1. Important Phone Numbers
Vince Kelly Medicare Insurance Specialist Phone number
Important Phone Numbers
Medicare:
Social Security:

2. What is Medicare? Federal health insurance program
Began in 1965, as a result of the “Medicare Act”

3. 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

4. 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%

5. Medicare 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 31st
Open Enrollment Period – Jan1st – March 31st.

6. 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.

7. Medicare Part D Standard Coverage as required by law
beneficiary pays
for…
$30.36
monthly premium (national average)
$295
annual deductible
25%
coinsurance for drug costs between $ $ 2,700
100% (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 pays
for… 5%
coinsurance for drug costs of $ 4,350 and up
(greater of $2.40 generic/$6.00 brand or 5% coinsurance)

8. 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

9. Medicare Health Plan Choices
Part C (Medicare Advantage – MA) provides Medicare Parts A & B through private insurance companies approved by Medicare.
Medicare Advantage (MAPD) HMO – Includes Rx
Medicare Supplement (Medi-Gap) – No Rx
MAPD Private Fee-For-Service (PFFS) – Includes Rx
MAPD PPO – Includes Rx
Original Medicare – 80% Coverage – No Rx

10. 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)

11. 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

12. 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.

13. Medicare Advantage - HMO
Over 10 Medicare HMO’s in the South Bay
$0 Monthly premiums (must maintain Part B)
Various co-payments or co-insurance
for Services and Drugs
Must pick a PCP (Primary Care Physician)
Usually need referrals and authorizations for services
Specific list of Physicians and Hospitals
Low Cost Option, Will save you $$$

14. Why Me? No cost – I’m “Free”
Availability – Includes Annual Insurance Review
Objective Advice –Represent Most Plans
Over 22 Years of Experience
Local Resident and Knowledge
Monthly Meetings – Listed on my website

15. Next Steps Month Medicare Starts_________________
Name: ___________________________________
Address: ___________________________________
Phone: _______________________
Address _____________________________
Receive the Torrance Hospital IPA Newsletter? YES or NO
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? __________________
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