Vince KellyVince KellyMedicare Insurance SpecialistMedicare Insurance Specialist

Phone number 310-625-1837Phone number 310-625-1837e-mail:e-mail: vince@medicarebabyboomer.comvince@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 (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: $1,440Medicare 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 FreeNo 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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