2What is Medicare? Federal health insurance program Began in 1965, as a result of the “Medicare Act”
3Medicare Part A – Hospital Insurance Most people do not pay a monthly premiumCovers Hospital Stays and Home Health Care/DME$1068 Hospital Deductibledays 1-60 each “Benefit Period”additional daily fees for daysCovers 100 days in a Skilled Nursing Facility$0 per days 1-20$ per days
4Medicare Part B – Medical Insurance 2009 Monthly Premium for most people$96.40 ($ quarterly)Covers Doctor Services$135 annual deductibleCovers 80% of costs, YOU PAY 20%
5Medicare Enrollment Periods Initial Enrollment – Begins 3 months before 65th 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 15th- Dec 31stOpen Enrollment Period – Jan1st – March 31st.
6Medicare Prescription Drug Coverage (Part D) Medicare HMO and PPO plans include Part DOriginal 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.
7Medicare Part D Standard Coverage as required by law beneficiary paysfor…$30.36monthly premium (national average)$295annual deductible25%coinsurance for drug costs between $ $ 2,700100% (donut hole)coinsurance for drug costs between $ 2,700 - $4,350TrOOP costs do not include $30.36/month premiumTrOOP costs do not include non-formulary drugsonce $ 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)
8Medicare Does Not Cover AcupunctureChiropractic services (except to correct a subluxation)Custodial care/Long Term Care (nursing home)Dental care and DenturesHearing AidsRoutine Vision and Glasses (except after cataracts)Prescription drugsOut of Country travel coverage
9Medicare Health Plan Choices (Part C) Medicare Advantage (MAPD) HMO – Includes RxMedicare Supplement (Medi-Gap) – No RxMA Private Fee-For-Service (PFFS) – Includes RxMA PPO – Includes RxOriginal Medicare – 80% Coverage – No Rx
10Medicare Advantage - HMO Over 10 Medicare HMO’s in the South Bay$0 Monthly premiumsVarious co-payments for Services and DrugsNeed to pick PCP (Primary Care Physician)Need to get referrals and authorizations for servicesLimited choice of Physicians and HospitalsLow Cost Option, Will save you $$$SNP (Special Needs Plans), Medi-Medi’s and “Chronic illness” Plans
11Medicare Advantage –PPO or PFFS $0 Monthly Premium PPO - $1050 DeductiblePFFS – Various CopaymentsProviders bill the insurance company NOT MedicareIncludes a Medicare Part D drug plan“Freedom” Choice of Doctors and HospitalsNo need to pick a PCP (Primary Care Physician)
12Medicare 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 ExcessComplete Freedom of Doctors and Providers
13How 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.
14Why Me?No cost – I’m FreeAvailability – Includes Annual Insurance ReviewObjective Advice –Represent Most PlansOver 22 Years of ExperienceLocal Resident and KnowledgeMonthly Meetings – Listed on my website
15Next Steps Month Medicare Starts_________________ Name: ___________________________________Address: ___________________________________Phone: __________________________________-Address: _____________________________Will continue with Group Health Insurance? YES or NOIf NO, circle one or more interested options:HMO PPO Medi-Gap PFFSWhat date would you like me to call? __________________COMMENTS: