1. Senior Retirement Service
Presenting
Medicare and You
For your Future
Presented By
Senior Advisor
A. Cherie Kolinski

2. Understand your Medicare choices
We Will Help You …
Understand your Medicare choices
Unravel the mysteries of Medicare
Understand your options and make the right choice

3. What is Medicare?
A health insurance program established in 1965
Provides health coverage to millions of people
People age 65 and over
People who are disabled
People who are in Permanent Kidney Failure
Tf the Social Security Act was in 1935 by Franklin D Roosevelt and then the Medicare health insurance program was established in 1965 by Lynden B Johnson and in 1972 it was expanded to cover Disability.
Now Providing health coverage to over 44 million people
People age 65 +
People who are disabled
People who are in permanent kidney failure

4. About Medicare Insurance Company's Med-Supp policies
Can apply 3 months prior to turning 65
Medicare Insurance Insurance Company applications to be taken up to six months in advance of Medicare effective date if,
First-time Med-Supp applicants age 64½ and above
Not currently on a Med-Supp disability policy
CMS regulation allows applicants to apply 3 months prior to turning 65
United American allows advance dating
Up to six months in advance of Medicare effective date.
For first-time Med-Supp applicants age 64½ and above or
Not currently on a Med-Supp disability policy

5. Medicare Basics – Medicare Advantage (Part C)
Optional Part D
Part A
Part B
Usually Part D
Can not join a Medicare Advantage Plan (Part C) and purchase a Medicare Supplement Insurance (Medigap) policy

6. Medicare Basics – Original Medicare
Optional Part D
Part A
Part B
Optional Medicare Supplement Insurance (Medigap)

7. Medicare Part A – Hospital
Automatic Enrollment (if receiving Social Security benefits)
Eligible at age 65, or 2 years on disability
Premium-free for most people, if
Eligible for Social Security or Railroad benefits
You or your spouse had Medicare-covered government employment
Source: medicare.gov

8. Medicare Part A – Hospital
Medicare Part A – Coverage
Inpatient Hospital Room and Board
Skilled Nursing Facility (not Long Term Care)
Hospice and Respite Care services
Some Home Health Care services
Blood
Source: medicare.gov

9. Medicare Part A – Hospital (Out-of-Pocket Costs)
Day 1-60 $1156 Deductible
Day $289 per day
Day $578 per day
SKILLED NURSING CARE:
Minimum 3 day hospital stay
Day 1-20 Covered
Day $ per day
BLOOD
First 3 pints usually covered
HOSPICE CARE
Terminally ill with less than 6 months to live
Hospital
Day 1-60
$1,364 Deductible
Day 61-90
$341 per day
Day
$682 per day
Skilled Nursing Care
Minimum 3 day hospital stay
Day 1-20
Covered
Day
$ per day
Hospice Care
Terminally ill (with less than 6 months to live)
Blood
First 3 pints usually covered
Source: medicare.gov

10. Medicare Part B – Medical
Optional Enrollment
Can delay Part B enrollment if on Employer Group Medical Plan
Monthly Premium (deducted from Social Security check)
$ (income dependent)
Enroll 3 months prior to age 65 (including month of birthday)
Enroll no later than 3 months after birthday – 7 months total
Source: medicare.gov

11. Medicare Part B – Medical
Medicare Part B – Coverage
Doctor Services
Outpatient Care
‘Welcome to Medicare’ visit
Preventive Services (flu shots)
Ambulance Services
Doctor services
Outpatient care
‘Welcome to Medicare’ visit
Preventative services (flu shots)
Ambulance services
Source: medicare.gov

12. Medicare Part B – Medical
Medicare Part B – Coverage (continued)
Cancer Screenings and Chemo
Diabetes Screenings and Supplies
Durable Medical Equipment
Limited Chiropractic, Vision, Hearing
OT/PT and Laboratory Services
Cancer screenings & chemo
Diabetes screenings & supplies
Durable medical equipment
Limited chiropractic, vision, hearing
OT/PT and Laboratory Services

13. Medicare Part B – Medical [ Out-of-Pocket Costs ]
HOSPITAL:
Day 1-60 $1156 Deductible
Day $289 per day
Day $578 per day
SKILLED NURSING CARE:
Minimum 3 day hospital stay
Day 1-20 Covered
Day $ per day
BLOOD
First 3 pints usually covered
HOSPICE CARE
Terminally ill with less than 6 months to live
Premium
$ per month deducted from Social Security check
Deductible
$185 per year
Coinsurance
20% of Medicare approved charges
PREMIUM:
$ per month
Deducted from Social Security check
ANNUAL DEDUCTIBLE:
$166
COINSURANCE
20%
Source: medicare.gov

14. Medicare Part D – Prescription Drug
Enroll After Parts A and B
Guaranteed Acceptance
Can get with a Medicare Advantage Plan
Can get as a Stand Alone Prescription Drug Plan (PDP)
May pay penalty if not enrolled when first eligible
Enroll after Parts A/B
Guaranteed acceptance
Can get with a Medicare Advantage Plan
Can purchase stand alone Prescription Drug Plan (PDP)
May pay penalty if not enrolled when first eligible
* NEED SOURCE

15. Medicare Part D – Prescription Drug (d)
Can get Low Income Subsidy (LIS)/Extra Help Assistance:
Single Income < $17,655; Resources < $13,640*
Couples Income < $23,895; Resources < $27,250*
Must Select a Private Drug Plan
Choose by Plan Formulary
*Income limits are currently based on 2015 income limitHealth & Human Services Centers for Medicare s at 150% of poverty and will be updated in early 2016.
Source: Department of & Medicaid Services
Can get Low Income Subsidy (LIS)/Extra Help assistance:
Single Income < $17,655/Yr; Resources < $13,640*
Couples Income < $23,895/Yr ; Resources < $27,250*
Must select a private drug plan
Choose by plan formulary
Etc.

16. Medicare Part C – Medicare Advantage
About Medicare Part C
Can join or switch plans only during certain times of the year
Must cover at least what Medicare covers
Some plans charge small monthly premiums, others do not
The Maximum out-of-pocket (MOOP) costs vary by plan and can go up to $10,000
Can join or switch plans only during certain times of the year
Must cover at least what Medicare covers
Some plans charge small monthly premiums, others do not
The Maximum Out-of-Pocket (MOOP) costs vary by plan and can go up to $10,000

17. Medicare Part C – Medicare Advantage
About Medicare Part C
Benefits and Premiums can change annually
You cannot own a Medicare Supplement and a Medicare Advantage plan
NOT Guaranteed Renewable
You cannot own a Medicare Supplement with a Medicare Advantage (PD) plan
Benefits and Premiums can change annually
Over last few years, MOOP expenses have climbed exponentially
Advantage plans are NOT guaranteed renewable (plan member)

18. Medicare Part C – Medicare Advantage
About Medicare Part C
Some plans have certain rules to follow, like referrals, etc.
You may have to use providers who belong to the plan
Insurers can opt out of these plans
Doctors can opt out of these plans
Hospitals can opt out of these plans
Some plans have certain rules to follow, like referrals, etc.
You may have to use certain providers who belong to the plan
Insurers can opt out of these plans
Doctors can opt out of these plans
Hospitals can opt out of these plans

19. Medicare Supplement Plans (Medigap)
Plans available to help cover the Gap
Medicare Approved Charges
Excess Charges
GAP
Senior Pays Excess Charges
Senior Pays 20%
Medicare Pays 80%
Senior Pays Deductibles,
Coinsurance,
and Copays
Helps covers the “gaps” in Medicare:
Deductibles
Coinsurance
Copays
Excess Charges
These amounts change each year but Medigap plans cover it

20. Medicare Supplement Plans (Medigap)
All Med-Supp Plans are Guaranteed Renewable
Flexibility and Freedom to Choose
Any Doctor *
NO referrals
Any Hospital *
NO networks
Any Specialist *
All Medicare Supplement plans are GUARANTEED RENEWABLE
Flexibility and Freedom to choose any Doctor, Hospital, or Specialist that takes Medicare with NO referrals and NO networks
* That accepts Medicare

21. Medicare Supplement Plans (Medigap)
All Companies Must Follow Federal and State Laws
Costs Vary By
Companies Vary By
Company
Ratings
Where you Live
Stability
Plan Selected
All companies must follow Federal and State laws
Costs vary by company, where you live, and by the plan
Financial ratings and stability vary by com

22. Medicare Supplement Plans
How are Medicare Supplement plans priced?
Issue Age
Rated 65 $
66-69
70-75
76-79
80+
Premium based on age when policy purchased
Issue Age Rated
Premium based on age when policy purchased

23. Medicare Supplement Plans
United American’s Medicare Supplement Plans in Florida
Issue Age Rated
Premium based on age when policy purchased
Sex Distinct
Premium rated on policyholder’s gender
Preferred Rates
No tobacco use

24. Medicare Supplement Plans
Rate Adjustments
Helps keep pace with
Rising Medicare claim trends
Changes in annual deductibles

25. Medicare Supplement Open Enrollment Qualifiers
Enrolled in Medicare Parts A and B
Within 6 months before and after you turn age 65
Cannot be denied during the Open Enrollment period
Cannot be charged more because of health
Medicare Supplement Guaranteed Issue Qualifiers
Must be on Original Medicare and Involuntarily Disenrolled from your Employer’s Group Health Plan
Involuntarily Disenrolled from your Medicare Advantage Plan
Must go through underwriting if outside Open Enrollment
Must be enrolled in Medicare PARTS A & B
6 months before and 6 months after you turn 65
Cannot be denied during this Guaranteed Issue period
Cannot be charged more because of health
If replacing an existing Medigap plan (creditable coverage)
No waiting period
No pre-existing limitations
NOTE: Must go through underwriting if outside Open Enrollment or Guaranteed Issue Periods
Involuntarily disenrolled from your employer’s plan
Involuntarily disenrolled from your employer’s Medicare Advantage (PD) plan
No pre-exisitng
NOTE: Must go through underwriting if outside Open Enrollment or Guaranteed Issue Period
Source: medicare.gov

26. Medicare Advantage 2014 Pre-Enrollment Period
October 1 – October 14
Annual Election Period (AEP)
October 15 – December 7
Annual Disenrollment Period
January 1 – February 14
Pre-Enrollment Period
Annual Election Period (AEP)
Annual Disenrollment Period
Oct 1 – Oct 14
Oct 15 – Dec 7
Jan 1 – Feb 14
Pre-Enrollment Period
October 1 – October 14
Annual Election Period (AEP)
October 15 – December 7
Annual Disenrollment Period
January 1 – February 14
Source: medicare.gov

27. Today’s Medicare Environment Includes more Coverage Options for You!
Includes all the benefits of:
Original Medicare
(Part A-Hospital)
(Part B-Medicare) Or
Medicare Advantage health plan only (MA only)
MA only with stand-alone Part D
MAPD-MA health plan with Part D included

28. How do I Choose…
Which plan is right for me?
Do you want to choose your own specialists without referrals and not worry about networks?
YES

29. How do I Select a Carrier ?
Why choosing a carrier is important
How quickly do they issue policies and pay claims?
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30. Split into multiple slides -mt
Why choosing a carrier is important
Do they outsource their Customer Service call center or is it here in the USA?
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31. Thank You Cherie Kolinski
SENIOR RETIREMENT SERVICES