Medicare is Health Insurance
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- Victor Parsons
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1 Basics
2 is Health Insurance Part A Hospital Insurance Medigap Parts A and B is called Original administered by the federal government Part D Prescriptio n Drug Plan has 4 Parts Part B Medical Insurance Parts C and D are purchased through private insurance companies to supplement Original Part C Advantage Plan Medigap plans are purchased to fill in the gaps to supplement Original
3 Original Your costs under Original Original only (Parts A and B) pays 80% for approved services only Member is responsible for 20% Pays 80% You Pay 20% Does not include: Part D Prescription Drug coverage Supplemental insurance (Medigap/ Advantage)
4 Original PART A Hospital Insurance Covers inpatient services, skilled nursing facilities, and hospice Typically no premium $1,340 deductible per hospital admit in 2018 No coinsurance PART B Medical Insurance Covers outpatient services, lab, x-ray, and office visits $134 monthly premium in 2018 $183 annual deductible in % coinsurance for most covered services
5 Medigap (Supplement) Plan Medigap plans are purchased to fill in the gaps to supplement Original Pays 80% Plan Pays 20% In addition to Original (Parts A and B) pays 80% for approved services only Plan pays the 20% doesn t cover Does not include Part D Prescription Drug coverage Limited to approved services No network Can see any provider that is accepting assignment
6 Advantage (Part C) Part C Advantage Plan Different from a supplement (Medigap) plan Purchase separately through private insurance companies Variety of plan designs (PPO, HMO, HMO-POS) Medical providers bill insurance company directly Combines Part A and Part B 1 and typically includes a Part D Prescription Drug Plan (PDP) May include additional services not available with Original (e.g. routine vision, gym memberships, care management) You must be enrolled in Parts A and B and can only be enrolled in one Prescription Drug Plan (PDP) at a time. 1 You will continue to be billed separately by for your Part B premium. Medigap or Advantage Plans are a separate premium to the insurance carrier.
7 Prescription Drugs (Part D) Part D Prescription Drug Plan (PDP) Purchase separately through private insurance companies that contract with CMS Pay a co-pay or co-insurance for covered generic and brand name drugs - varies by plan Drug formulary varies by plan Must use a network of pharmacies in most cases 2018 Catastrophic Coverage is $5,000 Late Enrollment Penalty You pay 1% of the Part D National Base Beneficiary Premium for every full month you did not have creditable prescription drug coverage; continues for lifetime Part D IRMAA Assessment You pay a Part D premium assessment if your Modified Adjusted Gross Income (MAGI) exceeds $170,000 (married filing jointly) or $85,000 (all other filing statuses) You must be enrolled in Parts A and B and can only be enrolled in one Prescription Drug Plan (PDP) at a time.
8 Medigap (Supplement) Plan vs. Advantage Plan Medigap (Supplement) Plan Advantage Plan (Part C) Offered by Private insurance companies Private insurance companies You must have Parts A and B Parts A and B Do you pay a premium Premium Costs Yes. You pay a premium for the plan and you pay the Part B premium Premiums vary with gender, health, and age Yes. You pay a premium for the plan and you pay the Part B premium All plan members pay the same premium Provider Choice No Network Provider Networks Prescription Drug Coverage (Part D) Extras Not Included Must purchase separately None - Covers only the same as Original Typically included May include hearing or vision, gym memberships, and travel benefits
9 Coverage Options Original Part A - Hospital Part B - Medical Part D - Prescription Drug Plan not included; you will need to purchase separately is primary, member pays what does not cover Original + Medigap (Supplement) Plan Part A - Hospital Part B - Medical Part D - Prescription Drug Plan not included; you will need to purchase separately is primary, Medigap plan is secondary Advantage (Part C) Combines Part A and B under one plan 1 Variety of plan designs (PPO, HMO, HMO-POS) Part D - Typically included Advantage is primary; is not billed You must be enrolled in Parts A and B and can only be enrolled in one Advantage or Part D Prescription Drug Plan (PDP) at a time. 1 You will continue to be billed separately by for your Part B premium. Medigap or Advantage Plans are a separate premium to the insurance carrier.
10 Eligibility is administered by The Centers for & Medicaid Services (CMS) PART A is health insurance for people: 65 years of age or older Under 65 but have been receiving Social Security Disability Insurance for more than 24 months Have End State Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) PART B You become eligible for at age 65, regardless of whether you are receiving Social Security benefits at the time.
11 Enrolling In How you enroll in Part A and B varies based on if you are: PART A PART B Collecting Social Security You are automatically enrolled on the first of the month of your 65 th birthday (unless your birthday is on the 1 st ) You are automatically enrolled on the first day of 25 th month after your Social Security Disability benefits began If you want it, keep the Card sent to you. This is proof of your Entitlement Not collecting Social Security Enrollment is not automatic, you must contact the Social Security office to apply ( or call (800) ) May apply 90 days in advance of eligibility
12 Enrolling In PART A PART B Enrollment Periods Coinciding with PHIP enrollment opportunities Initial Coverage Election Period 7 month Initial Coverage Enrollment Period (ICEP) 3 months before the month you turn 65 The month of your 65 th birthday 3 months after the month you turn 65 Special Enrollment Period Loss of employer sponsored group coverage Based on current employment (COBRA and Retiree coverage doesn t apply)
13 Already Eligible for but Still Working? When will your active employersponsored group coverage end? Contact your Human Resources Department to determine when your coverage will end once you leave employment Your Parts A and B will begin the first of the month after your active group-sponsored coverage ends Enroll in Parts A and B Contact Social Security Administration to enroll in Parts A and B You can enroll up to 90 days prior to your active employersponsored group coverage ending Enroll in a Supplement plan (Medigap or Advantage Plan) The effective date of your Supplement Plan will be the same date as the effective date of your Parts A and B Select and enroll in a Supplement plan (Medigap or Advantage Plan) You cannot enroll in PHIP until Parts A and B have been obtained
14 Recap Enroll in Parts A & B Select a Medigap or Advantage Plan* Your Coverage *You may have to purchase a separate Part D Prescription Drug plan in addition to your Medigap or Advantage Plan
Medicare. has 4 Parts. Medicare is Health Insurance. Medigap. Part A Hospital Insurance. Part D Prescription Drug Plan. Part B Medical Insurance
Basics is Health Insurance Parts A and B is called Original administered by the federal government Part A Hospital Insurance Medigap Parts C and D can be individual plans purchased through private insurance
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