Welcome to Medicare! Presented by Roger Ward Insurance 2002 2005 - - - PowerPoint PPT Presentation
Welcome to Medicare! Presented by Roger Ward Insurance 2002 2005 - Independent Agent 2005 2012 - Humana September 2012 - Independent Agent aAer 7 years with Humana 2013 - Cer*fied Senior Advisor Last Century: Late 90s
Presented by
Ø 2002 – 2005 - Independent Agent Ø 2005 – 2012 - Humana Ø September 2012 - Independent Agent aAer 7 years with Humana Ø 2013 - Cer*fied Senior Advisor Ø Last Century: Ø Late 90’s – 2002 - Business Consultant Ø Prior Corporate America
In July 1965, under the leadership of President Johnson, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.
In the United States, Medicare is a naWonal social insurance program, administered by the U.S. federal government since 1966, currently using about 30 private insurance companies across the United States.[1] Medicare provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with disabiliWes, end stage renal disease and amyotrophic lateral sclerosis. In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabiliWes. It was the primary payer for an esWmated 15.3 million inpaWent stays in 2011, represenWng 47.2 percent ($182.7 billion) of total aggregate inpaWent hospital costs in the United States.[2] Medicare serves a large populaWon of elderly and disabled individuals. On average, Medicare covers about half (48 percent) of the health care charges for those enrolled in Medicare. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form
supplemental insurance.[3]
Not to be confused with Medicaid From Wikipedia, the free encyclopedia
55.3 million in 2015 (46.3 + 9.0)
Part A: No premium for most people Part B: $104.90 per month 2016 Newbies: $121.80 per month DeducWbles: Part A: $1,288 per Benefit Period Part B: $166 per year Medicare pays 80%, your cost share is 20% Part D Premiums: $18 per month to $100+/mth DeducWbles, CoPays, Coinsurance, Drug Tiers, Coverage Gap/Donut hole! Medicare Supplements pick up some or all of the DeducWbles and the 20%
aka “Medigap” plans since they fill-in the gaps
Ø Pick up some or all of the DeducWbles and 20% cost sharing that Medicare does not pay Ø Popular plans include Plan F, G, N, High DeducWble F Ø Supplements do not include Drug Coverage! Must get a PDP Ø Plans are “Standardized”, so coverage is same with each company Ø Key differences are iniWal premiums and annual rate increases Ø UnderwriWng requirements – BCBS and AARP/UHC easy to change Ø Extra Benefits e.g., Vision Discounts, etc, Silver Sneakers Ø Popular carriers: BCBS, AARP/UHC, Mutual of Omaha, Aetna, Humana
Plans A thru N Plan F most comprehensive Plan F Most expensive Plan F @ age 65 Male: $135 per month Female: $118 per month Plan G: Male: $102 Female: $90 Plan N: Male: $85 Female: $81 High DeducWble F: Male: $26 Female: $26 DeducWble is $2,180 Medicare paying 80%, you pay 20%
(extended to 12 months if you enroll first in Medicare Advantage plan)
Ø Created by the Medicare Improvement & ModernizaWon Act 2003 Ø Coverage began January 2006 Ø Medicare contracts with Insurance Companies Ø Medicare determines which drugs are covered Ø Plans can have co-pays, or coinsurance, and DeducWbles Ø Plans use Drug Tiers, e.g., 1,2,3,4,5 Ø Tiers ARE NOT Standardized, so very important to check!! Ø All plans have the Donut Hole aka Coverage Gap! $3310 in 2016 Ø Recommend Medicare.gov to check drugs Ø 23 plans in Rockingham County
Ø First began in 1990’s as Medicare Plus Choice Ø Medicare contracts with Insurance Companies Ø Popularity grew in 2006 with Medicare Rx plans Ø Today, 32% of Beneficiaries have Part C - MA plans Ø Plan types include HMO, PPO, PFFS
Medicare Advantage Plan Carriers: Ø Aetna/Coventry Ø Blue Cross Ø Humana Ø United Healthcare/AARP Ø Cone’s Health Team Advantage Medicare Advantage Plan Premiums $0 to over $100 per month, Copays, Max Out of Pocket Most include Drug Coverage Annual ElecWon Period October 15 – December 7 If it’s covered under Medicare , it’s covered under the plan!
Copays or Co-ins for Labs, Xrays, MRI’s; and Annual Max Out of Pocket $3,400-$6,700
Sneakers
Medicare Supplements:
Medicare Advantage:
Lower premiums on Plans N and High F
Medicare Supplements
hospitals, providers
Medicare Advantage
Medicare, e.g., safety nets, i.e., Dollar limits and extra’s,
Depends on your circumstances, your Health, your Budget, your feelings about risk