This document provides an overview and summary of Medicare and supplemental insurance options. It begins with introducing Boone Insurance Associates, which provides various health and life insurance products. The bulk of the document then summarizes Medicare Parts A, B, C, and D - including what they cover, who qualifies, premium and cost-sharing details. It also discusses options for covering gaps in Medicare like Medicare Advantage plans, Medigap plans, and Part D prescription drug plans. Specific plan types like HMOs, PPOs, and POS plans are defined.
Medicare 101: The A,B,C, and D\’s of MedicareMark Lane
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.
Medicare 101: The A,B,C, and D\’s of MedicareMark Lane
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.
Two day presentation created to form a foundation to the user on understanding the basic fundamentals of insurances, how to read and understand the contracts. Explanation of the jargon and terms used. And finally how to apply it in EPIC
The Centers for Medicare and Medicaid Services (CMS) is the largest health payer in the United States, covering almost 90 million Americans. Medicare, the federal health insurance program for adults over age 65 and other qualified individuals, accounts for more than 48 million of those Americans through expenditures of more than $545 billion. But what is Medicare? How does it work? What should helping professionals and caregivers know about the program? This session will provide a broad overview of the Medicare program’s Parts A and B as well as introduce the CMS National Training Program as a resource for further training and information.
Medicare 101 - 2021 Update from Erin HartMary Hagan
Medicare 101 – 2019 Update
Medicare Benefit Education Topics
Health benefits options for retirees and people over 65
Medicare and Medicaid benefits
Structuring an Eldercare program for your employees
Patient Advocacy – what is it?
Emeritrust Benefits provides a Medicare educational seminar to help explain what Medicare does and does not cover. We also explain what other types are available including Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D drug plans.
Practical Steps for Managing Provider Relief Fund DistributionsCitrin Cooperman
Our Healthcare Practice professionals participated in a webinar discussion, "Practical Steps for Managing Provider Relief Fund Distributions," for healthcare organizations.
Topics included: Provider Relief Fund Overview Managing Provider Relief Funds Eligibility Fund Usage & Risk Management Tracking, Documentation, and Reporting Tax and Audit Considerations Sector-Specific Considerations Post-Acute Providers Dental Providers
Medicare Bad Debt Checklist and Recent ClarificationsPYA, P.C.
PYA Senior Consultant Holly Bizic presented “Medicare Bad Debt Checklist and Recent Clarifications.” The presentation reviews:
Key facts and expectations.
Progression of Medicare bad debt policy.
Recommendations for compiling and defending bad debt listings.
Audit and desk review clarifications.
Benchmarking.
The idea of Medicare was born when Harry S Truman called for a health insurance fund in 1945. Truman’s dream was realized when Lyndon B. Johnson signed it into law in 1965...Read more here
http://www.bluegoosemaine.com/deep-dive-into-medicare-insurance-trends-2020/
Two day presentation created to form a foundation to the user on understanding the basic fundamentals of insurances, how to read and understand the contracts. Explanation of the jargon and terms used. And finally how to apply it in EPIC
The Centers for Medicare and Medicaid Services (CMS) is the largest health payer in the United States, covering almost 90 million Americans. Medicare, the federal health insurance program for adults over age 65 and other qualified individuals, accounts for more than 48 million of those Americans through expenditures of more than $545 billion. But what is Medicare? How does it work? What should helping professionals and caregivers know about the program? This session will provide a broad overview of the Medicare program’s Parts A and B as well as introduce the CMS National Training Program as a resource for further training and information.
Medicare 101 - 2021 Update from Erin HartMary Hagan
Medicare 101 – 2019 Update
Medicare Benefit Education Topics
Health benefits options for retirees and people over 65
Medicare and Medicaid benefits
Structuring an Eldercare program for your employees
Patient Advocacy – what is it?
Emeritrust Benefits provides a Medicare educational seminar to help explain what Medicare does and does not cover. We also explain what other types are available including Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D drug plans.
Practical Steps for Managing Provider Relief Fund DistributionsCitrin Cooperman
Our Healthcare Practice professionals participated in a webinar discussion, "Practical Steps for Managing Provider Relief Fund Distributions," for healthcare organizations.
Topics included: Provider Relief Fund Overview Managing Provider Relief Funds Eligibility Fund Usage & Risk Management Tracking, Documentation, and Reporting Tax and Audit Considerations Sector-Specific Considerations Post-Acute Providers Dental Providers
Medicare Bad Debt Checklist and Recent ClarificationsPYA, P.C.
PYA Senior Consultant Holly Bizic presented “Medicare Bad Debt Checklist and Recent Clarifications.” The presentation reviews:
Key facts and expectations.
Progression of Medicare bad debt policy.
Recommendations for compiling and defending bad debt listings.
Audit and desk review clarifications.
Benchmarking.
The idea of Medicare was born when Harry S Truman called for a health insurance fund in 1945. Truman’s dream was realized when Lyndon B. Johnson signed it into law in 1965...Read more here
http://www.bluegoosemaine.com/deep-dive-into-medicare-insurance-trends-2020/
Beyond Medicare – Meeting the Needs of Senior CustomersGen Re
There is no time like the present for insurers to consider growing their senior product portfolio with either Medicare Advantage or Medicare Supplement insurance. However, it’s important to understand some clear differences between these products and which needs they address for customers.
Read more: http://www.genre.com/knowledge/blog/meeting-the-needs-of-senior-customers-en.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Today’s Agenda
About BIA
Introduction & History of Medicare
Medicare Parts A, B, C, D
Coverage Gaps
General Medicare Plan Types
And More . . .
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3. About Boone Insurance Associates
Boone Insurance Associates provides health and life insurance products to clients all over
Oregon.
We work directly with the companies to resolve any of your claim, benefit, & premium
questions.
Unlike a captive insurance producer who represents that insurance company alone, we are
independent of a specific insurance company and represent a variety of different
companies and products.
Boone Insurance Associates provides this educational program today to help inform you.
There is no obligation for you to purchase services from us.
“Our pledge is to provide our clients with superior customer service and product knowledge in
order to guide them in making the most informed decisions."
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4. Basic Medicare Terminology
Deductible
Copay / Coinsurance
OOP – Out of Pocket Maximum
LIS – Low Income Subsidy
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5. Introduction & History of Medicare
Medicare is a Federal Insurance Program
Administered by CMS, a federal agency in the
Department of Health and Human Services.
“Center for Medicare & Medicaid Services”
Consists of Hospital insurance, Medical insurance,
Medicare Advantage plans, and Prescription Drug
plans
In July 1965, Congress passed a bill to establish
Medicare.
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6. Introduction & History of Medicare cont…
Balanced Budget Act of 1997 established Part C,
known as Medicare + Choice (M + C) Program
Plans also called Medicare Advantage
Medicare Modernization Act (MMA) was passed in
2003
Implements new prescription drug benefit
Implements new Medicare Advantage program (replacing
M+C)
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7. Who gets Medicare?
It is available to qualified individuals, including:
People age 65 or older
People under age 65 who have been declared
disabled
People with End-Stage Renal Disease (ESRD), also
known as kidney failure.
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8. Medicare is comprised of:
Medicare Part A: Hospital coverage
Medicare Part B: Medical coverage: (Outpatient
Surgery & Doctor Visits)
Medicare Part C: Medicare Advantage
(Offered by Insurance Carriers)
Medicare Part D: Medicare Prescription Drug
coverage (Offered by Insurance Carriers)
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9. Medicare Part A
(Hospital Insurance)
What do I pay for Medicare Part A?
It has no premium cost for individuals who have
worked at least 40 calendar quarters
Is automatically provided to those who reach 65
years of age
Includes a monthly premium for those who have
worked fewer than 40 calendar quarters.
All taxpayers are contributing towards Medicare
via payroll FICA deductions.
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10. Medicare Part A
(Hospital Insurance) Cont…
What does Part A cover?
Hospital stays
Home health services
Hospice care
Minimal care in a skilled nursing facility (SNF)
Cover the first 20 days in full days after a 3 day hospital
stay, then cover days 21-100 at a daily rate. Then no
coverage after 100 days.
Does not include intermediate or custodial coverage.
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11. Medicare Part A
(Hospital Insurance) Cont…
Part A Deductibles
[2013] Hospital stay per benefit period:
Days 1-60 [$1184] per benefit period
Days 61-90 [$296] per day
Days 91-150 [$592] per day
[2013] Skilled Nursing Facility:
Days 1-20 [$0] per day
Days 21-100 [$148] per day
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12. What is a Medicare Benefit Period?
Begins the day you go into a hospital or skilled
nursing facility, ends when you have not received
hospital or skilled nursing care for 60 days in a
row
If you go into the hospital after one benefit period
has ended, a new benefit period begins
There is no limit to the number of benefit periods
you can have.
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13. Medicare Part B
What does Medicare Part B cover?
Physician Services
Laboratory, X-rays, MRI, CT Scans
Chemotherapy
Ambulance, Emergency Room Care
Outpatient Surgery
Preventive Care
Part B Medications
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14. Medicare Part B Cont…
What do I pay for Medicare Part B?
Part B premium is based on Part B medical costs and annual income level per
individual
[2013] Part B Premium Annual Income per Individual
$104.90 [$85,000 or less]
$146.00 [$85,001 to $107,000]
$209.80 [$107,001 to $160,000]
$272.70 [$160,000 to $214,000]
$335.70 More than [$214,000]
Double amounts listed above for married couples filing jointly
Premiums are deducted from the Social Security benefits, or billed quarterly
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15. Medicare Part B Cont…
Deductibles & Coinsurance for
Deductible:
2013 [$147] per year
Other Services:
Patient pays [20%] of approved amount, after
deductible. {Medicare pays 80%}
[50%] for most Outpatient mental healthcare
services.
There is no OOP maximum, risk is unlimited
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16. Original Medicare Does Not Cover
Out-of-pocket maximum spending safety net
Certain deductibles and coinsurances
Routine physical (beyond one-time initial physical and
annual wellness visit)
Dental (except if medically necessary)
Vision (except if medically necessary)
Access to complementary (alternative) care benefits
Gym Memberships or professional health coaches
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17. Covering Medical & Prescription Gaps
Three main options available
Medicare Part C (Medicare Advantage Plans)
Traditional Medicare Supplement Plans (Medigap)
Medicare Part D Prescription Drug Plans (PDP)
Employer-Sponsored Retiree Plans
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18. Covering Medical & Prescription Gaps
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Original Medicare
Parts A & B
PDP
Part D RX
Medicare
Supplement
(Medigap) Medicare
Advantage
(Part C)
Employer
Retirement Plan
19. Medicare Part C (Medicare Advantage)
Expands Medicare choices with a variety of
options.
A few examples:
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Point of Service (POS)
Private Fee For Service (PFFS)
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20. Medicare Part C (Medicare Advantage) Coverage
Who is eligible?
Must be enrolled in Medicare Part A & B?
Permanent resident in plan service area?
Cannot have End Stage Renal Disease (ESRD)?
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21. Medicare Part C (Medicare Advantage)
They are health plan options that are part of the
Medicare program
Medicare pays the plan a set amount every
month for your care
MA plans must offer all benefits of Original
Medicare and coverage can include Part D
prescription drug coverage
You may have to use a network of providers that
participate with the plan
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22. Medicare Part C (Medicare Advantage)
In most plans, there are generally extra benefits
and out-of pocket costs that are lower that with
Original Medicare.
Plans cover everything Medicare covers, at a
minimum.
Plans typically have copay and coinsurance that
are paid when client goes in for services.
Plans may cover extra benefits such as routine
vision exams, preventive dental, alternative care,
gym membership, etc.
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23. Medicare Part C (Medicare Advantage)
Choose from options with or without integrated
Part D prescription drug coverage.
No drugs included: Medicare Advantage (MA) only
Prescription drugs included: Medicare Advantage
with drugs (MA-PD)
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24. Medicare Part C (Medicare Advantage)
Preferred Provider Organization (PPO)
Defined network of providers
Allows flexibility to use providers who are not part
of the network
No referral needed to see any doctor
However, out-of-pocket costs increase significantly
when out-of-network providers are used
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25. Medicare Part C (Medicare Advantage)
Preferred Provider Organization (PPO) Cont…
Greatest saving for use of network providers
because the plan pays a larger share of the
cost
No referrals are required. Prior authorizations
may be required for some services. (Cost
Sharing with the co-pays and/or deductibles.
Cost is reflected in the lower monthly
premium.)
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26. Medicare Part C (Medicare Advantage)
Health Maintenance Organization (HMO)
Defined network of providers
Primary Care Physician (PCP) manages all
of your care
You must have a referral from your PCP to
see a Specialist
You must use network providers for all
scheduled care
Out-of-pocket costs may be significantly
lower with an HMO plan
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27. Medicare Part C (Medicare Advantage)
Health Maintenance Organization (HMO) Cont…
Health maintenance organizations (HMO) offer a provider
network, and members are covered for most of their Plan
services in-network only. Urgent and emergency care is
covered inside and outside the HMO network, however.
With most HMOs, a primary care physician (PCP) acts as
a health care coordinator (gatekeeper) to provide or to
refer for all the patient care. Referrals are usually
required to see a specialist.
You may change your PCP any time (usually not more
than twice a year.)
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28. Medicare Part C (Medicare Advantage)
Point Of Service (POS)
A Point of Service (POS) plan usually offers HMO-style
benefits in-network. It also provides the ability to choose
whether to get some selected services in-network or out-of-
network.
Otherwise, POS plans are very similar to HMOs.
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29. Medicare Part C (Medicare Advantage)
Private Fee For Service (PFFS)
No plan network
Plan works similar to Original Medicare except the
insurance company pays for your services, not Medicare
Freedom to use any provider that accepts Medicare and,
agrees to the plan’s payment terms
You should check with your providers to make certain
that they are willing to accept the PFFS plan’s terms
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30. Medicare Part C (Medicare Advantage)
Private Fee For Service (PFFS)
Out-of-pocket costs may be lower than with Original
Medicare coverage
Private Fee For Service (PFFS) plans usually offer benefits
intended to compete with Medicare Supplements.
Members can go to any Medicare provider who accepts
them as patient, and agrees to the plan’s terms and
conditions of payment.
Before joining, people should contact their health care
provider to assure will accept PFFS.
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31. Traditional Medicare Supplements (Medigap Plans)
Private companies sell Medicare Supplement plans
(also known as MediGap plans).
After initial enrollment eligibility, may require health
statement underwriting. (exception is Bday Rule)
Nationally standardized plan designs (Plans A-N).
Prescription drugs are not included in plans sold after
1/1/2006.
Medicare pays for Medicare-eligible benefits. Then
MediGap pays plan’s portion.
MediGap also pays some benefits not covered by
Medicare. Benefits vary between plans A-N.
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32. Traditional Medicare Supplements (Medigap Plans)
Standardized plans offered by various insurance
companies. Companies can offer between 1 to 10
plans, plans lettered A-N most people get plan F.
Open Enrollment is for all people going on
Medicare within the first six months of the effective
date. After that, one is subject to medical
underwriting.
You may see any Medicare provider in the United
States. You do not have a Primary Care physician
and can see any specialist.
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33. Traditional Medicare Supplements (Medigap Plans)
All of your care is subject to what Medicare
allows. It must be medically necessary. The
doctor codes it, when the claim is submitted to
Medicare. If Medicare pays on the claim, then
the secondary insurance pays on it as well.
If the claim is denied – the secondary insurance
cannot pay it.
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34. Employer Sponsored Retiree Plans
Employers may continue to offer coverage to
retirees
Retirees are usually provided with information at
retirement, if available.
Check with employee benefits department.
Costs and coverage options may vary.
Plan may include Part D creditable drug coverage, or
not. Important to know.
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35. Employer Sponsored Retiree Plans
Cont…
To Note:
If you currently have health coverage from an
employer or union, joining a Medicare Advantage
plan or a stand-alone prescription drug plan could
affect your employer or union health benefits. If
you have health coverage from an employer or
union, joining a Medicare Advantage or stand-alone
prescription drug plan may change how your
current coverage works. Read the communications
your employer or union sends you. If you have
questions, visit their website, or contact the office
listed in their communications.
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36. Medicare Part D RX Coverage
Private companies must be approved by The Centers
for Medicaid and Medicare Services (CMS) to offer
Part D prescription drug coverage. Two ways to get
RX coverage.
(MAPD) People with a Medicare Advantage plan (such as
PPO or HMO) coverage may obtain Part D drugs
integrated with their health plan
(PDP) People with other insurance, such as Original
Medicare, Medicare Supplements, and others, may obtain a
stand-alone prescription drug plan in addition to their
health coverage.
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37. Medicare Part D prescription drug plans
(PDP)
Medicare Part D prescription drug plans (PDP)
Stand-alone drug coverage(PDP) may be paired with
health plans such as:
MediGap (Medicare Supplement)
Only Original Medicare
Private Fee for Service (not most MAPD plans)
Some (not all) other private health coverage that doesn’t
include Part D creditable coverage
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38. Medicare Part D prescription drug plans (PDP) or
(MAPD)
2014
Deductible $310 for RX.
Initial coverage $2850
Doughnut Hole or Coverage Gap: Most Medicare drug
plans have a coverage gap (also called the “donut hole”).
This means that after you and your drug plan has spent
$285, you have to pay 72% for generics and 47.5% for
brand name prescriptions up to a yearly limit.
Catastrophic Coverage: Once paid $4550 then pays 95%
Medicare print out is simply an estimate of the plans
available to you.
Donut Hole or Coverage Gap Closing: In 2020 will be same
as initial coverage Limit.
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39. Medicare Part D prescription drug plans (PDP) or
(MAPD)
Medicare offers an imaginary basic plan and then gives it
to private health insurance companies.
Basic Plan has three elements.
Deductible, Initial Coverage, and Catastrophic coverage.
Doughnut hole.
The plan has to be equal to, or greater than the basic
Medicare plan.
Look at what you are taking, and run it thru the Medicare
web-site for analysis for the best plan for your needs.
Plans change every year.
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40. Medicare Part D prescription drug
plans (PDP)
Penalty. One must enroll when they first enroll in
Medicare, or be charged a 1% penalty on premium for
every month they have not been enrolled. The penalty is
based on the “basic” plan offered by Medicare cost, and
then added to your premium with the plan you select.
Group Retirement RX or Veterans Benefits RX is excluded
from penalty
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41. GENERAL ENROLLMENT PERIODS
Enrollment Timeline examples
(IEP) Initial Enrollment in Medicare. Three months
before and three months after the initial effective
date.
Example: Birthday is May 15. Medicare is effective May
1st. You may enroll in March or April for a May 1st
effective date. Any day after May 1st, you will have a
June 1st, July 1st or August 1st effective date.
(AEP) Oct 15 – Dec 7: Switch plans. Add or delete
Part D drug coverage for Jan 1.
(ADP) Jan 1 – Feb 14: Dis-enroll from a Medicare
Advantage and return to original Medicare
(SEP) Feb 14 – Dec 31: Medicare beneficiaries may
still qualify for additional enrollment periods
(examples: change residence, loss of group
coverage, and more) Special Election Period.
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42. Enrolling in a Medicare Plan
When entitled to Medicare and enrolling
Make sure to talk to social security 90 days prior
to 65th b-day regardless if still working
Do your homework first. Apply for plan between
30 and 60 days out from requested effective date.
Choose the plan that best fits your needs.
Work with your agent to complete the enrollment
form, or enroll online.
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43. Enrolling in a Medicare Plan
When entitled to Medicare and enrolling Cont…
Submit it during the appropriate enrollment
period.
You may not combine an MA-only PPO or HMO
with a stand-alone PDP. Choose one or the other.
If you did not have creditable coverage in [2006],
your monthly plan premium may be slightly
higher when you enroll in Part D coverage plan
(MAPD, PDP).
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44. Help with RX Costs ? (LIS)
People with Medicare may be able to get extra help to
pay for prescription drug premiums and costs. To see
if you qualify for getting extra help, call. The Social
Security Administration at 1-800-772-1213.
Your resources must be limited to $13,070 for an individual
or $26,120 for a married couple living together. Resources
include such things as bank accounts, stocks, and bonds. We
do not count your home, car, and any life insurance policy as
resources.
Your annual income must be limited to $16,755 for an
individual or $22,695 for a married couple living together.
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45. Help with RX Costs? (LIS)
Apply for low-income subsidy (LIS) if you think you
may be eligible. Form available from Social Security
or Medicare.
Other assistance programs may be available.
Oregon Prescription Drug Plan
The state of Oregon offers a prescription drug program to
Oregon residents who do not have prescription drug
coverage, or who are in a coverage gap.
For more information: Visit www.OPDP.org or call 1-800-
913-4146
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46. Recap…how do I choose?
There are three basic factors to weigh when choosing
a plan:
Cost – Compare the out-of-pocket costs. (MAPD vs
Medicare Supplement)
Providers – Will the plan allow me to see the providers I
need or want to see( HMO vs PPO)?
Benefits – Does the plan offer you the coverage and
benefits you need? (RX, OOP)
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