medicare overview presentation
Post on 15-May-2015
202 Views
Preview:
TRANSCRIPT
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
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
Overview
http://www.youtube.com/watch?v=slVO3p83_S0
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
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.
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
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.
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.
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.
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
Wellness Programs
Does not cover Hospice Care
Medicare Advantage Plans
Health Maintenance Organization (HMO)
Preferred Provider Organization (PPO)
Private Fee-for-Service (PFFS)
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.
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.
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.
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
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
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
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
Plans
top related