Medicare 101

Medicare Basics provided by:

Dan Stevens256-338-4571

Dan@AlabamaHealthGuidance.comwww.AlabamaHealthGuidance.com

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Medicare

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Medicare Road Map

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Medicare

Sign up for Medicare

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Medicare

Health PlansCompare Prescription Drug Plans

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Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

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Medicare

Health PlansCompare Prescription Drug Plans

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Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

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Medicare

Health PlansCompare Prescription Drug Plans

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Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

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Medicare

Health PlansCompare Prescription Drug Plans

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Review your coverage annually

Medicare Road Map

Learn the

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Medicare

Who is Alabama Health Guidance?Alabama Health Guidance is an independent insurance agency located in Florence, Al, specializing in

Medicare education and Medicare health plans. Started in 2009 to assist individuals with their Medicare healthcare needs, AHG has transitioned to providing Medicare education to both individuals

and corporations. With over 25 representatives working throughout Alabama, AHG is here to serve you!

Why are we here?To provide Medicare education to people with Medicare.

Medicare 101

Our Qualifications?We are licensed insurance agents, certified to discuss and guide people

to appropriate Medicare health plans, drug plans, and Medicare Supplements.

What can we do?This a Medicare education class. We’ll discuss the general principles of Medicare,

what it covers, what it does not cover, and some ways to limit your exposures.

What can’t we do?We are not allowed to discuss specific companies or plans.

Our contact information is available to you to arrange private meetings.

Medicare 101

What is Medicare and Who Qualifies? • People 65 years of age and older• People with certain disabilities• Anyone with End-Stage Renal Disease or

ALS

Medicare 101

“When do I sign up for Medicare?”

Medicare 101

Signing up for MedicareInitial Enrollment Period:

When you first become eligible for MedicareCan be for disability (usually 24 month

waiting period)Can be for aging in at 65

3 months beforeThe month you turn 65

2 months beforeThe month you turn 65

1 month beforeThe month you turn 65

The month you turn

65

1 month after you turn 65

2 months after you turn 65

3 months after you turn 65

Medicare 101

Signing up for Medicare Special Election Period:• For people who have a special circumstance

happen to them• Example: Losing employer insurance

coverage

Medicare 101

Annual Enrollment Period• Time frame set aside for a Medicare

beneficiary to make changes to their Medicare Advantage or Medicare Prescription Drug Plans for the upcoming year.• AEP extends from October 15 through

December 7 each year.

Medicare 101

Late Enrollment Penaties Part B and Part D late-enrollment penalties: • A Medicare eligible person can be charged a late-enrollment

penalty if they do not sign up for Part B and/or Part D coverage during their Initial Election Period

• An exception to this rule is if the Medicare eligible person is on employer insurance they may not be charged this penalty when they sign up

• IMPORTANT – Just because a Medicare eligible is covered by an employer prescription drug plan does not mean that plan is creditable coverage under Medicare!!!

Medicare 101

4 Parts of Medicare:

 

Medicare 101

Private Insurance Companies

1. Part A2. Part B

3. Part C4. Part D

Federal Government

Medicare Part A  Part A covers: • Inpatient Care• Has a deductible of $1,288 for each benefit

period• Part A has coinsurance starting after 60 days of

inpatient care• Part A is free to most Medicare recipients

Medicare 101

Medicare Part B  Part B covers:

• Outpatient Care – PCP & Specialist• Preventive Services• Has an annual deductible of $166• Part B covers 80% of Medicare covered procedures (includes outpatient & inpatient Part B services)• Most Medicare recipients pay a monthly premium of

$121.80• A late-enrollment penalty may apply if not taken out

when eligible

Medicare 101

80%/20%

Medicare 101

Medicare is basically an Plan

Medicare 101

80%/20%

Medicare Part C 

Part C Covers: 

• Also known as Medicare Advantage Plans

• Sold through private insurance companies

• Covers inpatient and outpatient Medicare benefits

• May also provide prescription drug coverage

• May have deductibles, coinsurance and/or copays

• Must cover everything Original Medicare covers

• May provide additional benefits

Medicare 101

Medicare Part D Part D Covers: • Prescription Drug Coverage• Sold through private insurance companies• Part D coverage is optional• Premiums, deductibles, copays and networks vary with

plans• A late-enrollment penalty may apply if not taken out

when eligible

Medicare 101

Medicare Basics

Part DPrescription Drugs

Part CMedicare Advantage

(All in One)

Part AHospital Insurance

Part BOutpatient Insurance

“What are my health insurance options under

Medicare?”

Medicare 101

The mailbox of a person on Medicare

Original Medicareor

Medicare Advantage

Medicare 101

+ + +

Original Medicare withNO PDP

Original Medicare +PDP

Original Medicare +Medicare Supplement

Original Medicare +Medicare Supplement + PDP

Medicare 101

Original Medicare

Medicare Supplement: Plan F covers:• Medicare Part A deductibles• Medicare Part A coinsurance• Medicare Part B deductible• Medicare Part B coinsurance• Medicare Part B excess charges• First 3 pints of blood used in a procedure• Skilled Nursing Facility coinsurance• Coverage outside the United States

Medicare 101

$166 Annually

Plan G covers everything Plan F covers except the Medicare Part B deductible ($166)

Medicare Supplement Plans F and G

$166

Medicare Supplement Rate ComparisonCompany 4

(Plan F)

$148.33

$148.33

$164.86

$193.52

Company 3(Plan F)

$122.76

$133.67

$149.59

$174.55

Company 1(Plan F)

$174.96

$189.08

$212.44

$258.04

Company 2(Plan F)

$139.47

$151.43

$169.36

$199.25

Company 3(Plan G)

$102.10

$102.10

$115.68

$193.52

Company 4(Plan G)

$115.81

$115.81

$128.71

$151.09

Age(Female)

65

67

70

75

Annual Savings with Medicare Supplement Plan GPlan F Plan G

Monthly Premium $146.38*

x 12

Annual Premium $1,756.56

Part B Expense $0

Total Annual Cost $1,756.56Total Annual Savings

*Based on the average of the companies listed on the prior slide for a 65 yo female

$108.95*

x 12

$1,307.40+$166

$1,473.40

$283.16

Go to Medicare Advantage:

Private Insurance Company

Copays for most covered Medical and Prescription Drug Expenses

PPO HMOPFFS

Most plans will have specific network and formulary restrictions

Medicare 101

PPO• Nationwide Coverage for most plans

• Flexibility to receive services from out of network providers

Medicare Advantage: PPO or HMO

Review

HMO• Plans will usually have a specific provider list you must

use to have coverage• Usually have zero coverage for services rendered by

“out-of-network” providers

Traditional• Nationwide Coverage for most plans

• Providers who accept Medicare will also accept the traditional Medicare Supplement

Select• Plans will usually have a specific provider list you must

use to have coverage

• Usually have zero coverage for services rendered by “out-of-network” providers

Medicare Supplement: Traditional or Select

Low Income Medicare Programs

Medicare Savings Program

• QMB• SLMB• Qi-1

Low-Income Subsidy

For those who don’t qualify for Medicaid

Medicare Savings Program

QMBQualified Medicare Beneficiary

Income Limits$0 - $1,010/ Individual$0 - $1,355/ Couple

Part A Deductible

Part B Deductible

Part B Premium

Part B Coinsurance

Part D Premium

Part D Deductible

Part D Copays

Part D Donut Hole

$0

$0

$0

$0

$0

$0

$3.60 B

$0

$1,288

$166

$121.80

20%

$0 - $90

$360

$1.20 G

$4,850

Medicare Beneficiary

Medicare Savings Program

SLMBSpecified Low-Income Medicare Beneficiary

Income Limits$1,010 - $1,208/ Individual$1,355 - $1,622/ Couple

Part A Deductible

Part B Deductible

Part B Premium

Part B Coinsurance

Part D Premium

Part D Deductible

Part D Copays

Part D Donut Hole

$1,288

$166

$0

20%

$0

$0

$6.35B

$0

$1,288

$166

$121.80

20%

$0 - $90

$320

$2.55 G

$4,557

Medicare Beneficiary

QMedicare Savings Program

Qi-1Qualified Medicare Beneficiary

Income Limits$1,208 - $1,357/ Individual$1,622 - $1,823/ Couple

Based on available funds

Part A Deductible

Part B Deductible

Part B Premium

Part B Coinsurance

Part D Premium

Part D Deductible

Part D Copays

Part D Donut Hole

$1,288

$166

$0

20%

$0

$0

$6.35B

$0

$1,288

$166

$121.80

20%

$0 - $90

$360

$2.55 G

$4,850

Medicare Beneficiary

Low- Income Subsidy

LISLow-income Subsidy

Income Limits$1,345 - $1,471/ Individual$1,823 - $1,991/ Individual

Part A Deductible

Part B Deductible

Part B Premium

Part B Coinsurance

Part D Premium

Part D Deductible

Part D Copays

Part D Donut Hole

$1,288

$166

$121.80

20%

Reduced

Reduced

$6.35B

$0

$1,288

$166

$121.80

20%

$0 - $90

$360

$2.55 G

$4,850

Medicare Beneficiary

Sign up for Medicare

Compare

Medicare

Health PlansCompare Prescription Drug Plans

20%

Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

Compare

Medicare

Health PlansCompare Prescription Drug Plans

20%

Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

Compare

Medicare

Health PlansCompare Prescription Drug Plans

20%

Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

Compare

Medicare

Health PlansCompare Prescription Drug Plans

20%

Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Sign up for Medicare

Compare

Medicare

Health PlansCompare Prescription Drug Plans

20%

Review your coverage annually

Medicare Road Map

Learn the

Basics of

Medicare

Medicare 101

Medicare Basics provided by:

Dan Stevens256-338-4571

Dan@AlabamaHealthGuidance.com

Ron Stone256-709-7112

rstone3@roadrunner.com

www.AlabamaHealthGuidance.com

Medicare 101

Medicare Basics provided by:

Dan Stevens256-338-4571

Dan@AlabamaHealthGuidance.comwww.AlabamaHealthGuidance.com