1. MEDICARE SUPPLEMENT SERVICES
UNDERSTANDING MEDICARE
MEDICARE 101
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

2. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
Welcome to Medicare 101
You will learn about the following:
4 Basic parts of Medicare
What Medicare Covers
How much does Medicare Cost
Your coverage options beyond Medicare
Medicare Advantage Plans (Part C)
Medicare Supplement Plans
Part D (Rx Plans)
Frequently Asked Questions
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

3. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
FOUR PARTS TO MEDICARE
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

4. Cost/Enrollment for Part A
MEDICARE PART A
Basic Benefits
Hospital Care
Skilled Nursing Facility
Home Health Care
Hospice
Cost/Enrollment for Part A
In most cases, you will not have to pay premium for part A. This is based on the amount of quarters you worked in a Medicare approved workplace.
For individuals who do have to pay for part A, the average premium in 2018 was $422/month. There is a one-time late enrollment penalty of 10%.
You will be enrolled automatically upon turning 65 or being on disability for 2 consecutive years.

5. Medicare
SupplementServices
Call Today (570)

6. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
Medicare part b
Basic Benefits (Medicare pays 80%)
Doctor Care
Mental Health
Home Health
Durable Medical Equipment
Preventative Services
Medicare Part B does NOT cover:
Long Term Care
Routine dental or eye exams
Dentures
Hearing Aids
Cost/Enrollment for Part B
All individuals will pay premium for Part B and is typically deducted from your SS check.
Average premium in 2018 for Part B is $134/month.
Annual Deductible $183
Late enrollment penalty of 10% annually
Most individuals enrolled automatically when turning 65 or having disability for 2 consecutive years
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

7. Medicare
SupplementServices
Call Today (570)

8. Your choices beyond medicare
Now that you understand Medicare only covers 80%, its important you understand your options beyond what Original Medicare covers.
Stay on Original Medicare
Stay on Original Medicare and enroll in a Part D (Rx) plan
Stay on Original Medicare, enroll in a Medicare Supplement (Medigap) and Part D plan
Enroll in a Medicare Advantage (such as HMO, PPO, PFFS, etc.)
So, how do you know which is best for you? Below are some general questions to we ask when evaluating plan options:
Is it important to be able to keep your current providers?
Are you worried about being restricted to the providers and area you can seek care?
How much coverage do you need/want?
Do you have a budget?
If you have a budget, are you concerned with pricing vs. benefits?
Are benefits such as dental, vision, and gym membership a priority for you to have?
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

9. Medicare part c (medicare advantage)
Alternative way to receive Medicare benefits through private insurance companies.
Referred to as Medicare Advantage or Medicare Complete Plans
Most popular plans are: HMO, PPO and PFFS
In most cases, Annual Enrollment Period (AEP) is the time to change plans; October 15th- December 7th
Pros
Low to zero monthly premium
May include additional benefits such as: Vision, hearing, dental and wellness
Some plans include drug coverage (Part D)
Cons
Restrictions to certain providers and facilities if you want the lowest price (could also require referrals for specialists)
Annual Maximum out of Pocket
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

10. Medicare
SupplementServices
Call Today
(570)

11. Medicare supplement (Medigap)
Pros
No provider restrictions. See any physician or facility nationwide so long as they agree to accept Medicare assignment.
Monthly premium, so the cost is predictable
Electronic claim filing with most companies
Cons
No additional benefits; e.g., dental, vision, hearing
No Rx coverage
Purchased through private insurance companies to help pay for cost out of pocket costs not covered by Medicare; e.g., co-pays, co-insurance and deductibles.
Most popular Medigap Plans are: Plan F, Plan G and Plan N
Medicare pays first then the Medigap picks up a portion of the remaining balance, depending on plan.
Enroll anytime throughout the year
There may be underwriting
Highly recommended to add Rx coverage
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

12. Key differences: Medigap vs. Medicare ADVANTAGE
1. Cost 1a. Medigap Plans traditionally have a higher monthly premium. MA Plans may have a zero to a low monthly premium, but there is a Maximum out of Pocket cost. These vary by plan and plan type. 2. Network 2a. Medigap Plans have NO Network and policy holders can see any DR nationwide that participates with Medicare. On the other hand, most MAPD plans require that you use certain DR’s in order for the plan to work its best and help keep costs down. 3. Additional Benefits 3a. Medigap Plans do not include any additional benefits such as dental, vision, prescriptions, etc. and would require you to purchase separate plans which means additional premium. Many MAPD plans may include some basic coverage for Rx, dental, vision, gym membership discounts, etc.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

13. Medicare
Supplement
Services
Call Today
(570)

14. Medicare
SupplementServices
Call Today
(570)

15. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
MEDICARE PART D (Rx)
Not required to enroll, but there is a late enrollment penalty of 1% each month you don’t have credible drug coverage
Cost vary by plan, prescriptions and pharmacy.
Three thresholds of Part D:
Initial Coverage Phase (up to $3,750).
Coverage Gap/Donut Hole (up to $5,000).
Catastrophic Phase
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

16. Medicare
SupplementServices
Call Today
(570)

17. Original medicare- faq
What is Medicare? Medicare is a federal health insurance program for individuals 65 or older and certain younger individuals with disabilities, and people with End-Stage Renal disease (ESRD). Am I enrolled in Medicare automatically? If receiving Social Security benefits prior to turning 65, individuals will be enrolled in Medicare Part A and Part B automatically based on working the Medicare required amount to receive benefits. Typically, you should receive your Medicare information, including Medicare card in the mail 3 months prior to you turning 65. However, not everyone is enrolled automatically, in which case you would need to contact the Social Security. You may do so three months before, the month of and three months after turning 65. Certain individuals that are 65 and still have group insurance will still receive Medicare Part A benefits, but can delay Medicare Part B benefits due to still having credible coverage through an employer.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

18. Original medicare- faq
I Have Group Insurance, Do I Still Need Medicare?
It depends, is your group coverage comparable or better than traditional Medicare options?
Our licensed agents will compare pricing, coverage, deductibles, co-payment, co-insurance and flexibility of choosing your own doctors.
We also take into consideration if there are any other members on the current group policy, as this could affect premiums for other individuals on your current plan.
Before making any decision, the beneficiary should contact either HR or their benefits administrator.
Depending on the company – in some cases, once an individual goes off the group coverage, they may ever return to that coverage.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

19. Medicare supplement- faq
What Is Medicare Supplement Insurance? Medicare Supplement Insurance Plans (also referred to as Medigap Plans) are offered through private health insurance carriers such as AARP (United HealthCare), Mutual of Omaha, Aetna and Humana to name a few. These plans are designed to supplement Original Medicare. This means it helps pay some and sometimes all of the health care costs (“gaps”) that Original Medicare doesn’t cover such as: co-payments, coinsurance, and deductibles. Each standardized Medicare Supplement policy must offer the same basic benefits, no matter which insurance company sells it. Cost and rating is usually the only difference between Medicare Supplement Insurance policies with the same letter sold by different insurance companies.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

20. Medicare supplement- faq
How Do Insurance Companies Price Medicare Supplement Plans?
In most cases, insurance companies use these common factors to determine Medicare Supplement Insurance Rates:
Age
Gender
Location
Health
Tobacco Use
There are also other parameters that insurance companies and/or states require the use of, such as:
Community Rating (also referred to as “no-age” rating)
Issue Age Rating (also referred to as “entry-age” rating)
Attained Age Rating
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

21. Medicare advantage- faq
What is the difference between an HMO and PPO?
The most common difference between an HMO and PPO plan is that by having an HMO plan, one must use the network provided by the insurance company. If the HMO enrollee decides to seek care outside of the plans network, he/she will pay out of pocket costs to the maximum Medicare allowed amount.
Having a PPO will allow you to seek care at any provider that accepts Medicare. However, you may pay more out of pocket for not using the plans “preferred” network.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

22. Medicare advantage- faq
What is the difference between a Medicare Advantage and a Medicare Supplement Plan? Medicare Advantage Plans replace and in some cases enhance original Medicare. Medicare Advantage plans typically have little, to no premium. In most cases, clients of a Medicare Advantage plan are limited to a “network” of doctors and hospitals they must attend for their plan to work accordingly and minimize out-of-pocket expenses. If a client of a Medicare Advantage plan travels outside the network, there is coverage for urgently needed and emergency care. A Medicare Supplement Plan does NOT replace original Medicare and is designed to pay for cost (or fill “gaps”) not covered by traditional Medicare. Medicare Supplement Insurance Plans typically have a monthly premium that can vary depending on age, gender, location and health to name a few. Medicare Supplement clients are NOT restricted to a network of doctors and in most cases will experience very little to zero out-of-pocket expenses after the monthly premium has been paid, depending on the plan.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

23. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
medicare part d- faq
How much do Medicare Part D plans cost? There are several companies and plans to choose from. The average premium in 2018 was about $34.00/month with the lowest cost plan costing $15.70 and as high as $175. Deductibles, co-payments and co-insurance also vary depending on the plan you choose, this helps find a plan with costs that suit your needs. What is the donut hole? The “donut hole” is also known as the coverage gap. This occurs when you and the insurance company have reached a spending limit of $3,750. Once this happens, you cost sharing will increase 65% for covered brand name drug and 56% of covered generics.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

24. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
Medicare part d- faq
I don’t take any prescriptions, why do I need a Medicare drug plan? As with any insurance we purchase, we have it for the “what if” reasons. Furthermore, Medicare will charge a penalty for not enrolling in a prescription drug plan; so long you are eligible to enroll. If I buy a Medicare Part D plan, do I still have a co-pay for my prescriptions? Depending on the plan you choose, you may have to pay a deductible, co-pay and/or con-insurance. Some plans offer $0 deductibles and $0 co-pays on most generics. Each company has a formulary of covered drugs that are listed into different “tiers”. The level tier of the drug will determine the cost; the lower the tier of the drug, the lower the cost. To compare Medicare plans in your area, call one of our licensed advisers today. We take the time to review your needs for healthcare and use that information to find the plan in your area that best fits your needs and budget.
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor

25. Medicare Supplement Services – Cheryl Cloke - Benefits Advisor
Thank you
We Are Here To Help!
Medicare Supplement Services – Cheryl Cloke - Benefits Advisor