DIABETES

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MEDICARE OVERVIEW
800-234-7119
402- 444-6617
Program Manager
Pam Roberts
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VOLUNTEERS ASSISTING SENIORS

• Non-Profit Agency
• Created in 1977
• Programs
• Insurance Counseling and Assistance- SHIIP
• Legal Assistance
• Homestead Exemption Assistance
• Conservator Program
• Consumer Issues/Scams/Fraud

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What is Medicare Who Runs the Medicare Program?

• Medicare is the federal health insurance program
  for people age 65 or older. It also covers
  persons under age 65 with disabilities and people
  with End-Stage Renal Disease (ESRD)
• The Centers for Medicare Medicaid Services
  (CMS) is the Federal agency that runs Medicare.
  CMS is part of the U.S. Department of Health and
  Human Services (HHS)

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Todays Medicare is about CHOICE.

• Original Medicare Plan
• Fee-For-Service (pay-per-visit) health plan that
  lets people go to any doctor, hospital or other
  health care provider who accepts Medicare.
• Medigap policies are Medicare supplement
  insurance sold by private insurance companies to
  fill gaps in Original Medicare Plan coverage.
• Medicare Advantage Plans
• Health Plan options that are approved by Medicare
  but run by private companies. They are part of
  the Medicare Program and sometimes called Part
  C.
• Prescription Drug Coverage
• Open to everyone with Medicare, but you must join
  a drug plan to get this coverage.

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Medicare has three parts
Part A Hospital Insurance Most people do not
have to pay for Part A.
Part B Medical Insurance Most people pay
monthly for Part B.
Part D Prescription Drug Insurance Provided
through private insurance companies
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Part A
D5

• Inpatient Hospital Stays
• Skilled Nursing Facility (SNF) Care
• Home Health Care
• Hospice Care

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Original MedicarePart A Beneficiary Costs in 2007
D7

• In-Patient Hospitalization
• 992. deductible for a hospital stay of 1-60 days
• 248. per day copayment for days 61-90
• 496. per day copayment for days 91-150
• All costs for each day beyond 150 days
• Blood deductible -- first three pints
• Skilled Nursing Facility Costs
• Days 1-20 Medicare pays 100 (approved)
• Days 21-100 124. copayment per day
• Beyond 100 days Beneficiary pays all costs

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Original MedicarePart A Beneficiary Costs in 2007
D16

• Home Health Care
• Medicare pays 100 for Home Health Care covered
  services You pay 0.
• 20 of the Medicare-approved amount for covered
  Durable Medical Equipment
• Hospice Care
• Medicare pays 100 for services You pay 0
• Beneficiary pays
• No more than 5 for each prescription drug and
  other similar products
• 5 of Medicare approved amount for inpatient
  respite care

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Part B
E5

• Monthly Premium Generally, 93.50 in 2007
• Doctors Services
• Outpatient Hospital Emergency Room
• Durable Medical Equipment
• Clinical Lab Services
• Other Services Supplies

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Original Medicare - Part BBeneficiary Liability
E6

• Yearly Deductible - 131.00 in 2007
• Coinsurance Amounts
• 20 of Medicare approved amount for physician
  services 50 of Medicare approved amount for
  outpatient mental health services Set co-payment
  amount for hospital outpatient services
• Excess Charges
• generally limited to 15 over Medicare approved
  amount exceptions include durable medical
  equipment, flu shots, some drugs
• Noncovered Items

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Part B Preventive Services Available to Help you
Stay Healthy

• Welcome to Medicare physical exam
• Bone mass measurement
• Cardiovascular screening
• Colorectal cancer screening
• Diabetes screening, services, and supplies

• Glaucoma screening
• Pap test and pelvic exam with clinical breast
  exam
• Prostate cancer screening
• Screening mammogram
• Smoking cessation counseling
• Vaccinations (shots)

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Medicare Supplement Insurance

• Sometimes referred to as a Medigap Policy, this
  is health insurance sold by private insurance
  companies to fill gaps in Original Medicare
  Plan coverage.
• Medigap policies help pay your share
  (coinsurance, copayments, or deductibles) of the
  costs of Medicare-covered services
• Medigap policies DO NOT work with Medicare
  Advantage plans
• Insurance companies in NE can sell you a policy
  from 12 standardized Medigap policies (Medigap
  A through L). These Medigap policies must all
  have specific benefits.
• Costs vary by policy and company.
• An employer/union/retiree plan may offer similar
  coverage

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Medicare Advantage Basics

• A unique alternative to Original Medicare
• Sometimes referred to as Medicare Choice or
  Part C
• Approved by Medicare and administered by private
  companies, so MA Plans provide ALL of your Part A
  (hospital) and Part B (medical) coverage and must
  cover medically-necessary services.
• You must have Medicare Parts A B to join
• Operates under an annual contract with Medicare
• Usually includes coverage for prescription drugs
  (MAPD)
• May offer extra benefits, i.e. vision, hearing or
  dental care
• Must accept all Medicare beneficiaries, even
  those on Medicare due to disability, and cannot
  have a waiting period for pre-existing
  conditions.
• The exception are those with End-Stage Renal
  Disease (ESRD)

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In a Medicare Advantage Plan, be aware that.
N6

• You must continue to pay Part A (if necessary)
  and Part B premiums
• Some Medicare Advantage Plans charge a monthly
  premium in addition to your Part A/Part B
  premium. Costs vary by plan and the services you
  use.
• You must live in area where plan is offered
• You are responsible for the co-payments
• Plans determine their own rates charges.Co-pays
  vary according to plan
• Medigap (supplement) Plans do not work with
  Medicare Advantage Plans
• Your current provider may or may not accept the
  plan you choose as these plans often have
  networks
• Doctors or hospitals are not required to accept
  payment from MA plans. If the provider does NOT
  accept the plan, you may be responsible for the
  entire payment!

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Important MA Considerations

• Does your provider accept the plan?
• You may have to see doctors who accept the plan
  or go to certain hospitals to get covered
  servicesare you willing to change?
• In most Medicare Advantage Plans, if your plan
  offers Medicare prescription drug coverage and
  you want drug coverage, you must get it from your
  plan.
• Are your prescriptions covered under this plan?
• Can you cover the maximum out of pocket?
• i.e. in-patient hospital co-pays
• Rules for enrollment and disenrollment
• Annual Co-ordinated Election Period (AEP)
• November 15 through December 31Coverage begins
  January 1
• Medicare Advantage open enrollment period
• January 1 through March 31 each yearlateral move
  only

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Twelve Month Trial Run

• Can leave the MA plan at any point during first
  12 months
• If enrolled when turned 65
• Can go to Original Medicare and buy any Medigap
  plan A-L (OR)
• If left Medigap and original Medicare
• Can return to Original Medicare and get their
  Medigap policy back, if still available, or pick
  another one (A,B,C,F,K or L) from any issuer

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Medicare Prescription Drug Coverage--Part D--

• Began January 1, 2006
• Offered by private plans approved by Medicare
• Available for all people with Medicare
• Part A, Part B, or both
• Must join a Medicare drug plan to get coverage

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Part D Enrollment Penalties

• Initial Enrollment Period (IEP)
• 7 months
• Starts 3 months before month of eligibility
• Annual Coordinated Election Period (AEP)
• Special Enrollment Period (SEP)
• People who wait to enroll may pay penalty
• Additional 1 of national base premium for every
  month eligible but not enrolled

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Annual Coordinated Election Period (AEP)

• November 15 December 31 every year
• People who dont have a Medicare drug plan can
  enroll
• People who currently have a Medicare drug plan
  can switch
• Changes are effective January 1, 2008
• Special Enrollment Period (SEP) may apply in
  special circumstances

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Annual Notice of Change

• All Part D plans send to all members
• By October 31, 2007
• Will include information for 2008
• Summary of Benefits
• Formulary
• Any changes
• Premium
• Copayment/coinsurance

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Basic Standard Coverage
Does not include premium cost
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Part D Plan Finder Tool and MyMedicare.gov

• Both available at
• www.medicare.gov
• Part D Plan Finder Tool
• Allows beneficiaries to personalize their search
  for prescription drug coverage that best meets
  their needs
• Compare plans
• Use preferences to narrow results
• Provides information on Prescription Drug Plans
  Medicare Advantage Prescription Plans
• MyMedicare.gov
• Secure online service for accessing your personal
  Medicare information

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Limited Income and Resources?

• What is Medicaid?
• What is the Medicare Savings Program?
• What is Medicares Extra Help?
• Low Income Subsidy

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Reevaluation and Enrollment Events

• Begin November 16th, 2007
• Call VAS office for list of events close to you
• Can come into VAS office for one-on-one
• 1941 South 42nd Street, Suite 502
• The Center
• 444-6617