1. WHAT DOES MEDICARE HAVE TO DO WITH FAMILIES? Presented by Nancy A. Dykeman, CLTC, CSA for Corporation for Long-term Care Certification

2. “I turn 65 next year and I’m counting on my Medicare to replace my current insurance.”

3. “There are so many moving parts to Medicare, I’m confused.”

4. “Where would I find information to help me understand my new insurance benefits?”

5. “Help, I need somebody, help, not just anybody…” The Beatles

6. Let’s Start at the Very Beginning New Premiums New Limits New Plans Added All PARTS of Medicare Where to Learn More

7. C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government handbook with important information about the following: What's new 2009 Medicare costs What Medicare covers Health and prescription drug plans Your Medicare rights Fraud and identity theft Medicare &You 2009

8. Medicare’s goal is to make it easy for you to get the highest quality health care at the most affordable price. Medicare is transforming itself from a program which simply pays the bills to a program which actively supports a high quality health care system.

9. Communicates using an interconnected, computerized health ■■information network, so providers can get a What do we mean by a high quality health care system? It’s a system that does the following: Rewards providers for quality and efficiency. Uses objective standards to determine quality and efficiency. Communicates using an interconnected, computerized health information network, so providers can get a comprehensive view of the patient securely and without delay. Offers consumers complete, objective, easily accessible information, so they can make solid decisions about their own health care based on quality and price. Medicare shares quality information about providers in your area at www.medicare.gov. In addition, this “Medicare & You” handbook is another way Medicare is working to make sure you have reliable information to help you make good health care decisions.

10. November 15, 2008–December 31, 2008: Stay or Switch  You can switch your Medicare health or prescription drug coverage for 2009 during this period. January 1, 2009: 2009 Coverage and Costs Begin New coverage begins if you made a change between November 15, 2008–December 31, 2008. New costs and coverage changes also begin if you keep your current coverage.

11. What is Medicare? Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

12. What if? Picture no health insurance… Who would pay…the senior or family What happened to a lifestyle worth living?

13. “I’d like to retire but I am only working to continue my health insurance…you just never know.”

14. Medicare is a “Family” of Coverage Each family member (child) has a role: Oldest = PART A Next Oldest = PART B Middle Child = PART C Next Youngest = PART D Youngest = Medicare Supplement

15. Since 1965 Changes in Coverage Increasing Premiums More Out-of-Pocket Added Prescription Coverage Gee, do you think things might keep changing?

16. PART A – the eldest This is hospitalization insurance for inpatient care including rehabilitation facilities, some skilled nursing facility care, hospice care and some skilled home health care. Medically necessary and reasonable treatments Must show significant improvement Outpatient Speech-language, Occupational and Physical Therapy

17. PART A + Employer Plan Comprehensive One pays and the other, too ER plan covers co-pays and deductibles for PART A ER plan is primary

18. PART A - 2009 Premium is $0 if paid at least 40 credits to Social Security during working years Up to $443/month if less than 40 credits Deductible is $1,068 for each hospital stay of 1-60 days Up to $534/day for up to 150 days Co-insurance in Skilled Nursing Facility $133.50/day for days 21-100, each benefit period

19. Enrollment Begins automatically if on Social Security or Railroad Retirement for 65 and up. If under 65 and disabled, it is automatic after getting SS disability benefits for at least 24 months. If no SS benefits yet, then sign-up within a 7 month window for age 65.

20. PART B – Next Oldest Child Medically necessary services:  Doctor  Outpatient care  Other medical services  Preventive services

21. PART B - 2009 Premium is based on income  $96.40/month under $85,000 (individual)  Up to $308.30 for income above $212,000 Deductible $135 Annual Co-insurance or Co-pay amounts for most doctor services, durable medical equipment and outpatient mental health care.

22. Enrollment Card mailed 3 months before 65 birthday or 24 th month of disability. If PART B is not wanted but the card is kept, monthly premium will be automatically deducted from SS check If wait to enroll monthly premium increases 10% for each year while waiting If have ER plan there is an 8 month window to enroll in PART B without penalty

23. Without PART B Remember, PART B is the physician coverage and outpatient services, and complements PART A. A person will need another medical plan to pay the extras that PART A doesn’t cover (however, if an employer group has less than 20 people and not subject to COBRA, an individual who is 65 or older on the group plan should enroll in Medicare Part B. If a group member doesn’t have Part B, he/she could be exposed to costs which are not reimbursed by Medicare or the group plan.)

24. PART C – our Middle Child Medicare Advantage Covers PARTS A & B Offered by private companies Beneficiary can get more coverage than A & B offer

25. Vision exams and eyeglasses Dental Health and Wellness Programs Rx

26. PART C - 2009 Premiums vary depending on plans offered – some $0 premium Out-of-Pocket costs  Co-pays  Co-insurance  Deductibles

27. Premiums and Plans Contact Medicare at 1-800-663-4227 or www.medicare.gov

28. PART D – Next Youngest Prescription Drug Plan – 2004 Must have PARTS A & B Private companies sell plans Plans vary in cost and drugs covered

29. Enrollment After joining a plan the plan will mail membership materials and a card

30. Other PART D Costs Co-pays Co-insurance Deductibles

31. PART D - 2009 Premium  $18.40 to $107.60/month (state specific) Deductible – The annual deductible depends on your plan. Most plans have a deductible of $295. You usually pay all of your drug costs, up to $295. After you have paid $295 deductible for your drugs, you usually pay 25% of your prescription drug costs up to $2,700. Initial Coverage Limit – The coverage limit is $2,700. Once this limit is reached for prescription drugs, your coverage stops. You are responsible for paying 100% of the drug costs up to $4,350 (including the costs of the deductible and coinsurance). This period is known as the Coverage Gap or “Donut Hole”. Catastrophic Coverage – Once you have reached the out-of-pocket costs of $4,350, you qualify for catastrophic coverage. You will pay no more than 5% of your drug costs for the remainder of the year.

32. Medicare Supplement (Medigap) Youngest child in the Medicare Family Sold by private insurance agents Helps pay costs PART A & PART B don’t  Co-pays  Co-insurance  Deductibles Some plans offer out-of country coverage.

33. Plans Standardized plans – A through L A = basic coverage and add more coverage to Plan L Cost varies If join a PART C, Medicare Advantage plan don’t need Medigap.

34. Plan Examples A State offering 65 plans:  Premium $0 to $244.80 month  Co-pays and Deductibles vary

35. “So I have PART A and if I don’t want co-pays and deductibles out of my pocket, I buy a Medigap policy?” YES

36. “What’s a Medicare Medical Savings Account?” MSA by CMS 2007 High Deductible health plan with a medical savings account that beneficiaries can use to manage their health care costs. Cover PARTS A & B benefits and others

37. HOW? Medicare puts annual deposit into an interest-bearing account from CMS to help individual cover health care costs. High Deductible, less than $6,000 Each month Medicare pays a premium for the policy to the insurance company Use funds for medical services If “qualified medical expense” (IRS) then the payment is tax-free. No PART D drugs included Carry-over unused deposit dollars

38. Contact Medicare about MSA Special Information  1-800-318-2596  www.medicare.gov

39. Future of Medicare “Absent fundamental reforms, over the next two decades the average American household’s health-care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23% to 41% of average household income.

40. By curtailing revenues, today’s recession will bring closer the projected exhaustion of the Medicare Part A trust fund from early 2019 to perhaps 2016.” Michael Levitt, Secretary of Health and Human Services

41. Last Thoughts… In 1965 America’s median age was 28.4, now it is 36.6. Ratio of workers to seniors has steadily declined and number of seniors living long enough to have 5 or more chronic conditions – 23% of Medicare beneficiaries – has increased. Source: George Will, The Washington Post

42. Long-Term Care? PART A – only skilled, not custodial care PART B – no PART C – no PART D – no Medicare Supplements - no

43. The Family Your responsibility to be their source Your responsibility to learn Your responsibility to understand Your responsibility to keep up Your responsibility to protect families from uncertainty, confusion and the effects of long-term care

44. QUESTIONS?