Medicare 101

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If you are turning 65 soon review our presentation on Medicare Insurance.

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Medicare 101

  1. 1. An Educational Presentation forKansas City Medicare Eligible Folks.
  2. 2. Original MedicarePART A• Hospital Benefit• Room & Jell-OPART B• Doctors• Outpatient
  3. 3. PART A – Hospital Benefit• There is no premium for Part A.• It covers Room & Board.• The deductible is $1132 per Benefit Period.• The Benefit Period is 60 days.• For days 61 – 90 the cost is $283 per day.• For days 91 – 150 the cost is $566 per day.• All cost for each day beyond 150 days.Skilled Nursing Facility• Up to $141.50 a day for the 21st -100th day each benefit period.
  4. 4. PART B – Doctors• Monthly premium Part B is $115.40• Annual deductible is $162• Covers Doctor’s services, outpatient care etc.• Medicare pays 80% of Medicare’s approved amount.• Beneficiary pays 20% of Medicares approved amount.• Approval for Medically Necessary care only.• No Foreign Travel Coverage.
  5. 5. PART D – Prescription Drug Plan• Part D must be obtained through a private carrier.• The National Average premium is $32.00• Most plans have an Annual Deductible of $310.• The RX limit is $2840, then Coverage Gap• The Out-Of-Pocket limit is $4550• Catastrophic Coverage $2.50 (gen.) and $6.30 (brand)
  6. 6. PART D – Prescription Drug PlanThe basic plan – all Part D plans are required by law to offer benefits equal to orbetter than the following: 2011 Basic Benefits You PayDeductible $310 100% of first $310 25% of the next $2530Initial Coverage Limit $2,840 ($632.50)Coverage Gap* $3,607.50 100% of next $3,607.50Annual Out-Of-Pocket $4,450**Catastrophic Coverage Medicare and Plan 95% 5%**** CMS and drug companies to provide a 50% discount on covered brand name drugs while in the coverage gap or ‘Donut Hole’** Annual Out-Of-Pocket Amount does not include monthly premiums.*** Member pays the greater of $2.50 for generic/preferred drugs and $6.30 for all other drugs, or 5% percent coinsurance.
  7. 7. Are you eligible?• Enrolled in Medicare Part A and Part B through age ordisability?• Permanent resident in service area?• Do you have End Stage Renal Disease (ESRD)?
  8. 8. PART C – Medicare Advantage• Obtained through Private Insurance Carrier.• “Pay As You Go”• $0 - $60 monthly premium.• In most cases includes Part D Prescription Coverage.• Humana or Coventry for Kansas City Metro.• Can change plan at AEP – Oct. 15th – Dec. 7th 2011.
  9. 9. Medicare Supplements - Medigap• Obtained through Private Insurance Carrier• “All You Can Eat”• Guaranteed Issue for turning age 65• You pay a Monthly Premium• Typically more expensive than Advantage Plans• Plans types from A through N.• Must have a separate Prescription Drug Plan
  10. 10. Medicare Supplements - Medigap• Pays the Part A Deductable, some pay Part B also.• Pays the 20% Part B remainder.• Only pays if Medicare Approves.• Always go with an A rated company.• No Networks for services.• Can be used by anyone who accepts Medicare.• World wide coverage for emergency and urgent care.
  11. 11. What happens now?• Call Paul at 816-898-6969 for a consultation and thebest advice on which products to consider.• Email Paul with any questions atpaul@prairiehealthandlife.com• Complete an application and you will receive your IDcard in about two weeks.

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