Medicare 101: The A,B,C, and D\’s of Medicare
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Medicare 101: The A,B,C, and D\’s of Medicare

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A overview of the basic components of Medicare, how they work, and what financial exposure exists under Basic Medicare coverage. Highlights supplemental or alternative coverage options within the......

A overview of the basic components of Medicare, how they work, and what financial exposure exists under Basic Medicare coverage. Highlights supplemental or alternative coverage options within the Medicare framework.

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  • 1. Mark Lane A B C and D’s of Medicare
  • 2.
    • GarityAdvantage Agencies
      • National FMO
      • Focused on the Senior Market
        • Medicare Advantage
        • Medicare Supplement
        • Group Retiree Medical
        • PDP
        • Hospital Indemnity
        • Dental
        • Final Expense
        • Funeral Trust
        • Life
  • 3.
    • GarityAdvantage Agencies offers
      • Competitive Nationally recognized products
      • Comprehensive Training
      • Market Expertise
      • Ask us about our Lead Programs for Medicare Products!
      • www.garityadvantage.com
      • 800-234-9488
  • 4.  
  • 5.
    • Medicare Background
    • Original Medicare – Parts A & B
    • Medicare Part C – Options to Original Medicare
    • Medicare Supplements
    • Medicare Part D
    • Coverage Options
    • Questions???
  • 6. What is Medicare? A health insurance program for people: age 65 or older under 65 with certain disabilities any age with End Stage Renal Disease Administered by the Federal Government through the Centers for Medicare & Medicaid Services (CMS) Medicare currently provides coverage for 45-46 million People 77 million people aging into Medicare over the next 20 years
  • 7.
    • Covers:
      • Inpatient Hospital
        • $0 co-pay for days 1-60 after the deductible has been met
        • $283 co-pay for days 61-90
        • $566 co-pay for days 91-150 (Lifetime Reserve Days)
      • Home Healthcare
        • Medically necessary care ordered by a doctor and provided by a Medicare-certified home health agency (VNA)
      • Hospice Care
        • Terminally ill with life expectancy of less than 6 months
        • Home or Medicare approved facility
      • Skilled Nursing Facility up to 100 days
        • Only after a 3 day hospital stay
        • Co-pays for days 21-100 are $141.50 per day
  • 8.
    • The deductible for Part A is $1,132 in 2011
    • Benefit period
      • Starts the day you go into a hospital
      • Ends when you go 60 days without hospital or skilled nursing care
      • NO LIMIT
    • No premium for those with 40 quarters of work
      • $ 248 per month for those with more than 30 quarters
      • $ 450 per month for those with less than 30 quarters
  • 9.
    • Covers:
      • Doctors Services
      • Emergency Room Services
      • Outpatient care
        • In hospital or ambulatory surgical center if not admitted
      • Laboratory Tests
        • Certain blood tests (diabetes screening for those with risk factors)
        • Urinalysis
      • Some Diagnostic Screenings
        • Bone Density Screenings
        • Cardiovascular Screenings
        • Colorectal Cancer Screenings
        • X-rays, MRI’s, CT scans, EKG’s
  • 10.
      • Certain Drugs not covered under Part D
        • Oral cancer drugs, some types of injected drugs
      • Durable Medical Equipment
        • Oxygen equipment, Wheelchairs, Walkers, etc…
      • Flu Shots, Hep B shots
      • Mammograms and Pap tests
        • Once every 12 months
      • Mental Health Care
      • Diabetic Supplies
        • Some supplies may be covered under Part D
      • “ Welcome to Medicare” physical exam
      • Yearly “Wellness Exam” after 12 months on Part B
        • Part B deductible does not apply
  • 11.
    • Part B premium for 2011 is $115.40 for those new to Medicare.
      • Higher premiums for those earning more than $85,000 filing single or $170,000 filing joint with spouse
      • Penalties for late enrollment
    • Part B deductible for 2011 is $162
    • Part B generally pays 80% of the cost after the deductible
    • You pay the remaining 20% (co-insurance) in some instances co-pays may apply for certain services
    • There is no Out of Pocket Limit for the Part B co-insurance!!!
  • 12.
    • Neither Part A or Part B cover the following:
    • Acupuncture
    • Chiropractic (few exceptions)
    • Cosmetic Surgery
    • Dental Care
    • Routine Eye Exams
    • Routine Foot Care
    • Hearing Aids or Tests unless order by your doctor
    • Orthopedic Shoes
    • Service from non-Medicare Providers
    • Services incurred outside of the U.S.
  • 13.
    • Original Medicare
    • No Part A premium for most
    • Part B premium for all, varies for higher income
    • Deductibles apply
    • Co-pays may apply under Part A for long hospital stays
    • Co-insurance applies for Part B services
    • There is no Out of Pocket Maximum for either Parts A or B
  • 14.
    • Provide Supplemental coverage to Original Medicare
    • Approved by the individual states
    • Generally cover expenses that Medicare does not such as Part A & B deductible, Part B co-insurance, First 3 pints of blood, etc…
    • Usually do not go beyond what Original Medicare covers
    • Do not include Part D coverage
    • More comprehensive coverage than Part C plans but, also more expensive
    • Require Part A & B coverage
  • 15.
    • Part C - Medicare Advantage (MA)
      • Must be enrolled in both Part A & B to participate
      • Coverage provided by private insurers
      • Medicare pays a fixed amount to the company
      • Plans must be filed and approved each year by CMS
      • Must offer benefits at least as good as Original Medicare
  • 16.
      • May offer benefits above and beyond what Medicare provides, such as dental, hearing and vision benefits
      • Must include an Out of Pocket Maximum
      • Providers bill private insurers, not Medicare
      • Premiums are usually lower than Medicare Supplement plans
      • Part B premium must still be paid
      • Includes HMO’s, PPO’s, PFFS, & Medicare M SA’s
  • 17.
    • Part D - Prescription Drug Plan (PDP)
    • Provides Medicare Beneficiaries with assistance in paying prescription drug costs
      • Coverage provided by private insurers
      • Requires minimum coverage level - “Creditable Coverage”
      • Beneficiary is subject to penalty if they don’t have or maintain creditable coverage
      • May be purchased “stand alone”
      • Sometimes imbedded in a Medicare Advantage Plan (MAPD)
  • 18.
    • Formulary - list of drugs covered under the plan
    • Creditable Coverage - coverage that is at least as good as the Medicare Standard Requirement
    • Coverage Gap - prescription costs not covered by the plan (also referred to as the “Donut Hole”)
  • 19.
    • Drugs already covered by Medicare Part A or Part B
    • Drugs used for anorexia, weight loss, weight gain, fertility, cosmetic purposes, hair growth, or symptomatic relief of cough and cold
    • Prescription vitamins and mineral products
    • Non-prescription drugs
  • 20.
    • Employer Sponsored
      • Voluntary Plans
      • Retirees from Group Coverage
      • Part-time employees
    • Medicare Supplemental Coverage
      • Flexibility in coverage choices
      • Optional Benefit additions
    • Creditable coverage Part D options
      • Includes coverage for all drugs through the “Coverage Gap”
    • Available at any time during the year
  • 21.
    • Original Medicare only with a stand-alone Part D plan
    • Original Medicare with a Medicare Supplement Plan and a stand-alone Part D Plan
    • Medicare Advantage Plan that includes Part D coverage
    • Group Retiree Plan (if available) with a Part D plan included
  • 22.
    • Want to know more about the Senior Market?
    • Call us at 800-234-9488
    • www.garityadvantage.com
    • We provide the path to your success!