Medicare 101 Outline

Two goals for this program:

  1. Develop an overall understanding of Medicare
  2. Pinpoint and evaluate the choices available to Medicare beneficiaries
  3. Clarify, simplify and provide structure

Introduction and General Overview

  • What is Medicare? What is Medicaid and is it the same?
  • Can you qualify for both Medicare and Medicaid?
  • Eligibility requirements and when to enroll
  • Summarize the working parts of Medicare, i.e., Part A, Part B, Part C and Part D, and how they work together
  • The two most common choices of Medicare
  1.  Original Medicare (Part A and Part B)
  2.  Medicare Advantage
  • Detailed discussion of Original Medicare (Part A and Part B), Medicare Supplement Insurance, Prescription Drug Coverage (Part D) and Medicare Advantage Plans (Part C)

Part A

  • What specifically does it cover?
  • Is there a premium for Part A?
  • You and your spouse/partner’s work history
  • Define a benefit period
  • Out of pocket costs: How much will it cost if you go into the hospital?
  • How much will it cost for skilled nursing facility care?

Part B

  • What specifically does it cover?
  • Detail three out of pocket costs associated with Part B:
  1.  Monthly premium = Base Premium + IRMAA + Part B late enrollment penalty
  2.  Annual deductible
  3.  Coinsurance
  • Discuss the medical procedures that are not covered by Part A and Part B

Medicare Supplement Insurance (also called Medigap)

  • Definition: A private insurance contract
  • How does a Medigap plan work?
  • When can you buy a Medigap policy? How much will you pay?
  • How can you compare policies and how do they differ?
  • Six things to know about Medicare Supplement Insurance

Medicare Prescription Drug Coverage (Part D)

  • Definition: A private insurance contract
  • Two ways to get prescription drug coverage
  • What is creditable prescription drug coverage?
  • Eligibility requirements: When to join, switch or drop a Part D plan
  • How much will you pay for a Part D plan?
  • Late enrollment penalties
  • The four stages of Medicare’s Standard Benefit Plan:
  1.     Deductible
  2.     Initial Stage
  3.     Coverage Gap (Donut Hole)
  4.     Catastrophic Coverage
  • Seven key terms to know about prescription coverage
  • Will Part D cover all of your prescriptions?
  • Your rights and protections
  • Low income subsidy (Also called Extra Help)
  • Programs to help out with cost of prescriptions

Medicare Advantage Plans (Part C)

  • Definition: A private insurance contract
  • Differences between Part C and Original Medicare
  • The all in one approach
  • What are the different types of Medicare Advantage Plans?
  • How much does a Medicare Advantage Plan cost?
  • Maximum out of pocket limit
  • When can you enroll in a Medicare Advantage plan?
  • Eligibility checklist
  • 10 important things to know about Medicare Advantage Plans
  • Enrollment guides
  • Benefit highlights
  • Summary of Benefits
  • Multi-language interpreter services
  • Formulary
  • Star Ratings

Additional resources available to you.