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

1. Senior Health Care:
Medicare 101
Erin Hart
Business Development, American HealthCare Group
Email: ehart@american-healthcare.net
Ph: (412) 563-7807

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
•
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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
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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
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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
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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)
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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
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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
•
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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…
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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
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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
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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
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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
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