1. Maximize Your Medicare Benefits
[INSERT YOUR AGENCY NAME/LOGO HERE]
[INSERT DATE OF PRESENTATION]

2. Original Medicare Card
This is a sample of a Medicare Card. Your use of the Medicare Card will differ depending on the type of Medicare health plan option you choose. If you choose Original Medicare, you will use the red, white, and blue Medicare card when obtaining health care.
This card has your Health Insurance Claim Number (HICN). Please check this number for accuracy.
Your claim number may be….
Your Social Security or your spouse’s Social Security number followed by a letter.
If you worked for the Railroad you may have letters before numbers.
The number indicates who’s record your eligibility is based on.
The letter indicates how you are related to that person.
Your card also has listed the parts of Medicare you are enrolled in and the dates they became effective.
(Medicare Part A & B are the only parts that will be reflected in this card. Medicare Part C or D are offered through private companies.)

3. (Option to Original Medicare)
The Parts of Medicare…
Part A
Helps cover inpatient care in hospitals and skilled nursing facilities, and provides limited coverage of hospice and home health care.
Part B
Helps cover doctor’s services, outpatient care, home health care and some preventive services.
Part C
(Option to Original Medicare)
Medicare Advantage Plans: An alternative way to get Medicare benefits managed by a private insurance company approved by Medicare. Combines Part A and B and sometimes Part D (Prescription Drugs)
Part D
Helps cover the cost of prescription drugs. Run by private insurance companies approved by and under contract with Medicare.

4. Your Medicare Coverage Choices
Original Medicare
Part A
Hospital Insurance
Part B
Medical Insurance
You can add
Part D
Prescription Drug Coverage
Medicare Supplement Insurance (Medigap) Policy or
Medicare Advantage Plan
Part C
Combines Part A and Part B
May include or you may add
(Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.)
There are 2 main ways to get your Medicare coverage, Original Medicare, or Medicare Advantage (MA) Plans. You can decide which way to get your coverage.
Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). You can choose to buy a Medigap policy to help cover some costs not covered by Original Medicare. You can also choose to buy Medicare prescription drug coverage (Part D) from a Medicare Prescription Drug Plan (PDP).
MA Plans (Part C), like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), cover Part A and Part B services and supplies. They also may include Medicare prescription drug coverage (MA-PD). You can add a Medicare PDP to a Medicare Private Fee-for-Service Plan or Cost Plan if it doesn’t provide Part D coverage, and you can add it to a Medicare Medical Savings Account Plan. You can’t add a Part D plan to a Medicare HMO or PPO plan without drug coverage.
Medigap policies don’t work with these plans. If you join an MA Plan, you can’t use a Medicare Supplement Insurance (Medigap) Policy to pay for out-of-pocket costs.

5. Part A: A few more details…
Helps Cover Cost of Inpatient services
Hospital inpatient
Skilled nursing facility
Home health
Hospice benefits
Blood
Medicare Part A is part of Original Medicare
No Premium if you have enough “Work Credits”
$1,364 Deductible per Benefit Period (Benefit Periods separated by at least 60 days)

6. Hospital “Observation Status”
Not considered “Inpatient”
Medicare Part A pays nothing
Medicare Part B pays for doctors services and hospital outpatient services after YOU pay your deductibles, coinsurance and copayments
When in hospital more than a few hours, ALWAYS ask doctor or staff if you are Inpatient or Outpatient
Your hospital status affects how much you pay for hospital services and also whether Medicare will cover care you get in a skilled nursing facility (SNF)
“Complex medical decision based on your doctor’s judgement and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more overnight’s of medically necessary hospital care..”

7. Medicare Part B in 2019 Covers Outpatient Services
$ Standard Monthly Part B Premium
*Premiums may be higher if your income is over $85,000/year for single ($170,000/year if married)
$185 Annual Deductible
Covers Outpatient Services
80% of covered costs (after you pay your deductible)
You pay 20%

8. What Part B Covers: Doctors’ services
Outpatient surgical services and supplies
Diagnostic tests
Outpatient therapy
Outpatient mental health
Durable medical equipment (DME)
Outpatient hospital services
Blood
Ambulance services
Any other medically necessary items or services
Annual Wellness Exam
Zero co-pay coverage of many preventive services

9. Medicare does not pay 100% of your medical bills.
The Gaps
Medicare does not pay 100% of your medical bills.
You may choose to purchase a Medicare Supplement (Medigap) policy if you have Original Medicare, or
You may choose to enroll in a Medicare Advantage Plan
Gaps: Deductibles, co-insurance/co-payments, monthly premiums

10. Medicare Supplemental Policies (Medigap)
Private Insurance to supplement Original Medicare
Approved & regulated by WI Commissioner of Insurance
You must have Medicare Parts A and B to buy Medigap policy
You pay a premium for this type of plan (Average: $150/mo)
A Medigap policy covers one person
Basic Policy pays the 20% after Medicare
Medicare will pay its share of approved amounts, then Medigap policy pays its share
No need to change policies each year

11. Medigap in Wisconsin Basic Benefits Wisconsin Mandated Benefits
Covers 20% after Part B, copays for Part A, additional inpatient psychiatric days, first 3 pints of blood, 40 home care visits
Wisconsin Mandated Benefits
Chiropractic services, 30 days non-Medicare Skilled Nursing Facility
Discuss: OPTIONAL RIDERS! Part A ded, Part B. ded, Emergency foreign travel, etc.
Basic Benefits: 20% approved amount after Medicare on most services, co-
payments for Hospitalization and skilled nursing care, additional Psychicatric
care (175 days lifetime), First 3 pints blood, 40 additional Home Health care
visits.
WI Mandated: Usual/Customary cost of non-Medicare covered Chiropractic
care, 30 days non-Medicare skilled nursing facility care w/ no prior
hospitalization required (pays up to states Medicaid rate)
(note: some policies prior to 1/1/06 may still include diabetic mandate if the policy holder never took part D)
Medigap

12. Medigap in Wisconsin Optional Riders(benefits):
Part A Deductible (or Part A 50% Ded.)
Part B Deductible*
Part B Copay/co-insurance(reduces premiums)
Part B Excess Charges
Additional Home Health
Emergency Foreign Travel
*In 2020 the Part B Deductible rider will no longer be an option for people just starting Medicare. (Still available for those already on Medicare.)

13. Steps to Buy a Medigap Policy
STEP 1: Decide which benefits (Riders) you want, then decide which of the Medigap policies meets your needs
STEP 2: Find out which insurance companies sell Medigap policies in your state
STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs
STEP 4: Buy the Medigap policy

14. Best Time to Buy —For Guaranteed Acceptance
During Your Medigap open enrollment period (OEP)
6 months beginning the date you are 65 or older and enroll in Medicare Part B
Insurance company cannot deny a policy based on health status or medical condition
You can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health
If you apply during your Medigap OEP, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you don’t purchase a plan within your 6-month OEP, insurance companies can deny coverage based on your health conditions.
** Pre-existing conditions: While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre-existing condition. Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out‑of‑pocket expenses. You may buy a Medigap policy any time an insurance company will sell you one.

15. Delayed Medigap Open Enrollment Period (OEP)
If you delay enrolling in Medicare Part B
Because you or your spouse is still working, and
You have group health coverage (primary)
Medigap OEP is delayed
Until enrolled in Part B
No late enrollment penalty
If disabled, get a 2nd OEP when turning 65
Notify Social Security to delay Part B
If you have group health coverage through an employer or union, because either you or your spouse is currently actively working, you may want to wait to enroll in Medicare Part B. This is because benefits based on current employment often provide coverage similar to Part B, you would be paying for Part B before you need it, and your Medigap Open Enrollment Period (OEP) might expire before a Medigap policy would be useful.
When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty, which means your Medigap OEP will start when you’re ready to take advantage of it. If you enroll in Part B while you still have current employer coverage, your Medigap OEP will start, and unless you buy a Medigap policy before you need it, you’ll miss your OEP entirely. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare.
If you aren’t going to enroll in Part B due to current employment, it’s important that you notify Social Security that you want to delay Part B.
NOTE: Remember, if you took Part B while you had employer coverage, you don’t get another Medigap OEP when your employer coverage ends. You must have both Medicare Part A and Medicare Part B to purchase a Medigap policy.
See slide 25 for Medigap enrollment information for people with End-Stage Renal Disease.

16. Guaranteed Issue Other times you cannot be denied a policy:
Your Medicare Advantage plan terminates or stops providing care in your service area
You move outside the plan’s service area
Your employer group health plan ends some or all of your coverage
Your employer group plan increases cost by more that 25% in one 12 month period
You are in Trial Period of Medicare Advantage plan*
Apply within 63 days of date other coverage ends.

17. For Medigap Questions:
Wisconsin SHIP:
(“Medigap Helpline”)
Commissioner of Insurance
You can view the Medigap policies available in your area by using the Medigap Policy Search on under “Supplements and Other Insurance”.

18. Medicare Part C Medicare Advantage Plans
Replaces Original Medicare
Private Insurance Companies approved by Medicare
Includes BOTH Parts A & B
Low or No Premiums over what you pay for Medicare
In most plans you must see plan doctors
You usually pay a copayment for covered services
Costs, extra benefits and rules vary by plan

19. Advantages and Disadvantages of Medicare Advantage/Part C
ADVANTAGES DISADVANTAGES
Low or no monthly premium (besides Part B premium) Out of pocket costs if poor health
Coordinated care with network physicians Higher costs when out of network
Some offer extra benefits (Vision, dental, hearing) No State Mandates or protections
Varied plans and choices Confusion over plans/coverage
Can change plans each year May have to change plans each year
Out of Pocket Copay Maximum
Must follow CMS/Medicare regulations Enrollment is limited to specific times of the year
Annual Open Enrollment Dates: October 15th – December 7th
Important to Review Plan EVERY YEAR to be sure you will have appropriate coverage in the new year. Make any changes during open enrollment period.
Out of pocket costs may be higher than Traditional Medicare and a Supplemental policy.
Beneficiaries cannot receive any Medigap coverage while enrolled in a Medicare Advantage Plan.
Advantage Plans are annual contracts, between private insurance companies and Medicare, and are NOT GUARANTEED renewable.
The plan’s Premiums, copays, and benefits change every year. The changes in your plan are at the discretion of the insurance company, and are not governed by the state.
Medicare advantage plans are based on your geographic location.
Services are not available everywhere in the country.

20. Other Coverage Employer/Retiree Group Health Plan
Is it a Supplement or Medicare Advantage?
Some offer “creditable” prescription coverage
Contact your employer or union benefits administrator to find out how your insurance works with Medicare
Military Coverage: VA or TriCare
Medical Assistance/Low Income Programs

21. Protect Yourself & Prevent Fraud
Medicare beneficiaries receive mass mailings from insurance companies. Can be confusing!
No unsolicited phone calls allowed
Agents may not come to your home uninvited
Plans may not ask for personal information over the phone or
To report violation or concern about fraud, call:
1-800-MEDICARE
Be prepared before meeting with an agent.
Know what type of plan you are looking for, and be clear with your agent about what you want.
Do not let your agent talk you into something you do not feel comfortable with.
Have a list of questions ready.
When choosing an Advantage Plan you should consider…
What providers are available to you? Will the plan allow you to see the providers you want?
Does the plan offer Prescription Drug Coverage?
Are there any additional benefits that may be offered, and is there an additional charge for these benefits?
What are the benefits that are excluded that would be covered under an Original Medicare Supplemental Policy?
What is the total cost to you, including premiums, coinsurance, copayments, deductibles, or other out-of-pocket expenses?
What is the coverage area of your plan, will it cover you where you are traveling?
If you have a specific health condition, is one type of plan better suited to provide the services you need?

22. Medicare Part D Medicare approved private drug plans
Enrollment is voluntary but:
1% per month premium penalty if don’t enroll when first eligible
No penalty if previous “creditable” coverage within 63 days of enrolling
Two roads to Part D drug coverage:
Enroll in a plan with just drug coverage - PDP
Enroll in a plan with drug coverage and all your medical coverage- MA-PDP

23. Initial deductible no more than: $415
Part D in 2019
Catastrophic Coverage
Begins when Total Out of Pocket Costs reach $5,100
Beneficiary pays min. cost of
$3.35/Generics and $8.35/ Brand names
THE COVERAGE GAP When your Total Drug Costs reach $3,820
You Pay: 25% on Brand names 37% on Generics
Part D Plan Pays 75%
You pay about 25%
(Your Co-Pay)
Initial deductible no more than: $415 23

24. Annual Enrollment Period
October 15th – December 7th
Medicare Advantage Plans and Medicare Part D plans can change their plan details each year
Plan formularies and premiums can change each year
Review your current plan annually!

25. How to Choose a Plan?
Compare plans on the PlanFinder at:
Call Medicare at:
Call Medigap Hotline (WI SHIP):
For local assistance: <YOUR CONTACT INFO>

26. What is the Plan Finder? Click “Find Health and Drug Plans”
Although we all call it the planfinder, it is not referred to as such anywhere on the Medicare website

27. The Plan Finder
The plan finder walks you through multiple steps to achieve your personalized results
Results are based on the info you enter:
Zip code – plans vary by county
Your medications
Pharmacy preference
Eligibility for assistance – “Extra Help”
Retail/Mail order preference

28. Your Results
Results will be sorted by lowest annual cost

29. Results Continued

30. Additional Considerations
Are your medical providers/pharmacy in-network with this plan?
For Medicare Advantage plans, what services are you most likely to use? What are the co-pays for those services?

31. Ways to Enroll: Online via the Medicare website or the plan’s website
Call Medicare ( ) or the plan directly
Some plans will have an agent you can meet with

32. What if someone needs help with Medicare Costs?

33. For more information or assistance contact:
Medicare Related Programs For Medicare Beneficiaries with limited income and assets
Medicare Savings Plans
If eligible, your Medicare Part B premium will be paid for you
Some also have co-pays and deductibles paid as well based on income & assets
Extra Help (Low Income Subsidy)
Assistance with Medicare prescription drug coverage
Reduces Part D premiums, deductibles and co-pays based on income & assets
For more information or assistance contact:
<YOUR CONTACT INFO HERE>

34. SeniorCare WI Prescription Drug Assistance Program
Age 65 and over on Medicare
$30 Annual application fee
NO Asset limit
“Creditable” coverage
Level of assistance depends on income
May use alone or in addition to Part D

35. For more information or assistance contact: <YOUR CONTACT INFO HERE>