important phone numbers medicare: 1-800-633-4227 social security: 1-800-772-1213
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Vince Kelly Medicare Insurance Specialist Phone number 310-625-1837 e-mail: [email protected]. Important Phone Numbers Medicare: 1-800-633-4227 Social Security: 1-800-772-1213. What is Medicare?. Federal health insurance program Began in 1965, as a result of the “Medicare Act”. - PowerPoint PPT PresentationTRANSCRIPT
Vince KellyVince KellyMedicare Insurance SpecialistMedicare Insurance Specialist
Phone number 310-625-1837Phone number 310-625-1837e-mail:e-mail: [email protected]@medicarebabyboomer.com
Important Phone NumbersImportant Phone Numbers
Medicare: 1-800-633-4227Medicare: 1-800-633-4227
Social Security: 1-800-772-1213Social Security: 1-800-772-1213
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 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 for…
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 – 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
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: $1,440Medicare 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?Why Me?
• No cost – I’m “Free”No cost – I’m “Free”
• Availability – Includes Annual Insurance Availability – Includes Annual Insurance ReviewReview
• Objective Advice –Represent Most PlansObjective Advice –Represent Most Plans
• Over 22 Years of ExperienceOver 22 Years of Experience
• Local Resident and KnowledgeLocal Resident and Knowledge
• Monthly Meetings – Listed on my websiteMonthly Meetings – Listed on my website
www.MedicareBabyBoomer.comwww.MedicareBabyBoomer.com
Next StepsMonth 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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