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Medicare Overview Presentation


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  • 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 
  • 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.)…  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 
  • 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... 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