Medicare 101 Dan 2017 v.2
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Transcript of Medicare 101 Dan 2017 v.2
![Page 2: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/2.jpg)
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Sign up for Medicare
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Sign up for Medicare
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![Page 7: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/7.jpg)
Who is Alabama Health Guidance?Alabama Health Guidance is an independent insurance agency located in Florence, Al, specializing in
Medicare education and Medicare health plans. Started in 2009 to assist individuals with their Medicare healthcare needs, AHG has transitioned to providing Medicare education to both individuals
and corporations. With over 25 representatives working throughout Alabama, AHG is here to serve you!
Why are we here?To provide Medicare education to people with Medicare.
Medicare 101
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Our Qualifications?We are licensed insurance agents, certified to discuss and guide people
to appropriate Medicare health plans, drug plans, and Medicare Supplements.
What can we do?This a Medicare education class. We’ll discuss the general principles of Medicare,
what it covers, what it does not cover, and some ways to limit your exposures.
What can’t we do?We are not allowed to discuss specific companies or plans.
Our contact information is available to you to arrange private meetings.
Medicare 101
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What is Medicare and Who Qualifies? • People 65 years of age and older• People with certain disabilities• Anyone with End-Stage Renal Disease or
ALS
Medicare 101
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“When do I sign up for Medicare?”
Medicare 101
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Signing up for MedicareInitial Enrollment Period:
When you first become eligible for MedicareCan be for disability (usually 24 month
waiting period)Can be for aging in at 65
3 months beforeThe month you turn 65
2 months beforeThe month you turn 65
1 month beforeThe month you turn 65
The month you turn
65
1 month after you turn 65
2 months after you turn 65
3 months after you turn 65
Medicare 101
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Signing up for Medicare Special Election Period:• For people who have a special circumstance
happen to them• Example: Losing employer insurance
coverage
Medicare 101
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Annual Enrollment Period• Time frame set aside for a Medicare
beneficiary to make changes to their Medicare Advantage or Medicare Prescription Drug Plans for the upcoming year.• AEP extends from October 15 through
December 7 each year.
Medicare 101
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Late Enrollment Penaties Part B and Part D late-enrollment penalties: • A Medicare eligible person can be charged a late-enrollment
penalty if they do not sign up for Part B and/or Part D coverage during their Initial Election Period
• An exception to this rule is if the Medicare eligible person is on employer insurance they may not be charged this penalty when they sign up
• IMPORTANT – Just because a Medicare eligible is covered by an employer prescription drug plan does not mean that plan is creditable coverage under Medicare!!!
Medicare 101
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4 Parts of Medicare:
Medicare 101
Private Insurance Companies
1. Part A2. Part B
3. Part C4. Part D
Federal Government
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Medicare Part A Part A covers: • Inpatient Care• Has a deductible of $1,288 for each benefit
period• Part A has coinsurance starting after 60 days of
inpatient care• Part A is free to most Medicare recipients
Medicare 101
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Medicare Part B Part B covers:
• Outpatient Care – PCP & Specialist• Preventive Services• Has an annual deductible of $166• Part B covers 80% of Medicare covered procedures (includes outpatient & inpatient Part B services)• Most Medicare recipients pay a monthly premium of
$121.80• A late-enrollment penalty may apply if not taken out
when eligible
Medicare 101
80%/20%
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Medicare 101
Medicare is basically an Plan
Medicare 101
80%/20%
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Medicare Part C
Part C Covers:
• Also known as Medicare Advantage Plans
• Sold through private insurance companies
• Covers inpatient and outpatient Medicare benefits
• May also provide prescription drug coverage
• May have deductibles, coinsurance and/or copays
• Must cover everything Original Medicare covers
• May provide additional benefits
Medicare 101
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Medicare Part D Part D Covers: • Prescription Drug Coverage• Sold through private insurance companies• Part D coverage is optional• Premiums, deductibles, copays and networks vary with
plans• A late-enrollment penalty may apply if not taken out
when eligible
Medicare 101
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Medicare Basics
Part DPrescription Drugs
Part CMedicare Advantage
(All in One)
Part AHospital Insurance
Part BOutpatient Insurance
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“What are my health insurance options under
Medicare?”
Medicare 101
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The mailbox of a person on Medicare
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Original Medicareor
Medicare Advantage
Medicare 101
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+ + +
Original Medicare withNO PDP
Original Medicare +PDP
Original Medicare +Medicare Supplement
Original Medicare +Medicare Supplement + PDP
Medicare 101
Original Medicare
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Medicare Supplement: Plan F covers:• Medicare Part A deductibles• Medicare Part A coinsurance• Medicare Part B deductible• Medicare Part B coinsurance• Medicare Part B excess charges• First 3 pints of blood used in a procedure• Skilled Nursing Facility coinsurance• Coverage outside the United States
Medicare 101
$166 Annually
Plan G covers everything Plan F covers except the Medicare Part B deductible ($166)
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Medicare Supplement Plans F and G
$166
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Medicare Supplement Rate ComparisonCompany 4
(Plan F)
$148.33
$148.33
$164.86
$193.52
Company 3(Plan F)
$122.76
$133.67
$149.59
$174.55
Company 1(Plan F)
$174.96
$189.08
$212.44
$258.04
Company 2(Plan F)
$139.47
$151.43
$169.36
$199.25
Company 3(Plan G)
$102.10
$102.10
$115.68
$193.52
Company 4(Plan G)
$115.81
$115.81
$128.71
$151.09
Age(Female)
65
67
70
75
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Annual Savings with Medicare Supplement Plan GPlan F Plan G
Monthly Premium $146.38*
x 12
Annual Premium $1,756.56
Part B Expense $0
Total Annual Cost $1,756.56Total Annual Savings
*Based on the average of the companies listed on the prior slide for a 65 yo female
$108.95*
x 12
$1,307.40+$166
$1,473.40
$283.16
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Go to Medicare Advantage:
Private Insurance Company
Copays for most covered Medical and Prescription Drug Expenses
PPO HMOPFFS
Most plans will have specific network and formulary restrictions
Medicare 101
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PPO• Nationwide Coverage for most plans
• Flexibility to receive services from out of network providers
Medicare Advantage: PPO or HMO
Review
HMO• Plans will usually have a specific provider list you must
use to have coverage• Usually have zero coverage for services rendered by
“out-of-network” providers
Traditional• Nationwide Coverage for most plans
• Providers who accept Medicare will also accept the traditional Medicare Supplement
Select• Plans will usually have a specific provider list you must
use to have coverage
• Usually have zero coverage for services rendered by “out-of-network” providers
Medicare Supplement: Traditional or Select
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Low Income Medicare Programs
Medicare Savings Program
• QMB• SLMB• Qi-1
Low-Income Subsidy
For those who don’t qualify for Medicaid
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Medicare Savings Program
QMBQualified Medicare Beneficiary
Income Limits$0 - $1,010/ Individual$0 - $1,355/ Couple
Part A Deductible
Part B Deductible
Part B Premium
Part B Coinsurance
Part D Premium
Part D Deductible
Part D Copays
Part D Donut Hole
$0
$0
$0
$0
$0
$0
$3.60 B
$0
$1,288
$166
$121.80
20%
$0 - $90
$360
$1.20 G
$4,850
Medicare Beneficiary
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Medicare Savings Program
SLMBSpecified Low-Income Medicare Beneficiary
Income Limits$1,010 - $1,208/ Individual$1,355 - $1,622/ Couple
Part A Deductible
Part B Deductible
Part B Premium
Part B Coinsurance
Part D Premium
Part D Deductible
Part D Copays
Part D Donut Hole
$1,288
$166
$0
20%
$0
$0
$6.35B
$0
$1,288
$166
$121.80
20%
$0 - $90
$320
$2.55 G
$4,557
Medicare Beneficiary
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QMedicare Savings Program
Qi-1Qualified Medicare Beneficiary
Income Limits$1,208 - $1,357/ Individual$1,622 - $1,823/ Couple
Based on available funds
Part A Deductible
Part B Deductible
Part B Premium
Part B Coinsurance
Part D Premium
Part D Deductible
Part D Copays
Part D Donut Hole
$1,288
$166
$0
20%
$0
$0
$6.35B
$0
$1,288
$166
$121.80
20%
$0 - $90
$360
$2.55 G
$4,850
Medicare Beneficiary
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Low- Income Subsidy
LISLow-income Subsidy
Income Limits$1,345 - $1,471/ Individual$1,823 - $1,991/ Individual
Part A Deductible
Part B Deductible
Part B Premium
Part B Coinsurance
Part D Premium
Part D Deductible
Part D Copays
Part D Donut Hole
$1,288
$166
$121.80
20%
Reduced
Reduced
$6.35B
$0
$1,288
$166
$121.80
20%
$0 - $90
$360
$2.55 G
$4,850
Medicare Beneficiary
![Page 37: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/37.jpg)
Sign up for Medicare
Compare
Medicare
Health PlansCompare Prescription Drug Plans
20%
Review your coverage annually
Medicare Road Map
Learn the
Basics of
Medicare
![Page 38: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/38.jpg)
Sign up for Medicare
Compare
Medicare
Health PlansCompare Prescription Drug Plans
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Review your coverage annually
Medicare Road Map
Learn the
Basics of
Medicare
![Page 39: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/39.jpg)
Sign up for Medicare
Compare
Medicare
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Review your coverage annually
Medicare Road Map
Learn the
Basics of
Medicare
![Page 40: Medicare 101 Dan 2017 v.2](https://reader035.fdocuments.net/reader035/viewer/2022062502/58a712081a28ab02678b4bb7/html5/thumbnails/40.jpg)
Sign up for Medicare
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Learn the
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Medicare
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Sign up for Medicare
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Medicare 101
Medicare Basics provided by:
Dan Stevens256-338-4571
Ron Stone256-709-7112
www.AlabamaHealthGuidance.com