Baltimore County, MD Time of Your LIfe, 1 Nov 2018

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From YouTube: Medicare: What You Need to Know

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Sherry Kolbe, Program Manager, State Health Insurance Assistance Program (SHIP), Baltimore County Department of Aging.

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(Upbeat music).

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Welcome to the time of your life with the baltimore county department of aging., I'm your host, ethel rasmussen..

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Our goal in the time of your life is to keep you in the know by conveying important and interesting information about contemporary topics, events, and resources that benefit you,. Our viewing audience.

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Today's show offers an opportunity to educate our viewers about medicare,, which is an important topic for both current and future beneficiaries..

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This is a double segment,, so stay tuned to learn what you need to know about navigating this critical benefit.

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also on the show, is debbie orlove, community business liaison at the baltimore county department of aging,.

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Who concludes today's show with information about senior center travel, senior box office, and what's happening at your local senior center..

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Let's start today's show, with sherry, kolbe, program manager of the state health insurance assistance, program,, also known as ship at the baltimore county department of aging to talk about medicare. sherry,. Welcome to the show. thank you,. It's always a pleasure to be here.

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before we begin talking about medicare,.

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Can you please explain what is the state health insurance assistance, program?.

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Well,, when medicare was created,.

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There were no local offices to go to to talk about medicare.

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So,, the ships were created., it's a state health insurance assistance program., it's actually a federal grant.. It goes to every state in the union,.

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So there is a me in every county. and my role is to educate baltimore county residents about their medicare benefit.

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And we're gonna talk on the show about medicare,.

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So what is medicare and who is eligible for it?.

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I think sometimes we forget it's literally a federal insurance.

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It was designed in 1965 to serve seniors.

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Who at that point did not really have insurance outside of employer insurance., and then it was expanded to include those who successfully applied for social security, disability,.

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That they would get it the 25th month..

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If someone is on kidney dialysis,, the fourth month of dialysis, they can get it, when they're getting a kidney transplant..

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And if someone has the misfortune of having lou gehrig's disease, als,, they can get it the first month of disability.

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So,, how and when can beneficiaries enroll in medicare?.

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Okay,, if you are receiving a social security, benefit,.

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Either you're getting your social security retirement benefit at 62,, -3 or -4, or you're on social security disability,.

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You will automatically get a medicare card in the mail.

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About three months before you turn 65 or three months before the 25th month of getting a disability check.

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aside from that,, if you are not getting a social security check,, you must take action at age, 65.

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There is a seven-month window for initial enrollment,.

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Three months before you're 65, the month, you're 65, three months, after., that's when you'd apply for medicare a,, medicare b,.

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And also for a prescription benefit,, either a standalone prescription plan or through a medicare advantage. Plan.

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The other times to enroll, the only time you can delay enrolling beyond age 65 is.

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If you or your spouse is actively working,, you have group health insurance through that employer, and that employer has more than 20 employees.

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Then,, you can delay getting your b without a penalty.

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And you would apply for social,, I'm sorry, for medicare. Whenever you decide to retire,.

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Whatever age that's gonna, be.

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now then,, there are a few people out there that they don't enroll during initial period or during the special enrollment for working people.

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So, they get to join during a general enrollment.

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Where you can only enroll january 1st to march 31st each year, and it doesn't start until july, the 1st.

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So you've mentioned many parts of medicare..

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Can you explain each one to our viewers?.

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Okay, well first, medicare, a we think of for hospitalization..

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If you're literally admitted to the hospital,, it will be medicare a that will be paying for your room and board and so forth.

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medicare a will also pay. If you've been admitted for three midnights, you're transferred to a skilled nursing facility for rehab.

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It is medicare part a that will be paying towards the skilled nursing facility..

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If, after that, you still need maybe some physical therapy, occupational therapy in your home, or hospice.

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So,, that's your a benefit. and do remember that medicare does not pay 100%.

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For any of those. okay,, and then we have medicare part b.

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medicare part b pays for the doctors,, whether it's the cardiac surgeon, while you're in the hospital,, the anesthesiologist,, all the consultants,, as well as when you go to the er,, the doctor's office,, the clinic.. It's medicare part b.

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b also pays for cat scans, pet scans,.

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Regular x-rays, blood, work,, durable medical equipment,.

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The emergency room,, your flu, shot, pneumonia, shots.

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Lots of things are covered by medicare part b,.

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And that's where you usually think of medicare paying 80% and you paying 20%.

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Then we have medicare d,, which is a prescription plan, which we'll go into later. and then there's medicare c. and medicare c. Is the medicare advantage plans,.

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The hmos and the ppos., and if you get an advantage plan, you are joining that company, and they will provide.

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Your original medicare benefit for you.

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so, in a way,, I think of it kind of as a substitute for original medicare..

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You still have to have a and b in order to join an advantage. Plan.

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so, right, now, kaiser has three hmos.

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Cigna-Healthspring has two hmos.

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hopkins, has one hmo and two ppos.

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and those are our choices for 2019 for the c plan.

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Now, with those plans,, you would use your cigna card, say,.

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Or hopkins or kaiser card for hospital,, doctor,, lab,, x-ray, and pharmacy.

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Because you do get your drugs through those plans.

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and they also tend to offer some additional benefits.

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That medicare doesn't give, such as maybe some teeth, cleanings, a pair of glasses,.

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Maybe something towards a hearing, aid.

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so,. You need to check with a plan.

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if you're thinking of joining the advantage, plan, first,. Do your doctors accept it,? What hospitals does it use, and are your drugs covered, as well as the extra benefits to really know what you're buying.

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Lots to digest. yes., let's take a short break and when we return, we're gonna continue our conversation about medicare.

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(Upbeat music).

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Back to the time of your life., I'm your host, ethel rasmussen..

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Let's continue our conversation about medicare, with sherry, kolbe, program manager for the state health insurance assistance, program, known as ship, at the department of aging.

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sherry,. Let's turn out attention to part d, medicare's prescription drug benefit.. Can you explain this benefit, as well as some of the important facts to remember each year when you're selecting a plan?, okay,, well, medicare part d is.

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For those who do not have a retiree health benefit.

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With a prescription benefit or those who are not using va.

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So,, you do need to have a prescription benefit.

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If you do not sign up for one when you're on medicare,, there is a penalty,, so I just want people to be aware of that.

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So, with the part d plan, this year there is a deductible of up to $415.

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There are 25 part d plans for baltimore county.

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Seven of them still do not have a deductible,.

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But the majority of them do.

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now, when you've paid the deductible or not. If you have a no-deductible plan,, you enter the initial coverage area. in that period,, usually you're paying less than 25%.

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For the brand drug., the generics,, sometimes you're paying full, half, or it's not really., but the brands tend to be less than 25%.

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The other portion of the drug cost is paid for by your part d plan.. When you add up what you have paid and your plan, and if you reach $3,820,.

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Then, at that point, you're at the wall of what we call the donut hole.

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Now,, if you're only on generics,, you will never hit that wall.. But if you're on, particularly, at least two brand drugs,, probably you will. at that point, due to some change in the laws for 2019,.

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In the donut hole,, you will pay 25% for your brand drugs.

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Now,, you may have been paying less in the initial coverage area,, so this may be a bump up in price,, but it will be no more than 25% of retail.

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And for our generics, we're going to be paying a little bit over the 25%.

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Finally, in 2020, it will be 25% for brand.

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And generic in the donut hole area.

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now,. It has been said that at 25%,.

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The donut hole is closed, and some people think that must mean I pay nothing in the donut hole.

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no,. It means you pay 25% of retail, for the brand,.

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And next year that will include the generics.

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after 7,600 has been spent on your drugs,.

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Then you hit catastrophic, where you only pay 5%.

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But in that donut hole area,, you might say if I pay 25% of brand,, who pays the rest?.

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5% is paid for by your part d plan,, but 70% in 2019 will be paid by the drug manufacturers.

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So that really is excellent news for seniors..

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Not only are the brand drugs down to 25%,.

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But the 70%, the manufacturers pay, is counted.

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As though it came out of our own wallets., it's a little bit confusing,, but it's good news.

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Now, right now we're in open enrollment for part d.

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That's october, 15th to december 7th.

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actually,. This period is open, enrollment for not only part ds, but also your medicare advantage. Plans.

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Whether it's an advantage plan or a part d,, they are allowed to change every single year., your part ds,. They can change their formularies, tier structure,, pharmacy, contracts,, premiums,, deductibles.

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So,, we always say every year get in the habit of redoing. Your research.

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is your current part d really the best for the next year, or is it not?

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to assist people with this process,?

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I do have a team of volunteers that I take almost every day out into the various senior centers to give one-on-one help.

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We currently are taking phone calls to make appointments.

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So if you do need an appointment,, please call the office at 410-887-2059,.

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And we will be happy to try to accommodate you.

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For some beneficiaries, they may need a supplemental insurance like a medigap.

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Can you talk about these plans and how you get involved with them?.

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Okay,, if you have a retiree health, benefit,.

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Typically, that will be your secondary insurance, and how it will work with medicare,.

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You have to ask your benefit administrator., but there are many people who do not have a retiree health benefit, and when they look at the holes in medicare,.

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The out-of-pocket costs,, they say, wait a minute..

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I want another insurance. that other insurance is a medicare supplement or a medigap.

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It is another alphabet soup in life.

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the medigaps range from letter, a to letter, n.

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They are overseen by the maryland insurance administration.

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There are 30 companies that sell medigaps.

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In the state of maryland., the best thing to do if you're going to be buying one or just shopping around, is to call the maryland insurance administration.

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ask them to mail. You the medicare, supplement pricing booklet..

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It will show you the prices by companies for the various medigaps,, so you can decide which letter.

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Of medigap is gonna meet your need and your budget, because the budget is very important. Here.

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You will look at all 30, companies, and you'll say they all charge a different amount for like a g,, but by federal law, they're, all identical.

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Of the 30 companies, 29 of them are attained-age rated.

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That means, as you get older,, you pay more for your medigap.

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So not only does it go up because everything in life goes up,. It goes up because we age. (laughs).

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For those beneficiaries on a limited income,, there are some programs that assist with the cost of medicare.. Can you go over those for our viewers? okay, at the state level, through the department.

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Of social services,, you can apply for two programs,.

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Qmb, qualified medicare, beneficiary, and slmb, specified low-income medicare beneficiary.

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Those are income and asset-based programs.

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qmb, for instance,, an individual's gross income.

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Can be no more than $1,032, their assets, no more than $9,100.

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If the income and assets are under that,, not only will the state pay your medicare part b, premium,.

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$134, a month,, it will pay your copays.

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And deductibles associated with medicare.

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slmb is for a higher income level, up to $1,386.

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And for it, the state will only pay the medicare part b premium.

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if you are on either one of those programs,.

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You are also eligible through the federal government.

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Through social security to apply for extra help.

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And extra help is a program, again, income and asset-based.

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This program will help pay for your premium,, your deductibles, with your part d, and the actual cost of the medicine.

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so,. If you're on qmb or slmb,, you would be on full extra help,, you would pay no more than $3.40 for generics,.

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No more than $8.50 for brand drugs.

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so,! It's a wonderful program.!

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If your income's under $1,538 for an individual,.

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And your assets are under 14,000,. You would be on partial extra help where you get some help with the deductible,.

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Some with the premium, and you'd pay, no more than 15% of retail for your drugs.

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But you're like darn,, I have a little bit more money than that,. So is there nothing for me? well, there is, and it's called the maryland senior prescription drug assistance, program.

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So with that,, if a single,, your income's under 36,000,,.

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Couple under 49,000, you'll get up to $40 a month.

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Towards your part, d premium., you get to switch plans once outside of open enrollment.

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And they may give you some donut hole, help at the end of the year.. We always have to see each year what the general assembly does with that,, but fingers are crossed.

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Excellent, is there any additional information about medicare that you would like to share?.

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Well, anybody who's new to medicare,. I highly recommend that you come to one of my transitioning to medicare workshops.

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We give them once a month at area, libraries in the evening.

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Call the office. we'll tell you the when and where., and that's where I spend probably an hour and a half,, maybe two hours with questions, going over all the facets of medicare..

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It is a great way to start your medicare life.

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Excellent,, thank you, sherry for coming and sharing your wealth of information with our viewers.

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and thank you for having me. we're going to take a short break. when we return,. We will conclude today's show with exciting news about senior center travel, senior box office, and what's happening at your local senior center. (upbeat music).