Medicare

Question 0

When is the Medicare Open Enrollment period?

Answer 0

October 15 to December 7

Question 1

When is the Medicare Dis-enrollment period?

Answer 1

January 1 through February 14

Question 2

What portions of Medicare should be shopped each year and why?

Answer 2

Part D - Formularies and pricing change fairly frequently, as do individual drug needs. Shopping can reduce out of pocket drug costs in many instances.

MC Advantage??

MC Gap??

Question 3

Given the level of care it provides, how cost effective is Medicare at the level of the individual participant?

Answer 3

Extremely cost effective. Medicare offers broad high level healthcare at very affordable cost to the participant.

Question 4

With regard to Part A:

What are key areas of coverage?

What is premium?

What is he deductible?

Areas specifically not covered?

Answer 4

Covers most of the cost of hospital care, including the following:

Semi-private room

Nursing care and meals

Labs, medical devices and supplies furnished by the facility

Rehab or SNF for up to 100 days if needed for recovery from a hospitalization lasting at least 3 days, and if deemed medically necessary by physician. Pays for 100% for 20 days, and then another 80 days but with a daily deductible of $140 (2013). After 100 days, you pay 100% of costs. It only pays for SNF or rehab, not AL.

Certain home healthcare services or hospice if ordered by doctor.

Premium - For most participants, none (it is covered by payroll taxes). Notional premium for 2012 is $xxx

Deductible - $1,156 (2012) per “benefit period” (hospitalization period in days + 60 days continuously out of hospital).

Not Covered - Doctor costs, private room or nurse, TV, phone, other conveniences.

Question 5

Describe the LTC coverage provided by Medicare.

Answer 5

MC Part A covers 100% of the first 20 days of SNF care if deemed medically necessary by MD and if resulting from a hospitalization lasting at least 3 days.

If additional care is needed, MC will pay for another 80 days but there is a daily deductible of $140 (2013).

After 100 days, you pay 100% of the cost.

Note this for SNF and rehab care only, not AL.

Question 6

What agency operates Medicare?

Answer 6

Medicare itself is run by The Centers for Medicare and Medicaid Services.

Question 7

T or F - Part D premiums are poorly correlated with the quality of the coverage

Answer 7

True. Premium cost isn’t a good predictor of the quality of coverage. Many of the highest rated policies are about average in cost.

Question 8

How can one avoid Part D late enrollment penalties?

Answer 8

Enroll at age 65

Maintain creditable alternative coverage

Buy a very inexpensive Part D policy to avoid the permanent policy, then upgrade later

Question 9

What Medigap policy covers all the deductibles and coinsurance amounts for A and B and foreign medical coverage?

Answer 9

Type F

Question 10

T or F - If you are signed up for SS you are automatically enrolled in Medicare and vice versa

Answer 10

False. Signing up for SS does automatically enroll you in Medicare, but the opposite is not also true.

Question 11

What are the three requirement for Medicare eligibility?

Answer 11

All the following are required:

40 SS credits
At least 65 years old
U.S. citizen or permanent resident

Exceptions - Exceptions to above rules apply for those with a disability or who have End Stage Renal Disease (ESRD)

Question 12

What are the deductible and coinsurance/co-pay amounts for Part A?

How often is the deductible payable?

Answer 12

Deductible

$1260 per benefit period (a new benefit period starts after 60 days after the last benefit period (hospitalization) ends. So, it may be necessary to pay the deductible more than once in a year if there are multiple hospitalizations.

Coinsurance/Co-Pay

Benefit Days (hospitalization) Days 1 through 60 - $0

Benefit Days (hospitalization) Days 61 through 90 - $315 per day

Benefit Days (hospitalization) Days 91 + - $630 per day for up to 60 lifetime reserve days. Once all lifetime reserve days are used, beneficiary pays 100% of costs.

Question 13

What is the deductible and coinsurance amounts for Part B?

How often is the Part D deductible due?

Answer 13

Deductible

$146 per year (2015). (Only paid once year instead of once per benefit period as with Part A)

Coinsurance

After deductible is met, Medicare pays 80% of charges, and beneficiary pays 20%.

Question 14

How does a beneficiary’s AGI impact their Part B premium? What about part D? What about premiums for Advantage and Medigap?

Answer 14

AGI determines the amount of the surcharge on Part’s B and D.

Advantage and Medigap coverage are completely private insurance and are not impacted by the participants AGI.

Question 15

For those who are turning 65, but plan on continue working, how is the decision made regarding whether to stay on the employer plan, or start Medicare?

Answer 15

An insurance analysis is needed taking into account the following:

Premium cost of employer coverage versus total premium cost of Medicare (Part B, D and Medigap)

Deductibles and Copays - Note - With Medicare plus Medigap, there are no deductibles or copays)

Availability of preferred doctors

In many cases the premium cost of the Medicare/Medigap package is cheaper. Also, Medicare/Medigap often compares even more favorably when deductibles and copays are considered.

Note - For employers with less than 20 employees, it is necessary to sign up for Part B to avoid penalties later.

Question 16

Are those enrolled in Medicare Advantage plans also enrolled in Medicare Parts A and B?

Answer 16

No. Going into an Advantage plan replaces A and B. To get back onto A and B, Advantage plan members must dis enroll during the dis enrollment period that runs from January 1 to Feb 15. There is one exception to this, which during the first year you are in Medicare Advantage, during which time you can disenroll and go straight back into Traditional Medicare plus Medigap without having to wait.

Question 17

What percentage of people disenroll from Medicare Advantage each year?

What is the common reason?

Answer 17

About 10%.

The most common reason is the difficulty some Advantage plan members have getting access to particular doctors, both primary and particularly specialists, and treatments.

Question 18

Do you have to be enrolled in Medicare to begin receiving SS benefits? If yes, which part?

Answer 18

Yes, if you are 65 or older and you want to start SS benefits, you must enrolled in Part A!!

Question 19

When someone enrolls in Medicare Advantage, how long do they have to go back on Traditional Medicare plus Medigap without having to wait to the Special Enrollment period?

Answer 19

One year.

Question 20

How is coverage for drug costs covered by Medicare Advantage?

Answer 20

Most Medicare Advantage plans provide drug coverage, obviating the need for Part D. For those that don’t provide drug coverage, enrollees must obtain a separate Part D policy.

Question 21

What is the Initial Enrollment Period for Medicare? When do benefits start?

Answer 21

The IEP is the seven month period that begins 3 months prior to your birth month and ending in the third month after your birth month.

If you enroll in the three months prior to your birth month, benefits begin on the first day of your birth month.

Question 22

Which Medicare premiums can be deducted from SSA payments?

Answer 22

Part B (done automatically, unless a specific request is made by the recipient. Part D and C can also be paid from SS payments at the request of the participant. Medigap is generally paid by the participant to the insurance company.