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Senior Health Care: Medicare 101 (February 2014)

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Get the facts about the confusing world of Medicare. Invite Erin Hart to speak to your group about Medicare 101.

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Senior Health Care: Medicare 101 (February 2014)

  1. 1. Senior Health Care: Medicare 101 Erin Hart Business Development, American HealthCare Group Email: ehart@american-healthcare.net Ph: (412) 563-7807
  2. 2. HISTORY OF MEDICARE 1965: Medicare (Part A & B) • 1996: Medicare Advantage (Part C) • 2006: Prescription Drug Program (Part D) • 2010: Patient Protection and Affordable Care Act (PPACA) • Centers for Medicare & Medicaid Services (CMS) Erin Hart - ehart@american-healthcare.net - 412-563-7807 • 2
  3. 3. Health Care Reform: Impact on Medicare • • Added coverage for annual physical exams and other preventive services Eventual elimination of donut hole affecting 14%  Brand Name Drugs – 47.5% in donut hole Medicaid • Varies State by State • Expand Medicaid to 133% of the federal poverty level. Erin Hart - ehart@american-healthcare.net - 412-563-7807 Medicare 3
  4. 4. Medicare Considerations 65 years old • Under 65 with certain disabilities – after 24 months • End stage renal disease, Lou Gehrig’s, others • Who Pays First? Medicare as secondary • Medicare Savings Erin Hart - ehart@american-healthcare.net - 412-563-7807 • 4
  5. 5. Parts A & B Part A  Generally free (or up to $441/month)  65+, self/spouse worked 10 years/40 quarters  Hospital/Inpatient care/Home health/hospice/skilled nursing 100 days/year • Part B  2014 - $104.90/month  5% of enrollees pay higher premium – next slide  Physicians/Outpatient care/lab/x-ray/DME Erin Hart - ehart@american-healthcare.net - 412-563-7807 • 5
  6. 6. Medicare Part B Premiums If your yearly income in 2011 was: Filing Individual Return Filling Married Return You pay Old Rates 2012 (Based on 2010 income) $104.90 $99.90 above $85,000 up to above $170,000 up $107,000 to $214,000 $146.90 $139.90 above $107,000 up to $160,000 above $214,000 up to $320,000 $209.80 $199.80 above $160,000 up to $214,000 above $320,000 up to $428,000 $272.70 $259.70 above $214,000 above $428,000 $335.70* $85k or less $170k or less Erin Hart - ehart@american-healthcare.net - 412-563-7807 (in 2013) 6
  7. 7. Coverage Details: Traditional Medicare – 80/20 Hospital Stays 1-60 days $1,216 61-90 days $304/day 91-150 days $608/day 150+ days All Costs SNF $152/day for days 21 – 100 for each benefit period – covered after 3 day hospital stay Medicare Part B $147 deductible, then 20% Erin Hart - ehart@american-healthcare.net - 412-563-7807 Cost Sharing for 2014 7
  8. 8. Part C: Medicare Advantage From private insurers • Medicare Advantage and Medicare Advantage Prescription Drug plans • Live in plan’s service area • Entitled to Part A & enrolled in Part B • Premiums range from $0 – over $250. • Copays for services • Becomes only insurance • Most include RX benefit Erin Hart - ehart@american-healthcare.net - 412-563-7807 • 8
  9. 9. • Services covered that original Medicare doesn’t cover  Lower cost sharing  Vision, Hearing, Dental  Podiatrist & Chiropratic  Gym Membership • Combine benefit coverage for hospitals and doctors • Types: HMO, PPO, SNP, POS • Considerations: Formulary, Network Erin Hart - ehart@american-healthcare.net - 412-563-7807 Part C cont’d… 9
  10. 10.  Prescription Drug Coverage  Available from private insurers  Uses a formulary & tiers  2014 Coverage Gap: $2,970; $4,750 – 28% discount on generic; 52.5% discount on brand name  2014 Base Premium: $32.42 Erin Hart - ehart@american-healthcare.net - 412-563-7807 Part D 10
  11. 11. PACE/PACENET Information Individual Married Percentage of FPL 133% 120% Yearly $14,500 $17,700 Monthly $1,208 $1,470 Income Individual Married Yearly $23,500 $31,500 Monthly $1,958 $2,625 PACE PACENET RX Benefit Premium Benefit $6.00 & $9.00, potentially lower based on income level Covers the premium if RX plan is a partner plan $8.00 & $15.00 No premium benefit Erin Hart - ehart@american-healthcare.net - 412-563-7807 Income 11
  12. 12. Important Dates Timing  Initial enrollment – 3 months before & after 65  October 15 – December 7 in 2014 for January 1, 2015 effective date  January 1 – February 14 – disenrollment  Anytime throughout the year  Dual eligible  Move out of service area  Institutionalized  Lose employer coverage  Low Income Subsidy Erin Hart - ehart@american-healthcare.net - 412-563-7807 • 12
  13. 13. Erin Hart Director, Health Benefit Services American HealthCare Group ehart@american-healthcare.net (412)563-7807 Erin Hart - ehart@american-healthcare.net - 412-563-7807 Contact 13

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