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A Complete Guide to Health Insurance Coverage for Older New Yorkers

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A Complete Guide to Health Insurance Coverage for Older New Yorkers A Complete Guide to Health Insurance Coverage for Older New Yorkers 2018 Updated January 2018 Bill de Blasio Mayor City of New York Donna M. Corrado, PhD Commissioner NYC Department for the Aging This guide has been developed by the New York City Department for the Aging’s Health Insurance Information, Counseling and Assistance Program (HIICAP) to help older New Yorkers better understand the health care coverage options currently available in New York City. The topics include Medicare Parts A and B, “Medigap” insurance, Medicare Advantage health plans, Medicare Part D, Medicare Savings Programs, Medicaid, and Long-Term Care Insurance. The information detailed here is current at the time of printing. Use it in good health! HIICAP is New York’s source for free, current and impartial information about health care coverage for older people. The HIICAP Helpline can assist you in getting your questions answered. Please call 311 and ask for HIICAP to speak with one of our trained counselors. We have HIICAP counselors available to speak with you over the phone or meet with you in person at one of our counseling sites. Simply call our helpline for a referral to the counselor nearest you. Please note that inclusion of specific health care benefit programs does not necessarily constitute endorsement of these programs on the part of the New York City Department for the Aging. Dial 311 for information regarding this and other City services. www.nyc.gov/aging www.aging.ny.gov/healthbenefits CALL 311 AND ASK FOR HIICAP 1 TABLE OF CONTENTS Topic Page Medicare---------------------------------------------------------- 3 Part A---------------------------------------------------------- 5 Part B---------------------------------------------------------- 6 Preventive Services------------------------------------------- 10 Medicare as Secondary Payer (for people with other health 12 insurance, including employer-based coverage)------------- Medicare Supplement Insurance (Medigap)------------------ 15 Medicare Advantage Plans (HMO, PPO, HMO-POS, SNP)---- 22 M---ed--i---ca re Part D-Prescription Drug Coverage----------------- 27 Extra Help Paying for Part D--------------------------------- 31 Elderly Pharmaceutical Insurance Coverage (EPIC)---------- 32 BigAppleRx Prescription Drug Discount Card------------------ 35 Medicare Savings Programs------------------------------------- 36 Medicare Fraud and Abuse-------------------------------------- 37 Medicaid for 65+, Blind or Disabled--------------------------- 40 Mandatory Medicaid Managed Long Term Care----------- 42 NY State of Health/Health Insurance Exchange------------- 46 Medicaid for under 65, not blind, not disabled------------ 46 Essential Plan------------------------------------------------- 48 Qualified Health Plan---------------------------------------- 49 Veteran’s Benefits and TRICARE for Life---------------------- 50 Other Health Coverage Options for New Yorkers------------- 53 Patient Rights and Appeals------------------------------------- 55 Advance Directives---------------------------------------------- 56 Long Term Care Planning--------------------------------------- 57 Eligibility Charts-------------------------------------------------- 61 Resources--------------------------------------------------------- 64 Health Insurance Definitions----------------------------------- 68 Medicare Coverage Choices Summary Chart------------------ 69 - Medicaid Offices in NYC----------------------------------------- 70 CALL 311 AND ASK FOR HIICAP 2 MEDICARE Medicare is a national health insurance program for people 65 years of age and older, certain younger disabled people and people with kidney failure. It has four components: Hospital Insurance (Part A). Medical Insurance (Part B). Medicare Advantage plans (Part C - HMO, PPO, Special Needs Plans). Medicare Advantage plans provide hospital and medical coverage. If someone joins a Medicare Advantage plan, they will have coverage through that private plan, not through “original Medicare.” Prescription Drug Coverage (Part D). Medicare Advantage enrollees who want drug coverage must get that coverage through their plan. Enrollees in “original Medicare” who want drug coverage sign up for a stand-alone Part D plan. Who is Eligible for Medicare? You are eligible for Medicare if you are 65 years old or older, and a citizen or permanent resident of the United States for at least five consecutive years. People under age 65 may qualify for coverage after receiving Social Security Disability Insurance (SSDI) for 24 months; people with Amyotrophic Lateral Sclerosis (ALS) qualify the first month they receive SSDI. People with end stage renal disease (ESRD) can qualify for Medicare, regardless of age. A worker, as well as a worker’s spouse (including same-sex spouse) or children may be eligible for Medicare, based on the worker’s work record, if she or he receives continuing dialysis for permanent kidney failure or had a kidney transplant, even if no one else in the family is getting Medicare. If you or your spouse (including same-sex spouse) are insured through Social Security (by having earned 40 quarters of coverage), you are eligible for premium-free Part A at age 65. Without 40 quarters of coverage, one may still get Medicare by paying a premium for Part A at age 65. If you have questions about your eligibility for Medicare, or if you want to apply for Medicare, call the Social Security Administration at 1-800-772-1213 (1-800-325-0778 TTY). You can learn more about applying for Medicare at www.socialsecurity.gov. How Do I Enroll in Medicare? Automatic Enrollment: If you are already collecting Social Security or Railroad Retirement benefits when you turn 65, you do not have to apply for Medicare. You are enrolled automatically in both Part A and Part B and your Medicare card is mailed to you about three months before your 65th birthday. If you receive Social Security Disability benefits, you will automatically get a Medicare card in the mail after you have received Social Security Disability benefits for 24 consecutive months. If you wish to decline Medicare benefits, follow the instructions mailed with the Medicare card. If you are not receiving Social Security benefits as you approach age 65, and you want your Medicare benefits at age 65, you must apply for Medicare benefits by reaching out to the Social Security Administration. You can call 1-800-772-1213, visit a local Social Security office, or you may be able to enroll online at www.socialsecurity.gov. Applying for Medicare Part A: Individuals eligible for premium-free Part A at age 65 can enroll in Medicare Part A at any time, and coverage can be retroactive up to six months. Those CALL 311 AND ASK FOR HIICAP 3 who need to pay a premium for Part A (don’t have 40 quarters of coverage through Social Security) can only enroll during their Initial Enrollment Period, and thereafter only from January 1-March 31, with coverage effective July 1. These individuals may incur a 10% Late Enrollment Penalty. Applying for Medicare Part B: If you are not receiving Social Security when you turn 65, you have a seven-month Initial Enrollment Period (IEP) in which to enroll in Medicare. You can enroll by contacting the Social Security Administration (SSA) three months before you turn 65, the month in which you turn 65, and the three months that follow. If you enroll in the three months prior to your birthday, your Medicare coverage will be effective the first of the month of your birthday. If you enroll in the month of your birthday, your coverage will be effective the first of the following month. If you enroll in the month after your birthday, your coverage will be effective two months later. If you enroll two or three months after your birthday, your coverage will be effective three months later. Note: For people born on the first of the month, Medicare eligibility starts on the first of the prior month. If you do not enroll during this seven-month period and do not have health insurance through a current and active employer (yours or your spouse’s) you will have to wait to enroll during the General Enrollment Period which is January 1 to March 31 of each year, but Part B coverage will not start until July 1. If you do not enroll during the initial enrollment period and do not have other coverage through an active employer of you or your spouse, you may face a higher premium as a penalty for late enrollment. The penalty for late enrollment is 10% for every 12 months of non-enrollment in Part B. NOTE: COBRA coverage is NOT coverage through an active employer, thus COBRA does not qualify you for a special enrollment period. Actively Employed and Medicare Eligible: If you or your spouse are actively employed and have health insurance through that employer or union, you may not need to enroll in Medicare Part B when you first become eligible; contact the employer or union as to whether they require enrollment in Part B. You may wish to enroll in Part A regardless because there is no premium for this coverage, though this is prohibited if you are contributing to a Health Savings Account (HSA). Refer to the section on Medicare as Secondary Payer (see page 12) for more information. Medicare Card Replacement: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that Medicare no longer use Social Security numbers on their cards in order to prevent identity theft. Between April 2018-April 2019, Medicare will be sending new Medicare beneficiaries their cards with a randomly assigned identifier, not related
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