Medicare Education by Ray McPherson
•Download as PPTX, PDF•
1 like•262 views
This document summarizes the different parts of Medicare coverage including Part A for inpatient hospital insurance, Part B for outpatient medical insurance, Part C for Medicare Advantage plans, Part D for prescription drug coverage, and Medigap supplemental plans. It provides details on deductibles, premiums, coinsurance amounts, and coverage included under each part or plan type. It also discusses eligibility periods and options for obtaining Medicare coverage.
![Inpatient Hospital Ins.
Outpatient Medical Ins.
Part A
Part B
Use only by permission from Senior Insurance Services of NCW, LLC. VRM
A
B
Part A
Part B
Most often
included
Part DRx – Prescription Drugs
[Stand Alone Plans]
Part D
Medi-Gaps
Medicare ADVANTAGE
Original Medicare
Federal Gov’t
2 Ways
To Get Medicare
10 Letter Plans in Washington
Use only by permission from Senior Insurance Services of NCW, LLC. VRM
Part C](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
More Related Content
What's hot
What's hot (20)
Similar to Medicare Education by Ray McPherson
Similar to Medicare Education by Ray McPherson (20)
Recently uploaded
Recently uploaded (20)
Medicare Education by Ray McPherson
- 2. Inpatient Hospital Ins. Outpatient Medical Ins. Part A Part B Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B Part A Part B Most often included Part DRx – Prescription Drugs [Stand Alone Plans] Part D Medi-Gaps Medicare ADVANTAGE Original Medicare Federal Gov’t 2 Ways To Get Medicare 10 Letter Plans in Washington Use only by permission from Senior Insurance Services of NCW, LLC. VRM Part C
- 4. Inpatient Hospital Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Part A [Hospital, Hospice, Homecare, Skilled Nursing, etc.] Original Medicare Federal Gov’t 2 Ways To Get Medicare Use only by permission from Senior Insurance Services of NCW, LLC. VRM Medicare ADVANTAGE Part C
- 5. Outpatient Medical Ins. Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% [Doctor, Outpatient Surgery, Ambulance, etc.] Part B Use only by permission from Senior Insurance Services of NCW, LLC. VRM Inpatient Hospital Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Part A [Hospital, Hospice, Homecare, Skilled Nursing, etc.] Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 6. Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B Inpatient Hospital Ins. Outpatient Medical Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% [Doctor, Outpatient Surgery, Ambulance, etc.] Part A Part B [Hospital, Hospice, Homecare, Skilled Nursing, etc.] [Monthly Changeable] [Network: Any provider that accepts Medicare]Medi-Gaps 10 Letter Plans in Washington Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 7. Use only by permission from Senior Insurance Services of NCW, LLC. VRM
- 8. NF 100% $179-$188 100% K 50% $57 $4940 MOOP $128 Pt. B $147 Doc/$20 - ER/$50 Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B Inpatient Hospital Ins. Outpatient Medical Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% [Doctor, Outpatient Surgery, Ambulance, etc.] Part A Part B [Hospital, Hospice, Homecare, Skilled Nursing, etc.] G $158 Pt. B $147 [Monthly Changeable] [Network: Any provider that accepts Medicare]Medi-Gaps Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 9. Use only by permission from Senior Insurance Services of NCW, LLC. VRM Rx – Prescription Drugs [Stand Alone Plans] Part D 1% Penalty Avg. $33.13/ mo. Formulary – Rx List Tiers 1 -5 Inpatient Hospital Ins. Outpatient Medical Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% NF 100% $188/mo. 100% K 50% $57-mo. $4940 MOOP $128/mo. Pt. B $147 Doc/$20 - ER/$50 [Doctor, Outpatient Surgery, Ambulance, etc.] Part A Part B A B [Hospital, Hospice, Homecare, Skilled Nursing, etc.] G $158/mo. Pt. B $147 [Monthly Changeable] [Network: Any provider that accepts Medicare]Medi-Gaps Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 10. Use only by permission from Senior Insurance Services of NCW, LLC. VRM Rx – Prescription Drugs [Stand Alone Plans] Part D 1% Penalty Avg. $33.13/ mo. 1. Formulary - a list of prescription drugs covered by a Plan. 2. Tier level determines what your copay will be for a given drug. Higher tier = higher cost 3. 90-Day Supply 4. Step Therapy – Some drugs require you to try another drug first. 5. Exceptions 6. Network Pharmacies – unless emergency 7. Low Income Subsidy
- 11. Stage 1. Yearly Deductible You Pay 100% $0 to $320 Stage 3. Coverage Gap – “Donut Hole” Brand-name Stage 2. Initial Benefit Period Copays Insurance Pays Balance You Pay Copays Manufacturer Provides 50% discount Insurance Pays 5% You Pay 45% Of Drug Value You Pay 65% Of Drug Value Insurance Pays 35% Of Drug Value Generic Stage 4. Catastrophic Coverage You pay Greater of | 5% or $2.65 generic / $6.60 Brand Medicare Pays 80% Of Drug Value Insurance Pays 15% of Drug Value TrOOP When YOU have paid $4700 (including Mfg. 50% disc.) then… In 2015, when in Stage 3 Coverage Gap, 95 percent of the full price of a brand name and 65 percent of the full price of a generic goes toward True Out of Pocket expense (TrOOP). Once this amount reaches $4700, then Stage 4 – Catastrophic coverage is reached. (Monthly Premiums are in addition to cost shown below.)Part D – Standard Benefit, what you pay for drugs. When You + Insurance Pays = $2960
- 12. Inpatient Hospital Ins. Outpatient Medical Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% NF 100% $188/mo. 100% K 50% $57-mo. $4940 MOOP $128/mo. Pt. B $147 Doc/$20 - ER/$50 [Doctor, Outpatient Surgery, Ambulance, etc.] Part A Part B $104.90/mo. Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B [Hospital, Hospice, Homecare, Skilled Nursing, etc.] G $158/mo. Pt. B $147 Part A Part B Most often included Part DRx – Prescription Drugs [Stand Alone Plans] Part D 1% Penalty Avg. $33.13/ mo. Formulary – Rx List Tiers 1 -5 [Monthly Changeable] [Network: Any provider that accepts Medicare]Medi-Gaps Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 13. Inpatient Hospital Ins. Outpatient Medical Ins. Prem: $104.90/mo. HMO – Get your care in Network You choose your doctor Low to No Monthly Premiums Copays more predictable PCP copays Specialist copays Outpatient Surgery Worldwide Emergency Care Additional Benefits - Dental - Vision - Health Club 1. Review maximum cost exposure Accumulation of copays 2. Review Recurring Costs Doctor Visits Lab Visits Physical Therapy RX Costs Monthly Premium 3. Trial Right Formulary – Rx List Tiers 1 -5 Part A Part B $104.90/mo. Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B Part A Part B Most often included Part DRx – Prescription Drugs [Stand Alone Plans] Part D Medi-Gaps ELIGIBILITY Part A & B ESRD 6 months in service area Election Periods AEP: Oct 15 – Dec 7 MADP: Jan 1 – Feb 14 SEP: common examples Leave employer coverage Moving out of area LIS Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C
- 14. Inpatient Hospital Ins. Outpatient Medical Ins. Ded. $1260/Stay (Benefit Period Day 1-60) Prem: $104.90/mo. Ded: $147/yr. Co-Ins. You – 20% & Medicare – 80% NF 100% HMO – Get your care in Network You choose your doctor Low to No Monthly Premiums Copays more predictable PCP copays Specialist copays Outpatient Surgery Worldwide Emergency Care Additional Benefits - Dental - Vision - Health Club 1. Review maximum cost exposure Accumulation of copays 2. Review Recurring Costs Doctor Visits Lab Visits Physical Therapy RX Costs Monthly Premium 3. Trial Right Formulary – Rx List Tiers 1 -5 $188/mo. 100% K 50% $57-mo. $4940 MOOP $128/mo. Pt. B $147 Doc/$20 - ER/$50 [Doctor, Outpatient Surgery, Ambulance, etc.] Part A Part B $104.90/mo. Use only by permission from Senior Insurance Services of NCW, LLC. VRM A B [Hospital, Hospice, Homecare, Skilled Nursing, etc.] G $158/mo. Pt. B $147 Part A Part B Most often included Part DRx – Prescription Drugs [Stand Alone Plans] Part D 1% Penalty Avg. $33.13/ mo. Formulary – Rx List Tiers 1 -5 [Monthly Changeable] [Network: Any provider that accepts Medicare]Medi-Gaps Original Medicare Federal Gov’t 2 Ways To Get Medicare Medicare ADVANTAGE Part C