Tags:

Transcription

SERIP & MedicareWhat are your options if you drop your State of Iowa Retiree Insurance?Presented bySenior Health Insurance Information ProgramIowa Insurance Division1-800-351-4664

What is SHIIP?Objective Information Source Part of the State of Iowa InsuranceDivision Answers questions and providesassistance Doesn’t recommend or endorsespecific companies, products or agents2

Medicare Eligible – Retired & No Working Spouse Medicare is your primary coverage. Need to enroll in MedicarePart A and Part B. Enrolling in Part B later canresult in higher premium anda wait before getting coverage. Retirement health coverage fromemployer will pay after Medicare.3

Medicare Eligible - Your Spouse Works Do you have access to coverage throughyour spouse’s employer plan? You don’t need to enroll in Medicare Part Bif covered through employer healthinsurance Already enrolled in Part B, can suspenduntil spouse retires When spouse retires you must enroll inPart B to avoid penalty4

What are your options if you drop your State Retiree Insurance?Two OptionsOriginalMedicareMedicareAdvantageNo SupplementMedicareSupplementIncludes Part DPart D Plan5

OPTION 1 - Enroll in a Medicare Supplement and a Part D planEnroll in a Medicare Supplement: Medicare Supplement Insurance Health Insurance policies sold by private insurancecompanies Also called “Medigap” Covers gaps in Original Medicare 10 Standardized policiesPlans A, B, C, D, F, G, K, L, M, N Costs may vary By plan By company Where you live Your gender6

Medicare Supplement -Standard PlansTen Benefit PackagesSHIIP Counselors can help you compare and evaluate your options7

Guaranteed Right – Open Enrollment Available at age 65 or older Triggered when Medicare Part B firststarts Lasts six months from Part B effectivedate Can’t be turned down Can’t be charged higher premium becauseof health history8

Medicare Supplement InsuranceYou have a Guaranteed Right topurchase a Medicare Supplement if: It has been less than six months since youturned 65 and enrolled in Medicare Part BWhat does this mean? You cannot be turned down for anyMedicare Supplement being sold in Iowa.9

Medicare Supplement InsuranceYou will be subject to underwriting whenyou purchase a Medicare Supplement if: It has been more than six months since yousigned up for Part B.What does this mean? The insurance company may refuse to sellyou a policy or charge a higher premiumbecause of health reasons. You should allow up to 30 days to beapproved.10

Waiting period for Pre-Existing ConditionsA waiting period is a period of time whenan insurance company can deny paymentof benefits for pre-existing conditions.–Maximum of six monthsA pre-existing condition under the IowaInsurance Code: One for which advice was given ortreatment recommended within sixmonths before the effective date ofcoverage11

How can you avoid a waiting period for Pre-Existing Conditions?You can avoid a pre-x if you: Apply for a Medicare Supplement duringyour Medicare Supplement openenrollment period within 63 days of theend of previous health insurance coverageOR Look for a Medicare Supplement thatdoes not have a waiting period beforepre-existing conditions are covered12

OPTION 1 - Enroll in a Medicare Supplement and a Part D planEnroll in a Medicare Part D plan: You have a two-month Special Enrollment Periodto enroll in a Medicare Part D plan if you drop yourState of Iowa retire coverage– Starts when State coverage ends If you don’t join a Part D plan or have othercreditable drug coverage– Pay a late enrollment penalty if you join at a latertime Can change every year between Oct 15 – Dec 7SHIIP Counselors can help you compare Part Dplans13

OPTION 2: Enroll in a Medicare Advantage PlanEnroll in a Medicare Advantage: You have a two-month special enrollmentperiod when your State of Iowa retireecoverage ends Most plans include Part D coverage so Don’t need a separate Part D plan Don’t need a Medicare Supplement Opportunity to change plans every year14

OPTION 2: Enroll in a Medicare Advantage PlanMedicare AdvantageA Private Solution Medicare contracts with a private companyon an annual basis Plan can renew, change or terminate at endof contract year Must provide Medicare Part A and Part Bservices Must cover emergency care out-of-network The plan handles the claims Use network providers/providers whoaccept MA plan15

Medicare Advantage Eligibility Have Medicare Part A and Part B Do not have end-stage renal disease Live in service area16

Medicare Advantage Costs Must still pay the Part B premium May pay additional monthly premium Pay other out-of-pocket costs–Different from Original Medicare Plan–Vary from plan to plan Some have additional benefits17

Medicare Advantage – Types of PlansMedicare Advantage Plans: HMO – Health Maintenance Organization PPO – Preferred Provider Organization Private Fee-For-Service Special Needs Plans Must meet plan criteria to enrollOther Health Plans: Cost Plan Available in Dubuque area Continuous enrollment Need to enroll in a Part D plan18

Medicare Advantage - Things to consider before you enroll Will your doctors, hospitals and other providers acceptthe plan? If you are considering a PPO: Ask if your providers are in-network or out-of-network Your costs may be more if your provider accepts theplan but is out-of-network What are the deductibles, copayments or coinsurancefor the benefits I’m most likely to use? What is the annual out-of-pocket maximum? What is the premium? Do I live in the service area for the plan? Does the plan include drug coverage?19

Contact SHIIPStatewide : 1-800-351-4664(TTY ail:[email protected] to help you make important Medicare Decisions:Guides: Iowa Medicare Supplement and Premium Comparison Guide Medicare Advantage & Other Health Plans in Iowa GuideSHIIP Counselors can help you: Understand your Medicare benefits Compare and evaluate Medicare Supplement policies Understand and compare Medicare Advantage plans Compare Medicare Part D plans20

Iowa Medicare Supplement and Premium Comparison Guide Medicare Advantage & Other Health Plans in Iowa Guide SHIIP Counselors can help you: Understand your Medicare benefits Compare and evaluate Medicare Supplement policies Understand and compare Medicare Advantag