WHAT DOES MEDICARE HAVE TO DO WITH FAMILIES?Presented by Nancy A. Dykeman, CLTC, CSAforCorporation for Long-term Care Certification

“I turn 65 next year and I’m counting on my Medicare to replace my current insurance.”

“There are so many moving parts to Medicare, I’m confused.”

“Where would I find information to help me understand my new insurance benefits?”

“Help, I need somebody, help, not just anybody…” The Beatles

Let’s Start at the Very Beginning New Premiums New Limits New Plans Added All PARTS of Medicare Where to Learn More

C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government handbook with important information about the following:

What's new 2009 Medicare costs What Medicare covers Health and prescription drug plans Your Medicare rights Fraud and identity theft

Medicare

&You 2009

Medicare’s goal is to make it easy for you to get the highest quality health care at the most affordable price. Medicare is

transforming itself from a program which simply pays the bills to a program which actively supports a high quality health care system.

Communicates using an interconnected, computerized health ■■information network, so providers can get a

What do we mean by a high quality health care system? It’s a system that does the following: Rewards providers for quality and efficiency. Uses objective standards to determine quality and efficiency. Communicates using an interconnected, computerized health information network, so providers can get a comprehensive view of the patient securely and without delay.

Offers consumers complete, objective, easily accessible information, so they can make solid decisions about their own health care based on quality and price.Medicare shares quality information about providers in your area at www.medicare.gov. In addition, this “Medicare & You” handbook is another way Medicare is working to make sure you have reliable information to help you make good health care decisions.

November 15, 2008–December 31, 2008: Stay or Switch

You can switch your Medicare health or prescription drug coverage for 2009 during this period.

January 1, 2009: 2009 Coverage and Costs Begin New coverage begins if you made a change

between November 15, 2008–December 31, 2008. New costs and coverage changes also begin if you keep your current coverage.

What is Medicare?

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

What if? Picture no health insurance… Who would pay…the senior or family

What happened to a lifestyle worth living?

“I’d like to retire but I am only working to continue my health insurance…you just never know.”

Medicare is a “Family” of CoverageEach family member (child) has a role: Oldest = PART A Next Oldest = PART B Middle Child = PART C Next Youngest = PART D Youngest = Medicare Supplement

Since 1965 Changes in Coverage Increasing Premiums More Out-of-Pocket Added Prescription Coverage

Gee, do you think things might keep changing?

PART A – the eldest This is hospitalization insurance for

inpatient care including rehabilitation facilities, some skilled nursing facility care, hospice care and some skilled home health care.

Medically necessary and reasonable treatments

Must show significant improvement Outpatient Speech-language, Occupational

and Physical Therapy

PART A + Employer Plan Comprehensive One pays and the other, too ER plan covers co-pays and

deductibles for PART A ER plan is primary

PART A - 2009Premium is $0 if paid at least 40 credits to

Social Security during working years Up to $443/month if less than 40 creditsDeductible is $1,068 for each hospital stay of

1-60 days Up to $534/day for up to 150 daysCo-insurance in Skilled Nursing Facility $133.50/day for days 21-100, each benefit

period

Enrollment Begins automatically if on Social

Security or Railroad Retirement for 65 and up.

If under 65 and disabled, it is automatic after getting SS disability benefits for at least 24 months.

If no SS benefits yet, then sign-up within a 7 month window for age 65.

PART B – Next Oldest Child Medically necessary services:

DoctorOutpatient careOther medical servicesPreventive services

PART B - 2009 Premium is based on income

$96.40/month under $85,000 (individual) Up to $308.30 for income above $212,000

Deductible$135 Annual

Co-insurance or Co-pay amounts for most doctor services, durable medical equipment and outpatient mental health care.

Enrollment Card mailed 3 months before 65 birthday

or 24th month of disability. If PART B is not wanted but the card is

kept, monthly premium will be automatically deducted from SS check

If wait to enroll monthly premium increases 10% for each year while waiting

If have ER plan there is an 8 month window to enroll in PART B without penalty

Without PART BRemember, PART B is the physician coverage and

outpatient services, and complements PART A.

A person will need another medical plan to pay the extras that PART A doesn’t cover (however, if an employer group has less than 20 people and not subject to COBRA, an individual who is 65 or older on the group plan should enroll in Medicare Part B. If a group member doesn’t have Part B, he/she could be exposed to costs which are not reimbursed by Medicare or the group plan.)

PART C – our Middle Child Medicare Advantage Covers PARTS A & B Offered by private companies

Beneficiary can get more coverage than A & B offer

Vision exams and eyeglasses Dental Health and Wellness Programs Rx

PART C - 2009 Premiums vary depending on plans

offered – some $0 premium Out-of-Pocket costs

Co-paysCo-insuranceDeductibles

Premiums and Plans Contact Medicare at 1-800-663-4227

or www.medicare.gov

PART D – Next Youngest Prescription Drug Plan – 2004 Must have PARTS A & B Private companies sell plans Plans vary in cost and drugs covered

EnrollmentAfter joining a plan the plan will mail

membership materials and a card

Other PART D Costs Co-pays Co-insurance Deductibles

PART D - 2009 Premium

$18.40 to $107.60/month (state specific)

Deductible – The annual deductible depends on your plan. Most plans have a deductible of $295. You usually pay all of your drug costs, up to $295. After you have paid $295 deductible for your drugs, you usually pay 25% of your prescription drug costs up to $2,700.

Initial Coverage Limit – The coverage limit is $2,700. Once this limit is reached for prescription drugs, your coverage stops. You are responsible for paying 100% of the drug costs up to $4,350 (including the costs of the deductible and coinsurance). This period is known as the Coverage Gap or “Donut Hole”.

Catastrophic Coverage – Once you have reached the out-of-pocket costs of $4,350, you qualify for catastrophic coverage. You will pay no more than 5% of your drug costs for the remainder of the year.

Medicare Supplement (Medigap) Youngest child in the Medicare Family Sold by private insurance agents Helps pay costs PART A & PART B don’t

Co-pays Co-insurance Deductibles

Some plans offer out-of country coverage.

Plans

Standardized plans – A through L A = basic coverage and add more

coverage to Plan L Cost varies If join a PART C, Medicare Advantage

plan don’t need Medigap.

Plan Examples

A State offering 65 plans:Premium $0 to $244.80 monthCo-pays and Deductibles vary

“So I have PART A and if I don’t want co-pays and deductibles out of my pocket, I buy a Medigap policy?”

YES

“What’s a Medicare Medical Savings Account?” MSA by CMS 2007 High Deductible health plan with a medical

savings account that beneficiaries can use to manage their health care costs.

Cover PARTS A & B benefits and others

HOW? Medicare puts annual deposit into an interest-bearing

account from CMS to help individual cover health care costs.

High Deductible, less than $6,000 Each month Medicare pays a premium for the policy to

the insurance company Use funds for medical services If “qualified medical expense” (IRS) then the payment is

tax-free. No PART D drugs included Carry-over unused deposit dollars

Contact Medicare about MSA

Special Information1-800-318-2596www.medicare.gov

Future of Medicare

“Absent fundamental reforms, over the next two decades the average American household’s health-care spending, including the portion of its taxes that pays for Medicare and Medicaid, will go from 23% to 41% of average household income.

By curtailing revenues, today’s recession will bring closer the projected exhaustion of the Medicare Part A trust fund from early 2019 to perhaps 2016.”

Michael Levitt, Secretary of Health and Human Services

Last Thoughts… In 1965 America’s median age was 28.4,

now it is 36.6. Ratio of workers to seniors has steadily

declined and number of seniors living long enough to have 5 or more chronic conditions – 23% of Medicare beneficiaries – has increased.

Source: George Will, The Washington Post

Long-Term Care?

PART A – only skilled, not custodial care PART B – no PART C – no PART D – no Medicare Supplements - no

The Family

Your responsibility to be their source Your responsibility to learn Your responsibility to understand Your responsibility to keep up Your responsibility to protect families from

uncertainty, confusion and the effects of long-term care

QUESTIONS?