Medicare Workshop Avoid the Top 5 Mistakes People

Medicare Workshop Avoid the Top 5 Mistakes People Make on Medicare Presented by: www. senior-advisors. com info@senior-advisors. com Doug Lubenow, RHU, CLTC President Justin Lubenow Medicare Specialist Prior Member of Medicare Advisory Board for National Association of Health Underwriters 856. 866. 8900 214 W. Main St Suite 101 Moorestown, NJ 08057 908. 272. 1970 15 Alden Street, Suite 8 Cranford, NJ 07016 - 1 Q 2019 -

Proprietary © 2019 Parts of Medicare • premium • Part A: Part B: Part C: Part D: Hospital Insurance Medicare Advantage Prescription Drug Coverage Inpatient care in hospitals Skilled nursing facility, hospice, and home health care Usually, no premiums • • Doctors, hospital outpatient care, durable medical equipment and home health care Preventative services Usually, $135. 50/mo. * * Income adjusted • • • Another way to get • benefits covered under Part A & B • Most offer prescription drug coverage (part D) Run by private insurance companies Varies by plan Helps cover prescription costs Run by private insurance companies Usually, plan premium* * Income adjusted 2

Proprietary © 2019 Medicare Part B: Monthly Premiums 2019 INCOME TIERS 1 & PREMIUMS Tier File Ind. Tax Return File Joint Tax Return Prem. in 2019 1 <=$85 k <=$170 k $135. 50 2 $85, 001 -$107, 000 $170, 001 -$214, 000 $189. 60 3 $107, 001 -$133, 500 $214, 001 -$267, 000 $270. 90 4 $133, 501 -$160, 000 $267, 001 -$320, 000 $352. 20 $320, 001 -$750, 000 $433. 40 >$750, 000 $460. 50 5 >$160, 001 -$500, 000 6 1 >$500, 000 Income is based on prior full year tax return (e. g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums) 3

Proprietary © 2019 Medicare Part D: Monthly Premiums 2019 INCOME TIERS 1 & PREMIUMS Tier File Ind. Tax Return File Joint Tax Return Prem. in 2019 1 <=$85 k <=$170 k Your plan premium 2 $85, 001 -$107, 000 $170, 001 -$214, 000 3 $107, 001 -$133, 500 $214, 001 -$267, 000 4 $133, 501 -$160, 000 $267, 001 -$320, 000 5 >$160, 001 -$500, 000 6 1 >$500, 000 $320, 001 -$750, 000 >$750, 000 $12. 40 + your plan premium $31. 90 + your plan premium $51. 40 + your plan premium $70. 90 + your plan premium $77. 40 + your plan premium Income is based on prior full year tax return (e. g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums) 4

Proprietary © 2019 Medicare B & IRMAA* TOTAL Monthly Premiums * Income Related Monthly Adjustment Amounts 2019 INCOME TIERS 1 & PREMIUMS Tier File Ind. Tax Return File Joint Tax Return Prem. in 2019 1 <=$85 k <=$170 k $135. 50 2 $85, 001 -$107, 000 $170, 001 -$214, 000 $202. 00 3 $107, 001 -$133, 500 $214, 001 -$267, 000 $302. 80 4 $133, 501 -$160, 000 $267, 001 -$320, 000 $403. 60 $320, 001 -$750, 000 $504. 30 >$750, 000 $537. 90 5 >$160, 001 -$500, 000 6 1 >$500, 000 Income is based on prior full year tax return (e. g. 2016 MAGI for 2018 premiums; 2017 MAGI for 2019 premiums) 5

Proprietary © 2019 1 Initial Enrollment Period • 7 -month Initial Enrollment Period (IEP) IEP Example – Eligible 1 st of the month turn 65* – Critical to enroll during the 7 -month IEP – Can enroll later with penalties (10% per year) Sept 10 June 1 Enrollment Window Opens DOB Sept 1 Eligibility Date Dec 31 Enrollment Window Closes * If your birthday is 1 st of the month, you are eligible the previous month 6

Proprietary © 2019 Medicare Choices at a glance START STEP 1: Decide how you want to get your coverage. ORIGINAL MEDICARE ADVANTAGE Part C (like an HMO or PPO) Part B Medical Insurance Part A Hospital Insurance STEP 2: Decide if you need to add drug coverage. Part C Combines Part A, Part B, and usually Part D Prescription Drug Coverage END STEP 3: Decide if you need to add supplemental coverage. Medicare Supplement Insurance (Medigap) policy END If you join a Medicare Advantage Plan, you can’t use and can’t be sold a Medicare 7 Supplement Insurance (Medigap) policy.

Proprietary © 2019 Original Medicare compared to Advantage 3 Medicare Advantage Original Medicare Characteristic (Part C) Medicare Supplement Relationship to Medicare Parts A & B Replaces Supplements Private Network Required Most Plans No Referrals Required Some plans No Part D Included Most plans No Vary, but generally lower Vary, but generally higher Up to $6, 700 Minimal No Yes Monthly Premiums Annual Out-of-Pocket Costs Guaranteed Renewable for Life + 8

Proprietary © 2019 Hospitalization Semiprivate room and board, general nursing & misc. services & supplies First 60 Days 61 st-90 th day 91 st and after While using 60 lifetime reserve days Once lifetime reserve days are used: Additional 365 days Beyond the additional 365 days 19 Services 20 Plan F Example – Part A Medicare Pays Plan Pays You Pay $0 $0 $0 All but [$1, 364] (Part A deductible) All but [$341] a day All but [$682] a day $0 $0 100% Medicare Eligible Expenses All approved amounts $0 All but [$170. 50] a day Up to [$170. 50] a day $0 $0 All Costs Blood First 3 pints Additional Amounts $0 100% 3 pints $0 $0 $0 Hospice Care You must meet Medicare’s requirements, including a doctor’s certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs & inpatient respite care Medicare co-payment/ coinsurance $0 Skilled Nursing Facility Care You must meet Medicare’s requirements, including having been in a hospital for at least 3 days & entered a Medicare. Approved facility within 30 days after leaving the hospital First 20 days 21 st-100 th day 101 st day and after $0 All costs 9

Proprietary © 2019 Medicare Pays Medical Expenses IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical equipment First [$185] of Medicare-Approved amounts Remainder of Medicare-Approved amounts Part B Excess charges (Above Medicare-Approved amounts) Blood First 3 pints Next [$185] of Medicare-Approved amounts Remainder of Medicare-Approved amounts Clinical Laboratory Services TESTS FOR DIAGNOSTIC SERVICES 19 Services 20 Plan F Example – Part B $0 Plan Pays [$185] You Pay (Part B deductible) $0 Generally 80% Generally 20% $0 $0 100% $0 $0 $0 All costs [$185] $0 $0 80% (Part B deductible) 20% $0 100% $0 $0 10

Proprietary © 2019 Medicare Pays Plan Pays 19 Services 20 Plan F Example – Part A & B You Pay Home Health Care. MEDICARE APPROVED SERVICES n. Medically necessary skilled care services & medical supplies n. Durable medical equipment 100 % $0 $0 185] of Medicare. Approved amounts n. Remainder of Medicare-Approved amounts $0 [$185] $0 80% (Part B deductible) 20% $0 n. First [$ Other Benefits-Not Covered by Medicare Services Medicare Pays Foreign Travel-Not Covered Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA $0 First $250 each calendar year $0 Remainder of charges Plan Pays You Pay $0 80% to a lifetime max. benefit of $50, 000 $250 20% & amounts over $50, 000 lifetime max. 11

Proprietary © 2019 19 20 Plan G Example • Plan G is the same as Plan F, except for the Part B deductible Services Medicare Pays Plan Pays You Pay Medical Expenses IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical equipment First [$185] of Medicare-Approved amounts* $0 Remainder of Medicare-Approved amounts Generally 80% $0 $185 (Part B deductible) Generally 20% $0 12

Proprietary © 2019 19 20 Plan N Example • Plan N is the same as Plan G, except for doctor copays and Excess Charges Services Medical Expenses IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as physician’s services, inpatient & outpatient medical & surgical services & supplies, physical & speech therapy, diagnostic test, durable medical equipment First [$185] of Medicare-Approved amounts Remainder of Medicare-Approved amounts Medicare Pays Plan Pays You Pay $0 Generally 80% $0 Balance, other than $20 co-pay per office visit and up to $50 per ER visit* $185 up to $20 per office visit and up to $50 per ER visit* $0 0% All Costs *ER co-pay waived if admitted to the hospital Part B Excess charges (Above Medicare-Approved amounts) 13

Proprietary © 2019 Medigap Open Enrollment • 6 -month Open Enrollment Period* Up to 6 Months after your Medicare Part B effective date • You may be eligible for Open Enrollment… …if you were previously covered under Medicare (SS Disability) and you turn 65, you have another 6 -month open enrollment period * Guaranteed Issue: Will not need to answer health questions (no medical underwriting) 14

* Changes in Bipartisan Budget Act of 2018 Proprietary © 2019 MEMBER PAYS: 19 20 Medicare Part D: Prescription Coverage LEGEND Strikethrough: 2018 values Orange Text: 2019 Changes >$5, 000 Who Pays What? <$5, 000 <$5, 100 <$3, 750 <$3, 820 up to… $405 $415 • Member pays all • Plan pays nothing Step 1: Annual Deductible TOTAL COST OF DRUGS Many plans have $0 deducible. *based on retail costs • Member pays part • Plan pays part Step 2: Initial Coverage COPAYS or COINSURANCE *based on Tro-o. P • Member pays MOST • Plan pays a little Step 3: Coverage Gap >$5, 100* *based on Tro-o. P • Member pays a little • Plan pays most Step 4: Catastrophic Coverage Pharma Discount for brand name drugs: 50% 70%* 35% 25%* of Brand-Name Drugs The greater of 44% 37% of Generic Drugs $8. 35 $8. 50 (Brand-Name) $3. 35 $3. 40 (Generic) 5% or

Proprietary © 2019 Part D Examples on Medicare. gov Example 1 • Zip 08054 • Drug List ID: 3134985216 • Date: 10/15/2017 Metformin Example: • Zip: 07849 • Drug List ID: 7790380192 • Date: 07/07/2017 16

Medicare Workshop Avoid the Top 5 Mistakes People Make on Medicare Presented by: www. senior-advisors. com info@senior-advisors. com Doug Lubenow, RHU, CLTC President Justin Lubenow Medicare Specialist Prior Member of Medicare Advisory Board for National Association of Health Underwriters 856. 866. 8900 214 W. Main St Suite 101 Moorestown, NJ 08057 908. 272. 1970 15 Alden Street, Suite 8 Cranford, NJ 07016 - 1 Q 2019 -

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Who …we are Proprietary © 2019 Our top priority is to reduce stress for Medicare beneficiaries, by providing education, an overview of the choices available, and making recommendations for each individual's coverage. • Founded in 2009 • Over 20, 000 Medicare Clients Nationwide • President is Doug Lubenow; ~30 years in Insurance Industry • Family Owned & Operated • All 5 star reviews - https: //www. senior-advisors. com/testimonials. html • Member of the Medicare Advisory Board of National Association of Health Underwriters (NAHU) from 2012 -2016 READ THIS FOR MORE INFO https: //www. senior-advisors. com/about-us. html 19

Who …we are Proprietary © 2019 Our top priority is to reduce stress for Medicare beneficiaries, by providing education, an overview of the choices available, and making recommendations for each individual's coverage. • Rutgers Business School, B. S. Management Science & Information Systems (MSIS) • Master’s Degree, MIS, Stevens Institute of Technology • 15 years in “Corporate America” – Account Director for Several Software Companies managing accounts AT&T, Verizon, Citi, AMEX, and more! • Joined Senior Advisors in June 2015 and opened the office in Cranford • Member of the Medicare Advisory Board of National Association of Health Underwriters (NAHU) since 2016 READ THIS FOR MORE INFO https: //www. senior-advisors. com/about-us. html 20

Where…we are Proprietary © 2019 We have two offices in NJ, and we are licensed in 25+ states. Cranford Office 15 Alden Street, Suite 8 Cranford, NJ 07016 Moorestown Office 214 W Main Street Suite 101 Moorestown, NJ 08057 21

Where…we are Proprietary © 2019 We have two offices in NJ, and we are licensed in 25+ states.

What…we do Proprietary © 2019 Educate seniors on Medicare, provide options for coverage, and help them enroll. Educate Provide Options Assist with Enrollment • Part A (Hospital) • Part B (Doctors) • Medigap Plans (aka Medicare Supplement Plans) We offer FREE workshops: What Baby Boomers need to know about Medicare. • Medicare Advantage • Part D (RX Plans) https: //www. senioradvisors. com/watch-workshopnow. html And More! 23

Proprietary © 2019 Who Pays First? ? ? • There are several situations where knowing who pays first is extremely important, as it may cause employees claims to not be paid or for them to face penalties at a later date. If the member is… And… This is who pays first Over age 65, on group plan/spouse’s group plan Employer has less than 20 employees Medicare Over age 65, on group plan/spouse’s group plan Employer has more than 20 employees Group Health Plan Disabled & covered by group plan/spouse’s group plan Employer has less than 100 employees Medicare Disabled & covered by group plan/spouse’s group plan Employer has more than 100 employees Group Health Plan On an Employer Retirement plan Is entitled to Medicare Covered by COBRA* Is entitled to Medicare 24

Proprietary © 2019 Part B Enrollment Scenarios *Social Security • Turning 65 (already enrolled in SS*) – Auto-enrolled in A & B • Turning 65 (not enrolled in SS*) – Enroll online at https: //secure. ssa. gov/i. Claim/rib • Enrolling after age 65 (see next slide) 25

Proprietary © 2019 Enrolling After Age 65 Two forms needed to drop at Social Security Proof of Coverage Form https: //www. cms. gov/Medicare/C MS-Forms/CMS-Forms/Downloads/CMSL 564 E. pdf Enroll in Part B Form https: //www. cms. gov/Medicare/CMSForms/CMS-Forms/Downloads/CMS 40 B-E. pdf 26

Proprietary © 2019 Medicare Supplement Plans Overview Illustrative Diagram Premium The following examples will focus on plans F, G, & N F ~3% of 2018 policies* G ~78% of 2018 policies* N ~13% of 2018 policies* * Policies enrolled by Senior Advisors Level of Coverage 27

Proprietary © 2019 H. R. 2 - Medicare Access and CHIP Reauthorization Act of 2015 28

Proprietary © 2019 Supplemental Guaranteed Issue When are Supplemental Guaranteed Issue Periods? No Medical Questions You have guaranteed issue if… You can/must apply for a Medigap policy You have Original Medicare & an employer group health plan (including COBRA/retiree) or union coverage that pays after Medicare pays & that plan is ending. No later than 63 calendar days after… Date coverage ends Date on the notice of coverage ending Date on a claim denial You are in a Medicare Advantage Plan & your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area. Early as 60 calendar days before the date your health care coverage will end but not later than 63 days after it ends. Trial Right: You joined a Medicare Advantage Plan or Programs of All-inclusive Care for Elderly (PACE) when you were first eligible for Medicare Part A at 65, & within the first year of joining, you decide you want to switch to Original Medicare As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends Trial Right: You dropped a Medigap policy to join a Medicare Advantage Plan for the first time, you have been in the plan less than a year, & you want to switch back As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own. No later than 63 calendar days from the date your coverage ends. You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules or it misled you No later than 63 calendar days from the date your 29 coverage ends.

Proprietary © 2019 2 RX Card A Example Monthly Premium: $98. 30 Annual Drug Deductible: $0 Total Annual Cost: $4, 796. 41 Estimated Drug Cost Details at Retail Pharmacy Full Cost of Drug Initial Coverage Gap Catastrophic Coverage Acyclovir 880 MG $42. 69 $7. 00 $2. 65 Clonazepam. 5 MG $5. 07 $4. 01 $2. 65 Exelon Patch 9. 5 MG/24 hr $304. 98 $95. 00 $144. 87 $15. 25 Gelnique 10% gel $209. 64 $45. 00 $99. 58 $10. 48 Namenda 5 MG $273. 33 $45. 00 $129. 83 $13. 67 Norvasc 5 MG $84. 52 $40. 15 $6. 60 Restasis 5% $153. 95 $45. 00 $73. 13 $7. 70 Sinimet CR 50 MG/200 MG $206. 03 $95. 00 $97. 86 $10. 30 Zocor 40 MG $172. 02 $95. 00 $81. 71 $8. 60 Zoloft 50 MG $217. 61 $95. 00 $103. 36 $10. 88 Monthly Totals: $1669. 84 $611. 59 $781. 50 $88. 78 30

Proprietary © 2019 RX Card B Example Monthly Premium: $39. 20 Annual Drug Deductible: $0 Total Annual Cost: $12, 799. 48 Estimated Drug Cost Details at Retail Pharmacy Full Cost of Drug Initial Coverage Gap Catastrophic Coverage Acyclovir 880 MG $42. 69 $10. 00 $33. 73 $2. 65 Clonazepam. 5 MG $5. 07 $4. 01 $2. 65 Exelon Patch 9. 5 MG/24 hr $304. 98 $95. 00 $144. 87 $15. 25 Gelnique 10% gel $209. 64 $45. 00 $99. 58 $10. 48 Namenda 5 MG $273. 33 $45. 00 $129. 83 $13. 67 Norvasc 5 MG $94. 69 Restasis 5% $153. 95 $45. 00 $73. 13 $7. 70 Sinimet CR 50 MG/200 MG $231. 05 Zocor 40 MG $204. 18 Zoloft 50 MG $244. 04 Monthly Totals: $1763. 62 $1019. 03 $1259. 11 $826. 36 *not covered on Formulary 31

Proprietary © 2019 RX Card C Example Monthly Premium: $97. 00 Annual Drug Deductible: $325. 00 Total Annual Cost: $16, 256. 69 Estimated Drug Cost Details at Retail Pharmacy Full Cost of Drug Initial Coverage Gap Catastrophic Coverage Acyclovir 880 MG $46. 90 $5. 00 $2. 65 Clonazepam. 5 MG $1. 62 $1. 28 $1. 62 Exelon Patch 9. 5 MG/24 hr $304. 68 $38. 00 $144. 72 $15. 23 Gelnique 10% gel $234. 80 Namenda 5 MG $273. 03 $38. 00 $129. 69 $13. 65 Norvasc 5 MG $102. 80 Restasis 5% $153. 65 $38. 00 $72. 98 $7. 68 Sinimet CR 50 MG/200 MG $230. 75 Zocor 40 MG $203. 88 Zoloft 50 MG $263. 16 Monthly Totals: $1815. 27 $1156. 01 $1389. 06 $1076. 22 *not covered on Formulary 32

Proprietary © 2019 5 RX Comparison Monthly Premium Total Annual Cost Card A* Card B* Card C $98. 30 $39. 20 $97. 00 $4, 796. 41 $12, 592. 59 $16, 256. 69 *Card A and B are the same company 33

Proprietary © 2019 1 Not enrolling in Part B on-time • Initial Enrollment Period • 10% Penalty/year • COBRA • Retiree Plans • Social Security Disability 34

Proprietary © 2019 2 Not analyzing prescription drugs • Could cost you thousands of $$ • 30 different drug cards • Formularies are key • Medicare. gov • Annual Enrollment 10/15 to 12/7 35

Proprietary © 2019 3 Medicare Advantage vs Medigap • Networks & Referrals • Max. Out of Pocket Expense • Changes during Annual Enrollment • Extra Benefits • Overall expenses 36

Proprietary © 2019 4 Not analyzing retiree coverage • Premiums • Co-Pays • Co-Insurance • Compare all-in expenses 37

Proprietary © 2019 5 Listening to Friends & Family • Drug Cards • Advertisements • Analyze entire expense (not just prem. ) • Association Plans (not guar. renewable) 38

Proprietary © 2019 OTHER RESOURCES AVAILABLE Follow us on Facebook 20+ short videos available Weekly updates ~25 Instructional videos on Medicare www. senior-advisors. com ~90 min. Medicare workshop video FREE Part D Analysis Form Blog Articles monthly Get Quotes & More! 39