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Medicare preperation presentation final
- 2. Topics When to Apply Medicareand Your State Health Insurance Resources Understanding Medicare
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- 4. What Is Medicare? Healthinsurance for three groups of people • 65 and older • Under 65 with certain disabilities • Any age with End-Stage Renal Disease (ESRD) Administration • Centers for Medicare & Medicaid Services (federal government)
- 5. Four Parts ofMedicare Medical Medicare Advantage Prescription Drug HospitalPART A PART B PART C PART D
- 6. Automatic Enrollment inParts A and B Enrollment automatic for those receiving Social Security
- 7. When Enrollment IsNot Automatic Some people need to sign up • Those not getting Social Security Enroll through Social Security Apply three months before age 65 • Working – Part A only • Retired – Parts A and B
- 8. Your Seven-Month InitialEnrollment Period No Delay Delayed Start If you enroll in Part B 3 months before the month you turn 65 2 months before the month you turn 65 1 month before the month you turn 65 The month you turn 65 1 month after you turn 65 2 months after you turn 65 3 months after you turn 65 Sign up early to avoid a delay in getting coverage for Part B services. To get Part B coverage the month you turn 65, you must sign up during the first three months before the month you turn 65. If you wait until the last four months of your Initial Enrollment Period to sign up for Part B, your start date for coverage will be delayed.
- 9. General Enrollment Period(GEP) January 1 through March 31 each year Coverage effective July 1 May have to pay higher Part A and/or Part B premium for late enrollment
- 10. Enrolling in PartB if You’re Still Employed May want to delay enrolling in Part B if • You have health coverage through your or your spouse’s current employment 90 days before your employment or coverage ends • Enroll in Part B through Social Security without a penalty
- 11. Paying the PartB Premium Deducted monthly from • Social Security payments If not deducted • Billed every three months • Medicare Easy Pay to deduct from bank account Contact SSA about premiums
- 12. Monthly Part BPremium If Your Yearly Income in 2012 Was … In 2014 You Pay Individual Tax Return Joint Tax Return $85,000 or less $170,000 or less $104.90 $85,001–$107,000 $170,001–$214,000 $146.90 $107,001–$160,000 $214,001–$320,000 $209.80 $160,001–$214,000 $320,001–$428,000 $272.70 above $214,000 above $428,000 $335.70
- 13. Medicare and YourState Health Insurance
- 14. How Will MyHealth Coverage Change? Once on Medicare Part A and B, you will automatically be enrolled in the HealthSelect Medicare AdvantageSM plan • Administered by Humana • Lowers monthly insurance premiums • Allows participants to see any doctor who accepts Medicare
- 15. HealthSelect Medicare Advantage Providescomparable or better coverage than your current coverage You may continue to see your current providers as long as they accept Medicare
- 16. Extra Services andPrograms Humana Guidance Centers Well Dine Vision and hearing aid allowances SilverSneakers® In Home Health Assessments ERS cannot and does not guarantee the length of time that a specific type of “value-added” product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. HumanaFirst® Nurse Advice Line
- 17. Extra Services andPrograms
- 18. How Do IEnroll? If you are enrolled in Medicare Parts A and B you will • automatically be enrolled in HealthSelect Medicare Advantage, and • receive a Welcome Kit from Humana. You may opt in and out of your health plan anytime throughout the plan year.
- 19. Split Households Coverage fordependents remains the same when you are eligible for Medicare and they are not. If a dependent becomes eligible for Medicare before you, your coverage remains the same and your dependent will be enrolled in HealthSelect Medicare Advantage.
- 20. KelseyCare Advantage KelseyCare • MedicareAdvantage HMO • available to members in the Houston area KelseyCare Advantage received a five-star rating from Medicare
- 21. Extra Services andPrograms ERS cannot and does not guarantee the length of time that a specific type of “value- added” product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Free transportation to medical appointments Vision and hearing aid allowances • $150 coverage toward the purchase of eye wear through contracted providers • $1,500 coverage every two years toward the purchase of hearing aids YMCA Services in Houston • No joining fee • First full month is free • 10% off all programs
- 22. HealthSelect Secondary Providers fileclaims on your behalf • Medicare • UnitedHealthcare See any doctor who accepts Medicare $200 annual deductible
- 23. Extra Services andPrograms Wellness coaching and disease management ERS cannot and does not guarantee the length of time that a specific type of “value-added” product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. myHealthCare Cost Estimator Health4meTM App
- 24. Community First HealthPlans Available in the San Antonio area Must have a primary care physician (PCP) who accepts Medicare
- 25. Extra Services andPrograms Prescription medication discount card • for any family members who do not have pharmacy benefit ERS cannot and does not guarantee the length of time that a specific type of “value-added” product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Enhanced vision benefit Enhanced travel network Health risk assessment and wellness programs
- 26. Scott & WhiteHealth Plans Available in Central Texas Three new counties: Austin, Free stone, and Waller
- 27. Extra Service andPrograms ERS cannot and does not guarantee the length of time that a specific type of “value-added” product shall be offered. Any questions or concerns about these products should be directed to the plan administrator. Diabetes Day Vitality Coordinator Member Promise VitalBridges VitalCare
- 28. Prescription Drug Coverage HealthSelectMedicare Rx is a prescription drug program for Medicare retirees in HealthSelect Secondary and HealthSelect Medicare Advantage. The program saves plan money without raising your costs or changing your coverage from the previous plan. SilverScript manages the plan. Deductibles and copays are reviewed by ERS Board annually, and may change based on program funding. Drug formulary is reviewed by SilverScript periodically.
- 29. Prescription Drug Coverage PrescriptionDrug Program (PDP) Provides necessary medication at the lowest possible cost to you and the plan $50 per plan year, per person deductible • Applies to all health plans’ retail and mail service prescriptions Benefits and coverage are identical for employees and retirees
- 30. Income-Related Monthly Adjustment Amount(IRMAA) If Your Yearly Income in 2012 Was … In 2014 You Pay Individual Tax Return Joint Tax Return $85,000 or less $170,000 or less Your Plan Premium (YPP) $85,000.01 – $107,000 $170,000.01 – $214,000 YPP + $12.10* $107,000.01 – $160,000 $214,000.01 – $320,000 YPP + $31.10* $160,000.01 – $214,000 $320,000.01 – $428,000 YPP + $50.20* Above $214,000 Above $428,000 YPP + $69.30* *per month
- 31. Extra Help withDrug Plan Costs Everyone else must apply Social Security or state makes determination Some groups automatically qualify • People with Medicare and Medicaid • Those who get Supplemental Security Income (SSI) only • Those with QMB, SLMB, or QI • Some with QDWI
- 32. Applying for ExtraHelp Multiple ways to apply • Fill out a paper application • On the web at socialsecurity.gov • Through your state Medicaid office • Through a local organization, such as a HICAP You or someone on your behalf can apply
- 33. Annual Enrollment Period Medicare-eligible ERSretirees have a fall enrollment period.
- 34.
- 35. Social Security Administration 800-772-1213 (TTY:800-325-0778) www.socialsecurity.gov Medicare 800-MEDICARE (800-633-4227) www.medicare.gov Resources
- 36. Resources—Email Updates Be thefirst to know Sign up for our Digital Subscription Service
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Editor's Notes
- #5 Medicare is health insurance for three groups of people:Those who are age 65 (Active employees who are 65 can wait to take Part B until retirement),People under age 65 with certain disabilities, or People of any age who have End-Stage Renal Disease (ESRD - permanent kidney failure requiring dialysis or a transplant).The Centers for Medicare & Medicaid Services administers the Medicare program.
- #6 Medicare has four parts:Part A (Hospital Insurance) helps pay for inpatient hospital stays,skilled nursing care, home health care, and hospice care. Part B(Medical Insurance) helps cover medically-necessary services like doctor visits and outpatient care. Part B also covers some preventive services including screening tests and shots, diagnostic tests, some therapies, and durable medical equipment like wheelchairs and walkers.Part C (Medicare Advantage) is another way to get your Medicare benefits. Itcombines Parts A and B. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. Part D (Medicare Prescription Drug Coverage) helps pay for outpatient prescription drugs,may help lower your prescription drug costs and protect against higher costs in the future.
- #7 In most cases, if you’re already getting benefits from Social Security,you will automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. If you’re under 65 and disabled, you automatically get Part A and Part B, after you get disability benefits from Social Security or certain disability benefits from the RRB, for 24 months. Members who are still working through their 65th birthday, will receive a questionnaire from Medicare asking if they are still working. You should reply that you are. Three months prior to retiring, youshould contact SSA to signing up for Medicare. This is a sample Medicare card. The Medicare card shows the Medicare coverage (Part A hospital coverage and/or Part B medical coverage) and the date the coverage starts. Note: Your card may look slightly different from this one; it’s still valid.
- #8 If you aren’t getting Social Security,for instance, because you are still working, you need to sign up for Part A, NOT B. You should contact Social Security 3 months before you turn age 65. People who are retired and 65, should sign up for both Part A and Part B.While Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), the Social Security Administration (SSA) is responsible for enrolling most people in Medicare. Social Security advises people to apply for Medicare benefits 3 months before age 65. You do not have to be retired to get Medicare Part A. The full retirement age for Social Security retirement benefits is now 66 (for persons born between 1943 and 1954) and will gradually increase to 67 for persons born in 1960 or later; but, you can still receive full Medicare benefits at age 65.
- #9 If you are not automatically enrolled, you can choose to sign up for Part B during your Initial Enrollment Period (IEP).You can sign up for Part B any time during a 7-month IEP which begins 3 months before the month you become eligible for Medicare. You can choose whether or not to enroll in Part B. If you enroll, you pay a monthly premium for Medicare Part B. Sign up during the first 3 months of your IEP to get your Part B coverage effective the month you turn 65. However, if your birthday is the first day of the month, your coverage will start the first day of the prior month.If you wait to sign up until the last four months of your IEP, your Part B start date will be delayed. NOTE: If your date of birth is the first of the month, your effective date moves to the first of the month before your month of birth, if you apply within the first 2 months of your IEP.
- #10 If you are not working and you don’t take Part B when first eligible, you may have to wait to sign up during the annual General Enrollment Period (GEP), which runs from January 1 through March 31 of each year. Your coverage will be effective July 1 of that year. If you are not working and you don’t take Part B when you are first eligible, you will have to pay a premium penalty of 10% for each full 12-month period you could have had Part B but didn’t sign up for it, except in special situations. In most cases, you will have to pay this penalty for as long as you have Part B.
- #11 Special enrollment period rules do not apply if employment or employer-provided group health plan coverage ends during your initial enrollment period.You may want to delay enrolling in Part B if you have health coverage through you or your spouse’s current employment. Enroll in Part B through Social Security without a penalty. You have 8 months from the date you lose your employer coverage to enroll in Part B without a penalty.
- #16 This plan offers comparable coverage to HealthSelect secondary, administered by UHC or a GBP HMO, while lowering costs for you and the State. It’s important you contact your doctor and make sure they accept Medicare and are willing to bill Humana. If they don’t, you will have to pay for services up front and submit a claim to Humana for reimbursement.
- #17 Well Dine - After an overnight stay in the hospital or nursing facility, you are eligible for ten nutritious, precooked frozen meals delivered to your home at no cost to you. Vision and hearing aid allowances - $500 benefit toward hearing aids per ear, every three years. Access to 40,000 national providers in 20,000 locations with discounts on exams, frames, lenses, contacts, and more.SilverSneakers® - Complimentary gym membership at participating locations nationwide.HumanaFirst® Nurse Advice Line - A toll-free, 24 hour-a-day health information line. In home Health and Wellbeing Assessments – In home health evaluationsHumana Guidance Centers – Humana has Guidance Centers in Austin, San Antonio, Dallas, and Houston. These centers are open to the public and host a number of free activities and events. You can also stop in and talk with a representative one-on-one about your plan.
- #19 As long as you are enrolled in Medicare Part A and Part B, you and your dependents enrolled in Medicare will automatically be enrolled in HealthSelect Medicare Advantage. You will receive a Welcome Kit from Humana that provides information on your enrollment date. If after reviewing the information you decide you would like to stay in your current plan at your current premium rate, you’ll need to sign in to your online account at www.ers.state.tx.us or call ERS to update your Medicare options at (877) 275-4377. If you have already opted out of the HealthSelect Medicare Advantage Plan, you don’t have to do this again.Retirees eligible for Medicare may switch in and out of their current health plan anytime throughout the plan year.
- #21 KelseyCare Advantage is a Medicare Advantage HMO available to members living in the Houston area and includes Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Waller Counties. You must live in one of these counties to enroll in the plan and you have to see providers in the KelseyCare network.KelseyCare Advantage has recently received the coveted five-star rating from Medicare, which is Medicare’s highest ranking for excellence in quality of healthcare and service to our members. Very few Medicare Advantage plans achieve this level of excellence.
- #22 KelseyCare Advantage offers free transportation to medical appointments:20 one-way trips to medical appointments per year,Convenient scheduling over the phone,Wheelchair-friendly vehicles available, when needed, andCourteous drivers who are committed to getting you to your appointment safely and on timeKelseyCare Advantage also offers a $150 coverage limit toward the purchase of eye wear through contracted providers. This benefit provides coverage for glasses and/or contact lenses every two years. For the 2014 Plan Year, the plan has added a $1,500 plan coverage limit every two years toward the purchase of hearing aids.Through the KelseyCare Advantage membership, you will have access to a host of services at YMCA locations throughout the Houston area – at a significant savings.Advantages include:Pay no joining fee - a savings of up to $100, First full month is free,Choose between a Citywide Membership or Center-only Membership, andReceive 10% off all programs, like massage therapy, Pilates classes, and personal training.Free services included in KelseyCare Advantage YMCA Membership:A wide variety of group exercise classes such as water exercise and multiple ability-based classes focused on seniors,State-of-the-art strength and cardio equipment,Personalized nutrition counseling,Physical training, Healthy Living programs including nutritional seminars and diabetes prevention, andSocial clubs and activities for seniors.Grandchildren under the age of 17 residing in the same household are free and get 10% off all programs and classes. Grandchildren under the age of 17 not living in the same household may be added to the membership as a student. Go to ymcahouston.org for more information about the YMCA.KelseyCare Advantage Members may call (713) 442-YMCA to learn more about signing up for this membership.
- #23 You have a $200 deductible to meet with HealthSelect Secondary that runs concurrently with your Medicare deductible. You can see any provider that accepts Medicareand will bill UnitedHealthcare. Providers who accept both Medicare and UnitedHealthcare file the claims on your behalf. If you see a provider that does not accept UnitedHealthcare, they are not obligated to file claims.
- #24 UHC has a new tool for you to use called the myHealthcare Cost Estimator. You can access this tool through your online personal account. The cost estimator not only lets you search for providers but also helps you compare prices between providers and estimate what your out-of-pocket expenses will be for a specific service or procedure. As seen in the example here, the estimate provides you with information like the estimated duration of your treatment, the average total cost based on your geographic area, what HealthSelect will pay your provider and your out-of-pocket costs. You can also search for providers at a specific level so you can find the provider who meets your needs. If you have a smartphone, we encourage you to download the Health4me app which provides you with healthcare services on the go. With the Health4me app you can search for network providers and facilities based on your current location. You can get your member ID number, view your claims information, contact the myNurseLineSM 24/7 and estimate your healthcare costs using the myHealthcare cost estimator. The app is available for both iPhone and Android devices. There are different ways that you can engage in your health and get help from experienced professionals to achieve your wellness goals. You can take advantage of these programs either by phone or online. There are different areas that you can focus on, such as diabetes management, losing weight, if you want to quit smoking, and more. If you are interested in any of these programs, log in to your personal account, contact the myNurseLine, or call the customer service team.
- #26 Enhance Vision BenefitThrough an agreement with OptiCare, your vision benefit includes, in addition to the exam, the following:Lenses (single, bifocal, trifocal, and lenticular), $125 allowance on frames, $125 allowance for fitting and contact lenses in lieu of glasses, as well asA 15% discount on LASIK at LasikPlus. Emergency and urgent care medical services across the nation through the First Health NetworkMembers get an Enhanced Travel Network. You and your covered family members have the option to see a First Health network provider in an urgent or emergency care situation while traveling outside of the Community First HMO service area. If you are in need of urgent or emergency care while you are traveling outside of the service area, you may contact First Health at (800) 226-5116 to locate a provider. Prescription medication discount card for any family memberThe prescription medication discount card allows anyone in your family who does not have health care coverage, to get discounted prescriptions at participating pharmacies. The discounts range from 20% to 40%, depending on the medication. Health Risk Assessment and Wellness ProgramsAn online health risk assessment is available through CFHP’s partnership with Purewellness. The Preventive Health Unit has programs that focus on improving your health through education toward choosing healthy lifestyles. This includes a youth obesity program for children between the ages of 8-17; adult healthy lifestyle program; and mailed reminders to women who are overdue for mammograms and reminders for pap smears, beginning at age 19.
- #28 VitalCare - Health Education Audio Reference (HEAR) Library, Shared Decision Making, 24-hour Nurse Advise Line available toll-free at (877) 505-7949.VitalCare - Succeed online Health Risk Assessment (HRA) Vitality Coordinator - reviews members’ charts to double check what measures still need to be done. Add missing lab tests, do immunizations, identify and arrange for referrals.Diabetes Day – Free screenings once a quarter at Scott & White Hospitals. Includeseye exam, podiatric foot exam including vascular check, blood and urine work, weight/body mass index (BMI), and blood pressure.VitalBridges - Follows up with a member 2-4 days after discharge from hospital,skilled nursing facility or long-term care hospital. Identifies basic post hospitalization needs for an uncomplicated recovery.Member Promise – We will help you get an appointment when you need to be seen. If you are having difficulty getting an appointment to see one of our participating providers, please call us. Our new personalized service will get you an appointment to see a provider when you need to be seen. Call the toll-free number, (800) 321-7947.
- #29 HealthSelect Medicare Rx started January 1, 2013.This is the retiree prescription drug program for GBP members in HealthSelect secondary, HealthSelect Medicare Advantage, and KelseyCare Advantage. Retirees in Scott and White and Community First HMOs continue in those HMO drug plans.ERS automatically enrolls all Medicare-enrolled retirees and Medicare-enrolled dependents in Part D coverage. SilverScript Insurance Company, a wholly owned subsidiary of your current Pharmacy Benefits Manager, Caremark, manages the plan.
- #31 Some people will have a premium for Part D coverage. You pay only your plan premium if your yearly income in 2011 was $85,000 or less for an individual or $170,000 or less for a couple.You pay your plan premium plusan extra amount, based on your yearly income, if your yearly income in 2010 was higher than $85,000 for an individual or $170,000 for a couple. The amount of the IRMAA is adjusted each year, as it is calculated from the annual beneficiary base premium.You pay your Part D premium directly to SSA.
- #34 Annual Enrollment is the time when members of the Texas Employees Group Benefits Program (GBP) can make changes to their insurance benefits, such as adding an eligible dependent to their coverage. If you’re eligible for Medicare, Annual Enrollment for you and your dependents will take place in the fall instead of summer. You will receive your Annual Enrollment packet about a week before Annual Enrollment begins.
- #37 You can have news sent directly to youWant to keep up to date on benefits news? Sign up for the ERS digital subscription service. On www.ers.state.tx.us, click the green envelope next to “Sign Up for ERS Email Updates”. Subscribe to the topics you’re interested in. An invitation email will be sent to the address you provided. You must confirm within 48 hours, or you will need to repeat the subscription process.After you sign up, you’ll get an email whenever new information is posted on the ERS website. From the “ERS Subscription Management” page, you can manage your preferences and delivery methods, add topics to your subscription, or stop subscriptions. If you accidently delete an email or want to review past emails, you can view the last 30 days of emails from the “ERS Subscription Management” page, under “Subscription Updates”.
- #38 ERS on YouTube:www.youtube.com/ersoftexasERS on Facebook: www.facebook.com/ersoftexas