A overview of the basic components of Medicare, how they work, and what financial exposure exists under Basic Medicare coverage. Highlights supplemental or alternative coverage options within the Medicare framework.
Transcript of Medicare 101: The A,B,C, and D\’s of Medicare
1. Mark Lane A B C and Ds of Medicare
2.
GarityAdvantage Agencies
National FMO
Focused on the Senior Market
Medicare Advantage
Medicare Supplement
Group Retiree Medical
PDP
Hospital Indemnity
Dental
Final Expense
Funeral Trust
Life
3.
GarityAdvantage Agencies offers
Competitive Nationally recognized products
Comprehensive Training
Market Expertise
Ask us about our Lead Programs for Medicare Products!
www.garityadvantage.com
800-234-9488
4.
5.
Medicare Background
Original Medicare Parts A & B
Medicare Part C Options to Original Medicare
Medicare Supplements
Medicare Part D
Coverage Options
Questions???
6. What is Medicare? A health insurance program for people: age
65 or older under 65 with certain disabilities any age with End
Stage Renal Disease Administered by the Federal Government through
the Centers for Medicare & Medicaid Services (CMS) Medicare
currently provides coverage for 45-46 million People 77 million
people aging into Medicare over the next 20 years
7.
Covers:
Inpatient Hospital
$0 co-pay for days 1-60 after the deductible has been met
$283 co-pay for days 61-90
$566 co-pay for days 91-150 (Lifetime Reserve Days)
Home Healthcare
Medically necessary care ordered by a doctor and provided by a
Medicare-certified home health agency (VNA)
Hospice Care
Terminally ill with life expectancy of less than 6 months
Home or Medicare approved facility
Skilled Nursing Facility up to 100 days
Only after a 3 day hospital stay
Co-pays for days 21-100 are $141.50 per day
8.
The deductible for Part A is $1,132 in 2011
Benefit period
Starts the day you go into a hospital
Ends when you go 60 days without hospital or skilled nursing
care
NO LIMIT
No premium for those with 40 quarters of work
$ 248 per month for those with more than 30 quarters
$ 450 per month for those with less than 30 quarters
9.
Covers:
Doctors Services
Emergency Room Services
Outpatient care
In hospital or ambulatory surgical center if not admitted
Laboratory Tests
Certain blood tests (diabetes screening for those with risk
factors)
Urinalysis
Some Diagnostic Screenings
Bone Density Screenings
Cardiovascular Screenings
Colorectal Cancer Screenings
X-rays, MRIs, CT scans, EKGs
10.
Certain Drugs not covered under Part D
Oral cancer drugs, some types of injected drugs
Durable Medical Equipment
Oxygen equipment, Wheelchairs, Walkers, etc
Flu Shots, Hep B shots
Mammograms and Pap tests
Once every 12 months
Mental Health Care
Diabetic Supplies
Some supplies may be covered under Part D
Welcome to Medicare physical exam
Yearly Wellness Exam after 12 months on Part B
Part B deductible does not apply
11.
Part B premium for 2011 is $115.40 for those new to
Medicare.
Higher premiums for those earning more than $85,000 filing
single or $170,000 filing joint with spouse
Penalties for late enrollment
Part B deductible for 2011 is $162
Part B generally pays 80% of the cost after the deductible
You pay the remaining 20% (co-insurance) in some instances
co-pays may apply for certain services
There is no Out of Pocket Limit for the Part B
co-insurance!!!
12.
Neither Part A or Part B cover the following:
Acupuncture
Chiropractic (few exceptions)
Cosmetic Surgery
Dental Care
Routine Eye Exams
Routine Foot Care
Hearing Aids or Tests unless order by your doctor
Orthopedic Shoes
Service from non-Medicare Providers
Services incurred outside of the U.S.
13.
Original Medicare
No Part A premium for most
Part B premium for all, varies for higher income
Deductibles apply
Co-pays may apply under Part A for long hospital stays
Co-insurance applies for Part B services
There is no Out of Pocket Maximum for either Parts A or B
14.
Provide Supplemental coverage to Original Medicare
Approved by the individual states
Generally cover expenses that Medicare does not such as Part A
& B deductible, Part B co-insurance, First 3 pints of blood,
etc
Usually do not go beyond what Original Medicare covers
Do not include Part D coverage
More comprehensive coverage than Part C plans but, also more
expensive
Require Part A & B coverage
15.
Part C - Medicare Advantage (MA)
Must be enrolled in both Part A & B to participate
Coverage provided by private insurers
Medicare pays a fixed amount to the company
Plans must be filed and approved each year by CMS
Must offer benefits at least as good as Original Medicare
16.
May offer benefits above and beyond what Medicare provides,
such as dental, hearing and vision benefits
Must include an Out of Pocket Maximum
Providers bill private insurers, not Medicare
Premiums are usually lower than Medicare Supplement plans
Part B premium must still be paid
Includes HMOs, PPOs, PFFS, & Medicare M SAs
17.
Part D - Prescription Drug Plan (PDP)
Provides Medicare Beneficiaries with assistance in paying
prescription drug costs