Medicare

Medicare 101

What is Medicare?

  • Medicare is health insurance for individuals age 65 and over
  • Medicare is also available to individuals under the age of 65 in the 25th month of receiving Social Security Disability Benefits

When are you eligible for Medicare?

  • Individuals are eligible on the first of the month that they turn age 65
  • Turn 65 on June 24? Your are eligible June 1
  • Turn 65 June 1? You are eligible May 1
  • Eligible due to disability? Your eligibility begins the first of the month of the 25th month that you are receiving disability benefits.

Signing Up – Already Receiving Social Security Benefits

  • Already receiving Social Security Retirement Benefits?
  • You will be automatically enrolled in Medicare Part A and Medicare Part B
  • Your Medicare Part B Premium will be automatically deducted from your Social Security Retirement Benefits
  • Your Medicare benefits will become effective on the first of the month that you turn 65.

Signing Up – Not Receiving Social Security Benefits

  • You are turning 65 and have not signed up for Social Security. When can you sign up?
  • Sign up period: 7 months
  • 3 months before your 65th birthday month
  • The month of your 65th birthday
  • Three months after your 65th birthday month
When you sign up for Medicare When your Medicare will begin

Automatically enrolled/signed up before your 65th birthday month

First day of your birth month.

Automatically enrolled/signed up before 65th birthday month BUT your birthday falls on the 1st

Your coverage will start on the 1st day of month prior to your birthday

During the 1st month you turn 65

Medicare will start 1 month after you sign up

One month after you turn 65

Medicare will start 2 months after you sign up

2 months after you turn 65

Medicare will start 3 months after you sign up

3 months after you turn 65

Medicare will start 3 months after you sign up

After that time, you can usually only apply during the General Election Period (1/1-3/31)

Medicare will start July 1st

How to Sign Up

Sign Up Online
www.medicare.gov

Sign Up Over The Phone
800-MEDICARE (800-633-4227)

Sign Up at Your Local
Social Security Office

Social Security Office – Buncombe County
800 Centre Park Drive, Asheville, NC 28805
(866) 572-8361
Monday 9 AM – 4 PM
Tuesday 9 AM – 4 PM
Wednesday 9 AM – 12 PM
Thursday 9 AM – 4 PM
Friday 9 AM – 4 PM
Social Security Office – Henderson County
205 S Grove St, Hendersonville, NC 28792
(866) 964-5053
Monday 9 AM – 4 PM
Tuesday 9 AM – 4 PM
Wednesday 9 AM – 12 PM
Thursday 9 AM – 4 PM
Friday 9 AM – 4 PM

Medicare Parts A and B

Medicare Part A Hospital Insurance Premiums

  • No Cost! (If you have worked for at least 10 years for which you paid Medicare taxes)
  • If you have worked less than 10 years, you will share in the cost of your Medicare Part A premium.

A non-working spouse can qualify for no cost Part A at age 65 if their spouse has worked 10 years and is at least age 62.

Medicare Part B Medical Insurance Premiums

  • Monthly premium based on taxable income
Yearly Income and Filing Status for 2015 Part B Premium for 2017

File individual tax return

File joint tax return

File married & separate tax return

$85,000 or less

$170,000 or less

$85,000 or less

$134.00

$85,000 to $107,000

$170,000 to $214,000

Not applicable

$187.50

$107,000 to $160,000

$214,000 to $320,000

Not applicable

$267.90

$160,000 to $214,000

$320,000 to $428,000

$85,000 to $129,000

$348.30

$214,000 and above

$428,000 and above

$129,000 and above

$428.60

Medicare Benefits

Medicare Part A Hospital Insurance Benefits

  • Inpatient Hospital Care
  • Skilled Nursing Facility Care
  • Hospice Care
  • Some Home Health Care

Part A Benefits do not cover all costs. You will pay:

  • $1316 deductible for each benefit period
  • $329 per day for days 61 – 90 of a hospital stay
  • $658 per day per day after day 90 subject to a 60-day lifetime limit

Beyond the lifetime limit: you are responsible for all costs

Medicare Part B Medical Insurance Benefits

  • Doctor Visits
    • Primary Care
    • Specialists
  • Preventive Care
  • Ambulance
  • Durable Medical Equipment
  • Limited Outpatient Prescription Drugs

Part B Benefits do not cover all costs. You will pay:

  • $183 Annual Deductible
  • Typically, 20% of the Medicare Approved Amount for Part B Covered Services

There is no Out of Pocket limit on your responsibility for Medicare Part A and Medicare Part B Benefits

What about prescriptions?

Medicare Plans: Plugging the Holes in Medicare Part A and Medicare Part B

Path 1 Path 2
Medicare Supplement and a Part D Prescription Drug Plan Medicare Advantage Plan

Medicare Supplement Plans

  • Covers your out of pocket costs for Medicare Part A and Medicare Part B.
  • Medicare Supplement Plan F is the most popular.
  • Why?
  • Medicare Supplement Plan F covers most major out of pocket costs for Medicare Part A and Medicare Part B.
  • To enroll in a Medicare Supplement plan, you must be enrolled in Medicare Part A and Medicare Part B
  • You will have guaranteed insurability if you enroll within six months of enrolling in Medicare Part B (no medical questions)
  • You must answer medical questions if you change insurance carriers or if you apply outside the six-month window
  • No network. Freedom to choose providers and hospitals.
  • A Medicare Supplement Plan is accepted by any provider that accepts Medicare
  • If the provider does not accept Medicare, you can file a claim with Medicare and the Medicare Supplement insurance plan

Medicare Part D Prescription Drug Plans

  • Medicare Part D is subsidized and tightly regulated by CMS
  • A Medicare Part D Prescription Drug Plan is a private insurance plan
  • Plans compete with premiums, formulary and copays
  • Individuals and couples with higher incomes will pay a higher Part D plan premium
  • Individual: $ 85,000 and above
  • Couple: $ 170,000 and above
  • Additional premium ranges from 35% to 85% of the cost of the plan
  • Final cost is determined by CMS
  • If you enroll in a Medicare Supplement Plan, you will need a Medicare Part D Prescription Drug Plan to cover the costs of your outpatient prescription drugs
  • If you do not enroll in a Part D Prescription Drug Plan, you will be accessed a penalty when you do enroll in a plan for each month you were eligible but were not enrolled
  • Penalty is 1% per month of the average cost of a Part D Prescription Drug Plan nationwide and is determined by CMS.
  • You can shop for and enroll in a Medicare Part D Prescription Drug Plan through the Medicare Plan Finder at medicare.gov
  • Enter your zip code, prescriptions and pharmacy
  • Website will display all available plans in your zip code and your total out of pocket costs for prescriptions and your premium
  • Click enroll next to the plan you select
  • After you determine your plan, you can also enroll through these pathways
  • Call 1-800 MEDICARE (800-633-4227)
  • Call the insurance company

Annual Open Enrollment

  • You can change plans every year
  • The Annual Notice of Coverage for your current plan will arrive by September 30
  • You can start shopping for coverage on October 1
  • Open Enrollment is October 15 – December 7

Medicare Advantage Plans

  • Replace Medicare Part A and Medicare Part B with traditional medical plan benefits from a private insurance company
    • Copays
    • Coinsurance
    • Out of pocket maximums
  • You still pay your Medicare Part B Premium
  • Plans are available with and without prescription coverage
  • Participants must use a provider that is in the plan network
  • Most insurance companies offer a HMO and PPO plan design
  • Some plans cover out of network benefits
  • Some companies offer a Medical Only Plan at a $0 premium
  • If you enroll in a Medical Only Plan, you cannot enroll in a Medicare Part D Plan
  • If you enroll in a Medicare Advantage Medical Only Plan, you will be subject to the Part D penalty when you enroll in a Medicare Part D Prescription Plan or a Medicare Advantage Plan that includes prescription coverage.
  • If you enroll in a Medicare Advantage Plan Medical Only Plan and then enroll in a Medicare Part D Prescription plan, you will be dis-enrolled from the Medicare Advantage Medical Only plan.

How do I enroll? A local insurance agent can:

  • Help you decide if a Medicare Advantage Plan is right for you
  • Check your providers to make sure they are in the plan network
  • Check your prescriptions
  • Explain benefits and out of pocket costs

Annual Open Enrollment

  • You can change plans every year
  • The Annual Notice of Coverage for your current plan will arrive by September 30
  • You can start shopping for coverage on October 1
  • Open Enrollment is October 15 – December 7
  • Your local agent can help you with your Annual Open Enrollment decision.

Medicare Special Enrollment

If you… You Should…
  • Have group health insurance through your employer
  • Are covered by your spouse’s group plan
  • Enroll in Medicare Part A when eligible
  • Delay enrollment in Medicare Part B until you leave the employer plan
  • You can enroll in Medicare Part B at any time without penalty while you are covered by the group plan
  • You have 8 months to enroll in Medicare Part B without penalty after you leave the group plan

I am 65 and Will Keep Working
I am on my employer’s group plan
How do I decide what to do?

Analyze Cost and Benefits

What benefit package can deliver the most benefits at the lowest cost?

Employer Plan Medicare / Medicare Supplement / Part D
  • Pay period deduction
  • Pretax Benefit
  • Prescription coverage is included
  • Deductible
  • Copays
  • Out of pocket maximum
  • Medicare Part B Premium – Post Tax
  • Medicare Supplement Premium – Post Tax
  • Medicare Part D Prescription Plan Premium – Post Tax
  • Medicare Part D Prescription Plan Benefits

OR

Employer Plan Medicare Advantage
  • Pay period deduction
  • Pretax Benefit
  • Prescription coverage is included
  • Deductible
  • Copays
  • Out of pocket maximum
  • Medicare Part B Premium – Post Tax
  • Medicare Advantage Premium – Post Tax
  • Medicare Advantage Plan Benefits
  • Copays
  • Possible Deductible and Out of Pocket Maximum

Helpful Documents

Medicare and You This is the official U.S. government Medicare handbook.

Choosing a Medigap Policy A Guide to Health Insurance for People with Medicare. Published by the Centers for Medicaid and Medicare services and the National Association of Insurance Commissioners.

Blue Medicare SupplementSM

For North Carolina beneficiaries enrolled in Medicare Part B

Choose the Plan That’s Right for You

  • See the Doctor You Want
  • Value-Added Discounts
  • Control of Your Care

Savings and peace of mind

Medicare only covers some of your medical costs. That’s why Blue Cross® and Blue Shield® of North Carolina (BCBSNC) offers dependable Medicare supplement plans for Medicare beneficiaries, to help lessen the worries over costs that Medicare doesn’t cover. Choose from our 111 Blue Medicare SupplementSM plans to find the plan that best fits your needs and your budget.

  • Wide Selection of Plans
  • Protection Against Unexpected Events

A local company you can trust2

BCBSNC serves more than 273,0003 North Carolina Medicare beneficiaries with over 80 years of experience in the health care industry.

  • Named one of the world’s most ethical companies for five years in a row2

See the doctor you want

No matter which Blue Medicare Supplement plan you choose, you’re free to select your own Medicare-participating doctor or visit any Medicare-participating hospital. In most cases, your Part A and Part B Medicare claims and supplement claims are handled automatically by BCBSNC.

  • Choice of Medicare-participating doctors
  • Easy to use, virtually no claims to file

Blue365® Discount Program

Enroll in a Blue Medicare Supplement plan and get savings on a variety of products and services that can help you live a more healthy and active lifestyle – all at a discounted cost4. Save on services such as:

  • Vision
  • Laser Eye Surgery
  • Medical Bracelets
  • Healthy Eating
  • Hearing Aids
  • Gym Discounts

U4093, 1/17

Silver&Fit® Fitness Program

Blue Medicare Supplement is now offering an exercise and healthy aging program5. Questions about the program can be answered by calling 1-877-764-2746 (TTY/TDD 1-877-710-2746), Monday through Friday 8 a.m. to 9 p.m. Eastern Time

No waiting periods

If you enroll early, you may be eligible for this plan without waiting periods for pre-existing conditions. Pre-existing conditions are conditions for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage. If you wait until after the deadline to enroll, you may have a waiting period for pre-existing conditions.

  • No waiting periods for pre-existing conditions if you enroll early

Guaranteed acceptance by enrolling early

You cannot be turned down for Blue Medicare Supplement and may not have to complete a medical questionnaire if you meet the following:

  • You are age 65 or older, or under age 65 and are eligible for Medicare by reason of disability (Plans A and C 6)
  • You enroll within 6 months of enrolling in Medicare Part B
  • You are not covered by certain Medicaid programs
  • You are a resident of North Carolina

BCBSNC Blue Medicare Supplement Information
Compare Plan Benefits!
Get a free rate quote!
View the Blue Medicare Supplement Outline of Coverage brochure!

For more information about Blue Medicare Supplement plans, including a free rate quote, call Marcie Dicus at 828-348-2583, or e-mail marcie@wnchealthinsurance.com


For costs and further details of the coverage, including exclusions, any reductions or limitations and terms under which the policy may be continued in force, contact your agent or the company.

1 Plan A: BMS A, 11/13, Plan B: BMS B, 11/13, Plan C: BMS C, 11/13, Plan D: BMS D, 11/13, Plan F: BMS F, 11/13, HI DED Plan F: BMS HDF, 11/13, Plan G: BMS G, 11/13, Plan K: BMS K, 11/13, Plan L: BMS L, 11/13, Plan M: BMS M, 11/13, Plan N: BMS N, 11/13

2 Awarded by the Ethisphere Institute, http://ethisphere.com/worlds-most-ethical/wme-honorees (accessed December 2016).

3 Based on BCBSNC enrollment data, July 2016.

4 Blue365 offers access to savings on items that Members may purchase directly from independent vendors, which are different from items that are covered under the policies with BCBSNC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither BCBSNC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.

5 The Silver&Fit® program is a value-added service on most plans that is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH) and an independent company, to members of BCBSNC’s Blue Medicare Supplement plans. The program is not available on our F-HD plan and is not a part of a member’s policy or benefits. The program may be changed or discontinued at any time. Additional fees may apply and results are not guaranteed. You should consult with your doctor before taking part in a fitness program. All programs and services are not available in all areas. Silver&Fit and the Silver&Fit logo are trademarks of ASH and are used with permission herein.

CAUTION: POLICY BENEFITS ARE LIMITED TO THOSE APPROVED BY MEDICARE FOR PAYMENT.

WNC Health Insurance / The Asheville Blue Cross and Blue Shield of North Carolina® Store is an independent authorized Agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by WNC Health Insurance / The Asheville Blue Cross and Blue Shield of North Carolina® Store . Neither BCBSNC nor its agents are connected with or endorsed by the United States government or the federal Medicare program.

BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. All other marks are property of their respective owners. BCBSNC is an independent licensee of the Blue Cross and Blue Shield Association. U4093, 1/17

Home Health Care

Kemper

Most people would prefer not to enter a nursing home…

Kempers Home Health Care insurance plan is an affordable solution that gives you the flexibility to utilize the type of care that is right for you in the comfort of your own home.

Daily Benefits

Kemper will pay, subject to the policy provisions and limitations, a benefit each day you receive the following services from an approved Home Health Care Practitioner.

  • Skilled Nursing Care $75
  • General Nursing Care (LPN or LVN) $60
  • Physical Therapy $75
  • Speech Pathology $75
  • Occupational Therapy $75
  • Chemotherapy Specialist Services $60
  • Enterostomal Therapy $50
  • Respiration Therapy $50
  • Medical Social Services $50

The maximum benefit for these services is $150 / day for 360 days. The benefit will reset after 180 days of no care.

Prescription Drug Benefit

If you incur expenses in excess of the deductible of $50 per policy year for Prescription Drugs, Kemper will pay 80% of those expenses up to $250 per policy year.

Home Health Care Aide Benefit

Kemper will pay, subject to the policy provisions and limitations, a daily benefit of $40 for each day you require the services of a Home Health Care Aide for up to 60 days

Optional EXTRA Benefits

  • Annual Physical Exam $150
  • Vision $40 per exam
    • Frame and Lenses $75
  • Hearing Benefit $50 per exam
  • Ambulance $100 per trip
  • In Hospital Private Duty Nurse $80 per day

Affordable Rates for North Carolina Residents

Kemper Home Health Care Benefits
Attained Age Monthly Bank Draft Annual
40 – 45 $11.65 $140.20
46 – 50 $11.65 $140.20
51 – 55 $11.65 $140.20
56 – 60 $12.05 $144.65
61 – 64 $13.95 $167.80
65 – 70 $14.20 $169.45
71 – 75 $18.35 $220.25
76 – 80 $21.05 $252.85
81- 85 $24.80 $298.10
Kemper Home Health Care with EXTRA BENEFITS
Attained Age Monthly Bank Draft Annual
40 – 45 $17.45 $209.75
46 – 50 $17.45 $209.75
51 – 55 $17.50 $230.30
56 – 60 $17.90 $234.75
61 – 64 $19.85 $238.45
65 – 70 $20.05 $240.65
71 – 75 $24.40 $293.10
76 – 80 $27.15 $326.25
81- 85 $30.90 $371.50

Short Term Care

Bankers Fidelity Life

If you know the need for Long Term Care insurance but cannot afford the premiums, a Short-Term Care policy (B 9305) may be your answer for covering a Nursing Home Confinement expense. By providing up to 360 days of nursing home benefits per confinement, Short-Term Care will cover most all nursing home stays at a price that is much more affordable than traditional long-term care insurance.

In addition, Short-Term Care coverage helps provide a degree of protection from the depletion of your assets should you require a brief stay in a nursing facility. And a Short-Term Care policy allows you time to make critical financial arrangements if long term nursing home care becomes necessary.

Plan Highlights

  • Guaranteed Renewable for Life. As long as you pay your premium, your coverage cannot be cancelled.
  • No Prior Hospitalization Required. You may enter a nursing home directly from home.
  • Flexible Benefits. Choose from $ 20 a day to $ 300 a day with benefit periods from 180 days to 360 days.
  • Full Restoration of Benefits. Following confinement in a nursing home and after you have been confinement free for six consecutive months, 100% of any benefits paid are restored. Your lifetime maximum benefit is two times the benefit period selected.
  • Full Benefits Paid for Alzheimer’s Disease. Cognitive impairment, including senile dementia, Parkinson’s Disease and Alzheimer’s Disease are covered with the same benefits.
  • Broad Definition of Coverage. Benefits are paid when you are unable to perform two of five activities of daily living (ADL’s) and your nursing home stay is medically necessary as determined by your physician. ADL’s include:
    • Dressing
    • Toileting
    • Transferring
    • Continence
    • Eating

Long Term Care

It’s a fact: 70% of Americans over the age of 65 will need Long Term Care. Who says so? The Centers for Medicare and Medicaid Services.

For some people, the words “long term care” may bring to mind the image of a nursing home. In reality, long term care is a wide range of services and other support you may need to get though the basic and personal tasks of everyday life as you get older.

Putting a plan in place NOW, as you would for any other future financial need, can help prevent potential long-term care expenses from impacting your family and finances later on.

The cost of long-term care can be staggering. It’s estimated that one year of home health care, which costs about $ 45,000 today, will cost over $ 72,000 by the year 2034, assuming an annual inflation rate of 2.4%. Putting a plan in place NOW to address these expenses can give you the freedom to select the services and providers you want later on. Planning now may even extend the length of time you’re able to remain in your home.

Know Your Options

  • Health Insurance and Social Security
    DO NOT cover long term care expenses
  • Medicare
    May cover a portion of long term care costs, but only up to 100 days. Requires a three – consecutive – day stay in the hospital under treatment as well as other qualifiers.
  • Medicaid
    Covers long-term care expenses for individuals with assets of $ 2000 or less (varies by state); care may be limited to a nursing home.
  • Adult children
    Many people assume their adult children will care for them later in life, but this presents a huge financial, physical and emotional burden that some people aren’t willing or able to take on.
  • Out of Pocket
    Using income and savings or selling assets may be an option, however, considering the median annual cost for a private room in a nursing home is $ 87,600, it may not be a very efficient option.
  • Long-term care coverage
    Long-term care coverage is simply a way to protect yourself and your assets from the potentially devastating impact of a long-term care expense.

Together, We Can Select the Product that Fits Your Needs

If we decide that long-term care insurance is the right choice for you, here are three common types of products to choose from.

  • Life insurance policies with a LTC rider.
    Consider this option if you’re most concerned with leaving a legacy or caring for loved ones when you pass, but would still like to have access to the death benefit yourself if long-term care needs should arise;
  • Linked Benefit Policies
    If you are primarily concerned with LTC coverage and have less need for life insurance coverage, then a linked benefit LTC policy may be a good option for you; they offer an extension of LTC benefits beyond the life insurance coverage; premiums are guaranteed never to increase and are typically funded with a single premium or limited pay.
  • Stand Alone Policies
    If you don’t need additional life insurance coverage and desire LTC coverage with lower premiums compared to other polices, then a stand-alone LTC policy may be right for you. Please note that premiums may increase NUMEROUS times in the future, and there are no policy benefits other than LTC coverage.

How Benefits are Paid

Reimbursement-Style

With a reimbursement-style policy, which is the most common, the policy owner (or care provider) submits bills or receipts to the insurance carrier for approval. If approved, the insurance carrier then reimburses the exact amount of the bill monthly, up to the amount the insured qualifies for, but never more.

Cash Indemnity-Style

In contrast, cash indemnity-style policies pay the policy owner directly each month, without requiring monthly bills or receipts. Because the monthly benefit amount is sent to the policy owner, it offers flexability to use the funds for individualized care needs including:

  • Home Saftey Improvements
  • Prescription Medications
  • Massage Therapy
  • Home Maintenance or Yard Work

Don’t Leave Your Future Up To Chance

Taking control of your future long-term care expenses can be as simple as having a plan. Ask us for more information about long-term care coverage today!

Coming Soon