1. Medicare and How Drew University’s Plan Works for You

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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

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

18. 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, (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

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. 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.

26. 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.

27. Additional Features AmWINS Contact Center Support Manage My Health
For assistance with getting prescriptions filled
Claims or billing questions
General questions
Call , 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

28. 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
Medicare & You Handbook
1-800-MEDICARE

29. Questions?