Welcome to Medicare 101!

Intro

  • In today’s class, we’ll quickly cover the information you need to make an informed decision on your Medicare options. This is a 100-level course and covers the basics. For more details, please review one of our 200 level courses (coming soon).

  • Before we get started, it’s important to note that the information presented is for educational purposes only and in no way represents a recommendation of any particular option. It is general in nature. Each individual’s circumstances vary. Please seek the help of a licensed agent before making a decision on what Medicare option is best for you. Now, let’s get started!

  • Terms to know

    1. Original Medicare

    2. Parts A & B

    3. Parts C & D

    4. Supplement Plans

    5. Enrollment Periods

    6. Next steps

  • Premium: The monthly cost to maintain coverage

  • Deductible: The amounts you must first pay before insurance kicks in

  • Co-Pay: A flat rate $ amount that you are responsible for

  • Co-insurance: A percentage of the total cost that you are responsible for

Original Medicare

  • Original Medicare consists of Part A and Part B

  • Part A is for hospital coverage

  • Part B is for medical coverage

  • For more details on eligibility and enrollment for original Medicare, see our Medicare 200 level courses (coming soon)

Part A

  • Part A is your hospital/inpatient coverage

  • Covers:

    • Inpatient hospital care

    • Skilled Nursing Facility

    • Nursing home care (as long as custodial care isn’t the only care needed)

    • Hospice care

    • Home health services

Part B

  • Part B is your doctor/outpatient. It covers medical coverage outside of the hospital

    • Doctor visits, lab work, x-rays, ambulance, emergency room, outpatient surgery

    • Out-patient therapies

    • Durable medical equipment

Part C

  • Medicare Advantage plans are offered by private insurance companies approved by Medicare

  • They bundle Part A and Part B of Medicare

  • Part C or MA plans must cover everything Medicare covers, but can add additional benefits not covered by Medicare

    • These added benefits can include vision, dental, hearing, fitness programs, and more frequent routine care

Part D

  • Prescription drug coverage

  • What it covers:

    • Prescription drugs at a retail pharmacy

    • Benefits must be equal to or better than, a base plan model designed by Medicare

  • What it doesn’t cover:

    • Drugs on on the formulary

    • Drugs excluded from coverage by Medicare

    • “over the counter” medications

    • Medications purchased outside the United States

Supplement or Medical Plans

  • Original Medicare + “supplement” plan

  • Only works with original Medicare. Supplement plans cannot be combined with Medicare Advantage plans

  • Works as secondary insurance. Pays after Medicare pays

    • Only pays if Medicare approved the bill and pays first

  • They do not currently include prescription drug coverage

    • Part D coverage can be purchased separately if desired

The Four Parts of Medicare + Your Options Summary

  • Original Medicare

    • May add stand-alone Part D

  • Original Medicare + Supplement plan

    • May add stand-alone Part D plan

  • Medicare Advantage or Medicare Advantage w/Part D

    • Must receive Part D from MA plan if available (MAPD)

Enrollment Periods

  • Initial Coverage Election Period: Varies

  • Annual Election Period: October 15th - December 7th annually

  • Open Enrollment Period: January 1st - March 31st annually

Questions?

  • Congratulations, you’ve completed Medicare 101! You now have the information you need to make an informed decision on your Medicare coverage. If you would like to consult with a licensed agent that may address your specific needs, please go to the “Contact Me” page to request a follow up.