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MEDICARE SUPPLEMENT PLANSFROM WESTERN MARKETING
Western Marketing Associates Corporation800-852-7152www.wmacorp.com
WHAT IS MEDICARE?
Social insurance program established by Congress in 1965
Administered by a government agency called the Centers for Medicare and Medicaid Services (CMS)
Provides health coverage to over 44 million people*: Age 65 or older
Under age 65 with certain disabilities
Any age that has End-Stage Renal Disease (ERSD)
*www.hhs.gov/about/whatwedo.html (23 April 2012).
ABC’S (AND D) OF MEDICARE…
Original Medicare
Part A
Hospital
Insurance
Part B
Medical
Insurance
Part D
Prescription Drug Coverage
Part C
Medicare Advantage Plan
PART A: HOSPITAL INSURANCE
Covers the following: Inpatient hospital care
Skilled nursing facility care
Home health care
Hospice care
PART A: HOSPITAL INSURANCE
Service Medicare Pays Patient Pays
(2016)
Hospitalization
Deductibles
Days 1-60: All but $1,288 $1,288
Days 61-90: All but $322 per day $322 Per Day
Days 91-150: All but $644 per day $644Per Day
Nothing beyond 150 days 100% of Expenses
First 3 Pints of Blood: $0 100% of Expenses
Skilled
Nursing
Facility Care
Days 1-20: 100% of approved
amount
$0
Days 21-100: All but $148 per day $148 per day
Days 100+: $0 100% of Expenses
UsuallyIncreasesEach Year
PART B: MEDICAL INSURANCE
Standard monthly premium of $121.80 in 2016
Covers the following:Doctor’s and other health care providers’ services
Hospital outpatient care
Durable medical equipment
Home health care
Many preventative services
PART B: MEDICAL INSURANCE
Services Medicare Pays Patient Pays (2016)
Doctor’s and other health
Care providers’ services
Hospital outpatient care
Durable medical equipment
Home health care
Many preventative services
80% of the approved amount 20% of the approved amount
$166 deductible per calendar
year
May
Increase
Each Year
PART C: MEDICARE ADVANTAGE
Offers health plan options run by Medicare-approved private insurance companies
Option to choose Part C instead of utilizing Part A & Part B
Most Part C plans also cover Part D Coverage
Out of pocket costs can vary by plan
May have to use certain providers who belong to the plan
PART D: PRESCRIPTION DRUG COVERAGE
Helps cover the cost of prescription drugs
Run by Medicare-approved private insurance companies that are subsidized by the government
Plans may vary substantially, covering different drugs, charging their own premiums and co-pays
SO LET’S RECAP…
Medicare wasn’t designed to cover everything
With Medicare Parts A and B, one must pay deductibles and co-payments and co-insurance
Original Medicare does not offer coverage for prescription drugs in most cases
One can enroll in Part D
MEDICARE SUPPLEMENT INSURANCE
With a Medicare Supplement Plan, one can receive help paying some or all of the costs not paid by
original Medicare, year after year
MEDICARE SUPPLEMENT INSURANCE
Private health insurance designed to supplement Original Medicare
Sometimes referred to as Medigap Insurance, as it strives to cover the “gaps” in Medicare Deductibles, co-insurance and co-pays
These amounts change each year and supplement coverage covers those new amounts
MEDICARE SUPPLEMENT INSURANCE
10 standardized plans can be offered Plans are named for letters of the alphabet, and benefit
levels vary by plan
Cost can vary by plan, location, by company
Plans are managed according to federal and state laws
Can only cover one individual
Can only have one plan at a time
MEDICARE SUPPLEMENT INSURANCE
All plans cover basic benefits Part A coinsurance for inpatient hospital care
Cost of 365 extra days of inpatient hospital care
Part B coinsurance after deductible
First 3 pints of blood each year
MEDICARE SUPPLEMENT PLANS
Some of the plans also cover Part A deductible
Part B deductible
At-home recovery
Medicare Part B excess charge
Other services
Medicare Supplement Plans 2016
A B C D F* G K L M N
Medicare Part A Coinsurance and hospital costs up to an additional 365
days after Medicare Benefits are used up
Medicare Part B Coinsurance or Copayment 50% 75% ***
Blood (First 3 Pints) 50% 75%
Part A Hospice Care Coinsurance or Copayment 50% 75%
Skilled nursing Facility Care Coinsurance 50% 75%
Medicare Part A Deductible 50% 75% 50%
Medicare Part B Deductible
Medicare Part B Excess Charges
Foreign Travel Emergency (Up to Plan Limits
* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-
covered costs up to the deductible amount of $2,180 in 2016 before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medigap
plan pays 100% of covered services for the rest of the calendar year.
Out-of-Pocket Limit**
$4,960 $2,480
MEDICARE SUPPLEMENT PLANS
Some of the things the plans generally do NOT cover Long-term care
Vision or dental care
Hearing aids
Eyeglasses
Private-duty nursing
WHO IS ELIGIBLE?
Must be enrolled in Medicare Parts A and B at the time coverage begins
Must be a resident of the state in which one is applying for coverage
Must be age 65 or older, or under age 65 with certain disabilities
WHY CHOOSE A MEDICARE SUPPLEMENT PLAN?
Helps manage out-of-pocket expenses “Predictable” costs good for budgeting purposes
Guaranteed renewable As long as premiums are paid
First day coverage No waiting period for pre-existing conditions
WHY CHOOSE A MEDICARE SUPPLEMENT PLAN?
Medical coverage that can be used with any doctor or hospital throughout the U.S. that accepts Medicare assignment No referrals needed, no networks
Covers Medicare-allowable services when traveling within the US
Automatic claims filing, virtually no paperwork or claims to submit
MEDICARE SUPPLEMENT INSURANCE PRICING
States can choose from three methods below: No-Age Rated (Community Rated)
Everyone pays same
Issue-Age Rated Premium based on age when purchased
Attained-Age Rated Premium goes up automatically as you get older
MEDICARE SUPPLEMENT INSURANCE PRICING
Other pricing elements: Gender Rating (Male and Female) Tobacco/Non Tobacco Area rating Height/Weight
Rate Adjustments Help keep pace with rising Medicare claim trends and changes in
annual deductibles co-insurance and co-pays. The premium may also change for reasons other than attained age. This type of premium change can occur on any
Policy Renewal Date. However, such premium change cannot be made unless we make the same change to all policies of this form issued to persons of the same classification living in the same geographic area of your state. We will give you the advance written notice required by your state prior to any premium change.
MEDICARE SUPPLEMENT PLANS FROM WESTERN MARKETING
Standardized Plan A• Least amount of
benefits per the other plans
• Pays for Part A & Part B expenses
• Does not cover deductibles
Standardized Plan F• Covers 100% of
Medicare approved procedures
• Covers excess• No co-pays/deductibles