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