Hi everyone! This is Pam Fuchs with the Aging and Disability Resource Center
in Baraboo, Sauk County.
I am going to do my best to
provide you with an informational
session here
that you can access hopefully on our ADRC website
and/or
maybe ADRC Facebook page.
Typically, throughout the year my coworker and I provide you with some
face-to-face group
informational settings where we give you information
on Medicare and it's especially relevant to people who are
turning 65 soon. Due to CoVID we have not been able to do these sessions since January
so, I thought i'd do my best to provide you with this information online.
And, we'll see how today goes and maybe we can do some additional videos for you in the future if this goes well.
So, I'm hoping you can see my Power Point
slide presentation
to the side of my screen here
that says "Welcome to Medicare 2020".
Typically when we're meeting in person, we ask people to silence cell phones and give some logistic information, but we're going to pass through that
just to give you some basic information about our local Aging and Disability Resource Center office. We are located in the West Square Building
at 505 Broadway in Baraboo. It's a big building right across the street from the Courthouse.
Our office
offers a variety of services and we also have
six Information and Assistance Specialists who are licensed social workers
who also can provide you with a ton of information about other resources outside of our office that are offered throughout Sauk County.
So, if you have any questions about
where to go - you have a question - you don't know where to get the answer, give our office a call,
and if they don't know the answer they can direct you to someone who does.
We have some Disability Benefits Specialists
who assist people ages 18 to 59
in applying for Social Security Disability and also assisting with appeals if those disability
applications have been denied.
And then we also have Elder Benefit Specialists, which is what I am,
and
there are two of us.
I provide Elder Benefits Services to the eastern half of Sauk County, which includes Baraboo
Prairie du Sac, Sauk City, Merrimac, North Freedom;
and
my co-worker, Mindy Schrader,
provides
the same services to the folks in the western half of the county. And we provide services to people age 60 or older.
Some of the EBS or Elder Benefit Specialists
services provided
include assisting with some consumer issues like billing, debt collections, landlord tenant issues,
applying -
exploring eligibility and applying for Medicare Savings Programs or Medicaid programs.
We do help people age 60 or over apply for Social Security Disability.
We do not assist with appeals, but we can get you resources
on that if that is a necessity. We do -
the majority of what we do is related to
Medicare,
so helping -
you know, helping you guys understand Medicare,
the eligibility, how to apply for it, what the benefits are, what the costs are, and what your additional options are once you're on Medicare.
We do work under the supervision of a program attorney,
so if you do choose to work with us
you are - you are protected by that attorney-client privilege.
So, what i'm going to try to get through
in this meeting is a brief overview of Social Security,
but mainly the information regarding Medicare. I think that I'm limited to 40 minutes here,
so i'm going to do my best to get through everything
efficiently for you here
so, just a brief overview of Social Security retirement benefits. This is the cash
benefit money. This is not insurance. This is
your cash money retirement that you have earned through working your whole life or that your spouse has earned through working
throughout their lives that you're eligible for once you get older.
You can apply for Social Security retirement benefits through the Social Security Administration.
For folks living in Sauk County our local office is the Social Security Administration office in Portage.
Due to CoVID19 they are currently closed and working from home,
but you can still call them and and ask for an appointment by phone
to apply for your Social Security retirement benefits.
You can also apply for these benefits online at their website ssa.gov
or you can contact
either Mindy or myself depending on where you live in Sauk County. We can help you do that application also.
You can apply for Social Security retirement benefits at any age between 62 and 70.
Everyone has what's called a full retirement age.
If you wait until you reach your full retirement age
then
you are eligible to receive 100 percent
of your benefits that you have earned
If you want to, however, take your Social Security retirement benefits before you reach your full retirement age
you absolutely can do that.
You can take your benefits as early as age 62
but your monthly
amount, your monthly benefit amount will be reduced by about eight percent for every year that you take it early.
So, for example, if you waited until your full retirement age to draw your social security benefits
and your full 100% benefit is a thousand dollars a month
you'll get a thousand dollars a month.
If you decide to take it a year early
you'll get about nine hundred and twenty dollars a month because you're taking it about a year early,
so it'll be reduced by about eight percent.
Likewise, if you don't want to take your retirement benefits when you reach your full retirement age you can also
postpone taking them until
a later date - as late as age 70.
And,
what happens then is your benefits increase by approximately eight percent every year
until you reach age 70, and at age 70 they max out.
So, your full retirement age is based upon your date of birth.
I think for folks born in 1954
the full retirement age is 66, but if you were born after that
they've started adding on two months. So, for some people it's going to be 66 in two months
then it's 66 and four months and so on and so on until age 67, I think
for the younger folks.
You want to apply for Social Security retirement benefits approximately three months before you want them to begin
because it takes Social Security some time to process your application.
If you have decided to take your Social Security retirement benefits before
you turn 65, if you took them early,
you will automatically be enrolled into Medicare at age 65.
But, if you have not begun taking your Social Security retirement benefits early
then you're going to have to sign up for Medicare at age 65.
For everyone turning 65, they are eligible to sign up for original Medicare which includes two parts.
Part A which is hospital insurance and Part B which is medical insurance.
Medicare Part A enrollment.
Again, if you've already begun drawing on your Social Security retirement benefits, they're just -
Social Security is just going to automatically sign you up for Medicare Part A.
They are going to mail you your card in the mail and
you're just going to have a start date of the first of the month that you turn 65.
Some people who are on disability
who are under the age of 65 but have been awarded Social Security Disability
and have been on disability payments for 24 months
are eligible for Medicare regardless of age,
and, again, they will be automatically enrolled when they're eligible.
If you're not drawing Social Security benefits at age 65
then you need to
manually sign up for Medicare.
And, again, that can be done either by going to Social Security office in Portage in person,
normally, not during CoVID, but normally you can do that. Or you can call the Social Security office in Portage,
or you can do it online through their website ssa.gov,
or you can contact your local Elder Benefit Specialist at your local ADRC and we can help you with that too.
Your initial enrollment period for Medicare
is a seven month window. It's the three months before you turn 65,
the month that you turn 65, and then the three months after you turn 65.
So,
if you don't sign up
for medicare during this seven month window
you will be automatically enrolled into Medicare Part A later, when you sign up for your Social Security retirement benefits.
So, let's say at age 65 you don't sign up for Medicare, you keep working and then at age 67 you decide "Okay,
I want to take my social security retirement money benefit now!"
And you apply for that.
Social Security office will start your Social Security Retirement Benefits
and then they're going to automatically enroll you into Medicare Part A and back date that Part A start date
six months.
So, that is important information to know
if you work for an employer where you have a high deductible
health insurance plan
with a Health Savings Account that you contribute money into
because
everyone who is turning 65 is eligible for Medicare, and once you are eligible for Medicare you are no longer eligible
to make
those tax
deductible
Health Savings Account contributions.
So, it's important
- it's important if you have a Health Savings Account to stop making those contributions
before you're turning 65.
You can still use up whatever money is in that account, but you have to stop making the
contributions or you can face some tax penalties.
Also, for folks who are enrolled in a marketplace plan or an Affordable Care Act or Obamacare
it's important that if you are receiving any tax subsidies to help with those
premiums being lowered for you
you are also not eligible for those tax subsidies once you're eligible for Medicare.
So,
it's important to call and cancel your Affordable Care Act plan when you're turning 65 and signing up for Medicare.
Medicare Part A is free.
You don't pay a premium for that. It's only -
it's only hospital insurance. So, it's only going to provide you with coverage
for an inpatient hospitalization stay or inpatient nursing home stay.
You earned that if you're eligible for Medicare, you're eligible for Social Security retirement.
It means that you've earned 40 work credits throughout your life,
40 work credits is equivalent to 10 years of full-time work
added up over time.
And so you get Part A for free.
If you have Medicare Part A and you end up going into the hospital,
Medicare Part A has a deductible of
1,408 dollars per 60 day hospitalization.
So, what that means is - if you go into the hospital in January and let's say you're in the hospital for a week,
you're going to have a bill for 1,408 dollars
and then the rest of your hospitalization stay would be covered in full.
But, let's say you go back into the hospital in July of that same year,
more than 60 days have passed,
so, therefore you're going to pay that deductible a second time.
So, that deductible is not per year. It is for 60-day hospitalization.
And then there may be additional daily co-pays if you are in the hospital longer than 60 days.
So, this just kind of gives you a breakdown. If you're in the hospital between zero and 60 days
you pay that 1,408 deductible and then the rest of your stay is covered in full,
but, if you have to be in the hospital for up to 90 days
there's a 352 dollar co-pay per day.
Days 91 through 150 there's a 704 per day co-pay.
Medicare part a also includes some home health services,
some blood, hospice care,
and it covers skilled nursing facility stays
with a qualifying three-day hospital admission. So, what that means is if you go into the hospital
and
they say they want to transfer you to the nursing home for rehab
you must have
been admitted as an inpatient into the hospital for three days
before being transferred to the nursing home if you want Medicare to pay for that stay.
If you have that three-day qualifying hospital admission, then Medicare will pay for your first 20 days in the nursing home in full.
If you're there for days 21 through 100, you will have a
176 dollar per day copay, and if you're in there longer than 100 days you have zero percent coverage under your Medicare Part A.
Now, there are some additional things that can help with those costs and we'll get there, but this is
the starting point of your Medicare Part A coverage.
We've kind of already covered this -
You have to be admitted as an inpatient for at least three days into the hospital prior to being transferred to the nursing home.
You cannot be held as on observational status. You cannot be held for one night or two nights.
It must be inpatient three nights.
Once you're transferred to the nursing home in order for medicare to continue paying for your stay you must be receiving skilled nursing care
provided by nursing or therapy staff as ordered by your physician.
So, things like
occupational therapy and physical therapy. Skilled care must be being provided to you.
Medicare Part B.
Medicare Part B enrollment.
Again, if you're already drawing Social Security retirement benefits
then
you will automatically be enrolled into Medicare Part B
and your start date for Part B will be the first of the month that you turn 65.
If you
happen to have a birthday on the first of a month
it will be backdated by one month. So, let's say you're turning 65 on
August 1st and you're drawing Social Security,
Social Security will automatically enroll you into Medicare,
but your start date, instead of being August 1st - it will be back dated to July 1st.
For most people
your start date for Medicare A and B is going to be on the first of the month that you turn 65,
but if your birthday happens to fall on the first it gets backdated by one month.
Again, if you're under 65
but you're drawing Social Security disability benefits for at least 24 months it also, you also will be automatically enrolled.
If you're not drawing any Social Security benefits at age 65
then again same process as Part A. You need to sign up for
Medicare Part B through the Social Security Administration in person, by phone, or online.
You have the same seven month window.
If you have the three months before you turn 65,
and if you sign up anytime in those three months before you turn 65
you will get a start date of the first of the month that you're turning 65.
If you wait until the month that you turn 65, your start date for Part A
will still be
the first of the month that you turn 65,
but your Part B start date will be the first of the following month.
So, for example if you're turning 65 in August and you wait until the month of August to sign up for Medicare A and B,
your Medicare A will still start on August 1st, but your Part B will not start until September 1st.
Likewise, if you wait until the three months after your 65th birthday
your Part - your A will still start on the first of the month that you turn 65,
but that Part B
is going to be delayed for
anywhere between two and three months and it gets kind of complicated,
so i'm not going to get into that too much. You can contact us for information on that.
But, just know if it's important to you to get your A and B starting
when you turn 65 you do not want to delay signing up because the Part B
start date will be delayed anywhere between two and three months depending on how long you wait.
In addition to your initial enrollment period
there are also some other times when you can sign up for Medicare.
Every year between January 1st and march 31 there is an annual general enrollment period
for people who did not take Medicare when they turned 65
and did not have any other
coverage through work, so they don't have any other special circumstances that allow them to sign up whenever they want.
So, for people in that category they have to wait until
January, February, or March of whatever year they're in and they can sign up for Medicare.
Their Part A -
or their Part B, however, will not start until July 1st.
So, if you didn't take Medicare at age 65 and you just haven't had any other insurance and now you're
68 and you want to sign up for it
you'd have to wait until January, February, or March to sign up and then the Part B would not start until the following
July 1st.
So, and then those folks also would have a late enrollment penalty
I'm sure I'm going to get into this in a future slide, but if you don't have if you don't take Medicare Part
B when you turn 65 and you did not have any other
creditable coverage, and I'll explain what that is in a minute,
you're stuck with this general enrollment period and you're stuck not getting that Part B to start for you until the following
July 1st. So, you could have a lapse in coverage.
You might need it right now, but you can't get it right now.
And then, secondly, you may very likely have a late enrollment penalty assessed which
means that you know, they'll they will make you pay
10 percent
higher premium every single month
for every year that you didn't have Medicare Part B that you were supposed to they're going to assess a 10 percent late enrollment penalty
So, the current premium is about 145 dollars a month, if they assess you a 10
late enrollment penalty, you're not paying 145 bucks a month you're paying about
156 bucks a month every month for the rest of your life.
Some people do have what's called a special enrollment period.
If you're turning 65, but either you or your spouse is actively working
and carrying the insurance
you do have the right to sign up for Part A only and defer taking Part B.
Creditable coverage for Medicare is insurance that Medicare considers as good or better
than Medicare. The only thing that Medicare considers credible coverage is insurance through active employment
of you or your spouse
and that active employment is for a an employer that employs at least 20 or more employees. It can't be a small
Company. It can't be self-employment.
It has to be a large group
employer.
and
you have to verify with that employer's
personnel or HR department that the insurance that they're providing to you is considered creditable for Medicare.
But, if it is you can defer taking Part B until you're ready to stop working.
You have - you can sign up for Part B at any time while you're working or up to eight months after you stop working,
and you can pick your start date for Part B.
So, again, just kind of reiterating for people turning 65
creditable coverage is health insurance that is provided by a large group employer of 20 employees or more
that is earned by you or your spouse through active employment.
Retirement coverage does not count.
Cobra does not count.
Marketplace does not count. It is only active employment of a
of an employer of 20 employees or more and please verify with your personal department that your insurance is considered creditable.
For people under age 65 who have -
who are disabled,
it's a little bit stricter and generally
they have to be employed or their spouse has to be employed by a large group employer of 100 employees or more.
So, again, please verify with your
company
that you don't - You don't want to not take Part B thinking that you have creditable coverage and then find out later that it wasn't.
Again, what is not considered creditable is
Veterans.
Veterans is not considered creditable.
Marketplace, Cobra, retirement coverage, federal retirement insurance programs.
None of those - Some of those are great insurance programs, but they're not considered creditable coverage for Part B.
If you delay taking Part B
thinking that you have creditable coverage and then find out that you do not
you will have a premium penalty of 10 percent more for life for each year that you were eligible for Part B
but did not enroll.
Medicare Part B monthly premium is 144.60
for for the year 2020. Those rates can change.
If you have a higher income
you could pay pay more than that, but most people pay 144.60 a month.
If you're drawing Social Security they're going to take those premiums right out of your social security check
and you're going to continue to get - receive the the remainder of your Social Security minus that premium.
If you're not receiving Social Security yet, but you do take Medicare,
they are going to bill you. They're going to send you a bill for that premium and the billing is done quarterly.
So, they will send you a bill for three months worth of that premium at a time
and the first bill that they send you when you first sign up for Medicare
is sometimes even higher than that because it depends on when you're signing up within their billing cycle.
And, again, Social Security can take some time to get things processed.
So, you might sign up for Part B and have it
for a month or two and not receive a bill, and then when you do receive the bill
Social Security is going to send you a bill for the past
two months and then the next three months, so you might get a bill for
three months, four months, or five months that first - that first
bill that you receive. After that they will send you a bill quarterly or
they will send you information on how you can set up an auto withdrawal from a checking or savings account on a monthly basis if
you want to do it that way. And then once you do begin receiving your Social Security retirement benefits
then they'll start taking the premium right out of that.
The Medicare Part B
Is your medical insurance. So, remember I said Part A is hospital? That only works as an inpatient.
This is your medical outpatient health insurance. It has a 198 dollar per year deductible
and then after you meet the deductible, it pays 80 percent of your medical bills,
and the other 20 is your responsibility and there is no cap to that.
IRMAA is Income Related Monthly Adjustment Amount. This just means that if you have a higher
income
that your premium for Part B may be higher.
They base this on your income from your taxes from two years prior
and then they review it every single year, and if it changes they'll lower or raise your premiums depending on on what your income
was.
There is a Medicare Costs at a Glance handout that we usually give you,
but you can find that information on Social Security's website also.
Medicare Part B covers medically necessary outpatient services including doctors visits, specialist visits, lab work, x-rays,
ambulance rides, emergency room, urgent care,
outpatient hospitalization. So, if you're kept on observation status
or
you have an outpatient day surgery or procedure where you're not admitted overnight as an inpatient. That's all under your Part B.
Any outpatient therapies. Part B medications include things like chemotherapy or kidney dialysis where you have to go
and have the the medicine or drug administered to you
there
and then there are some preventive services that Medicare Part B covers where you do not have to worry about the
deductible or the 20 copay.
And, again, there is a
Guide to Medicare's Preventive Services brochure
that you can locate. I would say we probably have them at the ADRC office.
I know that we -
that they are found on medicare.gov
also.
When you first start your Medicare, it includes a Welcome to Medicare Visit
for the first time and then every year after that.
it includes a yearly wellness visit. When you're scheduling these appointments it's very important to use that terminology
when scheduling the appointments, because if you call and say i'm calling to schedule my annual physical
or i'm calling to schedule an exam,
that is not a Welcome to Medicare Visit and that is not a yearly wellness visit.
The Welcome to Medicare and the yearly Wellness Visits are very -
are very short, brief contacts with your doctor where they kind of go through a checklist with you.
If you during those visits say, you know "I've been feeling dizzy." and he says "Well, let's check you for vertigo."
or "Let's do some blood work and make sure you're doing okay."
that gets flipped over into a regular office visit, and it will be subject to the deductible in the copay.
So, it's very important to
when you're scheduling those visits say i'm calling to schedule my Yearly Wellness Exam or my - i'm sorry - my Yearly Wellness Visit under Medicare
so that they know
what to schedule you for to make sure that you don't have to worry about that deductible and 20 copay.
Services not included by your Medicare. Medicare does not include any vision. No dental. No hearing aids. Nothing.
No long-term care needs.
No cosmetic procedures. Not, no acupuncture.
It does not provide any health care outside of the united states. So if you're traveling anywhere in the country
Medicare is a federal insurance. It's going to work anywhere inside the united states,
but it will not work outside the United States at all.
It does not include routine foot care.
Basically, anything that's not considered medically necessary Medicare is not going to cover it. It also does not include prescription drug coverage.
So, original Medicare is health insurance administered
by the center for Medicare and Medicaid Services or CMS.
For those of you that are already drawing Social Security retirement benefits,
remember I said that they're just going to automatically enroll you into Medicare and then mail you your card.
Watch in the mail for anything from CMS.
That will be your Medicare card. I know that people turning 65 are being inundated with a lot of junk mail,
and so sometimes they just start throwing stuff in the garbage. If you get anything that says SSA that stands for Social Security Administration.
Anything from CMS stands for Center for Medicare Services. Don't throw that stuff out that's important.
Again Medicare pays a big part of your health insurance expenses, but it doesn't pay for all of them.
So, next we're going to look at your additional options
to go along with your Medicare.
So,
before we start looking at prescription drug options the first thing that we kind of look at is:
Do you want anything to go along with your
Original Medicare A and B health insurance? And you have two
routes that you can go. The first option is that you can add on what's called a Medicare Supplement
or those are sometimes called Medigap policies.
The second option is that you can add on a Medicare Advantage plan, which those are sometimes referred to as Medicare Part C.
So, we will start by kind of looking at the Medicare Supplements.
So, a supplement, true to its name, is going to
supplement your Medicare - your med -Your original medicare is going to pay first.
Your Medicare Supplement is going to pay second. And you're going to have very comprehensive health insurance coverage.
Medicare Supplements are sometimes called medigap policies because they fill in that 20 percent gap that's left over by Medicare Part B.
If you want to buy a medicare supplement, the very best time to do so is within six months of your part b starting
Because you have what's called six months of guaranteed issue.
Guaranteed issue means that you are guaranteed to be issued any supplement that you want,
No questions asked. you do not have to answer health questions.
You do not have to worry about pre-existing conditions.
You can go to an insurance agent and you can buy any supplement that you want and they cannot ask you any health questions.
However, once that six month window closes
If you then want to purchase a supplement
Your guaranteed issue window has closed, and at that time you would be subject to health underwriting.
They can ask you health questions. They can deny selling you a policy they can
exclude
pre-existing conditions, or they can charge you more money for a supplement if you
Do have pre-existing conditions. So, if your health history is not the greatest and you
do want to have comprehensive coverage the best time to buy a supplement is right away when your Part B is starting
so that you don't have to worry about that in the future.
Once you sign up for a Medicare Supplement, it's guaranteed renewable for life. As long as you pay your premium
It's the safest most comprehensive option.
If you buy a supplement sold in the state of Wisconsin
they are all monitored by the Office of Commissioner of Insurance or OCI
and they are all standardized.
In Wisconsin - these plans that are sold in Wisconsin
are going to follow you wherever you go,
so if you are a snowbird and you want to live down south part of the year,
or if you want to travel a lot throughout the country, or if you plan to move maybe to a different state
the traditional supplement sold in the state of Wisconsin
Is going to follow you wherever you go. So, as long as you go somewhere
and Medicare is paying first your traditional supplement that you buy in Wisconsin is going to always pay second.
And, it's not going to matter
if you go to the Dean network of providers, or the UW network of providers, or if you move to Alaska.
It will follow you there.
OCI mandates that
all of these supplements are going to provide you with the same basic coverages and the same options to add on
Medicare Supplements are sold by insurance agents.
So, all insurance agents doing business in Wisconsin are licensed by OCI
and, and they're all - all the supplements are mandated to provide you with the same basic stuff.
So, you know if you if you see an agent and you have a concern you can always contact OCI
to file a complaint or to check on an agent's license.
Most of the agents, I think,
do believe that their product is the best or they wouldn't be selling it,
but if you ever feel pressured certainly you don't have to purchase a supplement from from that particular agent. You can feel
safe in knowing that all of the Wisconsin supplements are going to do just fine for you.
So, you can feel free to purchase one from whichever agent you feel comfortable with.
Traditional supplements again are always going to pick up the other 20 percent left over by Medicare Part B
They're going to include all of the OCI mandated benefits.
So, OCI has a list of benefits that they mandate that every single supplement sold in Wisconsin has to provide to you
and any supplement that you buy is going to provide that.
You can see any provider who accepts Medicare first. Your traditional supplement is going to pay second
and it's always going to pick up that 20 percent. You can add on
some optional riders if you are okay with your premium being a little bit higher.
So, if you want your supplement to pick up that Part A deductible when you go into the hospital, you don't want that bill for
1,408 dollars.
You can add on
a Part A deductible rider onto your supplement and your supplement will cover that for you.
Or you can ask your supplement to pay 50 percent,
so, if you go into the hospital your supplement will pay about 700 and you'll pay the other 700.
For folks whose Medicare started -
at least their Medicare Part A started prior to
January 1 of 2020
they can also purchase a Part B deductible rider to cover that
198 dollar per year Part B medical deductible. If your medicare is starting after January 1st 2020
this is no longer an option for you to purchase.
There's a rider called Part B access charges
which means if you happen to go to a provider that does not like the Medicare assigned rate
and they want to charge you more money than Medicare wants to -
than Medicare feels the service is worth,
they have the right to charge you what's called excess charges of up to 15 percent more.
So, what that means is if you happen to go to the doctor -
Let's say you go to the Prairie Clinic and you have an appointment
and the Prairie Clinic bills it to Medicare and Medicare says okay that appointment's worth a hundred dollars,
so Medicare is going to pay 80 percent of that, which is 80 dollars.
Your supplement would pick up the other 20 dollars. You're not going to have a bill.
But, let's say you have that same appointment at the Mayo Clinic.
Mayo Clinic reserves the right to charge excess charges.
So, Medicare is going to say well we still feel it's only worth a hundred dollars,
so we're gonna pay eighty percent which is eighty dollars.
Your traditional supplement is going to come in next and pay the other 20,
and then the Mayo Clinic is going to have that extra 15 percent
or 15 dollars hanging out there because they they reserve the right to charge more
which would be your responsibility
unless you have this Part B Excess Charges rider on your supplement.
If you have that rider, then the supplement will also pick up that 15 percent
extra charge that the Mayo Clinic is charging you.
So, most of the providers in this area do accept Medicare assignment.
The Mayo Clinic is the only one in this area that we are aware of that does not.
But, we do see this a little bit more at places that sell durable medical equipment
where they require you to pay in full for your durable medical equipment, and then they will bill Medicare,
and then they will refund you the money
that Medicare pays minus the excess charges.
So, if you don't want to worry about any of that
you can just tell your insurance agent to add on that excess charges rider, so it's taken care of.
Supplements will also provide you with some emergency medical coverage
if you wish to travel outside of the United States. Remember I said Medicare is a is a federal insurance?
It's going to work anywhere within the United States with no problem.
Your Medicare supplement, if purchased in Wisconsin, your traditional Medicare supplement will also follow you wherever in the United States that you go.
But, if you go outside of the country
and
have an emergency, Medicare isn't going to work. If you add on the Emergency Foreign Travel coverage rider onto your supplement
your supplement will provide you with some medical emergency coverage outside of the country.
Your supplement also gives you the option to add on some extra home health care.
Medicare and your supplement already provide you with some home health care
if you need that upon your release home from the hospital or the nursing home. This is just an
extra home health care benefit for continued services if needed.
Most of the supplements are going to be - I would say an average price range for a supplement is probably going to be around
140 bucks a month for someone age 65.
They can be less they can be more. There are ways to keep your premiums a little bit lower.
Most of them are going to be what are
called Attained Age, which means
the cheapest they're ever going to be is at age 65 and then in age 70 75 80 and 85
they're gonna bump up their premiums just because you're getting older.
There are some that are called Issue Age
where they the premiums will not go up every five years because of your age,
but they still can't increase for inflation and other reasons.
Cost sharing means, you know, you're willing to pay a 25 percent
or 50 percent
co-pay
in order to keep your monthly premium down. And then high-deductible same thing if you're willing to pay some sort of a deductible
then some of the insurance agents can sell you a plan that is going to have a lower premium.
Historically, there have been things called Select Supplements
which work like HMO's. I'm going to skip over that because
they're not sold anymore in Wisconsin. So, it's not an option for you.
So,
if you had chosen to go with the Medicare Supplement again, Medicare pays first Supplement pays second.
You have 100 coverage. You can go to any doctor you want.
If
you know, you say well, you know, I
live in Baraboo and I doctor in Baraboo and I don't travel and I don't want to spend 140 dollars a month on a supplement,
some people choose a Medicare Advantage Plan.
Medicare Advantage Plans are sometimes called Part C.
They do not work like supplements at all.
A Supplement pays second to Medicare.
So, if you have a Supplement you go to the doctor you show them your Medicare card.
It pays first. You show your Supplement card. It pays second.
If you choose to instead sign up for a Medicare Advantage Plan, Medicare Advantage plans
do not pay second to your Medicare. They pay instead of your Medicare.
So,
you still have to remain enrolled in Medicare A and B.
You still have to pay that Part B premium.
But, think of it like taking your Medicare Card and you're going to put it away
on a shelf at home in a safe place because you need to have it.
You need to be enrolled in it. You need to pay for it, but you're not going to be allowed to use it
If you choose to sign up for an Advantage Plan
the Advantage Plan steps in front of that Medicare and it becomes your only health insurance.
It becomes your health insurance and your drug coverage. Usually all-in-one. Most advantage plans include your drug coverage right in them.
So, it's - Medicare
contracts with these Advantage Plans to take over
providing you with your health insurance. So, they replace your Medicare. They do not pay in addition to it. They pay instead of it.
They are not guaranteed renewable for life. They can end each year.
Every year there's an annual open enrollment where you can get in or out of these Advantage Plans.
They are monitored by Medicare.
So, they have to pay at least as good as Original Medicare would have. So, Original Medicare
Part B is
pretty much 80/20. It pays 80 percent you pay 20 percent.
An Advantage Plan can't pay worse than that.
But, they are not monitored by OCI, so they're not required to provide you with any of those OCI mandated benefits.
Most Advantage Plans have lower premiums than supplements. I say most because there are some Advantage Plans that are
200 to 250 dollars
a month.
Most -
almost all of them are going to have
co-pays, deductibles, co-insurance of some sort. Those 200
to 250 dollar range
obviously have much fewer, co-pays and deductibles, but they still have them.
You have to buy an Advantage Plan that is sold in your county and you have to see providers that accept your plan.
There are
Advantage Plans that that are HMO's where they say you absolutely have to see
our providers network or we will give you zero percent coverage if you go out of network. There are some plans that are called PPO's
where they say we have a provider network that we want you to use,
but we'll let you go out of network if you want to,
but
there's usually strings attached to that which include if you go out of network
we're going to have a higher copay or we're not going to pay as well. Not always but most of the time.
There's some Advantage Plans that say that they are private fee for service
and they say we don't have a network of providers that you can go anywhere you want, which is technically true.
They don't have a network of providers
but you still can't necessarily go everywhere anywhere you want
because you have to ensure - you have to double check and make sure that whatever provider you want to go to
is willing to accept that insurance.
So, just because the the Advantage Plan says you can go wherever you want doesn't mean that the Doctor
Smith down the road is willing to accept that insurance. So you still have to make sure that he's willing to take it.
Let's see here. So you must see providers who accept the plan.
If you go to a provider that does not accept your Advantage Plan
then you're gonna get a bill for the full amount of the service.
Because, you remember, you've replaced that Medicare Card with your Advantage Plan now so you don't have that Medicare card to fall back on.
Most Advantage Plans are going to include drug coverage and they will offer you some perks
like some vision, some dental, some hearing aid benefit, maybe some free over-the-counter medicines.
The - the amount the amount of perks that you get is generally directly
related to the premium that you pay, so Advantage Plans can be as low as zero dollars per month
which sounds great, but for a zero dollar a month plan
you're not going to get a lot of those perks, and you're going to have a lot of medical co-pays, and
co-insurance, and deductibles, and medical bills.
An Advantage Plan that has, you know, a premium of 200 or 250 dollars
a month is probably going to come with a lot more of those perks and a lot fewer
medical co-pays, and deductibles, and co-insurance when you go to use the insurance, so it's usually a pretty direct
correlation there. Medicare Advantage plans do not ask you any health questions,
so other than if you have had or if you currently have end-stage renal disease,
which is kidney disease, if you have end-stage renal disease you are not eligible to purchase an Advantage Plan.
If you develop end-stage renal disease while you're enrolled into an Advantage Plan they will not kick you out,
but if you already have that they're not going to sell you a policy.
Other than that
they don't ask any health questions so you can get in or out of them every single year during that annual open enrollment.
And they do have annual caps on your out-of-pocket costs,
so what that means is if they charge you co-pays every time you go to the doctor, they're going to keep track of those co-pays
and the co-insurance that you've paid, and if you need a certain cap per year
they will cover you in full for the rest of the year.
So, for example, if you're if your two hundred and forty dollar a month Advantage Plan has an annual
cap of four hundred dollars that means that you will pay no more than four hundred dollars in co-pays or coinsurance per year.
If your zero dollar per month plan has a cap of six thousand seven hundred dollars
that means you're going to be paying co-pays and co-insurance until you meet that sixty seven hundred dollar cap
per year, and then next year it starts over.
Medicare Advantage Plans have that initial enrollment window at age 65 the same as Medicare Part A and B,
so it's the three months before you turn 65,
the month you turn 65, and then the three months after.
You have that seven month window to sign up for an advantage plan at age 65 if you wish to do so.
After that
you have an annual open enrollment every single year between October 15th and December 7th where you can get in or out of them.
Anyone on medicare is eligible to do that.
Additionally, every January 1st through March 31st there's a second
open enrollment period for people who are
currently in an Advantage Plan if they did not
take care of it during the fall.
People who are currently enrolled in a Medicare Advantage Plan have a second opportunity
to drop their plan or switch into a different Advantage Plan.
That second open enrollment from January 1 through March 31 is not open to everyone.
It's only open to people who are currently enrolled in a Medicare Advantage Plan.
And then again, there's always special enrollment periods based upon different scenarios. So if you are ever feeling stuck
you can always call us. We can always see if we can find a special enrollment. No guarantee.
But, we can always see what we can figure out.
I kind of already touched on this - there's PPO's, HMO's, and private fee for services and I kind of already explained those to you.
In 2020, there are 29 different Advantage Plans offered in Sauk County by five different companies.
The premiums range from zero dollars a month to 241.
There are deductibles and
co-pays
ranging from zero dollars up to twenty percent depending on which plan - how much - how high of a premium you have.
Most of them include drug coverage - not all of them - but most of them include drug coverage right in them.
So if after hearing the difference between Supplements and Advantage Plans, you're leaning towards. "Oh, I think I want to go with a supplement.".
Remember, Medicare does not include prescription drugs.
So, a Supplement is only going to pay second to whatever Medicare pays so a Supplement is not going to include drugs either.
So, if you're going to go with Medicare plus a Supplement, you also have to add on some sort of prescription drug coverage.
And for people who are on Medicare, you have a couple of options. Well, you have a few options.
You can sign up for a Medicare Part D prescription drug plan or you can have creditable coverage from another source.
So, credible drug coverage
for Medicare purposes does not necessarily need to be from active employment. Remember we said
creditable health insurance for Medicare Part B does have to be through active employment.
That's the only thing that's considered creditable for Part B (as in boy).
But for Part D (as in drug),
you can have creditable coverage from another source such as Veterans, Meds by Mail program is creditable,
employer coverage, retirement coverage, Cobra, coverage from a spouse is insurance,
State of Wisconsin Senior Care is another option in the state of Wisconsin and I will explain that to you.
So, creditable coverage for Part D (as in drug) can be from various places other than active employment,
but again, just verify that it is considered credible.
State of Wisconsin Senior Care is a state of Wisconsin drug plan. It's called a State Pharmaceutical Assistance Program.
You have to be a resident of the state of Wisconsin and you have to be at least 65 years old to enroll.
State of Wisconsin Senior Care does not charge a monthly premium. It charges a yearly thirty dollar enrollment fee.
Your gross yearly income
determines if you have a deductible under Senior Care or not.
If you are single it goes by your single gross annual income.
If you are married
it goes by your combined gross annual income regardless
of whether you both are signing up for Senior Care or only one of you is.
It's accepted at most Wisconsin pharmacies. You can sign up for it at any time of the year.
You don't have to worry about "Do I have a special enrollment?", "Is it annual open enrollment?",
"Am I in in my initial enrollment?". You can you can sign up for Senior Care anytime you want as long as you're 65
or older.
It is the lowest cost option for those with no medications.
So, Medicare says you have to have some sort of insurance to cover your prescription drugs
Sometimes people say well, I don't take any prescription drugs.
So, why should I pay for a Medicare drug plan when I don't take any meds? Sign up for State of Wisconsin Senior Care.
It's the cheapest. Something that you can have to satisfy
the requirement that says you have to have something. It's 30 bucks for the whole year
and it it meets the requirement. And what that's going to do is it's going to prevent you from having a late enrollment penalty,
later, if and when you do need to sign up for a Medicare drug plan.
So, you don't you don't want to do nothing because if you do nothing,
and then five years down the road you want one of those medicare drug plans,
they're gonna charge you a higher premium every single month because you didn't have something.
This is the cheapest something you can have.
If you do take meds and you need a Medicare drug plan,
again, it has the exact same initial enrollment period as Medicare A and B
and
C.
Those Advantage Plans D (as in drug) has the exact same initial enrollment period.
It's the three months before you turn 65,
the month you turn 65, and the three months after you turn 65.
If you don't sign up for a Medicare Part D drug plan during your IEP
then
you have the annual open enrollment of October 15 through December 7th every single year
to get in or out of those drug plans. You can drop it. You can switch it. You can sign up for something different.
You can enroll if you never enrolled before and then your coverage will start January 1 of the next year.
If you sign up for a medicare drug plan and you're really happy with it this year, and everything's going great,
and you think "Uh, i'm just gonna stick with it.", please check it every single fall.
The medicare drug plans work on an annual contractual basis with Medicare
which means that every single year these plans can change.
They can raise their premiums, raise their deductibles.
They can choose to no longer cover your meds. They can choose to no longer work at your pharmacy.
A new plan might come out that is going to save you some money.
Your medications could have changed in over the course of a year
and you might get put on something - you might be on something different that maybe a different plan would cover better for you.
So, even if you think this plan has been fine for me
please double check it every fall
because lots of times if you switch plans and get a new plan for next year
you're gonna save some money. And if you don't know how to check that or don't feel comfortable checking that
call the ADRC. We will do that for you every single year.
Again, there's always the possibility that a special enrollment period might be available.
We would just need to meet with you and or talk to you about that and see what we could figure out.
This year for 2020
there are 30 different drug plans to choose from. They range in premium price from 13 dollars a month up to
124 dollars a month. They can have a deductible of anywhere from zero to
435 dollars per year. And they can - and all of them are going to have co-pays
that you pay at the pharmacy when you pick up your meds and that's going to just vary depending on is your medication a generic,
are you using this at a preferred pharmacy.
You know - does the drug plan have some special deal? So, we we can always run that plan finder for you -
medicare.gov. www.medicare.gov
is Medicare's website where we can sit down with you, enter your medications, and to the pharmacy that you like to use, and help you find the plan that's going to work best for
you. Some people come in and say "Well, just sign me up for that 13 month plan
because it's got the cheapest premium or the lowest premium.".
It's not going to save you any money if it's not going to work at the pharmacy that you want to use
and it's not going to cover your medications for you at the lowest cost.
So, please, please, please run the plan finder into your meds.
Don't just look at the premium.
Don't let a plan with a 435 deductible scare you away because lots of times it's not going to affect you at all.
If if it's confusing to you
call us at the ADRC. We will help you
review this and and look at your options.
You need to look at your costs overall for the whole year when you add up the premium any deductible any co-pays,
and find the plan that's going to save you the most money.
Again,
all of the plans can have a deductible.
Many of them do.
Lots of them will waive that deductible for you if you use their preferred pharmacy or if all of your meds are
tier one generic, so, don't let the deductible necessarily scare you away.
Then they're all going to bump you into an initial period of coverage where you're going to have some sort of co-pay.
The donut hole kind of scares people. That's where your co-pays can go up.
Again, if you have a few generic meds, that's not going to affect you a whole lot, if at all.
The donut hole really kind of affects people that have have
insulins, inhalers,
tier three, four, five - you know, tier three or four name brand, or tier five specialty medications.
Those are gonna be the really pricey meds. That's where that donut hole is gonna -you're gonna feel that a lot.
And, then some people end up in the catastrophic coverage phase where your co-pays go way down again at the end of the year.
It really depends on your medications that you take. So again, just contact us.
We will help you go through all of this. We will sit down with you
and show you your data
and help you pick the best plan.
Medicare Part D plans cover prescribed medications
that are on their formulary. Not all medications are covered by all plans
So, a good example is if you are prescribed the pro-air inhaler, your plan may not cover that pro-air inhaler,
but they will cover maybe the ventilating inhaler or the Advair inhaler.
So, if you really need that pro-air you want to pick a plan that's going to cover that pro-air. If you can
handle any inhaler, it doesn't have to be the pro-air,
then you know maybe your plan would be okay, a different plane would be okay for you.
You have - they will only cover medications that are being prescribed for the medically prescribed use,
so if you're being prescribed
an antidepressant to help you stop smoking,
but it's not approved to stop smoking, it's only approved as an anti-depressant.
A drug plan isn't going to cover that. You have to be being prescribed the medication for the prescribed use.
Part D will cover insulin needles and syringes for the administration of insulin and medications that are approved by the FDA.
So if you want to try a drug, that's not FDA approved Medicare Part D will not cover that.
Part D will not cover over-the-counter meds,
non-prescription meds, vitamins, mineral supplements,
drugs for non-medically necessary purposes not approved by FDA, or for your need
and not on your plan's formulary. That being said if you sign up for a drug plan
and then after you're on this drug plan your doctor prescribes you a medicine that your drug plan doesn't cover -
again just know that sometimes
things can work out - you can ask your doctor to request an exception
to the drug plan to cover it for you until the rest of, for the rest of the year until we can
look at a different plan for you for next year.
Sometimes,
like I said, with the the inhaler maybe your plan doesn't cover this brand of inhaler,
but your doctor can prescribe you a different brand, sometimes doctors have programs where you can get samples or help
with meds in another way.
So, and sometimes we can find a special enrollment to get you out of your drug plan and into something else
throughout the year. It just kind of depends. So, don't,
don't just sit there and not get your medication because your drug plan says they're not going to cover it.
Talk to your doctor or call the ADRC and we can see if we can try to help you.
Where to go for help with a Medicare Part D drug plan? Again www.medicare.gov
is Medicare's website. Do not go to Medicare.com
or org. You will get connected to people trying to sell you something or get redirected somewhere else
Dot gov is Medicare's
legitimate website. You can also call Medicare or or the State of Wisconsin has a helpline called the Medigap
Prescription Drug Helpline.
But, the easiest way is probably - unless you're really good with computers - the easiest way is to just call us at the ADRC.
Again, I cover Baraboo, Merrimac, Sauk City Prarie du Sac, and north freedom. And Mindy covers Reedsburg, Spring Green, Rock Springs, Plain, Lake
Delton, Wisconsin Dells, and some of those outlying. I know i'm missing some communities, but there are some
other outlying communities out there.
But, you can always just call the ADRC regular number and the receptionist will
get you connected with an intake worker, and they will connect you with the right person if you don't remember all this.
If this is overwhelming as far as the prices are going, there - there are programs that can help people
pay for either their Medicare Part B premium,
that 145 a month,
or and/or their Medicare Part D for drug premium.
They can get rid of those Part D deductibles.
They can get you really low co-pays at the pharmacy for your medications
and some of the programs even get you the Medicaid Card that
can serve as a supplement to your Medicare, so you don't have to pay for a supplement you can just have Medicare plus the Medicaid.
And those are all free programs if you're eligible based on your income and your assets.
So again, this is just kind of a list of those programs. There's QMB, Slim B, Slim B Plus.
There's other - a few other programs too. You can apply for those programs through the Capital Consortium
which is
- I'll give you the number at the end of the slide program.
But, on the fourth floor of the West Square Building, we do have Economic Support intake workers who can help you make those - do those applications.
But, again, the easiest way is probably to contact the ADRC
and ask for
either Mindy or me, and we'd be happy to screen you for those programs.
And, if we think you might be eligible we can certainly help you apply for those programs as well.
Even if you're not eligible for those programs, the Social Security Administration also has their own program called Extra Help,
and, it specifically helps just with your drug medication costs. So, you again you can apply
for that program through the Social Security Administration.
But, the easiest way again is just contact the ADRC ask for Mindy or me
and we can screen you for that program. And, if we think you might be eligible we can certainly help you apply for it
Just some final words of caution. Always review your quarterly Medicare summary notice.
So, once you're on Medicare, Medicare sends you a statement or an explanation of benefits every three months that outlines
where you've been seen, what services you've received, what Medicare paid, what was left over,
what you might be billed if you didn't have a supplement.
It's important to review those because if you see anything on there that doesn't look right -
you know - if you get that Medicare summary and it says you saw Dr.
X in July of 2019 and you didn't see a Dr X in July of 2019
then
that might be the case that
somebody's got your Medicare number and they're trying to bill - it bill your Medicare for things that you haven't been receiving.
So, it's important to not ever give out your Medicare number except to your doctor
or a confirmed Medicare provider.
Lots of times people say "Oh, I saw this commercial on TV for a free back brace!" or -
Those are people trying to get your Medicare
number so that they can bill your Medicare card for services
that you don't receive.
Or, they they have these
braces that you get in the mail and they're not gonna - they're not in good quality
or they're not right if you need a brace or some sort of durable medical equipment. Talk to your doctor.
He can write your prescription. He or she can write you a prescription and you can go to a reputable durable medical equipment
provider and get it covered.
I caution people -
Medicare doesn't ever call you or visit you or try to sell you anything.
Social Security does not call you, unless
under certain circumstances, if we do an application and I tell you Social Security might give you a follow-up phone call because we
contacted them first,
very rarely. But, Social Security will never call you out of the blue and say
your benefits are going to be ending unless you do something.
Be very wary of any offers for free
medical services or products.
Treat your Medicare card and your Social Security number like a credit card.
If you suspect after looking at your explanation of benefits that there is has been some Medicare fraud or abuse
call that provider to let them know.
Gather as much information and documentation as you can and you can also contact the Wisconsin Senior Medicare Patrol
at (888) 818-2611
for free and confidential help to report your concerns.
So, some final reminders and I'm hoping we're not running out of time here.
You sign up for Social Security retirement between the ages of 62 and 70,
but don't sign up, any earlier than three months before you want your benefits to start.
You sign up for Medicare A and B at age 65 during your seven month initial enrollment period - the three months before your birthday month,
the month you turn 65, the three months after.
Medicare supplements
are sold by insurance agents
and you have six months of Guaranteed Issue from the start date of your part B to buy any supplement that you want, no questions
asked.
You can contact your insurance agent that you purchase your auto or your home insurance through
and work with them, or you can contact the ADRC.
We do have an Insurance Agent Resource Guide of some agents in Sauk county that do sell Medicare Supplements.
Advantage plans, also known as Part C,
and prescription drug plans known as Part D have the same initial enrollment period
as Medicare A and B, so the three months before you turn 65, the month you turn 65, and the three months after.
After that
you're kind of stuck
waiting for the annual open enrollment if you want to sign up for an Advantage Plan or a drug plan.
The annual open enrollment is October 15th through December 7th
and that's your time to sign up for a plan if you did not do so at age 65.
And, it's also your time every single year
to check the plan that you do have to make sure it's going to be good for you for next year.
And, if it is great, you just stay in it. if it's not
then you might want to switch and, again, we can review that for you.
If you're enrolled in the Medicare Advantage plan,
you have a second opportunity to switch that plan or drop that plan every January, February, and March.
And again
if none of those apply to you and you're feeling stuck see us because sometimes other special enrollment windows may apply.
So, if you've had other work coverage or something else and that's ending
you may very likely have a special enrollment period to sign up for one of these things at that time.
Some final - just information contact numbers: the ADRC office in Baraboo, our phone number is (608) 355-3289.
Social Security office in Portage (888) 875-1681
or you can go on their website ssa.gov.
If you're a veteran or the spouse of a veteran, please contact our Sauk County Veterans Services Office
at 355-3260
to see what
services or programs you may be eligible for.
Medigap Helpline
Medicare - 1 (800) Medicare. You can call if you have questions.
State of Wisconsin Medigap Helpline for help with prescription drug
insurance is 1 (800) 242-1060.
Medicare again is 1 (800) Medicare or medicare.gov.
The Office of Commissioner of Insurance, or OCI, can be reached at
(800) 236-8517.
The Senior Medicare Patrol (888) 818-2611.
And, the Capital Consortium where you can call to apply for those Medicare Savings or Medicaid Programs is
(888) 794-5556.
But, again, if you just want to call us at the ADRD we are more than able and willing to help you with any of these
programs. So, if you do not feel comfortable calling
on your own to those places, please just feel free to contact the ADRC. So, that's all I have for you today.
If you have any questions or concerns, or would be interested in a follow-up appointment
you can contact our office again, our ADRC office number is (608) 355-3289.
or we do have a toll-free number of 1 (800) 482-3710
And you can give us a call anytime. Thank you.