Medicare Unraveled: What your Employees Need to Know

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Medicare UnraveledWhat your Employees Need to
Know

• presentation location
• presentation date

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Topics

• What is Medicare?
• When should an employee enroll?
• How does other coverage work with Medicare?
• Who can help?

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What is Medicare?

• Established in 1965, a federal health insurance
  program
• Enroll through SSA
• Managed by CMS
• Who can get Medicare?
• People 65 years of age and older
• People under 65 with certain disabilities
• People with ESRD and other specific diseases

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Components of Medicare

• Part A
• Inpatient hospital coverage
• Part B
• Outpatient coverage (including doctors services,
  labs, tests, etc.)
• Part C (Medicare Advantage)
• Combines all benefits into a single plan
• Similar to an HMO or PPO
• Part D
• Prescription drug coverage

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For Comprehensive Coverage

• Medicare has premiums, deductibles, and
  co-payments
• To offset these costs, beneficiaries may purchase
  additional coverage
• Retiree coverage
• Medigap policies
• Medicare Advantage Plans (Part C)
• Veterans benefits or TRICARE

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When Should an Employee Enroll?

• First opportunity approaching 65th birthday

Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4 Birthday July 4
Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period Enrollment Period
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
If you join during If you join during If you join during Three months before Three months before Three months before Month of Three months after Three months after Three months after
Medicare starts Medicare starts Medicare starts July 1 July 1 July 1 Aug 1 Oct 1 Dec 1 Jan 1
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What Parts Should an Employee Choose?

• 65 years old continuing to work covered by EGHP
  (through self or spouse)
• Part A
• Can defer Parts B D
• Does not apply to same-sex marriages
• 65 years or older and retiring
• Parts A, B, D
• May have retiree coverage
• May purchase additional coverage

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What if Part B was Deferred?

• If deferred Part B due to coverage through active
  employment
• 8-month enrollment period
• Begins at separation or loss of EGHP coverage
  (whichever is first)
• Enrollment beyond 8-month period may result in a
  lifetime late enrollment penalty and a waiting
  period for coverage to begin

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What if Part D was Deferred?

• If deferred Part D due to creditable coverage
• 2-month enrollment period
• Begins after loss of creditable coverage
• Beneficiary must provide proof of creditable
  coverage (provided by employer/EGHP)
• Enrollment beyond 2 month period may result in
  lifetime late enrollment penalty and a waiting
  period for coverage to begin

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When Should an Employee NOT Defer?

• COBRA
• Not coverage through active employment
• Medical Security Program
• Health coverage through Department of
  Unemployment Assistance
• Active employment coverage through same-sex
  spouse
• Federal programs cannot recognize same-sex
  marriages

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How does Medicare work with other coverage?
If you Situation Pays first Pays second
Are 65 or older and covered by a group health plan because you or your spouse is still working Entitled to Medicare Group health plan Medicare
Are 65 or older and covered by a group health plan because you or your spouse is still working The employer has 20 employees Group health plan Medicare
Are 65 or older and covered by a group health plan because you or your spouse is still working The employer has less than 20 employees Medicare Group health plan
Have an employer group health plan after you retire and are 65 or older Entitled to Medicare Medicare Retiree coverage
Are disabled and covered by a large group health plan from your work, or from a family member who is working Entitled to Medicare Large group health plan Medicare
Are disabled and covered by a large group health plan from your work, or from a family member who is working The employer has 100 employees Large group health plan Medicare
Are disabled and covered by a large group health plan from your work, or from a family member who is working The employer has less than 100 employees Medicare Group health plan
Are 65 or over OR disabled and covered by Medicare and COBRA Entitled to Medicare Medicare COBRA
Are covered under workers compensation because of a job-related illness or injury Entitled to Medicare Workers compensation for services related to workers compensation claim Usually doesnt apply. However, Medicare may make a conditional payment.
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Medicare and HSAs

• An individual who is entitled to Medicare is no
  longer able to contribute to a Health Savings
  Account (HSA)
• Even if beneficiary only enrolls in Part A and
  defers Part B
• If a Medicare beneficiary has an HSA, he/she can
  still use existing funds in the account
• Funds can even be used to pay Medicare premiums,
  deductibles, or co-payments

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Who Can Help?

• Medicare
• 1-800-MEDICARE
• www.medicare.gov
• Social Security
• 1-800-772-1213
• www.ssa.gov

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SHINE

• Funded by Medicare, administered by Massachusetts
  Executive Office of Elder Affairs in partnership
  with local agencies
• 13 Regional Offices and one statewide
• (Greater Boston Chinese Golden Age Center)
• 600 certified counselors in almost every city or
  town in Massachusetts
• 1-800-AGE-INFO, press 3
• (1-800-243-4636)

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What does a SHINE Counselor Do?

• Provides free, and unbiased health insurance
  counseling to Medicare beneficiaries of all ages
  and their caregivers
• At a local site, on the phone, or via email
• Home visits are available for homebound clients
• Assists clients in finding coverage that meets
  their needs
• Answers questions regarding Medicare eligibility,
  enrollment periods, and benefits
• Assists with Medicare appeals and billing issues
• Screens for public assistance programs