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1 About to Retire: Preparing for Medicare Patient Financial Services

2 Agenda Medicare Enrollment Covered Services Medicare-covered covered Preventive Services

3 Agenda, continued Advance Beneficiary Notice (ABN) What you may owe Medicare Assignment Three Steps Supplemental Coverage Additional Information

4 Medicare Age 65 or older Under age 65 with certain disabilities Any age with End Stage Renal Disease (ESRD)

5 Four Parts to Medicare Medicare Part A Medicare Part B Medicare Part C Medicare Part D

6 Medicare Part A Inpatient Hospital Fees Skilled Nursing Facility Fees Hospice Care Home Health Care

7 Medicare Part B Physician Fees Outpatient Care Some Preventive Care

8 Medicare Part C Medicare Advantage Plans Private Insurance Companies Part A and B

9 Medicare Part D Helps cover the cost of prescription drugs May help lower the cost of prescription drugs May protect against higher costs in the future

10 Enrolling in Medicare Part A Initial Enrollment Period: Three months prior to the month of your 65 th birthday to three months after Medicare becomes effective the first day of the month you turn 65 (if already enrolled)

11 Enrolling in Medicare Part A General Enrollment Period: January 1 st - March 31st Coverage begins on July 1 st Enrollment after Initial Enrollment Period may result in higher premium (if applicable)

12 Enrolling in Medicare Part B Initial Enrollment Period: Three months prior to the month of your 65 th birthday to three months after Medicare becomes effective the first day of the month you turn 65 (if already enrolled)

13 Enrolling in Medicare Part B General Enrollment Period: January 1 st - March 31st Coverage begins on July 1 st Enrollment after Initial Enrollment Period may result in higher premium (if applicable)

14 Enrolling in Medicare Part C (Medicare Advantage Plan) Initial Enrollment Period: Three months prior to the month of your 65 th birthday to three months after

15 Enrolling in Medicare Part C (Medicare Advantage Plan) General Enrollment Period: Enroll January 1 st March 31 st Coverage begins July 1st st Enroll November 15 th December 31 st Coverage begins January 1st Enrollment after Initial Enrollment Period may result in higher premium (if applicable)

16 Enrolling in Medicare Part D Initial Enrollment Period: Three months prior to the month of your 65 th birthday to three months after Becomes effective the first day of the month you turn 65 (if already enrolled)

17 Switch or Drop November 15 th December 31 st Check with the coverage you are switching from or dropping to ensure you can enroll again later if you choose i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

18 Things to Consider Coverage Other Coverage Cost Doctors and Hospitals Prescription Drugs Quality of Care Travel i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

19 Medicare Part A: Services Generally Covered Blood Home Health Services Hospice Care Inpatient Hospital Stays Skilled Nursing Facility Care

20 Medicare Part B: Services Generally Covered One-time physical exam Ambulance services Blood Bone mass measurement (Bone Density) Clinical laboratory services

21 Medicare Part B: Services Generally Covered Clinical research studies Defibrillator Diabetes self-management training and supplies Doctor services (medically necessary) Durable medical equipment

22 Medicare Part B: Services Generally Covered Emergency room services Eyeglasses (limited) Flu shots Home health services Outpatient hospital services Physical therapy Practitioner services

23 Medicare Part A and B: Services Generally NOT Covered Service not medically necessary Acupuncture Chiropractic services Cosmetic surgery Deductibles, co-insurance, co- payments Dental care and dentures

24 Medicare Part A and B: Services Generally NOT Covered Routine eye exams Routine foot care Hearing aids and hearing tests Laboratory tests for screening purposes Orthopedic shoes Physical exams

25 Medicare Part A and B: Services Generally NOT Covered Prescription drugs Self-administrable pharmacy Shots to prevent illness Syringes or insulin Travel (Outside the U.S.)

26 i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

27

28 Example of Medicare Assignment We bill Medicare for your office visit that costs: Medicare approves the claim in the amount of: Medicare pays 80% of the approved amount: You pay 20% of the approved amount: Your provider of service accepts assignment, so they adjust: $100 $80 $64 $16 $20

29 Choose Your Medicare Options Three steps help you decide Step 1 Decide if You Want Medicare Coverage With: Original Medicare OR Medicare Advantage Plan i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

30 Joining a Medicare Advantage plan may require you to use plan doctors, medical professionals, and hospitals. You will pay additional costs, and/or may not be covered when you do not use plan healthcare providers. i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

31 Choose Your Medicare Options Three steps help you decide Step 2 Decide if You Want Prescription Drug Coverage: You chose Original You chose a Medicare Medicare in Step 1 OR Advantage Plan in Step 1 i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

32 Choose Your Medicare Options Three steps help you decide Step 3 Decide if You Want Supplemental Coverage: You chose Original You chose a Medicare Medicare in Step 1 OR Advantage Plan in Step 1 i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

33 Consider your options for supplemental coverage: Medigap Group Health Plan Coverage with Your Employer or Union Other Supplemental Coverage

34 More About Supplemental Coverage: What is MEDIGAP? A Medigap policy is health insurance sold by private companies to fill gaps in Original Medicare coverage. Medigap policies do not work with any other type of coverage except Original Medicare.

35 More About Supplemental Coverage: What is MEDIGAP? Medigap policies help pay your share of the cost of Medicare covered services including deductible, co-insurance, and co-pays. Some Medigap policies may cover certain costs not covered by Original Medicare

36 More About Supplemental Coverage: What is MEDIGAP? You cannot be sold a Medigap coverage if you have chosen a Medicare Advantage Plan! i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

37 What Will a Medigap Plan Help Cover?

38 Employer or Union Group Health Plans Your Coordination of Benefits May be Affected by: Continuing to work after the age of 65 You and your spouse s retirement status Employer Group Size Disability covered by Medicare

39 Joining a Medicare Advantage Plan may limit or end your group health plan coverage. Carefully read any materials your group health plan sends you or contact them if you are unsure. i.e.: Medicare, The Official U.S. Government Site for People With Medicare.. December 7,

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