Understanding Medicare: A Brief Overview of Its History and Parts

Medicare 101 Presentation Medicare 101 Presentation by Craig J. Friedman by Craig J. Friedman

The History of Medicare and Social Security: Great Depression Era: August 1929 to March 1933 Social Security Act was signed by President Franklin D. Roosevelt on August 14, 1935. The Purpose of Social Security Act was to provide benefits for aged persons, blind person, dependent and crippled children, and eventually those that qualified for disability. November 19, 1945, President Truman asked congress for creation of national health insurance fund. Medicare was signed by President Lyndon Johnson on July 30,1965 which was part of Title XVIII of the Social Security Act to provide health insurance for those who are 65 and older regardless of income or medical history.

The History of Medicare Prescriptions Drugs The History of Medicare Prescriptions Drugs President George W. Bush signed The Medicare Prescription Drug Improvement and Modernization Act on December 8, 2003, which was originally proposed by President Bill Clinton in 1999. This went into effect on January 1, 2006.

What are Medicare Parts? What are Medicare Parts? Part A: Hospital Insurance Benefits which also includes coverages for skilled nursing facilities, rehabilitation facilities and hospice. This does not cover nursing home, assisted living facilities, and long-term care! Part B: Medical Insurance Benefits which includes physician care. Advance Practicing Nurse, Register Nurse, License Practicing Nurse, Occupational Therapy, Physical Therapy and etc. Part C: Medicare Advantage plans which is a private insurance companies that must cover Part A and Part B benefits. Some may also cover Part D.

What are Medicare Parts ? What are Medicare Parts ? Part D: Prescription Drug Coverage offer through Private Insurance Companies. Part E: Medicare law that regulate Medicare Cost Plans which is only offer in limited number of states. It also deals with Medicare Supplement Insurance which is known as Medigap Plans. Both are offer through Private Insurance Companies.

Medicare Enrollment Period Medicare Enrollment Period Initial Enrollment Period (IEP): Begins three months before the month one turn 65 on one s birthday month and after 3 months one turn 65. One can apply for Medicare Supplement guarantee issued. ICEP is Initial Coverage Election Period that pertain for Medicare Advantage Plans and/or prescription drug plan for 1sttime enrollee due to turning 65 or when one completed 24 months of Social Security Disability. Initial Enrollment Period 2(IEP2): Another enrollment period for those who are already eligible for Part A and B before they turned 65 years old. Then one can pick a new prescription drug plan and enroll in a Medicare Supplement Plan guaranteed issue or pick a new Medicare Advantage Plan Special Enrollment Period (SEP): When you can make changes to your Medicare Advantage Plan, Prescription Drug Plan, and Medicare Supplement (Select Plans) because you moved outside of your coverage area and/or you lost creditable coverage such as losing your spouse s group health insurance and/or current plan has gone out of business.

Medicare Enrollment Period General Enrollment Period (GEP): During the General Enrollment Period from January 1stto March 31st, you can enroll in Parts A and B. You may pay the penalty if you didn t join Part B during IEP or SEP. Coverage will begin 1stday of the next month. Also, if you enroll in Part B and don t have Part A than you can apply for Part D prescription Drug plan in the month of April 1 through June 30 of that year. Annual Enrollment Period (AEP): This period is when one can review their Prescription Drug Plan, Medicare Advantage Plan for the following year as well as make changes to the following year. This time frame is October 15 through December 7. Open Enrollment Period (OEP): This is for Medicare Advantage Plan customers only!!! They can make a one-time change to a different Medicare Advantage Plan and/or go back to the original Medicare and pick a new prescription drug plan.

Medicare Saving Program QMB (Qualified Medicare Benefits) 100% of Federal Poverty Level which pick up Full Medicaid and extra 20%. SLMB (Specified Low-Income Medicare Beneficiary) 100%-120% Federal Poverty Level Pays Part B Premium only QI1P(Qualifying Individual Program) Federal Poverty Level 120% to 135% Add $20 for income disregards to monthly amount.

Medicare Saving Program LIS (Low Income Subsidy)150% Federal Poverty Level for Lower Drug Premium and Drug Copays. Resource Limit: For QMB, SLMB, QI1P, Single $8400 and Married and $12,600. This includes Checking Account, Saving, Certificate of Deposit and Individual Retirement Account.

Part A Premium When one worked and pay into Medicare Tax portion of the Social Security Tax for 10 years(40 quarters) or longer than one have already pre-paid their Part A Premium. If one worked 30 quarters and less than 40 quarters than the Premium is $278.00 a month. If one worked less than 30 quarters than the Premium is $506.00 a month.

Income Related Monthly Adjusted Amount For Part B File Individual Tax Return File Joint Tax Return File Married & Separate Tax Return You pay each month (2023) $97,000 or less $194,000 or less $97,000 or less $164.50 Above $97,000 up to $123,000 Above $194,000 up to $246,000 Not Applicable $230.80 Above $123,000 up to $153,000 Above $246,000 up to $306,000 Not Applicable $329.70 Above $153,000 up to $183,000 Above $306,000 up to $366,000 Not Applicable $428.60 $183,000 and less than $500,000 $366,000 and less than $750,000 Above $97,000 and less than $403,000 $527.50 $500,000 or above $750,000 or above $403,000 or above $560.50

Part B Immunosuppressive Drug Coverage Only Part B Immunosuppressive Drug Coverage Only 2023 Year File Individual Tax Return File Joint Tax Return File Married & Separate Tax Return You pay each month (2021) $97,000 or less $194,000 or less $97,000 or less $97.10 Above $97,000 up to $123,000 Above $194,000 up to $246,000 Not Applicable $161.80 Above $123,000 up to $153,000 Above $246,000 up to $306,000 Not Applicable $258.90 Above $153,000 up to $183,000 Above $306,000 up to $366,000 Not Applicable $356.00 $183,000 and less than $500,000 $366,000 and less than $750,000 Above $97,000 and less than $403,000 $453.10 $500,000 or above $750,000 or above $403,000 or above $485.50

Income Related Adjusted Amount for Part D File individual Tax Return File Joint Tax Return File married & Separate Tax Return You pay each month (2021) $97,000 or less $194,000 or less $97,000 or less Your Plan Premium Above $97,000 up to $123,000 Above $194,000 up to $246,000 Not Applicable $12.20 + Your Plan Premium Above $123,000 up to $153,000 Above $246,000 up to $306,000 Not Applicable $31.50 + Your Plan Premium Above $153,000 up to $183,000 Above $306,000 up to $366,000 Not Applicable $50.70 + Your Plan Premium $183,000 and less than $500,000 $366,000 and less than $750,000 Above $97,000 and less than $403,000 $70.00 + Your Plan Premium $500,000 or above $750,000 or above $403,000 or above $76.40 + Your Plan Premium

Late Enrollment Penalty Part A Late Enrollment Penalty is 10% of Part A Premium. Part B Late Enrollment Penalty is 20% of the standard premium for as long as you have Part B Part D Late Enrollment Penalty is 1% of the National base beneficiary premium. For 2023 it is $31.50 per month for however long one doesn t have Part D. For example, 2 years with no Part D: .24% x $31.50 = $7.56 a month for as long as they have Part D.

How to Choose your Medicare Plan 1. Enroll in the Original Medicare Part A and Part B. 2. Enroll in the Original Medicare Part A, Part B and Part D. 3. Enroll in the Original Medicare Part A, Part B, Part D, and a Medicare Supplement. 4. Enroll in Medicare Advantage Plan. Most Medicare Advantage Plan have Part A, Part B and Part D

Type of Medicare Advantage Plans 1. HMO(Health Maintenance) This plan limits coverage to care from doctors who work for or have contract with the HMO Insurance Plan. 2. PPO(Preferred Provider Organization) This plan provide more flexibility when picking doctor or hospital. They also have a network of providers, but there are fewer restrictions on seeing non-network providers. If a patient see a non-network than they may pay a higher out of pocket cost. 3. DSNP(Dual Special Needs Plans)This plan is for individuals who are entitled both Medicare and Medicaid.

Type of Medicare Advantage Plan 4. CSNP(Chronic Special Needs Plan) designed to meet the unique needs of people with one or more chronic conditions, including diabetes, end-stage renal disease, lung conditions or heart disease.

Medicare Coverage Cost 2023 Medicare Coverage Cost 2023 Part A Hospital Coverage: Medicare Pays all but $1600 all but $400/day all but $800/day Nothing You Pay $1600 $400/day $800/day All cost Supp 0 0 0 0 Adv $ 0 0 0 Hospital Insurance 0 Days 1-60 Days 61-90 Days 91-150 Days 151 and up Skilled Nursing Care: Days 1-20 Days 21-100 Days 100 and up all Cost all but $200/day nothing 0 $200/day all cost 0 0 $ 0 $ $ 0 0 $ Medicare will only pay for skilled nursing care if you have been in the hospital for 3 days as an inpatient and not for observation, you are being treated for the same illness which caused you to enter into the hospital, and you are making daily progress.

Medicare Cover Cost 2023 Medicare Cover Cost 2023 Blood: You are responsible for the first three pints. Part B: Medical Coverage $226/deductible per year Hospital Ins. Medicare Pays You Pay 80% approved amt Supp Adv 0 $ maybe if critical illness or accident. 15% excess charge K,N only 0 $226 Deductible except for plan C,F,J G, N, K, 0

Prescriptions Drug Stages Stage 1 Deductible: $505 Stage 2 Initial Coverage Period Stage 3 Cost of Drugs (Coverage Gap) $1 to $105 Copays From $505.00 to $4660.00 25% of all Drugs from $4661.00 to $7400.00 Stage 4 Out of Pocket Threshold (Catastrophic Coverage) $7401, 5%, $4.15 for generic and $10.35 for brand Copays for all other drugs whichever is greater. Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Preferred Generic Generic Drugs Preferred Brand Non-Preferred Brand Specialty Tier Drugs