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Copyright 2016
North American Life Plans welcomes you to:
MEDICARE 101
“Simplifying Your Options”
Copyright 2016
About NALP
North American Life Plans, LLC is a national independent
insurance and financial advisory firm addressing the
needs of retirees.
With Advisors in over 30 states, we have tens of
thousands of clients and a proven history of excellence.
Our home office is in Frisco, TX.
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Today’s Agenda
• The difference between Medicare Supplement,
Medicare Advantage & Part D plans
• Resources for information
• Eligibility requirements & service areas
• Sample overviews of benefits available
• Important dates to remember
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Resources For Information
• Centers for Medicare & Medicaid Services
– “Medicare & You” handbook
– “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare”
• www.medicare.gov
• BEST RESOURCE - Your friendly NALP Medicare Representative
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About Medicare
• Federal health insurance program
• Original Medicare
– Part A (hospital) and Part B (medical)
– Has gaps in coverage that can be expensive to fill; no
coverage for most prescriptions
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Four Parts Of Medicare
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Medicare Supplement Plans
• Helps fill in the gaps
• Plan types
– 10 standardized plans
– Only difference from carrier to carrier is price
– Most commonly purchased is the “F” plan
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Medicare Supplement Plans
• Underwriting
– “M” and “N” Plans offer reduced health requirements
• Possible premium discounts
• NO DRUG COVERAGE - Part D is a separate
premium and stand-alone plan
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Part D Plans
• Do you have to take one?
• What is “creditable” coverage and why is it an important term?
• Drug formularies
• Things to consider
– Premium, deductibles, tiers/copays
• The two most confusing words - “doughnut hole”and/or “coverage gap”
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Part - 2018
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Med Advantage (Part C)
• Medicare Advantage (Part C) is another way people can get their Medicare benefits
– About 14 million people enrolled in Part C
• Approved by Medicare, offered by private companies with a government contract
• Plans vary: PPO’s, HMO’s, PFFS, etc.
• Many Medicare Advantage plans:
– Offer extra benefits, lower cost-sharing
– Include Part D drug coverage
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How MA Plans Are Funded
Centers for Medicare & Medicaid Services (CMS)
Prepays Your Health Care Costs
Medicare Advantage Company
Pays Doctors, Hospitals, Pharmacies and Others
Thorough
CMS Oversight
Premiums Locked
In Each Year
Independent 3rd
Party Appeals Review
U.S. Government
Part B Premium + Medicare Dollars
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MA Eligibility Requirements
• Must have Medicare Parts A and B
• Can’t have End Stage Renal Disease (in most cases)
• Must reside in the plan service area
Reminder: HMO members must use in-network plan providers for routine care, and certain care (e.g., specialty
care) may require a referral from your primary care doctor.
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MA Things To Consider
• Premium
• Copays/co-insurance
• Physician/hospital participation
• Annual Maximum Out of Pocket Limit
• Extras not offered by Original Medicare
– Vision care
– Dental care (normally preventive)
– Transportation
– Fitness club membership
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Preventive Health Services
• Normally included in Med Advantage plans
– Flu and pneumonia shots
– Mammograms
– Well woman exams
– Colorectal screenings
– Bone mass measurements
– Prostate screenings
• Part D coverage is often included
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Enrollment Periods For MA & Part D
Limited To Certain Times
• Initial Coverage Election Period (ICEP)
– Three months before, the month of, and three months after you become eligible for Part B
• Annual Election Period (AEP)
– October 15 – December 7
• Special Election Period (SEP)
– In certain special cases, as defined by CMS, people with Medicare may enroll in a plan outside of the AEP or the ICEP
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Enrollment Periods For MA & Part D
Limited To Certain Times
• Medicare Advantage Disenrollment Period (MADP)
– January 1 – February 14
– MA and MAPD plan members can return to Original Medicare and can enroll in a stand-alone PDP
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Help Paying For RX DrugsYou may be able to get extra help to pay for your prescription drug
premiums and costs. To see if you qualify, call:
1-800-MEDICARE (1-800-633-4227).
TTY users: 1-877-486-2048.24 hours a day, 7 days a week
Or, contact the Social Security Office at:
1-800-772-1213
TTY users: 1-800-325-07787 am – 7 pm, Monday - Friday
Or, contact your state Medicaid office
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Disclaimers
The benefit information provided on these slides is a
brief summary, not a comprehensive description of
available benefits. Additional information about
benefits is available to assist you in making a decision
about your coverage.
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Questions
North American Life Plans
2500 Legacy Drive, #130
Frisco, TX 75034
888-362-1214
<Advisor Name>
NALP Advisor
@lifeplansllc.com
Thank You for Attending
