2014 Medicare options explained
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Your options for Medicare coverage explained along with how it has changed in the last year.
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2014 Medicare options explained
- 1. RLee Insurance Solutions “Using Common Sense”
- 2. Who are we?... RLee Insurance Solutions 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 Lee President
- 3. In the Beginning… 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: RLee Insurance Solutions 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; VicePresident Hubert Humphrey; and Mrs. Truman. 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.
- 4. Today… RLee Insurance Solutions People are living much longer, and life expectancy keeps going up! Today there are 47 million people on Medicare By 2030 that number will rise to 79 million!
- 5. RLee Insurance Solutions What are my cost?... Part A cost: For 2013, for those that don’t get Part A at no cost they pay $441.00/month Part B cost: If your yearly income in 2011 was You pay in 2013 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
- 6. RLee Insurance Solutions When you are Hospitalized for: Medicare Covers: 1-60 days Most confinement cost after the required Medicare Deductible. 61-90 days All eligible expenses, after the patient pays a per-day copayment. 91-150 days All eligible expenses, after patient Pays a per-day copayment (Theses Are Lifetime Reserve Days which may never be used again). 151 or more days At least 3 days and enter A Medicare approved SKILLED NURSING FACILITY within 30 days After hospital discharge NOTHING All eligible expenses, for the first20 days; then all eligible expenses for 21-100, after patient pays a per-day copayment. You pay: (per benefit period) $1,184 Deductible $296 A DAY COPAYMENT as much as $8,880 $592 A DAY COPAYMENT as much as $35,520 YOU PAY ALL COST After 20 days $148.00 A DAY COPAYMENT as much as $11,840
- 7. RLee Insurance Solutions When you are Hospitalized for: Medicare Covers: 1-60 days Most confinement cost after the required Medicare Deductible. 61-90 days All eligible expenses, after the patient pays a per-day copayment. 91-150 days All eligible expenses, after patient Pays a per-day copayment (Theses Are Lifetime Reserve Days which may never be used again). 151 or more days At least 3 days and enter A Medicare approved SKILLED NURSING FACILITY within 30 days After hospital discharge NOTHING All eligible expenses, for the first20 days; then all eligible expenses for 21-100, after patient pays a per-day copayment. You pay: (per benefit period) $1,216 Deductible $304 A DAY COPAYMENT as much as $9,120 $608 A DAY COPAYMENT as much as $36,480 YOU PAY ALL COST After 20 days $152.00 A DAY COPAYMENT as much as $12,160
- 8. RLee Insurance Solutions On expenses Incurred for: Medicare Covers: 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) You pay $147 Annual Deductible PLUS: Generally 20% of Approved amount Generally 100% of Approved amount Nothing for services Home Health Care Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services. (not subject to Part B deductible) 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) Blood After first three pints of blood, 80% of approved amount (subject to part B deductible) Clinical Laboratory Services Blood test for diagnostic services Generally, 20% of billed amount First three pints plus 20% Of approved amount for additional pints
- 9. What are the gaps?... RLee Insurance Solutions They include… Part A deductible Part B deductible Part B 20% including the first 3 pints of blood Part B excess charge (15% of Medicare approved amount) Foreign travel emergency care Skilled nursing facility co-pay Drug coverage
- 10. RLee Insurance Solutions What is Part B excess? 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. Example of Medicare Basics at Mayo “Mayo Clinics don’t currently accept assignment, here is an example of how it could effect your bill”. 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 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 major hospital stay”?
- 11. Why Will Excess Charges be a Factor?... The AMA explains that the cost to run a medical practice has risen every year while reimbursements from Medicare go down every year. Where will it end? RLee Insurance Solutions
- 12. What Do Doctors Think?... RLee Insurance Solutions 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%) primary care physicians**, nearly one-third (31 percent) currently restrict the Looking at just 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%) *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.
- 13. What about the very near future?... RLee Insurance Solutions 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.. The bill cleared the House by a vote of 257167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote.
- 14. RLee Insurance Solutions We can fill those gaps!... With a Medicare supplement policy… Plan A Basic Benefits Skilled nursing co-pay Part A deductible Part B deductible Part B excess charges Foreign Travel Drug coverage Plan F Plan G Plan N Part D Plan N has a $20 copayment per office visit and a $50 copayment each ER visit.
- 15. RLee Insurance Solutions What are my cost?... Part D cost: If your yearly income in 2011 was You pay in 2013 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
- 16. RLee Insurance Solutions 2013 Part D coverage ... 2013 Basic Medicare Drug Coverage 2013 Basic Benefits You Pay Deductible $325 100% of first $325 Initial Coverage Limit $2645 25% of the next $2645 ($661.25) Coverage Gap $2970.00 100% of the drug cost Annual – out- of- pocket amount Catastrophic Coverage Medicare and Plan 95% $4750 5%
- 17. RLee Insurance Solutions 2014 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 Catastrophic Coverage Medicare and Plan 95% $4550 5%
- 18. New benefits in 2013... “How will the new healthcare law benefit me?” … RLee Insurance Solutions
- 19. RLee Insurance Solutions What are your options?... Medicare Advantage Plans Original Medicare Original Medicare Part A &B Medicare Supplement Medicare Part D Part C One or the other Part D
- 20. What is part C or Advantage Plans?… RLee Insurance Solutions 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
- 21. What is part C or Advantage Plans?… RLee Insurance Solutions • 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
- 22. What are your choices with Advantage Plans?… RLee Insurance Solutions 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
- 23. Is an Advantage Plan right for You?… RLee Insurance Solutions 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?
- 24. Things 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 Solutions
- 25. Something not to consider... RLee Insurance Solutions
- 26. Our Full line of Services… RLee Insurance Solutions Making your healthcare decisions A matter of “using common sense” SERVICES AVAILABLE Medicare Supplements Medicare Advantage Plans Part D Drug Cards Life Insurance Annuities Long Term Care Insurance Supplemental Health Travel Insurance