1. Presented by:
Nicole Kennedy

2. HTA Client Services Division
What is the No.1 concern with Medicare Planning?
Quality Education & Insurance in an
easy to understand format
EXPERIENCE- 20 years+ specializing in Medicare QUALITY- Detailed education and guidance FRIENDLY- Salaried Reps. Not commissioned based. Never pressured to buy. RELIABLE- Unlimited phone support- can work with same Advisor or anyone on the our team.

3. What is Original Medicare?
Original Medicare is “health insurance” for
Age 65 and over
Under 65 on SSDI for 24 months
End Stage Renal Disease (ESRD)- permanent kidney failure requiring dialysis or a kidney transplant
Has nothing to do with
“Normal Retirement Age”

4. Medicare Supplement Insurance
4 Parts of Medicare
Original Medicare
Federal Government
*A = Hospital (Inpatient)
*B = Medical (Outpatient)
Secondary Insurance
Choice of Companies
C = *Medicare Advantage OR
Medicare Supplement Insurance
(Plans A to N)
*D = Prescription Drug Plan +
*Can pay premium out of SSI

5. Medicare Part A
Generally no cost (provided you or your spouse have worked a minimum of 40 quarters)
Hospital Admission
Helps cover
Inpatient care in hospitals
Skilled nursing facility care (limited)
Hospice
Home health services (limited)

6. Medicare Part B
2018 Base Premium = $134/month (depends on income of 2 years prior)
Outpatient Medical Insurance
Doctors & Specialists
Outpatient Labs and Xrays
Hospital outpatient care
Surgery, Chemo, ER, Hospital Observation
Durable medical equipment
Some preventive services

7. Part B Premiums by Income- 2018
Based on 2016 Income Tax Return
Premiums are Per Person

8. What Medicare Does Not Cover
Long-term care
Personal Care/Custodial Care
Routine dental or eye care
Hearing aids & exams for fitting them
Dentures
Cosmetic Surgery
Acupuncture
Routine foot care

9. Medicare Confusion!! Get advice when you turn 64 Know what to expect
Do I have to go on Medicare when I turn 65?
What are my Medicare Options?
Can I defer Medicare Parts A or B?
What if I am not ready to retire?
Get advice when you turn 64
Know what to expect

10. Possible consequences by not signing up
Gaps in Coverage
Sometimes Medicare is Primary Insurance
If you don’t enroll, you may have to pay any bills Medicare would have paid if you were enrolled
Deadlines
After your initial eligibility period expires, you can only enroll during the General Election Period (one a year).
Enroll 1/1-3/31 for a 7/1 effective date
If you don’t enroll within your enrollment period, you will accrue a penalty.
Penalties
Part A – No Penalties as long as you are eligible for $0 premium
Part B - 10% for every 12 months without creditable coverage- added to Part B premium for life

11. And even as your Co-Workers
You are not the same…
As your Parents
As your Siblings
As your Neighbors
And even as your Co-Workers

12. 1 Page Roadmap

13. NO MAYBE YES Am I required to Enroll in Medicare A or B? Not Working
(based on the Primary Insured on the Policy) NO
MAYBE
YES
Still Working
&
On Group Creditable Coverage
Over 20 Employees
Still Working
&
On Group Creditable Coverage
Under 20 Employees
Not Working
Individual Coverage
No Coverage
Retiree Coverage
COBRA

14. Applying for Medicare AT age 65
If you are already collecting SSI, Enrollment is Automatic
All others…Go online
up to 3 months prior to 65th birthday
or month of or 3 months after
birthday month
Effective date = 1st of Birthday Month
Default Effective Date depending on when you enroll
If you plan to enroll the 3 months after your birthday, review in advance to work out the timing of your effective dates

15. Applying for Medicare AFTER age 65
Visit your local Social Security office within 8 months of not being actively employed
(or covered under the group health plan from which you are employed)
Employer Verification Form is your Golden Ticket
Cannot have >8 month lapse in coverage
Or Call to schedule an appointment

16. NO MAYBE YES Am I required to Enroll in Medicare A or B? Not Working
(based on the Primary Insured on the Policy) NO
MAYBE
YES
Still Working
&
On Group Creditable Coverage
Over 20 Employees
Still Working
&
On Group Creditable Coverage
Under 20 Employees
Not Working
Group Coverage Primary
Medicare
Primary? – Check with Insurance Co
Medicare
Primary + Late Enrollment Penalty
Primary
Individual Coverage
Have 8 months once group health or employment end
Have 8 months once group health or employment end
Have 3 months before, month of, & 3 months after 65
No Coverage
Deadlines
Retiree Coverage
Take
Golden Ticket to
Social Security
Enroll online if 65 or
Take Golden Ticket
if older
Enroll online at
Enroll
COBRA

17. Warning for Health Savings Accounts
Part A =
Deposit = NO
Use Funds = YES
Use Savings For…
Medicare Part A
Medicare Part B
Medicare Advantage
Prescription Drug Plan
Out of Pocket Medical Expenses
Cannot
Use Savings For…
Medicare Supplement

18. Should I consider Medicare?
Over 20 Employees
1. Good Network?
> $3,600/year
(more if high income)
2. Current Costs?
Premium
+ OOP Expenses (copays, deductibles
not Rxs)
Under 20 Employees, Retiree, COBRA
> $2,400/year
Dependent spouses may have higher costs making Medicare attractive

19. What about my
under Age 65 Spouse?

20. Why Secondary Coverage?
Medicare Out of Pocket Expenses:
Part A deductible ($1,340/occurrence)
Part A copays (varies for hospital and skilled nursing)
Part B deductible ($183/calendar year)
Part B coinsurance (20%- no cap)
Part B “Excess” (up to 15% over
Medicare allowable amount- no cap)
*as of 2018

22. *Looking for a low cost higher deductible option? High Deductible F
Max Out of Pocket $2,240
Out of Pocket Limit
in 2017 $5,240
***
Up to:
$20/office $50/ER

23. Price Comparison F 65, Mid Atlantic
$ – Plan F
$0 out of pocket
$ – Plan G
$183 out of pocket
$ – Plan N
$183 + copays + excess charges (no cap)
$32.00 – Plan HDF
$2,240 out of pocket
Plan G Net Savings = $130/year
($312 premium savings
- $183 out of pocket expenses)

24. Medicare Supplement = MediGap
Same benefits Same network
Same claims Throughout USA
Shop Premiums

26. Part C (MA) vs MS C = Medicare Advantage OR Medicare Supplement
Managed Care
No Managed Care
Networks
(PPO, HMO, PFFS)
No Networks
Little to No Premium
(approx $0-$150/month)
Higher Premiums
(approx $100-$250/month)
Higher Out of Pocket Expenses
(up to $6,700/year in network)
Little to No Out of Pocket Expenses
(typically below $200/year)
Prescription Drug Plan
Included
Purchase separate
Enrollment Period (no underwriting)
First go on Medicare & Annually
First go on Medicare

27. Start by reviewing your “non negotiable” doctors and hospitals
Medicare Advantage
Different benefits Different networks Different claims Coverage varies across USA
Shop Everything
Start by reviewing your
“non negotiable” doctors and hospitals

28. Stage 4: Stage 3: Stage 2: Stage 1: >$5,000 <$5,000 <$3,750
2018
>$5,000
*based on Tro-oP
Purchase from Government Contracted Carriers
Average Premium $35/month
<$5,000
*based on Tro-oP
<$3,750
*based on retail costs
Stage 4:
Catastrophic
Up to
$405
Stage 3:
Donut Hole
Coverage Gap
Stage 2:
Copay
Initial Coverage Level
Stage 1:
Deductible
Total Drug Cost
May be a discount
Copay or Coinsurance
35%-Brand
44%-Generic 5%

29. Donut Hole Vanishing

30. Part D Premiums by Income- 2018
Based on 2016 Income Tax Return
Premiums are Per Person

31. Approx. $270-$325

32. Approx. $650-$700

33. Request a consultation
How to get started
, option 1
Request a consultation
Rx bottles handy for the call
Short Intake & Schedule Phone Appointment
Receive personalized “Roadmap to Medicare” & enrollment recommendations