Vince Kelly
Medicare Insurance Specialist
Phone number 310-625-1837
e-mail: vince@medicarebabyboomer.com
Important Phone Numbers
Medicare: 1-800-633-4227
Social Security: 1-800-772-1213
What is Medicare?
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Federal health insurance program
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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 61-150.
• Covers 100 days in a Skilled Nursing Facility
$0 per days 1-20
$133.50 per days 21 - 100
Medicare Part B – Medical Insurance
2009 Monthly Premium for most people
$96.40 ($289.20 quarterly)
• Covers Doctor Services
• $135 annual deductible
• Covers 80% of costs, YOU PAY 20%
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.
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…
$30.36
monthly premium (national average)
$295
annual deductible
25%
coinsurance for drug costs between $ 295 - $
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
5%
for…
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:
Medicare Supplement pays 20%
$1,440
$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?
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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
www.MedicareBabyBoomer.com
Next Steps
Month Medicare Starts_________________
Name:
___________________________________
Address: ___________________________________
Phone:
__________________________________-
E-Mail 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? __________________
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