1.Understanding Your Medicare ~Benefits and Options~ Prepared by the North Central Area Agency on Aging (860) 7246443 / 1(800) 994-9422

2. What is Medicare?

Free health insurance for anyone over 65

Retirement insurance that covers all healthcare needs

Insurance for eligible individuals that provides some health care coverage for some healthcare services

9 3. What is Medicare?

Modeled after private health insurance, Medicare coverssomeof the cost ofsomehealth care

Generally, Medicare coverage is available for health care services that are considered medically reasonable and necessary for treatment or diagnosis of illness or injury

4. Who is eligible for Medicare?

Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits

Individuals whove received Social Security Disability for 24 months

Individuals with End Stage Renal Disease or ALS

All of the above

0 5. Whos Eligible?

Individuals aged 65 yearsandeligible for Social Security or Railroad Retirement benefits

Individuals who have received Social Security Disability for 24 months

If you have End Stage Renal Disease (ESRD) or ALS, you may be eligiblewithoutwaiting 24 months

6. A person turning 65 has7 full months to enroll in Medicare?

TRUE

FALSE

Answer Now 7. Medicare Enrollment Periods

Initial Enrollment Period 7 months, beginning 3 months before month of 65 thbirthday and ending 3 months.

General Enrollment Period January 1 stthrough March 31 stof every year. Part B benefits do not begin until July 1 stof that year.

8. 65 and Still Working?

If you continue working after 65, you may chose to delay enrollment in Medicare Part B without penalty.

• • 20 or more employees Employer insurance is primary

• • Less than 20 employees Employer regulationsmayrequire that your Medicare be primary insurance

• • Once you retire and stop active employment, Medicare becomes primary insurance

9. Special Enrollment Period (SEP)

• For actively working elderly or disabled

• • begins 1 stday a beneficiary is no longer covered under their own (or spouses)active employmentand ends on the last day of the 8 thfull consecutive month.

• For disabled individuals previously covered by large group health plan (+100employees)

• • Same 8 month SEP as above, but the coverage ending is that from a family membersactive employment .

10. Traditional Medicare

Created in 1965 consisting of 2 parts:

• • Medicare A Hospital

• • Medicare B Medical

People in traditional Medicare can receive their health care from any provider certified by Medicare

11. Medicare Part A Covers

Inpatient Hospital Care

Skilled Nursing Facility Care

Home Health Care

Hospice Care

12. Traditional Medicare Costs

Part A

- No monthly premium if you have 40+ quarters of work

- You can buy-in to Medicare A if youve worked less than 40

quarters

- associated deductibles and co-insurances

$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. Medicare Part B Covers

Physicians Services

Home Health Care

Outpatient Services and Therapy

Durable Medical Equipment

Prosthetic Devices

Ambulance Services

• And

14. Medicare Part B Covers

Certain Preventative Services

• • One physical exam when 1 stenrolled in Part B

• • Flu, Pneumococcal, Hepatitis B vaccines

• • Annual Mammograms

• • Some pap smear and pelvic exams

• • Colorectal Screenings

• • Diabetes Self-Management Training/Tests

• • Bone Mass Measurements

• • Prostate Cancer Screening

• • Some Glaucoma Screening

• • Some Medical Nutrition Therapy Services

• • Some Cardio-vascular tests

15. Medicare Part B Services

Are free and cover 100% of care

Have a monthly premium, annual deductible, cover 80% of the cost of care and have a 20% co-insurance for the beneficiary

Have a monthly premium and cover 80% of the cost of care and is then considered paid in full by the doctor

0 16. Traditional Medicare Costs

Part B

- Annual deductible $135

- Monthly premium of $96.40 (or higher

depending on your income)

- Generally, Medicare pays for 80% of the

approved Medicare rate of service and the

beneficiary is responsible for the remaining 20%

17. Help with Medicare related Expenses

There are Federal and State Programs available for beneficiaries with limited incomes

• Medicare Savings Programs (QMB/SLMB/ALMB)

• • Income guidelines are:

• • • • Single: $1,497.05/month (2009 limit)

• • • • Couple: $2,196.25/month (2009 limit)

18. Medicare Supplement Insurance

There are Supplement insurance plans available to offset some of the costs related to traditional Medicare

Medicare Supplement plans (Medigap policies) are standardized in Connecticut and overseen by the Department of Insurance

Plans range in cost and coverage options depending on the level of coverage you choose

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

TRUE

FALSE

Answer Now 20. Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection?

Once a year

Once a month

Only during thegeneral enrollment period (Jan-March)

0 21. Medicare Part D

In 2006 Medicare Part D was created to provide beneficiaries with prescription drug coverage

Part D provides coverage ofcertainmedications through a variety ofprivateinsurance plans

22. A beneficiary must have Medicare AandB in order to be eligible for Medicare Part D

TRUE

FALSE

Answer Now 23. When can a beneficiary make changes to their Medicare Prescription Drug Plan?

At any time

Only during the Open Enrollment Period (Nov 15 Dec 31) or if they qualify for a Special Enrollment Period

During the Open Enrollment Period (Nov 15 Dec 31) and during the year if their medication needs change and the plan doesnt cover them

9 24. Traditional Medicare Costs

Part D

Because benefits are provided byprivateinsurance plans, all related costs vary by plan

• • Monthly premiums range from $19.40 to $111.40

• • Deductible of up to $295/year

• • Co-payments and co-insurances

You want to make sure you complete a Drug Comparison Screeneach yearto make sure you enroll in a plan that best covers YOUR medications.

25. Paying for Part D

There are also programs that help pay for the cost of Medicare Part D plans

• • 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

• • • • Income Guidelines (2009)

• • • • Single:$2,092/month

• • • • Couple:$2,817/month

• • 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)

26. Options in Receiving Your Medicare Benefits

Beneficiaries have the option to enroll in Traditional Medicare (parts A, B, and D), or to go with a Medicare Part C plan instead

27. What is Medicare Part C?

Medicare Part C, orMedicare AdvantagePlans, are private insurance companies that contract with Medicare to provide beneficiaries with all their Medicare benefits and offers additional benefits as well

• Health Maintenance Organizations (HMOs)

• Preferred Provider Organizations (PPOs)

• Private Fee For Service (PFFS)

• Special Needs Plans (SNPs)

28. If you enroll in a Medicare Advantage Plan you no longer have Medicare

TRUE

FALSE

Answer Now 29. Medicare Advantage

Generally Medicare Advantage Plans require patients to get their health care services from certain providers in their network

In return these plans may offer additional benefits that are not offered in traditional Medicare and reduced premiums

• • Extra Days in the hospital

• • Preventative Care

• • Dental or Eye Coverage

30. Medicare Advantage continued

Most Medicare Advantage Plans offer Prescription Drug coverage as well

If you enroll in a Medicare Advantage Plan without drug coverage, you can not get a stand alone drug plan through Traditional Medicare

31. If enrolled in an Advantage Plan do you still have to pay Medicare B premiums?

No, you only pay the Advantage Plan premium

Yes, you pay the Medicare B premium and the Advantage Plan premium separately

Yes, but the Medicare Part B premium is included in the Advantage Plan premium you pay each month

15 32. Medicare Advantage continued

Caution is needed if/when selecting a Medicare Advantage Plan

• • Plans available are based on geographical location

• • 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

• • May need to get referrals as deemed medically appropriate for coverage with a specialist

33. Ready to test your Medicare knowledge?

Get your buttons ready as we review what weve learned today!

34. What is Medicare?

Free health insurance for anyone over 65

Retirement insurance that covers all healthcare needs

Insurance for eligible individuals that provides some health care coverage for some healthcare services

0 35. Who is eligible for Medicare?

Individuals aged 65 yrs and eligible for Social Security/Railroad Retirement benefits

Individuals whove received Social Security Disability for 24 months

Individuals with End Stage Renal Disease or ALS

All of the above

0 36. A person turning 65 has7 full months to enroll in Medicare?

TRUE

FALSE

Answer Now 37. Medicare Part B Services

Are free and cover 100% of care

Have a monthly premium, annual deductible, cover 80% of the cost of care and have a 20% co-insurance for the beneficiary

Have a monthly premium and cover 80% of the cost of care and is then considered paid in full by the doctor

1 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

TRUE

FALSE

Answer Now 39. Once a beneficiary enrolls in a Medicare Supplement Plan, how often can they change their plan selection?

Once a year

Once a month

Only during thegeneral enrollment period (Jan-March)

0 40. A beneficiary must have Medicare AandB in order to be eligible for Medicare Part D

TRUE

FALSE

Answer Now 41. When can a beneficiary make changes to their Medicare Prescription Drug Plan?

At any time

Only during the Open Enrollment Period (Nov 15 Dec 31) or if they qualify for a Special Enrollment Period

During the Open Enrollment Period (Nov 15 Dec 31) and during the year if their medication needs change and the plan doesnt cover them

0 42. If you enroll in a Medicare Advantage Plan you no longer have Medicare

TRUE

FALSE

Answer Now 43. If enrolled in an Advantage Plan do you still have to pay Medicare B premiums?

No, you only pay the Advantage Plan premium

Yes, you pay the Medicare B premium and the Advantage Plan premium separately

Yes, but the Medicare Part B premium is included in the Advantage Plan premium you pay each month

0 44. CHOICES is Here to Help

As the State Health Insurance Assistance Program for Connecticut, CHOICES providesFreeandUnbiasedinformation and assistance in navigating the benefits and options available to you through Medicare

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 -

1-800-994-9422

45. Helpful Resources

Medicare 1-800-MEDICARE (1800-633-4227)

www.medicare.gov

CHOICES Program 1-800-994-9422

CMA www.medicareadvocacy.org

BenefitsCheckUpwww.benefitscheckup.org

Infoline (211) www.infoline.org