www.MedicareGals.com

ABOUT THE MEDICARE GALS

Sondra FordCompliance Officer

•Native Houstonian.•Has been in the Insurance Industry since 2007.•Field agent with Trusted Senior Specialists since 2009.•Experienced in call center and now compliance.•Has a 2-week University child, and one that just turned 2.

Mary DornVP of Agent Support

•Originally from Ohio, moved to Texas in 1990.•Insurance Agent, licensed in many states.•Has been helping our community since 2008.•Has been with Trusted Senior Specialists since 2002.•Is a Grandmother of 4, 3 girls and 1 boy.

ABOUT TRUSTED SENIOR SPECIALISTS

We began in Texas over 13 years ago and are now in 40-plus states across the country.

As members of the Better Business Bureau, we have an A+ rating and have been honored

as a Winner of Distinction at the 2011, 2012, 2013 Awards for Excellence.

For the past decade, we have established a name and reputation based on reliable service,

honesty, integrity and have built an Insurance Marketing Organization of over

3,000 agents in 42 states.

We are dedicated to assisting families, groups and individuals with their different insurance

needs such as: Life Insurance, Health Insurance, Final Expense, Long Term Care and Cancer.

We specialize in Medicare Supplements and Medicare Advantage Plans.

www.TrustedSeniorSpecialists.comwww.MedicareGals.com

TOPICS FOR TODAY

1. COVERAGE GAPS2. MEDICARE PART C3. MEDICARE SUPPLEMENTS4. MEDICARE PART D

(What is covered and what is not)5. PHASES OF COVERAGE FOR PART D

(Initial, Gap and Catastrophic)6. THINGS TO CONSIDER WHEN CHOOSING A PART D PLAN7. QUESTIONS8. PRESENTATION OVERVIEW

COVERAGE GAPS

Yesterday we spoke about Medicare Parts A and B.The costs involved and some of the gaps in this coverage.

The following services are not covered under Medicare:

•Long Term Care: In Nursing Home or Home•Hearing Aids•Dental Care (Including Dentures)•Routine Foot Care(Limited exceptions such as for diabetics)•Foreign Health Care Services

COVERAGE GAPS

Costs for these services will be paid out of pocket, with no out-of-pocket limitations. In addition to paying 100% for uncovered services, you will also be responsible for paying deductibles and co-insurance (the 20% not covered by Medicare).

There are options available to help reduce out of pocket expenses:

Medicare Advantage VS Medicare Supplement

MEDICARE PART C

These plans are also known as Medicare Advantage Plans.Provided through private insurance companies, these plans offer all the benefits under Parts A & B.

Some of the features of Part C plans are:•Generally lower premiums•No health qualifications (Cannot have ESRD)•Plans are local or regional•Same premiums regardless of age of health•Several types of plans available (HMO, PPO, PFFS, SNP)•May be limited to using network providers

MEDICARE PART C

• May include Prescription Drug Coverage• Plans have a Maximum Out-of-Pocket limit• May offer additional benefits such as vision, hearing, dental,

wellness programs. These benefits will vary by plan.

NOTE: These plans can terminate, be terminated, or leave the market each year. If any of these occur you will have to change plans.

Enrollment into a Medicare Advantage Plan is limited to certain Enrollment Periods (AEP, SEP)

MEDICARE SUPPLEMENT

These plans are designed to pay AFTER Medicare thus reducing the amount paid out of pocket. Medicare covers 80%. While there are several different Medicare Supplements to Choose from, all are designed to take care of the remaining 20%. Any additional benefits will vary dependent on the plan selected.

Features of these plans include: • Generally higher premiums (predictable)• No Co-Payments when visiting doctors (including specialists)• Guaranteed Renewable• Premiums may vary by age, sex and zip code

MEDICARE SUPPLEMENT

• Can see any doctor who accepts Medicare (in most cases)• If applying outside of a Guaranteed Issue period, may have to

qualify medically• Do not have Prescription Drug Coverage ( Will need to

purchase a separate Part D plan

MEDICARE PART D

The Medicare Modernization Act, 2003, introduced the prescription drug benefit for Medicare beneficiaries and it became effective January 1, 2006.

Covered:•Most prescriptions, both brand and generic•Vaccinations•Insulin ( though not all brands will be included)

MEDICARE PART D

Each Part D plan will have its own formulary, which is a list of drugs they cover. They are required to cover drugs in each category or class.

In order for a drug to be covered it must meet the following criteria:

•FDA approved•Bought and sold in the U.S.A.•Used for medically accepted purposes

MEDICARE PART D

Not Covered Under Part D:

•Drugs used for weight gain or weight loss•Drugs used for cosmetic purposes (ex: Hair regrowth)•Drugs used for symptomatic relief of coughs and colds (except for asthma treatment)•Drugs sold over the counter•Prescription vitamins and minerals ( exceptions may apply)•Barbiturates•Benzodiazepines•Drugs used to promote fertility•Drugs used to treat sexual or erectile dysfunction

MEDICARE PART D

There are three phases of Prescription Drug Coverage:

•Before Meeting Deductible - Each Part D plan will have its own deductible which ranges from $0 to $310. Until the deductible is met, all drug costs are paid 100% out of pocket.

•Initial Coverage - Beneficiary will pay applicable co-pays for their prescriptions until the total drug costs reach $2,850. This is the initial coverage amount. Once drug costs reach that amount, the beneficiary will enter the coverage gap.

MEDICARE PART D

• Coverage Gap (doughnut hole) - While in the Doughnut Hole, beneficiaries will pay 100% of their drug costs until reaching the Maximum Out-of Pocket Limit for Part D. For 2014, this amount is $4,550.

• Catastrophic Coverage - At that time, a beneficiary will now enter their catastrophic coverage period. In this phase, the out of pocket cost for generic drugs will be $2.55 and brand name drugs will be $6.35.

THINGS TO CONSIDER WHEN CHOOSING A PART D PLAN

1. Coverage:• Are all medications covered on the formulary• Do prescriptions require prior authorization• Is there a quantity limit• Does the plan require step therapy

THINGS TO CONSIDER WHEN CHOOSING A PART D PLAN

2. Costs: • How much is the monthly premium• Is there a deductible that has to be met before the plan

begins paying• How many tiers are there and what are the co-pay

amounts

THINGS TO CONSIDER WHEN CHOOSING A PART D PLAN

3. Network: • Can I still fill my prescriptions at my current pharmacy• Can I receive my prescriptions through mail order or do

I have to use a retail pharmacy• Is there any discount for a 90 day fill vs a 30 day fill

Q&APLEASE ASK QUESTIONS

REVIEW

Today we talked about the gaps in coverage for someone who only has Medicare Part A and Part B. We reviewed the options available to help cover some of the out of pocket costs that result from these gaps. It is important to remember that some of these options require you to enroll within certain time frames.

NOTE: While you can enroll in a Medicare Supplement any time, Enrollment into Part C and Part D is limited to your Initial Coverage Eligibility Period (ICEP), Annual Election Period (AEP) and during any applicable Special Election Period (SEP). Tomorrow we will cover each of these enrollment periods, when they are, and what changes are allowed during each of them.

THANK YOU!

If you haven’t already done so, we’d like to invite you to register for tomorrow’s event. We are currently in the Annual Election Period but is soon ending.

Register for tomorrow’s event at:www.MedicareGals.com

We hope you’ll join us once again to ensure you know all of your options before this year’s enrollment period comes to an end.

THANK YOU!

If you’d like to speak with a specialist one on one, please call us at:

(281) 879-7711Monday – Friday

9:00 a.m. to 7:00 p.m.

On behalf of Trusted Senior Specialists and The Medicare Gals, we would like to thank you for joining us today.

We look forward to our next presentation in this series and hope you will join us once again.

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