The A, B, C, and D of

Medicare

Raymond Estrada, KelseyCare

Advantage

Medicare

A federal health insurance program for

people:

• Age 65 or older

• Under age 65 with certain disabilities

• Any age with End-Stage-Renal Disease

(permanent kidney failure)

MEDICARE

PART A (HOSPITAL)

PART B (PHYSICIAN)

PART C (MEDICARE ADVANTAGE)

PART D (Rx DRUGS)

Medicare Private Companies

Cost of Medicare

Premiums

Part A $0

(entitled due to payment of Medicare taxes)

Part B $134

(for most people)

Part C Part B +

Health Plan Premium

Part D Determined by your drug plan –

National Average $35.02

What is NOT covered under Medicare?

General Chiropractic You Pay 100%

Routine Eye Exams You Pay 100%

Routine Dental You Pay 100%

Prescription Drugs You Pay 100%

Solutions

Retiree Coverage

Supplemental Coverage (“Medigap” Policies)

Medicare Advantage

Supplemental Insurance “MediGap”

Benefits Considerations

Will cover service gaps with

traditional service

Will cover some copays and

coinsurance

Can go to any Medicare

participating provider

Premiums may be high, are “aged-

attained,”and usually go up year to year

May have to qualify

Will only work with traditional Medicare

Will usually only cover what Medicare

covers (no additional benefits)

No prescription benefits

May have to submit claims

Medicare Part C

(Medicare Advantage)

Part A - Hospital Part B - Physician

Part C

Medicare Advantage

• PPO

•HMO

•PFFS

Medicare Part C - Combines Your Coverage

Medicare Advantage

Benefits Considerations

Most often NO premium or a very

low premium

Most often NO or very low

deductibles

Most often covers more than

traditional Medicare covers

May offer your Part D coverage with

no additional charge

Most often will provide “value-

added” benefits

Most often will be restricted to a

provider network

Eligibility for membership in a MA

and PDP at the same time is very

restrictive

Medicare Part D –

Prescription Drug Coverage

First offered in 2006

Offered by private insurance companies

May pay a penalty if you choose to join later

Creditable Prescription Drug Coverage

HRA with Medicare

A Health Reimbursement Arrangement (HRA) is an account established by

your employer to help pay for out-of-pocket health care costs.

• Only an employer can contribute funds to an HRA.

• HRA contributions are NOT included as part of your taxable income

from your employer.

• Eligible expenses depend on how your employer has set up the HRA.

Typically, HRA funds apply to most health care expenses such as:

– Deductibles

– Copayments

– Coinsurance

– Medicare eligible premiums

Questions & Answers