Presentation on theme: "Vince Kelly Medicare Insurance Specialist Phone number 310-625-1837 Important Phone Numbers."— Presentation transcript:
Vince Kelly Medicare Insurance Specialist Phone number Important Phone Numbers Medicare: Social Security:
What is Medicare? Federal health insurance program Began in 1965, as a result of the “Medicare Act”
Medicare Part A – Hospital Insurance Most people do not pay a monthly premium Covers Hospital Stays and Home Health Care/DME $1068 Hospital Deductible days 1-60 each “Benefit Period” additional daily fees for days Covers 100 days in a Skilled Nursing Facility $0 per days 1-20 $ per days
Medicare Part B – Medical Insurance 2009 Monthly Premium for most people $96.40 ($ quarterly) Covers Doctor Services $135 annual deductible Covers 80% of costs, YOU PAY 20%
Medicare Enrollment Periods Initial Enrollment – Begins 3 months before 65 th birthday and ends 3 months after. Special Enrollment Period – Anytime, depending upon when the individual stops working and/or coverage from a Group Health Plan is terminated. Annual Election Period – Nov 15 th - Dec 31 st Open Enrollment Period – Jan1st – March 31 st.
Medicare Prescription Drug Coverage (Part D) Medicare HMO and PPO plans include Part D Original Medicare only or Medi-Gap should consider enrolling in a “Stand-Alone Drug Plan” Part D Late-Enrollment Penalty – Multiply 1% of the “national base premium” ($30.36) by the number of months you were eligible to join. Example: 12 months equals $3.60/monthly penalty.
Medicare Part D Standard Coverage as required by law beneficiary pays for … $30.36monthly premium (national average) $295annual deductible 25%coinsurance for drug costs between $ $ 2, % (donut hole)coinsurance for drug costs between $ 2,700 - $4,350 TrOOP costs do not include $30.36/month premium TrOOP costs do not include non-formulary drugs once $ 4,350 in drug costs have been reached, catastrophic coverage begins: beneficiary paysfor… 5%coinsurance for drug costs of $ 4,350 and up (greater of $2.40 generic/$6.00 brand or 5% coinsurance)
Medicare Does Not Cover Acupuncture Chiropractic services (except to correct a subluxation) Custodial care/Long Term Care (nursing home) Dental care and Dentures Hearing Aids Routine Vision and Glasses (except after cataracts) Prescription drugs Out of Country travel coverage
Medicare Health Plan Choices (Part C) Medicare Advantage (MAPD) HMO – Includes Rx Medicare Supplement (Medi-Gap) – No Rx MA Private Fee-For-Service (PFFS) – Includes Rx MA PPO – Includes Rx Original Medicare – 80% Coverage – No Rx
Medicare Advantage - HMO Over 10 Medicare HMO’s in the South Bay $0 Monthly premiums Various co-payments for Services and Drugs Need to pick PCP (Primary Care Physician) Need to get referrals and authorizations for services Limited choice of Physicians and Hospitals Low Cost Option, Will save you $$$ SNP (Special Needs Plans), Medi-Medi’s and “Chronic illness” Plans
Medicare Advantage –PPO or PFFS $0 Monthly Premium PPO - $1050 Deductible PFFS – Various Copayments Providers bill the insurance company NOT Medicare Includes a Medicare Part D drug plan “Freedom” Choice of Doctors and Hospitals No need to pick a PCP (Primary Care Physician)
Medicare Supplement (Medi-Gap) You pay Monthly Premiums, varies by Insurance Co. 12 Medicare Standardized Plans (Plans A through L) Plan “F”- Most Popular - Covers Part B Excess Complete Freedom of Doctors and Providers
How Medicare Supplements Plans Work Medicare pays the Medicare-Approved Amount first, then your Medicare Supplement plan pays all or part of the balance, depending on which plan you choose. EXAMPLE: Total Cost of Physician’s service is: $2000 Medicare-approved amount is: $1800 Medicare pays 80% of approved amount: $1,440 Medicare Supplement pays 20% $360 If a physician does not accept Medicare assignment, you must pay the difference between the total amount and the Medicare-approved amount. Legally the physician may not bill for more than 115% of Medicare-approved charges. In this example, you would pay $200, UNLESS you have Plan F, I, or J, which covers the Excess Part B charges.
Why Me? No cost – I’m Free No cost – I’m Free Availability – Includes Annual Insurance Review Availability – Includes Annual Insurance Review Objective Advice –Represent Most Plans Objective Advice –Represent Most Plans Over 22 Years of Experience Over 22 Years of Experience Local Resident and Knowledge Local Resident and Knowledge Monthly Meetings – Listed on my website Monthly Meetings – Listed on my website
Next Steps Month Medicare Starts_________________ Name: ___________________________________ Address: ___________________________________ Phone: __________________________________- Address: _____________________________ Will continue with Group Health Insurance? YES or NO If NO, circle one or more interested options: HMO PPO Medi-Gap PFFS What date would you like me to call? __________________ COMMENTS: