1. Presented by:
Brenda Rich

2. HTA Client Services Division
Medicare can be overwhelming!!
We Simplify Medicare
Who we are
Free & Unlimited phone support
Work with same Advisor or anyone on our Team
Specializing in Medicare for over 20 years
Access to over 35 insurance companies
Provide assistance Nationwide
What makes us different
Salaried Advisors - Not commissioned based – NO pressure to buy

3. This is a complementary service!
NO COST to YOU, FAMILY or FRIENDS
Anyone who needs help can call
Nationwide
Our Only Request…
Please allow us to help with your paperwork!
- HTA is paid by the insurance companies -
You do not pay a higher premium by enrolling through us rather than directly with the insurance company 

4. What is Original Medicare?
Original Medicare is “health insurance” for
Age 65 and over
Under 65 on SSDI for 24 months
End Stage Renal Disease (ESRD)- permanent kidney failure requiring dialysis or a kidney transplant
Has nothing to do with
“Normal Retirement Age”

5. Medicare Supplement Insurance
4 Parts of Medicare
Original Medicare
Federal Government
*A = Hospital (Inpatient)
*B = Medical (Outpatient)
Secondary Insurance
Choice of Companies
C = *Medicare Advantage OR
Medicare Supplement Insurance
(Plans A to N)
*D = Prescription Drug Plan +
*Can pay premium out of Social Security Income

6. Medicare Part A
Generally no cost (provided you or your spouse have worked a minimum of 40 quarters)
Hospital Admission
Helps cover
Inpatient care in hospitals
Skilled nursing facility care (limited)
Hospice
Home health services (limited)

7. Medicare Part B 2019 Base Premium = $135.50/month
Outpatient Medical Insurance
Doctors & Specialists
Diagnostic Testing - Labs, X-rays & MRIs
Outpatient Procedures - Surgery & Chemotherapy
Non-Inpatient hospital - ER & Hospital Observation
Durable medical equipment
Some preventive services
2019 Base Premium = $135.50/month

8. Part B Premiums by Income- 2019
Per Person, Per Month – Same Premium for each Spouse
Based on MAGI Income & Tax Return from 2 years ago

9. What Medicare Does Not Cover
Long-term care
Personal Care/Custodial Care
Routine dental or eye care*
Hearing aids & exams for fitting them
Dentures
Cosmetic Surgery
Acupuncture
Routine foot care
*Major Medical Eye Care is covered by Medicare
Cataract Surgery, Diabetic Eye Check Ups, Glaucoma

10. Medicare Confusion!! Get advice when you turn 64 Know what to expect
Do I have to go on Medicare when I turn 65?
What are my Medicare Options?
Can I defer Medicare Parts A or B?
What if I am not ready to retire?
Get advice when you turn 64
Know what to expect

11. And even as your Co-Workers
You are not the same…
As your Parents
As your Siblings
As your Neighbors
And even as your Co-Workers

12. 1 Page Roadmap

13. Is Medicare Automatic? Collecting Social Security?
Enrollment is Automatic
Valid reason to Defer = Return Part B
NOT Collecting Social Security?
Enrollment is not Automatic
Valid reason to Defer = Do Nothing

14. Possible consequences by not signing up
Penalties (without creditable coverage)
Part A – No Penalties as long as you are eligible for $0 premium
Part B – 10% for every 12 months added to Part B premium for life
Part D – 1% for each month you go with out creditable drug coverage after age 65
Deadlines (without creditable coverage)
Initial Enrollment Period = 7 months surrounding 65th Birthday
General Enrollment Period = once a year Jan 1st to Mar 31st for a July 1st effective date
Gaps in Coverage
Sometimes at age 65 Medicare becomes your Primary Insurance
If you don’t enroll, you may have to pay any bills Medicare would have been responsible for (approximately 80% of your medical care)

15. What is creditable coverage?
Group Health Coverage
Based on Current Active Employment
of the primary Insured
Who is your Primary Insured?
Non Creditable Coverage
Individual Plans – ACA, Obamacare
Group Plans not based on Current Active Employment – Cobra, Retiree, Severance

16. With Creditable Coverage
Penalty if not enrolled at age 65?
Employment Verification Form works like a Golden Ticket NO
Deadline to Enroll
8 months
Once Group Coverage or Employment end
To Enroll:
Visit local Social Security office
Over 20 Employees
Group Coverage
Primary
Under 20 Employees
Medicare Primary?
Check with Insurance Co

17. Do I have to enroll in Part A?
Enroll at age 65 or anytime thereafter
WITHOUT PENALTY OR DEADLINE
(As long as you qualify for PREMIUM FREE Part A)
HSA
Deposit = NO
Use Funds = YES
Use Savings For…
Medicare Parts A, B, C (Medicare Advantage), D
Out of Pocket Medical Expenses
Cannot Use Savings For…
Medicare Supplement Insurance

18. Without Creditable Coverage
Penalty if not enrolled at age 65?
Examples: ACA, Obamacare, Cobra, Retiree, Severance
YES
Deadline to Enroll
Enroll Online
7 months
3 months before + month of + 3 months after
65th Birthday
If you plan to enroll in the 3 months after your birthday, there could be a delay in your start date.
Individual Coverage
Medicare
Primary
Retiree, Cobra, Severance
Medicare Primary?
Check with Insurance Co

19. Am I required to Enroll in Medicare A or B?NO
MAYBE
YES
Primary Insured
Actively Working
&
On Group Creditable Coverage
Over 20 Employees
Primary Insured
Actively Working
&
On Group Creditable Coverage
Under 20 Employees
Not Working
Individual Coverage
No Coverage
Retiree Coverage
COBRA, Severance

20. Should I consider Medicare?
Breakeven Analysis
Group costs lower? Group plan is more cost effective.
Group costs higher? Possibly consider Medicare.
Good Network?
Over 20 Employees
$3,600/year
(more if high income)
Current Costs?
Premium
+ Out of Pocket Expenses
(copays, deductibles, not Rxs)
Under 20 Employees, OR Retiree, COBRA
$2,400/year
Dependent spouses may have higher costs making Medicare attractive

21. What about my
under Age 65 Spouse?

22. Medicare A/B Out of Pocket Expenses
Part A (Inpatient):
Deductible - $1,364/occurrence
Copays
Hospital after 60 days = $341-$682/day
Skilled Nursing after 20 days = $170.50, After 100 days = 100% of costs
Part B (Outpatient):
Deductible - $185/calendar year
Coinsurance - 20% - no maximum out of pocket limit
Excess Charges - up to 15% over Medicare allowable amount- no max oop
2019

24. ***Copays Up to:
$20/office $50/ER

25. Price Comparison F 65, Mid Atlantic
$155.87/month – Plan F
$0 out of pocket
$129.58/month – Plan G
$185 out of pocket
$108.33/month – Plan N
$185 + copays + excess charges (no cap)
$32.00/month – Plan HDF
$2,300 out of pocket
Plan G Net Savings = $130/year
($312 premium savings
- $185 out of pocket expenses)

26. Medicare Supplement = MediGap
Same benefits No networks
Same claims process Throughout USA
Any Doctor that accepts Medicare
Shop Premiums

28. Differences in Coverage
Medicare Supplement
(MediGap)
Part C
Medicare Advantage VS
No Managed Care
Managed Care
No Networks
(use any doctor that accepts Medicare)
Networks
(PPO, HMO, PFFS)
Care
Premiums = Higher
(approx $100-$250/month)
Purchase Separate Prescription Drug Plan
(approx. $33/month)
Premiums = Lower
(approx $0-$150/month)
Includes Prescription Drug Plan
(no additional cost)
Out of Pocket Expenses = Lower
(typically below $200/year)
Out of Pocket Expenses = Higher
(up to $6,700/year in network)
Cost
Initially = No Medical Questions
Anytime thereafter = Medical Questions
Annually = No Medical Questions
Apply

29. Start by reviewing your “non negotiable” doctors and hospitals
Medicare Advantage
Different benefits Different networks Different claims Coverage varies across USA
Shop Everything
Start by reviewing your
“non negotiable” doctors and hospitals

30. How to shop Rx plan What we need What we provide
Purchase from Government Contracted Carriers
Average Premium $33/month
20-30 plans available in each state
Plans cover different medications
Plans Rank medications in different tiers
What we need
List of meds including dosage & frequency
Name of Pharmacy
What we provide
Medicare Report
ReShop Annually during AEP 10/15-12/7

31. Stages of Rx Coverage Stage 4: Stage 3: Stage 2: Stage 1: >$5,100
*based on Tro-oP
2019
<$5,100
*based on Tro-oP
<$3,820
*based on retail costs
Stage 4:
Catastrophic
Up to
$415
Stage 3:
Donut Hole
Coverage Gap
Stage 2:
Copay
Initial Coverage Level
Stage 1:
Deductible
Total Drug Cost
May be a discount
Copay or Coinsurance
25%-Brand
37%-Generic 5%

32. Part D Premiums by Income- 2019
Per Person, Per Month – Same Premium for each Spouse
Based on MAGI Income & Tax Return from 2 years ago

33. Base
Income
Bracket
Approx. $275-$325
Add $100
per
Income
Bracket

34. Highest
Income
Bracket
Approx. $700-$750

35. Request a consultation
How to get started
, option 1
Request a consultation
Rx bottles handy for the call
Short Intake & Schedule Phone Appointment
Receive personalized “Roadmap to Medicare” & enrollment recommendations