This document provides an overview of Medicare and related health insurance terms. It explains the different parts of Medicare including Part A for hospital coverage, Part B for doctors, and Part D for prescription drugs. It also discusses Medicare Advantage plans, Medigap supplemental plans, Medicaid, and important dates for enrollment. Key eligibility requirements and costs are outlined for each part of Medicare and related programs.
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.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
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.
Read the latest benefits information from Independent Medicare broker Erin Hart from American HealthCare Group. Learn about Medicare income limits, care plans, and topics to consider when planning for health benefits in retirement.
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 & Retiree Health Benefits Information from our resident expert, Erin Hagan Hart. Erin is an independent Medicare broker who can give you an unbiased review of your benefits needs and options.
Call 412-563-7807 to invite Erin to speak to your group for free!
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
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 & Retiree Health Benefits Information from our resident expert, Erin Hagan Hart. Erin is an independent Medicare broker who can give you an unbiased review of your benefits needs and options.
Call 412-563-7807 to invite Erin to speak to your group for free!
Medicare 101 Presentation from Erin Hart, American HealthCare GroupMary Hagan
Erin Hart is an independent licensed Medicare Broker who helps retirees and seniors decide which Medicare benefit is the best choice for them. She meets with individuals or employer and community groups.
If you are beneath 65 and disabled, you automatically get Medicare Portion A and Component B (called Original Medicare) soon after you've received disability benefits from Social Security or certain disability added benefits in the Railroad Retirement Board for 24 months.
http://capstoneinsurancesolutions.com/medicare-supplement-medigap-insurance-plans/
[ON-DEMAND WEBINAR] Social Security v. Medicare: Addressing Your Most Asked Q...Rea & Associates
Will Social Security Be There For You?
We don't know anybody who doesn't have questions when it comes to the topic of Social Security and Medicare. There are worries regarding long-term availability, how to maximize benefits, and when certain tasks should be done - to name a few. This hour-long webinar will answer many of these vital questions to provide you with the peace of mind that you need when entering this new phase of your life.
What You'll Learn:
Presented by later life planning experts, Darlene Finzer with Rea & Associates and Terry O'Shea and Rhonda Kraus with Senior Benefit Advantage, we will dive into the following points:
- The two big questions regarding Social Security: Will it be there for me and (if so) how do I maximize benefits?
- A deeper look at the history of Social Security versus where it stands today.
- Important (but maybe lesser-known) facts about Social Security that all Americans should know.
- What is Medicare, what does it cost, what does it cover and when can you get it?
- Comparing original Medicare, Medicare Supplement, and Medicare Advantage - and which one is right for you?
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.
Debra Myers presented her Reset Your Stress, Release Your Tension for our Fall 2020 Virtual Where to Turn Resource Fair. The Virtual Resource Fair is free and brought to you by American HealthCare Group located in Pittsburgh, PA.
Avoiding Scams & Identity Theft presented by George Dillman, Consumer Outreach Specialist, Investor Education & Consumer Outreach Office.
As presented to the Where to Turn Resource Fair Virtual Fall 2020 Event
Learn about what's new for Medicare in 2019 from American HealthCare Group, licensed independent Medicare brokers. Invite us to speak at your place of work and educate your retiring employees, free of charge!
2019 Farm to Table Western PA Partnership OpportunitiesMary Hagan
Our partners receive year-round benefits including events and brand exposure on our digital properties. We actively engage the consumer audience by sharing information to make real, local food available to everyone in Western PA.
Where to Turn Resource Fair, September 2016, American HealthCare GroupMary Hagan
Erin Hart from American Healthcare Group discusses Healthcare Basics and How to Choose Your Health Plan. Navigating through deductibles, out-of-pocket expenses and coverage benefits can be overwhelming; get guidance from experienced and independent healthcare professionals.
Where to Turn Resource Fair, September 2016, ACHIEVAMary Hagan
Melissa Allen from ACHIEVA Disability Healthcare Initiative and Nora Lugaila, PHDHP with Pittsburgh Mercy Health System talk about Oral Health: Why it Matters and What you Need to Know pertaining to the effects on public health.
Where to Turn Resource Fair, September 2016, 412 Food RescueMary Hagan
Jen England from 412 Food Rescue talks about saving our nation's discarded but edible food and how they are tackling the problem in the Pittsburgh and Southwest Pennsylvania region.
Chatham University Food Studies Program Meat Production PresentationMary Hagan
Sustainable Meat Production Presentation from Chatham University students in the Food Studies program. Compiled presentations of chicken, pork, beef, and sustainable seafood.
2016 Farm to Table Pittsburgh Sponsorship InformationMary Hagan
Becoming a sponsor of the Farm to Table Pittsburgh Local Food Conference supports ongoing education about long-term healthy eating habits, supporting local sustainable agriculture as well as the strengthening of our region's food security.
Health care update jan-2016-american-health care-groupMary Hagan
The latest information about health benefits for employers, human resource professionals, caretakers, Medicare recipients, and more.
Contact Erin Hart if you would like this presentation at your school, office, or community group.
Sourcing Sustainable Beef & Lamb in the Pittsburgh RegionMary Hagan
Chefs and at-home cooks are learning that sustainably sourced meat products are healthier and tastier. But where do you find sustainably raised beef and lamb sources?
Elise Miranda and Alicia Franken from Chatham University outline what you need to know to find sustainably and humanely raised beef and lamb.
How does the Affordable Care Act affect your employee group? Get the basics here! Contact Erin Hart for more specific questions about your group.
ph: 412-657-3028
8th Annual Farm to Table Pittsburgh Conference - Why Eat Local? Mary Hagan
We are gearing up for our 2 day Farm to Table Local Food Conference on March 21 & 22, 2014 at the David L. Lawrence Convention Center in downtown Pittsburgh.
Get your head in the game and do some early studying about the issues at hand. This is a quick intro to Why Local is important and some key numbers.
See you in March!
www.FarmToTablePA.com
2014 Farm to Table Pittsburgh Exhibitor & Sponsorship InformationMary Hagan
This is the 8th year that the Farm to Table Pittsburgh Local Food Conference has been feeding the minds and stomachs of hungry Locavores.
Farm to Table Pittsburgh is an educational program that teaches healthy eating and food preparation methods.
Are you interested in exhibiting, sponsoring, or attending the event this year? Learn more about it on our website: www.FarmToTablePA.com
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
2. HEALTH INSURANCE TERMS
⬛ Network – the providers that have contracted with the
insurance company
⬛ PPO – Preferred Provider Organization – a product that
has an out-of-network benefit
⬛ HMO – Health Maintenance Organization – a product
that does not have an out-of-network benefit
⬛ Emergency Coverage – most plans allow for
emergency coverage notwithstanding network
3. HEALTH INSURANCE TERMS
⬛ Premium – monthly cost of policy
⬛ Copay – flat amount charged for health care service
⬛ Coinsurance – percentage charged for health care service
⬛ Deductible – initial payment due to health care provider before
insurance pays
⬛ Out of pocket max – the most the member pays out of pocket –
does not include premium
4. MEDICARE BASICS
Medicare is a Federal health insurance program
Administered by: Centers for Medicare & Medicaid Services (CMS)
Eligibility and Enrollment handled by: Social Security Administration &
Railroad Retirement Board
1965: Medicare (Part A & B)
1996: Medicare Advantage (Part C)
2006: Prescription Drug Program (Part D)
2010: Patient Protection and Affordable Care Act (PPACA)
5. WHO IS ELIGIBLE?
⬛ 65 years or older US Citizen or permanent legal resident
⬛ Under 65 year of age and receive disability payments for 24 months
(SSDI)
⬛ People with End Stage Renal Disease (ESRD on dialysis) or Lou Gehrig’s
disease
6. MEDICARE PART A: HOSPITAL COVERAGE
Cost Sharing for 2021
⬛ Part A: Generally Free (or up to $471/mo)
⬛ $1,484 for a hospital stay 1 – 60 days; $371/day for a hospital stay for days 61
– 90; $742/day for a hospital stay for days 91 – 150; All costs for 150+ days
⬛ Hospice
⬛ Home Health Services
⬛ Skilled Nursing Facility - $185.50/day for days 21 – 100 for each benefit period
– covered after 3 day hospital stay
⬛ Blood
7. MEDICARE PART B: DOCTORS
Premium for 2021 is $148.50/month
⬛ Medicare Part B Recipients $203 deductible, then 20% of all charges.
⬛ Exception for higher earners (above $88,000 for singles & $176,000 for married
filing jointly.)
⬛ You can pay your Part B premium out of your social security check
8. MEDICARE PART B: DOCTORS
Part B Covers:
⬛ Doctors’ services – Welcome to Medicare Visit and Annual
⬛ Outpatient care
⬛ Durable medical equipment
⬛ Mental health services
⬛ Preventive services
9. MEDICARE PREVENTIVE SCHEDULE
⬛ Initial physical exam
⬛ Cardiovascular screening
⬛ Cancer tests
⬛ Shots – vaccines
⬛ Bone mass measurements
⬛ Diabetes screening
⬛ Glaucoma test
⬛ Tobacco cessation
⬛ Medical Nutrition Therapy
10. PART C: MEDICARE ADVANTAGE
⬛ From private insurers
⬛ Still pay your Part B Premium
⬛ Includes AT LEAST Part A, Part B and most of the time Part D in
one plan
⬛ Medicare Advantage and Medicare Advantage Prescription Drug
plans
⬛ Live in plan’s service area
⬛ Entitled to Part A & enrolled in Part B
⬛ Premiums range from $0 – over $300 – not based on age
⬛ Copays for services
11. PART C: MEDICARE ADVANTAGE
⬛ You can pay your Part C premium out of your social security
check
⬛ Services covered that original Medicare doesn’t cover:
⬛ Lower cost sharing
⬛ Vision, Hearing, Dental
⬛ Podiatrist & Chiropractic
⬛ Gym Membership
⬛ Types: HMO, PPO, SNP, POS
12. HOW TO CHOOSE?
⬛ Check network providers
⬛ Check formulary
⬛ Annualize monthly premium
⬛ Project services needed in the year (based on known
problems & family history)
⬛ Calculate copays, coinsurance & deductibles for these
services
⬛ Choose most affordable plan
13. PART D – PRESCRIPTION DRUG PLANS
⬛ Prescription Drug Coverage
⬛ Available from private insurers
⬛ You must obtain a Part D plan when you become eligible,
or you will pay a penalty when you do sign up.
⬛ Uses a formulary & tiers
⬛ Initial Coverage Period, Coverage Gap, Catastrophic
Coverage
⬛ What counts toward the gap? deductible, coinsurance,
copays.
14. SOME PEOPLE GET A & B AUTOMATICALLY
⬛ If you are already collecting Social Security or Railroad Retirement
Benefits – you will be signed up automatically the first day of the month
you turn 65.
⬛ If you’re under 65 and disabled, you’ll automatically get Part A & B after
you disability benefits for 24 months.
⬛ If you have ALS (Lou Gehrig’s disease) you’ll get A & B automatically the
month your Social Security disability benefits begin.
15. MEDICARE SUPPLEMENT PLANS (MEDIGAP)
⬛ No Managed Care/Medicare’s network
⬛ Private insurance coverage to cover “gaps”
⬛ Still pay your Part B Premium
⬛ You will be medically underwritten outside of Open Enrollment (6 months
after joining Part B)
⬛ Premiums are based on your age, zip code, tobacco use and/or gender
⬛ Covers certain cost sharing (deductibles, coinsurance, copayments)
⬛ Secondary to Medicare
17. PACE/PACENET INFORMATION: MUST BE 65+
Income Individual Married
Percentage of FPL 133% 120%
Yearly $14,500 $17,700
Monthly $1,208 $1,470
Income Individual Married
Yearly $27,500 $35,500
Monthly $2,291 $2,958
PACE PACENET
RX Benefit $6.00 & $9.00,
potentially lower based on
income level
$8.00 & $15.00
Premium Benefit Covers the premium
if RX plan is a
partner plan
No premium benefit
18. IMPORTANT DATES
⬛ Parts A & B
⬛ Initial enrollment – 3 months before, the month of and 3 months after
65th birthday
⬛ January 1 – March 31 for July 1 effective date for Parts A & B
⬛ Medicare Advantage
⬛ October 15 – December 7 for January 1 effective date
⬛ January 1 – March 31: Open Enrollment Period
⬛ Anytime throughout the year – Special Enrollment Periods
19. 65 YEARS OF AGE AND STILL WORKING
⬛ You can keep your employer plan and not be charged the Part B penalty.
***COBRA doesn’t count as employer coverage
⬛ Sign up for Medicare Part A only - $0 hospital coverage, UNLESS
⬛ You cannot have any parts of Medicare and still contribute to a Health
Savings Account (HSA).
20. SPECIAL ENROLLMENT PERIODS
⬛ Dual eligible: once/quarter
⬛ Chronic Disease SNP
⬛ Move out of service area: 60 days
⬛ Institutionalized – nursing home
⬛ Lose employer coverage – 8 month period
⬛ Low Income Subsidy/Extra Help
⬛ Medicare Savings Program
⬛ Pace/Pacenet
21. HOW TO APPLY
You must sign up for Part B when you become eligible or you will pay a
penalty when you do. (UNLESS YOU’RE COVERED BY EMPLOYER
COVERAGE)
1. Apply via the telephone at Social Security Administration (SSA): SSA at 1-
800-772-1213 (TTY 1-800-325-0778)
2. Paper forms can be requested at: SSA at 1-800-772-1213 (TTY 1-800-325-
0778)
3. Online forms available at:
⬛ http://www.ssa.gov/prescriptionhelp/
4. Additional information is available at:
⬛ http://www.socialsecurity.gov/pubs/10525.html
22. MEDICAL ASSISTANCE: MEDICAID
⬛ Medicare/Medicaid: Dual eligible
⬛ For individuals who receive Medicare, the income limit to enroll in Medical Assistance
is $1,074/month. Asset limit is less than $2,000.
⬛ Medicaid is always payor of last resort, so Medicare is primary
⬛ Primary coverage – Medicare or Medicare Advantage Dual SNP
⬛ Coverage for Medicaid now through Community Health Choices – whole state
implemented 1/1/2020.
⬛ Community Health Choices plans: Amerihealth, PA Health & Wellness & UPMC
⬛ Find out if you’re eligible: http://www.phlp.org/quickscreen-questionnaire
23. MEDICAID ENROLLMENT
⬛ PA Department of Human Services
⬛ Online: Compass website:
https://www.compass.state.pa.us/compass.web/Public/CMPHome
⬛ Telephone: 866-550-4355
⬛ In Person: County assistance office
⬛ On Paper – download form
Editor's Notes
can not rise more than the previous year's cost of living increase in Social Security benefits.