Understanding Your Medicare   ~  Benefits and Options  ~ Prepared by the North Central Area Agency on Aging (860) 724–6443...
What is Medicare? <ul><li>Free health insurance for anyone over 65 </li></ul><ul><li>Retirement insurance that covers all ...
What is Medicare? <ul><li>Modeled after private health insurance, Medicare covers  some  of the cost of  some  health care...
Who is eligible for Medicare? <ul><li>Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefit...
Who’s Eligible? <ul><li>Individuals aged 65 years  and  eligible for Social Security or Railroad Retirement benefits </li>...
A person turning 65 has  7 full months to enroll in Medicare? <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
Medicare Enrollment Periods <ul><li>Initial Enrollment Period  – 7 months, beginning 3 months before month of 65 th  birth...
65 and Still Working? <ul><li>If you continue working after 65, you may chose to delay enrollment in Medicare Part B witho...
Special Enrollment Period (SEP) <ul><ul><li>For actively working elderly or disabled </li></ul></ul><ul><ul><ul><li>begins...
Traditional Medicare <ul><li>Created in 1965 consisting of 2 parts: </li></ul><ul><ul><ul><li>Medicare A – Hospital  </li>...
Medicare Part A Covers… <ul><li>Inpatient Hospital Care </li></ul><ul><li>Skilled Nursing Facility Care </li></ul><ul><li>...
Traditional Medicare Costs <ul><li>Part A   </li></ul><ul><li>- No monthly premium if you have 40+ quarters of work </li><...
Medicare Part B Covers… <ul><li>Physicians Services </li></ul><ul><li>Home Health Care </li></ul><ul><li>Outpatient Servic...
Medicare Part B Covers… <ul><li>Certain Preventative Services  </li></ul><ul><ul><ul><li>One physical exam when 1 st  enro...
Medicare Part B Services… <ul><li>Are free and cover 100% of care </li></ul><ul><li>Have a monthly premium, annual deducti...
Traditional Medicare Costs <ul><li>Part B   </li></ul><ul><li>- Annual deductible $135 </li></ul><ul><li>- Monthly premium...
Help with Medicare related Expenses <ul><li>There are Federal and State Programs available for beneficiaries with limited ...
Medicare Supplement Insurance <ul><li>There are Supplement insurance plans available to offset some of the costs related t...
Once you select the letter plan you want, the company selling it for the highest monthly premium offers the best coverage ...
Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? <ul><li>Once a y...
Medicare Part D <ul><li>In 2006 Medicare Part D was created to provide beneficiaries with prescription drug coverage </li>...
A beneficiary must have Medicare A  and  B in order to be eligible for Medicare Part D <ul><li>TRUE </li></ul><ul><li>FALS...
When can a beneficiary make changes to their Medicare Prescription Drug Plan? <ul><li>At any time </li></ul><ul><li>Only d...
Traditional Medicare Costs <ul><li>Part D   </li></ul><ul><li>Because benefits are provided by  private  insurance plans, ...
Paying for Part D <ul><li>There are also programs that help pay for the cost of Medicare Part D plans </li></ul><ul><ul><u...
Options in Receiving Your Medicare Benefits <ul><li>Beneficiaries have the option to enroll in “Traditional Medicare” (par...
What is Medicare Part C? <ul><li>Medicare Part C, or  Medicare Advantage  Plans, are private insurance companies that cont...
If you enroll in a Medicare Advantage Plan you no longer have Medicare <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answ...
Medicare Advantage <ul><li>Generally Medicare Advantage Plans require patients to get their health care services from cert...
Medicare Advantage continued… <ul><li>Most Medicare Advantage Plans offer Prescription Drug coverage as well </li></ul><ul...
If enrolled in an Advantage Plan do you still have to pay Medicare B premiums? <ul><li>No, you only pay the Advantage Plan...
Medicare Advantage continued… <ul><li>Caution is needed if/when selecting a Medicare Advantage Plan </li></ul><ul><ul><ul>...
Ready to test your Medicare knowledge? <ul><li>Get your buttons ready as we review what we’ve learned today! </li></ul>
What is Medicare? <ul><li>Free health insurance for anyone over 65 </li></ul><ul><li>Retirement insurance that covers all ...
Who is eligible for Medicare? <ul><li>Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefit...
A person turning 65 has  7 full months to enroll in Medicare? <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
Medicare Part B Services… <ul><li>Are free and cover 100% of care </li></ul><ul><li>Have a monthly premium, annual deducti...
Once you select the letter plan you want, the company selling it for the highest monthly premium offers the best coverage ...
Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? <ul><li>Once a y...
A beneficiary must have Medicare A  and  B in order to be eligible for Medicare Part D <ul><li>TRUE </li></ul><ul><li>FALS...
When can a beneficiary make changes to their Medicare Prescription Drug Plan? <ul><li>At any time </li></ul><ul><li>Only d...
If you enroll in a Medicare Advantage Plan you no longer have Medicare <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answ...
If enrolled in an Advantage Plan do you still have to pay Medicare B premiums? <ul><li>No, you only pay the Advantage Plan...
CHOICES is Here to Help <ul><li>As the State Health Insurance Assistance Program for Connecticut, CHOICES provides  Free  ...
Helpful Resources <ul><li>Medicare 1-800-MEDICARE (1800-633-4227) </li></ul><ul><li>www.medicare.gov </li></ul><ul><li>CHO...
Upcoming SlideShare
Loading in …5
×

Understanding your Medicare - North Central CT AAA

1,066 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,066
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
13
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Understanding your Medicare - North Central CT AAA

  1. 1. Understanding Your Medicare ~ Benefits and Options ~ Prepared by the North Central Area Agency on Aging (860) 724–6443 / 1(800) 994-9422
  2. 2. What is Medicare? <ul><li>Free health insurance for anyone over 65 </li></ul><ul><li>Retirement insurance that covers all healthcare needs </li></ul><ul><li>Insurance for eligible individuals that provides some health care coverage for some healthcare services </li></ul>9
  3. 3. What is Medicare? <ul><li>Modeled after private health insurance, Medicare covers some of the cost of some health care </li></ul><ul><li>Generally, Medicare coverage is available for health care services that are considered “medically reasonable and necessary for treatment or diagnosis of illness or injury” </li></ul>
  4. 4. Who is eligible for Medicare? <ul><li>Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits </li></ul><ul><li>Individuals who’ve received Social Security Disability for 24 months </li></ul><ul><li>Individuals with End Stage Renal Disease or ALS </li></ul><ul><li>All of the above </li></ul>0
  5. 5. Who’s Eligible? <ul><li>Individuals aged 65 years and eligible for Social Security or Railroad Retirement benefits </li></ul><ul><li>Individuals who have received Social Security Disability for 24 months </li></ul><ul><li>If you have End Stage Renal Disease (ESRD) or ALS, you may be eligible without waiting 24 months </li></ul>
  6. 6. A person turning 65 has 7 full months to enroll in Medicare? <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  7. 7. Medicare Enrollment Periods <ul><li>Initial Enrollment Period – 7 months, beginning 3 months before month of 65 th birthday and ending 3 months. </li></ul><ul><li>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. </li></ul>
  8. 8. 65 and Still Working? <ul><li>If you continue working after 65, you may chose to delay enrollment in Medicare Part B without penalty. </li></ul><ul><ul><ul><li>20 or more employees – Employer insurance is primary </li></ul></ul></ul><ul><ul><ul><li>Less than 20 employees – Employer regulations may require that your Medicare be primary insurance </li></ul></ul></ul><ul><ul><ul><li>Once you retire and stop active employment, Medicare becomes primary insurance </li></ul></ul></ul>
  9. 9. Special Enrollment Period (SEP) <ul><ul><li>For actively working elderly or disabled </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul><ul><ul><li>For disabled individuals previously covered by “large group health plan” (+100employees) </li></ul></ul><ul><ul><ul><li>Same 8 month SEP as above, but the coverage ending is that from a family members active employment . </li></ul></ul></ul>
  10. 10. Traditional Medicare <ul><li>Created in 1965 consisting of 2 parts: </li></ul><ul><ul><ul><li>Medicare A – Hospital </li></ul></ul></ul><ul><ul><ul><li>Medicare B – Medical </li></ul></ul></ul><ul><li>People in traditional Medicare can receive their health care from any provider certified by Medicare </li></ul>
  11. 11. Medicare Part A Covers… <ul><li>Inpatient Hospital Care </li></ul><ul><li>Skilled Nursing Facility Care </li></ul><ul><li>Home Health Care </li></ul><ul><li>Hospice Care </li></ul>
  12. 12. Traditional Medicare Costs <ul><li>Part A </li></ul><ul><li>- No monthly premium if you have 40+ quarters of work </li></ul><ul><li>- You can buy-in to Medicare A if you’ve worked less than 40 </li></ul><ul><li>quarters </li></ul><ul><li>- associated deductibles and co-insurances </li></ul>$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. 13. Medicare Part B Covers… <ul><li>Physicians Services </li></ul><ul><li>Home Health Care </li></ul><ul><li>Outpatient Services and Therapy </li></ul><ul><li>Durable Medical Equipment </li></ul><ul><li>Prosthetic Devices </li></ul><ul><li>Ambulance Services </li></ul><ul><ul><li>And… </li></ul></ul>
  14. 14. Medicare Part B Covers… <ul><li>Certain Preventative Services </li></ul><ul><ul><ul><li>One physical exam when 1 st enrolled in Part B </li></ul></ul></ul><ul><ul><ul><li>Flu, Pneumococcal, Hepatitis B vaccines </li></ul></ul></ul><ul><ul><ul><li>Annual Mammograms </li></ul></ul></ul><ul><ul><ul><li>Some pap smear and pelvic exams </li></ul></ul></ul><ul><ul><ul><li>Colorectal Screenings </li></ul></ul></ul><ul><ul><ul><li>Diabetes Self-Management Training/Tests </li></ul></ul></ul><ul><ul><ul><li>Bone Mass Measurements </li></ul></ul></ul><ul><ul><ul><li>Prostate Cancer Screening </li></ul></ul></ul><ul><ul><ul><li>Some Glaucoma Screening </li></ul></ul></ul><ul><ul><ul><li>Some Medical Nutrition Therapy Services </li></ul></ul></ul><ul><ul><ul><li>Some Cardio-vascular tests </li></ul></ul></ul>
  15. 15. Medicare Part B Services… <ul><li>Are free and cover 100% of care </li></ul><ul><li>Have a monthly premium, annual deductible, cover 80% of the cost of care and have a 20% co-insurance for the beneficiary </li></ul><ul><li>Have a monthly premium and cover 80% of the cost of care and is then considered paid in full by the doctor </li></ul>0
  16. 16. Traditional Medicare Costs <ul><li>Part B </li></ul><ul><li>- Annual deductible $135 </li></ul><ul><li>- Monthly premium of $96.40 (or higher </li></ul><ul><li>depending on your income) </li></ul><ul><li>- Generally, Medicare pays for 80% of the </li></ul><ul><li> approved Medicare rate of service and the </li></ul><ul><li>beneficiary is responsible for the remaining 20% </li></ul>
  17. 17. Help with Medicare related Expenses <ul><li>There are Federal and State Programs available for beneficiaries with limited incomes </li></ul><ul><ul><li>Medicare Savings Programs (QMB/SLMB/ALMB) </li></ul></ul><ul><ul><ul><li>Income guidelines are: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Single: $1,497.05/month (2009 limit) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Couple: $2,196.25/month (2009 limit) </li></ul></ul></ul></ul></ul>
  18. 18. Medicare Supplement Insurance <ul><li>There are Supplement insurance plans available to offset some of the costs related to traditional Medicare </li></ul><ul><li>Medicare Supplement plans (Medigap policies) are standardized in Connecticut and overseen by the Department of Insurance </li></ul><ul><li>Plans range in cost and coverage options depending on the level of coverage you choose </li></ul>
  19. 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 <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  20. 20. Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? <ul><li>Once a year </li></ul><ul><li>Once a month </li></ul><ul><li>Only during the general enrollment period (Jan-March) </li></ul>0
  21. 21. Medicare Part D <ul><li>In 2006 Medicare Part D was created to provide beneficiaries with prescription drug coverage </li></ul><ul><li>Part D provides coverage of certain medications through a variety of private insurance plans </li></ul>
  22. 22. A beneficiary must have Medicare A and B in order to be eligible for Medicare Part D <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  23. 23. When can a beneficiary make changes to their Medicare Prescription Drug Plan? <ul><li>At any time </li></ul><ul><li>Only during the Open Enrollment Period (Nov 15 –Dec 31) or if they qualify for a Special Enrollment Period </li></ul><ul><li>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 </li></ul>9
  24. 24. Traditional Medicare Costs <ul><li>Part D </li></ul><ul><li>Because benefits are provided by private insurance plans, all related costs vary by plan </li></ul><ul><ul><ul><li>Monthly premiums range from $19.40 to $111.40 </li></ul></ul></ul><ul><ul><ul><li>Deductible of up to $295/year </li></ul></ul></ul><ul><ul><ul><li>Co-payments and co-insurances </li></ul></ul></ul><ul><li>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. </li></ul>
  25. 25. Paying for Part D <ul><li>There are also programs that help pay for the cost of Medicare Part D plans </li></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Income Guidelines (2009) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Single: $2,092/month </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Couple: $2,817/month </li></ul></ul></ul></ul></ul><ul><ul><ul><li>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) </li></ul></ul></ul>
  26. 26. Options in Receiving Your Medicare Benefits <ul><li>Beneficiaries have the option to enroll in “Traditional Medicare” (parts A, B, and D), or to go with a Medicare Part C plan instead </li></ul>
  27. 27. What is Medicare Part C? <ul><li>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 </li></ul><ul><ul><li>Health Maintenance Organizations (HMOs) </li></ul></ul><ul><ul><li>Preferred Provider Organizations (PPOs) </li></ul></ul><ul><ul><li>Private Fee For Service (PFFS) </li></ul></ul><ul><ul><li>Special Needs Plans (SNPs) </li></ul></ul>
  28. 28. If you enroll in a Medicare Advantage Plan you no longer have Medicare <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  29. 29. Medicare Advantage <ul><li>Generally Medicare Advantage Plans require patients to get their health care services from certain providers in their network </li></ul><ul><li>In return these plans may offer additional benefits that are not offered in traditional Medicare and reduced premiums </li></ul><ul><ul><ul><li>Extra Days in the hospital </li></ul></ul></ul><ul><ul><ul><li>Preventative Care </li></ul></ul></ul><ul><ul><ul><li>Dental or Eye Coverage </li></ul></ul></ul>
  30. 30. Medicare Advantage continued… <ul><li>Most Medicare Advantage Plans offer Prescription Drug coverage as well </li></ul><ul><li>If you enroll in a Medicare Advantage Plan without drug coverage, you can not get a stand alone drug plan through Traditional Medicare </li></ul>
  31. 31. If enrolled in an Advantage Plan do you still have to pay Medicare B premiums? <ul><li>No, you only pay the Advantage Plan premium </li></ul><ul><li>Yes, you pay the Medicare B premium and the Advantage Plan premium separately </li></ul><ul><li>Yes, but the Medicare Part B premium is included in the Advantage Plan premium you pay each month </li></ul>15
  32. 32. Medicare Advantage continued… <ul><li>Caution is needed if/when selecting a Medicare Advantage Plan </li></ul><ul><ul><ul><li>Plans available are based on geographical location </li></ul></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><ul><ul><li>May need to get referrals as deemed medically appropriate for coverage with a specialist </li></ul></ul></ul>
  33. 33. Ready to test your Medicare knowledge? <ul><li>Get your buttons ready as we review what we’ve learned today! </li></ul>
  34. 34. What is Medicare? <ul><li>Free health insurance for anyone over 65 </li></ul><ul><li>Retirement insurance that covers all healthcare needs </li></ul><ul><li>Insurance for eligible individuals that provides some health care coverage for some healthcare services </li></ul>0
  35. 35. Who is eligible for Medicare? <ul><li>Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits </li></ul><ul><li>Individuals who’ve received Social Security Disability for 24 months </li></ul><ul><li>Individuals with End Stage Renal Disease or ALS </li></ul><ul><li>All of the above </li></ul>0
  36. 36. A person turning 65 has 7 full months to enroll in Medicare? <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  37. 37. Medicare Part B Services… <ul><li>Are free and cover 100% of care </li></ul><ul><li>Have a monthly premium, annual deductible, cover 80% of the cost of care and have a 20% co-insurance for the beneficiary </li></ul><ul><li>Have a monthly premium and cover 80% of the cost of care and is then considered paid in full by the doctor </li></ul>1
  38. 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 <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  39. 39. Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection? <ul><li>Once a year </li></ul><ul><li>Once a month </li></ul><ul><li>Only during the general enrollment period (Jan-March) </li></ul>0
  40. 40. A beneficiary must have Medicare A and B in order to be eligible for Medicare Part D <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  41. 41. When can a beneficiary make changes to their Medicare Prescription Drug Plan? <ul><li>At any time </li></ul><ul><li>Only during the Open Enrollment Period (Nov 15 –Dec 31) or if they qualify for a Special Enrollment Period </li></ul><ul><li>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 </li></ul>0
  42. 42. If you enroll in a Medicare Advantage Plan you no longer have Medicare <ul><li>TRUE </li></ul><ul><li>FALSE </li></ul>Answer Now
  43. 43. If enrolled in an Advantage Plan do you still have to pay Medicare B premiums? <ul><li>No, you only pay the Advantage Plan premium </li></ul><ul><li>Yes, you pay the Medicare B premium and the Advantage Plan premium separately </li></ul><ul><li>Yes, but the Medicare Part B premium is included in the Advantage Plan premium you pay each month </li></ul>0
  44. 44. CHOICES is Here to Help <ul><li>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 </li></ul><ul><li>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 - </li></ul><ul><li>1-800-994-9422 </li></ul>
  45. 45. Helpful Resources <ul><li>Medicare 1-800-MEDICARE (1800-633-4227) </li></ul><ul><li>www.medicare.gov </li></ul><ul><li>CHOICES Program 1-800-994-9422 </li></ul><ul><li>CMA www.medicareadvocacy.org </li></ul><ul><li>BenefitsCheckUp www.benefitscheckup.org </li></ul><ul><li>Infoline (211) www.infoline.org </li></ul>

×