1. Medicare 101 Presentation
College of the Desert
Medicare 101 Presentation
October 17, 2016
Presented by Kim Lyon
SISC Account Manager

2. Agenda Who is SISC? What is Medicare? Medicare Part A, B, C & D
When do I enroll in Medicare?
Retiree Options, District Plans and/or IRP plans
How to enroll
How to Disenroll and/or Change plans
Summaries of Advantage and Supplement Plans
Dependent Coverage
Missing Medicare
Resources

3. Who is SISC? SISC – our motto “Schools Helping Schools”
Established in 1979, Self-Insured Schools of California (SISC) operates as a public school Joint Powers Authority (JPA) administered by the Kern County Superintendent of Schools Office.
Our staff members are certificated and classified public school employees.
SISC pools resources of over 400 school districts throughout the state to share risk and provide long term health benefit solutions.

4. What is Original Medicare?
Health insurance for people age 65 or older.
Health insurance for people under age 65 with certain disabilities.
Health insurance for people of any age with end-stage renal disease (ESRD).
Helps cover out-of-pocket expenses on certain services.
You can go to any doctor
or hospital that accepts
Medicare.

5. Medicare Part A - Hospital
Medicare Part A (hospital insurance)
Helps cover inpatient care in hospitals
Helps cover skilled nursing facility, hospice, and home health care
Sometimes called "premium-free Part A”
When to Enroll in Part A
If member is actively working and turning age 65 and has earned Part A premium free, it is advantageous to enroll at age 65
If a member is turning 65 and is retiring
If member is over 65 and is retiring
Call MEDICARE 1-(800) for more information

6. Medicare Part B - Doctor
Medicare Part B (medical insurance)
Helps cover may preventive services, physician services, hospital outpatient care, and home health care
Everyone pays for Part B.
For 2016 Part B “Standard Premium” is $ (or higher depending on your income).
When to Enroll in Part B
Retiring and age 65
Contact Social Security 3 months prior to your 65th birthday to begin the process. (recommended)
Call Social Security 1-(800)
Call MEDICARE 1-(800) for more information

7. Medicare Part C Medicare Advantage
Medicare Part C (also known as Medicare Advantage)
Offers health plan options run by Medicare-approved private insurance companies like Blue Shield of California and Kaiser Permanente.
Automatically enrolled when enrolling in a Medicare Advantage plan.
Combines benefits and services covered under Part A, Part B, and often Part D.
Feature of a Medicare Advantage plan: Member would ‘assign’ their Medicare benefits to the carrier and would not be able to use outside of the plan.

8. Medicare Part D
Medicare Part D is for Prescription Drug coverage.
The SISC Plans do NOT have a “donut hole”.
What is the ‘donut hole’?
This means there is a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. Once you and your plan have spent $3,310 on covered drugs for 2016, your are in the coverage gap or ‘donut hole’.
This amount may change each year. (Refer to
Members enrolled on a SISC plan would automatically be enrolled into Medicare Part D.

9. Medicare Part D
Caution: If member enrolls in a Med D plan outside of SISC they will lose their SISC benefits. CMS does not allow two enrollments into Med D.
SISC sends an annual notice to all employee/retirees that turn age 65.
This notice is confirmation you have been enrolled in a Credible Coverage Plan that is “as good as or better than Med D”.
This letter allows the member to seek other coverage outside of SISC without being penalized.
Call MEDICARE 1-(800) for more information

10. When do I enroll in Medicare?
Window of enrollment
3 months prior to your 65th birthday (recommended)
Month of your 65th birthday
3 months after your 65th birthday
Retirees are required to be enrolled in Medicare Part A&B if enrolling in a SISC Retiree plan at age 65.
It is best to begin this process prior to turning age 65.
Contact Social Security to begin process.

11. Resources for enrollment into Medicare Part A&B
You can call MEDICARE ( )
You can go online to
You can call and make an appointment with the Social Security office by calling
HICAP-Health Insurance Counseling & Advocacy Program

12. Plan Options

13. District Retiree plan options with SISC
College of the Desert offers a variety of retiree plan options. You can select from the following plans.
4 Blue Shield PPO plans
1 Blue Shield HMO plan
1 Kaiser Permanente plan
3 Individual Retiree Plans (IRP)
If you move out of state you will need to select either one of the PPO plans or the CompanionCare Medicare Supplemental Plan.

14. How does a member enroll in one of the District’s retiree plans?
The employee upon retirement would notify the district of their plan selection.
The employee would provide a copy of their Medicare card showing enrollment into Medicare Part A&B.
The district would notify SISC of the enrollment.
New ID cards will be issued.

15. How to change from one district plan to another district plan?
At the next Open Enrollment the retiree would have the same plan options available to them as the Active employees.
The retiree would notify the district of their interest in changing plans.

16. Individual Retiree Plans (IRP) options Medicare Advantage Plans - HMO
Blue Shield of California Medicare Advantage 65+ OR
Kaiser Permanente Senior Advantage
Part C includes both Part A (Hospital) and Part B (Medical Insurance).
Everyone must pay Part B premium.
You will need to use the plan doctors and facilities.
Confirm you live in a Kaiser or Blue Shield service area by calling customer service.
You have reasonable and predictable copayments or coinsurance.
Combines Part A , Part B and Part D.
Affordable monthly premium.

17. Individual Retiree Plans (IRP) options Medicare Supplement Plan
SISC CompanionCare
administered through Anthem Blue Cross
Everyone must pay Part B Premium.
You must be enrolled in Medicare Part A & B.
SISC automatically enrolls member in Medicare Part D Plan.
Allows you to see any doctor, hospital or specialist that accepts Medicare throughout the U.S.A.
No referrals needed.
Single Contract

18. How does a member enroll in one of the Individual Retiree Plans (IRP)?
SISC will communicate with the retiree regarding billing, payment options and plan options at Open Enrollment. An enrollment form must be completed and submitted to SISC along with a copy of the member’s Medicare card showing proof of enrollment in Medicare Part A&B. SISC requires a 45 calendar day advance notice Each retiree plan has its unique enrollment form. New ID cards will be issued except for Kaiser.

19. How does a member disenroll from the IRP plan?
A SISC disenrollment form must be completed to cancel, a 45 calendar
day advance notice is required.
By disenrolling, the member will have their Medicare benefits restored.
Until the cancellation process is complete, the retiree cannot use their
Medicare benefits. (Kaiser and Blue Shield)
This termination will cancel both the medical and prescription drug
benefits.

20. Can I change from one IRP plan to another?
At the next Open Enrollment you may change plans. SISC will notify you of your options.
SISC requires a 45 day advance notice of change.
A new enrollment form for the different plan will be required.

21. Brief Plan Comparison for the IRP plans

22. * Brief Summary of some services – October 1, 2016
BLUE SHIELD 65+
KAISER PERMANENTE SENIOR ADVANTAGE
COMPANION CARE
Cost for Plan
$226
$198
$419
• Office visits
$20 co-pay per visit
$10 co-pay per visit
$0 co-pay
Ambulance
$50 co-pay per trip
Annual Physical Examination
(office visit co-pay may apply if part of visit)
Not covered
Durable Medical Equipment (DME) Medicare covered services
100%
(Kaiser DME formulary guidelines apply)
• Hospitalization Inpatient
$0 co-pay per admission
$200 per admission

23. Mental Health - Outpatient unlimited visits $20 co-pay
SERVICES
BLUE SHIELD 65+
KAISER PERMANENTE SENIOR ADVANTAGE
COMPANION CARE
• Emergency Room
$50 co-pay/waived if admitted
$0 co-pay
Immunizations
No charge
(office visit co-pay may apply if part of visit)
Contact Medicare to see
what other immunizations
are covered
Mental Health - Inpatient
No charge for day 1-150
Member pays 100% from day 151 and over
 Mental Health - Outpatient unlimited visits
$20 co-pay
$10 co-pay per individual visit/ $5 co-pay per group visit

24. KAISER PERMANENTE SENIOR ADVANTAGE COMPANION CARE
SERVICES
BLUE SHIELD 65+
KAISER PERMANENTE SENIOR ADVANTAGE
COMPANION CARE
Skilled Nursing Facility
Covered in full for 100 days per benefit period
$0 co-pay
X-Ray Services
(office visit co-pay may apply if part of visit)
Generic Drugs
$10 Retail,
$20 Mail order
$10 co-pay for up to a 100 day supply
$9 Retail, $18 Mail order
Brand Drugs
$30 Retail,
$60 Mail order
$20 co-pay for up to a 100 day supply
$35 Retail ,
$90  Mail Order

25. Is there dependent coverage?
IRP Plans:
Individual enrollment:
Blue Shield 65 Plus HMO Medicare Advantage Plan - No
CompanionCare Medicare Supplement plan - No
If a spouse/domestic partner qualifies for enrollment they would enroll on their own
contract.
Kaiser Senior Advantage has dependent coverage available.- Yes
District Retiree over age 65 plans: - Yes
There is dependent coverage if the dependent has Medicare Part A&B

26. What if the member is missing a part of Medicare or does not assign their Medicare to the plan of choice?
The member would not be eligible to enroll. Members who wish to be enrolled in these plans are required to have continuous coverage in Medicare Part A&B. District plan: A surcharge will be assessed and added to the district invoice if a retiree drops any part of Medicare A and/or B. IRP plans: The retiree would be disenrolled if they drop Medicare Part A and/or Part B.

27. Thank you! Questions?