1. Welcome and Introductions
Understanding Medicare
An Educational Seminar
Different thinking. Better outcomes.

2. Understanding Medicare Basics Different thinking. Better outcomes.
Agenda
Understanding Medicare Basics
Different thinking. Better outcomes.

3. Different thinking. Better outcomes.
Know The Rules
There are special enrollment periods for Medicare
If you are new to Medicare make sure you sign up when you are first eligible. This enrollment period begins with the month that is three months prior to the month of your sixty fifth birthday, the month of your 65th birthday, and a three month period after the month of your 65th birthday. (Seven Months in Total). Your plan will be effective the first day of the month of your 65th birthday or, the first day of the month following your application, if you are enrolling after you turn 65.
If you qualify for Social Security Disability income regardless of age, after 24 months you will automatically receive a Medicare card.
You have the option, if your Group plan allows, to stay on the plan until you decide to leave the Group plan or retire at which point you are eligible to enroll into Medicare without penalty.
Different thinking. Better outcomes.

4. Part B late enrollment penalty Different thinking. Better outcomes.
Original Medicare
Part B late enrollment penalty
If you don't sign up for Part B when you're first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12- month period that you could have had Part B, but didn't sign up for it.
Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
Different thinking. Better outcomes.

5. Different thinking. Better outcomes.
Sample Medicare Card
Different thinking. Better outcomes.

6. Different thinking. Better outcomes.
Original Medicare
Modified Adjusted Gross Income
(MAGI)
Part B
monthly
Premium
Prescription drug coverage monthly premium
Individuals with a MAGI of $85,000 or less
Married Couples with a MAGI of $170,000 or less
2017
standard premium
$134
Your plan premium
Individuals with a MAGI above $85,000 up to $107,000
Married Couples with a MAGI about $170,000 to $214,000
$187.50
Your plan premium + $13.30
Individuals with a MAGI above $107,000 up to $160,000
Married Couples with a MAGI above $214,000 up to $320,000
$267.90
Your plan premium + $34.20
Individuals with a MAGI above $160,000 up to $214,000
Married Couples with a MAGI above $320,000 up to $428,000
$348.30
Your plan premium + $55.20
Individuals with a MAGI above $214,000
Married Couples with a MAGI above $428,000
$428.60
Your plan premium + $76.20
Different thinking. Better outcomes.

7. HSA Rules Under Medicare
IF YOU HAVE EITHER PART A AND OR PART B OF MEDICARE,THE FOLLOWING APPLY.
YOU CANNOT ADD ANY PRE-TAX FUNDS TO YOUR HSA.
IF YOUR EMPLOYER MAKES AN HSA CONTRIBUTION IT IS CONSIDERED TAXABLE INCOME AND YOU WILL OWE INCOME TAX ON THE AMOUNT DEPOSITED PLUS ANY GAINS IN THE ACCOUNT. YOU WILL ALSO PAY A 6% EXCISE TAX ON THE WHOLE AMOUNT.
Different thinking. Better outcomes.

8. Different thinking. Better outcomes.
Original Medicare
Medicare Part A
Covers hospital costs and skilled nursing services after a hospital stay of a minimum of 3 days.
Covers inpatient hospital care, inpatient mental health care, home health care, hospice care, some blood for transfusions. For 2017 Part A carries a $1316 deductible. Days $0
Days $329
(lifetime reserve 60 days) Days $658
Medicare Part B
Covers doctor’s office visits and other medical services that do not require a hospital stay.
Covers outpatient services, ambulance, lab services, DME, outpatient physical, occupational and speech-language therapy. For 2017 Part B carries a $183 deductible and 20% co-insurance.
Different thinking. Better outcomes.

9. Match Your Plan to Your Needs
The right plan for YOU is the one that matches YOUR health care needs and your budget.
Remember, as your health care needs change and plans change you need to CHECK and make sure you’ve still got a match!
Different thinking. Better outcomes.

10. Medicare Supplement Plans
Medicare supplement plans - for people who have Part A and Part B and want help covering the deductibles and the 20% co- insurance that Medicare imposes.
Plans are identified by letters (A,B,C,D,F,G,K,L,M and N) and have the same benefits no matter what company you buy from. The prices however can differ widely which is why it is important to compare Medicare Supplement plans.
No networks. No referrals.
Different thinking. Better outcomes.

11. Different thinking. Better outcomes.
Medicare Supplements
Some or all of your out-of-pocket costs are covered.
Unless you are new to Medicare, you will have to qualify by answering health questions.
Premiums do increase over time. Coverage is guaranteed as long as you pay the premium.
Different thinking. Better outcomes.

12. Different thinking. Better outcomes.
Know The Rules
Medicare Advantage (Part C) and Part D Plans
You may enroll in these plans at anytime during your initial 7 month eligibility window.
Medicare’s Annual Enrollment Period (AEP) is from October 15th- December 7th. This is the time to switch Medicare Advantage and Medicare Part D plans for the following year.
If you have both Medicare and Medicaid (dual eligible) or Low Income Subsidy (LIS) you are able to change your plan monthly during the year. If you have Pace/Pace Net you may make one change per year after the AEP ends.
Different thinking. Better outcomes.

13. Medicare Advantage (Part C)
Plans offered by private insurance companies under contract to Medicare to manage all your Medicare Benefits. All plans must meet Medicare’s standards.
Covers all Part A and Part B Medicare benefits.
Usually requires you to use a network of doctors and hospitals and pay deductibles and co-pays.
Often includes Part D and sometimes includes special benefits like dental, vision and gym memberships.
Guaranteed Issue (one health question regarding end stage renal disease)
Different thinking. Better outcomes.

14. Types of Medicare Advantage Plans
HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization)
PFFS (Private Fee for Service)
SNP (Special Needs Plans)
Different thinking. Better outcomes.

15. Different thinking. Better outcomes.
HMO
Must select a Primary Care Provider (PCP) from an approved list. PCP will coordinate all your care and you must have referrals to see other providers. These plans have networks and you must stay in the network unless you are in an emergency situation. Typically these plans are richer in benefits.
Different thinking. Better outcomes.

16. Different thinking. Better outcomes.
PPO
These plans have networks of providers and no referrals are required to see any in-network provider. You may go out-of-network but you will pay more for these services unless you are in an emergency situation.
Different thinking. Better outcomes.

17. Different thinking. Better outcomes.
PFFS
These plans permit you to use any Medicare Provider as long as they accept the plan’s terms and conditions and are willing to bill the carrier. They must treat you in an emergency situation. No Referrals are required.
Different thinking. Better outcomes.

18. Special Needs Plans (SNP)
Coordinated care for people with often complex and special healthcare needs.
Chronic conditions like diabetes, heart disease, COPD.
For people eligible for Medicare and Medicaid.
Includes extra benefits to help with these conditions.
Different thinking. Better outcomes.

19. Special Needs Plans (SNP)
Special Needs Plans offer some unique benefits since they are tailored to people with certain health conditions. Benefits can include:
Zero Premium or Low Premiums
Zero or low co-pays (Doctor, Hospital, Ambulance)
Low co-pays for prescription drugs
Dental coverage including dentures, Vision exams & help purchasing glasses, Hearing benefit
Transportation
Over The Counter medications help
If you are eligible for Medicare/Medicaid you may be able to switch into a SNP plan at anytime. Ask about enrollment periods.
Different thinking. Better outcomes.

20. Different thinking. Better outcomes.
What does Part C Cost?
The cost depends upon the plan you choose and the insurance company you select.
You will be responsible for deductibles and co-pays when you use your Medicare Part C plan.
If your plan has drug coverage, be sure your specific drugs are covered.
Typically much lower premiums than Medicare Supplements.
Plans are issued on a yearly basis. Costs & coverage can change. You should review your plan every year.
Different thinking. Better outcomes.

21. Prescription Drugs (Part D)
Medicare Part D prescription drug plans offered only by private insurance companies.
Plans vary in benefits, co-pays, and drugs covered in the formulary, therefore it is important you check each plan based on your individual needs. Picking the plan with the lowest premium does not always mean it is the best or lowest cost plan for you.
Understand the coverage gap.
Can be included in a Medicare Advantage Plan.
Different thinking. Better outcomes.

22. Prescription Drug Coverage
What's the Part D late enrollment penalty?
The late enrollment penalty is an amount added to your Medicare Part D premium. You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage.
How much is the Part D penalty?
The cost of the late enrollment penalty depends on how long you went without creditable prescription drug coverage.  
The late enrollment penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($35.63 in 2017) times the number of full, uncovered months you were eligible but didn't join a Medicare Prescription Drug Plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to your monthly premium.
The national base beneficiary premium may increase each year, so the penalty amount may also increase each year.
Different thinking. Better outcomes.

23. Prescription Drug Coverage
Stage 1
Deductible
Stage 2
Initial Coverage
Stage 3
Coverage Gap
Stage 4
Catastrophic
You Pay:
Depending on the plan you choose, you may have up to a $400 deductible.
Your plan copayment and/or coinsurance
Your Carrier Pays: Remaining costs
Until the combined amount (plus any deductible) reaches $3,700.
After your total yearly drug cost reaches $3,700*:
You Pay: 40% of negotiated drug cost for brand and 51% of negotiated drug cost generics.
*Some plans have coverage in the gap. You pay a copay/coinsurance for covered drugs.
After your total Annual Out-of-Pocket drug costs reach $4,950 (which includes crediting 100% of drug cost while in stage 3):
You Pay: $3.30 for generics and $8.25 for brand or 5% (whichever is greater)
Different thinking. Better outcomes.

24. Different thinking. Better outcomes.
Generic Drugs
Talk to your doctor about drugs you are currently taking and see if there are generics or less expensive brand name drugs.
Some plans cover generic drugs for little or no co-pays through the “donut hole”.
Different thinking. Better outcomes.

25. Different thinking. Better outcomes.
A Helping Hand
Government, national and community based charitable programs can help with your prescription and healthcare costs.
Most of these programs will pay for prescriptions through the coverage gap (donut hole).
If you are a grandparent raising a grandchild programs are available to pay for their healthcare costs.
Different thinking. Better outcomes.

26. Different thinking. Better outcomes.
Extra Help (LIS)
Investigate the “extra help” program for people with limited income and resources to help pay for prescription drugs.
If you qualify you pay not more than $3.30 for each generic and $8.25 for each brand drug.
Different thinking. Better outcomes.

27. Different thinking. Better outcomes.
Pace/Pace Net
Pennsylvania state program that offers prescription drug coverage. (Paid for through the State Lotteries)
It may pay for your prescriptions when Medicare Part D does not.
You must be 65 or older to be eligible.
Even if you have applied before, check again to see if you qualify as the requirements may have changed.
Different thinking. Better outcomes.

28. Different thinking. Better outcomes.
Pace/Pace Net
Single
Income
Limit
Married
Copay
Generic
Single-
Source
Brand
$14,500
(or less)
$17,700 $6 $9
$14,501-
$23,500
$17,701-$31,500 $8
$15
Pace
Pace Net
Different thinking. Better outcomes.

29. Different thinking. Better outcomes.
You Are Unique
Compare plans from multiple companies - there are lots of choices and as your needs change be ready to change plans. This review should be done on an annual basis.
Medicare.gov plan finder is a good resource.
Do not select a plan just because your friend or relative has it; you need to find a plan that matches your unique healthcare needs.
Different thinking. Better outcomes.

30. About AIA Benefits Resource Group
AIA offers a free service that helps match people with the right Medicare plan. We listen to your needs, explain your options to you, guide you in comparing plans and help you enroll in the right plan for you.
Our goal is simply to help you find the right plan!!
Different thinking. Better outcomes.