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MedicareMedicare
22
Four Parts of Medicare:Four Parts of Medicare:
Medicare Part A – Hospital InsuranceMedicare Part B – Medical Insurance
Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage
Medicare Part A – Hospital InsuranceMedicare Part B – Medical Insurance
Medicare Part C – Medicare Advantage Plans Medicare Part D – Prescription Drug Coverage
33
65 & older
-or-
Receiving Social Security disability benefits at least 24 months
-or-
Permanent kidney failure
-or-
Amyotrophic Lateral Sclerosis (ALS)
65 & older
-or-
Receiving Social Security disability benefits at least 24 months
-or-
Permanent kidney failure
-or-
Amyotrophic Lateral Sclerosis (ALS)
Who Can Get Medicare?Who Can Get Medicare?
44
When Can I Sign Up for Medicare?When Can I Sign Up for Medicare?
Medicare Enrollment Periods: Initial - at age 65
Special - if still working
General - January-March
55
Full Retirement AgeFull Retirement Age
Year of Birth Full Retirement Age
1937 or earlier 65
1938 65 & 2 months
1939 65 & 4 months
1940 65 & 6 months
1941 65 & 8 months
1942 65 & 10 months
1943 – 1954 66
1955 66 & 2 months
1956 66 & 4 months
1957 66 & 6 months
1958 66 & 8 months
1959 66 & 10 months
1960 or later 67
Year of Birth Full Retirement Age
1937 or earlier 65
1938 65 & 2 months
1939 65 & 4 months
1940 65 & 6 months
1941 65 & 8 months
1942 65 & 10 months
1943 – 1954 66
1955 66 & 2 months
1956 66 & 4 months
1957 66 & 6 months
1958 66 & 8 months
1959 66 & 10 months
1960 or later 67
66
Medicare CoverageMedicare Coverage
Part A Hospital Insurance Covers most inpatient hospital expenses.
2008 Deductible $1,024
Part B Supplementary Medical Insurance Covers 80% doctor bills & other outpatient medical
expenses after 1st $135 in approved charges.
2008 Monthly Premium $96.40
Part D Medicare Prescription Drug Plan Covers a major portion of prescription drug costs
for Medicare beneficiaries.
2008 average Monthly Premium $27.93
Part A Hospital Insurance Covers most inpatient hospital expenses.
2008 Deductible $1,024
Part B Supplementary Medical Insurance Covers 80% doctor bills & other outpatient medical
expenses after 1st $135 in approved charges.
2008 Monthly Premium $96.40
Part D Medicare Prescription Drug Plan Covers a major portion of prescription drug costs
for Medicare beneficiaries.
2008 average Monthly Premium $27.93
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Part B Medically-Necessary ServicesPart B Medically-Necessary Services
77
•Ambulatory Surgical Services
•Clinical Laboratory Services
•Emergency Room Services
•Outpatient Hospital Services
•Diagnostic Tests (x-rays, MRI, CT scan)
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“Welcome to Medicare” Physical Exam Bone Mass Measurement
Cardiovascular ScreeningsColorectal Cancer Screenings
Diabetes ScreeningDiabetes Self-Management Training
Annual Flu ShotMammograms
Prostate Cancer ScreeningsSmoking Cessation Counseling
“Welcome to Medicare” Physical Exam Bone Mass Measurement
Cardiovascular ScreeningsColorectal Cancer Screenings
Diabetes ScreeningDiabetes Self-Management Training
Annual Flu ShotMammograms
Prostate Cancer ScreeningsSmoking Cessation Counseling
PREVENTIVE SERVICESPREVENTIVE SERVICES
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ASSIGNMENTASSIGNMENT
An agreement between you and your doctor that he/she will accept as payment the amount Medicare
approves for the service provided.
An agreement between you and your doctor that he/she will accept as payment the amount Medicare
approves for the service provided.
1010
The highest amount you can be charged for a Part B-covered service is the
“limiting charge”. The limiting charge is 115% over the Medicare-approved
amount. It applies to only certain services and does not apply to some supplies and
durable medical equipment.
The highest amount you can be charged for a Part B-covered service is the
“limiting charge”. The limiting charge is 115% over the Medicare-approved
amount. It applies to only certain services and does not apply to some supplies and
durable medical equipment.
LIMITING CHARGELIMITING CHARGE
1111
NON-STANDARD PART B PREMIUMSNON-STANDARD PART B PREMIUMS
If Your Yearly Income is: You pay:
Individual Tax Return Joint Tax Return
$82,000 or below $164,000 or below $ 96.40
$82,001 - $102,000 $164,001 - $204,000 $122.20
$102,000 - $153,000 $204,001 - $306,000 $160.90
$153001, - $205,000 $306,001 - $410,000 $199.70
Above $205,000 Above $410,000 $238.40
1212
NON-COVERED SERVICESNON-COVERED SERVICES
• Acupuncture
• Chiropractic services with one exception
• Cosmetic Surgery
• Routine Eye Exams
• Routine foot care
• Hearing aids
• Long –term care
• Routine physical examinations
1313
How Will the Prescription Drug Plan Affect You?
How Will the Prescription Drug Plan Affect You?
You will pay the first $275 (called an “annual deductible”).
Medicare will pay 75% of costs between $275 and $2,510 in drug spending. You pay only 25% of these costs.
Example: $2510 - $275 = $2235. $2235 x 75% = $1676.25.
You will pay 100% of the drug costs between $2,510 and $5726.25. Part D pays nothing. (Donut hole).
Medicare will pay about 95% of the costs above $5726.25. You pay between $2 and $5 per prescription.
1414
Extra Help Could Further ReduceMedicare Prescription Drug CostsExtra Help Could Further ReduceMedicare Prescription Drug Costs
Extra help is available for low income beneficiaries to pay for part of the Medicare
Part D monthly premiums, annual deductibles and prescription co-payments. The extra help
could be worth more than $3,600 per year.
Go online to www.socialsecurity.gov to apply for extra help.
Extra help is available for low income beneficiaries to pay for part of the Medicare
Part D monthly premiums, annual deductibles and prescription co-payments. The extra help
could be worth more than $3,600 per year.
Go online to www.socialsecurity.gov to apply for extra help.
1515
Income and Resource Limits - SubsidyIncome and Resource Limits - Subsidy
INCOME:
Individual – below $15,600 a year ($1300 per month)
Couple – below $21,000 a year ($1750 per month)
RESOURCES:
Individual – no more $11,990
Couple – no more than $23,970
1616
Advantages of Qualifying for Medicare Part D Subsidy?
Advantages of Qualifying for Medicare Part D Subsidy?
No monthly premium (limited to several plans)
No yearly deductible
No donut hole
Can enroll in Part D anytime you qualify
No monthly premium (limited to several plans)
No yearly deductible
No donut hole
Can enroll in Part D anytime you qualify
1717
For More Medicare InformationFor More Medicare Information
1-800-MEDICARE(1-800-633-4227)
TTY 1-877-486-2048
www.medicare.gov
1-800-MEDICARE(1-800-633-4227)
TTY 1-877-486-2048
www.medicare.gov
1818
Social Security’s Online ServicesSocial Security’s Online Services
Retirement & Disability Applications
Apply for Extra Help
Retirement/Survivors/Disability Planner
Request a Statement
Change of Address
Medicare Card Replacements
Request a Benefit Verification Letter
Start or Change Direct Deposit
Retirement & Disability Applications
Apply for Extra Help
Retirement/Survivors/Disability Planner
Request a Statement
Change of Address
Medicare Card Replacements
Request a Benefit Verification Letter
Start or Change Direct Deposit
1919
Social Security Cost-of-Living AdjustmentsSocial Security Cost-of-Living Adjustments
Effective Date Amount
June 1975 8%June 1976 6.4%June 1977 5.9%June 1978 6.5%June 1979 9.9%June 1980 14.3%June 1981 11.2%June 1982 7.4%Dec 1983 3.5%Dec 1984 3.5%Dec 1985 3.1%Dec 1986 1.3%Dec 1987 4.2%Dec 1988 4%Dec 1989 4.7%Dec 1990 5.4%Dec 1991 3.7%
Effective Date Amount
June 1975 8%June 1976 6.4%June 1977 5.9%June 1978 6.5%June 1979 9.9%June 1980 14.3%June 1981 11.2%June 1982 7.4%Dec 1983 3.5%Dec 1984 3.5%Dec 1985 3.1%Dec 1986 1.3%Dec 1987 4.2%Dec 1988 4%Dec 1989 4.7%Dec 1990 5.4%Dec 1991 3.7%
Effective Date Amount
Dec 1992 3%Dec 1993 2.6%Dec 1994 2.8%Dec 1995 2.6%Dec 1996 2.9%Dec 1997 2.1%Dec 1998 1.3%Dec 1999 2.5%Dec 2000 3.5%Dec 2001 2.6%Dec 2002 1.4%Dec 2003 2.1%Dec 2004 2.7%Dec 2005 4.1%Dec 2006 3.3%Dec 2007 2.3%
Effective Date Amount
Dec 1992 3%Dec 1993 2.6%Dec 1994 2.8%Dec 1995 2.6%Dec 1996 2.9%Dec 1997 2.1%Dec 1998 1.3%Dec 1999 2.5%Dec 2000 3.5%Dec 2001 2.6%Dec 2002 1.4%Dec 2003 2.1%Dec 2004 2.7%Dec 2005 4.1%Dec 2006 3.3%Dec 2007 2.3%