1. 1 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Medicare 101 April 2015 Benefits 101

2. 2 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging What we’ll cover  What is Medicare?  Stats and facts  How is Medicare paid for?  How does Medicare work? Who is eligible? The 4 parts of Medicare How and when to enroll  Medicare and other benefits  Medicare in health care reform

3. 3 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging What is Medicare?  Government-sponsored health insurance for seniors aged 65+, and younger adults with disability/permanent kidney failure Helps pay for health care service, but doesn’t cover all costs or most long-term care  Created in 1965 by Congress under Title XVIII of Social Security Act Effort to equalize insurance for seniors regardless of income or medical history  1972 – expanded to include people under 65 who received Social Security disability benefits and those with ESRD  Medicare Modernization Act of 2003 established Part D

4. 4 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Stats and Facts  ~52 million people enrolled in Medicare, or 16% of total population of the United States 83% (43 million) qualify by age (65+) 17% (9 million) qualify by disability/health status  Roughly half of all Medicare beneficiaries have incomes below 200% of poverty ($23,540 in 2015); 16% have incomes below poverty ($11,770 in 2015)  10.1 million people with Medicare are also eligible for Medicaid (“dual eligibles”)

5. 5 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging How is Medicare financed?  Payroll taxes paid by workers and their employers help pay for Part A.  Cost-sharing (premiums, deductibles, coinsurance) by Medicare beneficiaries for Parts B, C, and D.  Other sources of financing: Part A: Income tax paid on Social Security benefits, premiums on Part A paid by those who don’t get it premium-free Part B: General revenue (mostly federal income taxes) Payments from states for Part D drug benefit

6. 6 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging How Medicare works: Who is eligible?  U.S. citizens aged 65 and older with sufficient quarters of work credit under Social Security Legal non-citizens may be able to enroll based on residency status, age, and work history  Adults younger than 65 with disabilities Eligible once they’ve received Social Security Disability benefits (or certain Railroad Retirement benefits) for 24 months Anyone with amyotrophic lateral sclerosis (Lou Gehrig’s Disease) qualifies in the 1 st month they receive disability Persons of any age with End Stage Renal Disease can enroll; coverage usually begins during 4 th month of dialysis

7. 7 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part A  Referred to as hospital or inpatient insurance  What Part A covers: Care while in a hospital Some of the costs of skilled nursing facility care or home health services Hospice care for those who are terminally ill

8. 8 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part A (cont.)  What Part A costs: Most people don’t pay premiums—paid for through FICA taxes Those without work credits (through their own work history or a spouse) pay a sliding scale premium up to $407/month in 2015 $1,260 deductible for hospital stay Skilled nursing facility, home health, and hospice have no deductibles Other co-payments depend on length of stay and type of facility/service (no cost-sharing for hospice)

9. 9 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part B  Outpatient insurance  With Part A, referred to as Original/Traditional Medicare  What Part B covers: Doctors’ services Outpatient hospital care Laboratory tests Medical equipment Orthotics and prosthetics Mental health care Ambulance services Prevention and wellness screenings

10. 10 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part B (cont.)  What Part B costs: In 2015, most people pay $104.90/month premiums for Part B unless they have income over $85,000 (individual) or $170,000 (couple) $147 annual deductible in 2015 Once deductible is paid, individual pays 20% of the Medicare- approved cost of the Part B covered service Important to see providers who accept Medicare assignment, otherwise the patient's cost-sharing responsibility increases

11. 11 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part C (cont.)  Part C: Medicare Advantage  Plans offered by private companies that contract with Medicare to offer Part A and B benefits  Many offer drug coverage (Part D)  May offer additional benefits not covered under Original Medicare (dental, hearing, vision, wellness programs)  What Part C costs: Patient still pays Part B premium (unless plan covers part of it) Additional premiums, deductibles, and cost-sharing vary by plan and service

12. 12 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The 4 parts of Medicare: Part D  Provided through private insurance plans—either stand-alone or as part of Part C/Medicare Advantage plans  Plans must accept anyone who is eligible and enrolls (no pre- existing condition clause)  Important to enroll when first eligible (unless they have creditable drug coverage), otherwise will incur a penalty if enrolling later (unless eligible for Low Income Subsidy)  Plans have different formularies (drug lists) and cost structures  Patients can compare plans and costs online using the Medicare Plan Finder: https://www.medicare.gov/find-a- plan/questions/home.aspxhttps://www.medicare.gov/find-a- plan/questions/home.aspx

13. 13 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Other Medicare-related programs  Medigap is a form of supplemental insurance Pays for cost-sharing (deductibles, premiums) for Parts A and B and some services not covered by Parts A and B Purchase from private insurance companies 11 different standard plans, except in MA, MN, WI Can see any doctor, regardless of whether they accept Medicare Usually easiest (and best) to buy when first enrolling in Medicare at age 65 See our Medigap webinar for more information  Can also fill gaps in coverage through other types of insurance (COBRA, TRICARE, Medicaid, Indian Health Service, Medicare Savings Programs, etc.)

14. 14 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging How to enroll  Automatic enrollment into Parts A & B occurs for: Those who receive disability benefits when they reach their 24-month window (or earlier for ALS and ESRD patients) Early retirees who receive Social Security, when they turn 65  All others must apply for Medicare through Social Security Online By calling 1-800-772-1213 (TTY 1-800-325-0778) By visiting their local Social Security office  Once signed up through Social Security, they can choose to enroll in Part C and/or D via the plan itself, or online using the Medicare Plan Finder for Part D

15. 15 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging When to enroll  Initial Enrollment Period: 7-month window around 65 th birthday to join Parts A, B, and D  General Enrollment Period: Jan 1 – March 31 each year to enroll in Parts A & B Oct 15 – Dec 7 (called Open Enrollment) each year to enroll in Parts C & D (or switch plans)  Special Enrollment Periods: When retiring/losing employer-sponsored insurance When moving or transitioning out of a nursing home When a plan changes its service area  Remember potential penalties for not enrolling on time!

16. 16 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Benefits that help pay for Medicare  Medicare Savings Programs (MSP) Administered through state Medicaid agencies Helps pay Medicare Part B premiums and/or cost sharing For more information, please see our MSP 101 Training  Extra Help/Low-Income Subsidy (LIS) Helps pay Part D premium and cost sharing People eligible for Medicaid or SSI are automatically eligible (known as “deemed eligible”) for the Extra Help/LIS under Part D. If a beneficiary does not choose a plan, they will automatically be enrolled into a zero-premium plan People with LIS can switch Part D plans at any time For more information, please see our LIS 101 Training

17. 17 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Medicare and other benefits (cont.)  Medicaid 10.1 million duals in the United States Medicaid helps pay for some of the costs of Medicare Anyone who is enrolled in both Medicare and Medicaid is automatically eligible for LIS/Extra Help For more information, please see our Medicaid 101 training

18. 18 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The Affordable Care Act & Medicare  ACA passed into law in March 2010, upheld by Supreme Court in June 2012  Significant implications for Medicare include: Closing the Part D coverage gap by 2020 Moved and extended Open Enrollment for Parts C & D Provides new free preventive benefits, including Annual Wellness Visit Tests new models of better care and coordination of services

19. 19 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Resources from NCOA  My Medicare Matters: http://www.mymedicarematters.orghttp://www.mymedicarematters.org Up-to-date information about coverage, costs, and enrollment Also sections on staying healthy with Medicare, using the Plan Finder, and joining Medicare for the first time  NCOA’s Center for Benefits Access: http://www.ncoa.org/centerforbenefits http://www.ncoa.org/centerforbenefits Benefits 101 and other training webinars (also at http://www.vimeo.com/channels/ncboe) http://www.vimeo.com/channels/ncboe Fact sheets Promising practices Issue Briefs and more!

20. 20 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Resources from the government  Centers for Medicare & Medicaid Services: http://www.medicare.gov (consumer focused) http://www.medicare.gov http://www.cms.gov (for professionals) http://www.cms.gov Medicare Plan Finder: https://www.medicare.gov/find-a- plan/questions/home.aspxhttps://www.medicare.gov/find-a- plan/questions/home.aspx Search http://www.medicare.gov/contacts for SHIPs and state departments of insurance, health, Medicaidhttp://www.medicare.gov/contacts  Social Security Administration: http://www.ssa.govhttp://www.ssa.gov  Health Care: http://www.healthcare.govhttp://www.healthcare.gov Information on provisions of Affordable Care Act Portal for Health Insurance Exchanges

21. 21 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Other resources  From the Kaiser Family Foundation: Financing Medicare from the Kaiser Family Foundation: http://www.kff.org/medicare/upload/7731.pdf http://www.kff.org/medicare/upload/7731.pdf Medicare Advantage 2015 Spotlight: Plan Availability and Premiums: http://kff.org/medicare/issue-brief/medicare- advantage-2015-data-spotlight-overview-of-plan- changes/http://kff.org/medicare/issue-brief/medicare- advantage-2015-data-spotlight-overview-of-plan- changes/  Medicare Rights Center: http://www.medicarerights.org/ http://www.medicarerights.org/

22. 22 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Thank You!  Thank you for participating in the Benefits 101 Series from the Center for Benefits Access at NCOA  We invite you to learn more about us by visiting our website: www.ncoa.org/centerforbenefits  If you have any questions or comments, please contact us at centerforbenefits@ncoa.orgcenterforbenefits@ncoa.org