1. Medicare Made Clear
Neither “We Speak Medicare” nor the presenting agent is connected with the Federal Medicare Program

2. Eligibility You are 65 or qualify due to disability
You are a US citizen or legal resident for 5 years
It does not matter if you are or are not collecting Social Security
It does not matter what age your spouse is
If you do not enroll when eligible you may pay a penalty

3. Enrollment
Initial Enrollment – at age 65 or after age 65 when coming off of group coverage
After 24 months with qualifying disability at any age
Annual Open Enrollment – Oct. 15th – Dec 7th.
Special Enrollment Periods – moving into a new area, discontinuation of a plan, skilled nursing care, low income/Medicaid
Open Enrollment Period – can change plan selection for 90 days after effective date in many but not all cases

4. Part A Most people don’t pay a premium
Provides help with the cost of a hospital stay, skilled nursing services after a hospital stay plus some other skilled care, i.e. hospice
Most people don’t pay a premium
$1,364 hospital deductible (per stay of up to 60 days) additional co-pays beyond that
Go to any hospital in the U.S. that is qualified and accepting Medicare patients

5. Part B
Provides help with the cost of doctor visits and other medical services that do not require an inpatient hospital stay
Premium is /month for most, if you have a higher income you may pay more
Annual deductible of $185
You usually pay 20% of the medical cost, there is no cap on your total spending
Go to any doctor in the U.S. that is qualified and accepting Medicare patients

6. Medicare Supplement Plans
Private insurance that helps pay your part of cost sharing in traditional Medicare Parts A & B. Also known as Medigap plans
10 standardized plans – A through N
Premium costs can vary significantly from company to company and state to state.
Predictable monthly premiums versus unknown medical expenses

7. Medicare Supplement Plans
Private insurance that helps pay your part of cost sharing in traditional Medicare Parts A & B. Also known as Medigap plans
10 standardized plans – A through N
Premium costs can vary significantly from company to company and state to state.
Predictable monthly premiums versus unknown medical expenses

8. Part D
Provides help with the cost of prescription drugs through private insurance companies
Medicare provides guidelines about the types of drugs to be covered
Each plan has its own formulary and network
Costs can vary significantly from plan to plan
Your level of cost sharing will change depending on the total cost of the drugs you use

9. Part D cost sharing Annual deductible of up to $415
Initial coverage limit of $3,820
Donut hole or coverage gap
Catastrophic coverage - $5,100 and above
Drug copays drop to 5%

10. Medicare Part C Advantage Plans
A single plan offered by private insurance companies that combines coverage for Medicare Parts A & B. Most Plans include Part D
Must cover all services provided by Original Medicare
Provides cap on total out of pocket medical expenses
May offer additional benefits and options

11. Medicare Part C – cont. HMO type plans
Receive care from in network Doctors and Hospitals
Care outside of network is not covered – unless it is an emergency. Some plans also provide urgent care services out of network
Primary Care physician refers to specialists

12. Medicare Part C – cont. PPO type plans
Receive care from in network or out of network Doctors and Hospitals
May have higher co-insurance or co-pays for out of network care

13. Provides help with your share of prescription drug costs
Part D Extra Help
Provides help with your share of prescription drug costs
Low Income Subsidy (Federal)
State Programs
Patient assistance programs

14. Social Security Administration
Resources
Medicare
1-800-MEDICARE ( )
TTY
24 hours/day, 7 days/week
Social Security Administration
TTY