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Medicare and Supplemental
Insurance Options
In 1965 …In 1965 …
The birth of Medicare was formed by the federal government.
Medicare GovernmentHealth Insurance Program
Medicare GovernmentHealth Insurance Program
● Part AHospital Insurance
● Part BMedical Insurance
Medicare Part AMedicare Part A
● Inpatient Hospital
● Inpatient Skilled Nursing Facility Care
● Home Hospice Care, Medicare Approved Services
● Hospice Care
● Blood
Inpatient HospitalInpatient Hospital
Days You Pay Medicare Pays
1 – 60 $992 100% after deductible
61 – 90 $248 per day All additional eligible expenses
91 – 150 $496 per day All additional eligible expenses
150+ All expenses No coverage
Inpatient Skilled Nursing Facility Care
Inpatient Skilled Nursing Facility Care
Days You Pay Medicare Pays
1 – 20 $0 100% of eligible expenses
21 – 200 $124 per day All additional eligible expenses
100+ All expenses No coverage
Also Covered UnderMedicare Part A
Also Covered UnderMedicare Part A
● Home Health Care – 100% of Medicare eligible
● Hospice Care – including outpatient drugs and respite care
● Blood Deductible – does not pay for the first three pints
Medicare Part A leaves you to pay…
Medicare Part A leaves you to pay…
● All deductibles
● All copayments
● All hospital expenses after day 151
● First three pints of blood
● All Skilled Nursing Facility care after day 100
● All personal comfort items
Medicare Part BMedicare Part B
● Doctor’s Care
● Surgery
● Outpatient Care
● Lab Tests and X-rays
● Home Health Care
● Durable Medical Equipment
● Other Medically Necessary Services & Supplies
● Preventive Benefits, For Medicare Covered Services
Medicare Part BMedicare Part B
● Medicare Pays– 80% of eligible charges
– Medicare approved charges
● You Pay– $131 annual deductible
– Monthly premium
– 20% of all eligible expenses and any excess charges
Example of Medicare Approved Charges of $200
Example of Medicare Approved Charges of $200
Accepts Assignment Doesn’t Accept Assignment
Doctors fee $230 Doctors fee $230
Pays 80% x $200 = $160 Pays 80% x $200 = $160
Your portion 20% x $200 = $40 Your portion 20% x $200 = $40
$30 excess charge is waived $30 excess + $40 = $70
Medicare Claims ProcessMedicare Claims Process
● The majority of providers accept Medicare assignment
● If they do not accept assignment, they cannot charge more than 15% over the approved amount. Plan F pays for these excess charges
● Either way, the doctor files your claim by law
● BCBS provides the crossover benefit
Non-eligible Medicare ExpensesNon-eligible Medicare Expenses
● Dental
● Routine eye exams
● Eyewear
● Hearing aids
● Hearing tests
● Health care outside the United States
Medicare Preventive ServicesMedicare Preventive Services
● Colorectal cancer screenings
● Bone density measurement
● Flu and pneumonia shots
● Mammograms screening
● Pap smears
● Diabetes education and supplies
● Prostate cancer screenings
● Cardiovascular screening
● Diabetes screening
● Glaucoma screening
● New Enrollees – “Welcome to Medicare” physical examination
In 2007, Medicare added:In 2007, Medicare added:
● Smoking Cessation Program
● Ultrasound for aortic abdominal aneurysm. If detected during “Welcome to Medicare Physical Exam”
What Are Your Choices?What Are Your Choices?
● Traditional Medicare
● Traditional Medicare without Group Retiree plan
● Traditional Medicare with a Supplemental Insurance Policy
● Medicare HMO or PPO only available in limited areas
Group Coverage – over 65 active employees
Group Coverage – over 65 active employees
● Sign up for Medicare Part A
● Check with your plan Administrator, you may be eligible to delay enrollment in Medicare Part B until you actually retire
What You Should KnowWhat You Should Know
● You need both Medicare Part A and Part B to buy a Supplemental Insurance policy
● As long as you are a Texas resident, age 65 or older, have Medicare Part A and are within the six months following your enrollment for Medicare Part B, your acceptance is guaranteed. If you are a Texas resident, under age 65, have Medicare Part A and are within the six months following your enrollment for Medicare Part B, your acceptance is guaranteed for Plan A. If you are a Texas resident turning age 65, were previously enrolled in Medicare Parts A and B, and apply within six months of turning age 65, your acceptance is guaranteed.
Why Blue Cross and Blue ShieldWhy Blue Cross and Blue Shield
● A better value
● Freedom to choose
● No claim forms
● No waiting period
● Security and stability
● Widely recognized
● Keeps pace with Medicare
● A name you can trust
Basic Benefits, A – F Supplemental Plans
Basic Benefits, A – F Supplemental Plans
● Copayments in the hospital days 61 – 90
● 100% for Part A eligible hospital expenses after Medicare benefits are exhausted
● First three pints of blood
● Coverage for 20% coinsurance for Part B after deductible is met
Medicare Supplemental Insurance Standardization Effective 1992
Medicare Supplemental Insurance Standardization Effective 1992
Today you can purchase plans lettered A – J from insurance companies and the plan benefits are the same; however, not all companies are the same nor are the premiums they charge for their plans.
At Blue Cross and Blue Shield of Texas, we offer Medicare Supplement plans A, D, F, K, and L
Medicare Supplemental Plans K & LMedicare Supplemental Plans K & L
● Plans K & L – part of the Medicare Modernization Act of 2003
● Low cost, cost-sharing
● Benefits are comparable to other plans with coinsurance, copayments and deducibles (50% Plan K; 75% Plan L)
● Annual out-of-pocket limit ($4,140 Plan K; $2,070 Plan L)
● Pays 100% coinsurance, copayments and deductibles for the rest of the calendar year
Plans K & L Cost Sharing Benefits Medicare Part A
Plans K & L Cost Sharing Benefits Medicare Part A
● Plan K– 50% Part A Deductible
– 50% Hospice Cost Sharing
● Plan L– 75% Part A Deductible
– 75% Hospice Cost Sharing
Plans K & L Cost Sharing Benefits Medicare Part B
Plans K & L Cost Sharing Benefits Medicare Part B
● Plan K– 50% Coinsurance
– 50% Blood
● Plan L– 75% Coinsurance
– 75% Blood
At Blue Cross and Blue Shield of Texas
At Blue Cross and Blue Shield of Texas
● No fees to sign up
● No pre-existing condition waiting period
● Take it with you when you travel
● Added values: Easy Payment Plans, “Service in the Neighborhood for Seniors”, and Lifetimes
www.bcbstx.com
1-800-654-9370
Medicare Reform – Drug BenefitMedicare Reform – Drug Benefit
● Part D: Effective 1-1-06
● Voluntary
● $265 Annual Deductible
There are Three Enrollment PeriodsThere are Three Enrollment Periods
● Initial Enrollment Period
● Annual Coordinated Election Period (AEP)
● Special Enrollment Period (SEP)
Blue Cross and Blue Shield of Texas offers:
Blue Cross and Blue Shield of Texas offers:
Blue MedicareRx
Three choices to best fit your needs:
1. Standard Plan
2. Value Plan
3. Plus Plan
Contact InformationContact Information
Blue MedicareRx covers an extensive list of both generic and brand name drugs
Call 1-888-579-9373
(TTY Users: 1-888-579-9375)
Monday – Sunday 8:00 am – 8:00 pm
Or go to www.bcbstx.com to learn more
Questions?
