Understanding Your Medicare ~ Benefits and Options ~ Prepared by the North Central Area Agency on Aging (860) 724–6443 / 1(800) 994-9422

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

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

What is Medicare? Modeled after private health insurance, Medicare covers some of the cost of some health 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”

Modeled after private health insurance, Medicare covers some of the cost of some health 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”

Who is eligible for Medicare? Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits Individuals who’ve received Social Security Disability for 24 months Individuals with End Stage Renal Disease or ALS All of the above 0

Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits

Individuals who’ve received Social Security Disability for 24 months

Individuals with End Stage Renal Disease or ALS

All of the above

Who’s Eligible? Individuals aged 65 years and eligible 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 eligible without waiting 24 months

Individuals aged 65 years and eligible 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 eligible without waiting 24 months

A person turning 65 has 7 full months to enroll in Medicare? TRUE FALSE Answer Now

TRUE

FALSE

Medicare Enrollment Periods Initial Enrollment Period – 7 months, beginning 3 months before month of 65 th birthday and ending 3 months. General Enrollment Period – January 1 st through March 31 st of every year. Part B benefits do not begin until July 1 st of that year.

Initial Enrollment Period – 7 months, beginning 3 months before month of 65 th birthday and ending 3 months.

General Enrollment Period – January 1 st through March 31 st of every year. Part B benefits do not begin until July 1 st of that year.

65 and Still Working? If you continue working after 65, you may chose to delay enrollment in Medicare Part B without penalty. 20 or more employees – Employer insurance is primary Less than 20 employees – Employer regulations may require that your Medicare be primary insurance Once you retire and stop active employment, Medicare becomes primary insurance

If you continue working after 65, you may chose to delay enrollment in Medicare Part B without penalty.

20 or more employees – Employer insurance is primary

Less than 20 employees – Employer regulations may require that your Medicare be primary insurance

Once you retire and stop active employment, Medicare becomes primary insurance

Special Enrollment Period (SEP) For actively working elderly or disabled begins 1 st day a beneficiary is no longer covered under their own (or spouses) active employment and ends on the last day of the 8 th full consecutive month. For disabled individuals previously covered by “large group health plan” (+100employees) Same 8 month SEP as above, but the coverage ending is that from a family members active employment .

For actively working elderly or disabled

begins 1 st day a beneficiary is no longer covered under their own (or spouses) active employment and ends on the last day of the 8 th full consecutive month.

For disabled individuals previously covered by “large group health plan” (+100employees)

Same 8 month SEP as above, but the coverage ending is that from a family members active employment .

Traditional Medicare Created in 1965 consisting of 2 parts: Medicare A – Hospital Medicare B – Medical People in traditional Medicare can receive their health care from any provider certified by Medicare

Created in 1965 consisting of 2 parts:

Medicare A – Hospital

Medicare B – Medical

People in traditional Medicare can receive their health care from any provider certified by Medicare

Medicare Part A Covers… Inpatient Hospital Care Skilled Nursing Facility Care Home Health Care Hospice Care

Inpatient Hospital Care

Skilled Nursing Facility Care

Home Health Care

Hospice Care

Traditional Medicare Costs Part A - No monthly premium if you have 40+ quarters of work - You can buy-in to Medicare A if you’ve worked less than 40 quarters - 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

Part A

- No monthly premium if you have 40+ quarters of work

- You can buy-in to Medicare A if you’ve worked less than 40

quarters

- associated deductibles and co-insurances

Medicare Part B Covers… Physicians Services Home Health Care Outpatient Services and Therapy Durable Medical Equipment Prosthetic Devices Ambulance Services And…

Physicians Services

Home Health Care

Outpatient Services and Therapy

Durable Medical Equipment

Prosthetic Devices

Ambulance Services

And…

Medicare Part B Covers… Certain Preventative Services One physical exam when 1 st enrolled in Part B Flu, Pneumococcal, Hepatitis B vaccines Annual Mammograms Some pap smear and pelvic exams Colorectal Screenings Diabetes Self-Management Training/Tests Bone Mass Measurements Prostate Cancer Screening Some Glaucoma Screening Some Medical Nutrition Therapy Services Some Cardio-vascular tests

Certain Preventative Services

One physical exam when 1 st enrolled in Part B

Flu, Pneumococcal, Hepatitis B vaccines

Annual Mammograms

Some pap smear and pelvic exams

Colorectal Screenings

Diabetes Self-Management Training/Tests

Bone Mass Measurements

Prostate Cancer Screening

Some Glaucoma Screening

Some Medical Nutrition Therapy Services

Some Cardio-vascular tests

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

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

Traditional Medicare Costs Part B - Annual deductible $135 - 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%

Part B

- Annual deductible $135

- 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%

Help with Medicare related Expenses There are Federal and State Programs available for beneficiaries with limited incomes Medicare Savings Programs (QMB/SLMB/ALMB) Income guidelines are: Single: $1,497.05/month (2009 limit) Couple: $2,196.25/month (2009 limit)

There are Federal and State Programs available for beneficiaries with limited incomes

Medicare Savings Programs (QMB/SLMB/ALMB)

Income guidelines are:

Single: $1,497.05/month (2009 limit)

Couple: $2,196.25/month (2009 limit)

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

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

Once you select the letter plan you want, the company selling it for the highest monthly premium offers the best coverage for that plan TRUE FALSE Answer Now

TRUE

FALSE

Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? Once a year Once a month Only during the general enrollment period (Jan-March) 0

Once a year

Once a month

Only during the general enrollment period (Jan-March)

Medicare Part D In 2006 Medicare Part D was created to provide beneficiaries with prescription drug coverage Part D provides coverage of certain medications through a variety of private insurance plans

In 2006 Medicare Part D was created to provide beneficiaries with prescription drug coverage

Part D provides coverage of certain medications through a variety of private insurance plans

A beneficiary must have Medicare A and B in order to be eligible for Medicare Part D TRUE FALSE Answer Now

TRUE

FALSE

When can a beneficiary make changes to their Medicare Prescription Drug Plan? At any time 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 doesn’t cover them 9

At any time

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 doesn’t cover them

Traditional Medicare Costs Part D Because benefits are provided by private insurance plans, all related costs vary by plan Monthly premiums range from $19.40 to $111.40 Deductible of up to $295/year Co-payments and co-insurances You want to make sure you complete a Drug Comparison Screen each year to make sure you enroll in a plan that best covers YOUR medications.

Part D

Because benefits are provided by private insurance plans, all related costs vary by plan

Monthly premiums range from $19.40 to $111.40

Deductible of up to $295/year

Co-payments and co-insurances

You want to make sure you complete a Drug Comparison Screen each year to make sure you enroll in a plan that best covers YOUR medications.

Paying for Part D There are also programs that help pay for the cost of Medicare Part D plans 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 Income Guidelines (2009) Single: $2,092/month Couple: $2,817/month 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)

There are also programs that help pay for the cost of Medicare Part D plans

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

Income Guidelines (2009)

Single: $2,092/month

Couple: $2,817/month

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)

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

Beneficiaries have the option to enroll in “Traditional Medicare” (parts A, B, and D), or to go with a Medicare Part C plan instead

What is Medicare Part C? Medicare Part C, or Medicare Advantage Plans, are private insurance companies that contract with Medicare to provide beneficiaries with all their Medicare benefits and offers additional benefits as well Health Maintenance Organizations (HMOs) Preferred Provider Organizations (PPOs) Private Fee For Service (PFFS) Special Needs Plans (SNPs)

Medicare Part C, or Medicare Advantage Plans, are private insurance companies that contract with Medicare to provide beneficiaries with all their Medicare benefits and offers additional benefits as well

Health Maintenance Organizations (HMOs)

Preferred Provider Organizations (PPOs)

Private Fee For Service (PFFS)

Special Needs Plans (SNPs)

If you enroll in a Medicare Advantage Plan you no longer have Medicare TRUE FALSE Answer Now

TRUE

FALSE

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 Extra Days in the hospital Preventative Care Dental or Eye Coverage

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

Extra Days in the hospital

Preventative Care

Dental or Eye Coverage

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

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

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

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

Medicare Advantage continued… Caution is needed if/when selecting a Medicare Advantage Plan Plans available are based on geographical location 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 May need to get referrals as deemed medically appropriate for coverage with a specialist

Caution is needed if/when selecting a Medicare Advantage Plan

Plans available are based on geographical location

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

May need to get referrals as deemed medically appropriate for coverage with a specialist

Ready to test your Medicare knowledge? Get your buttons ready as we review what we’ve learned today!

Get your buttons ready as we review what we’ve learned today!

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

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

Who is eligible for Medicare? Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits Individuals who’ve received Social Security Disability for 24 months Individuals with End Stage Renal Disease or ALS All of the above 0

Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits

Individuals who’ve received Social Security Disability for 24 months

Individuals with End Stage Renal Disease or ALS

All of the above

A person turning 65 has 7 full months to enroll in Medicare? TRUE FALSE Answer Now

TRUE

FALSE

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

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

Once you select the letter plan you want, the company selling it for the highest monthly premium offers the best coverage for that plan TRUE FALSE Answer Now

TRUE

FALSE

Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? Once a year Once a month Only during the general enrollment period (Jan-March) 0

Once a year

Once a month

Only during the general enrollment period (Jan-March)

A beneficiary must have Medicare A and B in order to be eligible for Medicare Part D TRUE FALSE Answer Now

TRUE

FALSE

When can a beneficiary make changes to their Medicare Prescription Drug Plan? At any time 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 doesn’t cover them 0

At any time

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 doesn’t cover them

If you enroll in a Medicare Advantage Plan you no longer have Medicare TRUE FALSE Answer Now

TRUE

FALSE

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

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

CHOICES is Here to Help As the State Health Insurance Assistance Program for Connecticut, CHOICES provides Free and Unbiased information 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 - 1-800-994-9422

As the State Health Insurance Assistance Program for Connecticut, CHOICES provides Free and Unbiased information 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 -

1-800-994-9422

Helpful Resources Medicare 1-800-MEDICARE (1800-633-4227) www.medicare.gov CHOICES Program 1-800-994-9422 CMA www.medicareadvocacy.org BenefitsCheckUp www.benefitscheckup.org Infoline (211) www.infoline.org

Medicare 1-800-MEDICARE (1800-633-4227)

www.medicare.gov

CHOICES Program 1-800-994-9422

CMA www.medicareadvocacy.org

BenefitsCheckUp www.benefitscheckup.org

Infoline (211) www.infoline.org