1. Medicare ABCs

2. What Is Medicare?
Federal health insurance created in (amendment to Social Security Act)
Must be U.S. citizen or legal permanent resident and
65 or older
Under 65 and 24+ months on Social Security Disability
End-Stage Renal Disease
(any age)

4. Part C Medicare Advantage
OPTIONS 1 and 2
Part A Hospital
Part B Medical
Supplement
Part D Drugs
Part C Medicare Advantage OR

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

6. 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 by a doctor’s order. The day before discharge is your last Inpatient day.
SNF covered only if:
Inpatient status for 3 midnights,
and admitted to SNF w/in 30 days for the hospital-treated
condition.
Outpatient – When a doctor hasn’t written an order to admit you, even
if you spend the night.
Medicare Outpatient Observation Notice (MOON) – provided when observation status longer than 24 hours, before 36th hour.

7. 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
Health care outside the U.S (a few emergency exceptions)

8. 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
Hair growth or cosmetics
Sexual or erectile dysfunction

9. So how much does it COST?

10. Part A costs
$0 premium for Part A -- if you or spouse paid FICA taxes at least 40 quarters (10 total years)
Everyone pays Part A deductible and co-pays
2019 benefit period deductible = $1364
Co-pays based on number of days in hospital

11. Part B deductible and co-pays
Part B costs
2019 monthly premium is $135.50
(low income get help /high income pay extra)
(if drawing SS, premium increase capped at COLA)
Part B deductible and co-pays
2019 deductible = $185
Co-pays = 20% of most services

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

13. Income Related Monthly Amount Adjustment (IRMAA) –2019 PART B COST --based on 2017 return
Individual tax return
Joint tax return
IRMAA
Part B premium
$85,000 or less
$170,000 or less
$0.00
$135.50
Above $85,000
up to $107,000
Above $170,000
up to $214,000
$54.10
$189.60
Above $107,000
up to $133,500
Above $214,000
up to $267,000
$135.40
$270.90
Above $133,500
up to $160,000
Above $267,000
up to $320,000
$216.70
$352.20
Above $160,000,less than $500,000
Above $320,000, less than $750,000
$297.90
$433.40
$500,000 or more
$750,00 or more
$325.00
$460.50

14. Part D Costs Premiums range from $15 to $94.30 per month
(low income get help / high income pay Part D IRMAA)
Deductible and co-pays at pharmacy counter
Deductible = $0 to $415
Co-insurance share = 5% to 37%, depending
on your total drug costs

15. Insuring your share of Medicare Costs
Parts A and B pay 80% with
no cap on your 20% share
Part D medicine shares can be high

16. Cap Your Medicare Costs
Choices for insuring your cost shares
Option 1: Part A, Part B, Medicare Supplement and Part D (front-end loaded)
Option 2: Part C - Medicare Advantage (back-end loaded)

17. Medicare Supplements (part of Option 1)
Supplements help pay your A & B share (deductibles/co-pays)
Buy Supplement from private company
6 months from Part B effective date, have one-time “guaranteed issue” right -- no medical underwriting
Think long term, don’t just shop for price

18. Medicare Supplements (part of Option 1)
Supplements have front-end premiums, but low out-of-pocket when using medical services
10 Standardized plans available in Nebraska
2019 Monthly premiums for Plan G
$92--$226 (female)
$ (male)

20. Part D Plans (part of Option 1)
Plans help pay prescription drug costs
Buy Part D plan from private company
Initial Enrollment when you start Medicare
Open Enrollment each year Oct. 15 – Dec. 7
Good idea to review periodically
Think short term, do shop for price

21. Option 1 - overall cost Part A Part B Supplement Part D
Medicare Part A
$0.00
Medicare Part B
$135.50
Medicare Supplement*
$130.00
Medicare Part D*
$36.00
Total (*Average cost)
$301.50

22. Cap Your Medicare Costs
What is the ALTERNATIVE ?

23. Part C – Medicare Advantage Plans (Option 2)
Sold by private insurance companies (they collect per capita administrative fees from government)
Must have Parts A + B
Wraps hospital, medical and (usually) drug coverage into single plan
May have additional benefits (dental, gym membership)
Plans are not standardized
Approx. 33% nationwide/approx. 12% in Nebraska

24. Part C – medicare Advantage Plans
Low premiums, but higher deductibles & co-pays
Premiums $0 - $108 per month, in addition to Part B
You pay deductible or co-pay for every service
Network of medical providers (HMO/PPO/PFFS)
Out-of-pocket annual caps (don’t apply if not in-network)
You verify that all providers are in-network
Travel/residence restrictions -- may or may not cover care outside of service area

25. Part C – medicare Advantage Plans
36 Nebraska counties have no Advantage plan in 2019
Brown
Cedar
Chase
Cherry
Clay
Custer
Deuel
Dundy
Fillmore
Franklin
Frontier
Furnas
Garden
Garfield
Grant
Greeley
Harlan
Hayes
Hitchcock
Howard
Johnson
Kimball
Lincoln
Nemaha
Nuckolls
Pawnee
Phelps
Polk
Red Willow
Richardson
Rock
Sioux
Thayer
Valley
Webster
York

26. Part C Medicare Advantage
Option 2 - overall cost
Medicare Part A
$0.00
Medicare Part B
$134.00
Medicare Part C*
$44.00
Total
$178.00
*Average cost
Part C Medicare Advantage

27. When, where to enroll in Medicare?

28. agencies responsible for Medicare Enrollment, premiums & replacement cards Administration

29. Medicare Enrollment 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 (creditable coverage), there can be permanent late enrollment premium penalties

30. Working After Age 65
You can keep work insurance (creditable coverage) and delay Medicare (includes spouse on your work insurance or you on spouse’s work insurance)
So long as work insurance is from your/spouse’s current employer of 20+ people
Small employers (under 20 employees) can require taking 65
Retiree health plans are not creditable coverage

31. Starting Medicare Apply for Parts A & B
If starting at 65, may apply (must have ssa.gov account)or at local Social Security office (If drawing Social Security, card sent to you automatically)
If working past 65 and have work insurance
--O.K. to have Part A (but not with 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)

32. Starting Medicare
2. Choose Option 1 or Option 2 and apply for Medicare Supplement policy or Advantage plan through mail, phone, or agent/broker
3. Enroll in Part D plan (if you choose Option 1)
@ medicare.gov, agent/broker, or see Aging Partners/ SHIIP for plan comparisons & enrollment

33. Medicare Information and Help
Offers individual appointments
Counsels persons age 60 and over
Serves Lincoln and 8 surrounding counties
1005 O Street
Lincoln, NE 68508

34. Nebraska Department of Insurance
Federally funded program for Medicare education and counseling
Based in Nebraska Department of Insurance
7 locations, statewide service
Nebraska Department of Insurance