2015 medicare presentation

RLee Insurance Solutions

“Using Common Sense”

RLee Insurance SolutionsWho are we?...

Providing the right information to help make the right decisions

“Having worked in the senior market for years I was continually frustrated with the way seniors were treated by both agents and their companies. There was always the assumption that they were incapable of making the decision that would be best for them on their own and they were often pressured into products that may not have been in truly their best interest. I have always found seniors to be more than capable of making the right decision when given all the facts. I believe if I provide the right information making the right decisions just becomes a matter of “common sense”

Robin LeePresident


President Johnson signing the Medicare program into law, July 30, 1965. Shown with the President (on the right in the photo) are (left to right) Mrs. Johnson; former President Harry Truman; Vice-President Hubert Humphrey; and Mrs. Truman.

At the bill-signing ceremony President Johnson enrolled President Truman as the first Medicare beneficiary and presented him with the first Medicare card. This is President Truman's application for the optional Part B medical care coverage, which President Johnson signed as a witness.

Back then:The average person retiring was male and his average life expectancy was only 68 years!Part B cost just $3.00 a month!19 million people signed up that first year.

In the Beginning…

RLee Insurance SolutionsToday…

Today there are 47 million people on MedicareBy 2030 that number will rise to 79 million!

People are living much longer, and life expectancy keeps going up!

RLee Insurance SolutionsWhat are my cost?...

Part A cost:For 2013, for those that don’t get Part A at no cost they pay $407.00/month

Part B cost:

If your yearly income in 2014 was You pay in 2015

File individual return File a joint return

$85,000 or less $170,000 or less $104.90

Above $85,00 up to $107,000 Above $170,00 up to $214,000 $146.00

Above $107,000 up to $160,000 Above $214,000 up to $320,000 $209.80

Above 160,00 up to $214,000 Above $320,000 up to $428,000 $272.70

Above $214,000 Above $428,000 $335.70


When you are

Hospitalized for:Medicare Covers:

You pay:(per benefit period)

1-60 daysMost confinement cost after

the required Medicare

Deductible.$1,216 Deductible

61-90 daysAll eligible expenses, after

the patient pays a per-day

copayment.

$304 A DAY COPAYMENT

as much as $9,120

91-150 days

All eligible expenses, after

patient Pays a per-day

copayment (Theses Are

Lifetime Reserve Days which

may never be used again).


as much as $36,480

151 or more days NOTHING YOU PAY ALL COST

At least 3 days and enter

A Medicare approved

SKILLED NURSING

FACILITY within 30 days

After hospital discharge

All eligible expenses, for the

first20 days; then all eligible

expenses for 21-100, after

patient pays a per-day

copayment.

After 20 days $152.00 A

DAY COPAYMENT as much as

$12,160


When you are

Hospitalized for:Medicare Covers:

You pay:(per benefit period)

1-60 daysMost confinement cost after

the required Medicare

Deductible.$1,260 Deductible

61-90 daysAll eligible expenses, after

the patient pays a per-day

copayment.


as much as $9,450

91-150 days

All eligible expenses, after

patient Pays a per-day

copayment (Theses Are

Lifetime Reserve Days which

may never be used again).


as much as $37,800

151 or more days NOTHING YOU PAY ALL COST

At least 3 days and enter

A Medicare approved

SKILLED NURSING

FACILITY within 30 days

After hospital discharge

All eligible expenses, for the

first20 days; then all eligible

expenses for 21-100, after

patient pays a per-day

copayment.

After 20 days $157.50 A

DAY COPAYMENT as much as

$12,600


On expenses

Incurred for:Medicare Covers:

You pay $147

Annual Deductible

PLUS:Medical Expenses

Physician’s services, inpatient, outpatient

medical/surgical services, physical/speech

therapy, diagnostic test and durable medical

equipment

Generally 80% of approved

Amount

(subject to Part B deductible)

Generally 20% of

Approved amount

Clinical Laboratory Services

Blood test for diagnostic services

Generally 100% of

Approved amount(not subject to Part B deductible)

Nothing for services

Home Health Care

Part-time or intermittent skilled care,

home health aide services, durable medical

supplies and other services.

100% of the approved amount

(not subject Part B deductible)

80% of the approved amount for durable

medical equipment

(subject to part B deductible)

Nothing for services;

20% of approved amount for

Durable medical equipment

Outpatient Hospital Treatment

Services for the diagnosis or treatment

Of an illness or injury

Generally 80% or approved

Amount (subject to Part B deductible)

Generally, 20% of billed amount

Blood

After first three pints of blood,

80% of approved amount

(subject to part B deductible)

First three pints plus 20%

Of approved amount for additional pints

RLee Insurance SolutionsWhat are the gaps?...

They include…

Part A deductiblePart B deductiblePart B 20% including the first 3 pints of blood Part B excess charge (15% of Medicare approved amount) Foreign travel emergency careSkilled nursing facility co-payDrug coverage


Example of Medicare Basics at Mayo

Mayo Clinic Charge $115.00

Medicare approved amount $100.00

Medicare pays 80% of approved amount $80.00

Secondary insurance pay 20% or approved amount $20.00

Total paid by Medicare and Secondary insurance $100.00

Patient responsibility $15.00

Medicare assigns a price for any and all covered procedures. If the doctor or hospital accepts this price they are accepting Medicare “assignment” . If they choose to not accept assignment they can charge 15% more than the Medicare approved amount only.

What is Part B excess?

“Mayo Clinics don’t currently accept assignment, here is an

example of how it could effect your bill”.

Heart Surgery $150,000

Medicare Assignment $100,000

Part B pays 80% $80,000

Supplement pays 20% $20,000

Part B Excess Charge 15% $15,000

“How can Excess Charges effect a majorhospital stay”?

RLee Insurance SolutionsWhy Will Excess Charges be a Factor?...

The AMA explains that the cost to run a medical practice has risen every yearwhile reimbursements from Medicare go down every year. Where will it end?


AMA ONLINE SURVEY OF PHYSICIANS The Impact of Medicare

Physician Payment on Seniors Access’ To Care May 2010 Key Findings from a new AMA online survey of 9,000+ physicians who care for Medicare patients.

About one in five physicians overall (17%) are currently restricting the number of Medicare patients in

their practice. The top two reasons they gave*: • Medicare payment rates are too low (85%) • ongoing threat of future payment cuts makes Medicare an unreliable payer (78%)

Looking at just primary care physicians**, nearly one-third (31 percent) currently restrict the number of

Medicare patients in their practice. The top two reasons they gave: • Medicare payment rates are too low (83%) • ongoing threat of future payment cuts makes Medicare an unreliable payer (82%)

In response to this year’s two short-term delays to the 21% Medicare physician payment cut, nearly two-thirds (60%) of physicians looked into opting

out of Medicare and treating patients through the private contracting option. Other actions included:

• Delayed payments for supplies, rent and/or other expenses (39%)

• Took out a loan or line of credit in order to continue paying bills (17%)

• Held up paychecks or laid off/furloughed staff (17%)

• Cancelled or postponed scheduled services to Medicare patients (14%)

• Temporarily closed practice to new appointments with Medicare patients (13%)

Asked about temporary proposals under consideration by Congress, physicians say that the short-term

actions will impact patients’ access to care.

If Congress enacts a 4-7 month Medicare payment freeze with a 21% payment cut, physicians say they

will: • Restrict the number of Medicare patients they treat (54%)

• Stop taking new Medicare patients (50%)

• Stop taking any Medicare patients (31%)

If Congress enacts a 3-5 year increase in Medicare payments with a 21% payment cut to physicians in the

future, physicians say they will:

• Restrict the number of Medicare patients they treat (48%)

• Stop taking new Medicare patients (42%)

• Stop taking any Medicare patients (26%)

What Do DoctorsThink?...

*Physicians in this survey were asked to

check all answers that apply. **Primary

care is defined as Family Practice,

General Practice, Internal Medicine,

and Obstetrics/Gynecology.


Physician Medicare Cuts Delayed Til 2014

Well, they did it again. The press is congratulating Congress on the "success" of coming up with a New Year's Night deal on that no one likes. For physicians, this deal contains a delay in the 27% cut in Medicare payments to physicians according to the Sustainable Growth Rate (SGR). For full coverage of this story, I encourage you to read articles from Medpage Today, Kaiser Health News, and Modern Healthcare. (Photo credit: New York Times)The 26.5% cut in Medicare reimbursement mandated by the sustainable growth rate (SGR) formula was averted in a literal 11th hour vote Tuesday in the House of Representatives. The House vote to pass the "fiscal cliff" bill OK'd earlier by the Senate delays the SGR cuts for a year. The bill cleared the House by a vote of 257-167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote.While Congress has put another Band-Aid on the SGR problem, a long term solution is still needed, because when December 31, 2013 comes, we'll be going through this thing all over again, and the potential cuts will probably be in the 30% range. Medical organizations will again be out encouraging their members to lobby congress for a long term Medicare payment solution. How effective will they be? We'll see..

What about the very near future?...

The bill cleared the House by a vote of 257-167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote.

RLee Insurance SolutionsWe can fill those gaps!...

With a Medicare supplement policy…

Plan A Plan F Plan G Plan N Part D

Basic Benefits

Skilled nursing co-pay

Part A deductible

Part B deductible

Part B excess charges

Foreign Travel

Drug coverage

Plan N has a $20 copayment per office visit and a $50 copayment each ER visit.

RLee Insurance SolutionsWhat are my cost?...

Part D cost:

If your yearly income in 2014 was You pay in 2015

File individual return File a joint return

$85,000 or less $170,000 or less Your plan premium

Above $85,00 up to $107,000 Above $170,00 up to $214,000 $11.60 + your plan premium

Above $107,000 up to $160,000 Above $214,000 up to $320,000 $29.90 + your plan premium

Above 160,00 up to $214,000 Above $320,000 up to $428,000 $48.30 + your plan premium

Above $214,000 Above $428,000 $66.60 + your plan premium

RLee Insurance Solutions2014 Part D coverage ...

2014 Basic Medicare Drug Coverage

2014 Basic Benefits You Pay

Deductible $310 100% of first $310

Initial Coverage Limit $2540 25% of the next $2540 ($635.00)

Coverage Gap $2850.00 100% of the drug cost

Annual – out- of- pocket amount $4550

Catastrophic Coverage Medicare and Plan 95%

5%

RLee Insurance Solutions2015 Part D coverage ...

2015 Basic Medicare Drug Coverage

2015 Basic Benefits You Pay

Deductible $320 100% of first $320

Initial Coverage Limit $2640 25% of the next $2640 ($660.00)

Coverage Gap $2960.00 100% of the drug cost

Annual – out- of- pocket amount $4700

Catastrophic Coverage Medicare and Plan 95%

5%


“How will the newhealthcare lawbenefit me?” …

New benefits in 2011...

RLee Insurance SolutionsWhat are your options?...

Original Medicare

Original Medicare Part A &B

Medicare Supplement

Medicare Part D

One or the other

Medicare Advantage Plans

Part C

Part D

RLee Insurance SolutionsWhat is part C or Advantage Plans?…

What Are Advantage Plans?

•Medicare Advantage (MA) plans are health plan options that are part of the Medicare program

•MA plans are not the same as Medicare Supplement insurance

•Medicare pays the plan (the insurance company) a set amount every month for your care

•MA plans must offer all benefits of Original Medicare and can include Part D prescription drug coverage

RLee Insurance SolutionsWhat is part C or Advantage Plans?…

• Most plans offer health and drug coverage, as well as extra benefits

• Most have lower out-of-pocket costs than with Original Medicare

• You may have to use certain healthcare providers

• You do not need a Medicare Supplement

RLee Insurance SolutionsWhat are your choices withAdvantage Plans?…

Choices in Medicare Advantage (MA) Plans• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Private-Fee-For-Service (PFFS)

Plus, Part D Medicare Prescription Drug Coverage• May be purchased as a stand-alone plan; or

• As part of a Medicare Advantage Prescription Drug plan (MAPD)

• All plans must meet minimum coverage level set by Medicare

•You should evaluate your prescription drug needs in relation to those covered by the plan, and your cost for those drugs

RLee Insurance SolutionsIs an Advantage Plan right for You?…

Things to consider before deciding on an Advantage Plan

•What is the current state of your health?

•How often do you visit the doctor or hospital?

• Will the cost savings in monthly premium offset the co-pays?

• Where is the plan coverage area?

•Are the added benefits important to you?

•Can you return to “traditional Medicare” if you are not happy?

RLee Insurance SolutionsThings to consider...

… with your healthcare.Does your current doctor accept assignment?If so, will he be likely to continue to do so in the future?How often do you visit the doctor?How often do you visit the ER?

… with your agent.Can I trust the agent?Who do I call with my questions and concerns?How well do they understand Medicare and my concerns?Are they local?

… with the company.Is my policy Guaranteed Renewable?Will they pay my bills quickly?Who will take care of all the paperwork?What is the insurance company’s rating?Is the plan accepted in my area?

RLee Insurance SolutionsSomething not to consider...


SERVICES AVAILABLEMedicare Supplements

Medicare Advantage PlansPart D Drug Cards

Life InsuranceAnnuities

Short Term CareLong Term Care Insurance

Supplemental HealthTravel Insurance

Our Full line of Services…

Making your healthcare decisionsA matter of “using common sense”

2015 medicare presentation

Presentations & Public Speaking

Transcript of 2015 medicare presentation