Back to Basics: Medicare

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Transcript of Back to Basics: Medicare

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Back to Basics: Medicarehttps://learn.extension.org/events/2358

This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family Readiness Policy, U.S. Department of Defense under Award Numbers 2012-48755-20306 and 2014-48770-22587.

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Research and evidenced-based professional development through engaged online communities

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Providing educational tools and caregiving tips for military professionals and family caregivers.

[email protected]#MFLNMCmilfamlnMilitary Families Learning NetworkLinkedIn Groupmfln_mc

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Whos in the audience today? Air Force ArmyCoast GuardMarine CorpsNavyDepartment of Defense AffiliationFamily CaregiverUniversity AffiliationOther

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Asking Questions:

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Back to Basics: MedicareAndrew B. CrockerExtension Program Specialist IIIGerontology & Health

Texas A&M AgriLife Extension Service2016

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A Little About MeEducationBA, BiologyMS, GerontologyExperienceExtension Program Specialist III Gerontology & HealthPI, Military Caregiving ConcentrationArea, Military Families LearningNetworkPI, Texas A&M AgriLife ExtensionService, Texas Consortium of GeriatricEducation Centers

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ObjectivesExplore the ABCDs of MedicareDescribe the CMS National Training Program

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MedicareWhat is it?Health insurance for people 65 and olderUnder 65 with certain disabilitiesAmyotrophic Lateral Sclerosis End-Stage Renal DiseaseWho runs it?Centers for Medicare & Medicaid Services (CMS) administers programSocial Security Administration (SSA) enrolls most individualsRailroad Retirement Board enrolls railroad retirees

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How Are Medicare and Medicaid Different? Medicare MedicaidNational program that is consistent across the countryStatewide programs that vary among statesAdministered by the federal governmentAdministered by state governments within federal rulesHealth insurance for people 65 and over and with certain disabilities or with End-Stage Renal DiseaseHealth insurance for people based on needNations primary payer of inpatient hospital services to the disabled, elderly and people with ESRDNations primary public payer of acute health care, mental health and long-term care services

10US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Getting Started with Medicare.Retrieved 25 January 2016 from https://www.cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/Training-Library-Items/CMS1248263.html

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Four Parts of Medicare

11US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Medicare and You 2016. CMS Product No. 10050. Retrieved 18 January 2016 from https://www.medicare.gov/Pubs/pdf/10050.pdf

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Medicare Coverage ChoicesOriginal MedicarePart AHospital InsurancePart BMedical InsuranceYou can addMedicare Supplement Insurance (Medigap) PolicyPart DPrescription Drug Coverageor Medicare Advantage PlanPart CCombines Part A and Part BMay include, or you may be able to addPart DPrescription Drug Coverage(Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.)US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Medicare and You 2016. CMS Product No. 10050. Retrieved 18 January 2016 from https://www.medicare.gov/Pubs/pdf/10050.pdf

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Medicare EnrollmentAutomatic enrollment for those receivingSocial SecurityRailroad RetirementInitial Enrollment Period3 months before 65th birthday25th month of disability benefitsIf not automatically enrolledSocial SecurityGo to socialsecurity.govCall 800.772.1213Railroad Retirement BoardCall 877.772.5772

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Original Medicare Part A: Hospital Insurance CoveragePart A helps coverInpatient hospital careInpatient skilled nursing facility careBlood (inpatient)Home health careHospice care

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Paying for Medicare Part A Most people dont pay a premium for Part A If you paid Federal Insurance Contributions Act (FICA) taxes at least 40 quartersIf you paid FICA less than 10 yearsCan pay a premium to get Part AMay have a penalty if you dont enroll when first eligible

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Part A: What You Pay in Original Medicare (2016)Hospital Inpatient Stay$1,288 deductible and no coinsurance for days 160 of each benefit period $322 per day for days 6190 each benefit period $644 per lifetime reserve day after day 90 of each benefit period (up to 60 days over your lifetime) All costs for each day after the lifetime reserve days Inpatient mental health care in a psychiatric hospital limited to 190 days in a lifetimeSkilled Nursing Facility Care$0 for the first 20 days of each benefit period$161 per day for days 21100 of each benefit period All costs for each day after day 100 in a benefit period Home Health Care Services$0 for home health care services 20% of the Medicare-approved amount for durable medical equipment

16US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Medicare and You 2016. CMS Product No. 10050. Retrieved 18 January 2016 from https://www.medicare.gov/Pubs/pdf/10050.pdf

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Original Medicare Part B: Medical Insurance CoveragePart B helps coverDoctors servicesOutpatient medical & surgical services and suppliesClinical lab testsDurable medical equipmentDiabetic testing suppliesPreventive services

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What You Pay Part B PremiumMost current beneficiaries will continue to pay $104.90/month due to no Social Security cost-of-living adjustmentYou may pay a higher premium if you have a Part B late enrollment penalty

New standard premium some people will pay in 2016

Enroll in Part B for the first time in 2016Dont get Social Security/Railroad Retirement benefitsAre directly billed for their Part B PremiumsHave both Medicare and Medicaid, and Medicaid pays their premiumsHave a modified adjusted gross income, as reported on their IRS tax return from 2 years ago, is above a certain amount

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Income-Related Medicare Adjustment Amount for 2016NOTE: You may pay more if you have a Part B late enrollment penalty.If your yearly income in 2014 (for what you pay in 2016) wasFile Individual Tax ReturnFile Joint Tax ReturnFile Married & Separate Tax ReturnIn 2016 You Pay $85,000 or less$170,000 or less$85,000 or less$121.80 $85,000.01$107,000 $170,000.01$214,000Not applicable$170.50 $107,000.01$160,000 $214,000.01$320,000Not applicable$243.60 $160,000.01$214,000 $320,000.01$428,000Above $85,00 and up to $129,000$316.70 Above $214,000Above $428,000 Above $129,000$389.80

19US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Medicare and You 2016. CMS Product No. 10050. Retrieved 18 January 2016 from https://www.medicare.gov/Pubs/pdf/10050.pdf

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Part B: What You Pay in Original Medicare (2016)Yearly Deductible$166.00Coinsurance for Part B Services20% coinsurance for most covered services, like doctors services and some preventive services, if provider accepts assignment $0 for some preventive services20% coinsurance for outpatient mental health services, and copayments for hospital outpatient services

20US Department of Health and Human Services Centers for Medicare and Medicaid Services. (2015). Medicare and You 2016. CMS Product No. 10050. Retrieved 18 January 2016 from https://www.medicare.gov/Pubs/pdf/10050.pdf

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To B or Not To Part BConsiderMost people pay a monthly premiumUsually deducted from SSA/Railroad Retirement benefitsAmount depends on incomeIt may supplement employer coverageYou must have Part B if:You want to buy a Medigap policyYou want to join a Medicare Advantage PlanYou're eligible for TRICARE for Life or CHAMPVAYour employer coverage requires you have it

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Part C: Medicare AdvantageHealth plan options approved by Medicare Another way to get Medicare coverageStill part of the Medicare programRun by private companiesMedicare pays the plan an amount May have to use network doctors or hospitalsTypes of plans available may vary

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How Medicare Advantage (MA) Plans WorkIf you join an MA Plan you Are still in Medicare with all rights and protectionsStill get those services covered by Part A and Part B But the MA Plan covers those services insteadMay choose a plan that includes prescription drug coverageMay have different benefits and cost-sharing May choose a plan that includes extra benefits such as vision or dental offered at the plans expense

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Comparison Summary Original Medicare Medicare Advantage PlanCovers Part A and Part B benefitsMedicare provides this coverage directlyYou have your choice of doctors and hospitals that are enrolled in Medicare and accepting new Medicare patientsGenerally, you or your supplemental coverage pay deductibles and coinsuranceYou usually pay a monthly premium for Part BCovers Part A and B benefits and may cover additional