Medicare 101 – What is Medicare?

Medicare - The Basics Medicare is only complex when you're getting started. Basically, Medicare pays 80% of the client's medical bills. The Supplement pays the other 20%. It does so electronically, automatically, only by showing their card at the provider's office. They can see ANY provider in the country (doctor, lab, hospitals, etc.) that accept original Medicare. NO network restrictions. No pre-authorizations required for most procedures. What your doctor says, goes, as long as it is a Medicare-approved procedure (not experimental or witch-doctor stuff.) Part A of Medicare Hospital Admission Part B of Medicare Everything else - all outpatient procedures Part C of Medicare Their term for Medicare Advantage (a term which confuses folks) Part D of Medicare Drug plan You can market to those Turning 65 years old, as they are in "Open Enrollment" and can pick any plan without any health underwriting. Easy to write up, but they require a lot of follow-up and there is a lot more competition for those turning 65. Lists are available where you can merely download a group of folks in any area that are turning 65 and market to them. Trust me, it is not complicated to those we market to that are between 67 and 75 years old. Why? They already know how Medicare works and they've already selected, and used their Medicare Supplement plan extensively. Very little education is needed vs. the turning 65 folks who know absolutely nothing about Medicare and how it works. Our goal, with this older group, is to replace their existing plan with a very similar plan at a much better price. This is simplicity at its best, and how we got started in the business. We would save folks $50 to $200 per month on the same coverage they had before. That said, a thorough understanding of how Medicare works will serve you well. To be sure, the more you can learn, the better agent and advocate for your client that you will be. My advice is to not get overwhelmed with the information that is provided here. As a matter of fact, the best place to start is the very book that was designed by CMS (Center for Medicare and Medicaid Services) for seniors to read when they are considering their Medicare options every year. This is the Medicare & You guidebook, and it's known as the "bible" of Medicare for seniors. The first step a Medicare agent should take is to call Medicare and request your own copy of the printed version of the Medicare & You book. This book should always be on your desk. I reference mine all the time and show it to my clients on my video camera often. You can download the entire Medicare & You guidebook in the electronic version (PDF) here: You can contact Medicare directly to request your printed version here: 1-800-MEDICARE (1-800-633-4227) This, below, is my favorite single page of the Medicare & You guidebook. You can print this page out here and have it available to show your clients, either when you send them something in the mail, attach it to an e-mail, or hold it up on camera if you do so on a screen share. This page is powerful, and sums up our entire reason for existing right here: (This same page existed in the 2012 edition, too, but on Page 64). For 2014, it is found on page 68. Medicare Supplement Plan Side-by-Side Comparison Medigap Plans Note The Medigap policy covers coinsurance only after you've paid the deductible (unless the Medigap policy also pays the deductible). Compare Medigap plans side-by-side The chart below shows basic information about the different benefits Medigap policies cover. Yes the plan covers 100% of this benefit No the policy doesn't cover that benefit % the plan covers that percentage of this benefit N/A not applicable Medigap Benefits Medigap Plans A B C D F* G K L M N Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Part B coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes*** Blood (first 3 pints) Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes Part A hospice care coinsurance or copayment Yes Yes Yes Yes Yes Yes 50% 75% Yes Yes Skilled nursing facility care coinsurance No No Yes Yes Yes Yes 50% 75% Yes Yes Part A deductible No Yes Yes Yes Yes Yes 50% 75% 50% Yes Part B deductible No No Yes No Yes No No No No No Part B excess charge No No No No Yes Yes No No No No Foreign travel exchange (up to plan limits) No No 80% 80% 80% 80% No No 80% 80% Out-of-pocket limit** N/A N/A N/A N/A N/A N/A $5,240 $2,620 N/A N/A * 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 $2,240 in 2018 before your Medigap plan pays anything. ** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission. You live in Massachusetts, Minnesota, or Wisconsin If you live in one of these 3 states, Medigap policies are standardized in a different way. You live in Massachusetts You live in Minnesota You live in Wisconsin (click the image) Medicare 101 Video - this is a pretty good overview of the entire Medicare program and the options seniors are presented with when they are Medicare Eligible. Part 2 - Coverages on top of Medicare - this is where we come in. We will go more in-depth as to which plan is best to recommend. This is just an overview of the differences in the plans available. This explains the time periods, as it pertains to someone new to Medicare and when they can sign up for a Medicare Supplement Plan: https://www.youtube.com/watch?vwkQHcNSHtaA 5.5 Things Seniors Do Not Know About Medicare: https://www.youtube.com/watch?vLVtiT0GDczo NEW: See this post on Underwriting and Guarantee Issue state-by-state rules when leaving an employer plan, etc. Also: Special Guarantee Issue Rules Some states have odd guarantee issue rules. Those rules usually cause the companies to pay the agent half, or zero, commission when exercising their guaranteed issue rules.. like MO and CA. Here is thought to be the latest list of these special rules. If nothing is next to the state, there is no special rule there. Alabama Alaska Arizona Arkansas California - 30 Days after the birthday Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas - NONE Kentucky - NONE Louisiana Maine - GI at any time provided you move to plan of like or lessor value (no more than 90 break in coverage) Maryland Massachusetts Michigan - NONE Minnesota Mississippi Missouri - Annually on the Anniversary date of the supplement Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York - GI All year North Carolina North Dakota Ohio - NONE Oklahoma Oregon - 30 days after birthday Pennsylvania - NONE Rhode Island South Carolina South Dakota Tennessee - NONE Texas - NONE Utah - NONE Vermont Virginia - NONE Washington - Washington, is odd, You can change Medicare supplements at any time as long as you currently have coverage. You can also switch from MA to supp. West Virginia Wisconsin Wyoming

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