Next Meeting: Tuesday, September 13, 2011, 2-3:30 pm
Location: Malta Community Center, 1 Bayberry Drive, Malta.
Topic: A general overview of Medicaid presented by Saratoga County Department of Social Services staff.
**We will hold meetings on the 2nd Tuesday of every month, 2:00-3:30 p.m., unless otherwise indicated.
“Our mission is to promote community awareness of the programs and services available to Saratoga County residents who are aging and/or disabled, and their caregivers, so as to better meet the needs of these ever increasing populations.”
Introductions & Announcements:
· Opening/Introduction-Cindy Harrington
· Aging and Disability Network is four years old!
· Last month's topic was "Tips for Caregivers"
· Todays' speaker is Bill Bregenzer and his topic is "Understanding Medicare-Module 1A."
· Our next meeting will be Tuesday 9/13/11 at Malta Community Center. The topic will be a general overview of Medicaid, presented by Saratoga County Department of Social Services staff members, Kathy Thompson and Patty McConkey. Their presentation will include the topics of eligibility and spend-downs, and questions will be gladly taken.
· Our October meeting will be held on 10/11/11 at Saratoga United Methodist Church.
· Our November meeting will be held on the third Tuesday of that month, instead of the second Tuesday, due to Election Day. We will meet at St. Edward the Confessor Church in Clifton Park.
· The Walk to End Alzheimer's will be held in September.
· On 9/10/11, SAIL will host its Annual Boat Ride.
· Also, on 9/12/11, there will be a Free Forum.
Today's Topic and Speaker: "Understanding Medicare-Module 1A," presented by Bill Bregenzer from the Saratoga County Office for the Aging, Health Insurance Information, Counseling and Assistance Program (HIICAP). Bill can be reached at 884-4100, if anyone is interested in scheduling an appointment with him.
Bill provided two handouts, which contained information as follows:
What is Medicare?
Medicare is health insurance for three groups of people:
-Age 65 and older
-Under 65 with certain disabilities
-Any age with end-stage renal disease
Administration: Centers for Medicare and Medicaid Services
Enrollment:
-Social Security Administration (for most)
-Railroad Retirement Board (RRB)
Enrolling in Medicare
If you already get Social Security or Railroad Retirement, you are enrolled automatically:
-3 months before age 65
-3 months before your 25th month of disability benefits
You receive your Initial Enrollment Package in the mail. This includes your Medicare card.
If you are not already getting Social Security or Railroad Retirement, you must:
-enroll through SSA or RRB'
-apply 3 months before age 65
You do not have to be retired to get Medicare.
Medicare Part A (Hospital Insurance):
-Premium is free for most people
-Have less than 10 years of Medicare-covered employment.
You can pay a premium to get Part A.
For information, call SSA at 1-800-772-1213. TTY users call 1-800-325-0778.
Medicare Part A Helps Pay for:
Hospital stays: semi-private room, meals, general nursing and other hospital services and supplies; includes care in critical access hospitals and inpatient rehabilitation facilities and inpatient mental health care in psychiatric hospital (lifetime 190-day limit).
Skilled Nursing Facility Care: semi-private room, meals, skilled nursing and rehabilitation services, plus other services and supplies.
Home Health Care Services:
Can include part-time or intermittent skilled care and physical therapy, speech-language pathology, and occupational therapy.
Hospice Care:
Includes drug and medical support services from a Medicare-approved hospice.
Blood:
In most cases, if you need blood as an inpatient, you won't have to pay for it or replace it.
Paying for Hospital Stays:
For each benefit period in 2011, you pay:
-$1,132. total deductible for days 1-60
-$283. co-payment per day for days 61-90
-$566, co-payment per day for days 91-150 (60 lifetime reserve days)
-all costs for each day beyond 150 days
Part B Coverage (Medical Insurance): You must pay for this yourself. It currently costs $115.40 per month.
-Doctor's services
-Outpatient medical/surgical services and supplies
-Diagnostic tests
-Outpatient mental health services
-Some preventive health care services
-Other medical services
Enrolling in Medicare Part B:
Automatic enrollment:
-If you already get Social Security, Railroad Retirement, or disability benefits
-*Must opt out if you do not wish to be enrolled
Initial Enrollment Period (IEP): Seven- (7) month period. Starts 3 months before month of eligibility and includes the month you turn 65 and 3 months after the month you turn 65
General Enrollment Period (GEP):
-January 1 through March 31 each year
-Coverage effective July 1
-Premium penalty
- 10% for each 12-month period eligible but not enrolled
- Paid for as long as the person has Part B
- Some exceptions
-Deducted from monthly Social Security, Railroad or Federal retirement payments
-If you don't get any of these retirement benefits
- You can be billed every 3 months, or
- Use Medicare Easy Pay
-Contact SSA, RRB, or OPM about paying premiums
-In original Medicare, you pay
- Your deductible of $162. in 2011
- 20% coinsurance for most services
- Some copayments
-Some programs may help pay these costs
Part B Late Enrollment Penalty:
-Penalty for not signing up when first eligible
- 10% more for each 12-month period
- May have penalty as long as you have Part B
-Usually no penalty if you sign up during a SEP
Medicare Costs - 2011
Part A
-No premium
-Inpatient Deductible $1,132. (Days 1-60)
-Coinsurance Days 61-90 $283. per day
Part B
-Premium (current) $96.40 per month
-Premium (prospective) $115.40
-Annual Deductible $162.
Part D
-Premium $14.80-$107.80 per month
-Annual deductible $0-310.
Assignment:
Medicare doctors/providers/suppliers
-Accept the Medicare-approved amount
- As full payment for covered services
- Only charges Medicare deductible/coinsurance amount
-They submit your claim to Medicare directly
Applies to Original Medicare Part B claims
We say "accepts assignment"
Part B and Employer or Union Coverage:
-Find out how your insurance works with Medicare-Contact your employer/union benefits administrator
-You may want to delay enrolling in Part B if
- You have employer or union coverage, or
- You or your spouse is still working
Employer or Union Coverage Ends:
-When your employment ends:- You may get a chance to elect COBRA
- You may get a special enrollment period-Sign up for Part B without a penalty
-IMPORTANT-Medigap open enrollment period-NYS has continuous open enrollment period
Your Medicare Choices:
1. Original Medicare
2.Medicare Advantage Plans
3. Medicare Prescription Drug Coverage
Original Medicare:
-Run by the Federal government
-Provides your Part A and/or Part B coverage
-Can go to any doctor or hospital that accepts Medicare
-You pay:
- Part B premium (Part A is free for most people.)
- Deductibles, coinsurance, or copayments-You can buy a Medigap policy to help pay some of these costs.
-Get Medicare Summary Notice (MSN)
-Can join a Medicare RX Plan to add drug coverageMedigap:
Medigap (Medicare Supplement Insurance) policies:
- Private health insurance for individuals
- Sold by private insurance companies
- Supplements Original Medicare coverage
- Follow Federal/state laws that protect you
- Must state "Medicare Supplement Insurance"
MEDICARE:
Original Medicare: Supplemental Insurance:
Part A-Hospital Medigap or Retiree Health Plan
Part B-Medical EPIC
Part D-Prescription Only
Medicare Advantage (MA) Plans:
-You are still in the Medicare program
-You still have Medicare rights and protections
-You still get regular Medicare-approved services
-You may get extra benefits, such as vision, hearing, or dental care
-You may be able to get prescription drug coverage
-Examples of companies that offer MA: CDPHP, MVP, Blue Shield
MA Eligibility Requirements:
-You must live in plan's service area
You must have Medicare Part A and Part B
-You must not have ESRD at time of enrollment-There are some exceptions.
When You Can Join or Switch MA Plans:
-When first eligible for Medicare at age 65 - 3 months before to 3 months after month you are 65
-When eligible due to disability - 3months before to 3 months after your 25th month of disability
-Between October 15-December 7 in 2011 - This period changes in 2011
-Special Election Period
Medicare Advantage Plan Costs:
-You must still pay Part B premium
- Some plans may pay all or part for you
- Some people may be eligible for state assistance
-You may pay additional monthly premium to plan
-You pay deductibles, coinsurance, and copayments- Different for Original Medicare
- Varies from plan to plan
Medicare Prescription Drug Coverage (Part D):
-Available for all people with Medicare-Provided through:
- Medicare Prescription Drug Plans
- Medicare Advantage Plans
- Other Medicare plans
Who Can Join?
-You must have Medicare Part A and/or Part BYou must live in plan service area
-You must enroll in a Medicare Rx plan
-You can't live outside the U.S. or be incarcerated
When You Can Join or Switch Medicare Prescription Drug Plans:
-During IEP when first eligible for Medicare at age 65 - 3 months before to 3 months after month you are 65
-When eligible due to disability - 3 months before to 3 months after 25th month of disability
-Between October 15 - December 7 in 2011 - This period changed in 2011.
-Anytime, if you qualify for Extra Help
-Other times, when certain events occur
Late Enrollment Penalty:
-People who wait to enroll after their IEP pay an additional 1% of base beneficiary premium
- For every month eligible and not enrolled
- For as long as they have Medicare drug coverage
- Except those with other creditable drug coverage
Extra Help with Drug Plan Costs:
-Help for people with limited income and resources-Social Security or state makes determination
-Some groups are automatically eligible:
- People with Medicare and Medicaid
- Supplemental Security Income (SSI) only
- Medicare Savings Plan
Formulary:
-A list of prescription drugs covered by the plan-May have "tiers" that cost different amounts
___________________________________________________
Examples of Tiers (Plans can form tiers in different ways):
Tier: You Pay: Prescription Drugs Covered:
1 Lowest copayment Most generics
2 Medium copayment Preferred, brand name
3 Highest copayment Non-preferred, brand name
Specialty Highest copayment or coinsurance Unique, very high cost
MEDICARE:
Original Medicare Supplemental Insurance
Part A - Hospital Medigap or Retiree Health Plan
Part B - Medical EPIC
Part D - Prescription Drug
Medicare Advantage Plans - Part C - HMOS's, PPO's, and PFFS's:
Hospital and Medical
Prescription Drug / EPIC
IMPORTANT PHONE NUMBERS:
1-800-MEDICARE or 1-800-633-4227
TTY Users Should Call 1-877-486-2048
WEBSITE: www.medicare.gov
Social Security Administration 1-800-772-1213
Website: www.ssa.gov
EPIC (NYS Elderly Pharmaceutical Insurance Coverage Program)
1-800-332-3742
Website: www.health.state.ny.us
New York State Medicaid Helpline:
1-800-541-2831
-Medicare & You handbook, CMS Publication #10050
-Other Medicare publications are on www.medicare.gov
-www.cms.gov
-Your State Health Insurance Assistance Program (SHIP)
Saratoga County Office for the Aging
Health Insurance Information Counseling and Assistance Program (HIICAP)Telephone: (518) 884-4100
Supplement - August 8, 2011
Medicare Card
-Keep it and accept Medicare Parts A and B
-Return it to refuse Part B - Follow instructions on back of card
Five Conditions for Home Health Care:
-Must be homebound
-Must need skilled care on intermittent basis
-Must be under care of a physician - Receiving services under a plan of care
-Have face-to-face encounter with doctor - prior to start of care
-Home health agency must be Medicare-approved
Hospice Care:
-Special care for terminally ill and family - Expected to live 6 months or less
-Focus on comfort and pain relief, not cure
-Doctor must certify each "benefit period"
· Two 90-day periods
· Then unlimited 60-day periods - face-to-face encounter
-Hospice provider must be Medicare-approved
Part B Covered Preventive Services:
-"Welcome to Medicare" exam
-Yearly "Wellness" exam
-Abdominal aortic aneurysm screening*
*(when referred during "Welcome to Medicare" physical exam)
-Bone mass measurement
-Cardiovascular disease screenings
-Colorectal cancer screenings
-HIV screening
-Diabetes screenings
-Flu shots
-Glaucoma tests
-Hepatitis B shots
-Mammograms (screening)
-PAP test/pelvic exam/clinical breast exam
-Prostate cancer screening
-Pneumococcal pneumonia shots
-Smoking cessation
Part B Late Enrollment Penalty Example:
Mary delayed signing up for Part B two full years after she was eligible. She will pay a 10% penalty for each full 12-month period she delayed. The penalty is added to the Part B monthly premium ($115.40 in 2011). So for 2011, her premium will be as follows:
$115.40 (2011 Part B standard premium)
+ 23.08 (20% [of $115.40] (2 x 10%)
$138.48 (Round up) (For this example only)
$138.50 (Mary's Part B monthly premium for 2011)
When You Can Join or Switch MA Plans:
_______________________________________________________________________Initial Enrollment Period
7-month period begins 3 months before the month you turn 65
______________________________________________________________________Annual Enrollment Period
-October 15 - December (New in 2011)
-Coverage begins January _______________________________________________________________________
Special Enrollment Period
-Move from the plan service area and cannot stay in the plan
-Plan leaves Medicare program-Other special situations
_______________________________________________________________________
When You Can Drop and MA Plan:
Medicare Advantage Disenrollment Period
-Between Jan. 1 - Feb. 14
-You can leave an MA plan
-Go back to Original Medicare (coverage begins the first of the month after you leave the MA plan)
-If you make this change, you also may join a Part D Plan to add drug coverage. -Drug coverage begins first of the month after the plan gets enrollment form
-Cannot join another MA plan during this period
When You Can Join or Switch Medicare Prescription Drug Plans:
Initial Enrollment Period (IEP)
-7-month period
-Starts 3 months before month of eligibility (New in 2011)
_______________________________________________________________________
Annual Enrollment Period
-October 15 - December 7 each year
-These are new dates.
______________________________________________________________________
Annual Medical Advantage
-Between January 1 - February 14,
Disenrollment Period
you can leave an MA plan and switch to Original Medicare. If you make this change, you may also join a Part D plan to add drug coverage.
_______________________________________________________________________
Prescription Drug Costs:
-Costs vary by plan
-In 2011, most people will pay:
· A monthly premium
· An annual deductible
· Copayments or coinsurance
· 50% on covered brand-name drugs in donut hole ($2,840. - $4,550.)
· 7% on generic drugs in donut hole
· Very little after spending $4,550. out-of-pocket
Part D Coverage Gap:
-If you reach the coverage gap in 2011
· You get a 50% discount on brand-name Rx drugs
· You get a 7% discount for generic drugs
· Entire price counts toward catastrophic coverage
· Dispensing fees not discounted
-Additional savings in coverage gap each year
-Gap to be closed in 2020
Medicare Prescription Drug Coverage Premium:
-Higher income pay higher Part D premium - Uses same thresholds used to compute income-related adjustments to the Part B premium - As reported on your IRS tax return from 2 years ago
-Must pay if you have Part D coverage
-Effective January 2011
For More Information on Medicare Rights, Including Explanations and Questions:
www.medicarerights.org
Respectfully submitted,
Bonnie L. Logan, Volunteer
Saratoga County Office for the Aging/RSVP
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