Document - National Council on Aging

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Transcript Document - National Council on Aging

Benefits 101:
Medicare 101
March 2017
Improving the lives of 10 million older adults by 2020
What We’ll Cover
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What is Medicare?
Stats and Facts
How is Medicare paid for?
How does Medicare work?
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Who is eligible?
The 4 parts of Medicare
How and when to enroll
 Medicare and Other Benefits
 Medicare & Health Care Reform
 Resources
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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What is Medicare?
 Government-sponsored health insurance for seniors
aged 65+, and younger adults with
disability/permanent kidney failure
• Helps pay for health care service, but doesn’t cover all
costs or most long-term care
 Created in 1965 by Congress under Title XVIII of
Social Security Act
• Effort to equalize insurance for seniors regardless of
income or medical history
 1972 – expanded to include people under 65 who
received Social Security disability benefits and those
with ESRD
 Medicare Modernization Act of 2003 established
Part D
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Stats and Facts
 ~55 million people enrolled in Medicare, or
16% of total population of the United
States
• 84% qualify by age (65+)
• 16% qualify by disability/health status
 50% of all Medicare beneficiaries had
incomes below $24,150 in 2014; 25% had
incomes below $14,350
 ~10 million people with Medicare are also
eligible for Medicaid (“dual eligibles”)
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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How is Medicare financed?
 Payroll taxes paid by workers and their
employers help pay for Part A
 Cost-sharing (premiums, deductibles,
coinsurance) by Medicare beneficiaries for
Parts B, C, and D
 Other sources of financing:
• Part A: Income tax paid on Social Security
benefits, premiums on Part A paid by those who
don’t get it premium-free
• Part B: General revenue (mostly federal income
taxes)
• Payments from states for Part D drug benefit
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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How Medicare works: Who is eligible?
 U.S. citizens aged 65 and older with sufficient
quarters of work credit under Social Security
• Legal non-citizens may be able to enroll based on
residency status, age, and work history
 Adults younger than 65 with disabilities
• Eligible once they’ve received Social Security
Disability benefits (or certain Railroad Retirement
benefits) for 24 months
• Anyone with amyotrophic lateral sclerosis (Lou
Gehrig’s Disease) qualifies in the 1st month they
receive disability
• Persons of any age with End Stage Renal Disease
can enroll; coverage usually begins during 4th
month of dialysis
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part A
 Referred to as hospital or
inpatient insurance
 What Part A covers:
• Care while in a hospital
• Some of the costs of skilled
nursing facility care or home
health services
• Hospice care for those who
are terminally ill
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part A (cont.)
 What Part A costs:
• Most people don’t pay premiums—paid for
through FICA taxes
• Those without work credits (through their own
work history or a spouse) pay a sliding scale
premium up to $413/month in 2017
• $1,316 deductible for hospital stay
• Skilled nursing facility, home health, and hospice
have no deductibles
• Other co-payments depend on length of stay and
type of facility/service (no cost-sharing for
hospice)
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part B
 Outpatient insurance
 With Part A, referred to as Original/ Traditional
Medicare
 What Part B covers:
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Doctors’ services
Outpatient hospital care
Laboratory tests
Medical equipment
Orthotics and prosthetics
Mental health care
Ambulance services
Prevention and wellness screenings
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part B (cont.)
 What Part B costs in 2017:
• Premiums up to $134/month, depending on
when person first enrolled in Part B
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Higher premiums for people with incomes over
$85,000 (individual) or $170,000 (couple)
• $183 annual deductible
• Once deductible is paid, individual pays 20% of
the Medicare-approved cost of the Part B
covered service
• Important to see providers who accept Medicare
assignment, otherwise the patient's cost-sharing
responsibility increases
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part C
 Part C: Medicare Advantage
 Plans offered by private companies that
contract with Medicare to offer Part A and B
benefits
 Many offer drug coverage (Part D)
 May offer additional benefits not covered under
Original Medicare (dental, hearing, vision,
wellness programs)
 What Part C costs:
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Patient still pays Part B premium (unless plan
covers part of it)
Additional premiums, deductibles, and cost-sharing
vary by plan and service
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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The 4 Parts of Medicare: Part D
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Provided through private insurance plans—either standalone or as part of Part C/Medicare Advantage plans
Plans must accept anyone who is eligible and enrolls (no
pre-existing condition clause)
Important to enroll when first eligible (unless they have
creditable drug coverage), otherwise will incur a penalty if
enrolling later (unless eligible for Low Income Subsidy)
Plans have different formularies (drug lists) and cost
structures
Patients can compare plans and costs online using the
Medicare Plan Finder: https://www.medicare.gov/find-aplan/questions/home.aspx
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Other Programs to Fill Coverage Gaps
 Medigap is a form of supplemental insurance
• Pays for cost-sharing (deductibles, premiums) for Parts A
and B and some services not covered by Parts A and B
• Purchase from private insurance companies
• 11 different standard plans, except in MA, MN, WI
• Can see any doctor, regardless of whether they accept
Medicare
• Usually easiest (and best) to buy when first enrolling in
Medicare at age 65
• See our Medigap webinar for more information
 Can also fill gaps in coverage through other types of
insurance (COBRA, TRICARE, Medicaid, Indian
Health Service, Medicare Savings Programs, etc.)
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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How to Enroll
 Automatic enrollment into Parts A & B occurs for:
• Those who receive disability benefits when they reach their 24month window (or earlier for ALS and ESRD patients)
• Early retirees who receive Social Security when they turn 65
 All others must apply for Medicare through Social
Security
• Online
• By calling 1-800-772-1213 (TTY 1-800-325-0778)
• By visiting their local Social Security office
 Once signed up through Social Security, they can
choose to enroll in Part C and/or D via the plan itself,
or online using the Medicare Plan Finder for Part D
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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When to Enroll
 Initial Enrollment Period: 7-month window
around 65th birthday to join Parts A, B, and D
 General Enrollment Period:
• Jan 1 – March 31 each year to enroll in Parts A & B
• Oct 15 – Dec 7 (called Open Enrollment) each year to
enroll in Parts C & D (or switch plans)
 Special Enrollment Periods:
• When retiring/losing employer-sponsored insurance
• When moving or transitioning out of a nursing home
• When a plan changes its service area
 Remember potential penalties for not enrolling
on time!
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Benefits That Help Pay for Medicare
 Medicare Savings Programs (MSP)
• Administered through state Medicaid agencies
• Helps pay Medicare Part B premiums and/or cost sharing
• For more information, please see our MSP 101 Training
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Extra Help/Low-Income Subsidy (LIS)
• Helps pay Part D premium and cost sharing
• People eligible for Medicaid or SSI are automatically
eligible (known as “deemed eligible”) for the Extra
Help/LIS under Part D.
• If a beneficiary does not choose a plan, they will
automatically be enrolled into a zero-premium plan
• People with LIS can switch Part D plans at any time
• For more information, please see our LIS 101 Training
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Medicare & Other Benefits
 Medicaid
• 10.1 million duals in the United States
• Medicaid helps pay for some of the costs of
Medicare
 Medicaid is always secondary payer to
Medicare
• Anyone who is enrolled in both Medicare
and Medicaid is automatically eligible for
LIS/Extra Help
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Medicare & Health Care Reform
 Affordable Care Act passed into law in March
2010, upheld by Supreme Court in June 2012
 Significant implications for Medicare include:
• Closing the Part D coverage gap by 2020
• Moved and extended Open Enrollment for Parts C &
D
• Provided new free preventive benefits, including
Annual Wellness Visit
• Tests new models of better care and coordination of
services
 Unclear at time of writing how current proposals
to repeal/replace ACA will affect these
provisions
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Resources from NCOA
 My Medicare Matters:
http://www.mymedicarematters.org
• Up-to-date information about coverage, costs, and
enrollment
• QuickCheck tool provides personalized enrollment advice
 NCOA’s Resource Library: www.ncoa.org/resources
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Benefits 101 slides and fact sheets
Fact sheets
Archived webinars
Issue briefs and more!
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Resources from the Government
 Centers for Medicare & Medicaid Services:
• http://www.medicare.gov (consumer focused)
• http://www.cms.gov (for professionals)
• Medicare Plan Finder: https://www.medicare.gov/find-aplan/questions/home.aspx
• Search http://www.medicare.gov/contacts for SHIPs and state
departments of insurance, health, Medicaid
 Social Security Administration: http://www.ssa.gov
 Health Care Exchange: http://www.healthcare.gov
• Information on provisions of Affordable Care Act
• Portal for Health Insurance Marketplaces
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Other Resources
 Find your State Health Insurance Assistance
Program (SHIP) at www.shiptacenter.org or
call 877-839-2675
 Medicare Rights Center:
http://www.medicarerights.org/
 Center for Medicare Advocacy:
http://www.medicareadvocacy.org/
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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Thank You!
 Thank you for participating in the Benefits 101
Series from the Center for Benefits Access at
NCOA
 Learn more about us at:
www.ncoa.org/centerforbenefits
 Find other Benefits 101 resources at:
www.ncoa.org/resources (search for 101)
 If you have any questions or comments, please
contact us at [email protected]
Improving the lives of 10 million older adults by 2020
| © 2017 National Council on Aging
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