Welcome to Kaiser PermanentePresenting Medicare 101 and Kaiser Permanente Senior Advantage HMO REEP Strategic Planning Workshop Nancy Voltero Retiree Consultant October 11, 2013
What is Medicare? • Medicare is a federally funded health insurance program for eligible beneficiaries. • Medicare was established in 1965. • Medicare is administered by the Centers for Medicare & Medicaid Services (CMS).
Who is eligible? Medicare beneficiaries include: • Individuals 65 or older if they or their spouses are eligible for Social Security. • Individuals under 65 who are disabled. • Must be eligible for Social Security disability • Requires 2-year waiting period • Individuals with end-stage renal (kidney) disease (ESRD).
Medicare Part A • Inpatientinsurance • Hospital, skilled nursing facility, hospice, home health care • Eligibility • First day of the month that you turn 65 • 2 years after becoming disabled • After end-stage renal dialysis begins • Cost • No premium if you or your spouse has worked 40 quarters of Medicare-covered employment. • If you worked fewer than 40 quarters, there is a monthly premium which is set by a Medicare formula.
Medicare Part B • Outpatientinsurance • Physician services, outpatient surgery, lab, radiology, durable medical equipment (DME), dialysis. • Enrollment • Optional: You are responsible for enrolling with Social Security Administration. • You can enroll over a 7-month period, which starts 3 months before your 65th birthday. • Late enrollment penalty may apply if you do not enroll in this 7-month window.
Medicare Part B Cost • Monthly premium is usually deducted from your Social Security check. • Premium goes up 10 percent for each 12-month period that you decline coverage. • Known as late enrollment penalty.* • Not imposed if you continue to work for—and receive your health coverage from—an employer group or trust fund plan of 20 or more eligibles. • In 2013, Part B premium will range from $115.40 to $369.10, depending on income. * This amount is not a one-time penalty, but continues throughout enrollment.
2013 Monthly Premiums for Medicare Part B If you have questions about your Part B premium, call Social Security at 1‑800‑772‑1213. TTY users should call 1‑800‑325‑0778.
How to Enroll in Medicare Part B • Fill out an Application for Enrollment in Medicare Part B. • Mail it to the nearest Social Security office, or • Submit it in person to any Social Security office. Note: Completing the application form and submitting it does not automatically enroll you in Medicare Part B. Social Security must first determine if you are eligible to enroll.
Medicare Plan Options Plan options for how you receive Medicare coverage: • Option 1: Original Medicare Plan through the Centers for Medicare & Medicaid Services (CMS). • Option 2: Medicare Advantage Plans (Part C) such as: • A Health Maintenance Organization (HMO) • Preferred Provider Organization (PPO) • Private Fee-for-Service (PFFS) • Medical Savings Account Plans (MSA)
Medicare Part D • Medicare Modernization Act (MMA) created Medicare prescription drug coverage (Part D), effective January 1, 2006. • Provides outpatient prescription drug coverage. • Enrollment options for Part D • Private insurer plan, such as Kaiser Permanente. • Prescription Drug Plan (PDP): A plan type that offers prescription drugs only. Note: Unlike Parts A and B, Part D is enrolled directly with the plan. Part D is not available through Medicare or Social Security.
Medicare Part D Enrolling in Part D • You are eligible for initial enrollment during the 7-month period, which starts 3 months before your 65th birthday. • Late enrollment penalty (LEP) • As with Part B, you must obtain Part D or creditable Part D coverage as soon as you are eligible or you will be charged a penalty. • LEP is 1 percent per month that enrollment is deferred.
Medicare Part D Medicare’s extra help program: Low Income Subsidy (LIS) • For Medicare beneficiaries with limited income and resources. • Provides extra help with Part D premiums and outpatient drug copayments. • Degree of help depends on income and resources. • Additional facts about extra help: • Apply at Social Security or state Medicaid office. • Administered by the member’s plan, for CMS. • Beneficiaries must be enrolled in a Part D plan to receive assistance.
Senior Advantage The Kaiser Permanente Senior Advantage (HMO) plan is a Medicare Advantage plan for people with Medicare. • Senior Advantage provides services covered by Medicare (including Medicare Part D prescription drug coverage). • As a Senior Advantage member, you get your Medicare benefits through Kaiser Permanente. • The Medicare program pays Kaiser Permanente to manage health care for people with Medicare (our Senior Advantage members).
Contact Information • If you have questions on the Senior Advantage Group Plan,contact your HR Benefits Department. • Kaiser Permanente Member Services: 1-800-464-4000 (TTY 1-800-777-1370) Monday through Friday, 7 a.m. to 7 p.m., Saturday and Sunday 7 a.m. to 3 p.m. • Social Security: 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 7 a.m. to 7 p.m. • Medicare: 1-800-MEDICARE (1-800-633-4227) TTY 1-877-486-2048, 24 hours a day, seven days a week.
Kaiser Permanente is a health plan with a Medicare contract. You must continue to pay your Part B premiums. Anyone who has Medicare Parts A and B (or Part B Only), including some people under the age of 65 with disabilities, may apply. You must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. Benefits, formulary, pharmacy network, and/or co-payments/co-insurance may change on January 1, 2014, and at other times if your group makes changes. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.
If your group's plan includes Medicare Part D prescription drug coverage, that coverage is available only to Kaiser Permanente Senior Advantage members. You must use network pharmacies to fill your prescription, except under non-routine circumstances and quantity limitations and restrictions may apply. People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to 75 percent or more of your drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get extra help to pay for your prescription drug premiums and cost. For more information about extra help, call: · 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week. · The Social Security Office at 1-800-772-1213, between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778. · Your State Medicaid Office.
Notes SKU 60046907 (05/2011)