Presentation on theme: "Welcome to our meeting! Thank you all for coming today. This is an Educational Presentation only. No specific company premiums or benefits will be reviewed."— Presentation transcript:
Welcome to our meeting! Thank you all for coming today. This is an Educational Presentation only. No specific company premiums or benefits will be reviewed today.
Goals Educate the group on the “in’s and out’s” of MA-PD / Medigap plans and the easiest ways to save money with them. Review the choices you have as a Medicare Beneficiary.
What is Medicare? Part A gives you help with hospital costs. Part B helps with doctors care and outpatient care. Part C combines hospital, doctor’s care and Rx drug coverage in a single plan with additional benefits instead of receiving benefits through original Medicare. (also known as MAPD) Part D provides prescription drug coverage and is required by law, whether you take prescriptions or not. A and B are part of original Medicare, C and D are available through Medicare approved private companies.
Medigap Basics A Medigap plan is also called a Medicare Supplement Policy and is a private insurance policy designed to supplement Original Medicare (Parts A & B). This means it helps pay the “gaps,” or 20% that Original Medicare doesn’t cover. If you are in Original Medicare and have a Medigap plan, Medicare will pay its share of the Medicare approved amounts for health care cost and Medigap will pay its share. Medigap is an alternative to part C, you cannot have both.
When can you get Part C and MA-PD plans? Part C (and D) plans can generally only be purchased during AEP (Oct. 15-Dec. 7) There are some exceptions that will allow someone to enroll in C or D outside of this period Medigap plans can be purchased any time throughout the year, but you must qualify medically in most cases.
Saving money with Medigap and Part C Each Medigap plan must offer the same benefits, no matter what insurance company sells them. For example, Blue Cross, Aetna, and AARP all sell plan “F” supplements and they all work the same at every doctor that accepts Medicare. COST IS THE ONLY DIFFERENCE!
When can you get a plan with health conditions? In some cases, you can get a Medigap policy even if you have health issues. “ICEP” or when you first turn 65. Sometimes the only option to change for someone with health conditions is to choose a MA-PD plan. Only health question for MA-PD is “Do you have ESRD?”
Medigap vs. MA-PD What is the difference? Pros and Cons… MAPD is like an HMO or PPO - network of doctor’s and hospitals. Vacation? Travel? Higher premiums and no co-pays (Supp) vs. Lower premiums with co-pays (MA-PD) MA-PDs offer extra benefits like Vision, Hearing, Fitness Facility memberships, and sometimes Dental and Transportation
What do I need to know if I want to buy a Medigap Policy? You must have parts A and B in order to be eligible to enroll in any Medicare plan. You pay the private insurance company a monthly premium for your policy in addition to your monthly Part B premium of $104.90. A Medigap supplement policy only covers one person. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your policy as long as you continue to pay the premium. This is why auto draft payments are so important.
Why would you want to switch? You may be paying for benefits you don’t need. You need more benefits than before. You want to change insurance companies. You want to find a policy that costs less. Your current MA-PD plan is ending?
SPAPs SPAP is a State Pharmaceutical Assistance Program – PACE, PACEPlus, PACENet Qualification varies by state. PA is from $23,500 to $15,500 for a single person or $31,500 to $17,700 for a couple. In some cases you may also have protection from the coverage gap.
SPAP’S Continued Who is eligible? To be eligible for PACE and PACENET: · You must be 65 years of age or older. · A Pennsylvania resident for at least 90 days prior to the date of application. · You cannot be enrolled in the Department of Public Welfare's Medicaid prescription benefit. PACE and PACENET eligibility is determined by your previous calendar year ’ s income.
Effective for 2014 Social Security Medicare Part B premiums are now excluded from income. This change has the same effect as raising the income limits by that amount. For most Medicare beneficiaries, this amount is $1,258.80 per person for a year. For married couples, the excluded amount would be $2,517.60 for a year.
Eligible for State’s Benefits? www.BenefitsCheckUp.org/Coventry There are more than 1,500 local, state and federal programs available to qualified individuals that can help you with: Medical costs Prescription drugs Heating bills Housing/rent Meal programs Legal services In-home services In addition, you will be provided with a personalized report that you can print, which tells you exactly how and where to apply for these programs.
Find out more with a FREE personal consultation. I’ll be happy to talk with each of you privately to discuss how and which of these programs may be the right fit for you. Everyone’s situation is different, all your information is always confidential and secure with a licensed representative.
THANK YOU! Questions??? We look forward to working with you in the near future. Visit us on the web at www.capitalseniorservices.netwww.capitalseniorservices.net Email me at firstname.lastname@example.org@capitalseniorservices.net Call me on my cell phone at (717) 991-8500.