Presentation on theme: "Medicare Understanding your options PART A PART B D PART D PART C MEDICARE SUPPLMENT."— Presentation transcript:
Medicare Understanding your options PART A PART B D PART D PART C MEDICARE SUPPLMENT
Agenda The ABC’s of Medicare Insurance –Who pays for what? –Plan Types –Plan Comparisons & –YOUR OPTIONS
The Parts of Medicare Part A - covers hospital and inpatient services. Part B - is the part of Medicare that covers doctor’s office and outpatient services Part C - an optional part of Medicare that is also known as Medicare Advantage (still part of Medicare, coverage is provided through the private insurance carrier combining part A,B & D) Part D is the prescription drugs part of Medicare Medigap – Also called Medicare Supplements are standardized plans can help you pay some of the costs not covered by Original Medicare
What Medicare Covers Part A – Hospital Insurance helps cover* –Inpatient Hospital Care –Skilled Nursing Facility care –Home health care –Hospice care Part B – Medical Insurance helps cover* –Doctor’s visits –Outpatient medical services –Clinical lab tests –Durable Medical Equipment –Preventive services
Paying for Part A What does Part A cost? –Most people get Part A premium free If you or your spouse paid FICA taxes at least 10 years –If you paid FICA less than 10 years You can pay a premium to get Part A
Paying for Part B If your Income in 2011 wasyour premium for 2013 was File Individual Tax ReturnFile Joint Tax Return Mo Premium $85,000 or less$170,000 or less$104.90 $85,000.01 – $107,000$170,000.01 – $214,000$146.90 $107,000.01 – $160,000$214,000.01 – $320,000$209.80 $160,000.01 – $214,000$320,000.01 – $428,000$272.70 Above $214,000Above $428,000$335.70 Premiums are typically deducted directly from your Social Security
Who pays for what In Original Medicare you pay. Yearly deductible of $147 in 2013 and 20% coinsurance for most services. What you need to consider is paying for the 20%
Medicare Insurance Options Medicare Supplement Insurance Policies –Sold by private companies Fill the gaps in Original Medicare –Deductibles, coinsurance, copayments Standardized plans All plans with same letter –Have same coverage –Only the costs are different To join a private Medigap plan, you pay a monthly fee to an insurance company in addition to the premium you pay to the government for Medicare Part B. Medicare Supplement Insurance
Standardized Supplment Plans Medigap Benefits ABCDF*GK* * L**MN Part A Coinsurance and Hospital Costs (up to an additional 365 days) 100% Part B Coinsurance 100% 50%75%100% Blood (first 3 pints) 100% 50%75%100% Hospice Care Coinsurance 100% 50%75%100% Skilled Nursing Coinsurance 100% 50%75%100% Part A Deductible 100% 50%75%50%100% Part B Deductible 100% Part B Excess Charges 100% Foreign Travel Emergency 100% (Up to Plan Limits) Out-of-pocket limit in 2013 $4,800$2,400 * Plan F also has a high deductible options, some companies may offer this option. ** Plans K & L pay 100% of covered services for the rest of the calendar year after you meet your out-of-pocket yearly limit. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
Part C Combining Parts A&B Health plan options approved by Medicare –Another way to get Medicare coverage –Still part of the Medicare program –Run by private companies Medicare pays the insurance carrier a premium –You continue paying for your Part B May have to use network doctors or hospitals May include additional benefits, Vision & Dental Types of plans available may vary HMOs PPOs & Special Needs
Part D Available for all people with Medicare Provided through –Medicare Prescription Drug Plans –Medicare Advantage Plans
How Part D Works It’s optional (however you may have a penalty for joining late) –You can choose a plan and join Plans have formularies –Lists of covered drugs –Must include range of drugs in each category You pay the plan a monthly premium You pay deductibles and copayments
For Comparison Medicare Plan Type Monthly YearlyOut of PocketOffice Visit PremimumDeductableMaxIn NetworkOut of Network LB City - Anthem Blue Cross Medicare Supplement$554.30$50.00Unlimited100%80% Anthem Plan F$192.00$0.00100%* LB City- UHC Group Medicare Advantage (HMO)$365.82N/A$3,400.00$5.00Plan Dr. Only United Health AARP Advantage (HMO)$0.00 $3,000.00$0.00Plan Dr. Only LB City- SCAN Medicare Advantage (HMO)$331.56N/A$6,700.005.00%No Coverage Scan Clasic HMO$0.00 $5,400.00$0.00Plan Dr. Only Anthem Blue Cross Medicare Perfered PPO W/Rx$0.00$300.004,500.00$15.00$45.00 $28.00 $90.00 Rx Part D Anthem Perceription Drug Pans$76.80$140.00 Medicare supplement pays 100% of the co-insurance allowable Medicare charges ( 147.00 Medicare Deductible and the remaining 20%) MEDICARE Advantage plans include prescription drug in the plan. Plan Dr Only - You will be responsible for service obtained from non-plan physicians except for emergency services. Supplemt Plans do not include Prescription Drug Coverage Plan information is for educational purposes only.
Things to keep in mind Plans must offer at minimum, coverage equal to or greater than Original Medicare. You have resources – we are here to help