Understanding Medicare and Supplemental Insurance

Options…

Medicare Government- Health Insurance Program

Medicare Government- Health Insurance Program

Part AHospital Insurance

Part BMedical Insurance

Medicare Part A covers…Medicare Part A covers…

Inpatient Hospital

Inpatient Skilled Nursing Facility Care

Home Health Care

Hospice Care

Blood

Medicare Part B covers… Medicare Part B covers…

Doctor’s Care Surgery Outpatient care Lab Tests and X-rays Home Health Care Durable Medical Equipment Other Medically Necessary Services &

Supplies Preventive Benefits

Here’s how Medicare Part A works… Inpatient Hospital Here’s how Medicare Part A works… Inpatient Hospital

Days You Pay Medicare Pays

1-60 $992 100% after

deductible

61-90 $248/day All additional

eligible expenses

91-150 $496/day All additional

eligible expenses

150+ All Expenses No Coverage

Medicare Part A –Inpatient Skilled Nursing Facility

Care

Medicare Part A –Inpatient Skilled Nursing Facility

CareDays You Pay Medicare Pays

1-20 $0 100% of eligible expenses

21-100 $124/day All additional eligible expenses

100+ All expenses No coverage

Medicare Part A - also covers…Medicare Part A - also covers…

Home Health Care - 100% Medicare eligible

Hospice Care-Including outpatient drugs and respite care

Blood Deductible - Does not pay for the first 3 pints

Medicare Part A leaves you to pay…

Medicare Part A leaves you to pay…

All deductibles

All co-payments

All hospital expenses after day 151

First three pints of blood

All SNF care after day 100

All personal comfort items

Medicare Part B…Medicare Part B…

You Pay

$131.00 Deductible

$93.50 Monthly Premium

20% of all eligible expenses

and any excess charges

Medicare Pays

80% of

eligible charges…

Medicare

approved charges

Medicare Approved Charges…$200.00

Medicare Approved Charges…$200.00

Accepts Assignment

• Doctors fee $230.00

• Pays 80% x $200= $160.00

• Insurance 20% x $200= $40.00

• $30.00 excess charge is waived

Doesn’t Accept Assignment

• Doctors fee $230.00

• Pays 80% x $200 = $160.00

• Insurance 20% x $200= $40.00

• $30.00 excess +$40.00 = $70.00

Medicare Claims Process…Medicare 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 these excess charges

Either way, the doctor files your claim by law

BCBS provides the crossover benefit

Non-eligible medical expensesNon-eligible medical expenses

• Dental Exams

• Hearing Aids and Hearing tests

• Eyewear and Eye Exams

• Health Care Outside the United States

• Prescription Drugs

• With Blue Cross, we offer our members a Members First “free” discount program

Medicare Preventive Services...Medicare Preventive Services...

Colorectal Cancer Screenings

Bone Density Measurements

Flu and Pneumonia Shots

Mammograms

Prostate Cancer Screenings

Diabetes education and supplies

Glaucoma screening

Pap smears

Cardiovascular Disease Screening

Diabetes Screening

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...still working after 65

Group Coverage...still working after 65

Sign up for Medicare Part A

Check with your plan Administrator… you may be eligible to delay enrolling in Medicare Part B until you actually retire

What You Should Know…What You Should Know…

You need both Medicare Part A and Part B to buy a Supplemental Insurance policy

“Guaranteed issue” if insured within six months of Medicare eligibility…otherwise, you will be considered for coverage if you are age 65 or over, reside in Texas and have Medicare Part A and Medicare Part B.

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

Co-payments in the hospital days 61-150

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-L 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 Blue Shield, we offer Medicare Supplement plans A,D and F and K & L.

A High Deductible Plan F.

Introducing…Medicare Supplemental Plans K & L

Introducing…Medicare 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, co-payments and deductibles (50%-Plan K; 75%-Plan L)

Annual out-of-pocket limit ($4,140 Plan K; $2,070 Plan L) then

Pays 100% coinsurance, co-payments, 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

K L50% Part A Deductible 75% Part A

50% Hospice Cost Sharing 75 Hospice Cost Sharing

Plans K & L Cost Sharing Benefits Medicare Part B

Plans K & L Cost Sharing Benefits Medicare Part B

K50% Coinsurance

50% Blood

L75% Coinsurance

75% Blood

At Blue Cross & Blue Shield… At Blue Cross & Blue Shield…

No fees to sign up

No pre-existing condition waiting period

Take it with you when you travel or move

Added values: Members First, Easy Payment Plans, “Service In The Neighborhood for Seniors”, Lifetimes, and Medicare Part D Drug Plans…

Member’s First – What you should know…

Member’s First – What you should know…

Prescription Drug Discount 3-30% at Participating Pharmacies

Mail Order Option for additional savings

Discounts on dental, vision, hearing, chiropractic, vitamins and more…

Card is free to members

Medicare Reform- Drug BenefitMedicare Reform- Drug Benefit

Part D: Effective 1/1/06

Voluntary

$265 deductible per year

1. Initial Enrollment Period

2. Annual Coordinated Election Period (AEP)

3. Special enrollment Period (SEP)

There are Three Enrollment Periods

Blue Cross and Blue Shield of Texas offers:

Blue Cross and Blue Shield of Texas offers:

Blue MedicareRx

3 choices to best fit your needs:

Standard Plan

Value Plan

Plus Plan

Blue Medicare Rx Standard BenefitsBlue Medicare Rx Standard Benefits

Deductible $265

Annual drug costs up to $2,400 You pay 25%

Annual drug costs exceeding $2,400 (up to

$3,850 out-of-pocket maximum)

You pay 100%

After your out-of-pocket annual drug costs exceed

$3,850

You pay the greater of $2.15 for generic or

preferred brand drug that is a multi-

source drug and $5.35 for all other drugs,

or 5% coinsurance.

Monthly Plan Premium$28.70

Blue MedicareRx Value Plan BenefitsBlue MedicareRx Value Plan Benefits

Deductible $0

Annual drug costs up to $2,400 $ 5 $40 $60

co-pay co-pay co-pay

Annual drug costs exceeding $2,400 (up to $3,850out-of-pocket

maximum) You pay 100%

After your out-of-pocket annual drug costs exceed $3,850

You pay the greater of $2.15 for generic or

preferred brand drug that is a multi-

source drug and $5.35 for all other drugs,

or 5% coinsurance.

Monthly Plan Premium

$29.60

GenericPreferred

Brand Brand

Blue MedicareRx Plus Plan BenefitsBlue MedicareRx Plus Plan Benefits

Deductible $0

Annual drug costs up to $2,400 $ 3 $20 $50

co-pay co-pay co-pay

Annual drug costs exceeding $2,400 (up to $3,850 out-of-pocket

maximum) $5 co-payment for Generics. You pay 100% for Preferred Brand, Brand and Specialty Drugs.

After your out-of-pocket annual drug costs exceed $3,850

You pay the greater of $2.15 for generic or

preferred brand drug that is a multi-

source drug and $5.35 for all other drugs,

or 5% coinsurance.

Monthly Plan Premium

$55.60

GenericPreferred

BrandBrand

Most Medications Are CoveredMost Medications Are Covered

● Available only by prescription

● Prescription drugs, biologicals, insulin

● Medical supplies associated with injection

of insulin

● Brand name and generic drugs will be in each formulary

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 8:00AM to 8:00PM or go to www.bcbstx.com to learn more

What Happens Next…What Happens Next… Look at which benefits best meet your clients needs...

Then complete and submit their application…

Now, let us answer your questions…

Now, let us answer your questions…

Thank you for your time.

We look forward to serving you.

www.bcbstx.com