Medicare 101. Understanding the Basics
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1 Medicare 101 Understanding the Basics
2 1. What is Medicare? 2. Who can get Medicare? 3. How much does it cost? 4. What does Medicare cover? 5. What is not covered? 6. Medicare Advantage Plans 7. Prescription Drug Plans 8. When can I enroll in Medicare? 9. Where do I go for help?
3 Medicare Consists of 4 Main Parts: HOSPITAL MEDICAL ADVANTAGE PRESCRIPTIONS
4 Part A Covers hospital insurance Part B Covers medical insurance (Like doctor visits)
5 Parts A & B are known as Original Medicare HOSPITAL MEDICAL They are administered and provided by the federal government $ $
6 Who can has access to Medicare Coverage? HOSPITAL MEDICAL People 65 or older People under 65 with certain disabilities Anyone with End-Stage Renal Disease
7 How much does it cost? HOSPITAL MEDICAL No monthly premiums* for those with 10 years of tax paying credits. Monthly premium set by Social Security based on income tax records using a 2-year look back (IRMAA) *Those with less than 10 years of tax paying credits can get Part A for a monthly premium
8 What is Covered by Original Medicare?
9 Medicare Parts A & B will pay only 80% of your healthcare costs. Hospital and Doctor visits and some drugs
10 You are responsible for the remaining 20% You You mo r ney The Doctor
11 What Services Does Part A Cover? Semi-private room Hospital meals Care on special hospital units Drugs, medical supplies as an inpatient Care to manage symptoms & control pain for the terminally ill Skilled healthcare for those who cannot leave their home Lab tests, X-rays & radiation treatment as an inpatient Rehabilitation services, such as physical therapy received through home health
12 What Services Does Part B Cover? Annual physical exam Preventative care such as flu or pneumonia shots Emergency room services Blood tests, urinalysis, etc. Some diagnostic screenings (colorectal, prostate cancer, and mammograms) Outpatient mental health care X-rays, MRIs, CT Scans etc. Durable medical equipment for use at home (oxygen, walkers wheelchairs, etc.)
13 So what is NOT Covered by Original Medicare?
14 Services NOT Covered by Medicare Hearing Tests Routine Eye Care Most Dental Care Acupuncture Routine Foot Care Foreign Travel Coverage
15 How do we fill the gaps in coverage?
16 Part C: Medicare Advantage Plans ADVANTAGE Administered by private insurance companies Combines Parts A & B and may offer Part D drug coverage Can include additional benefits such as vision, dental, hearing and fitness membership Helps cover costs including: deductibles, copays and coinsurance
17 Part D: Prescription Drug Plans PRESCRIPTIONS Administered by private insurance companies Prescription drug coverage Typically paired with with Medicare Supplement plans Each drug plan is unique with its own formulary and restrictions
18 When Can I Enroll in Medicare? Initial Enrollment Period Consumers have a 7-month window to enroll in Parts A & B This window includes the 3 months before their 65th birthday, the month of their 65th birthday and the 3 months following their 65th birthday. 7-Month Window
19 Administered by The Government HOSPITAL MEDICAL $ $ Administered by Insurance Companies ADVANTAGE PRESCRIPTIONS
20 Medicare Advantage and Prescription Drug plans are subject to change each year. My Senior Health Plan is a free service that helps people find a health plan that fits their needs. When your plan has changes, we will let you know and help you find a solution. This Year s Plan Changes
21 Have questions? Need more information? Get your free consultation with a licensed professional today! Call (877) today or visit us online at MySeniorHealthPlan.com is not connected with or endorsed by the U.S. Government or the Federal Medicare Program. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change.
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