Understanding your Medicare Benefits and Insurance Options

MedicareCompareUSA, MedicareCompareUSA an Insurance Agency LLC, and Insurance Helpline Services comprise the MedicareCompareUSA, Inc. family of companies. MedicareCompareUSA is an insurance agency and call center not affiliated with the federal Medicare program. All services provided at no cost; MedicareCompareUSA and affiliated agents are paid directly by the plan you choose. Health care providers receive no financial benefit when patients use the services of MedicareCompareUSA.

MedicareCompareUSA IntroductionOriginal Medicare ExplainedDifferent Types of Medicare Insurance Important Considerations When Finding YOUR Medicare SolutionYour Next Steps

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Independent Insurance AgencyWe represent many Medicare plans including: Advantage, Supplement and Prescription plansWe serve health systems and physicians as:

Medicare Insurance Helpline FYI: MedicareCompareUSA now serves as the Medicare Insurance Helpline for hospital systems and physician organizations that provide care for more than 6 million Medicare beneficiaries!

About Us…3

Why Healthcare Providers refer patients to us:

Free Medicare Education and Guidance for PatientsUnbiased Medicare plan comparisonsUp-to-date information about health care network changes that impact access to your trusted providers Annual review of plan benefits and options during the Medicare Annual Enrollment Period

Let’s Get Started with Medicare Information!

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Medicare Part A: Hospital CoverageMedicare Part B: Medical Coverage

Part A & B together equal Original Medicare

Medicare is a health benefits program for U.S. citizens or permanent residents who meet certain work history requirements:Must be: Age 65 or older or Under age 65 with certain disabilities•All who get disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months•Individuals with Amyotrophic Lateral Sclerosis (ALS), often referred to as Lou Gehrig’s Disease or with End-Stage Renal Disease

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Hospitalization: Semi-private room and board, general nursing and miscellaneous services and supplies

First 60 Days 100% covered $1,408 Deductible61st – 90th Day $ 352 per day91st – 150 (While using 60 lifetime reserve days) $ 704 per day

Skilled Nursing Facility Care: Requires 3-day Hospital StayFirst 20 Days 100% Covered21st – 100th Day $ 176 per day101st Day and Above Not Covered

Home Health CareMedicare Approved Services 100% CoveredOnly for Medically necessary skilled care services and medical supplies. (Not Long Term Care needs)

Cost information for 2020 Calendar year

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Medical Expenses: In or out of the hospital and outpatient hospital treatment, such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment.

Part B Premium $144.60 /month*

Deductible $198.00 Annually**

After Deductible, Part B generally covers 80% of Medicare Approved Amounts Note: Some preventative care is also covered.

*2020 Data

*2020 Premium Information. May be higher, based on individual or household income. ** Deductible Only Counts Towards Medicare Approved Amounts

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Original Medicare Does Not Cover:

Deductibles and co-insurance

Prescription Drugs

Preventative Dental Benefits

Routine eye exam/eyewear

Out-of-pocket maximum spending safety net

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Medicare supplement insurance plans and Medicare Advantage plans are both offered by private insurance companies. Both require you to pay your monthly Part B Medicare premium.

Medicare Supplement and Medicare Advantage

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Medicare supplement insurance plans and Medicare Advantage plans are both offered by private insurance companies. Both require you to pay your monthly Part B Medicare premium.

Medicare Supplement and Medicare Advantage

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InsuranceYou may add a Medicare Supplement Plan to your Original Medicare

Unless you are new to Medicare, Supplement Plans may require health statement underwriting (medical questions).

You must have Part A & Part B and continue to pay the Part B premium

Plan designs range from A through N.

Plan designs are standardized - meaning they must be exactly the same, only the premium may vary.

Prescription drug coverage is not included in plans sold after January 1, 2006.

Medicare pays first for Medicare-eligible benefits - then Medicare Supplement pays next for some or all of the patient’s portion.

Medicare Supplements may also include some benefits not covered by Original Medicare [example: foreign travel coverage (limitations apply)].

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You may choose a Medicare Advantage PlanPrivate insurance companies contract with Medicare to offer Medicare Advantage Plans (MA) If you enroll in a Medicare Advantage Plan, you still have Medicare- The insurance company pays your claims, not Medicare

You must have Part A & Part B and continue to pay the Part B premiumYou must reside in the service area of the plan you select

You may not have End-stage Renal Disease (kidney failure) prior to enrollingBy contract MA plans must, at a minimum, cover everything original Medicare covers and most plans also include Part D prescription drug coveragePlans may cover additional benefits such as routine vision exams, preventative dental, gym memberships, etc.You may not have a Medicare Supplement plan and a Medicare Advantage Plan at the same time

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$0 or Low Monthly Plan Premium (must continue to pay Part B Premium)

Most MA plans include a Medicare Prescription plan

Annual out-of-pocket max for Medicare-approved services

Additional MA plan benefits are often included (examples: eyewear, dental, ask-a-nurse, transportation, mail-order program, gym membership).

Note: Medicare Advantage plan benefits vary by plan, so carefully review the Summary of Benefits associated with any Medicare Advantage plan you may be considering.

Helping you understand Medicare plan benefits is what we do!

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Plans offered by private insurance companies must meet or exceed the minimum standard plan:

Available to anyone who is enrolled in Medicare (Part A or Part B or Parts A & B)Provided by private insurance companiesMonthly premiums vary by planYou are only allowed to have one Part D Plan at a timeIf you don’t enroll when you are first eligible you will pay a penalty of 1% for every month that you did not enrollJust like Part B, premiums could be subject to an income based premium surchargeExtra Help or low-income subsidy (LIS) is a Medicare program that helps people with limited income and resources pay for Medicare prescription drug costs

Late enrollment penalty is 1% per month multiplied by “national base beneficiary premium” rounded to the nearest $.10 and added to your monthly premium

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FormularyEach Medicare Prescription Drug Plan has its own list of covered drugsThese drugs are placed into different “tiers” representing different costs- for instance: tier 1- preferred generic, tier 2- non-preferred generic, tier 3- preferred brand name, tier 4- non-preferred brand name, tier 5- Specialty tier- the higher the tier, the more expensive the drug

Prior AuthorizationThe plan you enroll in may require prior authorization for certain medications

Step TherapyYour drug plan may require you first try certain less expensive drugs that have been proven for most people with your condition before you can move up a “step” to a more expensive drugIf you have already tried the similar, less expensive drugs and they didn’t work, your prescriber can contact the plan to ask for an exceptionIf approved your plan will cover the step-therapy prescription drug

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Coverage GapYou pay 25% of the

cost of genericprescription drugs and

25% of the cost ofmost brand-name

prescription drugs*

Deductible Stage

You pay $0 - $435Depending on your plan

Catastrophic Stage

You pay 5% co-insurance or

$3.60 /$8.95 co-pay for covered drugs (whichever is

greater)

Initial Coverage

StageYou pay co-pays based on Tier of

Medication

Initial Coverage Limit $4,020

Members prescription drug out-of-pocket limit $6,350

Cost information for 2020 Calendar year

*Total out of pocket costs are the amounts paid by you in the first two stages plus any applicable drug manufacturer discounts applied in the Coverage Gap Stage 101PY2020

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Medicare rates Advantage and Prescription plans from one to five stars:

***** Excellent

**** Above Average

*** Average

** Below Average

* PoorBeneficiaries can transfer to a five star plan, if there is one available in their area, December 8 – November 30. Only one transfer is allowed per year.

- Enrollment in plans with a below average or poor rating is discouraged by Medicare (If you do enroll in one of these plans and want to change, contact Medicare at 1-800-Medicare for assistance)

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Initial Enrollment Period (IEP/ICEP) This is the time frame most people sign up for Medicare. A seven-month period, starting three months before the month in which you turn 65 and ending three months after that month (assumes you do not delay in Part B benefits)

Medicare Annual Enrollment Period (AEP) October 15 - December 7Beneficiaries may switch plans or add or delete Part D drug coverage- New plans will be effective January 1 of the following year. Guidelines apply.

Medicare Open Enrollment Period (OEP) January 1 – March 31MA plan enrollees may enroll in another MA plan or disenroll from their MA plan and return to Original Medicare. Individuals may make only one election during period.

Special Election Period (SEP)Special enrollment periods may apply for change of residence, loss of group coverage, or if your plan withdraws from the market for the upcoming year.

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Important:There is no ONE plan that is right for everyone. Keep the following in mind as you compare Medicare plans in search of YOUR solution:

Is the plan accepted by your physicians and hospital?Does the plan of choice provide the right balance between monthly plan premium and cost-sharing? Are your medications covered at the most affordable cost?Does the plan meet your travel preferences and lifestyle?

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Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs.

Medicare covers all medically necessary hospitalizations. This includes if you're diagnosed with COVID-19 and might otherwise have been discharged from the hospital after an inpatient stay, but instead you need to stay in the hospital under quarantine.

At this time, there's no vaccine for COVID-19. However, if one becomes available, it will be covered by all Medicare Prescription Drug Plans (Part D).

If you have a Medicare Advantage Plan, you have access to these same benefits. Medicare allows these plans to waive cost-sharing for COVID-19 lab tests. Many plans offer additional telehealth benefits beyond the ones described below. Check with your plan about your coverage and costs.

Medicare now pays for you to communicate with your doctor by “virtual check-in” or through an “online patient portal”. Check with your physician office to see what services they make available.

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