1. Medicare 2019 Basics What’s inside:
The aim of this seminar is to help give you a basic understanding of what Original Medicare is and what options you may have when selecting additional coverages that work with Medicare.
When you are able to enroll in Medicare and when you can enroll in a Medicare Advantage Plan, Prescription Drug plan and Medicare advantage plan.
What’s inside:
An overview of Medicare and options 
Prescription drug, Medigap and Advantage Choices 
When and how to enroll
Getting independent advice

2. WHAT IS MEDICARE?
Medicare is a federal insurance program for people 65 or older
Under 65 with disabilities
End Stage Renal Disease (ESRD)
Lou Gehrig’s Disease (ALS)
No premium for Part A if you have worked at least 10 years
Part B premium is based on income
Just a quick refresher on Medicare (run through quickly as a level set before getting to their options and questions)
Medicare is the federal health insurance program for people 65 or older, under 65 with disabilities and for those with end stage renal disease or Lou Gehrig’s Disease. The program helps with the cost of health care. However, Medicare does not cover all medical expenses or the cost of long-term care. Medicare has four parts: Part A, Part B, Part C, and Part D. 
You cannot enroll into Medicare Advantage if you have ESRD – however if you get the disease after enrollment you can keep your MA or Supplement Plan.

3. WHO IS ELIGIBLE? U.S. Citizens 65 or older
Permanently Disabled Individuals
No premium for Part A if you have worked at least 10 years
Part B premium is based on income
U.S citizens 65 years or older and persons on disability; if you have worked for at least 10 years there may be no premium for Medicare Part A, premiums for Part B are based on income. 
You or spouse have paid tax for 40 quarters (10 Years).

4. WHY IS IT IMPORTANT TO ENROLL?
Late Enrollment Penalty for Part B
Restricted enrollment period after your Initial Enrollment Period
Cobra & HSA issues and part A
Late Enrollment Penalty for Part D
Creditable Coverage
There are regulations that can result in financial penalties for late enrollment. If you are working you may or may not need to enroll in Part A and/or Part B. Other regulations involve COBRA (not creditable coverage) , HSA (once you are enrolled into Medicare, you cannot contribute to a HSA) You may need to unenroll in Medicare to keep contributing to your HSA if you are remaining on your group health plan.
Your health Advisor or financial advisor can help with your decisions.
Also you may want to ensure you do not miss the Guarantee Issue period into Supplements if that is your preferred option – Your 6 months GI clock begin once you sign up for part B. Therefore do not sign up for part B if you will be staying on a Group Health plan (consult your HR).
Employer coverage must be creditable, otherwise a penalty will occur for part B and/or part D. (creditable coverage means the prescription drug coverage in their Group Plan is at least as good as coverage under Medicare).

5. HOW DO I ENROLL? In person at a local Social Security office
Online at (preferred option).
There are specific enrollment periods (more a little later).
An individual can enroll in Original Medicare (A+B) at a Social Security office. Recommended and usually much easier is to enroll online at are specific time frames when enrolling. Consult your advisor about your enrollment periods.
A Medicare advisor will help you decide if your current employer plan or enrolling in Medicare meets your needs (depends on Group size as to whether Group or Medicare would be primary payer, also quality of the plan and how much you contribute to Group Benefits, discuss with HR. 

6. HOW TO CHOOSE WHICH PLAN IS RIGHT FOR ME?
Network
Decide which Doctors, Clinics and Hospitals you need in your Network
Formulary
Have your prescriptions ready to guide your choice
Discuss the importance of getting them to think of Network, Formulary, Portability and Cost. With the Message, IF THEY LIKE THEIR CARRIER THEY CAN KEEP THEIR CARRIER.
If they are worried about having a plan that has a networks and out of pocket cost – let them know that a Medigap may be a good fit for them but it will cost them more $
If that is out of there budget, there should be a good Medicare Advantage plan that will check most of their boxes.

7. HOW TO CHOOSE WHICH PLAN IS RIGHT FOR ME?
Portability
How often do you travel and duration of your stay
Do you need access to out of state Doctors for routine visits when traveling?
Cost
What is your budget
Are you willing to pay a higher premium for lower to $0 copays
Do you want a low premium with higher copays
Networks apply to Medicare Advantage plans – some MA plan have wide networks and some very narrow networks.
Asking if the provider accepts Medicare is the key question for a Medicare Supplement (Medicare Supplements are highly portable as they typically have no network).

8. A B D A B C MEDICARE PLAN OPTIONS A D B
Original Medicare
Includes Parts A and B
Prescription Drug Coverage A B D
Part A: Covers Hospital visits and prolonged stays
Part B: Covers doctors’
visits and outpatient care
Part D: Helps cover the
Cost of prescription drugs
Medicare Advantage
Medicare Supplement Insurance
Medicare Part C:
Combines Parts A and B, and usually D
Helps pay for cost not covered by Parts A & B
Original Medicare is the basis of all Medicare options – Members must continue to pay their Part B premiums whether they choose a Supplement or Medicare Advantage.
Members cannot have a stand alone PDP with Medicare Advantage.
Cannot have a MediGap supplement and a Medicare Advantage Plan. v A B A C
Also know as
Suitability is key. Take into consideration your health, lifestyle, desired benefits, pharmacy, network and costs when choosing the right Medicare coverage for you.  D
Medigap
Policy B
May include additional coverage for cost not covered by Parts A & B

9. FAST FACTS:
Majority of people have coverage in addition to Original Medicare - only 14% have Original Medicare only.
People choose additional Medicare coverage for many reasons, one main reason is the 20% coinsurance for Part B services with no cap.
Now lets recap on the key Parts of Medicare
Transition to talking about the parts of Medicare.

10. MEDICARE PART A Most people pay no premium
Covers Inpatient Hospital Care
Skilled Nursing Care
Hospice Care
Home Health Care
Part A
Medicare Part A covers hospital inpatient and Limited skilled nursing, hospice and home care. If you or your spouse have worked 10 years there may be no premium for Part A.
Be prepared to answer a question about what the actual Part A deductible is:
Reminder Medicare does not cover Long Term Care.

11. MEDICARE PART B Doctors Services Preventive Services X-rays
Physical/Occupational Therapy
Durable Medical Equipment
Most people will pay a premium
20% Co-Insurance
Part B
Medicare Part B covers services and supplies that are medically necessary, including outpatient care, preventive services, ambulance services and durable medical equipment. There is a premium you must pay for Part B and without supplemental coverage you may be responsible for 20% of Medicare approved fees. This is a primary reason people select supplemental coverage.
Part A & B together make up what is known as Original Medicare and there is no drug coverage (except while inpatient at hospital).
Be prepared to talk about Part B deductible and premium – Also mention that there is No out of pocket maximum protection with Part B which is a key reason to enroll into a supplement or MA option.

12. MEDICARE PART D
Contract between CMS (Medicare) and a private insurance company
Enrollment is voluntary
Late enrollment penalty
Stand-alone plans
Embedded in Medicare Advantage plans.
Part D
Medicare Part D are private plans providing prescription drug coverage. It is available as stand-alone coverage with a Medicare Supplement or embedded within a Medicare Advantage Plan. Plans vary in price, networks, copays and the drugs included on their formulary (prescription drug list).

13. MEDICARE PART C Also known as Medicare Advantage
A contract between private insurance companies and CMS.
Must be as good as original Medicare
May include additional benefits not covered by original Medicare.
All Medicare Advantage plans have a maximum out-of-pocket limit
Most plans do not require a referral to see a specialist in the Network
Part C
Medicare Part C, also known as Medicare Advantage, is offered by private companies approved by Medicare, as an alternative to Original Medicare. Your Medicare benefits are assigned to your Medicare Advantage Plan; who in return provide you with your Medicare Coverage. Medicare Advantage Plans must provide coverage at least as good as Original Medicare.
Medicare Advantage Plans have variable premiums depending on factors such as networks and how much of the cost you share. All Medicare Advantage Plans have an out-of-pocket maximum, limiting your financial risk. Medicare Advantage Plans may include additional benefits not covered by Original Medicare, such as prescription drugs, comprehensive physical exams, dental, vision, and gym memberships.
The number of people enrolling into Medicare Advantage Plans is increasing every year due to the similarity of Medicare Advantage Plans with conventional health insurance plans offered by employers before retirement.

14. MEDICARE SUPPLEMENT Also known as MediGap
Fills in the Gaps of original Medicare
Usually no networks
Can see any provider that accepts Medicare
Supplements don’t cover drugs
Guaranteed issue during your initial enrolment period
Minimal underwriting after your Initial Enrollment Period (IEP)
Supplement
Medicare Supplement Insurance, also known as MediGap, were created by private companies to fill gaps in Original Medicare. These gaps include deductibles, copays and your liability for the 20% cost sharing with Original Medicare.
Medigap plans typically do not have a network and can be used with any provider that accepts Medicare. Combining Original Medicare with Prescription Drug coverage and a Medigap plan is a popular strategy.
Medigap plans are guaranteed issue during the first six months of eligibility, however, after that you may have to go through underwriting.

15. PLAN COMPARISON Supplement Plans  Cost Plans  Advantage Plans
Guarantee Issue 
Low Premiums
Networks
Underwriting NA
Primary Care Provider
Portable
Travel in US 
Dental
Vision
May include Drugs
Max out of pocket
The point of this slide is to illustrate that the some of the same benefit features can be found in both Medicare Advantage and MediGap options. Make sure that they understand that Cost Plans are no longer an option for most of them and they need to start considering what options are most important to them when choosing a plan.
Speak to each category:
GI- if they are losing a Cost Plan or new to Medicare they will qualify for Guarantee Issue.
Low Premiums – help them understand that their will be a range of premiums – typically higher premiums mean lower out of pocket.
Networks- help them understand that if they want the largest Medicare network then a MediGap plan is what they should be looking at. Out of network for MA plans is an option with most plans at a higher cost share amount.
PCP- Most individuals that have Medicare Advantage plans right away think HMO and that they have to get referrals to see specialists (not true if in network for most plans). Make sure they understand that even though they may need to choose a PCP that they still have flexibility to see who they want to in the network. They also think small networks –some plans do have small networks but there are plans today that have 90%+ of all Doctors & Hospitals in network
Travel in US- If they want the flexibility to travel and have access to Doctors for routine visits then a MediGap policy is your best option. Some MA plans do have networks out of state. All plans will cover them for emergencies (remember the emergency phase of treatment is very limited).
Drug Plan- If they need or want a standalone PDP then their only options are MediGap or Original Medicare. With Medicare Advantage plans, their option is to take the included drug plan.
Travel outside USA – ensure they connect with you about Travel Medical if they are planning trips, or holidays abroad.
The bottom line is that there will be a plan option that will meet their needs.

16. MEDICARE FAQS Can I keep my doctor if I enroll In Medicare?
I am taking prescription drugs what happens?
Will I have Medicare coverage during international travels?
Will I have Medicare coverage during domestic travels?
Can I keep my doctor if I enroll In Medicare?
If you have a Medicare Supplement Plan then you must check to see if your doctor or provider accepts Medicare Assignment. With a Medicare Advantage Plan you must check the network associated with your plan. (Networks can change at any time and must be checked before every visit).
I am taking prescription drugs what happens?
Part D plans and Medicare Advantage plans have formularies and the drugs on these lists may change from year to year. Reviewing your formulary is important so we recommend bringing the labels or photos of your medication labels when meeting with your advisor.
Will I have Medicare coverage during international travels?
Medicare does not provide health insurance coverage outside of the United States. Some Supplements and Medicare Advantage Plans may have limited cover for emergencies worldwide. We recommend speaking to your advisor about a Travel Medical Plan to ensure your medical and repatriation needs are covered abroad.
Will I have Medicare coverage during domestic travels?
Whether a snowbird or just traveling, you need to discuss portability with your advisor (portability means how your plan covers you away from home) Generally speaking all plans cover you in an emergency medical situation. Some Medicare Advantage plans have broad and some narrow networks. Medicare Supplements may provide coverage across the country but always check to see if a provider accepts Medicare.

17. MEDICARE FAQS
How does Social Security benefits impact my Medicare coverage?
How am I impacted if I am over 65 and am still on my employer’s health insurance plan?
Medicare costs
How does Social Security benefits impact my Medicare coverage?
If you are not receiving Social Security, you will have to personally enroll into Medicare Parts A & B in order to receive benefits.
If you are receiving Social Security, you may be auto enrolled into Medicare.
It is your choice to make, if you are 65 or older, on whether to you would like to receive or delay Social Security.
Your Medicare Part B premium may be deducted from your Social Security check if you are receiving Social Security.
How am I impacted if I am over 65 and am still on my employer’s
health insurance plan?
If your employer offers health insurance, speak to your HR and/or advisor to discuss how Medicare impacts you. By remaining on your employer plan you may be able to delay enrolling in Medicare.
Medicare costs.
Medicare increases have been stable for many years. Generally, you need to pay the Part A deductible, Part B premium and a Part B deductible. Most people don’t pay a premium for Part A since they or their spouse have worked for 10 years or more.
Part D also has a monthly premium, as do Medicare Supplement plans and Medicare Advantage Plans. Price varies with plan design and geographical location. Medicare Advantage Plans often include Part D drug coverage.
You must continue to pay Part B premiums if you have a Medicare Supplement or Advantage plan.

18. KEY ENROLLMENT PERIODS
Initial Enrollment Period (IEP)
Enroll anytime during the seven months surrounding your 65th birthday
Three months prior
Two months prior
One month prior
BIRTHDAY month
One month after
Two months after
Three months after
Annual Enrollment Period (AEP)
Guarantee Issue for Medicare Supplements is 6 months following your first enrollment into Part B (clients must be careful to consider their decision to enroll in Part B if they do not intend to sign up for a Medicare Supplement at that time as the clock starts).
The IEP only applies when you are first eligible for Medicare.
AEP is an opportunity every year to review your choices.
GI is again an option when a plan (such as Cost Plans) are withdrawn from the market and provide another opportunity to subscribe to a supplement plan without health underwriting.
October 15 to December 7
(effective date will be January 1 allow you to review coverage every year)
October
November
December
New plan starts January 1st

19. KEY ENROLLMENT PERIODS
Special Enrollment Period (SEP) 63
Days after qualifying event
Medicare Advantage Open Enrollment
January 1 to March 31
(effective date will be first of the month following enrollment)
Special Enrollment Periods (SEP) are for 60 days after qualifying event like leaving an employer plan or moving outside of your service area.
MA Open Enrollment is new for 2019 as a result of the 21st Century Cures Act – anyone WITH an Advantage plan on Jan 1st has a one time opportunity to switch Medicare Advantage Plans during OE. During this time they could also dis-enroll and go back to OM and select a PDP (they must have had drug coverage with their MA to select a PDP).
With the new OE the old MADP goes away (it is no longer needed).
OE has no effect on Supplements or standalone PDP plans and members with these plans cannot switch during OE.
Reminder:
To get coverage on 1/1/ of any year enrollment must be by 12/07.
There are normally 2 enrollment periods: AEP (when you can review your choices) and OE when (if you have an MA plan) you can make a one time decision to change your Medicare Advantage Plan or go back to OM.
January
February
March

20. NEXT STEPS
Medicare options can be reviewed every year – The key is your needs, lifestyle, health and many other aspects that go into providing the right advice to guide your decision.
We have provided a list of questions and information your advisor will need to ensure you get the right coverage; please take a copy and call or if you wish to have a personal consultation.
Pls print and provide the Medicare needs analysis form if you find this helpful. Or remove this slide. Invite your audience to reach out with further questions. (remember in an Educational Seminar you cannot hand out your contact details – you can leave cards at the back, give to anyone requesting and you can invite everyone to ask for your contact detail (of course include your details on this presentation).

21. QUESTIONS ? <Agent Name> <Agency> <Phone Number>
< >
Logo or Photo
Invite questions. Many questions and answers will impact everybody.
Fill in your agency and contact details for follow up.
You cannot reach out to members who are not your clients unless they provide you with contact details and request you to follow up.
We recommend inviting people to ask for you card, take a brochure or contact you for further information.
The key is education – members need to understand what is happening and know they have a resource to answer their questions and ensure their health insurance needs are covered.
You are that trusted resource.