SAIL OFF INTO YOUR GOLDEN YEARS,

WELL PREPARED AND WORRY-FREE!

Your trusted source for easy to understand

Medicare guidance

WELCOME TO MEDICARE 101 - THE BASICS

You've worked, raised kids and saved your entire life. Now it's time to enjoy the fruits of your labor! To help make sure you have the peace of mind you deserve, let's be sure you understand the basics of Medicare.

ORIGINAL MEDICARE INCLUDES PARTS A-B-D

Medicare Part A:

Inpatient

What It Covers

  1. Inpatient Hospital Stays

  2. Inpatient Rehab

  3. Skilled nursing (up to 20 days)

  4. Hospice Care

What It Costs

This coverage is $0 for most people who have worked at least 40 quarters (10 years). If you don't qualify for free coverage, you might be able to pay a monthly premium for your Part A coverage. Contact Medicare for more information about your specific benefits.

How Are Claims Paid

1st: You pay the Medicare Part A annual deductible which changes every year. For 2024, it's $1634.

2nd: Medicare pays 100% of the balance (if any).

Doctor Network

You can use any facility in the United States that accepts Medicare. No referrals are necessary.

How to Apply

Enrollment into Medicare Part A is usually automatic. You should receive your documents from Social Security / Medicare a few months prior to your 65th birthday.

I recommend you create an online account at both ssa.gov and medicare.gov. This way you can track everything related to your Retirement and Medicare Benefits and confirm you have been automatically enrolled into Part A.

How It Works With Other Coverage

This depends on what coverage you have but most of the time, Medicare pays first and your group health plan (retiree) coverage pays second. If the employer has 100 or more employees, then the group health plan pays first, and Medicare pays second. If you have other coverage available, be sure to notify your agent for proper guidance.

Medicare Part B:

Outpatient

What It Covers

  1. Doctor & Specialist Visits

  2. Outpatient Procedures

  3. Emergency Room (if not admitted)

  4. Urgent Care

  5. Labs and Scans

What It Costs

In 2024, this coverage is $174.70 per month for most people who have worked at least 40 quarters (10 years). This monthly premium amount changes each year. Higher income earners could pay more. If you DO NOT sign up for this coverage when you're first eligible, you could face penalties!

How Are Claims Paid

1st: You pay the Medicare Part B annual deductible which changes every year. For 2024, it's $264.10.

2nd: Medicare pays 80% of the remaining balance.

3rd: You pay 20% of the remaining balance.

Doctor Network

You can use any provider in the United States that accepts Medicare. No referrals are necessary.

How to Apply

Enrollment into Medicare Part B is sometimes automatic but sometimes it's not. The best thing to do is to create an online account at ssa.gov and medicare.gov. This way you can be sure your coverage and your monthly payment are properly set up and ready to go in time for your coverage to start. You might not need Part B if you already have coverage. Be sure to talk to your agent for proper enrollment guidance. If you don't sign up for this coverage when you are first eligible, you could face a penalty.

How It Works With Other Coverage

Usually, it doesn't work with any other coverage because you don't need duplicate "outpatient coverage". So if you have other coverage available, be sure to notify your agent for proper guidance.

Medicare Part D:

Prescriptions

What It Covers

Prescription Drugs

What It Costs

Most prescription drug plans will cost between $10 - $99 per month. This depends on your prescription list and doesn't include the cost of the drugs, only the cost of the plan itself. If you don't enroll in a plan when you're first eligible, you could face penalties!

How Are Claims Paid

Each Part D Drug Plan is different but, for the most part, you move through the coverage stages in this order: deductible (if applicable), initial coverage, coverage gap (donut hole), and catastrophic coverage.

This can be a confusing topic for those with expensive medications. For a more in depth understanding about how Part D plans pay RX claims, click here.

Pharmacy Network

Each plan has their own pharmacy network, which includes both preferred and standard pharmacies. Most also offer mail order for RX as well. If you have a favorite pharmacy, be sure to let your agent know, otherwise, we will choose the least expensive on the list.

How to Apply

Medicare Part D Prescription drug Plans only allow for enrollment at certain times of the year or under special circumstances. You can enroll when you first become eligible for Medicare and during the "annual election period" each year between 10/15-12/07. If you don't sign up for this coverage when you are first eligible, you could face a penalty. Be sure to reach out to me each year to cross-check your medications against the new plans that come out for the following year.

How It Works With Other Coverage

It does NOT work with any other coverage because you don't need double prescription coverage. if you have other coverage available, be sure to notify your agent for proper guidance.

You Have Two Additional Options For Your

Medicare Coverage

MEDICARE ADVANTAGE

This would be instead of Original Medicare

What It Covers

Medicare Advantage AKA: PART C is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. They can also include services like dental, vision and credit towards over-the-counter needs (not available in with all plans).

What It Costs

Most plan premiums are between $0-$99 per month depending on the features and benefits of the plan you choose. Keep in mind, you will still need to pay your Part B monthly premium in addition to the cost of your Medicare Advantage Plan.

How Are Claims Paid

1st: You'll pay according to the specific plan you choose. You could have deductibles, copays and coinsurance to meet, prior to your plan paying for benefits.

2nd: The plan pays benefits according to the plan selected.

Doctor Network

HMO: If you select an HMO Advantage Plan, you must stay within their network of providers except in the event of an emergency. You will likely also need to get a referral annually to visit your specialists.

PPO: If you select a PPO, you will get the best prices by staying in their network but you may have the option to go out of network for a higher cost. You might also be able to see your specialists without a referral (see specific plan for exact details, benefits and restrictions).

How to Apply

You can enroll in a Medicare Advantage Plan only at certain times of the year. For example: When you first turn 65 and during the "annual election period" which is 10/15 - 12/07 each year. There are several exceptions to this rule. For example, if you move out of your original plan area or if you lose other coverage, you are allowed to change plans mid year. Learn more about "special enrollment periods".

How It Works With Other Coverage

You would not have any other coverage. An Advantage Plan has Parts A, B & D rolled in and will cover all services that Medicare covers so you wouldn't need duplicate coverage.

Learn More

SEE SAMPLE ADVANTAGE PLAN

DIFFERENCES BETWEEN A MEDICARE ADVANTAGE PLAN & A MEDICARE SUPPLEMENT PLAN

UNDERSTANDING MEDICARE ADVANTAGE PLANS

MEDICARE SUPPLEMENT

This would be in addition to Original Medicare

What It Covers

AKA: Medi-Gap. Medicare Supplements help to cover some or all of your out of pocket risks under Original Medicare. This type of plan is "paired with" your Original Medicare Plan. Medicare would be your primary insurance, your Supplement will come in and pay secondary. Depending on the Supplement you choose, almost all costs can be paid on your behalf leaving you with a annual maximum out of pocket of $264 (for 2024).

What It Costs

Most plan premiums for those just turning 65 are between $99-$149 per month depending on the features and benefits of the Supplement Plan you choose. Keep in mind, you will still need to pay your Part B monthly premium in addition to the cost of your Medicare Supplement.

How Are Claims Paid

1st: Original Medicare pays their part

2nd: You pay according to the specific Supplement Plan you choose.

3rd: Your Medicare Supplement pays the balance (depending on the plan you choose)

Doctor Network

You can use any provider in the United States that accepts Medicare. No referrals are necessary.

How to Apply

You can apply to enroll in a Medicare Supplement Plan any time of the year as long as you have Medicare Parts A & B. If you're just turning 65, you have a one-time chance to enroll in a Medicare Supplement without having to answer any health questions. After your "initial election period", you can be declined Supplement coverage for health reasons. Your initial election period begins 3 months prior to your 65th birthday and continues until 3 months after your 65th birthday.

How It Works With Other Coverage

You would have Original Medicare (see above) Parts A, B & D as well as a Medicare Supplement Plan. No other coverage is necessary. Medicare pays as primary and your Supplement pays as your secondary.

Learn More

SEE PLANS CHART

DIFFERENCES BETWEEN A MEDICARE ADVANTAGE PLAN & A MEDICARE SUPPLEMENT PLAN

CHOOSING A MEDIGAP PLAN

GET STARTED

Let's Build Your Plan!

Select Your Open Enrollment Period

YOUR AUTHORIZATION IS REQUIRED BY LAW

Before we are allowed to assist you with your Medicare needs, we will first need your written authorization to do so. Please review and complete this agreement at this two days prior to your appointment with yiour agent.

Scope of Sales Appointment Confirmation Form. The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any individual sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative at least two days prior to the meeting with your agent..

By signing this form, you agree to a meeting with a sales agent to discuss the types of products you initialed above. Please note, the person who will discuss these products is either employed or contracted by a Medicare plan. They do not work directly for the Federal government. This individual may also be paid based on your enrollment in a plan. Signing this form does NOT obligate you to enroll in a plan, affect your current or future enrollment, or enroll you in a Medicare plan at this time.

PLEASE STOP HERE AND CLICK "NEXT" TO MOVE ON TO THE NEXT QUESTION. THE BOTTOM HALF OF THIS PAGE NEEDS TO BE COMPLETED BY THE AGENT.

Medicare Member Profile

Member Health History

Member Income Information

$

LET'S BUILD YOUR CUSTOM PLAN

Medicare and other health benefits are highly customizable. This means that we can select higher or lower levels of coverage based on your specific health needs and your financial situation.

In this last section, we will ask series of multiple choice and yes or no health questions that will help us narrow down from the thousands of options that are available to only those options that match your specific needs.

I will be asking for your financial snapshot as well. There are numerous programs available to almost every income level and we help determine which programs (if any) that you qualify for. Your answers don't have to be exact so if you're unsure, just give us your best guess.

WHICH TYPE OF PLAN HAVE YOU BEEN COVERED UNDER IN THE LAST 60 DAYS?

WHICH PLAN ARE YOU MOST INTERESTED IN?

FAMILY HISTORY ACUTE CARE

FAMILY HISTORY - CHRONIC CARE

ORAL HEALTH

OPTICAL HEALTH

HEARING HEALTH

LET'S ASSESS YOUR RISK OF CATASTROPHE

FINANCIAL SNAPSHOT

$
$
$
$
$
$
$
$
$

IMPORTANT MESSAGE!

Once you click the submit button, you'll be taken directly to my calendar where you can book your 30 minute plan recommendation appointment. If you've already booked this appointment with your agent, then after you submit your form, you can simply close out the window. This meeting will take approximately 30 minutes over the phone and computer (best for viewing). We will spend this time going over your proposal and recommendations as well as all of your questions.

It will take approximately 24-48 business hours to complete your assessment. In the meantime, if you think of anything that might be important for us to know, or if you have any questions, please reach out via text, email or phone.

OFFICE: 866-758-7229 - CALL OR TEXT: 520-272-5950]
EMAIL: [email protected] - ON THE WEB: www.snibrokers.com

NEXT