statistics 2002 –Medicare paid 247 billion dollars 2003 –Over 41 million persons in Medicare 2030 –Projected 70.5 million over 65 Almost double in only 30 years

7 Medicare Health Plan Choices Original Medicare Plan Medicare Advantage plans –Medicare Managed Care plans Some have POS option –Medicare Preferred Provider Organization plans –Medicare Private Fee-for-Service plans –Medicare Specialty plans MMA

8 Medicare Medicare has two parts Part A Hospital Insurance Part B Medical Insurance

9 Paying for Medicare Part A Most people receive Part A premium free People with < 10 years of Medicare-covered employment will pay a Part A premium For information, call SSA – – for TTY users

10 Enrolling in Medicare Part B Initial Enrollment Period –7 months beginning 3 months before age 65 General Enrollment Period –January 1 through March 31 each year –Coverage effective July 1 –Premium increases 10% for each 12-month period you were eligible but did not enroll You carry this increase for the rest of your life Limited exceptions

11 Enrolling in Medicare Part B Special Enrollment Period –Sign up within 8 months of the end of employer or union group health plan coverage –No increased premium For questions, or to enroll, call SSA or RRB

12 Paying for Medicare Part B You pay –Monthly Medicare Part B premium $66.60 in 2004 –$100 per year deductible –20% coinsurance for most services –Some co-payments Some programs may help

13 Paying the Part B Premium Taken out of your monthly payment –Social Security –Railroad Retirement –OPM Retirement For information about premiums –SSA, RRB or OPM May be billed every 3 months Medicare Easy Pay

14 The Original Medicare Plan Go to any provider that accepts Medicare Part A is premium free for most people You pay Medicare Part B premium You pay deductibles You pay coinsurance

15 Your Medicare Card (front) Jane Doe

16 Medigap Fills in gaps in the Original Medicare plan Must follow Federal and state laws Ten standardized Medigap plans (A-J) in most states –Not Massachusetts, Minnesota, or Wisconsin May get little benefit from Medigap if in Medicare Advantage plan Will be changes in 2006 MMA

17 Medicare Advantage Plans Medicare Managed Care plans –Some have POS option Medicare Preferred Provider Organization plans Medicare Private Fee-for-Service plans Medicare Specialty plans

18 Eligibility Entitled to Medicare Part A Enrolled in Medicare Part B Live in plan’s service area Not have ESRD at the time of enrollment (with some exceptions)

19 Important Information Still in Medicare program Continue to pay Medicare Part B premium Still have Medicare rights and protections Get all regular Medicare-covered services May pay additional monthly premium May receive additional benefits

20 Medicare Managed Care Plans Offered by private companies Available in certain areas Plan can join or leave Medicare each year Providers can leave the plan Benefits may change each year Premiums may change each year

21 How Does Managed Care Work? Usually go to only certain providers Generally need referral to see specialist May get extra benefits Some plans offer a Point-of-Service option –Can go to doctors and hospitals not on plan's list

22 Prescription Drug Coverage Medicare-approved drug discount card Prescription drug benefit in 2006 Medicare Advantage program MMA

23 Medicaid Federal-State health insurance program –People with lower-income and limited resources –Certain disabled persons Eligibility determined by state Application processes vary –Social Services –Public Assistance –Human Services

24 How to Apply If you think you might qualify –Review guidelines –Collect your personal documents –Complete required paperwork

25 How to Apply Locate the proper agency –Look in phone book –Call MEDICARE ( ) –Call your SHIP Produce your documents Complete the necessary application forms

26 Information Channels MEDICARE Medicare & You handbook –Other publications Your local SHIP

27 Key Concepts Medicare is a health insurance program It is administered by CMS You may have choices about how you get your health care There are programs to help you with costs There are information sources available

28 Introducing Ben… You can call me Ben. But, I don’t like the nickname Benny. Hi! I’m Ben E. Ficiary.

29 What does Ben know…. Which government agency is directly responsible for administering the Medicare program? A.Social Security Administration B.Department of Health & Human Services C.Centers for Medicare & Medicaid Services D.Centers for Disease Control

30 Ben says… C. Centers for Medicare & Medicaid Services

31 What does Ben know…. Which is true about Medicare Managed Care plans? A.You still pay your Part B premium B.You receive all the services covered by Medicare C.You may pay an additional premium D.All statements are true

32 Ben says… D. All statements are true

33 What does Ben know…. Medicaid is… A.A managed care plan available in some areas B.A State-administered and jointly funded Federal-State health insurance program for people with limited income and resources C.The amount you pay for Part A D.A private policy you buy to fill in the gaps in the Original Medicare Plan

34 Ben says… B. A State-administered and jointly funded Federal-State health insurance program for people with limited income and resources

35 Thanks for your attention!