1
Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.
C o m m u n i t y P a r t n e r s
P i c k i n g a P l a n : M e d i c a r e
T h e w e b i n a r w i l l b e g i n s h o r t l y
2
Where you can find handouts for today’s
webinar
Where you can make comments and ask
questions
Get to know
how it works
meet
Medicare
The Michigan Numbers
Over 2 million seniors here in Michigan
are on Medicare to help pay for their prescription
drugs, doctor visits, and hospitalizations.
One in five Michigan residents - 20%
Agenda
Medicare basics
Medicare choices
Resources and tools
A smooth transition to Medicare
▪ 10,000 Boomers a day are turning
age 65
▪ Enrollment path and timing is not
the same for everyone
▪ Important to enroll at the right time
When to enroll?
Initial Enrollment Period:
▪ 3 months before the month you turn 65
▪ The month you turn 65
▪ 3 months after the month you turn 65
Exceptions to enrolling at 65
▪ If your employer has 20 or more employees
▪ You can choose to sign up at 65 or later
▪ If your employer has 20 or fewer employees
▪ You could be required to join when you
turn 65
You can stay on your employer’s
plan until…
You stop working
You drop your employer coverage
Your employer coverage ends
Other times to
enroll are limited
General Enrollment Period
January 1
st
– March 31
st
every year
Coverage starts July 1
st
Late enrollment penalties
▪ Late enrollment penalties can happen when you don’t sign up within the
enrollment windows (a life-changing event
▪ will allow for enrollment outside the regular windows)
▪ Part A (hospital coverage) penalty
▪ 10% for twice the number of years you could have had part A, but didn’t sign up
▪ Part B (medical coverage) penalty
▪ 10% for each 12 - month period you could have had part B
▪ These penalties are PERMANANT!
Late enrollment penalties
▪ Part D (prescription drug coverage) penalty
▪ 1% per month for each month you did not signup or have credible
coverage, i.e. employer cover, etc.
▪ If you did not take drugs at age 65 when you signed up for Medicare and
did not have other prescription coverage and signed up when you start
taking drugs at age 70, your penalty would be 60% per month as long as you
had Part D
How can you apply
for Medicare?
▪ Apply in person at your local Social
Security office
▪ www.socialsecurity.gov/locator
▪ Apply by phone
▪ 1-800-772-1213
▪ 1-800-325-0778 TTY
▪ Apply online
▪ www.socialsecurity.gov
Medicare Choices
1) Original Medicare
• Parts A and B
• Part D (if you want prescription drug coverage)
2) Medicare Advantage (Part C)
• Combines Parts A, B, and D
Original Medicare
▪ Fee-for-service health plan
▪ Includes Parts A and B
▪ You can go to any provider that accepts Medicare
▪ Pays for many health care services, but not all
▪ You must choose and join a Medicare Prescription Drug plan
to get prescription drug coverage
What is Medicare?
A Federal Health Insurance Program for:
▪ People 65+
▪ People under 65 with
certain disabilities
▪ People of any age with
End-Stage Renal Disease
or Lou Gehrig’s Disease
What Medicare Does Not Cover
Medicare does not cover all health care costs. (No vision, dental, hearing coverage
for example)
◦ You are responsible for:
• Monthly premiums
• Deductibles
• Coinsurance
• Co-payments
The Different Parts of Medicare
Part A
Part A (Hospital Insurance)
Part B
Part B (Medical Insurance)
Part D
Part D (Medicare
Prescription Drug Coverage)
Part A - Hospital
Insurance
▪ Helps cover inpatient hospital care
▪ Other Part A services include:
▪ Some skilled nursing facility care
▪ Hospice and home health care
Part B - Medical
Insurance
▪ Helps cover medical care
▪ Doctor visits
▪ Outpatient hospital services
▪ Durable medical equipment
▪ Medicare-approved
preventive services
▪ Emergency room visits
▪ Ambulance
▪ Lab tests
▪ X-rays & CT scans
Part B - Costs for 2021
Premiums
Standard premium is $148.50 per month for those enrolling in 2021
Premiums go up for those with higher incomes
•Individuals who earn more than $88,000
•Couples who earn more than $176,000
Deductible: Annual deductible is $ 203
Coinsurance: 20% for most services
Part D - Prescription
Drug Coverage
▪ Helps cover the cost of prescription
drugs
▪ Run by Medicare-approved private
insurance companies
What Part D Covers
▪ Each plan has a list of covered
drugs (formulary)
▪ Includes both brand-name and
generic prescription drugs
▪ Plans place drugs into “tiers”
▪ Each tier has a different cost
Part D - Costs 2021
▪ People enrolled in Part D may pay:
▪ Monthly premiums
▪ Copayments or coinsurance
▪ Annual deductible up to $445
▪ People with higher incomes pay higher Part
D premiums
Medicare Part D Coverage Gap Closure Timetable
Under the Patient Protection & Affordable Care Act
Year What You Pay for Brand Name Drugs in the
Coverage Gap
What You Pay for Generic Drugs in the
Coverage Gap
2012 50% 86%
2013 47.5% 79%
2014 47.5% 72%
2015 45% 65%
2016 45% 58%
2017 40% 51%
2018 35% 44%
2019 30% 37%
2020 25% 25%
Options Available To You At Age 65
▪ Traditional (Basic) Medicare
▪ Basic Medicare + Medigap/Supplemental Plan
▪ Basic Medicare + Prescription Plan
▪ Medicare Advantage Plan (may or may not include prescriptions)
▪ How do you determine what is right for you?
HOW DO YOU DETERMINE WHICH PLAN IS
RIGHT FOR YOU?
Basic/Traditional Medicare
• Includes Part A (Hospital Coverage), and
Part B (Medical Coverage)
• Single
-Payer (Federal Government)
• Fixed premium
• Low deductible per year
• 20% co
-pays for most services
• You need to sign up for a separate Part
D Plan (Prescription Drug Coverage)
Medigap Plan
(purchase in addition to Basic Medicare)
• Marketplace Driven
• Separate premium for Medigap Plan
• Additional benefits covered at 100% for
most services
• Sign
-up for Medigap is through limited
time period
• Limited number of companies offering
Medigap plan
• You need to sign up for a separate Part D
Plan (Prescription Drug Coverage)
Supplemental Plan
(purchase in addition to Basic Medicare)
• Marketplace driven
• Separate premium for Supplemental
Plan
• Separate deductibles and co
-pays
• You need to sign up for a separate Part
D Plan (Prescription Drug Coverage)
Advantage Plans
• Includes Medicare Parts A, B & D all in
one plan
• Marketplace driven
• Premium for coverage
• Deductibles and Co
-pays
• Option to add benefits such as eyeglass,
hearing aid, etc.
Some Advantage plans do not cover
prescriptions
Medigap Plans and Supplemental
Plans
▪ The terms Medigap Plan and Supplemental Plan are often used
interchangeably
▪ Even in your Medicare and You handbook!
Medigap Coverage
• Medicare Supplement Insurance policies and Medigap
policies, are sold by private companies.
• They help pay some of the health care costs that Original
Medicare doesn't cover, like copayments, coinsurance,
and deductibles.
• Medigap does not work with Medicare Advantage Plans
How Medigap Works
▪ People can choose to buy a Medigap policy. There are up to 10
standardized plans so people can compare easily.
▪ Must be purchased within 6 months of enrolling in Part B, Must be age
65 or older
▪ After 6 months companies do not have to sell you a plan or you may
subject to higher prices or pre-existing conditions
▪ You pay a monthly premium
▪ Note: Does not cover the costs of prescription drugs
How Medigap
Works
Medicare
Advantage
Plans (Part C)
▪ Alternatives to Original Medicare
▪ Plans are offered by private
insurance companies
▪ All plans include Parts A, B, and
in most cases, Part D
What Medicare Advantage Covers
▪ Independent of Original Medicare
▪ Includes both parts A (Hospital) and B (Medical)
▪ Many include Part D (Prescription drug coverage)
▪ May include extra benefits depending on the plan selected
(such as eye glasses, dental, etc.)
Things You Should Be Aware Of
▪ Medicare Advantage Plans
▪ Are subject to possible premium increases
▪ Commercial carrier could decide to get out of the
marketplace and you would need a new plan
▪ May not be accepted everywhere
Things You Should Be Aware Of
▪ Basic Medicare does not cover you when you are traveling
abroad.
▪ If you plan to travel abroad make sure the plan you choose to
purchase (Medigap, Medicare Supplemental or Medicare
Advantage) covers you when you travel
▪ Private hospitals may not accept Medicare or any Medigap,
Supplemental or Advantage Plan you have
▪ All plans will include a premium of some amount
Medicare Q & A Tool
www.aarp.org/MedicareQA
www.aarp.org/MedicareYtu
Michigan
Medicare/Medicaid
Assistance Program (MMAP)
▪ Need help figuring out what choices make sense for YOU?
▪ Call MMAP at 1-800-803-7174 to make an appointment with a MMAP counselor.
▪ MMAP provides free, unbiased information and counseling to help individuals navigate the
array of available heath benefits and make informed health benefit decisions.
Michigan
Medicare/Medicaid
Assistance Program (MMAP)
▪ MMAP works through the local Area Agencies on Aging to provide high quality health benefit information
and counseling, supported by a statewide network of unpaid and paid skilled professionals.
▪ MMAP is funded by a grant from the state Aging and Adult Services Agency through funding received
from the federal government
▪ MMAP has grants from the Agency for Community Living and from state and federal sources. Nationally,
this program is called the State Health Insurance Assistance Program (SHIP).
▪ MMAP is not affiliated with the insurance industry.
▪ 1-800-803-7174
Paying for Medicare If You are Low Income
▪ If you are eligible for Medicare but are low income you may also be eligible for
Medicaid.
▪ This is called dual eligible
▪ You may also qualify for the Medicare Savings Program or Extra Help
▪ Contact MMAP for assistance 1-800-803-7174
Resources
43
As the schedule is updated, it will be added along with registration information to
Michigan.gov/MIBridgesPartners under the Community Partner Training section. MDHHS will
also email an announcement to registered MI Bridges Community Partners.
Upcoming Webinars
• TBD; Tentatively planning for the week
of November 30
Renewals
• TBD; Tentatively planning for the week
of December 14
Appeals
44
What Questions Do You Have?
www.
45
Thank You for Attending!
