DIVERSIFIED INSURANCE BROKERS, INC.
Medicare Basics
PRESENTED BY:
Tonia Pettitt
Diversified Insurance Brokers
Since 1980
770-662-8510 Local
800-533-5969 Toll Free
770-662-0516 Fax
1
WHY LEARN ABOUT MEDICARE?
2
WHO ARE THE BABY BOOMERS?
Born between 1946 - 1964
 78 million baby boomers
 $13 trillion in assets
 January 1st 2011
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10,000 a day will reach age 65
Will continue for the next 19 years
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WHERE ARE THEY?

States with the most active retirement
communities
New York
 Pennsylvania
 California
 Texas
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States that have the highest percentage of Baby
Boomers
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Vermont
New Hampshire
Maine
Connecticut
Montana
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Medicare Insurance
Basics
5
WHAT IS MEDICARE?

Federal health insurance program:
 Medicare was signed into law in 1965
 Medicare is administered by the Centers for
Medicare & Medicaid Services, an agency of
the U.S. Department of Health and Human
Services
 Covers people 65 years of age and older
 Covers qualified disabled people under age 65
(about 9% of total beneficiaries)
 Covers people of all ages with End Stage Renal
Disease (ESRD)
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Original Medicare Plan
The Original Medicare Plan is one of the health
plan choices that is part of the Medicare
Program.
 This plan is a fee-for-service plan managed by the
Federal Government.
 Members use the red, white and blue card when
receiving health care
 Members can go to any doctor or supplier that
accepts Medicare.
 Members pay a set amount for their health care
(deductible) before Medicare pays its part.
Medicare pays its share and beneficiaries pay
their share (coinsurance or copayment) for
covered services and supplies.

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PART A: HOSPITAL INSURANCE


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Pays for medical care furnished by Medicare-certified
hospitals, skilled nursing facilities, home health agencies and
hospices (not custodial or long-term care).
Can enroll with no premium for Part A:

Must have worked and paid Medicare taxes for 40 or more
quarters (10 years).

In 2012, a patient pays an initial deductible of $1,156 at the
beginning of each benefit period.
Part A may be purchased if not received premium free.
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PART B: MEDICAL INSURANCE


The Medicare Part B premium is paid each month Standard Premium for 2012 $99.90 per month based on
Modified Adjusted Gross Income (MAGI); premium is
adjusted upward based on the MAGI.
Generally pays 80% of the Medicare allowed amount less a
$140 annual deductible (in 2012) for:
 Doctors’ services
 Outpatient hospital services (including ambulance
transportation and emergency room visits)
 Diagnostic tests, laboratory services
 Some preventive care such as mammography and pap smears
 Outpatient therapy services
 Durable medical equipment and supplies
 Some home health care services for which Part A does not pay
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WHAT MEDICARE DOESN’T COVER
First 3 pints of blood
 Traveling outside the United States
 Long-Term Care
 Routine Dental Care
 Cosmetic surgery
 Hearing aids
 Vision (except when in conjunction with
cataracts)

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WHAT IS A MEDIGAP POLICY?
A Medigap policy (Medicare Supplement) is
private health insurance that’s designed to
supplement Original Medicare.
 Every Medigap policy must follow Federal and
State laws.
 Every Medigap policy is standardized, identified
by letters A through N.
 In Massachusetts, Minnesota and Wisconsin,
Medigap policies are standardized differently.

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WHEN CAN YOU BUY MEDIGAP
Must have Medicare Part A and Part B to buy a
Medigap policy.
 If under 65 and receiving Social Security
Disability must wait 24 months (exceptions are
ALS and ESRD).
 When turning age 65 there is a 6 month Medigap
open enrollment period.
 Coming off group coverage.

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ISN'T THE RISK WORTH YOUR ATTENTION?
If you have prospective clients who are concerned about their ability to pay expenses not
covered by Medicare, you might want to use this example to illustrate how Medicare
Supplement insurance can address their concerns:
Marilyn Grady, age 67, has a total hospital bill of $28,000 based on the following:
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In 2004, Medicare paid $25,044 of the $28,000:
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$19,124 (the hospital expense minus the $876 deductible)
$3,920 (80 percent of the approved physician expenses)
$2,000 (all expenses for the first 20 days of skilled nursing care)
$0 (skilled nursing care expenses in excess of $109.50 for days 21-100)
That left Marilyn to pay the remaining $3,051. Had Marilyn had Medicare Supplement
insurance, the coverage would have paid $3,051 (the amount not covered by Medicare),
bringing her total to $0.
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$20,000 hospital expenses
$5,000 approved physician expenses
$3,000 skilled nursing care expenses (30 days at $100 per day)
$876 (Part A deductible)
$1,080 ($100 Part B deductible and 20 percent of the remaining physician expenses approved by
Medicare)
$1,095 ($100 a day for days 21-30 of skilled nursing care)
Ask your prospects if this financial risk is worth their attention
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Questions
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DIVERSIFIED INSURANCE BROKERS
WE THANK YOU FOR YOUR TIME
AND TRUST
Contact:
Tonia@diversifiedins.com
730 Holcomb Bridge Road
Norcross, GA 30071
800-533-5969 Toll Free
770-662-8510 Local
770-662-0516 Fax
WWW.DIVERSIFIEDINS.COM