- 1.Understanding Your Medicare ~Benefits and Options~ Prepared
by the North Central Area Agency on Aging (860) 7246443 / 1(800)
994-9422
2. What is Medicare?
- Free health insurance for anyone over 65
- Retirement insurance that covers all healthcare needs
- Insurance for eligible individuals that provides some health
care coverage for some healthcare services
9 3. What is Medicare?
- Modeled after private health insurance, Medicare coverssomeof
the cost ofsomehealth care
- Generally, Medicare coverage is available for health care
services that are considered medically reasonable and necessary for
treatment or diagnosis of illness or injury
4. Who is eligible for Medicare?
- Individuals aged 65 yrs and eligible for Social
Security/Railroad Retirement benefits
- Individuals whove received Social Security Disability for 24
months
- Individuals with End Stage Renal Disease or ALS
0 5. Whos Eligible?
- Individuals aged 65 yearsandeligible for Social Security or
Railroad Retirement benefits
- Individuals who have received Social Security Disability for 24
months
- If you have End Stage Renal Disease (ESRD) or ALS, you may be
eligiblewithoutwaiting 24 months
6. A person turning 65 has7 full months to enroll in
Medicare?
Answer Now 7. Medicare Enrollment Periods
- Initial Enrollment Period 7 months, beginning 3 months before
month of 65 thbirthday and ending 3 months.
- General Enrollment Period January 1 stthrough March 31 stof
every year. Part B benefits do not begin until July 1 stof that
year.
8. 65 and Still Working?
- If you continue working after 65, you may chose to delay
enrollment in Medicare Part B without penalty.
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- 20 or more employees Employer insurance is primary
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- Less than 20 employees Employer regulationsmayrequire that your
Medicare be primary insurance
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- Once you retire and stop active employment, Medicare becomes
primary insurance
9. Special Enrollment Period (SEP)
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- For actively working elderly or disabled
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- begins 1 stday a beneficiary is no longer covered under their
own (or spouses)active employmentand ends on the last day of the 8
thfull consecutive month.
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- For disabled individuals previously covered by large group
health plan (+100employees)
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- Same 8 month SEP as above, but the coverage ending is that from
a family membersactive employment .
10. Traditional Medicare
- Created in 1965 consisting of 2 parts:
- People in traditional Medicare can receive their health care
from any provider certified by Medicare
11. Medicare Part A Covers
- Skilled Nursing Facility Care
12. Traditional Medicare Costs
- - No monthly premium if you have 40+ quarters of work
- - You can buy-in to Medicare A if youve worked less than
40
- - associated deductibles and co-insurances
$133.50 per day Days 21-100 Skilled Nursing Facility $534 per
day Days 91-150 Hospital Stay $267 per day Days 61-90 Hospital Stay
$1,068 per admission Days 1-60 Hospital Stay 13. Medicare Part B
Covers
- Outpatient Services and Therapy
- Durable Medical Equipment
14. Medicare Part B Covers
- Certain Preventative Services
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- One physical exam when 1 stenrolled in Part B
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- Flu, Pneumococcal, Hepatitis B vaccines
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- Some pap smear and pelvic exams
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- Diabetes Self-Management Training/Tests
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- Prostate Cancer Screening
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- Some Medical Nutrition Therapy Services
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- Some Cardio-vascular tests
15. Medicare Part B Services
- Are free and cover 100% of care
- Have a monthly premium, annual deductible, cover 80% of the
cost of care and have a 20% co-insurance for the beneficiary
- Have a monthly premium and cover 80% of the cost of care and is
then considered paid in full by the doctor
0 16. Traditional Medicare Costs
- - Monthly premium of $96.40 (or higher
- depending on your income)
- - Generally, Medicare pays for 80% of the
- approved Medicare rate of service and the
- beneficiary is responsible for the remaining 20%
17. Help with Medicare related Expenses
- There are Federal and State Programs available for
beneficiaries with limited incomes
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- Medicare Savings Programs (QMB/SLMB/ALMB)
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- Single: $1,497.05/month (2009 limit)
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- Couple: $2,196.25/month (2009 limit)
18. Medicare Supplement Insurance
- There are Supplement insurance plans available to offset some
of the costs related to traditional Medicare
- Medicare Supplement plans (Medigap policies) are standardized
in Connecticut and overseen by the Department of Insurance
- Plans range in cost and coverage options depending on the level
of coverage you choose
19. Once you select the letter plan you want, the company
selling it for the highest monthly premium offers the best coverage
for that plan
Answer Now 20. Once a beneficiary enrolls in a Medicare
Supplement Plan, how often can they change their plan
selection?
- Only during thegeneral enrollment period (Jan-March)
0 21. Medicare Part D
- In 2006 Medicare Part D was created to provide beneficiaries
with prescription drug coverage
- Part D provides coverage ofcertainmedications through a variety
ofprivateinsurance plans
22. A beneficiary must have Medicare AandB in order to be
eligible for Medicare Part D
Answer Now 23. When can a beneficiary make changes to their
Medicare Prescription Drug Plan?
- Only during the Open Enrollment Period (Nov 15 Dec 31) or if
they qualify for a Special Enrollment Period
- During the Open Enrollment Period (Nov 15 Dec 31) and during
the year if their medication needs change and the plan doesnt cover
them
9 24. Traditional Medicare Costs
- Because benefits are provided byprivateinsurance plans, all
related costs vary by plan
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- Monthly premiums range from $19.40 to $111.40
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- Deductible of up to $295/year
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- Co-payments and co-insurances
- You want to make sure you complete a Drug Comparison Screeneach
yearto make sure you enroll in a plan that best covers YOUR
medications.
25. Paying for Part D
- There are also programs that help pay for the cost of Medicare
Part D plans
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- ConnPACE: a state pharmacy assistance program that pays the
monthly premium of Part D plan, and limits medication co-payments
to $16.25/perscription for an annual fee of $30
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- Low Income Subsidy (LIS) or Extra Help through Social Security:
Helps pay the monthly premiums of Part D plans and limits
co-payments of medications. Eligibility is based on income and
asset guidelines. (Please see additional handouts)
26. Options in Receiving Your Medicare Benefits
- Beneficiaries have the option to enroll in Traditional Medicare
(parts A, B, and D), or to go with a Medicare Part C plan
instead
27. What is Medicare Part C?
- Medicare Part C, orMedicare AdvantagePlans, are private
insurance companies that contract with Medicare to provide
beneficiaries with all their Medicare benefits and offers
additional benefits as well
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- Health Maintenance Organizations (HMOs)
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- Preferred Provider Organizations (PPOs)
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- Private Fee For Service (PFFS)
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- Special Needs Plans (SNPs)
28. If you enroll in a Medicare Advantage Plan you no longer
have Medicare
Answer Now 29. Medicare Advantage
- Generally Medicare Advantage Plans require patients to get
their health care services from certain providers in their
network
- In return these plans may offer additional benefits that are
not offered in traditional Medicare and reduced premiums
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- Extra Days in the hospital
30. Medicare Advantage continued
- Most Medicare Advantage Plans offer Prescription Drug coverage
as well
- If you enroll in a Medicare Advantage Plan without drug
coverage, you can not get a stand alone drug plan through
Traditional Medicare
31. If enrolled in an Advantage Plan do you still have to pay
Medicare B premiums?
- No, you only pay the Advantage Plan premium
- Yes, you pay the Medicare B premium and the Advantage Plan
premium separately
- Yes, but the Medicare Part B premium is included in the
Advantage Plan premium you pay each month
15 32. Medicare Advantage continued
- Caution is needed if/when selecting a Medicare Advantage
Plan
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- Plans available are based on geographical location
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- All providers used by the beneficiary must be covered in the
network. If not, you will be responsible for the cost of care and
services received
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- May need to get referrals as deemed medically appropriate for
coverage with a specialist
33. Ready to test your Medicare knowledge?
- Get your buttons ready as we review what weve learned
today!
34. What is Medicare?
- Free health insurance for anyone over 65
- Retirement insurance that covers all healthcare needs
- Insurance for eligible individuals that provides some health
care coverage for some healthcare services
0 35. Who is eligible for Medicare?
- Individuals aged 65 yrs and eligible for Social
Security/Railroad Retirement benefits
- Individuals whove received Social Security Disability for 24
months
- Individuals with End Stage Renal Disease or ALS
0 36. A person turning 65 has7 full months to enroll in
Medicare?
Answer Now 37. Medicare Part B Services
- Are free and cover 100% of care
- Have a monthly premium, annual deductible, cover 80% of the
cost of care and have a 20% co-insurance for the beneficiary
- Have a monthly premium and cover 80% of the cost of care and is
then considered paid in full by the doctor
1 38. Once you select the letter plan you want, the company
selling it for the highest monthly premium offers the best coverage
for that plan
Answer Now 39. Once a beneficiary enrolls in a Medicare
Supplement Plan, how often can they change their plan
selection?
- Only during thegeneral enrollment period (Jan-March)
0 40. A beneficiary must have Medicare AandB in order to be
eligible for Medicare Part D
Answer Now 41. When can a beneficiary make changes to their
Medicare Prescription Drug Plan?
- Only during the Open Enrollment Period (Nov 15 Dec 31) or if
they qualify for a Special Enrollment Period
- During the Open Enrollment Period (Nov 15 Dec 31) and during
the year if their medication needs change and the plan doesnt cover
them
0 42. If you enroll in a Medicare Advantage Plan you no longer
have Medicare
Answer Now 43. If enrolled in an Advantage Plan do you still
have to pay Medicare B premiums?
- No, you only pay the Advantage Plan premium
- Yes, you pay the Medicare B premium and the Advantage Plan
premium separately
- Yes, but the Medicare Part B premium is included in the
Advantage Plan premium you pay each month
0 44. CHOICES is Here to Help
- As the State Health Insurance Assistance Program for
Connecticut, CHOICES providesFreeandUnbiasedinformation and
assistance in navigating the benefits and options available to you
through Medicare
- Specially trained staff, counselors and volunteers are
available to speak with you or set up an appointment to go over
your unique needs and options. Just call -
45. Helpful Resources
- Medicare 1-800-MEDICARE (1800-633-4227)
- CHOICES Program 1-800-994-9422
- CMA www.medicareadvocacy.org
- BenefitsCheckUpwww.benefitscheckup.org
- Infoline (211) www.infoline.org