Event ID: 1626437
Event Started: 9/28/2010 4:48:00 PM ET
Please stand by for realtime captions.
[ Captioner dialed 619-594-0680, and the line continues to ring busy. Captioner will continue to stand by. Please contact Caption Colorado at 800-590-4197 or firstname.lastname@example.org. Thank you.
[ Captioner re-dialed 619-594-0680, and the line continues to ring busy. Captioner will continue to stand by. Please contact Caption Colorado at 800-590-4197 or email@example.com and provide a different access telephone number. Thank you.
[ Captioner is attempting to access the URL http://www.onlineconferencingsystems.com/chiip provided, but is receiving an error message when attempting access to the conference room. Captioner will continue to stand by. Thank you. ]
I will give you the website for the agency that oversees Medi-CAL. But go ahead and go into the details about who is eligible for Medicare. 65 years of age or older. From what I read. That is the group we will focus on. Most of the information we will go over today. My focus is on those who get Medicare, they are younger than 65. They are getting Medicare because they qualify for SSDI and they have received it for least 12 month and they become eligible for Medicare. One exception or subgroup in this group is people with ALS. For them, there is no waiting period. They don't have to wait the full 20 months. Again, most beneficiaries younger than 65 is due to a disability. That is an area -- I'm sure you are where that.. [ Indiscernible -- poor audio ] .
The waiting period -- [ Indiscernible -- poor audio ] . What we still have a couple of months, a few things that we try to do, in terms of education is -- some are told that they qualify. Some are not told that. Whether they're told that or not, two years later, it is sometimes her to remember. We are hearing that for a lot of people. They are not enrolled in Medicare. They don't get the card. They don't remember to ask anyone. Although they are eligible, they have not been enrolled to get the benefits. Try to get the word out. Regarding the disability SSDI. To remember too expected. If they do not get the card, they should contact their Social Security office.
There are some circumstances where people may be entitled to Medicare. An example would be beneficiaries who have Medicare due to a disability. And they had before they were 65. In Medicare, they now have Medicare -- [ Sounds of typing are interfering with the audio quality ].
And then they get a disability. Again, in Medicare size, they are ready have Medicare -- already have Medicare. In a situation would be somebody who is younger than 65 and have a disability and they also have end stage renal disease. In this case, it is good they have SSDI. [ Indiscernible -- poor audio, audio cutting in and out ] . They get it because -- [ Indiscernible -- poor audio, audio cutting in and out ] . Their Medicare eligibility me and when they get -- me and when they get a transplant. -- and they get a transplant. They can also get Medicare for disability that can continue. [ Indiscernible -- static ] .
With someone has Medicare due to a disability and then they enter Medicare when they turn 65. Here is an outline of what this Medicare covers and the cost. They've reached the hospital -- [ Indiscernible -- poor audio, audio cutting in and out ] . It covers hospital and if you other things. And then-- [ Indiscernible -- static ] . And the differences services. All of the Medicare advantage plans -- they go into some detail in several slides. Okay, [ Sounds of typing are interfering with the audio quality ]. I will stop. Okay.
The microphone is cutting in and out. Is there some solution? I will try moving away. I will continue until you tell me again to do something different. That is much better.
Part B is the newest part of Medicare. And it is all about prescription drugs. This is kind of a big picture map for the different parts of Medicare. Again, in pink, that is the original Medicare. I have some details regarding part A, hospital entrance. There is a deductible for the hospital and if it only -- benefit only. You will see what I mean, later. Part B is outpatient benefits. There is a premium for those on part B. And there is a deductible. In the coinsurance is usually around 20%. Part C, that is the Medicare Advantage plan. And part D is the newest part, the yellow one. Medicare will cover if the care provider is medically necessary and feasible. That is the principle. That is the criteria. Part A covers in hospital patient care. The beneficiary must be admitted as an inpatient. A -- Part A covers psychiatric care. This is not nursing home care. Is a temporary care. [ Sounds of typing are interfering with the audio quality ].
It also covers simple healthcare and hospice care. If someone is in the hospital or in a facility and they need blood. Medicare will not cover it but only after the first -- [ Indiscernible -- poor audio, audio cutting in and out ] . The beneficiary is responsible for the first 3 pints that they need. Part A, for most people, there is no premium. I will not say that it is free because what happens is all of us, we pay into a trust fund. When we eventually become eligible -- [ Indiscernible -- poor audio, audio cutting in and out ] . Right now we are paying it for people who are beneficiaries now.
I will go into some detail about when people who are younger than 65 and they get Medicare because of a disability. They may have to pay later. I will get to that. Part A has a deductible. $1100 was what it was this year. That is from the first day and that is-- [ Indiscernible -- poor audio, audio cutting in and out ] . The cost sharing for the different benefits, there is coinsurance. I don't have time to get into that detail. If you need that, that is on our website. Or we can send it to you on a fact sheet. I will refer to that later.
Okay. One question that we get is, again, someone who has a disability, they're going back to work. And they are wanting to know if they will lose Medicare. For them, there is something called the Trial Work period. They going to be extended part of Medicare coverage. I were going to detail in the next few slides. After that is over, then they can buy part A if they want to continue. Let's talk about this. The month for the period is made up of nine months. One month is someone who gets SSDI and they work and they get more than a certain amount. That amount is $720 per month. Every time they go over this amount, it is counted toward the nine month requirement. It does not have to be consecutive. It has to be within a 60 month window. During this trial period, if they continue to be disabled and continued to receive SSDI. Medicare coverage will continue.
They don't have to pay that part A premium. But parts B and C, they both have premium and if they want part B, they have to pay those premiums. When someone has had the 90 month of -- I'm sorry, the nine-month during the 60 month period, once that is over, and they get SSDI -- [ Indiscernible -- poor audio, audio cutting in and out ] . If they work in their income is over a certain amount, this is where it starts. The extended period of Medicare coverage. This period goes on for three months and a maybe even longer. Depending on how much they earn. During this period of nine months, -- 90 month, that is seven years and nine months. They do not have to pay that part A premium. Again, if they want part B or D, they have to pay the premium for those two parts. After that extended area is over, if this person wants to continue to have Medicare coverage, they can buy part A. Again, if they want that, they need to continue to meet the disability requirements.
If they want to buy part A, the premium is $461 per month this year. We expect that amount to go up. If they want parts B and or D, they paid the premium or those parts. Again, that was part A. We will do part B. Again, a reminder, medically -- medical care must be reasonable. Part B covers a wide range of services. Here are some examples of what part B covers. The beneficiary doesn't do well, and the go to see the doctor, that is covered. That Dr. visit is covered. At the doctor wants them to take some test for them to be able to diagnose what they have, that test is covered by Medicare. If the person needs rehab services like physical their feet or artificial there be or speech there be, Medicare will cover it if it is ordered by the doctor. Durable medical equip it -- that is a huge area. Examples include a wheelchair or a hospital but or a walker.
Part B of the covers and beloved service. But there are some limitations for that. A lot of this you need to know about before you do that and get Medicare to cover that. Medicare part B covers metal health -- mental-health provisions as well. But coinsurance is different for services that are not mental-health visits. For other medical health services, part B -- usually there is a 20% coinsurance. For mental health services, this year, it is 45%. A couple years ago, there was a law that tried to decrease the. [ Indiscernible -- poor audio, audio cutting in and out ] Part B also covers outpatient there be and speech there be. I also put a limitation there. There is a. There is a. -- a cap.
Another way to think about part B is about what is not covered occur -- covered. Routine dental care or I care -- eye care -- [ Indiscernible -- poor audio, audio cutting in and out ] . Part B will cover some dietary care -- podiatry care. It generally does not cover of Medicare to. -- cosmetic surgery. [ Indiscernible -- poor audio, audio cutting in and out ] . Part B -- as someone once part B and they're eligible to get part B him a they have to pay a premium. This year, the standard premium is $110. It got real complicated this year -- before 2007, all beneficiaries paid the same amount for part B . In 2007, what started to happen was that Medicare decided to charge beneficiaries whose income was over a certain amount. They decided to charge them more. This year, [ Indiscernible -- poor audio, audio cutting in and out ] . If someone is more than $85,000, they paid more than $110. And the amount is tiered based on their income. [ Indiscernible -- poor audio, audio cutting in and out ] . About 73% of Medicare beneficiaries pay that amount. $96.40 because between 2009 and 2010, there was no cost of living adjustment. For people getting Social Security retirement checks am a there was no increase in their check. The provision in the law, [ Indiscernible -- poor audio, audio cutting in and out ] --- the Social Security checks do not increase. And the Medicare premium for them will often not increase. It will say the same.
Those are the same amount. People who are new to Medicare and are becoming new beneficiaries for the first time, as of January 1, 2010, they will pay $110.50. There is a late enrollment penalty. If they do not enroll and do not have coverage, for them, [ Indiscernible -- poor audio, audio cutting in and out ] . When they turn 65, again, I am assuming the situation was Medicare beneficiaries who get it do to a disability, when they turn 65, everything reset -- resets and that late penalty goes away when they turn 65.
In addition to a premium, there is a deductible. It is a annual to dockable of $135. I will pause here if you have questions. Please ask.
It sounds like there are new questions -- no question so I will move on. Moving on. There are questions. I cannot see them. To private insurance and 65, do you have to go with Medicare? Is it your primary insurance? I need more interest about -- more information about what that is. Can I follow-up with Murray a -- Maria afterward and we will follow-up on that. [ Indiscernible -- poor audio, audio cutting in and out ] .
The 1993 -- [ Indiscernible -- poor audio, audio cutting in and out ] . For part A, yes, you do have to pay a premium. Does it cover home renovations?, Not that I know of. I will have to refer you to another organization. It is not under Medicare. If someone has a foot injury, is not covered under Medicare? If it is not routine, if it is medically reasonable and necessary, it needs the standard. Vision only after cataract surgery? I am not sure what the question is. Okay. Most recent question. You cannot hear? You need some feedback on that? Can you use part A -- [ Indiscernible -- poor audio, audio cutting in and out ] . What do you mean? Please e-mail me some clarification on that.
The most recent question I have is that classes are covered under had a wreck surgery? -- under cataract surgery? I think so that I have to look that up. Can we move on? I am going to move on. Again, if you have more questions, e-mail me. I am very conscious about the time. Okay, I will move on to slide number six. This is the big picture of Medicare. I will talk about part D. I am skipping C for now and I will come back to it. Part C is not about benefits. It is about how you will get your Medicare coverage. I will come back to part C. Here is a true or false question. I don't know if it will work on the webinar. With an audience in person, I asked them, since January 1, January 1, 2006, they have covered prescription drugs, true or false? Some people say two and some people say false. You are both right. It depends on who you are talking to.
Some people would say true that they agree with Medicare. If he talks to someone who works with Medicare. Of course, since 2006. They have covered perception drugs, because that is the newest part of Medicare. If you ask hard-core advocates and a lot of beneficiaries, they will say no. That it doesn't cover prescription drugs. If you want them covered, you have to buy it through a private plan. And buy insurance through a private plan. There are other problems with the statement that it is a good soundbite. But it doesn't capture all of the competitions and new evidence -- complications and nuances.
Part D was created by legislation that we callthe Medicare -- [ Indiscernible -- poor audio, audio cutting in and out ] . The shorthand, we call it the MMA. We call it the drug prescription benefit. It was effective January 1, It was effective January 1, 2006. Basically what part D iss, the Medicare beneficiaries can buy insurance to cover their prescription drugs. He outpatient prescription drugs. They are brand-name and generic drugs that are covered. As well as biological vaccines.
The criteria for coverage of these drugs, prescription drugs or biological or vaccines, they have to be products approved IV FDA. -- by the FDA. But it has to be bought in the US. Again, people who use them and buy them from neighboring countries or other countries, that will not be covered by part D . Those drugs have to be used for medically accepted indications. Part D plans can be stand-alone plans and cover only prescription drugs or Medicare advantage plans that cover prescription drugs as well as hospital and medical benefits. They can choose which drugs they want to cover.
It is not a free-for-all. It is a formulary list. The plans need to follow certain parameters that Medicare set up. Medicare says that if you want to offer a Medicare part D plan, you have to cover at least two drugs in each category. As you know, there are many drug categories. At least two each. There are six drugs each that Congress cited they would protect. In these six categories are called the protected classes. For these six classes, every plan needs to cover all or substantially all drugs in each category. The six categories are antidepressant, antipsychotics, and to control the, anticancer, immunosuppressant, intro -- antiretrovirals. If you want to offer a part D plan, you have to substantiate all drugs in these categories.
Another way to see part D is what it does not cover. Here is the list. Agent for weight loss or weight gain. Anything used for cosmetic or business for hair growth. Drugs for the release of cough and cold. Nonprescription drugs come over-the-counter. Even prescription vitamins and minerals. There are some exceptions. I don't have time to go into detail. Barbiturate and die as a been -- diazapine. Currently not covered. If you have a beneficiary who also has Medi-CAL, that may cover it. I put two notes there. For those two classes, MITZPA, a law passed in 2008, they will cover it if it is used to treat a mental condition or cancer or epilepsy. The affordable care act -- Affordable Care Act opened it up even more. As of 2014, Medicare part D will cover these two classes. Part D will also not cover agencies that promote fertility or treat sexual disruption or erectile dysfunction.
Part D plans have to follow certain grandmother's set by Medicare. They can if they want to, be more generous and cover the drugs that we just said that are not covered by part D . They can have it in their plan. But the cost sharing will be a little bit different. The price of the drug will be different. Beneficiaries who want this insurance, they can get it by buying a standalone prescription drug plan or PDP, for short. Or they can plan a Medicare part C plan, the Advantage Plan. Those are the two ways they can get part D coverage. This is something I put out there is a lot of people think that by joining the Medicare part D plan, they do not have to pay for their prescription drugs. They think they are covered. Of course, we know that is not true.
Part D is a coverage for prescription drugs. Whatever we buy insurance, whether it is health insurance or car insurance, there is a premium. They pay the premium and, depending on the plan they choose, they may have a deductible. And then they have cost sharing. And that is where it gets really compensated. -- complicated. I will attempt to go through how the cost sharing works. Included in this will be talking about-- [ Indiscernible -- poor audio, audio cutting in and out ] .
This is the standard plan. It is something that Medicare -- part D plans -- they have to at least meet the standard plan requirement. They have to be as good as the standard plan or better. The way that part D car sharing works, the year start -- the standup plan has a deductible of $310. The beneficiary pays that first. Once they have met the deductible, they go into what is in the yellow row, the initial coverage phase. During the initial coverage phase, they will pay 75% of their cost. Tow truck cost. And the beneficiary pays 25% of their total drug costs. We are doing pretty well. Until the beneficiary total drug costs exceeds $2830. This is the beginning of the coverage gap.
Or what we refer to as the "donut hole." This $2830 is the beneficiary total drug costs. It is what they spent as well as what the plan is paid for them. People can reach that doughnut hole really early to get their drugs are expensive. The $2830 and $6400, that is a gap. That is what the beneficiary pays 100% of their drugs. The plan does not pay for anything at that time. And the beneficiary continues to pay the premium. At the beneficiary is lucky to meet -- if they need more drugs for the or, they will get into catastrophic coverage. That is when the total drug costs exceeds $6000. When they reach past that amount, the plan, and catastrophic covers, pays for 90% of their drugs. And they are responsible for 5%.
This is how the standard plan works are out of your -- throughout the year. Some beneficiaries by it they don't take drugs. And they never go through this through the year. Some beneficiaries need medication but not that much. So that they stay in the initial coverage stage all year through. For them, this is a really good deal because, compared to 2005 and previous years, they are only paying 25% of their drugs. Beneficiaries who hit the doughnut hole, of course, they are the ones who have to suffer through this. Those who reach the catastrophic coverage, this helps a. Their drugs are so expensive anyway. They get quite a bit of savings. For example, someone with the drug costs of 10,000 or more, -- $10,000 or more, this will really help them even after they go through the doughnut hole. I think this is a good time to break to see if there are any questions about parts A or B. Ask those questions.
Okay. The first question, how are these cost go with under the advantage care plan? With the Medicare advantage plan, making all of this prescription drug benefit. They would put that-- [ Indiscernible -- poor audio, audio cutting in and out ] . The way they structure their cost and the benefits for prescription drugs, they have to follow the standard part B plan. They can be more generous but not less generous. Again, they may follow the deductible and then the different cost sharing, 25% to 75%. And the doughnut hole. [ Indiscernible -- poor audio, audio cutting in and out ] .
What is the rebate listed? Thank you. The rebate, again, as a result of the new health law. The new health law is attempting to cover this coverage gap. For this year and this year only, people who fall into the gap, the federal government sends them a check for $230. They call it a rebate with a little bit of a misnomer. It is helping people who fall into the hole and instead of having to pay $3610, they are paying $3250 after they get the check. The goal with the new health law is that by 2020, there will not be this gap anymore. Throughout the year, their deductible is met. After it is met, there are some insurance is-- [ Indiscernible -- poor audio, audio cutting in and out ] .
Explained the rebar -- rebate under part D ? I did that. The person who says they cannot hear anything, I am not sure what I can do about that. What will the change in 2011 be with the doughnut hole? Again, this $250 is for this year only. 2010 only. Starting next year, for people who fall into the doughnut hole, and they need brand name drugs, they will get a 50% discount. The federal government is fully expecting all drug many factors to -- manufacturers decide an agreement for the 50% discount. So the discount is not coming from the part D plan. It is coming from the drug manufacturers. 50% discount on brand-name drugs. And the federal government will provide a subsidy for generic drugs.
Okay. I think I got all of the questions on part D . I will move on. I will go back to the big picture to let you know where we are in this map. We are going to move on to part C, the Medicare Advantage Plan. A lot of people who are in these plans, they do not know that there is a part C. This is again, a need for us to educate people. With part C, what Medicare does is contract with a private company and tells insurance companies. To offer plans just for Medicare beneficiaries. All Medicare advantage plans must include hospital and-- [ Indiscernible -- poor audio, audio cutting in and out ] . These lamps can be more generous. They can also cover prescription drugs. If they do, they are called Medicare Advantage Plan -- prescription plan. Or they can choose not to cover prescription drugs. And the shorthand is MA only. They will cover hospital and medical benefits only.
Another point of area of education is that we tell beneficiaries to joina Medicare Advantage Plan is optional. A lot of times, they got two sales of the patient and they are convinced that they must join the Medicare Advantage Plan . That is not true. If they do join the Medicare Advantage Plan , it replaces the original Medicare. They do not give up Medicare, they will always have it. If the Medicare Advantage Plan terminates or they decide they don't want to join him plan anymore, they can go back to the original Medicare.
Some beneficiaries think that when they join the Medicare Advantage Plan , they no longer have to pay the part B premium and that is not true. That is another area that we need to correct people a let them know they have to continue to pay their part B premium. And if the Medicare Advantage Plan has a premium, they have to pay that in addition. They try to make themselves different or more check it to Medicare beneficiaries. So that the beneficiaries joins their plan. And there may be additional benefits which might be like dental or vision or, more recently, they are offering a free June -- Jim membership -- gym membership.
There are many if it types of Medicare Advantage Plan offered. There are many types in California. We are familiar with the HMO which stands for health maintenance organization. And PPO. And PFS. It works like the original Medicare. In the original Medicare, the beneficiary goes to a doctor and the doctor old Medicare. And Medicare pays the doctor. In private see -- fee for service, they go to the doctor and the doctor bills the minute -- private plan. Medical savings account. We do not have this type this year in California. We did the last few years. But not this year. And they may not come back.
SNP stands for special needs plan. There are three types of these plans. One type is the dual-SNP. Special needs plans full in a fishery who have those Medicare and Medi-CAL. And C-NP. -- C-SNP. These are plans designed for people with chronic conditions. It could be diabetes or congestive heart failure. The beneficiaries need to have that condition to join the chronic SNP. Institutional SNP. Those over beneficiaries who are residing in a state institution. Or they need a level of care -- they are out in the community and not in an institution. But the level of their need for care is to hire someone who is from an institution.
I will focus all of it on the D-SNP. I understand from Carla that those of you on the webinar, that is the population user.. To join this, come -- the beneficiary must have Medicare and full medi-CAL. [ Indiscernible -- poor audio, audio cutting in and out ] . Special-needs plant -- the prescription drugs benefit will be covered. Peoples -- people in these plans do not have to buy a standalone separate plan. It is already included in their plan. With the special-needs plant, they work like HMOs in that the enrollees must go to providers in the network.
The cost of joining is -- this year, the premiums go from $0-$250. We remind people when they join the plans that they have to continue to pay their part B premium. The cost sharing -- once they join these plans, the original Medicare plan cost sharing -- echoes away. Or gets replaced with a plan cost sharing. Or example, we said -- for example, part B, it is a 20% coinsurance with the original Medicare. Was a join him plan, their plans may say that are going to see the doctor, your copayment is $25. So they pay the $25 instead of the 20% coinsurance. Some of these Medicare advantage plans like the regional PTO, that has a deductible. Some other plans have been in a deductible just for the drug benefits. The deductible applies only to win they fill the prescription.
Some of them have an annual out-of-pocket maximum which is a good feature for the beneficiary. It helps them budget for the year. Again, this is a good break for asking questions about Medicare advantage. And then we move on to the choices that people have to make.
First question is does the Medicare premium automatically deducted for the Social Security check? I am assuming that you meet the part -- mean the part B premium. Most people choose that. Those who join the Medicare Advantage Plan or standalone part D, they get to choose whether they wanted to duck up in the Social Security check or to pay that separately. Our advice and even Medicare advises that they have it built to them separately. What happened in the last few years and it may still be happening is that people chose to have the part D premium or the Medicare Advantage Plan premium deducted and it was really messy. It would be deducted from the check and the system didn't always work. So that the advantage plan did not get the premium. And is enrolled people because they thought they had paid. And they said they were being -- it was being deducted from the social. Again, for part D plans or part C plans, devices to have it billed separately. AARP Is an example? It is a membership example -- organization. They are not in it should company like people think. They do offer a lot of different drugs for their membership. One of their products is the Medicare Advantage Plan . In California, it is called Secure Horizon. AARP also offers the standalone part D plan.
And also offers Medi-gap plans. We will talk about that later. When they say they have AARP, it doesn't really tell us a lot until we ascertain what AARP plan they have. Sometimes the beneficiary does not know. How much is part A and B total? Are you talking about the premium? Please clarify. [ Indiscernible -- poor audio, audio cutting in and out ] . I need clarification. I am not sure what Medicare been a fishery is here. -- Beneficiary is your. -- beneficiary is here. Do you mean the child? I need more clarification. [ Indiscernible -- poor audio, audio cutting in and out ].
Medicare cost should not -- cards should not have AARP on there. Possibly, this is someone who signed up for an AARP plan. People are thinking that is their Medicare card. I am guessing that is what the question is about. Monthly premiums for A and B total, cost per month? Let's go back to this slide. For people -- again, most people -- we are talking about Medicare in a fishery's with a disability. They really don't have to pay upfront a premium. It is only after that extended period, of Medicare coverage, after they have exhausted their part A, then they have to pay a monthly premium. Part Z A --, it is $461 per month. And I'm assuming that this is someone who was recently eligible for Medicare. So their part B premium would be $110.50.
A and B premiums, if they have to pay both.
I am not ignoring your question. What about-- [ Indiscernible -- poor audio, audio cutting in and out ] . I don't see a question before that. If you please send it again? [ Indiscernible -- poor audio, audio cutting in and out ].
I will move on. My question is do you know what is changing with ADAP? I hope you mean and 2011? The new health law does change that. So far, the ADAP --what it helps people -- [ Indiscernible -- poor audio, audio cutting in and out ] . I think it is starting in 2011. It will be counted. That is a change next year. I hope that answers your question, if not, please e-mail me or ask again. This last question. For child to qualify for Medicare, and they are ready have old Medi-CAL, I understand there is a-- [ Indiscernible -- poor audio, audio cutting in and out ] . Does early retirement constitute fulfillment of their requirements are for they turn 65? I think this is a Medi-CAL question. I don't think they can qualify for Medicare because of that. If they turn 65, they had the disability and they get as a CI -- get SSDI for 24 months. I think this is a Medi-CAL question. I will move on to the steps in choices that people have to make. These are some questions that we get. Can someone delay part B enrollment and what is the situation? If I join a part D plan or if I get medication -- what about joining a Medicare Advantage Plan ? Must they join this was go I will go through all of these questions.
Part B, it is -- they have to pay for it. That has a premium. For a situation where they might not want to enroll in part B, if they are working. And they get health coverage. Or a family member works and that employer coverage covers them as well. If they are eligible for Medicare, they may want to delay enrollment in part B. Part A is usually not an issue because they do not have to pay a premium. Where is part B, they go they have coverage and the coverage is primary. White I want to pay $110.50 each month? For Medicare to be primary coverage -- secondary coverage? That is one situation where they want to delay it. Some people who have employer group coverage and they are also eligible for Medicare, they choose to enroll in Medicare. Again, in that situation, the employer is primary and Medicare is secondary. For whatever reason, they find that Medicare is secondary is helpful to them. So they have both. Another option that they have in the situation is they enroll in part B and they enroll their employer coverage. Reasons for that is that the coverage maybe really skimpy.
Or it is a really huge premium. Where is if they go with part B, it is only $110.50. Compared to what the employer is asking them to contribute. That may be a situation where they decline the employer coverage. Those are the options. The employer group health coverage, again, this is an area where people get confused. It is not the same as retiree health benefits. If someone is actively currently working. And employed. [ Indiscernible -- poor audio, audio cutting in and out ] . They are retired from that employer but they're still providing them with benefits. [ Indiscernible -- poor audio, audio cutting in and out ] .
Large group health plans. For someone who has Medicare due to a disability, if they are employed, and their employer has what hundred or more employees, federal law requires this employer to offer to their Medicare eligible employee, the same coverage as for all other employees. In other words, they cannot discriminate against his employee because they have Medicare due to a disability. Again, they have to offer them the same coverage.
Enrolling for parts A and B, and this situation, again, somebody who decides to enroll in their first eligible, their enrolling period is seven months. In their 25th month of getting SSDI, let's say that is used. Three months for that, March 1, that is when their initial enrollment period begins. In June, that is the month of eligibility. The fifth month is July. And in August and September. At the end of September, it is the end of the initial enrollment period. They can enroll in A or B if they choose to. If they missed the initial enrollment period and the seven months past and they later want to enroll, every year,the General. enrollment Erie is the first three months of the year. The special enrollment period is available only for people who delay enrolling in part B because they have employer group health coverage. So the special enrollment period is eight months. It is eight months beginning the first a of the first month after employment and. Or group health coverage as. Whichever is earlier. Social Security is very fickle about sticking to the state's. The earlier date. They will start counting date month after the earlier date. Are in a statement, a person may enroll in part B. And not have to pay the late enrollment penalty. If they miss the eight months, they waited nine or 10 months, and then enrolled in part B, during the General. enrollment period, they would probably have to pay the late enrollment penalty which is 10% for every 12 month period.
As for part D, people ask, I don't take any medications now, why should I buy this plan? It is optional. Part -- part C and D are optional. They bite because they understand that part D is insurance. Whether it is insurance or health insurance or home insurance, you get it before you need it. For sample, we don't get Carter and when we have an accident. By part D -- Or part D when you need medication. A lot of people do not want to buy -- pay for the late enrollment multi-fee -- penalty fee.
Other coverage maybe through their group plan. VA It may be coverage, Tri-Care. As long as their other coverage is creditable, that means as good as or better than the standard part D that we talked about, as long as that is as good as or better than they do not -- they do not need to join a part D plan. If they get this additional coverage, that is considered credible. Again, with those types of coverage, they don't have to join a part D plan. And if they decide to join one later, they will not have to pay the penalty. Again, this is what I just went over. They can delay. And not have to pay the late enrollment penalty. That is what LEP stands for. If it is not creditable, a may have to pay the late enrollment penalty fee.
The misconceptions, this year, there are 47 stand-alone prescription drug plans to choose from. One question that we get a lot is which is the best plan? This is a misconception. There is no best plan. Defensible the person needs. Another thing that people think about is the higher the premium, the better the coverage. Again, that is not true. Some people go with an established company or no-name. AARP -- people should choose a plan -- they shouldn't base it on that. It depends whether medication needs are. Again. They go by what other people tell them. It goes back to what medications do they need? To the plan that will cover all your medications ideally.
And the last part, [ Indiscernible -- poor audio, audio cutting in and out ] . That is partially true. The benchmark plan -- [ Indiscernible -- poor audio, audio cutting in and out ]. For someone who has the low-income subsidy, we will go over that. That may be a very good choice for them. The way to choose a part D plan is to look at the plans for military. We don't expect you to look at the whole list. On the Medicare website, that is Medicare .gov. There is a tool called the "plan finder." It allows them to enter in the medications that they take. And it will find a plan that will cover all or most of the beneficiaries medications. They will be given choices and they can choose based on premium and whether there are restrictions and there is really a lot to think about in choosing a part D plan.
The restrictions that I mentioned for a part D plan, it allows us to control the cost. They can do that by putting restrictions. There are three types of research and. One is called "prior authorization." Not all drugs are subjected to this. Some are. What the plan is saying that with this drug, we want the beneficiary Dr. to contact the plan and tell us why the doctor is prescribing this drug. Another restriction is called "quantity limit." It is not included on every drug. Every plant may have different rules. As to which one is restricted to this. It is saying that we will cover this drug, 30 pills for 30 days. If you need more than that, we are not covering more than that. You have to pay out-of-pocket.
Another tighter restriction is called "step their be -- therapy." Which is saying they want you to try a lower cost alternative. If you try and it doesn't work, then we will cover the more sensitive brand-name drug that your doctor prescribed for you. Again, those are the restrictions. Other things to consider when choosing a plan is the cost. Like any insurance, with a premium, it has a deductible and cost sharing as well. The plan finder on the Medicare website will provide all of the information for the plan for the drugs that the beneficiary takes.
Another thing to consider is convenient. Whether the beneficiary has access to that network pharmacy. Again, they go out to the pharmacies in the contract with those pharmacies. Those pharmacies get to choose which plans they want to contract with. They should choose a plan that has contracted with a pharmacy that he or she can access easily. Some plans provide mail-order services. And at the beneficiary want that, they should look for plans that do have that. Most of them do.
The eligibility, if you signed up for a part D, the beneficiary must have part A or B. They do not need to have both. Either one would make them eligible. The initial enrollment period is very much like part B. It is seven months. At three months after. The annual election period, that is was passed in 2005. It is the last six weeks of the year. Starting next year, 2011, those dates are going to change. For this year, it is still November 15 to December 31. A special enrollment period is when a beneficiary has a situation that would allow them to change plans midyear. For example, a beneficiary moves from LA to save the disco. They can be area specific. They service certain areas. Some may serve the whole state of health warning. Medicare advantage plans are different. For these, the Medicare Advantage Plan, they are county specific. I will go over that in a couple of slides.
Moving to part C choices, we talked about what the Medicare Advantage Plan is, people ask what the damages? If you join a plan and you still have copayments? Some advantages maybe that to join us, there is no help screening. Someone who has a pre-existing condition. The plan cannot refuse them because of that pre-existing condition. Other questions are, somebody wantsthe Medicare Advantage Plan but they don't know which type of plan to choose. We went over what an HMO and PPO its. That is where I come in explained to them the different types and whether preferences are in needs maybe. To choose a plan. If I am eligible, must I join a SNP? It is not mandatory. It is optional. That includes the special needs plan. If I join one, must I always -- also joining part D plan? The answer is No. C To join a part plan, they must have a A and B. That is really only the criterion to jointhe Medicare Advantage Plan . Also, they cannot have end stage renal failure to join a plan. [ Indiscernible -- poor audio, audio cutting in and out ] .
The initial coverage election period is seven months. It is the seven month window. They can join Medicare Advantage Plan during the annual election period, the last six weeks of every are. The annual does enrollment period -- that is something new starting next year. In previous years, including 2010, there used to be what was called the Medicare advantage open enrollment period. That was eliminate it by the new law. It says for the first 45 days of every year, if someone is in a Medicare Advantage Plan and they want to get out, they can do so during this time. Special enrollment plans -- we talked about someone moving him LA to San Francisco. In that situation,during the Medicare Advantage Plan, they can disenroll and join another plan that is available and services to.
That is a good time to stop and ask questions about parts C and D before I move on were different ways to supplement Medicare. All right. I do not see any questions. Weight. Here is one. How much is the LEP fourth part D? -- for part D? 1% Reverend. that a beneficiary delays in rolling and did not have credible coverage. It depends on how long they waited. For example, if someone waited I've years am a there were eligible to sign up when they were 65 but they did not sign up and they did not have creditable coverage. And then when they were 70, they decided to enroll. That is I've years times 12 which is 1% per month. Which is 60% of the current national average for part D. Plus the premium of the plan they chose. If there information -- is there a hotline for Lehman -- for a layman? I would suggest you call HICAP. That is the name and California. In other states it is called CHIIP. Or State Health Assistance. The HICAP number --- 1-800-434-0222. And HICAP is the Medicare benefits plan. All of the services are free. Any questions that they have, they can call that number to reach their local office. Wet website did you say has the best part /d -- D plan finder window Medicare.gov. How does someone know if there drove coverages creditable? Whatever plan is providing their drug coverage, they send a statement every your that tells them whether the drug coverage is creditable. It is an actuarial adulation. Did look at the standard part B plan to make a comparison. To make that determination. These are very dry facts. A lot of them are very technical. Yes, they can explain a. -- explain that. [ Indiscernible -- poor audio, audio cutting in and out ] That is all free. You can also call them. Or you can have your client call them. To help them with their situation in the questions.
I will move on because we have less than 30 minutes and I am only on slide 53. For them here on, I will talk about different ways to supplement Medicare. We talked a little bit about the large group health plan. For someone who is working. Or they have a family member who is working this is how they can delay in rolling. [ Indiscernible -- poor audio, audio cutting in and out ] . Retiree plans. And Medi-Cal. Oakley we have the time to go to the detail. I may skip some slides just because our time is ending. Again, cover is a federal law that helps people -- cobra is a federal law that helps he will continue their insurance. For 18 months. In our state, after those 18 months, they allow people to continue for another 18 months. So they may get it for 36 months. Cobra, whether that role or otherwise, if they choose that, they pay the premium plus any image straight if he. Under federal cobra, it is 2%. Under Cal COBRA, it may be higher. We talked about this.
Someone who has Medicare and then they become eligible for COBRA, if they want to, they can choose to have both. If they have both, Medicare pays first. And cover is secondary. -- Cobra is secondary. If someone becomes eligible for COBRA and then later becomes eligible for Medicare, cobra -- cobra usually and. -- And -- ends. Medigap -- that is another popular way to supplement Medicare. It is the Medicare supplement insurance. With that assurance does is it covers the gap in Medicare. Again, Medicare, as you know, doesn't cover every medical service that a person want.
Again, medically reasonable and necessary. The services that it does cover, it doesn't cover 100%. We talked about the 20% beneficiary coinsurance. Medigap is designed to cover the gaps in the original Medicare. Not with Medicare advantage plans. In our state, as of June 1, 2010, there are 10 standardized plans. Standardized just means that whichever company you buy it for him a if it is a -- or, -- for, if it is a Medigap plan, you have the same coverage. [ Indiscernible -- poor audio, audio cutting in and out ].
That is what standardized means. The clans -- plans that are currently sold now, these are these 10 plan. A-F, K -- M and N are the new plans. [ Indiscernible -- poor audio, audio cutting in and out ]. As of time, you can look at it later. If you have questions, the free to e-mail me. Again, this is what I mean by standardized. It covers only the basic benefits. There are no additional ones. All plans, A-G, everyone of these plans will cover the basic and if it that are listed in this slide. In addition to the basic benefits, they have additional benefits.
For example, plans C-G, they would cover the SNP coverage. [ Indiscernible -- poor audio, audio cutting in and out ]. There is a coinsurance after 20 days in the skilled nursing facility. [ Indiscernible -- poor audio, audio cutting in and out ]. Again, don't have time to go into detail on the planet but some on one -- someone who has anyone of these plans, the Medigap will cover $1100 for them. So I will move on.
These are structured very differently. What is unique about these two plans is that they have been out of pocket limit. And you will see for the benefit of the cover, they do not cover 100%. Plan K covers 50% were certain benefits. Plan L covers 75% for those benefits. Plans M and N are the new plans as of June 1. What is it about them is that for N, there is a copayment for the part B two insurance. Again, due to time, I will not go into details about this. One question that we get a lot is when can they buy a Medigap policy? Medigap are not part of the Medicare program. They are not regulated by federal law like other parts of Medicare. Again, they're not regulate by Medicare law. They are regulated by state law. In our state, the California Department of insurance, and the California apartment of managed healthcare. Those two state agencies run the Medigap in our state -- in our state. They can buy them at any time.
At any time, the insurance company can require that they go through hell screening. The insurance company can decide that because of a pre-existing condition, they can refuse to sell them the Medigap. Except for two different scenarios. Doing this, if they want to buy Medigap, the company cannot refuse to sell them a policy. One of those is the open enrollment. The other is a guaranteed issue. Guaranteed issue depends on the circumstances of the beneficiary. I will quickly go over these two. Open enrollment period, in our state, a Medicare beneficiary who is younger than 55 -- 65 is allowed to buy Medigap. That is not true in all states. In our state it is. The open enrollment period is six-month. Starting with the effective date during this time. The insurance company -- they cannot do the medical screening on them. Is the beneficiary has freezing conditions, that were treated during the previous six months am a the insurance company is allowed-- [ Indiscernible -- poor audio, audio cutting in and out ] .
The waiting period cannot be more than six months. If someone buys a Medigap and they're younger than 65, due to a disability they can choose from plans A, C and F. Also, they are allowed to choose beneficiaries with a disability higher than the beneficiaries who are 65 and older. With Elizabeth Medicare rest regularly their open enrollment period is not resurrected, it goes forward depending on the date of their notice.
These are a bunch of rules that are good for Medicare and the fisheries who got Medicare due to a disability and then they turn 65. In that situation, they get-- [ Indiscernible -- poor audio, audio cutting in and out ] . As we said earlier, when someone turn 65, in Medicare his eyes -- Medicare's I -- eyes-- [ Indiscernible -- poor audio, audio cutting in and out ]. They have the same choices for Medigap is the beneficiaries who are 65 and older. Another benefit during this time is that they can ask for a lower premium. If they already have Medigap, they can call the insurance company and say that they're turning 65 now. They no longer have Medicare do to a disability. Because they are 65. Can you give me a lower rate? Feedback guaranteed issue. That is a right people get to buy Medigap following an event. I have listed some here. If someone is working and their employer plans decides they're no longer going to cover-- [ Indiscernible -- poor audio, audio cutting in and out ] .
What is common in all these situations as someone is losing coverage. And by buying a Medigap, they will again have coverage for what Medicare does not cover. With a guaranteed issue, people can again -- they have the right. The period is usually 60 days. During this time, if they buy Medigap, the insurance company cannot require medical underwriting. And there is no waiting period. If they have a pre-existing condition. Their rights given I federal law and state law, they can choose from plans A, B, C, F and L. There waiting period is 63 days. In our state, if they have ESRD, they do not have guaranteed issue date. The 30 days from enrollment -- in our state, our state allows people to buy a Medigap 30 days Ali the first day of your. They must are ready have a Medigap. Every year, [ Indiscernible -- poor audio, audio cutting in and out ] .
For people who are interested in buying Medigap, this is kind of the drill down method. Again, they may go to HICAP or someone else who knows about Medigap to explain to them the different benefits in the plan. The beneficiaries can choose the plan that they want. In and find out which insurance company sells the plans that they want. For example, they may choose plan F\. They may -- F. They may look for plans and ensure companies that sell that. They may go to the website. insurance.ca.gov. That is a website for the California insurance Department. They can call these insurance companies.
[ Indiscernible -- poor audio, audio cutting in and out ]. The customer service can really very. They should really call the plans and interview them. And make sure that that is the company that they want to be providing their Medigap coverage. One question we get often is should I buy Medigap or join a Medicare Advantage Plan ? I will quickly go over that. As I said earlier, Medigap are not part of the Medicare program. They are issued by private insurance companies in regulated by state law. Medicare -- Medicare Advantage Plan are part of the Medicare plan and they are regulated by federal regulations. Medigap's are usually higher in premium. Plan F has a high deductible option which means that the beneficiary needs to pay the deductible first. Again, in that case, the premiums are lower. [ Indiscernible -- poor audio, audio cutting in and out ]. Not always your. It up on the plan. -- It depends on the plan. They need to take that into consideration when considering the cost, the deductible's.
With Medicare -- Medicare Advantage Plan , usually, they have to pay a copayment. I will skip this. Medigap people have original Medicare. They get to choose the doctor that they want to go to. We encourage them to go to be will to accept Medicare assignment. They may be limited in their choice. With an HMO, you have to go to providers within the network. Because I the network, they will not pay. With a PPO, there is a little bit more choice. If they do go outside the PPO, it is still covered. But at the lower rate. It will cost a little more. [ Indiscernible -- poor audio, audio cutting in and out ] .
Some other differences, Medigap's do not cover prescription drugs.Where is the Medicare Advantage Plan , some do. The way they were, they are the secondary -- [ Indiscernible -- poor audio, audio cutting in and out ] .With that Medicare Advantage Plan , it is not a primary or secondary situation.When they join the Medicare Advantage Plan, they joined-- [ Indiscernible -- poor audio, audio cutting in and out ] it is their only coverage. Medigap is the beneficiary -- if they move, they can keep a policy. Medigap's have the guaranteed renewable. [ Indiscernible -- poor audio, audio cutting in and out ]. . -- With Part C -- with Medicare Advantage Plan, they only -- [ Indiscernible -- poor audio, audio cutting in and out ] . It is usually a calendar year. They can terminate or be terminated Rob.. Or decided the end of the year but they do not want to come back to the market. For every year, beneficiaries can choose to continue with that plan were changed to a different plan. With Medigap, they may be subject to help grinning.Where is the Medicare Advantage Plan, there is no health screening, so long as someone has part A and B.
With Medigap, people who have Medicare -- the premiums may be higher. [ Sounds of typing are interfering with the audio quality ]. It is the same premium for all Medicare beneficiaries. Those are just some differences between the two.
I'm going to skip the Medi-Cal slides. Medi-Cal, again, someone who has both, they will pay first with Medicare. And Medi-Cal days afterward. This it seems that they have full Medi-Cal benefits. As many of you know him as there are different ones. [ Indiscernible -- poor audio, audio cutting in and out ] . If they do qualify for this, [ Indiscernible -- poor audio, audio cutting in and out ] . I'm going to skip some of the flights. If you have questions, you can even on me. With the LIS, it stands for low income subsidy. It has utter will subsidy to pay for their part D plan. I have here the slides that have to apply -- they have to apply online. [ Indiscernible -- poor audio, audio cutting in and out ] if they do qualify -- [ Indiscernible -- poor audio, audio cutting in and out ] .
They also get help paying their deductible. And their copayment for cautionary which might be much lower. For example, for someone who qualifies for. City, they do not -- subsidy, they do not put -- pay a deductible. And they pay no more than $1.10 for brand-name drugs. And no more than $2.30. If their income is higher, they pay no more than $2.60 for running drugs -- brand name drugs.
They may or may not have to pay a premium. Their deductible is $63. And the coinsurance is $50. [ Indiscernible -- poor audio, audio cutting in and out ] . One of the benchmark plans -- I know our time -- former minute. I will quickly explain this. The benchmark lands, every year, you know they change. Every year, Medicare will take all the plans available in the region. For us in California, our region is the whole state of California. We look at all of the plans and come up with a weighted average. For this year, that average turned out to be $20 and then I sent. All of these plans, these are basic plans for standard plans, if their premium is lower than -- [ Indiscernible -- poor audio, audio cutting in and out ]. With benchmark plans, they treat that plan and they do not pay a premium.. I will skip the slides. And go to when to call HICAP. [ Indiscernible -- poor audio, audio cutting in and out ] . Any Medicare questions? They are to place a call. We want to give you enough questions -- information to answer questions about enrollment and eligibility. We doubly are not expecting you to know all of this. Because we needed counseling. And they go through 30 hours of classroom testing for this. Know enough for when to call -- HICAP.
[ Indiscernible -- poor audio, audio cutting in and out ]. D If they are in the part -- if they are in the part D, that is good time to call them. These are some resources for you. The third bullet, that is their phone number. 1-800-434-0222. If you call anywhere in the state, it will route you to the one that serves your County. Another slides with resources, if you want to know more about the benefits and Medicare, these are two really good ones to go to. On the slight. Of course, it has website. There is tons of information about Medicare. Including the fact sheet we mentioned earlier. We take one topic and we talk about that. Whatever website is medicare.gov.
This is something [ Indiscernible -- poor audio, audio cutting in and out ] . I don't have my e-mail address up there. It is -- if you have other questions like a case or beneficiary -- call HICAP. My e-mail address is firstname.lastname@example.org. Thank you for your attention.. I am here to chat. It is past four o'clock. I will turn it over to Michelle.
Hello and congratulations Elaine for getting through the slides. There was a lot of information there. Once again, I want to let you know that we will follow-up with an e-mail. In e-mail, there will be information are accessing today's presentation in the archive. And also there will be information for evaluating today's presentation. And also for accessing the certified rehabilitation counselor credit. Be looking for that e-mail. We appreciate you joining us today. We had a nice big crowds. Sorry for some of the technical start a problem. We will be providing the full transcript in the archives in a week or 10 days. Okay, thanks for joining us. We look forward to seeing you next time. Thank you, Elaine. That was a lot of great information.
Thank you. We will go ahead and hang up now.
Think you -- thank you.
[ Event concluded ]