1. 2017 My Medicare Education Seminar
Copyright 2017 LeClair Group

2. Welcome Medicare Topics for Discussion Start of Medicare
Components of Medicare
Thank you for taking the time to educate yourself on learning some of the components of Medicare. We will be going over the components of Medicare so that by the end of our discussion today, you will be more familiar with Medicare, it’s terms and be able to make good decisions based on your increased Knowledge.
1. Original Medicare
2. Medicare Parts and Packages
3. Medicare Costs
4. Medicare Enrollment
Costs
How do I enroll?
Copyright 2017 LeClair Group

3. Copyright 2017 LeClair Group
Original Medicare
What happened in 1965?
Lyndon Johnson signed into law in 1965
Trivial pursuit:
Dwight Eisenhower was the first recipient
designed for the desegregation of hospitals
Copyright 2017 LeClair Group

4. Copyright 2017 LeClair Group
Original Medicare
Part A was part of the original medicare programs for insurance for Hospital stay
Part B was part of the original medicare program for the medical insurance such as hospital visits, lab tests, etc….
Copyright 2017 LeClair Group

5. Copyright 2017 LeClair Group
Original Medicare
Are you Eligible?
You are eligible to have Medicare if you have been paying taxes for at least 10 years and are 65 yrs. old.
Copyright 2017 LeClair Group

6. Copyright 2017 LeClair Group
Is Medicare Free?
No Premium
$1288 deductible (2016)
Remember that part A covers hospital, part B covers Medical services ,
Part A , there is no monthly premium ,however there is a deductible of $1288
Part B, New for 2016 there is a $166 dollar deductible, The premium for the this plan is $ for most people, there is greater premium for those individuals that make more than 80K a year of 170K as a couple in general. Medicare pays 80% of part B costs after the deductible.
$ premium (graded), (2016)
$166 deductible (2016)
20% Coinsurance (2016)
Copyright 2017 LeClair Group

7. What if I have to go to the Hospital ?
You pay $1,288 for a stay up to 60 days (2016)
$322 per day for days (2016)
$644 per day for days 91 and beyond (2016)
All costs for each day beyond lifetime reserve days
For each hospital benefit period, you pay . . .
A total of $1,288 for a stay up to 60 days
$322 per day for days 61-90
$644 per day for days 91 and beyond
All costs for each day beyond lifetime reserve days
Copyright 2017 LeClair Group

8. What if I am in a skilled Nursing Facility ?
You will receive…
Days 1 thru 20: full coverage**
Days 21 thru 100: $161 per day (2016)*
Days over 100: Medicare pays nothing
* Qualification requires prior 3-day stay in hospital & the delivery of skilled care, not custodial care
If qualified* in a skilled nursing facility, you will receive . . .
Days 1 thru 20: full coverage
Days 21 thru 100: $161 per day
Days over 100: nothing
* Qualification requires (a) prior 3-day stay in hospital , &
(b) the delivery of skilled, not custodial, care
Copyright 2017 LeClair Group

9. What if I have to visit the Doctor?
There is a $166 deductible. You pay the Part B Premium each month, for most is $ It is greater if your income is higher
Part B covers about 80% of medical costs. You pay 20%.
Example: When you visit your physician, present the medicare card. Medicare will help pay your bill.
$ monthly Premiu,
$166 deductible
20% coinsurance
Copyright 2017 LeClair Group

10. How can I address what Medicare does not cover ?
Medigap plans = Medicare Supplements
Created by insurance companies to help pay for costs not covered by Medicare
47 states use standardized plans identified by letter, from Plan A to Plan N. The benefits are the same no matter which company sells it. MN, WI, & MA are different.
Consumers should focus on
Company rating & financial strength
Price
Efficiency in claims processing
Copyright 2017 LeClair Group

11. Copyright 2017 LeClair Group
Medicare Advantage
A quick review.
A is for Hospital
B is for Medical
And C is called Medicare Advantage, which is Run by private insurance companies approved by and under contract with Medicare.
Part C provides your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. You still pay your Part B premiums, in addition to your Medical Advantage premiums.
If you want drug coverage, you must get it through your plan (in most cases).
Copyright 2017 LeClair Group

12. Part C - Medicare Advantage
Run by private insurance companies approved by and under contract with Medicare
Provides your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. You still pay your Part B premiums, in addition to your MA premium.
Most of the plans have drug coverage.
Copyright 2015 LeClair Group

13. Copyright 2017 LeClair Group
The Parts of Medicare
Part A: Hospital Insurance
Covers inpatient hospital care, hospice care, some skilled nursing facility care, and some home health care. Wide gaps in benefits.
Part B: Medical Insurance
Covers doctor services & outpatient services. Also has gaps.
Part C: Medicare Advantage Program
Coverage option run by private companies.
Includes Part A, Part B, and usually drugs.
Part D: Prescription Drug Coverage
The Medicare drug program run by private companiesYearly deductible - $320
Co-pay – This is what you pay the Pharmacy, until total payments reach $2960.
When this amount is reached, you are now in the coverage gap (doughnut hole), where you then pay 45% for brand name drugs, or 65% for generic drugs.
Once you have spent $4700 out of your pocket for drugs, the coverage gap ends, and you pay a small amount.
Copyright 2017 LeClair Group

14. Part D is for Drug Coverage
$360 deductible (2016)
Copay max of $3310 before the coverage gap (2016)
45% (2016)
58% (2016)
$4850 (2016)
Yearly deductible - $360
Co-pay – This is what you pay the Pharmacy, until total payments reach $3310.
When this amount is reached, you are now in the coverage gap (doughnut hole), where you then pay 45% for brand name drugs, or 58% for generic drugs.
Once you have spent $4850 out of your pocket for drugs, the coverage gap ends, and you pay a small amount.
You can purchase part D through an individual insurance plan, or it is in many Medicare Advantage plans.
Copyright 2017 LeClair Group

15. Copyright 2017 LeClair Group
Donut Hole
45%
Yearly deductible - $360
Co-pay – This is what you pay the Pharmacy, until total payments reach  $3,310.
When this amount is reached, you are now in the coverage gap (doughnut hole), where you then pay 45% for brand name drugs, or 58% for generic drugs.
Once you have spent $ $4850 out of your pocket for drugs, the coverage gap ends, and you pay a small amount.
58%
$360
$3310
$4850
Copyright 2017 LeClair Group

16. Copyright 2017 LeClair Group
What are Cost Plans ?
This is a hybrid alternative plan, partially like a supplement, and partially like an Advantage plan. Part A is run through Medicare, and Part B from your private insurance carrier.
Cost plans are a hybrid that have supplement and advantage plan components.
Under a cost plan, In part A, Medicare pays first, in part B, the insurance company pays first.
Minnesota, Wisconsin and Massachusetts are the only states that currently allow cost plans. We do not know how long these plans will be available.
Copyright 2017 LeClair Group

17. Let’s review the Parts of Medicare
Advantage or Cost Plans
Part A: Hospital Insurance
Covers inpatient hospital care, hospice care, some skilled nursing facility care, and some home health care. Wide gaps in benefits.
Part B: Medical Insurance
Covers doctor services & outpatient services. Also has gaps.
Part C: Medicare Advantage Program
Coverage option run by private companies.
Includes Part A, Part B, and usually drugs.
Part D: Prescription Drug Coverage
The Medicare drug program run by private companies.
Copyright 2017 LeClair Group

18. My Choices 1. Original Medicare
Original Medicare with Supplement
Medicare Advantage
Cost Plans
1. Original Medicare
Provides your Part A and Part B coverage from the Federal Government .
You can buy a Medigap (Medicare Supplement Insurance) policy (sold by private insurance companies) to help fill the gaps in Part A and Part B coverage (like coinsurance, copayments, and deductibles).
You can join a Medicare Prescription Drug Plan to add drug coverage.
2. Medicare Advantage (aka “Part C” or “MA”)
Run by private insurance companies approved by and under contract with Medicare
Provides your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan. You still pay your Part B premiums, in addition to your MA premium.
If you want drug coverage, you must get it through your plan (in most cases).
3. Medicare Cost Plans
It is a popular plan in certain parts of the country, like Minnesota, and generally provides a high level of coverage.
Copyright 2017 LeClair Group

19. Copyright 2017 LeClair Group
My Choices
Original Medicare
Pay part B premium
Original Medicare with Supplement
Pay part B premium + Supplement premium + drug plan premium
Medicare Advantage
Pay part B premium + Advantage plan premium
Cost Plan
Pay part B premium + Cost plan premium + drug plan premium
Copyright 2017 LeClair Group

20. Copyright 2017 LeClair Group
Enrolling in Medicare
If you are on Social Security you will be automatically enrolled.
If you are still working you must actively enroll yourself
Enrolling is easy – just go to the Social Security Website – you can enroll in less than 10 minutes.
Your initial enrollment period covers seven (7) months:
the 3 months before your birth month,
your birth month,
and the 3 months after that.
Age 65 is an important year
Copyright 2017 LeClair Group

21. Copyright 2017 LeClair Group
Enrolling in Medicare
It takes about 10 minutes to enroll
Copyright 2017 LeClair Group

22. Copyright 2017 LeClair Group
Enrollment
What if I plan on continuing to work past 65?
Most workers will enroll in part A, and not part B, where the employee health plan is still in force, and there is no need to pay part B premium. Check with your employer regarding this option. When your employment ends, you then must sign up for part B.
*There are some situations where parts A and B are in force, and your employer’s health plan will pay the remainder of costs (like a supplement).
What if I plan on continuing to work past 65?
Most workers will enroll in part A, and not part B, where the employee health plan is still in force, and there is no need to pay part B premium. Check with your employer regarding this option. When your employment ends, you then must sign up for part B.
*There are some situations where parts A and B are in force, and your employer’s health plan will pay the remainder of costs (like a supplement).
Copyright 2017 LeClair Group

23. Open Enrollment Period
You don’t need to sign up for Medicare each year.
HOWEVER, each year you’ll have a chance to review your coverage and make changes.
Your current plan will send you an “Annual Notice of Change” (ANOC) to help you assess if that plan meets your health care needs going forward.
In 2015, the time to make changes/switch coverage runs from October 15th thru December 7th.
All changes made will be effective on January 1, 2016.
Read the slide
Copyright 2017 LeClair Group

24. Copyright 2017 LeClair Group
Enrollment
Penalties for late enrollment
Part A – no premium, no penalty
Part B – 10% of premium for each year with no Part B
Part D – $33.13 X uncovered months
Copyright 2017 LeClair Group

25. Resources and Considerations
For more information go to medicare.gov.
Medicare and You is a publication put out by Medicare
Visit the social security site to register online for Medicare.
Also to apply for retirement, disability. Review your Social Security statement, get the address of your local SS office, request a replacement Medicare card, and find publications.
Social Security
Copyright 2017 LeClair Group

26. Thank You
Thank you for coming today, Hopefully, the information that you have learned today will provide you with a good start on understanding Medicare and it’s components. Our goal today was to give you a familiar understanding of Medicare. We would encourage you to work with an independent Medicare agent with a knowledgeable understanding of Medicare. This relationship should enable you to make the right decisions that fit with our aspirations and goals. We will be around after this sessions if you have any questions or comments. Again , thank you for your attendance today.