2. Table of Contents
 Overview of Original Medicare
 Medicare Part A
 Medicare Part B
 Medicare Part D
 Medicare Part C (Medicare Advantage Program)
 Medicare Supplements
 Purpose
 Plans

3. Original Medicare
Created to help elderly with health care costs as an
entitlement program.
 Medicare covers two markets: 65 and older, Or
those who are qualified under SSDI, or ESRD
 SSDI
 ESRD- End Stage Renal Disease
 Provided “free” to all Social Security and Railroad
Retirment beneficiaries upon registering for
Social Security at age 65
 The program is administered by the Center for
Medicare and Medicaid Services- CMS

5. Overview
 http://www.youtube.com/watch?v=slVO3p83_S0

6. Medicare Part A
 Part A- Provides for hospitalization and some
limited nursing home benefits.
 Benefits include
 Hospital Stays
 Some Skilled Nursing Facility Care
 Some Home Health Care
 Hospice Care
 Blood

8. Medicare Part B
 Part B- provides for medical and some limited
home health care coverage for Social Security and
railroad retirees.
 Part B is purchased (or optionally rejected) and
can be conveniently withheld from a retirees
social security check.
 The premium for Part B increases annually due
to ever increasing health care costs.

9. Benefits Included with purchase of Part
B
 Medical Services
 Doctors Services
 Outpatient medical and surgical
 Diagnostic tests
 Ambulatory surgery center
 Durable Medical Equipment
 Second surgical options
 Outpatient mental health care
 Outpatient physical and occupational therapy

10. Benefits included with purchase of Part
B continued
 Clinical Laboratory Services-blood, Urinalysis, etc.
 Home Health Care
 Outpatient Hospital Services
 Blood- with a 3 pint deductible.
 Preventive services- Bone mass, Colorectal Cancer
screening, Diabetes services and supplies, etc.

12. Medicare Part D
(Medicare Prescription Drug Coverage)
 Helps cover the cost of prescription drugs
 May help lower your prescription drug costs and
help protect against higher costs
 Run by Medicare-approved private insurance
companies
 Rates, Coverages, and Premiums will vary by
carrier.

13. Medicare Part D continued
 May have to pay $325 deductible for initial drug costs
 During initial coverage phase, insured pays a copayment or
coinsurance…Insured’s Part D plan pays the rest up until
your combined amount hits $2970
 Once insured hits $2970, they then enter what is known as
the “donut hole” where they are responsible for covering
47.5% of named-brand prescription drug costs and 79% for
generic prescription drugs.
 Once out-of-pocket expenses hit $4,750 the insured enters
the “catastrophic coverage” period in which all prescription
drug costs are covered by their medicare plan.

14. Medicare Part C
(Medicare Advantage Plan)
 Medicare Advantage plans (MA) are offered by private
companies approved by Medicare ( HMO, PPO, etc.)…
http://www.youtube.com/watch?v=8OK7SuXVkpQ
 MA plans include:
 Part A (Hospital Insurance)
 Part B (Medical Insurance)
 Most cover Part D (Drug Coverage)
 May offer
 Vision
 Hearing
 Dental

15. Medicare Advantage Plans
 Health Maintenance Organization (HMO)
 Preferred Provider Organization (PPO)
 Private Fee-for-Service (PFFS)

16. Health Maintenance Organization (HMO)
 A type of health insurance plan that usually
limits coverage to care from doctors who work for
or contract with the HMO.
 It generally won't cover out-of-network care
except in an emergency.
 An HMO may require you to live or work in its
service area to be eligible for coverage.

17. Preferred Provider Organization
(PPO)
 A type of health plan that contracts with medical
providers, such as:
 Hospitals
 Doctors
 You pay less if you use providers that belong to
the plan’s network.

18. Private Fee-for-Service
(PFFS)
 A type of Medicare Health Plan in which you may
go to any Medicare-approved doctor or hospital
that accepts the plan's payment.
 You may pay more or less for Medicare-covered
benefits.
 You may have extra benefits Original Medicare
doesn't cover.

19. Medicare Supplements
 Medicare Supplemental insurance (Medigap) is
designed to offer coverage for the costs not
covered by original Medicare
 If the insured has Original Medicare along with a
Medigap policy, Original Medicare will pay for its
share of expenses and the Medigap policy will
pickup the rest of the costs depending on the plan
 http://www.youtube.com/watch?v=sdVe-GlZ-mc

20. Medicare Supplements
(Medigap Policy)
 Must have Medicare Part A and Part B
 Guaranteed Issue Rights during open enrollment
period discussed earlier
 Guaranteed Issue Rights for other situations as
well as shown here...
http://www.medicare.gov/supplement-other-
insurance/when-can-i-buy-medigap/when-can-i-
buy-medigap.html

21. Medigap Issue Age (Community) Plans
 Senior consumers can purchase specific plans
based on their age
 Insurance provider can therefore not change
premiums on the plan as the insured’s age
increases
 Although the provider can raise premium rates
by class for all policies issued in their state

22. Medigap Attained Age Plans
 Attained age plans include premiums that
increase incrementally as the insured age
increases
 Some providers increase rates every year while
some increase based on attained age of insured
 Prices can change based on changes in Medicare
 Rates may also change due to increases in
medical costs