Medicare Understanding your options

PART A

PART B

PART D

PART C

MEDICARE SUPPLMENT

Agenda

• The ABC’s of Medicare Insurance– Who pays for what?– Plan Types– Plan Comparisons

&– YOUR OPTIONS

The Parts of Medicare

• Part A - covers hospital and inpatient services. • Part B - is the part of Medicare that covers doctor’s

office and outpatient services • Part C - an optional part of Medicare that is also known

as Medicare Advantage (still part of Medicare, coverage is provided through the private insurance carrier combining part A,B & D)

• Part D is the prescription drugs part of Medicare• Medigap – Also called Medicare Supplements are

standardized plans can help you pay some of the costs not covered by Original Medicare

What Medicare Covers

• Part A – Hospital Insurance helps cover*– Inpatient Hospital Care– Skilled Nursing Facility care– Home health care– Hospice care

• Part B – Medical Insurance helps cover*– Doctor’s visits– Outpatient medical services– Clinical lab tests– Durable Medical Equipment– Preventive services

Paying for Part A

• What does Part A cost?– Most people get Part A premium free

• If you or your spouse paid FICA taxes at least 10 years

– If you paid FICA less than 10 years• You can pay a premium to get Part A

Paying for Part B

If your Income in 2011 was your premium for 2013 was

 

File Individual Tax Return File Joint Tax Return Mo Premium

$85,000 or less $170,000 or less $104.90

$85,000.01 – $107,000 $170,000.01 – $214,000 $146.90

$107,000.01 – $160,000 $214,000.01 – $320,000 $209.80

$160,000.01 – $214,000 $320,000.01 – $428,000 $272.70

Above $214,000 Above $428,000 $335.70

Premiums are typically deducted directly from your Social Security

Who pays for what

80%

20%

Original Medicare

MEDICARE Parts A&BBalance

Medicare Part A & B pays about

In Original Medicare you pay.Yearly deductible of $147 in 2013 and 20% coinsurance for most services.

• What you need to consider is paying for the 20%

Medicare Insurance Options

• Medicare Supplement Insurance Policies– Sold by private companies

• Fill the gaps in Original Medicare – Deductibles, coinsurance, copayments

• Standardized plans • All plans with same letter

– Have same coverage– Only the costs are different

• To join a private Medigap plan, you pay a monthly fee to an insurance company in addition to the premium you pay to the government for Medicare Part B.

Medicare Supplement Insurance

Standardized Supplment Plans

Medigap Benefits A B C D F* G K**

L** M N

Part A Coinsurance and Hospital Costs (up to an additional 365 days)

100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Part B Coinsurance 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Hospice Care Coinsurance 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Skilled Nursing Coinsurance     100% 100% 100% 100% 50% 75% 100% 100%

Part A Deductible   100% 100% 100% 100% 100% 50% 75% 50% 100%

Part B Deductible     100%   100%          Part B Excess Charges         100% 100%        Foreign Travel Emergency    

100% 100% 100% 100%   

100% 100%(Up to Plan Limits)  Out-of-pocket

limit in 2013 

  $4,800 $2,400  

   * Plan F also has a high deductible options, some companies may offer this option.  ** Plans K & L pay 100% of covered services for the rest of the calendar year after you meet your out-of-pocket yearly limit.    *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.

Part CCombining Parts A&B

• Health plan options approved by Medicare – Another way to get Medicare coverage– Still part of the Medicare program– Run by private companies

• Medicare pays the insurance carrier a premium– You continue paying for your Part B

• May have to use network doctors or hospitals• May include additional benefits, Vision & Dental • Types of plans available may vary HMOs

PPOs & Special Needs

Part D

• Available for all people with Medicare • Provided through

– Medicare Prescription Drug Plans– Medicare Advantage Plans

How Part D Works

• It’s optional (however you may have a penalty for joining late)– You can choose a plan and join

• Plans have formularies – Lists of covered drugs– Must include range of drugs in each category

• You pay the plan a monthly premium• You pay deductibles and copayments

For Comparison

Medicare Plan Type Monthly Yearly Out of Pocket Office Visit Office Visit

Premimum Deductable Max In Network Out of Network

LB City - Anthem Blue Cross Medicare Supplement $554.30 $50.00 Unlimited 100% 80%  Anthem Plan F $192.00 $0.00 100%* 100%*

LB City- UHC Group Medicare Advantage (HMO) $365.82 N/A $3,400.00 $5.00 Plan Dr. Only  United Health AARP Advantage (HMO) $0.00 $0.00 $3,000.00 $0.00 Plan Dr. Only

LB City- SCAN Medicare Advantage (HMO) $331.56 N/A $6,700.00 5.00% No Coverage  Scan Clasic HMO $0.00 $0.00 $5,400.00 $0.00 Plan Dr. Only

Anthem Blue Cross Medicare Perfered PPO W/Rx $0.00 $300.00 4,500.00 $15.00 $45.00  $28.00 $90.00 Rx

Part D Anthem Perceription Drug Pans $76.80 $140.00

• Medicare supplement pays 100% of the co-insurance allowable Medicare charges ( 147.00 Medicare Deductible and the remaining 20%)

• MEDICARE Advantage plans include prescription drug in the plan.

Plan Dr Only - You will be responsible for service obtained from non-plan physicians except for emergency services.Supplemt Plans do not include Prescription Drug Coverage

Plan information is for educational purposes only.

Things to keep in mind

Plans must offer at minimum, coverage equal to or greater than Original Medicare.

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