1. Medicare 101 Seminar The Senior Planning Center 648 Wilton RD
Farmington, ME 04938

2. John Henninges

3. Agenda 1. Medicare Parts A - D 2. Government and private plans
3. Your options
4. Prescription drugs
5. Medical Supplemental Insurance
6. Next steps

4. Who Is Eligible? Medicare is available to people: 65 and Older
Under 65 with Disabilities
Of any age with End Stage Renal Disease (ESRD)
(permanent kidney failure requiring dialysis or a kidney transplant)
Lou Gehrig's Disease

5. Chapter 1: Medicare Has FOUR parts A, B, C, and D
Part A covers Hospital Insurance
i.e. In-patient stay at hospital, Skilled Nursing Facility, and Home Health Care
Part B covers Medical Insurance
i.e. Doctor’s Appointments, lab work at the hospital B
These are called Original Medicare
They are administered and provided by the federal government.

6. Part C Medicare Advantage
Part C is called Medicare Advantage and is purchased from a private insurance company. It is not a supplement to Medicare.
You can buy a Medicare Advantage Plan (Part C) if you:
Are enrolled in Parts A and B.
Live in the plan’s service area.
Do not have end-stage renal disease (some exceptions apply).
Medicare Advantage combines Parts A and B and may even offer prescription drug coverage.
Can include additional benefits ─eye care, hearing, wellness services, nurse phone line. C

7. Part D Prescription Drugs
Part D covers Prescription Drugs and is only offered through private insurance companies.
We will talk more about this later. D

8. The Four Parts of Medicare
Private Medical Plans
Government Programs
Hospital Care
Medicare Advantage B D
Private Drug Plans
Medical Care
Prescription Drugs

9. Chapter 2: Government and Private Plans
Why can’t I just rely on Parts A and B – what the government pays for? A B
Part A
Premium: $0
Deductible: $1316 every 60 days
Hospital Stays:
Days 1-60: Deductible
Days 61-90: $329 co-pay
Days 91+: $658 co-pay per day (60 day lifetime limit)
Skilled Nursing Care
Nursing Home Care (not LTC)
Hospice
Home Health Services
Part B
Premium: $134.00
Deductible: $183.00
Co-Insurance: 20% of ALL COSTS with NO LIMIT

10. A private plan may help cover costs like:
Deductibles
Copays and coinsurance
Drugs on a formulary
Preventive services
Dental, vision or other benefits

11. Chapter 3: Your Options How to Decide on a Plan
Questions to consider when choosing your Medicare options
1. Do I have a chronic condition?
2. What monthly premium can I afford?
3. Can I see the doctors I want?
4. Will my prescription drugs be covered?
5. What will my out-of-pocket costs be?
6. Can I use the pharmacies I want?

12. You Have Two Paths to Choose from:
Medicare
Part A: Hospital
Part B: Medical
Part D: Prescription
Supplemental Insurance
Medicare Advantage
Combines Part A: Hospital and Part B: Medical
It usually includes a drug plan
Medicare Part D: Prescription – You can buy it if it is not included

13. HMO PPO PFFS SNP Medicare Advantage You’ll use Doctors In the Network
Health Maintenance Organization
You’ll use Doctors In the Network
You may need a Referral to see a specialist
PPO
Preferred Provider Organization
You can use Doctors and Providers outside of the network, but often for a higher co-pay
PFFS
Private Fee for Service
You can use any Doctors who accept the terms and conditions of the plan
SNP
Special Needs Plan
Designed specifically to work for individual with Chronic Needs or the Dual-eligible individual.

14. What doesn’t Medicare Pay for?
$1,316
$164.50
Per Day
$183
20%
Coinsurance for Part B of covered services
Part A Deductible every 60 days
Skilled nursing facility co-pay for days 21 – 100
Annual Part B Deductible

15. What Else Will Medicare Advantage Help Cover?
Emergency Medical Abroad
Annual Hearing Exams, Eyewear & Hearing Aids
Part D: Prescription Drugs
Out of Pocket Medical Annual Limit

16. Chapter 4: Prescription Drugs You Have Two Choices
PDP
Medicare Advantage with Part D Coverage
Stand Alone Medicare Prescription Drug Plan

17. Have You Heard about the Donut Hole?

18. Here’s How it Works… You Have Four Phases of Coverage
Your Part D insurance pays until $3,700 in Total Part D drug spending is reached.
Once $3,700 is reached, you are in the coverage gap ─ until your expenses reach $4,950. This is the “donut hole.”
After $4,950 ─ you pay the greater of 5% or $3.30 for generics and $8.25 for all other drugs.
You pay until you reach your deductible
$400

19. Chapter 5: Medicare Supplemental Insurance
Sometimes it’s called Medigap insurance.
It is only available when you choose Original Medicare.
It helps cover the gaps of what Original Medicare doesn’t — such as portions of coinsurance, copayments and deductibles
Original Medicare
Part A: Hospital
Part B: Medical
Supplemental Insurance

20. Medicare Supplemental Insurance
BENEFITS A B C D F G K L M N
Part A coinsurance and hospital costs (up to an additional 365 days after Medicare Benefits are used)
100
Part B coinsurance or copay 50 75
Blood (First 3 Pints)
Part A Hospice Care coinsurance or copayment
Skilled Nursing care coinsurance
Part A deductible
Part B deductible
Part B excess charges
Foreign Travel Emergency (up to plan limits) 80
Co-pays and deductibles vary by plan, so pay close attention to what your plan does and doesn’t cover, and when.

21. Chapter 6: Bringing it all Together
Step One:
Enroll in Medicare Parts A & B once you are eligible
Step Two:
You now have two options
Keep Original Medicare and add:
Supplemental Insurance &/or Part D
Choose a Medicare Advantage:
which often offers Part D benefits.

22. How to Enroll
If you are getting Social Security when you turn 65, you will automatically be enrolled.
If you’re not getting Social Security when you turn 65, you’ll need to sign up. Contact Social Security three months before you turn 65.
If you worked for a railroad, contact the Railroad Retirement Board.
Note: People on social security disability will automatically be enrolled in their 25th month of disability.

23. When can I Enroll?
It’s a seven-month window. It includes the three months before you turn 65, your birthday month and the three months after your 65th birthday.
If you don’t enroll within this window, you will face a penalty of a higher premium. For Part D, you will face a penalty that increases based on each month that you delay.
For Parts C & D, you can also enroll during the “Annual Open Enrollment” (AEP).
AEP runs from October 15 to December 7, and all people with Medicare can change their health care plans.

24. Special Election Period (SEP)
You can also enroll in Parts C and D during a “special enrollment period” for special circumstances such as:
Losing your employer coverage.
5 Star Plan.
Moving to a new service area.
Getting “Extra Help” for prescription drugs.

25. When can I Enroll in a Supplement?
In most states, it’s a six-month window that starts when you turn 65 and enroll in Part B.
What if I delay enrollment?
You can still enroll but may be charged a late penalty.

26. Things to Remember
You can enroll in Medicare three months before, the month of, and three months after your 65th Birthday.
You can face a penalty if you choose not to enroll within this period.
You can change your plan during AEP (October 15th- December 7th) annually, unless you qualify for an SEP.

27. John Henninges