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The Medicare Maze: Avoid Costly Turns and Lifelong Penalties

Published byLaurel Wells Modified over 6 years ago

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Presentation on theme: "The Medicare Maze: Avoid Costly Turns and Lifelong Penalties"— Presentation transcript:

1 The Medicare Maze: Avoid Costly Turns and Lifelong Penalties
Kevin Dougherty , ext. 1

2 Medicare’s Four Parts Part A Hospital Part B Medical Part C Medicare Advantage Part D Prescription Drug Program

3 Original Medicare Part A: Hospital and Skilled Nursing Facility
Entitlement at age 65 (or earlier if disabled) $1,316 deductible for 2017 Co-payments for extended hospital stay Co-payments for skilled nursing facility Part B: Physician Services, Preventive Care, Urgent Care, Emergency Room and Durable Medicare Equipment Elective at age 65 Premium and possible Income Related Monthly Adjustment $183 Deductible 20% Co-insurance over the deductible Excess Charges

4 What’s NOT Covered by Medicare’s Part A and Part B?
Long-Term Care Dental and Routine Vision Acupuncture Hearing Aids and Exams for fitting Cosmetic Surgery Certain Chiropractic Services Prescription Drugs (covered by Part D)

5 Medicare Supplement Insurance
11Plans (A, B, C, D, F*, G, K, L, M and N) Also known as Medigap Insurance Plans may fill in some or all of Part A and Part B gaps in coverage Features and Benefits of a Plan are identical among insurance companies but cost varies Insurance companies only process claims – only Medicare may approve or deny Acceptance is guaranteed for 6 months after Part B enrollment and during special situations.

6 Medicare Supplement Insurance (continued)
Plan F is the most comprehensive Plan Plan F fills in all Part A and Part B gaps Plan F provides No deductible, No co- insurance, No co-payments for any Medicare approved Part A and/or Part B expenses No Networks but the doctor must accept Medicare

7 Part D Prescription Drug Program
Effective January 1, 2006 Medicare Beneficiaries are eligible when first enrolling in Medicare or when losing “creditable coverage” Part D Plans are NOT standardized Part D Plan may have a deductible up to $400 Insurance company sets formulary, tiers and co-payments Subject to late enrollment penalties and Income Related Monthly Adjustment

8 John, “aging in”, Potomac resident, joint income $250,000
Part A Monthly Premium $0.00 Part B Monthly Premium $134.00 Part B Monthly Income Adj $133.90 Medicare Supplement Plan F $171.85 Part D Prescription Drug Plan $33.90 Part D Monthly Income Adj $34.20 Probable Drug Co-payments Total Premium Cost $507.85

9 Part C – Medicare Advantage
Medicare HMOs, PPOs and Private Fee for Service Plans (PFFS) Network Plans Copayments for services Part D coverage may be included 12-month trial period Lower premium opportunity in exchange for limited flexibility and limited choice

10 John, “aging in”, Potomac resident, joint income $250,000
Part A Monthly Premium $0.00 Part B Monthly Premium $134.00 Part B Monthly Income Adj $133.90 Medicare Advantage PPO $78.00 Copayments for Services ? Part D Prescription Drug Plan N/A Part D Monthly Income Adj $34.20 Probable Drug Copayments Total Premium Cost $380.10

11 Points to Remember! Timing of Part B enrollment
If a beneficiary has “creditable coverage”, Part A and Part B enrollment may be delayed without penalty COBRA and retiree coverage are NOT “creditable” Enrollment error may be lead to a period of being uninsured for Part B If a beneficiary is receiving Social Security benefits, Part A and Part B enrollment is automatic Consequences for Health Savings Accounts (HSA)

12 Points to Remember! Timing of Part B enrollment
Medicare Supplement insurance options Standardized Plans – Choose the correct Plan Shop for a highly rated insurance company with competitive premium Review annually

13 Points to Remember! Timing of Part B enrollment
Medicare Supplement insurance options Part D Prescription Drug Plans Choose the correct Plan Review annually during Annual Enrollment Period which runs from October 15th through December 7th

14 Points to Remember! Kevin Dougherty
Avoid enrollment errors and penalties Compare Medicare options Annual Part D Drug Plan reviews No fee No additional premium cost Licensed in MD, VA, DC, DE, IN, MI, NJ, NC, OH, PA, SC and WV. Willing to assist any Medicare beneficiary or Medicare eligible individual

15 Points to Remember! Kevin Dougherty Ashcroft Terrace Monrovia, MD , Ext

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