Inpatient Hospital Ins.

Outpatient Medical Ins.

Part A

Part B

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

Part A

Part B

Most oftenincluded

Part DRx – Prescription Drugs[Stand Alone Plans]

Part D

Medi-Gaps

Medicare ADVANTAGE

Original MedicareFederal Gov’t

2 Ways To Get Medicare

10 Letter Plans in Washington

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

Part C

Inpatient Hospital Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Part A

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

Medicare ADVANTAGE

Part C

Outpatient Medical Ins.

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part B

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

Inpatient Hospital Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Part A

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

Inpatient Hospital Ins.

Outpatient Medical Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part A

Part B

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

[Monthly Changeable][Network: Any provider that accepts Medicare]Medi-Gaps

10 Letter Plans in Washington

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

NF

100%

$179-$188100%

K

50%

$57$4940 MOOP

$128Pt. B $147

Doc/$20 - ER/$50

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

Inpatient Hospital Ins.

Outpatient Medical Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part A

Part B

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

G$158

Pt. B $147

[Monthly Changeable][Network: Any provider that accepts Medicare]Medi-Gaps

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

Rx – Prescription Drugs[Stand Alone Plans]

Part D

1% Penalty

Avg. $33.13/ mo.

Formulary – Rx ListTiers 1 -5

Inpatient Hospital Ins.

Outpatient Medical Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

NF

100%

$188/mo.100%

K

50%

$57-mo.$4940 MOOP

$128/mo.Pt. B $147

Doc/$20 - ER/$50

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part A

Part B

A

B

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

G$158/mo.Pt. B $147

[Monthly Changeable][Network: Any provider that accepts Medicare]Medi-Gaps

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

Rx – Prescription Drugs[Stand Alone Plans]

Part D

1% Penalty

Avg. $33.13/ mo.

1. Formulary - a list of prescription drugs covered by a Plan.2. Tier level determines what your copay will be for a given drug. Higher tier = higher

cost3. 90-Day Supply4. Step Therapy – Some drugs require you to try another drug first.5. Exceptions6. Network Pharmacies – unless emergency7. Low Income Subsidy

Stage 1.Yearly Deductible

You Pay100%

$0 to $320

Stage 3.Coverage Gap – “Donut Hole”

Brand-name

Stage 2.Initial Benefit

Period Copays

Insurance PaysBalance

You PayCopays

ManufacturerProvides

50%

discount

InsurancePays 5%

You Pay45%

Of Drug Value

You Pay65%

Of Drug Value

Insurance Pays35%

Of Drug Value

Generic

Stage 4.Catastrophic Coverage

You pay Greater of | 5% or $2.65 generic / $6.60 Brand

Medicare Pays80%

Of Drug Value

Insurance Pays15% of Drug Value

TrOOP When YOU have paid $4700 (including Mfg. 50% disc.) then…

In 2015, when in Stage 3 Coverage Gap, 95 percent of the full price of a brand name and 65 percent of the full price of a generic goes toward True Out of Pocket expense (TrOOP). Once this amount reaches $4700, then Stage 4 – Catastrophic coverage is reached.

(Monthly Premiums are in addition to cost shown below.)Part D – Standard Benefit, what you pay for drugs.

When You + Insurance Pays = $2960

Inpatient Hospital Ins.

Outpatient Medical Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

NF

100%

$188/mo.100%

K

50%

$57-mo.$4940 MOOP

$128/mo.Pt. B $147

Doc/$20 - ER/$50

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part A

Part B

$104.90/mo.

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

G$158/mo.Pt. B $147

Part A

Part B

Most oftenincluded

Part DRx – Prescription Drugs[Stand Alone Plans]

Part D

1% Penalty

Avg. $33.13/ mo.

Formulary – Rx ListTiers 1 -5

[Monthly Changeable][Network: Any provider that accepts Medicare]Medi-Gaps

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Inpatient Hospital Ins.

Outpatient Medical Ins.

Prem: $104.90/mo.

HMO – Get your care in NetworkYou choose your doctorLow to No Monthly PremiumsCopays more predictable

PCP copaysSpecialist copaysOutpatient Surgery

Worldwide Emergency Care Additional Benefits

- Dental- Vision- Health Club

1. Review maximum cost exposureAccumulation of copays

2. Review Recurring CostsDoctor VisitsLab VisitsPhysical Therapy RX CostsMonthly Premium

3. Trial Right

Formulary – Rx ListTiers 1 -5

Part A

Part B

$104.90/mo.

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

Part A

Part B

Most oftenincluded

Part DRx – Prescription Drugs[Stand Alone Plans]

Part D

Medi-Gaps

ELIGIBILITYPart A & BESRD6 months in service area

Election PeriodsAEP: Oct 15 – Dec 7MADP: Jan 1 – Feb 14SEP: common examplesLeave employer coverageMoving out of areaLIS

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C

Inpatient Hospital Ins.

Outpatient Medical Ins.

Ded. $1260/Stay (Benefit Period Day 1-60)

Prem: $104.90/mo.Ded: $147/yr.

Co-Ins. You – 20% & Medicare – 80%

NF

100%

HMO – Get your care in NetworkYou choose your doctorLow to No Monthly PremiumsCopays more predictable

PCP copaysSpecialist copaysOutpatient Surgery

Worldwide Emergency Care Additional Benefits

- Dental- Vision- Health Club

1. Review maximum cost exposureAccumulation of copays

2. Review Recurring CostsDoctor VisitsLab VisitsPhysical Therapy RX CostsMonthly Premium

3. Trial Right

Formulary – Rx ListTiers 1 -5

$188/mo.100%

K

50%

$57-mo.$4940 MOOP

$128/mo.Pt. B $147

Doc/$20 - ER/$50

[Doctor, Outpatient Surgery, Ambulance, etc.]

Part A

Part B

$104.90/mo.

Use only by permission from Senior Insurance Services of NCW, LLC. VRM

A

B

[Hospital, Hospice, Homecare, Skilled Nursing, etc.]

G$158/mo.Pt. B $147

Part A

Part B

Most oftenincluded

Part DRx – Prescription Drugs[Stand Alone Plans]

Part D

1% Penalty

Avg. $33.13/ mo.

Formulary – Rx ListTiers 1 -5

[Monthly Changeable][Network: Any provider that accepts Medicare]Medi-Gaps

Original MedicareFederal Gov’t

2 Ways To Get Medicare

Medicare ADVANTAGE

Part C