RETIRING WITH MEDICARE
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1 MEDICARE! RETIRING WITH MEDICARE Helping You Make a Confident Decision To be used through employers only DoctorsChoiceUSA.com
2 WHAT S ON THE AGENDA! What is Medicare?! What are my options?! When and how do I sign up?! Why Doctor s Choice?
3 WHAT IS MEDICARE?! Health insurance for individuals 65 and older or those who are disabled! Subsidized by the Federal Government! Many parts: A B C D Medigap 3
4 ORIGINAL MEDICARE! Part A! Covers hospitalizations! No monthly charge for most! $1260 co-pay for each benefit period! Part B! Covers out-patient! Starts at $ per month! $147 deductible + 20% co-insurance 4
5 GET COMPLETE COVERAGE TWO MAIN OPTIONS! SUPPLEMENTAL + PART D MEDICARE ADVANTAGE (PART C) Prepay with higher monthly premiums, minimal co-pays, and a broad national provider network Pay when you need it with lower monthly premiums, higher co-pays, and typically a limited local provider network 5
6 ORIGINAL MEDICARE! Enroll in Part A (hospital) and B (outpatient)! Enroll in a Medicare Supplemental Plan! Covers some or all of the Part A ($1260 co-pay) and Part B ($147 deductible + 20% coinsurance) expenses! Supplemental Plans are offered by private insurance companies and range between $100-$300 depending on the plan 6
7 SUPPLEMENTAL PLANS! No Drug Coverage! You may be denied for pre-existing conditions if you don t sign up when you re first eligible! Standardized based on state and federal law 7
8 PART D! Prescription coverage! Deductibles and Co-pays based on tier! From private insurance companies! Mix and match with supplemental plans! Coverage gap Donut hole 8
9 HOW THE DONUT HOLE WORKS Your plan covers you with co- pays up to $2960 in total drug costs Stage 1 (inidal) Stage 2 (Coverage gap/donut hole) AGer $2960, you pay 45% cost of brand name 65% cost of generic drugs AGer you pay $4,700 for the calendar year, you pay 5% for the rest of the year (resets Jan 1) Stage 3 (Catastrophic) 9
10 ADVANTAGE PLANS (PART C)! Private insurance company combines A (hospital) + B (outpatient) + D (drug)! Usually HMO/PPO (network restrictions) with Co-pays/ deductibles! Lower monthly premium versus supplemental plans! Cannot be denied for medical reasons! Still have to pay for Part B 10
11 YOUR BIG DECISION! Supplemental (Medigap) + D! Higher monthly premiums! Lower out of pocket expenses! More choices of doctors and hospitals nationally! Part C (Advantage)! Lower monthly premiums! Higher out of pocket expenses! Restrictions on doctors and hospitals 11
12 MEDICARE DOESN T COVER! Dental! Vision hardware! Spouses or dependents! Long term care 12
13 CASE STUDY: SUPPLEMENTAL + PART D CAROL! 66 years old! Prefers to see specialists out of state (Boston)! Concerned about big medical bills Chose a Supplemental Plan with a Standalone Part D Prescription Plan 13
14 CAROL S WORKSHEET Part A Premium: $0 Part B Premium: $ Supplemental Plan Premium: $150 (est.) Part D Premium: $50 (est.) Total Monthly Premium: $ Figures are hypothetical and do no represent any particular plan 14
15 CAROL NEEDS CARE! Sick visit to the primary care: $0 co-pay! Sees a dermatologist: $0 co-pay! Has a lab test: $0 co-pay! Gets her HCTZ (generic) filled at her local pharmacy: $2 co-pay! Gets pneumonia and stays for 3 days in the hospital: $0 co-pay Figures are hypothetical and do no represent any particular plan 15
16 CASE STUDY: PART C ADVANTAGE ANN! 67 years young! Uses Local Doctors and hospitals! Good health Chose an Advantage Plan with prescription drug coverage 16
17 ANN S WORKSHEET! Part A Premium: $0! Part B Premium: $104.90! Part C Premium: $0! Part D Premium: $0 (included in Part C)! Total Monthly Premium:$ Figures are hypothetical and do no represent any particular plan 17
18 ANN NEEDS CARE! Sick visit to the primary care: $25 co-pay! Sees a dermatologist: $45 co-pay! Has a lab test: $15 co-pay! Gets her HCTZ (generic) filled at her local pharmacy: $2 co-pay! Gets pneumonia and stays for 3 days in the hospital: $345/day co-pay for a total of $1,035 Figures are hypothetical and do no represent any particular plan 18
19 DO I QUALIFY?! Age based (65/+)! Can continue to work! Individual only (no family plan) 19
20 PENALTIES AND SURCHARGES! Part B (outpatient) and Part D (prescription) premiums based on income.! Higher premiums for individuals earning over $85,000 single or $170,000 joint! Part B Penalty: 10% for each year not on B starting age 65! Part D Penalty: 1% per month for each month not on D starting age 65! No penalty if covered by employer plan (credible coverage) 20
21 WHEN TO ENROLL! Leaving work! More coverage: no deductibles, little or no co-pays, no network restrictions! Less expensive: Part C starts at $104.90/ month, Supplemental + D options are around $300-$400/month 21
22 WHEN SHOULD I ENROLL?! Turning 65! 7 month window (3 months before 65 to 3 months after)! Earliest coverage can start is the 1 st of the month you turn 65! Leaving work! Enroll 3 months before you need coverage to start! Can enroll up to 8 months after leaving work! COBRA does not count as credible coverage 22
23 HOW SHOULD I ENROLL! Sign up for Parts A + B with social security! Sign up for a Supplemental Plan + Part D plan or a Part C (Advantage) Plan with a licensed Doctor s Choice agent! Review your options each year with Doctor s Choice to go over changes 23
24 FREQUENTLY ASKED QUESTIONS! Q: Can I switch plans?! A: Each year during the annual enrollment period 10/15 12/7, you can switch your drug plan or Part C (advantage) plan! Q: Can I get a Part C (advantage) plan when I m healthy and go on a supplemental plan when I m sick?! A: Aside from special circumstances, supplemental plans can ask you medical questions after 6 months of your initial enrollment and you could be denied coverage. FAQ!! Q: Should I sign up for A + B when I turn 65! A: Only if you re leaving your work plan. If choose to stay on your work plan, make sure to decline Part B until you re ready to have Medicare as your primary coverage 24
25 OUR STORY Founded by Dr. Johnny Luo with a vision to help retirees get better access to care through creating a one stop resource for Medicare 25
26 WHY DOCTOR S CHOICE?! WE COMPARE MANY OPTIONS We work with numerous local and national insurance companies! NO COST CONSULTATION We are paid a fee by the insurance company when we help you enroll! DIRECT PRICING Same premiums as going direct to the insurance company 26
27 FROM OUR VALUED CLIENTS We feel we have been able to make appropriate, informed decisions about Medicare based on the professional services of Doctor's Choice. Linda H. Wakefield RI CONTACT US: Phone: Online: CONTACT US! 27
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