1. Topics When to Apply Medicare and Your State Health Insurance Resources Understanding Medicare

2. Understanding Medicare 3. What Is Medicare? Health insurance for three groups of people 65 and older Under 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) Administration Centers for Medicare & Medicaid Services (federal government) 4. Four Parts of Medicare Medical Medicare Advantage Prescription Drug HospitalPART A PART B PART C PART D 5. Automatic Enrollment in Parts A and B Enrollment automatic for those receiving Social Security 6. When Enrollment Is Not Automatic Some people need to sign up Those not getting Social Security Enroll through Social Security Apply three months before age 65 Working Part A only Retired Parts A and B 7. Your Seven-Month Initial Enrollment Period No Delay Delayed Start If you enroll in Part B 3 months before the month you turn 65 2 months before the month you turn 65 1 month before the month you turn 65 The month you turn 65 1 month after you turn 65 2 months after you turn 65 3 months after you turn 65 Sign up early to avoid a delay in getting coverage for Part B services. To get Part B coverage the month you turn 65, you must sign up during the first three months before the month you turn 65. If you wait until the last four months of your Initial Enrollment Period to sign up for Part B, your start date for coverage will be delayed. 8. General Enrollment Period (GEP) January 1 through March 31 each year Coverage effective July 1 May have to pay higher Part A and/or Part B premium for late enrollment 9. Enrolling in Part B if Youre Still Employed May want to delay enrolling in Part B if You have health coverage through your or your spouses current employment 90 days before your employment or coverage ends Enroll in Part B through Social Security without a penalty 10. Paying the Part B Premium Deducted monthly from Social Security payments If not deducted Billed every three months Medicare Easy Pay to deduct from bank account Contact SSA about premiums 11. Monthly Part B Premium If Your Yearly Income in 2012 Was In 2014 You Pay Individual Tax Return Joint Tax Return $85,000 or less $170,000 or less $104.90 $85,001$107,000 $170,001$214,000 $146.90 $107,001$160,000 $214,001$320,000 $209.80 $160,001$214,000 $320,001$428,000 $272.70 above $214,000 above $428,000 $335.70 12. Medicare and Your State Health Insurance 13. How Will My Health Coverage Change? Once on Medicare Part A and B, you will automatically be enrolled in the HealthSelect Medicare AdvantageSM plan Administered by Humana Lowers monthly insurance premiums Allows participants to see any doctor who accepts Medicare 14. HealthSelect Medicare Advantage Provides comparable or better coverage than your current coverage You may continue to see your current providers as long as they accept Medicare 15. Extra Services and Programs Humana Guidance Centers Well Dine Vision and hearing aid allowances SilverSneakers In Home Health Assessments ERS cannot and does not guarantee the length of time that a specific type of value-added product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. HumanaFirst Nurse Advice Line 16. Extra Services and Programs 17. How Do I Enroll? If you are enrolled in Medicare Parts A and B you will automatically be enrolled in HealthSelect Medicare Advantage, and receive a Welcome Kit from Humana. You may opt in and out of your health plan anytime throughout the plan year. 18. Split Households Coverage for dependents remains the same when you are eligible for Medicare and they are not. If a dependent becomes eligible for Medicare before you, your coverage remains the same and your dependent will be enrolled in HealthSelect Medicare Advantage. 19. KelseyCare Advantage KelseyCare Medicare Advantage HMO available to members in the Houston area KelseyCare Advantage received a five-star rating from Medicare 20. Extra Services and Programs ERS cannot and does not guarantee the length of time that a specific type of value- added product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Free transportation to medical appointments Vision and hearing aid allowances $150 coverage toward the purchase of eye wear through contracted providers $1,500 coverage every two years toward the purchase of hearing aids YMCA Services in Houston No joining fee First full month is free 10% off all programs 21. HealthSelect Secondary Providers file claims on your behalf Medicare UnitedHealthcare See any doctor who accepts Medicare $200 annual deductible 22. Extra Services and Programs Wellness coaching and disease management ERS cannot and does not guarantee the length of time that a specific type of value-added product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. myHealthCare Cost Estimator Health4meTM App 23. Community First Health Plans Available in the San Antonio area Must have a primary care physician (PCP) who accepts Medicare 24. Extra Services and Programs Prescription medication discount card for any family members who do not have pharmacy benefit ERS cannot and does not guarantee the length of time that a specific type of value-added product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Enhanced vision benefit Enhanced travel network Health risk assessment and wellness programs 25. Scott & White Health Plans Available in Central Texas Three new counties: Austin, Free stone, and Waller 26. Extra Service and Programs ERS cannot and does not guarantee the length of time that a specific type of value-added product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Diabetes Day Vitality Coordinator Member Promise VitalBridges VitalCare 27. Prescription Drug Coverage HealthSelect Medicare Rx is a prescription drug program for Medicare retirees in HealthSelect Secondary and HealthSelect Medicare Advantage. The program saves plan money without raising your costs or changing your coverage from the previous plan. SilverScript manages the plan. Deductibles and copays are reviewed by ERS Board annually, and may change based on program funding. Drug formulary is reviewed by SilverScript periodically. 28. Prescription Drug Coverage Prescription Drug Program (PDP) Provides necessary medication at the lowest possible cost to you and the plan $50 per plan year, per person deductible Applies to all health plans retail and mail service prescriptions Benefits and coverage are identical for employees and retirees 29. Income-Related Monthly Adjustment Amount (IRMAA) If Your Yearly Income in 2012 Was In 2014 You Pay Individual Tax Return Joint Tax Return $85,000 or less $170,000 or less Your Plan Premium (YPP) $85,000.01 $107,000 $170,000.01 $214,000 YPP + $12.10* $107,000.01 $160,000 $214,000.01 $320,000 YPP + $31.10* $160,000.01 $214,000 $320,000.01 $428,000 YPP + $50.20* Above $214,000 Above $428,000 YPP + $69.30* *per month 30. Extra Help with Drug Plan Costs Everyone else must apply Social Security or state makes determination Some groups automatically qualify People with Medicare and Medicaid Those who get Supplemental Security Income (SSI) only Those with QMB, SLMB, or QI Some with QDWI 31. Applying for Extra Help Multiple ways to apply Fill out a paper application On the web at socialsecurity.gov Through your state Medicaid office Through a local organization, such as a HICAP You or someone on your behalf can apply 32. Annual Enrollment Period Medicare-eligible ERS retirees have a fall enrollment period. 33. Resources www.ers.state.tx.us 34. Social Security Administration 800-772-1213 (TTY: 800-325-0778) www.socialsecurity.gov Medicare 800-MEDICARE (800-633-4227) www.medicare.gov Resources 35. ResourcesEmail Updates Be the first to know Sign up for our Digital Subscription Service 36. ResourcesFacebook and YouTube www.youtube.com/ersof texas www.facebook.com/ersof texas 37. Questions