This document provides an overview of the different parts of Medicare including Part A, Part B, Part C (Medicare Advantage), Part D (prescription drug coverage), and Medicare supplements. It describes the basic benefits covered by Parts A and B including hospital stays, medical services, and preventative care. It also explains the differences between Medicare Advantage plans like HMOs, PPOs, and PFFS and the purpose of Medicare supplements to cover costs not covered by original Medicare.

2. 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

3. 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

5. Overview
 http://www.youtube.com/watch?v=slVO3p83_S0

6. 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

8. 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.

9. 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

10. 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.

12. 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.

13. 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.

14. 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

15. Medicare Advantage Plans
 Health Maintenance Organization (HMO)
 Preferred Provider Organization (PPO)
 Private Fee-for-Service (PFFS)

16. 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.

17. 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.

18. 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.

19. 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

20. 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

21. 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

22. 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