MEDICARE SUPPLEMENT PLANSFROM WESTERN MARKETING

Western Marketing Associates Corporation800-852-7152www.wmacorp.com

MEDICARE BASICS

WHAT IS MEDICARE?

Social insurance program established by Congress in 1965

Administered by a government agency called the Centers for Medicare and Medicaid Services (CMS)

Provides health coverage to over 44 million people*: Age 65 or older

Under age 65 with certain disabilities

Any age that has End-Stage Renal Disease (ERSD)

*www.hhs.gov/about/whatwedo.html (23 April 2012).

ABC’S (AND D) OF MEDICARE…

Original Medicare

Part A

Hospital

Insurance

Part B

Medical

Insurance

Part D

Prescription Drug Coverage

Part C

Medicare Advantage Plan

PART A: HOSPITAL INSURANCE

Covers the following: Inpatient hospital care

Skilled nursing facility care

Home health care

Hospice care

PART A: HOSPITAL INSURANCE

Service Medicare Pays Patient Pays

(2016)

Hospitalization

Deductibles

Days 1-60: All but $1,288 $1,288

Days 61-90: All but $322 per day $322 Per Day

Days 91-150: All but $644 per day $644Per Day

Nothing beyond 150 days 100% of Expenses

First 3 Pints of Blood: $0 100% of Expenses

Skilled

Nursing

Facility Care

Days 1-20: 100% of approved

amount

$0

Days 21-100: All but $148 per day $148 per day

Days 100+: $0 100% of Expenses

UsuallyIncreasesEach Year

PART B: MEDICAL INSURANCE

Standard monthly premium of $121.80 in 2016

Covers the following:Doctor’s and other health care providers’ services

Hospital outpatient care

Durable medical equipment

Home health care

Many preventative services

PART B: MEDICAL INSURANCE

Services Medicare Pays Patient Pays (2016)

Doctor’s and other health

Care providers’ services

Hospital outpatient care

Durable medical equipment

Home health care

Many preventative services

80% of the approved amount 20% of the approved amount

$166 deductible per calendar

year

May

Increase

Each Year

PART C: MEDICARE ADVANTAGE

Offers health plan options run by Medicare-approved private insurance companies

Option to choose Part C instead of utilizing Part A & Part B

Most Part C plans also cover Part D Coverage

Out of pocket costs can vary by plan

May have to use certain providers who belong to the plan

PART D: PRESCRIPTION DRUG COVERAGE

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies that are subsidized by the government

Plans may vary substantially, covering different drugs, charging their own premiums and co-pays

SO LET’S RECAP…

Medicare wasn’t designed to cover everything

With Medicare Parts A and B, one must pay deductibles and co-payments and co-insurance

Original Medicare does not offer coverage for prescription drugs in most cases

One can enroll in Part D

MEDICARE SUPPLEMENT INSURANCE PLAN BASICS

MEDICARE SUPPLEMENT INSURANCE

With a Medicare Supplement Plan, one can receive help paying some or all of the costs not paid by

original Medicare, year after year

MEDICARE SUPPLEMENT INSURANCE

Private health insurance designed to supplement Original Medicare

Sometimes referred to as Medigap Insurance, as it strives to cover the “gaps” in Medicare Deductibles, co-insurance and co-pays

These amounts change each year and supplement coverage covers those new amounts

MEDICARE SUPPLEMENT INSURANCE

10 standardized plans can be offered Plans are named for letters of the alphabet, and benefit

levels vary by plan

Cost can vary by plan, location, by company

Plans are managed according to federal and state laws

Can only cover one individual

Can only have one plan at a time

MEDICARE SUPPLEMENT INSURANCE

All plans cover basic benefits Part A coinsurance for inpatient hospital care

Cost of 365 extra days of inpatient hospital care

Part B coinsurance after deductible

First 3 pints of blood each year

MEDICARE SUPPLEMENT PLANS

Some of the plans also cover Part A deductible

Part B deductible

At-home recovery

Medicare Part B excess charge

Other services

Medicare Supplement Plans 2016

A B C D F* G K L M N

Medicare Part A Coinsurance and hospital costs up to an additional 365

days after Medicare Benefits are used up

Medicare Part B Coinsurance or Copayment 50% 75% ***

Blood (First 3 Pints) 50% 75%

Part A Hospice Care Coinsurance or Copayment 50% 75%

Skilled nursing Facility Care Coinsurance 50% 75%

Medicare Part A Deductible 50% 75% 50%

Medicare Part B Deductible

Medicare Part B Excess Charges

Foreign Travel Emergency (Up to Plan Limits

* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-

covered costs up to the deductible amount of $2,180 in 2016 before your Medigap plan pays anything.

** After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medigap

plan pays 100% of covered services for the rest of the calendar year.

Out-of-Pocket Limit**

$4,960 $2,480

MEDICARE SUPPLEMENT PLANS

Some of the things the plans generally do NOT cover Long-term care

Vision or dental care

Hearing aids

Eyeglasses

Private-duty nursing

WHO IS ELIGIBLE?

Must be enrolled in Medicare Parts A and B at the time coverage begins

Must be a resident of the state in which one is applying for coverage

Must be age 65 or older, or under age 65 with certain disabilities

WHY CHOOSE A MEDICARE SUPPLEMENT PLAN?

Helps manage out-of-pocket expenses “Predictable” costs good for budgeting purposes

Guaranteed renewable As long as premiums are paid

First day coverage No waiting period for pre-existing conditions

WHY CHOOSE A MEDICARE SUPPLEMENT PLAN?

Medical coverage that can be used with any doctor or hospital throughout the U.S. that accepts Medicare assignment No referrals needed, no networks

Covers Medicare-allowable services when traveling within the US

Automatic claims filing, virtually no paperwork or claims to submit

MEDICARE SUPPLEMENT INSURANCE PRICING

States can choose from three methods below: No-Age Rated (Community Rated)

Everyone pays same

Issue-Age Rated Premium based on age when purchased

Attained-Age Rated Premium goes up automatically as you get older

MEDICARE SUPPLEMENT INSURANCE PRICING

Other pricing elements: Gender Rating (Male and Female) Tobacco/Non Tobacco Area rating Height/Weight

Rate Adjustments Help keep pace with rising Medicare claim trends and changes in

annual deductibles co-insurance and co-pays. The premium may also change for reasons other than attained age. This type of premium change can occur on any

Policy Renewal Date. However, such premium change cannot be made unless we make the same change to all policies of this form issued to persons of the same classification living in the same geographic area of your state. We will give you the advance written notice required by your state prior to any premium change.

MEDICARE SUPPLEMENT PLANS FROM WESTERN MARKETING

MEDICARE SUPPLEMENT PLANS FROM WESTERN MARKETING

Standardized Plan A• Least amount of

benefits per the other plans

• Pays for Part A & Part B expenses

• Does not cover deductibles

Standardized Plan F• Covers 100% of

Medicare approved procedures

• Covers excess• No co-pays/deductibles

MEDICARE SUPPLEMENT PLANS FROM WESTERN MARKETING

Standardized Plan G• All the features of

Plan F, EXCEPT does not cover part B deductible of $166

Standardized Plan N• Covers 100% of Part A• $20 co-pay for Doctors• $50 co-pay for

emergency room• Does not cover excess