1. Mark Lane A B C and Ds of Medicare

2.

• GarityAdvantage Agencies

• • National FMO

• • Focused on the Senior Market

• • • Medicare Advantage

• • • Medicare Supplement

• • • Group Retiree Medical

• • • PDP

• • • Hospital Indemnity

• • • Dental

• • • Final Expense

• • • Funeral Trust

• • • Life

3.

• GarityAdvantage Agencies offers

• • Competitive Nationally recognized products

• • Comprehensive Training

• • Market Expertise

• • Ask us about our Lead Programs for Medicare Products!

• • www.garityadvantage.com

• • 800-234-9488

4.

5.

• Medicare Background

• Original Medicare Parts A & B

• Medicare Part C Options to Original Medicare

• Medicare Supplements

• Medicare Part D

• Coverage Options

• Questions???

6. What is Medicare? A health insurance program for people: age 65 or older under 65 with certain disabilities any age with End Stage Renal Disease Administered by the Federal Government through the Centers for Medicare & Medicaid Services (CMS) Medicare currently provides coverage for 45-46 million People 77 million people aging into Medicare over the next 20 years

7.

• Covers:

• • Inpatient Hospital

• • • $0 co-pay for days 1-60 after the deductible has been met

• • • $283 co-pay for days 61-90

• • • $566 co-pay for days 91-150 (Lifetime Reserve Days)

• • Home Healthcare

• • • Medically necessary care ordered by a doctor and provided by a Medicare-certified home health agency (VNA)

• • Hospice Care

• • • Terminally ill with life expectancy of less than 6 months

• • • Home or Medicare approved facility

• • Skilled Nursing Facility up to 100 days

• • • Only after a 3 day hospital stay

• • • Co-pays for days 21-100 are $141.50 per day

8.

• The deductible for Part A is $1,132 in 2011

• Benefit period

• • Starts the day you go into a hospital

• • Ends when you go 60 days without hospital or skilled nursing care

• • NO LIMIT

• No premium for those with 40 quarters of work

• • $ 248 per month for those with more than 30 quarters

• • $ 450 per month for those with less than 30 quarters

9.

• Covers:

• • Doctors Services

• • Emergency Room Services

• • Outpatient care

• • • In hospital or ambulatory surgical center if not admitted

• • Laboratory Tests

• • • Certain blood tests (diabetes screening for those with risk factors)

• • • Urinalysis

• • Some Diagnostic Screenings

• • • Bone Density Screenings

• • • Cardiovascular Screenings

• • • Colorectal Cancer Screenings

• • • X-rays, MRIs, CT scans, EKGs

10.

• • Certain Drugs not covered under Part D

• • • Oral cancer drugs, some types of injected drugs

• • Durable Medical Equipment

• • • Oxygen equipment, Wheelchairs, Walkers, etc

• • Flu Shots, Hep B shots

• • Mammograms and Pap tests

• • • Once every 12 months

• • Mental Health Care

• • Diabetic Supplies

• • • Some supplies may be covered under Part D

• • Welcome to Medicare physical exam

• • Yearly Wellness Exam after 12 months on Part B

• • • Part B deductible does not apply

11.

• Part B premium for 2011 is $115.40 for those new to Medicare.

• • Higher premiums for those earning more than $85,000 filing single or $170,000 filing joint with spouse

• • Penalties for late enrollment

• Part B deductible for 2011 is $162

• Part B generally pays 80% of the cost after the deductible

• You pay the remaining 20% (co-insurance) in some instances co-pays may apply for certain services

• There is no Out of Pocket Limit for the Part B co-insurance!!!

12.

• Neither Part A or Part B cover the following:

• Acupuncture

• Chiropractic (few exceptions)

• Cosmetic Surgery

• Dental Care

• Routine Eye Exams

• Routine Foot Care

• Hearing Aids or Tests unless order by your doctor

• Orthopedic Shoes

• Service from non-Medicare Providers

• Services incurred outside of the U.S.

13.

• Original Medicare

• No Part A premium for most

• Part B premium for all, varies for higher income

• Deductibles apply

• Co-pays may apply under Part A for long hospital stays

• Co-insurance applies for Part B services

• There is no Out of Pocket Maximum for either Parts A or B

14.

• Provide Supplemental coverage to Original Medicare

• Approved by the individual states

• Generally cover expenses that Medicare does not such as Part A & B deductible, Part B co-insurance, First 3 pints of blood, etc

• Usually do not go beyond what Original Medicare covers

• Do not include Part D coverage

• More comprehensive coverage than Part C plans but, also more expensive

• Require Part A & B coverage

15.

• Part C - Medicare Advantage (MA)

• • Must be enrolled in both Part A & B to participate

• • Coverage provided by private insurers

• • Medicare pays a fixed amount to the company

• • Plans must be filed and approved each year by CMS

• • Must offer benefits at least as good as Original Medicare

16.

• • May offer benefits above and beyond what Medicare provides, such as dental, hearing and vision benefits

• • Must include an Out of Pocket Maximum

• • Providers bill private insurers, not Medicare

• • Premiums are usually lower than Medicare Supplement plans

• • Part B premium must still be paid

• • Includes HMOs, PPOs, PFFS, & Medicare M SAs

17.

• Part D - Prescription Drug Plan (PDP)

• Provides Medicare Beneficiaries with assistance in paying prescription drug costs

• • Coverage provided by private insurers

• • Requires minimum coverage level - Creditable Coverage

• • Beneficiary is subject to penalty if they dont have or maintain creditable coverage

• • May be purchased stand alone

• • Sometimes imbedded in a Medicare Advantage Plan (MAPD)

18.

• Formulary - list of drugs covered under the plan

• Creditable Coverage - coverage that is at least as good as the Medicare Standard Requirement

• Coverage Gap - prescription costs not covered by the plan (also referred to as the Donut Hole)

19.

• Drugs already covered by Medicare Part A or Part B

• Drugs used for anorexia, weight loss, weight gain, fertility, cosmetic purposes, hair growth, or symptomatic relief of cough and cold

• Prescription vitamins and mineral products

• Non-prescription drugs

20.

• Employer Sponsored

• • Voluntary Plans

• • Retirees from Group Coverage

• • Part-time employees

• Medicare Supplemental Coverage

• • Flexibility in coverage choices

• • Optional Benefit additions

• Creditable coverage Part D options

• • Includes coverage for all drugs through the Coverage Gap

• Available at any time during the year

21.

• Original Medicare only with a stand-alone Part D plan

• Original Medicare with a Medicare Supplement Plan and a stand-alone Part D Plan

• Medicare Advantage Plan that includes Part D coverage

• Group Retiree Plan (if available) with a Part D plan included

22.

• Want to know more about the Senior Market?

• Call us at 800-234-9488

• www.garityadvantage.com

• We provide the path to your success!