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1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

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Presentation on theme: "1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage."— Presentation transcript:

1 1 1 Medicare

2 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage

3 & older -or- Receiving Social Security disability benefits at least 24 months -or- Permanent kidney failure -or- Amyotrophic Lateral Sclerosis (ALS) 65 & older -or- Receiving Social Security disability benefits at least 24 months -or- Permanent kidney failure -or- Amyotrophic Lateral Sclerosis (ALS) Who Can Get Medicare?

4 4 4 When Can I Sign Up for Medicare? Medicare Enrollment Periods:  Initial - at age 65  Special - if still working  General - January-March

5 5 5 Full Retirement Age Year of BirthFull Retirement Age 1937 or earlier & 2 months & 4 months & 6 months & 8 months & 10 months 1943 – & 2 months & 4 months & 6 months & 8 months & 10 months 1960 or later67 Year of BirthFull Retirement Age 1937 or earlier & 2 months & 4 months & 6 months & 8 months & 10 months 1943 – & 2 months & 4 months & 6 months & 8 months & 10 months 1960 or later67

6 6 6 Medicare Coverage Part AHospital Insurance  Covers most inpatient hospital expenses Deductible $ 1,024 Part BSupplementary Medical Insurance  Covers 80% doctor bills & other outpatient medical expenses after 1 st $ 135 in approved charges Monthly Premium $ Part DMedicare Prescription Drug Plan  Covers a major portion of prescription drug costs for Medicare beneficiaries average Monthly Premium $ Part AHospital Insurance  Covers most inpatient hospital expenses Deductible $ 1,024 Part BSupplementary Medical Insurance  Covers 80% doctor bills & other outpatient medical expenses after 1 st $ 135 in approved charges Monthly Premium $ Part DMedicare Prescription Drug Plan  Covers a major portion of prescription drug costs for Medicare beneficiaries average Monthly Premium $ 27.93

7 7 7 Part B Medically-Necessary Services 7 7 Ambulatory Surgical Services Clinical Laboratory Services Emergency Room Services Outpatient Hospital Services Diagnostic Tests (x-rays, MRI, CT scan)

8 8 8 “Welcome to Medicare” Physical Exam Bone Mass Measurement Cardiovascular Screenings Colorectal Cancer Screenings Diabetes Screening Diabetes Self-Management Training Annual Flu Shot Mammograms Prostate Cancer Screenings Smoking Cessation Counseling “Welcome to Medicare” Physical Exam Bone Mass Measurement Cardiovascular Screenings Colorectal Cancer Screenings Diabetes Screening Diabetes Self-Management Training Annual Flu Shot Mammograms Prostate Cancer Screenings Smoking Cessation Counseling PREVENTIVE SERVICES

9 9 9 ASSIGNMENT An agreement between you and your doctor that he/she will accept as payment the amount Medicare approves for the service provided.

10 10 The highest amount you can be charged for a Part B-covered service is the “limiting charge”. The limiting charge is 115% over the Medicare-approved amount. It applies to only certain services and does not apply to some supplies and durable medical equipment. LIMITING CHARGE

11 11 NON-STANDARD PART B PREMIUMS If Your Yearly Income is: You pay: Individual Tax ReturnJoint Tax Return $82,000 or below$164,000 or below$ $82,001 - $102,000$164,001 - $204,000$ $102,000 - $153,000$204,001 - $306,000$ $153001, - $205,000$306,001 - $410,000$ Above $205,000Above $410,000$238.40

12 12 NON-COVERED SERVICES A cupuncture Chiropractic services with one exception Cosmetic Surgery Routine Eye Exams Routine foot care Hearing aids Long –term care Routine physical examinations

13 13 How Will the Prescription Drug Plan Affect You? How Will the Prescription Drug Plan Affect You?  You will pay the first $ 275 (called an “annual deductible”).  Medicare will pay 75% of costs between $ 275 and $ 2,510 in drug spending. You pay only 25% of these costs.  Example: $ $275 = $2235. $2235 x 75% = $  You will pay 100% of the drug costs between $ 2,510 and $ Part D pays nothing. (Donut hole).  Medicare will pay about 95% of the costs above $ You pay between $2 and $5 per prescription.

14 14 Extra Help Could Further Reduce Medicare Prescription Drug Costs Extra Help Could Further Reduce Medicare Prescription Drug Costs Extra help is available for low income beneficiaries to pay for part of the Medicare Part D monthly premiums, annual deductibles and prescription co-payments. The extra help could be worth more than $ 3,600 per year. Go online to to apply for extra help. Extra help is available for low income beneficiaries to pay for part of the Medicare Part D monthly premiums, annual deductibles and prescription co-payments. The extra help could be worth more than $ 3,600 per year. Go online to to apply for extra help.

15 15 Income and Resource Limits - Subsidy INCOME: Individual – below $15,600 a year ($1300 per month) Couple – below $21,000 a year ($1750 per month) RESOURCES: Individual – no more $11,990 Couple – no more than $23,970

16 16 Advantages of Qualifying for Medicare Part D Subsidy? Advantages of Qualifying for Medicare Part D Subsidy? No monthly premium (limited to several plans) No yearly deductible No donut hole Can enroll in Part D anytime you qualify No monthly premium (limited to several plans) No yearly deductible No donut hole Can enroll in Part D anytime you qualify

17 17 For More Medicare Information MEDICARE ( ) TTY MEDICARE ( ) TTY

18 18 Social Security’s Online Services  Retirement & Disability Applications  Apply for Extra Help  Retirement/Survivors/Disability Planner  Request a Statement  Change of Address  Medicare Card Replacements  Request a Benefit Verification Letter  Start or Change Direct Deposit  Retirement & Disability Applications  Apply for Extra Help  Retirement/Survivors/Disability Planner  Request a Statement  Change of Address  Medicare Card Replacements  Request a Benefit Verification Letter  Start or Change Direct Deposit

19 19 Social Security Cost-of-Living Adjustments Effective DateAmount June 19758% June % June % June % June % June % June % June % Dec % Dec % Dec % Dec % Dec % Dec 19884% Dec % Dec % Dec % Effective DateAmount June 19758% June % June % June % June % June % June % June % Dec % Dec % Dec % Dec % Dec % Dec 19884% Dec % Dec % Dec % Effective DateAmount Dec 19923% Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Effective DateAmount Dec 19923% Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec %


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