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Aetna medicare 101
- 1. Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding your Medicare options Brought to you by Aetna Medicare 101
- 2. Aetna Inc. Today’s agenda 1. Medicare Parts A - D 2. Government and private plans 3. Your options 4. Prescription drugs 5. Medical Supplemental Insurance 6. Next steps
- 3. Aetna Inc. 1 CHAPTER Let’s start at the beginning. Medicare parts A─D
- 4. Aetna Inc. Medicare has four parts: A, B, C and D. 4
- 5. Aetna Inc. 5 Covers hospital insurance. Covers medical insurance. Like doctor visits. HOSPITAL CARE A PART B PART MEDICAL CARE
- 6. Aetna Inc. 6 These are called “Original Medicare.” They are administered and provided by the federal government. HOSPITAL CARE A PART B PART MEDICAL CARE
- 7. Aetna Inc. 7 Medicare is health insurance for: • People 65 or older • People under 65 with certain disabilities • People of any age with End- Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) HOSPITAL CARE A PART B PART MEDICAL CARE
- 8. Aetna Inc. 8 Then there’s Part C. This is called Medicare Advantage.C PART MEDICARE ADVANTAGE
- 9. Aetna Inc. 9 You can buy Part C (Medicare Advantage) from private insurance companies.C PART MEDICARE ADVANTAGE
- 10. Aetna Inc. 10 Medicare Advantage combines Parts A and B and may even offer prescription drug coverage. It can include additional benefits like eye care, hearing, wellness services, or a nurse phone line. C PART MEDICARE ADVANTAGE
- 11. Aetna Inc. 11 You can buy a Medicare Advantage Plan (Part C) if you: • Are enrolled in Parts A and B. • Live in the plan’s service area. • Do not have end-stage renal disease (some exceptions apply) C PART MEDICARE ADVANTAGE
- 12. Aetna Inc. 12 Then there’s Part D. It helps pay for prescription drugs. It is only offered through private insurance companies. We’ll talk more about Part D later. D PART PRESCRIPTION DRUGS
- 13. Aetna Inc. 13 The four parts of Medicare. Private medical plans Government programs A PART HOSPITAL CARE B PART MEDICAL CARE D PART PRESCRIPTION DRUGS C PART MEDICARE ADVANTAGE Private drug plans
- 14. Aetna Inc. 2 CHAPTER Government and private plans Why can’t I just rely on Parts A and B – what the government pays for?
- 15. Aetna Inc. 15 You can rely on Parts A and B, but it only pays about 80 percent of your health care costs. It covers hospital and doctor visits, along with some drugs. $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
- 16. Aetna Inc. 16 Part C, a Medicare Advantage plan, will help you cover costs like: • Deductibles • Copays and coinsurance • Most drugs • Preventive services • Dental and vision (sometimes)
- 17. Aetna Inc. So what’s the bottom line? • Part C, or Medicare Advantage -helps you pay for what Original Medicare and Part D don’t. • There are many choices in the marketplace. • We can help you weigh your options. < >
- 18. Aetna Inc. 3 CHAPTER Your options How to decide which Medicare option is right for you
- 19. Aetna Inc. 19 Questions to consider when choosing your Medicare options 1. Do I have a chronic condition? 2. What monthly premium can I afford? 3. Can I see the doctors I want?
- 20. Aetna Inc. 20 And what about your prescription drugs? 4. Will my prescription drugs be covered? 5. What will my out-of-pocket costs be? 6. Can I use the pharmacies I want?
- 21. Aetna Inc. 21 You have 2 paths to choose from. Medicare Medicare Advantage Part A: Hospital Part B: Medical Part D: A separate drug plan – if you buy it. Supplemental insurance – if you buy it. Combines Part A: Hospital and Part B: Medical It usually includes a drug plan. Medicare Part D: You can buy it if it is not included in the Medicare Advantage plan.
- 22. Aetna Inc. Medicare 22 You have 2 paths to choose from. Part A: Hospital Part B: Medical Part D: A separate drug plan – if you buy it. Supplemental insurance – if you buy it. Medicare Advantage Combines Part A: Hospital and Part B: Medical. It usually includes a drug plan. Medicare Part D: You can buy it if it is not included in the Medicare Advantage plan.
- 23. Aetna Inc. 23 If you choose Medicare Advantage. Here are two options: A Health Maintenance Organization (an HMO) A Preferred Provider Organization (a PPO)
- 24. Aetna Inc. If you choose Medicare Advantage. A Health Maintenance Organization (an HMO) 24 Here are two options: A Preferred Provider Organization (a PPO) A Health Maintenance Organization (an HMO) Let’s take an HMO first. • You’ll use doctors in the network. • You might need a referral to see a specialist.
- 25. Aetna Inc. A Preferred Provider Organization (a PPO) A Health Maintenance Organization (an HMO) 25 Here are two options: Now let’s look at a PPO. You can use doctors and hospitals outside of the network, but often for a higher copay. A Preferred Provider Organization (a PPO) If you choose Medicare Advantage.
- 26. Aetna Inc. Let’s look at what a Medicare Advantage plan can help you pay for and what Original Medicare does not pay for.
- 27. Aetna Inc. 27 What Medicare Advantage can help you pay for $1,316 $183 20% Part A deductible Skilled nursing facility copay for days 21 through 100 Annual Part B deductible Coinsurance for covered doctor services $164.50Per day
- 28. Aetna Inc. 28 Depending on the plan, Medicare Advantage can help you pay for other things. Emergency medical care outside the U.S. Annual hearing exams Eyewear and hearing aids Part D prescription drugs Out-of-pocket medical costs annual limit $
- 29. Aetna Inc. 4 CHAPTER Prescription drugs Now let’s look at Part D – the drug plan.
- 30. Aetna Inc. 30 Here’s how Part D works. You have 2 choices. Stand-alone Medicare Prescription Drug Plan (PDP) A Medicare Advantage Plan that comes with prescription drug (Part D) coverage You buy this in addition to Parts A and/or B.
- 31. Aetna Inc. 31 Have you heard about the “donut hole”?
- 32. Aetna Inc. 32 Here’s how it works. Phase 1 You pay until you reach your deductible. Your Part D insurance pays until $3,700 in Total Part D drug spending is reached. Once $3,700 is reached, you are in the coverage gap ─ until your expenses reach $4,950. This is the“donuthole.” After $4,950 ─ you pay the greater of 5% or $3.30 for generics and $8.25 for all others drugs. Phase 2 Phase 3 Phase 4 You have four coverage levels.
- 33. Aetna Inc. 5 CHAPTER Ok, just one more type of insurance to go. Medicare Supplemental Insurance
- 34. Aetna Inc. Medicare Advantage 34 You have 2 paths to choose from. Combines Part A: Hospital and Part B: Medical. It usually includes a drug plan. Medicare Part D: if it is not included. Original Medicare Sometimes it’s called Med Supp or Medigap. You may want to consider this if you choose Original Medicare. It helps cover the gaps of what Original Medicare doesn’t cover — such as portions of coinsurance, copayments and deductibles. Part A: Hospital Part B: Medical Part D: A separate drug plan – if you buy it. Supplemental insurance – if you buy it.
- 35. Aetna Inc. Medicare Advantage Combines Part A: Hospital and Part B: Medical. It usually includes a drug plan. Medicare Part D: if it is not included in the Medicare Advantage plan. 35 You have 2 paths to choose from. Original Medicare Medigap plans are health insurance policies sold by private insurance companies. They help cover medical benefit “gaps,” such as Parts A and B deductibles and coinsurance. They do not include Part D drug coverage – you buy that separately. They cover visits to any doctor who accepts Medicare. Part A: Hospital Part B: Medical Part D: A separate drug plan – if you buy it. Supplemental insurance – if you buy it.
- 36. Aetna Inc. 6 CHAPTER Next steps Bringing it all together
- 37. Aetna Inc. Step 1 Enroll in Medicare Part A and Part B when you are first eligible. 37
- 38. Aetna Inc. Step 2 Now you have two ways to proceed. 38 Option 1 Keep Original Medicare and add: • Medicare supplement insurance • Medicare Part D Option 2 Buy a Medicare Advantage Plan This combines Medicare Parts A & B and often Part D and additional benefits.
- 39. Aetna Inc. Now that I understand my Medicare options, when can I enroll?
- 40. Aetna Inc. 40 How do I enroll in Part A and Part B? If you are getting Social Security when you turn 65, you will automatically be enrolled. If you’re not getting Social Security when you turn 65, you’ll need to sign up. Contact Social Security three months before you turn 65. If you worked for a railroad, contact the Railroad Retirement Board. Note: People on social security disability will automatically be enrolled in their 25th month of disability. HOSPITAL CARE A PART B PART MEDICAL CARE
- 41. Aetna Inc. 41 When can I enroll in Part A & Part B? It’s a seven-month window. It includes the three months before you turn 65, your birthday month and the three months after your 65th birthday. What if I don’t enroll when I am first eligible? You may have to pay a penalty in the form of a higher premium. HOSPITAL CARE A PART B PART MEDICAL CARE
- 42. Aetna Inc. D PART PRESCRIPTION DRUGS C PART MEDICARE ADVANTAGE 42 When can I first enroll in Parts C and D? It’s the same “seven-month window” as Part B: It includes the three months before you turn 65, your birthday month and the three months after your 65th birthday.
- 43. Aetna Inc. D PART PRESCRIPTION DRUGS C PART MEDICARE ADVANTAGE 43 Are there other times I can enroll in Parts C and D? From October 15 to December 7, all people with Medicare can change their health care plans. You can switch to Medicare Advantage during this Open Enrollment period, join a Medicare Prescription Drug Plan or change plans.
- 44. Aetna Inc. D PART PRESCRIPTION DRUGS C PART MEDICARE ADVANTAGE 44 You can also enroll in Parts C and D during a “special enrollment period” for special circumstances such as: Losing your employer coverage Moving to a new service area Being assigned to a Medicare Prescription Drug plan by the government
- 45. Aetna Inc. 45 What if I am late in signing up for Part D? You may face a late enrollment penalty. It increases based on each month that you delay. This can get costly. D PART PRESCRIPTION DRUGS C PART MEDICARE ADVANTAGE
- 46. Aetna Inc. 46 When can I enroll in a Medicare supplement plan? In most states, it’s a six-month window that starts when you turn 65 and enroll in Part B. What if I delay enrollment? You may join any plan. You can’t be denied coverage due to a pre-existing condition if you enroll during open enrollment. You may be denied coverage for a pre-existing condition, if you miss the enrollment period and try to apply later.
- 47. Aetna Inc. Important dates and instructions. Enroll in a Medicare plan during open enrollment October 15 – December 7 Here’s how: www.medicare.gov or call 1-800-MEDICARE TTY 1-877-486-2048, 24 hours a day, 7 days a week
- 49. Aetna Inc. Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits and/or co-payments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, free language assistance services are available. Visit our website at www.aetnamedicare.com or call the phone number listed in this material. ESPAÑOL (SPANISH): ATENCIÓN: Si usted habla español, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web en www.aetnamedicare.com o llame al número de teléfono que se indica en este material. 繁體中文 (CHINESE): 請注意：如果您說中文，您可以獲得免費的語言協助服務。請造訪我們的網站 www.aetnamedicare.com 或致電本材料中所列的電話號碼。 ©2017 Aetna Inc. Notice for Florida: This is a solicitation to sell Aetna Medicare Supplement coverage. Not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. 49 72.25.305.1 NR_0001_6956c 01/2017