Medicare 101 Dan 2017 v.2
- 1. Medicare 101 Medicare Basics provided by: Dan Stevens 256-338-4571 [email protected]
- 7. 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.
- 8. Our Qualifications? We are licensed insurance agents, certifiedto discuss and guide people to appropriateMedicarehealth plans, drug plans, and Medicare Supplements. What can we do? This a Medicareeducation 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.
- 9. 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
- 10. “When do I sign up for Medicare?”
- 11. Signing up for Medicare Initial Enrollment Period: When you first become eligible for Medicare Can be for disability (usually 24 month waiting period) Can be for aging in at 65 3 months before The month you turn 65 2 months before The month you turn 65 1 month before The 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
- 12. Signing up for Medicare Special Election Period: • For people who have a special circumstance happen to them • Example: Losing employer insurance coverage
- 13. 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.
- 14. 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!!!
- 15. 4 Parts of Medicare: Private Insurance Companies 1. Part A 2. Part B 3. Part C 4. Part D Federal Government
- 16. 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
- 17. 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 80%/20%
- 18. Medicare 101 Medicare is basically an Plan80%/20%
- 19. 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
- 20. 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
- 21. Medicare Basics Part D Prescription Drugs Part C Medicare Advantage (All in One) Part A Hospital Insurance Part B Outpatient Insurance
- 22. “What are my health insurance options under Medicare?”
- 23. The mailbox of a person on Medicare
- 25. + + + Original Medicare with NO PDP Original Medicare + PDP Original Medicare + Medicare Supplement Original Medicare + Medicare Supplement + PDP Original Medicare
- 26. 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 $166 Annually Plan G covers everything Plan F covers except the Medicare Part B deductible ($166)
- 27. Medicare Supplement Plans F and G $166
- 28. Medicare Supplement Rate Comparison Company 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
- 29. Annual Savings with Medicare Supplement Plan G Plan F Plan G Monthly Premium $146.38* x 12 Annual Premium $1,756.56 Part B Expense $0 Total Annual Cost $1,756.56 Total 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
- 30. Go to Medicare Advantage: Private Insurance Company Copays for most covered Medical and Prescription Drug Expenses PPO HMO PFFS Most plans will have specific network and formulary restrictions
- 31. PPO • Nationwide Coverage for most plans • Flexibility to receive services from out of network providers Medicare Advantage: PPO or HMO 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
- 32. Low Income Medicare Programs Medicare Savings Program • QMB • SLMB • Qi-1 Low-Income Subsidy For those who don’t qualify for Medicaid
- 33. 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
- 34. 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
- 35. QMedicare Savings Program Qi-1 Qualified 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
- 36. 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
- 42. Medicare 101 Medicare Basics provided by: Dan Stevens 256-338-4571 [email protected] Ron Stone 256-709-7112 [email protected] www.AlabamaHealthGuidance.com
- 43. Medicare 101 Medicare Basics provided by: Dan Stevens 256-338-4571 [email protected]
Editor's Notes
- #20: After a short introduction, we will cover information on: Original Medicare Plan Medicare Supplement Insurance (often known as Medigap) Medicare Advantage and other Medicare plans (e.g., HMOs and PPOs) Medicare prescription drug coverage Medicaid and Medicare Savings Programs
- #22: Medicare now has three parts. Medicare Part A is Hospital Insurance. Medicare Part B is Medical Insurance, which helps cover doctors’ services and outpatient care. Medicare also has prescription drug coverage, which is called Part D.
- #27: Tell them to buy everything!
- #28: Costs vary depending on the plan. Plans must provide a standard (minimum) level of coverage. Plans may offer more coverage and/or additional drugs generally at a higher monthly premium. The actual coverage and costs of the Medicare drug plans can be found on www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). In general for coverage in 2007, people pay A monthly premium, which is different for different plans. Some plans have $0 premiums. Others have higher premiums but might cover more. The average national monthly premium in 2007 is about $24. Deductible. This is the amount people must pay for covered prescriptions each year before the plan starts to pay. Some plans have a $0 deductible (usually for a higher premium). No plan can have a deductible higher than $265 in 2007. Copayment/Coinsurance. This is the amount people must pay for each prescription after meeting the deductible. In some plans, the copayment (a set amount) or coinsurance (a percentage of the cost) is the same for any prescription. In other plans, there are different levels or “tiers” with different costs. The amount may vary depending on how much the person has spent that year. There may be a point during the year when the person will be paying 100% coinsurance, called a coverage gap. Some plans do not have this coverage gap. Once people spend $3,850 out-of-pocket for covered drug costs during 2007, they pay 5% (or a small copayment) for the rest of the calendar year. This is called catastrophic coverage, and it could start even sooner in some plans. All these amounts can change each year.
- #29: Costs vary depending on the plan. Plans must provide a standard (minimum) level of coverage. Plans may offer more coverage and/or additional drugs generally at a higher monthly premium. The actual coverage and costs of the Medicare drug plans can be found on www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). In general for coverage in 2007, people pay A monthly premium, which is different for different plans. Some plans have $0 premiums. Others have higher premiums but might cover more. The average national monthly premium in 2007 is about $24. Deductible. This is the amount people must pay for covered prescriptions each year before the plan starts to pay. Some plans have a $0 deductible (usually for a higher premium). No plan can have a deductible higher than $265 in 2007. Copayment/Coinsurance. This is the amount people must pay for each prescription after meeting the deductible. In some plans, the copayment (a set amount) or coinsurance (a percentage of the cost) is the same for any prescription. In other plans, there are different levels or “tiers” with different costs. The amount may vary depending on how much the person has spent that year. There may be a point during the year when the person will be paying 100% coinsurance, called a coverage gap. Some plans do not have this coverage gap. Once people spend $3,850 out-of-pocket for covered drug costs during 2007, they pay 5% (or a small copayment) for the rest of the calendar year. This is called catastrophic coverage, and it could start even sooner in some plans. All these amounts can change each year.
- #30: Costs vary depending on the plan. Plans must provide a standard (minimum) level of coverage. Plans may offer more coverage and/or additional drugs generally at a higher monthly premium. The actual coverage and costs of the Medicare drug plans can be found on www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). In general for coverage in 2007, people pay A monthly premium, which is different for different plans. Some plans have $0 premiums. Others have higher premiums but might cover more. The average national monthly premium in 2007 is about $24. Deductible. This is the amount people must pay for covered prescriptions each year before the plan starts to pay. Some plans have a $0 deductible (usually for a higher premium). No plan can have a deductible higher than $265 in 2007. Copayment/Coinsurance. This is the amount people must pay for each prescription after meeting the deductible. In some plans, the copayment (a set amount) or coinsurance (a percentage of the cost) is the same for any prescription. In other plans, there are different levels or “tiers” with different costs. The amount may vary depending on how much the person has spent that year. There may be a point during the year when the person will be paying 100% coinsurance, called a coverage gap. Some plans do not have this coverage gap. Once people spend $3,850 out-of-pocket for covered drug costs during 2007, they pay 5% (or a small copayment) for the rest of the calendar year. This is called catastrophic coverage, and it could start even sooner in some plans. All these amounts can change each year.
- #34: People can choose whether or not to enroll in Part B (Medical Insurance). Those who enroll are responsible for a monthly premium for Medicare Part B, which is $93.50 in 2007. (Note: starting January 1, 2007, some people with higher annual incomes—over $80,000 if you file an individual tax return or over $160,000 if you are married filing jointly—pay a higher Part B premium. These amounts change each year. Most people still pay the standard Part B premium.) People can sign up for Part B any time during a 7-month period that begins 3 months before the month they become eligible for Medicare. This is called the Initial Enrollment Period (IEP). People who don’t take Part B when they are first eligible may have to wait to sign up during a General Enrollment Period (GEP). This period runs from January 1 through March 31 of each year, with coverage effective July 1 of that year. Most people who don’t take Part B when they are first eligible will also have to pay a premium penalty of 10% for each full 12-month period they could have had Part B but didn’t sign up for it, except in special situations. In most cases, they will have to pay this penalty for as long as they have Part B. Reference: Enrolling in Medicare, CMS pub. 11036
- #35: People can choose whether or not to enroll in Part B (Medical Insurance). Those who enroll are responsible for a monthly premium for Medicare Part B, which is $93.50 in 2007. (Note: starting January 1, 2007, some people with higher annual incomes—over $80,000 if you file an individual tax return or over $160,000 if you are married filing jointly—pay a higher Part B premium. These amounts change each year. Most people still pay the standard Part B premium.) People can sign up for Part B any time during a 7-month period that begins 3 months before the month they become eligible for Medicare. This is called the Initial Enrollment Period (IEP). People who don’t take Part B when they are first eligible may have to wait to sign up during a General Enrollment Period (GEP). This period runs from January 1 through March 31 of each year, with coverage effective July 1 of that year. Most people who don’t take Part B when they are first eligible will also have to pay a premium penalty of 10% for each full 12-month period they could have had Part B but didn’t sign up for it, except in special situations. In most cases, they will have to pay this penalty for as long as they have Part B. Reference: Enrolling in Medicare, CMS pub. 11036
- #36: People can choose whether or not to enroll in Part B (Medical Insurance). Those who enroll are responsible for a monthly premium for Medicare Part B, which is $93.50 in 2007. (Note: starting January 1, 2007, some people with higher annual incomes—over $80,000 if you file an individual tax return or over $160,000 if you are married filing jointly—pay a higher Part B premium. These amounts change each year. Most people still pay the standard Part B premium.) People can sign up for Part B any time during a 7-month period that begins 3 months before the month they become eligible for Medicare. This is called the Initial Enrollment Period (IEP). People who don’t take Part B when they are first eligible may have to wait to sign up during a General Enrollment Period (GEP). This period runs from January 1 through March 31 of each year, with coverage effective July 1 of that year. Most people who don’t take Part B when they are first eligible will also have to pay a premium penalty of 10% for each full 12-month period they could have had Part B but didn’t sign up for it, except in special situations. In most cases, they will have to pay this penalty for as long as they have Part B. Reference: Enrolling in Medicare, CMS pub. 11036
- #37: People can choose whether or not to enroll in Part B (Medical Insurance). Those who enroll are responsible for a monthly premium for Medicare Part B, which is $93.50 in 2007. (Note: starting January 1, 2007, some people with higher annual incomes—over $80,000 if you file an individual tax return or over $160,000 if you are married filing jointly—pay a higher Part B premium. These amounts change each year. Most people still pay the standard Part B premium.) People can sign up for Part B any time during a 7-month period that begins 3 months before the month they become eligible for Medicare. This is called the Initial Enrollment Period (IEP). People who don’t take Part B when they are first eligible may have to wait to sign up during a General Enrollment Period (GEP). This period runs from January 1 through March 31 of each year, with coverage effective July 1 of that year. Most people who don’t take Part B when they are first eligible will also have to pay a premium penalty of 10% for each full 12-month period they could have had Part B but didn’t sign up for it, except in special situations. In most cases, they will have to pay this penalty for as long as they have Part B. Reference: Enrolling in Medicare, CMS pub. 11036
- #38: People can choose whether or not to enroll in Part B (Medical Insurance). Those who enroll are responsible for a monthly premium for Medicare Part B, which is $93.50 in 2007. (Note: starting January 1, 2007, some people with higher annual incomes—over $80,000 if you file an individual tax return or over $160,000 if you are married filing jointly—pay a higher Part B premium. These amounts change each year. Most people still pay the standard Part B premium.) People can sign up for Part B any time during a 7-month period that begins 3 months before the month they become eligible for Medicare. This is called the Initial Enrollment Period (IEP). People who don’t take Part B when they are first eligible may have to wait to sign up during a General Enrollment Period (GEP). This period runs from January 1 through March 31 of each year, with coverage effective July 1 of that year. Most people who don’t take Part B when they are first eligible will also have to pay a premium penalty of 10% for each full 12-month period they could have had Part B but didn’t sign up for it, except in special situations. In most cases, they will have to pay this penalty for as long as they have Part B. Reference: Enrolling in Medicare, CMS pub. 11036