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Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
Medicare overview presentation
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Medicare overview presentation

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Transcript

  • 1. Table of Contents Overview of Original Medicare Medicare Part A Medicare Part B Medicare Part D  Medicare Part C (Medicare Advantage Program) Medicare Supplements Purpose Plans
  • 2. Original Medicare Created to help elderly with health care costs as an entitlement program. Medicare covers two markets: 65 and older, Or those who are qualified under SSDI, or ESRD SSDI ESRD- End Stage Renal Disease Provided “free” to all Social Security and Railroad Retirment beneficiaries upon registering for Social Security at age 65 The program is administered by the Center for Medicare and Medicaid Services- CMS
  • 3. Overview http://www.youtube.com/watch?v=slVO3p83_S0
  • 4. Medicare Part A Part A- Provides for hospitalization and some limited nursing home benefits. Benefits include Hospital Stays Some Skilled Nursing Facility Care Some Home Health Care Hospice Care Blood
  • 5. Medicare Part B Part B- provides for medical and some limited home health care coverage for Social Security and railroad retirees. Part B is purchased (or optionally rejected) and can be conveniently withheld from a retirees social security check. The premium for Part B increases annually due to ever increasing health care costs.
  • 6. Benefits Included with purchase of Part B Medical Services Doctors Services Outpatient medical and surgical Diagnostic tests Ambulatory surgery center Durable Medical Equipment Second surgical options Outpatient mental health care Outpatient physical and occupational therapy
  • 7. Benefits included with purchase of Part B continued Clinical Laboratory Services-blood, Urinalysis, etc. Home Health Care Outpatient Hospital Services Blood- with a 3 pint deductible. Preventive services- Bone mass, Colorectal Cancer screening, Diabetes services and supplies, etc.
  • 8. Medicare Part D (Medicare Prescription Drug Coverage) Helps cover the cost of prescription drugs May help lower your prescription drug costs and help protect against higher costs Run by Medicare-approved private insurance companies Rates, Coverages, and Premiums will vary by carrier.
  • 9. Medicare Part D continued  May have to pay $325 deductible for initial drug costs  During initial coverage phase, insured pays a copayment or coinsurance…Insured’s Part D plan pays the rest up until your combined amount hits $2970  Once insured hits $2970, they then enter what is known as the “donut hole” where they are responsible for covering 47.5% of named-brand prescription drug costs and 79% for generic prescription drugs.  Once out-of-pocket expenses hit $4,750 the insured enters the “catastrophic coverage” period in which all prescription drug costs are covered by their medicare plan.
  • 10. Medicare Part C (Medicare Advantage Plan)  Medicare Advantage plans (MA) are offered by private companies approved by Medicare ( HMO, PPO, etc.)… http://www.youtube.com/watch?v=8OK7SuXVkpQ  MA plans include:  Part A (Hospital Insurance)  Part B (Medical Insurance)  Most cover Part D (Drug Coverage)  May offer  Vision  Hearing  Dental
  • 11. Medicare Advantage Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS)
  • 12. Health Maintenance Organization (HMO) A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
  • 13. Preferred Provider Organization (PPO) A type of health plan that contracts with medical providers, such as: Hospitals Doctors You pay less if you use providers that belong to the plan’s network.
  • 14. Private Fee-for-Service (PFFS) A type of Medicare Health Plan in which you may go to any Medicare-approved doctor or hospital that accepts the plan's payment. You may pay more or less for Medicare-covered benefits. You may have extra benefits Original Medicare doesn't cover.
  • 15. Medicare Supplements Medicare Supplemental insurance (Medigap) is designed to offer coverage for the costs not covered by original Medicare If the insured has Original Medicare along with a Medigap policy, Original Medicare will pay for its share of expenses and the Medigap policy will pickup the rest of the costs depending on the plan http://www.youtube.com/watch?v=sdVe-GlZ-mc
  • 16. Medicare Supplements (Medigap Policy) Must have Medicare Part A and Part B Guaranteed Issue Rights during open enrollment period discussed earlier Guaranteed Issue Rights for other situations as well as shown here... http://www.medicare.gov/supplement-other- insurance/when-can-i-buy-medigap/when-can-i- buy-medigap.html
  • 17. Medigap Issue Age (Community) Plans Senior consumers can purchase specific plans based on their age Insurance provider can therefore not change premiums on the plan as the insured’s age increases Although the provider can raise premium rates by class for all policies issued in their state
  • 18. Medigap Attained Age Plans Attained age plans include premiums that increase incrementally as the insured age increases Some providers increase rates every year while some increase based on attained age of insured Prices can change based on changes in Medicare Rates may also change due to increases in medical costs

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