1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B –...

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1 Medicare

Transcript of 1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B –...

Page 1: 1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

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MedicareMedicare

Page 2: 1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

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Four Parts of Medicare:Four Parts of Medicare:

Medicare Part A – Hospital InsuranceMedicare Part B – Medical Insurance

Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage

Medicare Part A – Hospital InsuranceMedicare Part B – Medical Insurance

Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage

Page 3: 1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

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65 & older

-or-

Receiving Social Security disability benefits at least 24 months

-or-

Permanent kidney failure

-or-

Amyotrophic Lateral Sclerosis (ALS)

65 & older

-or-

Receiving Social Security disability benefits at least 24 months

-or-

Permanent kidney failure

-or-

Amyotrophic Lateral Sclerosis (ALS)

Who Can Get Medicare?Who Can Get Medicare?

Page 4: 1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

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When Can I Sign Up for Medicare?When Can I Sign Up for Medicare?

Medicare Enrollment Periods: Initial - at age 65

Special - if still working

General - January-March

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Full Retirement AgeFull Retirement Age

Year of Birth Full Retirement Age

1937 or earlier 65

1938 65 & 2 months

1939 65 & 4 months

1940 65 & 6 months

1941 65 & 8 months

1942 65 & 10 months

1943 – 1954 66

1955 66 & 2 months

1956 66 & 4 months

1957 66 & 6 months

1958 66 & 8 months

1959 66 & 10 months

1960 or later 67

Year of Birth Full Retirement Age

1937 or earlier 65

1938 65 & 2 months

1939 65 & 4 months

1940 65 & 6 months

1941 65 & 8 months

1942 65 & 10 months

1943 – 1954 66

1955 66 & 2 months

1956 66 & 4 months

1957 66 & 6 months

1958 66 & 8 months

1959 66 & 10 months

1960 or later 67

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Medicare CoverageMedicare Coverage

Part A Hospital Insurance Covers most inpatient hospital expenses.

2008 Deductible $1,024

Part B Supplementary Medical Insurance Covers 80% doctor bills & other outpatient medical

expenses after 1st $135 in approved charges.

2008 Monthly Premium $96.40

Part D Medicare Prescription Drug Plan Covers a major portion of prescription drug costs

for Medicare beneficiaries.

2008 average Monthly Premium $27.93

Part A Hospital Insurance Covers most inpatient hospital expenses.

2008 Deductible $1,024

Part B Supplementary Medical Insurance Covers 80% doctor bills & other outpatient medical

expenses after 1st $135 in approved charges.

2008 Monthly Premium $96.40

Part D Medicare Prescription Drug Plan Covers a major portion of prescription drug costs

for Medicare beneficiaries.

2008 average Monthly Premium $27.93

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Part B Medically-Necessary ServicesPart B Medically-Necessary Services

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•Ambulatory Surgical Services

•Clinical Laboratory Services

•Emergency Room Services

•Outpatient Hospital Services

•Diagnostic Tests (x-rays, MRI, CT scan)

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“Welcome to Medicare” Physical Exam Bone Mass Measurement

Cardiovascular ScreeningsColorectal Cancer Screenings

Diabetes ScreeningDiabetes Self-Management Training

Annual Flu ShotMammograms

Prostate Cancer ScreeningsSmoking Cessation Counseling

“Welcome to Medicare” Physical Exam Bone Mass Measurement

Cardiovascular ScreeningsColorectal Cancer Screenings

Diabetes ScreeningDiabetes Self-Management Training

Annual Flu ShotMammograms

Prostate Cancer ScreeningsSmoking Cessation Counseling

PREVENTIVE SERVICESPREVENTIVE SERVICES

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ASSIGNMENTASSIGNMENT

An agreement between you and your doctor that he/she will accept as payment the amount Medicare

approves for the service provided.

An agreement between you and your doctor that he/she will accept as payment the amount Medicare

approves for the service provided.

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The highest amount you can be charged for a Part B-covered service is the

“limiting charge”. The limiting charge is 115% over the Medicare-approved

amount. It applies to only certain services and does not apply to some supplies and

durable medical equipment.

The highest amount you can be charged for a Part B-covered service is the

“limiting charge”. The limiting charge is 115% over the Medicare-approved

amount. It applies to only certain services and does not apply to some supplies and

durable medical equipment.

LIMITING CHARGELIMITING CHARGE

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NON-STANDARD PART B PREMIUMSNON-STANDARD PART B PREMIUMS

If Your Yearly Income is: You pay:

Individual Tax Return Joint Tax Return

$82,000 or below $164,000 or below $ 96.40

$82,001 - $102,000 $164,001 - $204,000 $122.20

$102,000 - $153,000 $204,001 - $306,000 $160.90

$153001, - $205,000 $306,001 - $410,000 $199.70

Above $205,000 Above $410,000 $238.40

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NON-COVERED SERVICESNON-COVERED SERVICES

• Acupuncture

• Chiropractic services with one exception

• Cosmetic Surgery

• Routine Eye Exams

• Routine foot care

• Hearing aids

• Long –term care

• Routine physical examinations

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How Will the Prescription Drug Plan Affect You?

How Will the Prescription Drug Plan Affect You?

You will pay the first $275 (called an “annual deductible”).

Medicare will pay 75% of costs between $275 and $2,510 in drug spending. You pay only 25% of these costs.

Example: $2510 - $275 = $2235. $2235 x 75% = $1676.25.

You will pay 100% of the drug costs between $2,510 and $5726.25. Part D pays nothing. (Donut hole).

Medicare will pay about 95% of the costs above $5726.25. You pay between $2 and $5 per prescription.

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Extra Help Could Further ReduceMedicare Prescription Drug CostsExtra Help Could Further ReduceMedicare Prescription Drug Costs

Extra help is available for low income beneficiaries to pay for part of the Medicare

Part D monthly premiums, annual deductibles and prescription co-payments. The extra help

could be worth more than $3,600 per year.

Go online to www.socialsecurity.gov to apply for extra help.

Extra help is available for low income beneficiaries to pay for part of the Medicare

Part D monthly premiums, annual deductibles and prescription co-payments. The extra help

could be worth more than $3,600 per year.

Go online to www.socialsecurity.gov to apply for extra help.

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Income and Resource Limits - SubsidyIncome and Resource Limits - Subsidy

INCOME:

Individual – below $15,600 a year ($1300 per month)

Couple – below $21,000 a year ($1750 per month)

RESOURCES:

Individual – no more $11,990

Couple – no more than $23,970

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Advantages of Qualifying for Medicare Part D Subsidy?

Advantages of Qualifying for Medicare Part D Subsidy?

No monthly premium (limited to several plans)

No yearly deductible

No donut hole

Can enroll in Part D anytime you qualify

No monthly premium (limited to several plans)

No yearly deductible

No donut hole

Can enroll in Part D anytime you qualify

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For More Medicare InformationFor More Medicare Information

1-800-MEDICARE(1-800-633-4227)

TTY 1-877-486-2048

www.medicare.gov

1-800-MEDICARE(1-800-633-4227)

TTY 1-877-486-2048

www.medicare.gov

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Social Security’s Online ServicesSocial Security’s Online Services

Retirement & Disability Applications

Apply for Extra Help

Retirement/Survivors/Disability Planner

Request a Statement

Change of Address

Medicare Card Replacements

Request a Benefit Verification Letter

Start or Change Direct Deposit

Retirement & Disability Applications

Apply for Extra Help

Retirement/Survivors/Disability Planner

Request a Statement

Change of Address

Medicare Card Replacements

Request a Benefit Verification Letter

Start or Change Direct Deposit

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Social Security Cost-of-Living AdjustmentsSocial Security Cost-of-Living Adjustments

Effective Date Amount

June 1975 8%June 1976 6.4%June 1977 5.9%June 1978 6.5%June 1979 9.9%June 1980 14.3%June 1981 11.2%June 1982 7.4%Dec 1983 3.5%Dec 1984 3.5%Dec 1985 3.1%Dec 1986 1.3%Dec 1987 4.2%Dec 1988 4%Dec 1989 4.7%Dec 1990 5.4%Dec 1991 3.7%

Effective Date Amount

June 1975 8%June 1976 6.4%June 1977 5.9%June 1978 6.5%June 1979 9.9%June 1980 14.3%June 1981 11.2%June 1982 7.4%Dec 1983 3.5%Dec 1984 3.5%Dec 1985 3.1%Dec 1986 1.3%Dec 1987 4.2%Dec 1988 4%Dec 1989 4.7%Dec 1990 5.4%Dec 1991 3.7%

Effective Date Amount

Dec 1992 3%Dec 1993 2.6%Dec 1994 2.8%Dec 1995 2.6%Dec 1996 2.9%Dec 1997 2.1%Dec 1998 1.3%Dec 1999 2.5%Dec 2000 3.5%Dec 2001 2.6%Dec 2002 1.4%Dec 2003 2.1%Dec 2004 2.7%Dec 2005 4.1%Dec 2006 3.3%Dec 2007 2.3%

Effective Date Amount

Dec 1992 3%Dec 1993 2.6%Dec 1994 2.8%Dec 1995 2.6%Dec 1996 2.9%Dec 1997 2.1%Dec 1998 1.3%Dec 1999 2.5%Dec 2000 3.5%Dec 2001 2.6%Dec 2002 1.4%Dec 2003 2.1%Dec 2004 2.7%Dec 2005 4.1%Dec 2006 3.3%Dec 2007 2.3%


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