Medicare 101�

Moreno Valley Unified School District Pre-Retirement 2018-2019

Is original Medicare enough? Usually not!

• Original Medicare only pays about 80% of your health care cost including hospital and doctor visits, it does not include prescription drug coverage. You can purchase a separate prescription drug plan Medicare Part D and a supplemental insurance plan. These plans are often referred to as Med-Supplemental or Med-Gap. You have a 7 month guarantee issue period of 3 months before your eligibility or within 3 months after your eligibility date. Your eligibility period is when you are turning 65 or when you are losing a qualified employer plan. A qualified employer plan is a medical plan provided by employer with more than 20 employees. Enrollment in a supplemental plan is also allowed during any open enrollment period if you can qualify medically, or if your Advantage Plan is no longer being offered in your service area. You also have an open enrollment period if you move out of your Advantage Plan service area. Enrollment in one of these plans after you turn 65 may result in a higher premium because the rate is determined by your enrollment age.
• These plans help cover the gaps of what Medicare doesn’t cover-such as coinsurance, copayments and deductibles. Often they include extra benefits also such as Silver Sneakers etc. With on of these plans you will have to enroll in a separate drug plan.
• You also can purchase a (Medicare Advantage/ HMO, PPO Plan) from private insurance companies. Medicare Advantage combines Parts A and B and usually includes prescription drug coverage. Advantage plans may also include additional benefits such as vision, hearing aids, wellness services, nurse phone line, gym memberships, etc.
• Last but certainly not least there is Part D. Part D helps pay for prescription drugs. It is only offered through private insurance companies. Failure to enroll in Part D or in a plan that includes Part D will result in a life time penalty added to your premium.

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Medicare Has 5 Different Plan Types

• A-Covers Hospitalization
• B-Covers Doctor visits
• C-Medicare Advantage Plan (HMO or PPO). These plans may include drug coverage, eye ware, wellness etc.
• D-Prescription Drug Coverage
• F, G, N- Supplemental/Medi-Gap

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Medicare Part A

• Part A covers inpatient hospital care. Part A covers everything that is crucial for your treatment, such as medications (only in hospital), x-rays, lab test, surgery, and meals. It can also pay for necessary follow-ups to inpatient care such as physical therapy or skilled home nurse care. Medicare Part A also covers hospice services for the terminally ill.
• Most people don’t pay a monthly premium for Part A, there may be a deductible and some further cost sharing that you do pay. Medicare Part A usually pays 80% and you are responsible for 20%.

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Medicare Part B

• Part B covers doctor’s care. It pays for outpatient hospital, lab tests, and some in-home nursing care. Part B generally makes it easier to get preventative care including your annual wellness exam, preventative screenings, and yearly flu shots. It can cover medical equipment to use in your home, as well as emergency room visits and doctor services while you are in the hospital.
• You will have to pay a monthly premium which is currently $135.50 for the majority of Medicare recipients but it can be more or less depending on income.

Medicare Part C

Medicare Part C is Medicare Advantage. It is can be known as HMO or PPO plans. Many plans include prescription drug coverage as well as dental and vision. Some plans have no copays. Some plans even include extra benefits such as gym membership and medical transportation.

Many plans offer $0 premiums, but you still have to pay your Part B premium. Most plans have copays for treatment. Medicare Advantage Plans work all by themselves. They replace Medicare Part A and Part B.

Your two options if you choose Medicare Advantage:

• Health Maintenance Organization (HMO)- with this plan you will use doctors in the network and you might need a referral to see a specialist.
• Preferred Provider Organization (PPO)- with this plan you can use doctors and hospitals outside of the network, but often for a higher copay. Very limited PPO Medicare plans to choose from if any in Inland Empire.

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Medicare Part D

• Medicare Part D covers your prescription drugs and is a great addition to pair with Medicare. You probably won’t need it if you get a Medicare Advantage plan because it is usually included.
• It is important to review what prescriptions are covered, it may help you decide on the plan best for you. You can pair this with either regular Medicare or a supplemental plan. If you are electing a standalone prescription drug plan you will pay a monthly premium, you can change prescription plans each year. The cost of prescription drug plans vary depending on the drugs covered and copays. It is important to choose your pharmacy wisely because remember what is applied to the donut hole is your copay and what the pharmacy charges the plan.

Medicare Part F, G, N

• Medicare F, G, N plans are also called Medicare Supplement or Medi-gap. These plans pays for charges original Medicare doesn’t like copays, deductibles, and coinsurance. It does it all with a predictable monthly payment and it can’t be canceled. Each supplemental plan has a different level of coverage.
• Part F – pays what Medicare doesn’t such as $185 deductible and other normal out of pocket charges. Basically with it you pay nothing except premium, prescriptions, and anything not covered by Medicare.
• Part G – pays everything Part F pays except for the $185 deductible.
• Part N – has the lowest premium of all the supplemental plans because with it you have copayments for doctors and emergency room visits, and excess charges. If your doctor doesn’t accept Medicare assigned rate you might be responsible for the excess charges + copays. You will also be responsible for the $185 deductible.

Review: Original Medicare Only?

• Original Medicare only pays about 80% of your health care costs. It does not provide prescription drug coverage and has an $185 deductible.

Questions to consider when choosing your Medicare options

• 1) Do I have a chronic condition?
• 2) What monthly premium can I afford?
• 3)Can I see the doctors I want?
• 4) Will my prescription drugs be covered?
• 5) Can I use the pharmacies I want?
• 6) Do I want total flexibility in choosing providers or will I in the future?

Review: When considering plans you have 2 paths to choose from:

Path 1- Medicare Part A (hospitalization), B (doctors visits), and D (prescriptions) if you purchase a plan. You also can purchase a Medicare Part F, G or N Plan (supplemental plan) to help cover copays etc.

Path 2- Medicare Advantage (HMO and PPO plans) which combines Part A and B and usually includes Part D (prescriptions). You can purchase D separately if it is not included.

Prescription Drugs-Part D

You have 2 choices:

• Stand-alone, Medicare Prescription Drug Plan (PDP)
• Medicare Advantage Plans that come with prescription drug coverage (Part D)coverage.

You have 4 coverage levels

• Level 1-You pay until you reach your deductible.
• Level 2-Your Part D insurance pays their portion until your $3820 total Part D drug spending is reached. Note: this includes what you pay and the insurance company pays. Choose your pharmacy wisely.

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Prescription drugs-Part D (cont’d)

• Level 3- Once $3820 is reached (this includes what you pay and what the drug plan pays), you are in the coverage gap until your expenses reach $5000. This is the “coverage gap”.
• Level 4-You exit the coverage gap when your actual spending for covered medications reaches $5,000. Exit from the coverage gap assures you pay a small coinsurance amount or copayments for covered medications for the remainder of the year.

Coverage Gap Calculation

Example: In 2019 Mr. A reaches the coverage gap, He goes to the pharmacy to fill a prescription for a covered generic. The price of the drug is $20 and there’s a $2 dispensing fee. The patient will pay 37% of the plan’s cost for the drug and dispensing fee ($22 x .37=$8.14). Only $7.40 will be applied as out-of-pocket spending to help him out of the coverage gap; dispensing fees are not counted towards the gap. Other items not counted toward gap are drug plan premiums and non-covered drugs.

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Medicare Plans Thru SISC

1. Blue Shield 65+ Advantage Plan
2. Anthem Companion Care Medicare Supplement
3. Kaiser Senior Advantage
4. You can keep any SISC plan the District offers.

Advantages to SISC plans - often less out of pocket expenses and better prescription drug coverage, no coverage -gap.

Disadvantage to SISC plans – monthly cost. You pay for Medicare Part B plus SISC premium. Supplemental and prescription drug plans outside of SISC also have a monthly cost.

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Enrolling In Medicare�1) If you are currently receiving Social Security you will be enrolled in Medicare automatically. If you are not currently receiving Social Security you can sign up during the 7 month period that begins 3 months before you turn 65 and ends 3 months after you turn 65. If you sign up within the 3 months before you turn 65 your coverage will begin the first day of your birthday month. ��2) To enroll you can go to Medicare.gov or make an appointment with a Social Security office by calling (800)633-4227. If you are over 65 when you apply you will need a form completed by the employer providing your medical coverage. The form is REQUEST FOR EMPLOYMENT INFORMATION. The form can be obtained from MVUSD Benefits Office if the District is providing your health coverage or Social Security can provide the form for the employer providing the coverage. Forms can also be found at www.medicare.gov. ��3) Be timely, failure to enroll within the enrollment guidelines may result in a penalty for life.