Senior Health Care: Medicare 101 (February 2014)

Senior Health Care: Medicare 101Erin Hart

Business Development, American HealthCare Group

Email: ehart@american-healthcare.net

Ph: (412) 563-7807

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)

Health Care Reform: Impact on MedicareMedicare

• 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.

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

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

Medicare Part B Premiums

If your yearly income in 2011 was:

Filing Individual Return

Filling Married Return

You pay (in 2013)

Old Rates 2012

(Based on 2010 income)

$85k or less $170k or less $104.90 $99.90

above $85,000 up to $107,000

above $170,000 up 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*

Coverage Details: Traditional Medicare – 80/20Cost Sharing for 2014

Hospital Stays

1-60 days $1,216

61-90 days $304/day

91-150 days $608/day

150+ days All Costs

$152/day for days 21 – 100 for each benefit period – covered after 3 day hospital stay

Medicare Part B

$147 deductible, then 20%

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

Part C cont’d…

• 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

Part D 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

PACE/PACENET InformationIncome 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$6.00 & $9.00, potentially lower based on income level

$8.00 & $15.00

Premium BenefitCovers the premium if RX plan is a partner plan

No premium benefit

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

ContactErin HartDirector, Health Benefit Services

American HealthCare Group

ehart@american-healthcare.net

(412)563-7807

Senior Health Care: Medicare 101 (February 2014)

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