Medicare Made Clear Lunch and Learn

Medicare Made Clear lunch and learn is hosted by HNCLet's Talk Podcast. These lunch and learn sessions are designed to assist Medicare Eligible beneficiaries in understanding Medicare option during his/her enrollment. 

HNCLet's Talk Podcast is an affiliate of HealthNetCO Insurance Agency, licensed in several states. You can visit us online at HealthNetCO.com

Transcript

My name is Dexter Brooks and I wanna thank you for the opportunity to talk with you today about the basis of Medicare during our weekly sessions for lunch and learn for many medications like a new language.
 It starts with learning words and putting them together into sentences.
 Gradually you become more fluent as United Healthcare, we try to simplify this process through our medical made clear program.
 We hope you'll walk away today with a new vocabulary and a clear understanding of what Medicare is, how it works, and most importantly, how it could work for you.
 Next slide please.
 These are the top 10 Medicare questions we hear from people around the country.
 We'll try to answer them for you today.
 First, we'll define what Medicare is and who is eligible for it.
 Next, we will talk about Medicare.
 If you plan to work past 65, then we'll take a look or we'll look at the different Medicare coverage options and cost.
 After that, we'll touch on how to choose coverage and explain the difference.
 Enrollment periods last, we will talk about how you can how you may be able to save money and where you can find more information.
 There are some common miss perceptions about Medicare, so let's go over a few basic facts about what Medicare is and what it is not.
 Medicare is a health insurance for older and disabled Americans and currently serve more than 62.8 million people in the United States.
 It is funded in part by federal payroll taxes paid by employees and employers.
 The tax is labeled on your pay stub as FICA FICA.
 Medicare is Individual Insurance, which may be confused, and if you're used to getting coverage for yourself, your spouse and your children through an employer plan.
 Medicare is not free.
 You have some cost to pay, which we will cover in a in just a little bit.
 Medicare is also not a family health plan.
 Each person must meet Medicare eligibility requirements as an individual, and each person is covered as an individual.
 For example, one spouse may turn 65 and enrolled in Medicare, while the other spouse is not yet eligible.
 Finally, Medicare is different from Social Security, which is health insurance for people with limited income and resources, and we'll talk about that next.
 Now let's quickly touch on Medicaid.
 Medicaid is a state government program that helps pay health care costs for individuals, family and children with limited income and resources.
 Programs vary state to state, but do follow federal guidelines for benefits.
 Eligibility varies from state to state.
 Medicaid and Medicare can work together.
 In fact, some people can have both Medicare and Medicaid.
 These people are called dual eligible and we will talk about that a little more later.
 So we said that Medicare is Individual Insurance, but who can get it?
 As you might guess, there are eligibility requirements for Medicare.
 First, Medicare is for U.S. citizens.
 And residents living in the United States for at least the previous five years, you must also meet one of the following requirements.
 One be a 65 or younger than 65.
 With a qualifying disability and have received disability benefits for 24 months or any age with a diagnosis of end stage renal disease or ALS, each individual enrolled in Medicare can get a card with a unique number on it.
 Numbers are randomly generated and assigned.
 You can see here what a Medicare card looks like on this particular presentation.
 We mentioned the term dual eligible.
 Now we would dive a little more people who are dual eligible can have both Medicare and Medicaid.
 And yes, the two programs can work together if you have both Medicare and Medicaid, the two will work together and may cover most all of your healthcare costs.
 Additionally, dual eligible individuals may be eligible for special private Medicare plans.
 For example, people with Medicare and Medicaid can get a special coordinated care plan called dual special needs plans.
 So we covered who can get Medicare.
 But before we look at what Medicare covers, let's talk about this a situation many of you may be in today and that's working past a 65.
 If you plan to work past a 65 year Medicare decision may be different.
 In fact, you may be able to delay Medicare enrollment altogether.
 This is generally an option for people who work for an employer with 20 or more employees and have employer health coverage that is considered credible coverage by Medicare.
 Specifically, your plans prescribe drug coverage must be as good as or better than Medicare Part D people who have health coverage from an employer with fewer than 20 employees must enroll at a 65.
 Or they could face late enrollment penalties, but what about if your health insurance is through your spouse?
 Well, in this case you may be able to delay your delay, or you may still need to enroll at 865 even if the spouse employer has 20 or more employees.
 This is because employers can have their own rules for covered dependence.
 Some employers require covered dependence of Medicare Aid 65 to enroll in a Medicare in order to remain covered by the employer's plan, you can ask the employer benefits administrator to learn about your option for this type of situation.
 Now, there are some important things to know about getting Medicare when you continue to work.
 First off, Medicare and your employee Insurance can work together.
 Medicare will typically be secondary to your employers insurance until you leave your employer or lose the employer Insurance, whichever.
 Whichever happens first, then Medicare will become primary.
 2nd, If you take any part of Medicare, you will no longer be able to contribute to a health savings account.
 So when so you need to think carefully about this.
 If you're eligible to delay Medicare enrollment and are going to keep working Medicare, part A may seem like a great idea to go ahead and get even if you keep working, because for most people it's premium three.
 But if you want to keep contributing to your HSA plan, it may not be the right fit.
 Finally, Medicare will not cover your spouse or your children if you decide to take Medicare and also opt to drop your employer coverage, you'll want to talk with your employees, benefit administrator to understand what options they may offer for spouse and children.
 For example, some employers may offer COBRA.
 Make sure you know what drop in your employer coverage for Medicare only means for your family.
 Now let's move on to what Medicare covers.
 You may have heard about the different parts of Medicare.
 That's ABC and D first we'll explain Medicare Part A and Part B.
 Then we'll explain the private Medicare and Medicare related coverage options, which are Medicare Advantage, Part C, Part D, prescription drug coverage and Medicare supplemental Insurance, or Medigap.
 App.
 First up is original Medicare.
 The core coverage provided by federal government has two parts.
 Part A is hospital Insurance.
 Part B is medical insurance.
 Let's take a look at each of these, starting with part A.
 Part A hospital insurance covers service provided during an inpatient hospital stay.
 Most covered services are listed here on this slide.
 This includes your room, your mills and nursing and other services.
 One important thing you may notice missing from the list is Doctor Services.
 That's because doctor services are covered by Part B, even when you're in the hospital.
 Another thing to put out is that if you want a TV or a phone in your room, you may have to pay for it.
 Party doesn't cover these items.
 It also doesn't cover custodial care, which is care that helps with daily life activities like eating and bathing.
 Here are some additional important facts about part A party has a premium, but few people pay for it.
 Remember the FICA payroll tax that we spoke about earlier?
 If you or your spouse pay that for 10 or more years, you get part a premium free.
 You can't be denied party coverage, regardless of your health or financial status, and you're covered at any hospital in the country that accepts Medicare.
 Finally, you need to know a few terms to understand about part a benefits.
 Party covers in part a coverage and calls are based on benefit periods.
 A benefit period begins the day you are admitted into the hospital and ends after you've been out of the hospital for 60 days in a row.
 Observation status is another important term.
 Part A covers hospital stays when you are admitted as an inpatient by a doctor's order.
 Not if you're there for observation.
 Even if you stay overnight, Part B would pay some of these cost.
 And then there's lifetime reserve days, which are extra covered hospital days.
 You can draw on if you're in the hospital longer than 90 days.
 The maximum length of stay covered in a benefit period.
 You get 60 lifetime reserve days.
 Each can be used only once, but they can be applied to different benefit periods and we'll come back to these terms and a bit when we talk about cost.
 Now let's talk about Part B medical insurance.
 The main coverage services are listed here on the slide include doctor visits, the tests or exams, your doctor's may order, and other outpatient services.
 Also, as we just discussed, Part B covers doctor services.
 When you're in the hospital as well, there are a couple of things to point out here.
 First, the annual medical Wellness visit.
 This is an opportunity to meet with your doctor to discuss your health status and goals.
 These things, like a regular visit, may not provide time for it's covered at 100% with no copay, as long as it sticks to the purpose.
 If the discussion versus veers off into current health problems like call for example, or if you receive additional services that are not part of the visit like lab tests, procedures, or certain other services, then there may be a cost.
 It's good to know that this information ahead of time to prevent any surprise billing.
 The second thing to point out is about medical equipment, also called durable medical equipment or DME to be covered.
 The equipment needs to be medically necessary and prescribed by the doctor.
 It also needs to come from a supplier approved by Medicare, so in most cases you can't just buy a walk or somewhere and have Medicare pay for it.
 Talk to your doctor first.
 Now here are some additional important facts about Part B.
 Part B has a monthly premium.
 If you're receiving Social Security or railroad retirement board benefits, the Mount will be deducted from your check each month.
 Again, we'll talk more about cost and just a minute, just as with part A, you can't be denied Part B coverage regardless of your health or financial status.
 And you may see any provider in the country that accepts Medicare.
 Finally, Part B covers charges, a premium penalty for late enrollment unless you qualify for a special enrollment period.
 And we'll cover enrollment later in the presentation.
 But some people, including those who work past age 65, May delay Part B enrollment without a penalty.
 So we've gone over what original Medicare Part A and Part B covers.
 No, let's look at what it doesn't cover.
 Many people are surprised to learn that they will have out of pocket costs, which could be significant depending on the individual health care needs.
 Further, there is no out of pocket maximum, no financial protection with the Rich with the original Medicare, a series, a serious illness or injury could create real financial stress.
 Another possible surprise is that original Medicare does not cover prescription drugs, which can be a big expense as well as we get older.
 Other non covered services include routine dental, vision and hearing care.
 Even from these simple examples you can see that original Medicare doesn't cover everything, and that out of pocket costs for healthcare items and services could add up and take a bite out of your budget.
 The good news is that you have options for other coverage that can cover other key things like prescription drugs.
 And that may help turn that budget bite into it.
 Just they little nibble.
 On that note, we're now ready to talk about what Medicare Part C, Part D and Medicare Supplemental insurance plans cover and how they may work when you're deciding on Medicare covers to choose.
 Now we're going to see how part see or Medicare Advantage Part D and Medicare supplemental Insurance, or Medigap, plans fit into the picture.
 You have two options for more coverage option number one is to add Medicare Supplemental insurance and or a Part D prescription drug plan to original Medicare medical supplement insurance will help pay some of the other pocket costs not paid by Medicare Part A&B.
 Part D will cover prescription drugs.
 Option two is to choose a Medicare Advantage plan part C Most Medicare Advantage plans include drug coverage and additional benefits, such as routine dental and vision coverage.
 Before we delve into these option, I want to point out that all three of the components shown on the slide, medical Supplemental Insurance, Medicare banished plans and Part D plans are offered by private insurance companies.
 What this means in part is that there may be a number of plans to choose from, and they may vary in coverage and cost.
 By contrast, original Medicare is administered by the federal government and benefits and costs are the same for everyone.
 Medicare, vantage and Part D plans are approved by Medicare and held to the standard set by Medicare.
 These private plans options are provided to give you more choices and the ability to fill in for what isn't covered by original Medicare.
 Now we'll circle back to this graphic later, but now let's continue through the alphabets and talk about Medicare Advantage, otherwise known as part C.
 Now we're going to see how part C of Medicare Advantage Part D and Medicare.
 Excuse me.
 Parsi is a excuse me.
 Parsi is Medicare Advantage.
 It is an alternative to original Medicare and offers another way to get your Medicare Part A and Part B benefits plus more.
 You still have Medicare and Medicare contracts with the plan to administer your part A and Part B benefits.
 You also continue to pay your Part B premium directly to Medicare.
 Plans that offer regionally offer often in a county or state by private insurance companies.
 Most plans include other benefits like prescription drugs, dental and vision.
 All benefits are covered under one plan.
 By law, Medicare Advantage plan must provide all the benefits that arisen.
 Medicare does so plans combine part A and Part B coverage into one package.
 One exception is Hospice care, which is covered by part A.
 Even when you have a Medicare Advantage plan, most Medicare Advantage plans also include built in prescription drug coverage or Part D, which will talk about next.
 Finally, Medicare Advantage plans may also offer additional benefits, including coverage for dental, vision or hearing care, as well as fitness programs.
 The result is an all-in-one plan, similar to what you may be used to having through an employer.
 Now there's a different type of Medicare Advantage plan.
 Most are coordinated care plans.
 What care is delivered through a provider network?
 You may get care outside the network, but you may pay more or even the full cost.
 Most coordinated care plans are HMO or PPO plans.
 HMO plans have a network of doctors, hospitals and other care providers you use to receive covered services.
 POS, which is point of service plans or a type of HMO plan that also lets you see providers outside the plans network for certain covered services.
 And then you have the PPO plans, which have a provider network you can use, but also offer more freedom to see providers outside the Plan network for all covered services.
 A special niece plans are designed specifically for people with certain health care needs.
 Plans we talked about earlier is a kind of special needs plan specifically for those with both Medicare and Medicaid.
 There are also chronic special needs plans for people who have certain chronic conditions, such as diabetes.
 Institutional special needs plans for people living in a skilled nursing facility and institutional equivalent.
 Special needs plans for people living in assisted living facility and need the same kind of care as those lived in a skilled nursing facility.
 Then we have the private fee for service plans typically offered more flexibility and shoes and providers than other types of plans do.
 In general, you can get care from any Medicare approved provider who accepts the plans, terms and conditions.
 Now Medicare, save his account plans, combines a high deductible health plan with a medical savings account.
 They generally offer more choice with more financial risk.
 There are some additional things you need to know about parts C you must be enrolled in both part A and Part B to be eligible for Medicare Advantage plan.
 You must also live in the planned service area and you can't be denied coverage.
 You may pay a premium to your Medicare Advantage plan and continue to pay your monthly Part B premium to Medicare.
 It's easy to get confused by this.
 Then the plan provides part A&B coverage, but you're still need to enroll in part A&B.
 As we mentioned, you still and you're still in the Medicare program Medicare contracts with the plan to administer your benefits.
 Importantly, unlike original Medicare, every Medicare Advantage plan has an annual out of pocket maximum for part A and Part B services covered by the plan.
 Once you pay this amount, the plan covers their entire cost for these services for the rest of the year.
 And keep in mind the out of pocket maximum doesn't apply to your monthly premium or prescription drug costs or any cost for additional benefits not covered by original Medicare, like routine eyewear or hearing aids, Medicare sets standards maximum, but many plans cap your cost below this amount, the out of pocket maximum limit in 2024 is $8850.
 Now let's move on to Part D, which is prescription drug coverage as an easy way to think about this is D for drugs.
 Remember, drugs are not covered by original Medicare as except in select circumstances you can get drug coverage in two ways through a separate standalone Part D plan or through a Medicare Advantage plan.
 As we just discussed, stand alone Part D plans can work with the original Medicare Medicare supplemental insurance plans and select Medicare Advantage plans including private fee for service plans and medical Savings account plans without drug coverage.
 And like Medicare Advantage plans, Part D plans are offered by private insurance companies.
 Each part deep Plan or Medicare Advantage plan that includes drug coverage creates a list of specific drugs that it will cover.
 The list is called a formulary.
 Each plant has its own list of covered drugs, but every plan must cover a range of both generic and brand name drugs that are generally needed by people on Medicare plans also cover all commercially available vaccines, like the shingle shot that are covered by Part B.
 Part B covers things like flu and pneumonia shots.
 Many party group the drug they cover into levels or tears, drugs and different tiers have different cost.
 For example, you may pay more or higher copay or coinsurance for a Tier 5 drug.
 Then for a Tier 2 drug, also plans may have a deductible or some tiers and not for others.
 When choosing a plan is important to make sure that drugs you take are covered on the plan and understand the cost, which can vary from plan to plan.
 Let's take a minute here to talk about the different party cost stages.
 Especially the part of the coverage gap, commonly called the donut hole.
 Since it may be confusing for some people.
 There are four Part D cover stages.
 The stage you're in determines their amount you pay when you fill that prescription.
 Each days has a dollar limit set by Medicare that make that marks when you exit the stage and enter the next.
 The limits shown on the slide here can change from year to year.
 You began in the deductible stage.
 If your plan has one where you would pay the full cost for drugs or in the initial cover stage where you usually pay a copay.
 If your drug costs reach the limit for initial cover stage, then you would enter into the coverage gap where you pay a greater share of the cost for your drugs, which is normally 25% for generic and 25% for brand name drugs in 2024.
 Not everyone enters the coverage gap.
 If you do and your drug costs reach the limit, then you enter the catastrophic coverage stage and you pay reduced copays for the rest of the year.
 The cycle starts over on January 1.
 A few final points about Part D.
 You are eligible to join a Part D plan once you are enrolled and part A, but B are both.
 Plans often have pharmacy networks that you need to use to get the plans.
 Pricing plans may vary quite a bit in terms of what specific drugs they cover and what your cost may be.
 A final key point is that you could be charged a premium pencil penalty if you are late enrolling in Part D unless you qualify for a special enrollment period.
 I'll say more about this in a few minutes.
 Now we'll come to the Medicare supplemental insurance or what is often called Medigap.
 Medical supplemental insurance plans, which are often offered by private insurance companies, are different from the plans we've discussed so far.
 As the name says, there supplement Medicare, so they are not Medicare plans in and of themselves.
 Medicare supplement insurance plans help to pay some of the auto pocket costs that come with Medicare, like the deductible and coinsurance, they can only be used with the original Medicare, not with Medicare Advantage.
 Plans are standardized by the federal government.
 There are 10 plans labeled with letters planned A for example.
 Every Plan of the same letter provides the same benefit, no matter what insurance company offers it.
 For example, Minnesota, Maine, Wisconsin, or exception to the rule.
 As these states standardize their plans differently.
 It's also important to note that plan C and plan F are only available to individuals who were eligible for part A or turned 65 before January 2020.
 Now here are some costs that Medicare supplement plans may help with, and some that may not.
 You'll see that the they help pay for coverages already provided by original Medicare and may extend it in some cases, as with extra hospital days, Medigap plans can help with part a deductible.
 Original Medicare copays, coinsurance and provider access charges cost of blood transfusion and cost of foreign travel emergency.
 Additionally, some programs may cover part be deductible calls, but only for those individual who were eligible for part A or turn 65 before January 2020.
 But except for foreign travel emergency coverage, Medigap plans don't fill in for what are meta?
 What original Medicare doesn't cover such as dental, vision care?
 Some Plan providers may offer value added services for free or a discounted basis, but they are not part of the Medigap plan directly.
 Now this slide on this table you may have, you may help you to visualize with this side.
 If not read, which causes different standardized plans to help with and the level of coverage 100% means 100% coverage and the main point here is that Medigap plans vary.
 Example you have Medigap plans would plan a Plan B, plan D, Plan G, Plan K, Plan L, Plan L Plan N Plan CNF or not available unless you turn 65 and before January 1st of 2020.
 Now based on the slide, you can see that these plans do different based on what is covered.
 Now for some fast facts.
 You must be enrolled in both part A and Part B.
 To be eligible for Medicare Supplemental Insurance plan, and you must choose from the plans.
 Offered in your state also, there's a set enrollment period when you can be denied coverage or charge more based on your health history.
 This is any minute when we cover the enrollment period, Medicare supplement insurance coverage is nationwide and goes with you wherever original Medicare does.
 And while playing benefits are standarized, he's Plan sets his own premium.
 The mouth can vary even from the same coverage, so you and your friend who lives in a different state may both have Plan F but your primas may be very different in general through among the different standardized Plan.
 The broader the covers, the higher the premium.
 So for example, plan A which we said provide selective help may have a lower premium than plan F which cover more of your cost.
 Finally, you must continue to pay the Part B premium to Medicare.
 Now let's talk about Medicare cost.
 We'll start with some definitions.
 Most people are familiar with premium deductibles and copays, which are defined here.
 Co Insurance may be a less familiar term.
 This is an amount you pay when the cost of covered services is split with you.
 Is determined by percentages.
 For example, the cost of service is covered 80% and you pay the remaining 20%.
 You may have some of all of these types of calls with Medicare, again depending on your coverage.
 Finally, if you choose a Medicare Advantage plan Part D or Medicare supplement insurance plan.
 These are the causes you may pay for.
 Each costs will vary by plan and by provider.
 Let's start with Medicare Vanisher part C plans with Medicare Advantage plans, some plans have low to 0 premium.
 Some plans have deductibles and some others do not.
 You want to look at a planned carefully to see if they have either premium or deductible and how much they are.
 Medicare Advantage plan may also charge copay or coinsurance amount for covered health services.
 Medicare Advantage plans also have an out of pocket maximal which helps protect you financially by limiting your out of pocket cost.
 Finally, with Medicare Advantage plans, you will still pay the Part B premium to Medicare, which part deep prescription drug plans.
 You may have a monthly premium and deductible or copay and coinsurance amounts, but De plan costs will vary by plan and provider calls may also vary for your deductible and copays.
 If it's a Plan has a tier formulary.
 In this situation, drugs may have different and or higher deductible on a higher tier and copays, maybes be specific to certain drugs or tears as well.
 And finally, Medicare supplemental insurance plans, or Medigap plans, may charge a monthly premium.
 And also have a deductible and copay amounts.
 There are different types of Medigap plans, and private insurers set their own premiums.
 So you'll need to review the specific plan carefully to find out what's your cost will be.
 Some Medigap plans may also cover protection for out of pocket costs, but again, each plan and providers is different, so be sure to look closely before purchasing.
 We have covered a lot, hopefully you know.
 You now have a basic understanding of the different parts of Medicare, Medicare supplements, Insurance and the cost you could pay.
 Now what?
 Well, you get to put the different coverage options together to meet your needs like this.
 There are seven combination on this slide right away.
 You can see choices with A&B combos one through 4 or with C combos 5 to 7, but not with A&B&C together.
 Remember Medicare Advantage part C is an alternative to original Medicare parts A&B and Medicare.
 Supplement insurance only works with the original Medicare, not with Medicare Advantage.
 Part D gets along with everyone, but NOT option seven is only available with certain Medicare Advantage plans.
 Now that we review the coverage option, let's go back to the graphics we looked at earlier only as one whole picture step one is to enroll in the Medicare program.
 Again, original Medicare consists of part A and Part B, and it provides by the federal government.
 Step 2 is where it gets interesting.
 If you want more coverage than original Medicare provides.
 If you do like we saw on the previous slide, you have two options.
 Option one.
 Add plans to original Medicare or option two.
 Choose a Medicare Advantage plan instead.
 You can get Part D drug covered with either option.
 So the choice when looking at additional coverage is really between Medicare supplements, Insurance and Medicare Advantage.
 Let's look at this more closely.
 Let's think about this choice in terms of coverage, cost and convenience covers.
 Provides choice is one of the main consideration between these coverage option.
 Medicare Supplement insurance helps pay for care from providers nationwide.
 Medicare Advantage plans generally have a provider network and each serves a set of geographic area.
 Another key consideration is what you need to coverage for.
 Do you want coverage for prescription drugs, dental and vision?
 So the question to ask, am I able to get most of my health care needs met near home?
 Am I willing to change, doctor if I mind isn't set on a plan?
 The network do I won't coverage for additional health care services like dental, vision, hearing and fitness.
 Now let's talk about cost.
 Both options have managed cost but in very different ways.
 With the Medigap plan, you may pay a higher premiums than with the Medicare Advantage plan, but other calls may be lower with the Medicare Advantage plan, you pay copays, but the premium may be low and you're protected by an out of pocket maximum.
 So the question you're going to ask is how often do I use my health care services?
 What I like what I rather pay higher premiums even when I don't use the services.
 Or would I rather pay copays when I do use the services?
 What level of medical supplement insurance can I afford?
 The next last is convenience.
 Many people who opt for Medigap plans also buy a Part D plan with the original Medicare.
 That's three different plans with Medicare Advantage plans.
 It's usually just one, so the question you ask which cover option is the best fit for my lifestyle.
 How do I feel about working with multiple insurance carriers?
 What Part D plans are offered where and where I live, and what Medicare Advantage plans are offered, whether you choose Medicare, supplemental Insurance or Medicare Advantage, be sure to consider your needs and budget and to compare plans before making a decision.
 Or you can call us at 18334444139 to assist.
 Now, once you decide on coverage, you're ready to enroll.
 So let's explore the different enrollment periods.
 Most people first enrolled in Medicare during their initial enrollment period or IE P your ISP is 7 months long.
 It includes your 65th birthday month plus the three months before and the three months after.
 If your birthday is on the 1st, then your enrollment period begins and ends one month earlier.
 If you qualify for Medicare due to disability, then your ISP includes your 25th month receiving benefits the three months before and the three months after you are enrolled