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Medicare - PowerPoint PPT Presentation

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Medicare . Understanding your options. PART B. PART A. PART C. PART D. MEDICARE SUPPLMENT. Agenda. The ABC’s of Medicare Insurance Who pays for what ? Plan Types Plan Comparisons & YOUR OPTIONS . The Parts of Medicare . Part A - covers hospital and inpatient services .

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Understanding your options








  • The ABC’s of Medicare Insurance

    • Who pays for what?

    • Plan Types

    • Plan Comparisons



The parts of medicare
The Parts of Medicare

  • Part A - covers hospital and inpatient services.

  • Part B - is the part of Medicare that covers doctor’s office and outpatient services

  • Part C - an optional part of Medicare that is also known as Medicare Advantage (still part of Medicare, coverage is provided through the private insurance carrier combining part A,B & D)

  • Part D is the prescription drugs part of Medicare

  • Medigap – Also called Medicare Supplements are standardized plans can help you pay some of the costs not covered by Original Medicare

What medicare covers
What Medicare Covers

  • Part A – Hospital Insurance helps cover*

    • Inpatient Hospital Care

    • Skilled Nursing Facility care

    • Home health care

    • Hospice care

  • Part B – Medical Insurance helps cover*

    • Doctor’s visits

    • Outpatient medical services

    • Clinical lab tests

    • Durable Medical Equipment

    • Preventive services

Paying for part a
Paying for Part A

  • What does Part A cost?

    • Most people get Part A premium free

      • If you or your spouse paid FICA taxes at least 10 years

    • If you paid FICA less than 10 years

      • You can pay a premium to get Part A

Paying for part b
Paying for Part B

Premiums are typically deducted directly from your Social Security

Who pays for what
Who pays for what

  • In Original Medicare you pay.

  • Yearly deductible of $147 in 2013 and

  • 20% coinsurance for most services.

  • What you need to consider is paying for the 20%

Medicare insurance options
Medicare Insurance Options

Medicare Supplement Insurance

  • Medicare Supplement Insurance Policies

    • Sold by private companies

  • Fill the gaps in Original Medicare

    • Deductibles, coinsurance, copayments

  • Standardized plans

  • All plans with same letter

    • Have same coverage

    • Only the costs are different

  • To join a private Medigap plan, you pay a monthly fee to an insurance company in addition to the premium you pay to the government for Medicare Part B.

Standardized supplment plans
Standardized Supplment Plans

  • * Plan F also has a high deductible options, some companies may offer this option.

  • ** Plans K & L pay 100% of covered services for the rest of the calendar year after you meet your

  • out-of-pocket yearly limit.

  • *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some

  • office visits and up to a $50copayment for emergency room visits that don't result in an inpatient admission.

Part c combining parts a b
Part CCombining Parts A&B

  • Health plan options approved by Medicare

    • Another way to get Medicare coverage

    • Still part of the Medicare program

    • Run by private companies

  • Medicare pays the insurance carrier a premium

    • You continue paying for your Part B

  • May have to use network doctors or hospitals

  • May include additional benefits, Vision & Dental

  • Types of plans available may vary HMOs

    PPOs & Special Needs

Part d
Part D

  • Available for all people with Medicare

  • Provided through

    • Medicare Prescription Drug Plans

    • Medicare Advantage Plans

How part d works
How Part D Works

  • It’s optional (however you may have a penalty for joining late)

    • You can choose a plan and join

  • Plans have formularies

    • Lists of covered drugs

    • Must include range of drugs in each category

  • You pay the plan a monthly premium

  • You pay deductibles and copayments

Things to keep in mind
Things to keep in mind

Plans must offer at minimum, coverage equal to or greater than Original Medicare.

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