Guide to Medicare Helping You Navigate the Medicare Maze Provided by: Not conne

Guide to Medicare Helping You Navigate the Medicare Maze Provided by: Not connected with or endorsed by the United States government or the federal Medicare program. Medicare is complicated. With so many different plan choices, the constant stream of mail and TV ads, and even incorrect information, it’s no wonder Medicare seems like a confusing maze. This guide will help you navigate the different parts of Medicare and understand what is and isn’t covered. It explains Medicare Advantage, Medicare Supplement and Part D Prescription Drug plans and also includes two checklists to help you gather everything you need to enroll at age 65 and to review your plan every year after that. Let’s start with the basics. 2 What is Medicare? Who Is Eligible? Medicare is the government-run health insurance program for people age 65 and older, those under 65 with certain disabilities and those with end-stage renal disease. Care is provided by any doctor or facility that accepts Medicare. In general, those who are eligible for premium-free Part A (hospital insurance) and Part B (medical insurance) include individuals who are 65 and have worked 10 years in this country or who have a spouse who has, or individuals who are 65 and have received Social Security disability benefits for 24 months. If you are receiving Social Security, you are likely already enrolled in Part A and Part B when you turn 65. Part A Hospital Insurance Part C Medicare Advantage Part B Medical Insurance Part D Prescription Coverage Medicare Supplement ORIGINAL MEDICARE SUBSIDIZED PRIVATE INSURANCE PRIVATE INSURANCE Your Medicare coverage can consist of several parts. 3 Part B covers medically necessary outpatient doctor visits, outpatient surgery, physical therapy, durable medical equipment (such as crutches, wheelchairs and home oxygen supplies), ambulance services, and preventative services (such as flu shots and screenings for diabetes and cancers). Read the “What Does Medicare Cost?” section to learn what Part B costs you pay. Part C, also known as Medicare Advantage, is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage plans must cover all of the services that Original Medicare covers — except hospice care — and may also offer extra coverage. (Original Medicare covers hospice care even if you’re in a Medicare Advantage plan.) In all types of Medicare Advantage plans, you’re always covered for emergency and urgently needed care. Most MA-PD plans include Part D prescription drug coverage. Part A (Hospital Insurance) Part B (Medical Insurance) Part C (Medicare Advantage) Part D provides outpatient prescription drug coverage. Plans can be purchased on a standalone basis or be included in a Medicare Advantage plan. Plans vary in price, co-pays and the drugs included on their formulary (prescription drug list). While you may not currently be on any prescription medication, the chances of you having to take at least one, if not more, in your lifetime increase as you age. Medicare Supplement, or Medigap, plans can help pay some of the health care costs that Original Medicare doesn’t cover. These gaps include items like co-payments, co-insurance and deductibles. Medicare Supplement plans are provided by private insurance companies. If you have Original Medicare and you buy a Medicare Supplement policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medicare Supplement policy pays its share. Part D (Prescription Drug Plans) Medicare Supplement Plans (Or Medigap Plans) 4 Part A covers inpatient hospital services (such as lab tests and surgeries) and supplies (such as wheelchairs and walkers) considered medically necessary to treat a disease or condition, if you are admitted. Part A coverage includes inpatient hospital room and board, skilled nursing care, hospice and some home health care costs. Read the “What Does Medicare Cost?” section to learn what Part A costs fall to you. 5 Medicare Doesn’t Cover Everything You could be responsible for paying for certain items and services. Some not covered by Parts A and B include:* • Long-term care • Most dental care • Dentures • Eye examinations related to prescribing glasses • Cosmetic surgery • Hearing aids and exams for fitting them • Acupuncture • Routine foot care *Medicare Supplement plans generally do not cover these costs Original Medicare only covers about 62% of the cost of health care services (not including long-term care).* *“Amount of Savings Needed for Health Expenses for People Eligible for Medicare: Good News Not So Rare Anymore,” Employee Benefit Research Institute, October 2014, Vol. 35, No. 10. How do you pay for the rest? Call Medicare BackOffice at 1-888-747-3760 to speak with a Licensed Insurance Agent. We’ll help find supplemental health insurance that fits your needs and budget. Nearly 92% of older adults have at least one chronic condition, and 77% have at least two, according to the National Council on Aging. 6 What Is the Difference Between Medicare Advantage (Part C) and Medicare Supplement Plans? Medicare Advantage plans take the place of Medicare Parts A and B and usually include Part D Prescription Drug coverage, while Medicare Supplement plans supplement Medicare Part A and Part B, by covering the co-payments, co-insurance and deductibles that Original Medicare doesn’t pay. You are not required to enroll in a Medicare Advantage or Medicare Supplement plan, but if you do choose to enroll in one, you cannot be enrolled in the other. When you buy a Medicare Supplement plan, you are still enrolled in Original Medicare. When you enroll in a Medicare Advantage plan, you move completely into a private health insurance plan. Medicare Advantage plans must provide the same level of coverage as Original Medicare with the exception of hospice care. Take a look at the chart on the next page to see the differences! Call Medicare BackOffice at 1-888-747-3760 to speak with a Licensed Insurance Agent. We can clearly explain the differences between Medicare Advantage and Medicare Supplement and help you find a plan that works for you. How do you decide? 7 Medicare Supplement Medicare Advantage Fills the gaps in Original Medicare Replaces Original Medicare No Rx coverage — can be paired with Medicare Part D Prescription Drug coverage Often includes Medicare Part D Prescription Drug coverage Enrollment is year-round Enrollments are limited to open enrollment and annual election periods as well as special circumstance throughout the year called Special Election Periods Typically accepted by any provider that accepts Medicare Coverage is usually network-based, like an HMO or PPO Monthly premiums typically range from $85 – $150, but vary by plan and geography Premiums can be as low as $0 per month Premiums can be affected by age and gender Premiums are not impacted by age or gender, but do vary by county Health questions may be asked to determine eligibility Guaranteed acceptance, except for those with end-stage renal disease (ESRD) Benefits are the same regardless of which company offers them Benefits vary by company Most plans do not cap out-of-pocket costs Out-of-pocket costs are capped How do I compare Medigap policies? The chart below shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you’re responsible for the rest. Medicare Supplement Insurance (Medigap) plans Benefits A B C D F* G K L M N Medicare Part A co-insurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Medicare Part B coinsurance or co-payment 100% 100% 100% 100% 100% 100% 50% 75% 50% 100%** Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 50% 100% Part A hospice care co-insurance or co-payment 100% 100% 100% 100% 100% 100% 50% 75% 50% 100% Skilled nursing facility care co-insurance 100% 100% 100% 100% 50% 75% 50% 100% Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100% Part B deductible 100% 100% Part B excess charges 100% 100% Foreign travel emergency (up to plan limits) 80% 80% 80% 80% 80% 80% Out-of-pocket limit in 2017 $5,120 $2,560 *Plan F also offers a high-deductible plan in some states. If you choose this option, this means you must pay for Medicare-covered costs (co-insurance, co-payments and deductibles) up to the deductible amount of $2,200. in 2017 before your policy pays anything. **Plan N pays 100% of the Part B co-insurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission. 8 What Does Medicare Cost? Costs for Medicare vary from year to year. Most people don’t pay a monthly premium for Part A, because they have paid into the system during their working years. But generally, you will need to pay a Part A deductible, a Part B deductible and a monthly Part B premium. If you enroll in a Part D Prescription Drug plan, you also uploads/Ingenierie_Lourd/ free-guide-to-medicare.pdf

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