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1
Medicare 101
Medicare 101Educational Program
2
Medicare 101
Our members’ healthcare and satisfaction come first!
Torrance Memorial IPA
Presents:
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Medicare 101
Moderated by Norman Panitch, MD
Chairman
Torrance Memorial IPA, Physician Council
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Medicare 101
Housekeeping items
1. If you lose your internet connection, we ask that you re-join the meeting using the same Meeting ID# 298 396 8258.
2. Due to our large audience, our meeting host will mute everyone during the presentation. At the end of each section we
will have time for Q/A.
3 Should any unwanted guests enter our Zoom meeting, our host will temporarily end the meeting. You can re-join the
by using the same meeting ID: 298 396 8258.
Agenda
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Today’s program has 2 parts
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What is it?
How does it work?
What are my choices?
Which option may be right for me?
What is an IPA?
What is Torrance Memorial IPA?
What can it do for me?
What is coordinated care?
Medicare 101
1
About Medicare
About Torrance Memorial IPA
Vince KellyCa License #0B99231
(310) 625-1837www.MedicareBabyBoomer.com
Rose StraubCa License #0K48128
(310) 715-2300www.YMA Insurance.com
Independent Health Insurance AgentsSpecializing in Medicare
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Personal guidance withMedicare Part A&B enrollment, time frames, and coverage options.
Finding plans accepted by your preferred physicians and hospitals.
Finding plans that cover your prescription drugs (Part D).
Medicare Supplement plans
Medicare Advantage plans
HMO’s & PPO’s
There are no fees for our services!
Medicare 101Version 4.1 3/15/19
7
Medicare 101
Medicare Health Insurance Offices18411 Crenshaw Blvd. 4th Floor
Torrance, CA 90504
Crenshaw Blvd. & 405 Freeway
What is MedicareFederal Health Insurance Program
8
Medicare 101
A single-payer government program that provides
health insurance coverage for people who are 65 or
older or with certain disabilities.
• Became law in 1965
• A result of the Medicare Act
• Signed by President Lyndon Johnson
• Former President Truman - recipient of the 1st Medicare Insurance Card
President Johnson signing Medicare into law.
Former President Truman received the 1st Medicare Insurance Card
How to get my Medicare Card
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Medicare 101
Turning 65
• Receiving SS Benefits = Card is automatically sent USPS
• Delaying SS Benefits = Must request Parts A&B from Social Security Office
Under 65• Receiving SSDI with certain disabilities for over 24 months = Automatically
• End-Stage Renal Disease (ESRD) = Depends on circumstances
ESRD = Kidney failure requiring dialysis or kidney transplant
Items to watch for in the mailOfficial government publications & documentation
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Medicare 101
Trusted ResourcesOfficial government agencies and websites
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Medicare Resources
When to sign up for Medicare or make a change
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Medicare Enrollment Periods
Enrollment Periods
Initial Enrollment Period
Annual Enrollment Period
Special Enrollment Period
General Enrollment Period
Coverage begins January 1st
Turning 65
No late enrollment penalty for Part B
Late enrollment penalty for Part B
Coverage begins July 1st
Up to 8 months after leaving agroup health plan or moving
out of the service area.
October 15th - December 7th
January 1st - March 31st
The 4 Main Parts of Medicare
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Hospital Insurance
• Inpatient Care
• Skilled Nursing
• Hospice
Original Medicare
Parts of Medicare
Medical Insurance
• Outpatient Care
• Diagnostics
• Doctor Services
• Medical Supplies
Medicare Advantage
• Private Insurance takes over
Parts A&B
• HMO or PPO services
• Regulated by Medicare
Rx Drug Coverage
• Private Insurance
• Stand Alone or combined with
Part D = (MA+PD)
• Regulated by Medicare
In Patient Hospital Insurance, Skilled Nursing, and Hospice Care
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Part A Premium• Most people do not pay a premium = $0 per month• If you paid Medicare taxes for less than 40 quarters = $458 per month
Hospital Coverage
• Days 1-60 = $0 per benefit period
• Days 61-90 = $352 per day each benefit period
• Days 91-150 = $704 per day each benefit period (up to 60 days of your “Lifetime Reserve Days”)
• Days 151+ = you pay all costs
Skilled Nursing Facility Coverage
• Days 0-21 = $0
• Days 21-100 = $176 per day
• Days 101+ = you pay all costs
Parts of Medicare
Medicare Part A
Medical Insurance: Outpatient Care, Diagnostics, Doctor Services, and Medical supplies
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$144.60 monthly premium• Taken out of Social Security, or billed quarterly ($433.80/quarter)
• Higher incomes pay higher Part B Premiums
• Lower incomes may qualify for Medi-cal premium assistance
• Enrolling in Medicare may trigger a redetermination of Medi-cal
Covers 80% of all services
• You pay for 20% share of costs on all services with no cap
(including most inpatient hospital doctor services)
• $198 annual deductible
Parts of Medicare
Medicare Part B
3 Health Plan Options
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Parts of Medicare
• Medicare Supplement Plan (Medigap) + Rx Plan
• Medicare Advantage HMO Plan
• Medicare Advantage PPO Plan (not popular in LA county)
Medicare Supplement or Medicare Advantage
Medicare Supplement Insurance
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Medicare Supplement
aka Medigap Policy
Original Medicare Pays 80%
Hospital Insurance Medical Insurance
+
Medigap Policy Covers 20%
Most popular
is Plan G
(est $180.00 per month)
Medicare Prescription Drug Coverage (PDP), $40 per month on average
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The amount a plan will cover is based on a Formulary (list of prescription drugs)
• Consider how your prescriptions are covered before choosing a plan
• Tier 1 = $
• Tier 2 = $$
• Tier 3 = $$$, etc.
Parts of Medicare
Drug coverage is an optional benefit• If you decide not to get Rx coverage when you’re 1st eligible, you may pay a penalty
• unless you have creditable drug coverage or get extra help
• you will pay this penalty for as long as you have Rx coverage
• Coverage Gap - aka the Donut Hole
Medicare Rx Part D
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Parts of Medicare
Coverage Gap aka The Donut Hole
Medicare Rx Part D
$4,020 $6,350
Parts of Medicare
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Medicare Advantage Plans are offered by private insurance companies
• Plans are regulated by Medicare
• Takes over Parts A+B+D
• You must choose a Medical Group and Insurance Company
Medicare Advantage Plans with Prescription Drug Coverage (MAPD)
Medicare Advantage Part C
Original Medicare
+ + =
Parts of Medicare
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• Over 32 drug plans in LA County
• Monthly premiums average $40
• May have annual deductible up to $435
Part D stand-alone Rx Drug Plan
+
Medicare Advantage + Rx Drug Plan
• Medicare Advantage Plan (Parts A+B)
• Combined with Rx Drug Coverage (Part D)
• aka MAPD (Parts C+D)
There are 2 ways to get Medicare Prescription Drug Coverage (PDP)
Medicare Rx Part D
Medicare Advantage
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• Aetna
• Anthem Blue Cross
• Blue Shield (2 plan offerings)
• Health Net
• Humana
• SCAN
• United Health Care
Choose Insurance Company:
The Parts of Medicare Advantage HMO Plans
• Torrance Memorial IPA *• Healthcare Partners
• UCLA Health
• + many others
Choose Medical Group:
Torrance Memorial Medical Center – rated most outstanding hospital in the South Bay and recently chosen
most outstanding non-teaching hospital in the United States
Torrance Memorial IPA voted best medical group in the South Bay for 6 years
Routine Care is all done within the Medical Group
ER/Urgent Care covered worldwide
Monetary Advantages –many benefits at low cost
…and many other advantages that Dr. Panitch will talk about later
Case Study
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Case Study
A female, 65 years old, in 1 calendar year• Has 12 doctor visits
• Spent 4 days in the hospital for a minor surgical procedure
• She also takes 3 generic prescription drugs per month
After paying a monthly $144.60 premium for Medicare Part B, under the following scenarios she may have also paid:
Group retirement plans or Medi-Cal have different cost structures
* Additional costs for out of network providers may apply
$2,676*
Medicare AdvantagePPO
$4,462
Original MedicareParts A+B
$2,616$163/mo + $40 average
Medicare SupplementWith Plan G + Drug Coverage
$0 - $300
Medicare AdvantageHMO
Meet Heidi
Options to considerChoosing Medicare coverage
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Medicare 101
•No Drug Coverage
•Freedom to choose any doctor that accepts Medicare nationwide
•No limit to out of pocket costs
•Freedom to choose any doctor that accepts Medicare nationwide
•Out of pocket costs limited to monthly premiums only
•Added benefits - Health club, vision discounts, nurse help-lines
•Includes drug coverage
•Low or no co-payments or co-insurance
•Must use in-network doctors, specialists and hospitals
•Coordination of care, patient advocate, care management
•Added benefits - Health club, vision discounts, nurse help-lines
•Includes drug coverage
•Monthly premiums + co-payments + co-insurance applies
•Out of network providers = higher costs
•Annual deductible if out of network providers are used
•High maximum out of pocket costs
Original Medicare A+B
Medicare + Supplement + Rx Medicare Advantage PPOMedicare Advantage HMO
Q & A
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Medicare 101
TORRANCE Memorial IPAA non-profit multi-specialty physician network and a division of Torrance Memorial Health System, that has been taking care of the South Bay for more than 35 years
26Medicare 101
On April 1, 2020,Torrance Health IPA (THIPA) changed its name to Torrance Memorial IPA. We changed our name to better reflect our relationship with the nationally known Torrance Memorial Medical Center.
Medicare 101
Experience the Torrance Memorial IPA differenceHow we help our members stay healthy
Over *500 Primary Care Physicians & Specialists in all sub-specialties of Medicine
Over 35 years in the South Bay and a division of Torrance Memorial Health System
Convenience! The Only IPA offering Member Self-Referral to select specialties
Now affiliated with Cedars-Sinai Medical Center!
* thipa.org/find-a-doctor
Medicare 101
Convenient Access• The ONLY Medical Group in the South Bay offering direct access or
“Member Self-Referral” and open access to the specialties below
• No additional premiums or deductibles when using self-referral
• The following are the self-referral specialties:
Medicare 101
Medicare 101
Medicare Advantage Transportation
Some Medicare Advantage plans cover non-emergency transportation. In fact, some Medicare Advantage plans partner with ride-sharing services such as Lyft to provide transportation to members.
•Received a 4.5 out of 5 Medicare Advantage star rating
•Prestigious 5-STAR Elite Status from Association for Physician Groups (APG) for the 2019 Standards of Excellence™ Survey
• Voted South Bay’s Best Medical Group, for 6 years!
(2018, 2017, 2016, 2014, 2013, 2012)
Torrance Memorial IPA Awards and Recognition
31Medicare 101
Torrance Memorial Medical Center Recognized for Quality
Newsweek names Torrance
Memorial eighth best hospital in
California and top non-Academic
hospital in the nation!
Medicare 101
Torrance Memorial Medical Center has once again been recognized as a Best Hospital for 2019-20 for the eighth straight year by U.S. News & World Report, placing the hospital in the top 3% in the state.
Medicare 101
Torrance Memorial Medical Center Recognized for Quality
Medicare 101
Torrance Memorial Medical Center Recognized for Quality
Torrance Memorial Medical Center has received certification from DNV GL - Healthcare as a Comprehensive Stroke Center, reflecting the highest level of competence for treatment of serious stroke events.
Medicare 101
Torrance Memorial Medical Center Recognized for Quality
36Medicare 101Medicare 101
Cedars-Sinai Affiliation: What it Means
Cedars-Sinai AffiliationWhat it is and Means for Torrance Memorial IPA:
• Strong clinical partner
– Neurosurgery/Endovascular procedures
– Cardiothoracic Surgery
• Cancer Clinical Trials
• Strong specialty/quaternary care coordination
What it is Not:
• Consolidation or combination of provider networks
Medicare 101
Network Updates*: Cardiology
COR Healthcare Medical Associates
Azam, Salman, MDBanka, Gaurav, MDBauer, Brenton, MD
Chhabra, Ankush, MDCastleman, Eric, MDFrench, James, MD
Matchison, J. Christopher, MDReddy, Ram, MD
Wyman, Ray, Michael, MDYang, Ted, MD
Torrance Location2841 Lomita Blvd. #100
Torrance, CA 90505
Torrance Memorial Physician Network
South Bay HeartCarlson, L. Douglas, MD
Cohen, David, I., MDShin, Victoria Y., MD
Torrance Location2841 Lomita Blvd. #235
Torrance, CA 90505
Redondo Beach LocationJackson, Bruce, MD
520 N Prospect Ave. #300Redondo Beach, CA 90277
Averill, William K., MD3400 Lomita Blvd. #603
Torrance, CA 90505
Khaleeli, Emad, MD3475 Torrance Blvd. #D
Torrance, CA 90503
Lopez, Joseph, MD3475 Torrance Blvd. #D
Torrance, CA 90503
* See Torrance Memorial IPA Physician Directory for details
Medicare 101
Network Updates: Orthopedic SurgeryOrthopaedic Surgical Specialists
Frisancho, Juan, MDLorman, Peter, MDStriplin, Donald MD
23600 Telo Ave. #180,Torrance, CA, 90505
Torrance Memorial Physician NetworkOrthopedic and Spine Center
Andrawis, John, MDHoshino, Christopher, MD
Lim, Andrew, MDNuccion, Stephen, MD
Sanders, Don, MDZickur, Keri Reese, MD
Zinar, Daniel, MD705 Pier Ave., Suite B
Hermosa Beach, CA 90505
23550 Hawthorne Blvd.,#120Torrance, CA 90505
23560 Crenshaw Blvd., #102Torrance, CA, 90505
* See Torrance Memorial IPA Physician Directory for details
Member Services TeamHelp is just a phone call away!
A major advantage to you!
• Single Point of Contact: Helping members
navigate the system easier and faster
• Calls answered by a local rep
• Help with customer service needs: • Assistance in finding a doctor
• Verify eligibility
• Billing issues
• Check authorization status of medical treatments
Medicare 101
Toll-Free: 866-568-4472|TTY: 711Monday - Friday 8:30am - 5pmwww.TorranceMemorial IPA.org
Comprehensive Care Programs
• Care Management
–Nurses and Social Workers
–FREE for THIPA Members
–Members with Chronic Health
Conditions
• Care Coordination Center
• Health Coach
• Can self-refer to Care Management
without any authorization
41Medicare 101
Care Management
310-257-7282 | TTY: 711
Monday-Friday 8:30a.m.-5:00p.m.
Sina Samie, MD
Interventional Pain Medicine
Primary Office:
23550 Hawthorne Bl., Suite 120
Torrance, CA 90505
Secondary Office:
23560 Crenshaw Bl., Suite 102
Torrance, CA 90505
Medicare 101
Eve Makoff, MD
Internal Medicine specializing in Hospice and Palliative Medicine
514 N. Prospect Ave 4th Floor
Redondo Beach, CA
Medicare 101
Torrance Memorial IPA Senior Advisory Board
•We listen to our members!
•Torrance Memorial IPA members
meet with leadership quarterly to
share feedback and provide valuable
suggestions to management
Standing: Gayle, Noel, Bernie, Dr. Panitch, Gary, Robert, ArturoSitting: Christie, Sheila, Renee, Mike
Medicare 101
Convenient Urgent Care Centers
Medicare 101
Torrance Manhattan Beach
Torrance Memorial IPA is NOT Your Insurance Company
We contract with major Insurance Companiesthat offer Medicare Advantage plans approved by CMS
They provide the benefits & Torrance Memorial IPA provides the care
For a complete listing of plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/ 7 days a week or consult www.medicare.gov.
Medicare 101
How We Care For Our Members
Medicare 101
Medicare 101
Our New Primary Care Physicians Would Like to See New Patients
New To Medicare?
Join one of many
Medicare Advantage Plans
Ready To Join Torrance Memorial IPA?
Call the Torrance Memorial IPA Resource Center
and speak to Linda 310-257-7239
TorranceMemorialIPA.org/learnmore
Medicare 101
Already have a Medicare Advantage Plan?
Switch your medical group to Torrance Memorial
IPA today!
Thank You for attending!
Torrance Memorial IPA Mascot: Bella Panitch
Medicare 101
Q & A
Medicare 101