What is Medicare? Medicare is a federal health insurance program for People age 65 or disabled more than 24 consecutive months People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Lots of moving parts to Medicare- -Part A- Hospital -Part B- Doctor/Medical – Monthly Premium -Part C Medicare Advantage Plan-Combines parts A/B/D into 1 plan -Part D Prescriptions- Stand alone plans with premiums or included in Part C plan -Medicare Supplement- Supplements Medicare costs for those who do not want Medicare Part C

Medicare Limitations No coverage outside of U.S. (Exceptions: Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa) Some services are not covered Deductibles (Each Benefit period/Year) Coinsurance (20% most services) Gaps in coverage create financial risk No Maximum Out Of Pocket Structured prescription drug coverage/Drug coverage gaps

What's Not Covered Acupuncture Cosmetic surgery Custodial care (Long-Term-Care) Dental care/dentures (May be covered in certain instances) Health care while traveling outside the US Hearing aids/exams Orthopedic shoes (May be covered in certain instances) Routine foot care (podiatry) Routine eye care and eyeglasses Some screening tests and labs Syringes and insulin (insulin pump covered under Part D) Some Vaccines, except those covered under Part B or Part D)

Initial Enrollment Period Most are enrolled automatically when they turn 65 if getting Social Security or Rail Road Retirement and will receive a card approximately 3 months before 65 th birthday If not enrolled automatically, there is a 7-month period that begins 3 months before the month you turn 65,includes the month you turn 65, and ends 3 months after the month you turn 65 If you are not enrolled automatically, you can sign up 3 months prior to your birthday by calling social security at or mailing in an application to social security. We can also be of assistance in helping you sign up. We have the required applications handy.

Annual Enrollment Period October 15 th -December 7 th Each Year During this time you may change, add, or drop your Health Plan or Prescription Drug Plan Annual Disenrollment- Jan 1 st -February 14 th you can drop a health plan and go back to regular Medicare and a Prescription Drug Plan. Special enrollment outside of Oct 15 th -Dec 7 th - Turning 65 ( 3 months before or after birthday 6 months before for Supplement) -Medi-cal/Medicare or LIS (low income help with medications- Year Round - Chronic Condition (verified)- Special needs plan- Diabetes, Heart Disease, Dementia ect - Did you know….You can change your Medicare Supplement Plan Year round provided you are changing from one plan to another or you are adding a plan. You cannot change from Medicare Advantage to Medicare Supplement or change your prescription drug plan except during open enrollment/disenrollment or special enrollment situations.

Part A (Hospital Insurance) People age 65 or older who paid Medicare payroll taxes for 40 working quarters or some may qualify through their spouses work. Those who qualify get this coverage for free If you have not worked enough quarters it could be purchased for up to $441 (depending on how many quarter you are short) Helps cover inpatient care in hospitals Helps cover skilled nursing facility, hospice, and home health care

Part A Benefits Inpatient Hospital coverage for 90 days per benefit period after $1,260 yearly deductible After in the hospital 60 days co pay of $315 per day for days Copayment of $630 per day for days (after you have been in the hospital for 90 days; these are your 60 lifetime reserve days) No coverage for inpatient hospital once 90 days per year and reserve days are used. Inpatient psychiatric, 190 days lifetime Skilled Nursing (SNF) up to 100 days per benefit period after 3 days hospital stay) Days 0-20 $0 Days $ per day Home Health Care after a hospital visit Hospice Care

Part B (Medical Insurance) At age 65, those who elect Part B will have the premium deducted from Social Security check or billed each month (based on income / 2012 based on 2010) Helps cover doctors’ and other health care providers’ services, outpatient care, durable medical equipment Helps cover some preventive services. As of 2013 $ for most seniors (slightly higher for singles making over $85,000 or married over $170,000) 10% premium penalty for each year you wait so usually best to purchase right away unless you have other credible coverage.

Part B Benefits Outpatient Physician services Outpatient hospital services Clinical lab Ambulance Diagnostic tests (X-rays, MRIs, CT scans) Medical equipment Eyeglasses (only after cataract surgery) Home Health Care

$147 annual Part B deductible 20% of the Medicare-approved amount after deductible There is no yearly limit for what you pay out-of-pocket Part B Patient Cost

Part C: Medicare Advantage Plans Medicare Advantage Plans Must be entitled to Part A / enrolled in Part B Must reside in health plan’s service area -- Equivalent to, or better than, Parts A & B May include benefits not covered by A & B May include Part D drug coverage Annual Maximum Out-of-Pocket (MOOP) Must still pay Part B premium but many times no additional premiums. Popular due to extra

Medicare Advantage Plans Many Plans to choose from depending on a seniors needs Areas to consider when choosing a plan -Doctor/ Specialist/Providers in network -Prescription Co- Pays -Co Pays for Doctor/Specialists/Services -Additional benefits that may help reduce costs

Medicare Advantage Plans Continued - In Southern California Only HMO MA Plans Senior must use in network doctors and get referred to specialists. Referrals must be approved by the doctor and health plan. The benefit to a Medicare Advantage Plan is reduced/eliminated co-pays, protection of assets because of MOOP, most include part D with no added premium Additional benefits sometimes available that are not covered by original Medicare

 Covers Prescription Medications.  Is usually included in Part C plans if you opt to get Medicare part C  Must be purchased separately if you decide on original Medicare or Medicare + a Supplement plan  Must purchase as soon as you qualify for Medicare or you will be penalized for every month you wait to purchase with a higher premium if you do not have other credible drug coverage such as work or retirement insurance through work. Medicare Part D

Medicare Supplement Can be added to a Medicare Plan A, B, D plan to cover the gaps Medicare does not cover Great for seniors who want more freedom than an HMO offers IE no doctor referrals or having to see an in network doctor. See any doctor who accepts Medicare Additional Premium Several Plans to choose from Most popular plans cover all or most co pays/deductibles. Must pay for part D separately. Most popular plans are Plan F, G, and N

Medi-Cal Joint Federal and State program that helps pay medical costs if you have limited income and resources and meet other requirements. Some qualify for both Medicare and Medicaid and are called “Dual Eligible.” A household of 1 may qualify for medi-cal if their income is under $16,200. A 2 person household may qualify if income is under $21,700. If income is slightly higher, you may still qualify for reduced benefit medi-cal or LIS (Low Income Subsidy) to help with prescription costs There are special needs Medicare plans for those on Medi-cal. Medi-cal Recipients can sign on to a new plan all year long. We can help you apply for Medi-cal/LIS if you would like

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