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Medicare overview presentation


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Medicare overview presentation

  1. 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. 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. 3. Overview 
  4. 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. 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. 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. 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. 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. 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. 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. 11. Medicare Advantage Plans  Health Maintenance Organization (HMO)  Preferred Provider Organization (PPO)  Private Fee-for-Service (PFFS)
  12. 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. 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. 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. 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. 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. 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. 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