Medicare Overview
Overview <ul><li>For Medicare-eligible individuals the most common health insurance options are: </li></ul><ul><li>Medicar...
Medicare only <ul><li>Part A </li></ul><ul><li>Coverage begins after a deductible, which is $1100 for 2010 </li></ul><ul><...
Medicare only <ul><li>Part A </li></ul><ul><li>Skilled nursing facility coverage: </li></ul><ul><li>The first 20 days in a...
Medicare only <ul><li>Part B </li></ul><ul><li>Coverage starts after a calendar year deductible  $155 for 2010 </li></ul><...
Medicare only <ul><li>Part B </li></ul><ul><li>Coverage for chiropractic care: </li></ul><ul><li>80% co-insurance coverage...
Medicare only summary <ul><li>You must pay the monthly Medicare Part B premium. </li></ul><ul><ul><li>This is paid through...
Medicare only summary <ul><li>Out-of-pocket costs can be very high. </li></ul><ul><ul><li>$1100 deductible per benefit per...
Medicare only summary <ul><li>In general, prescription drug coverage is not provided. </li></ul><ul><li>You have the freed...
Medicare Advantage <ul><li>The Medicare Advantage plan replaces original Medicare. </li></ul>
Medicare Advantage <ul><li>Insurance companies contract with Medicare to offer plans and Medicare reimburses the company f...
Medicare Advantage <ul><li>Premiums can vary widely and can be as low as $0. </li></ul>
Medicare Advantage <ul><li>Coverage is subject to change or termination every January 1. </li></ul><ul><li>There is lock-i...
Medicare Advantage <ul><li>State-mandated benefits are not required with these plans. </li></ul><ul><ul><li>This could aff...
Medicare Advantage <ul><li>You cannot purchase a Medicare supplement to pay your out-of-pocket costs. </li></ul><ul><li>Be...
Medicare Advantage <ul><li>Out-of-pocket costs vary widely from plan to plan. </li></ul><ul><ul><li>This can vary from $50...
Medicare Advantage <ul><li>The OCI warns that you may also be responsible for paying your doctor or hospital bills if you ...
Medicare Advantage <ul><li>For some plans you have to obtain a referral from a primary care doctor before you can see a sp...
Medicare Advantage <ul><li>Out-of-area coverage can be limited to emergency care needed to diagnose and stabilize your con...
Medicare Advantage <ul><li>If you see a provider who does not accept the plan’s fee schedule, you will not be covered and ...
Medicare Advantage <ul><li>You can only receive care (except in emergencies) from providers that accept the terms and cond...
Medicare Advantage <ul><li>These plans must have benefits at least equivalent to Medicare only, but not necessarily any be...
Medicare Advantage <ul><li>Funding of Medicare Advantage plans will be reduced in the future.* Based on past experience, t...
Medicare Advantage summary <ul><li>Out-of-pocket costs can be very high. </li></ul><ul><li>There are no protections and gu...
Medicare Advantage summary <ul><li>The Board on Aging and Long Term Care offers the following perspective on Medicare Adva...
Medicare Supplement <ul><li>You must be covered by original Medicare Parts A and B. </li></ul><ul><li>The supplement pays ...
Medicare Supplement <ul><li>Five optional coverage riders are available: </li></ul><ul><li>1. Part A deductible </li></ul>...
Medicare Supplement <ul><li>Plan prices vary widely from company to company. </li></ul><ul><li>Long-term rate stability va...
Medicare Supplement <ul><li>The options you choose for your plan will create variations in cost. </li></ul><ul><li>The lea...
Medicare Supplement <ul><li>Medicare supplements are guaranteed renewable. </li></ul><ul><li>Plans can be purchased with n...
Medicare Supplement <ul><li>There is no paperwork to handle. </li></ul><ul><li>Freedom to use any doctor or hospital based...
MercyCare Senior <ul><li>Has been providing coverage since 1994 </li></ul><ul><li>Coordinates all aspects of health care t...
MercyCare Senior <ul><li>MercyCare Senior covers the five optional coverage riders  </li></ul><ul><li>1. Part A deductible...
MercyCare Senior <ul><li>Provides: </li></ul><ul><li>$25 Stay Healthy Benefit </li></ul><ul><li>Chiropractic Services </li...
Summary <ul><li>All benefits mandated by the state of Wisconsin are included in the policy </li></ul><ul><li>State mandate...
Summary <ul><li>Some things to keep in mind about all your Medicare plan alternatives: </li></ul><ul><li>Just because a pl...
Summary <ul><li>Don’t be pressured. </li></ul><ul><ul><li>- Don’t let a sales person pressure you into enrolling. </li></u...
Summary <ul><li>Get advice from professionals if you have any concern about a plan being offered to you. </li></ul>
Summary <ul><li>Make certain your decision is good for the long term, not just for now. </li></ul>
Questions? <ul><li>If you have any questions or are interested in MercyCare’s Medicare Supplement Plan,  </li></ul><ul><li...
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Mercy Health System - Medicare Presentation

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  • Hi my name is Josh Mummery, and I am a sales rep for MercyCare Health Plans. I am going to give you a presentation on Medicare options and benefits. After this presentation you should have a better understanding on Medicare as a whole, and I will try to answer any questions you might have.
  • Medicare has four parts. Part A = Hospital Insurance Part B = Medical Insurance Part C = Medicare Advantage Plans Part D = Drug coverage
  • Part A is Hospital Insurance
  • Part B = Medical Insurance
  • Most Medicare beneficiaries will pay $96.40 for Part B premium in 2010 .
  • Could be required to pay several deductibles in one year based on the number of hospital visits.
  • Medicare’s phone # 1-800-633-4227
  • Part C
  • Lock in period means that between April 1 and December 31 of each year you cannot change to another plan.
  • Medicare pays 80% of approved costs, and Medicare Supplement plans picks up the remainder 20%.
  • Mercy Health System - Medicare Presentation

    1. 1. Medicare Overview
    2. 2. Overview <ul><li>For Medicare-eligible individuals the most common health insurance options are: </li></ul><ul><li>Medicare only </li></ul><ul><li>Medicare Advantage plan </li></ul><ul><li>Medicare with a Medicare supplement </li></ul><ul><li>Medicare with an employer-sponsored plan </li></ul>
    3. 3. Medicare only <ul><li>Part A </li></ul><ul><li>Coverage begins after a deductible, which is $1100 for 2010 </li></ul><ul><li>Hospital coverage: </li></ul><ul><li>The first 60 days of a hospitalization are covered with no co-pays </li></ul><ul><li>Days 61-150 are covered with daily co-pays of $275-$550 for 2010 </li></ul><ul><li>No coverage after day 150 </li></ul>
    4. 4. Medicare only <ul><li>Part A </li></ul><ul><li>Skilled nursing facility coverage: </li></ul><ul><li>The first 20 days in a skilled nursing facility are covered with no co-pays </li></ul><ul><li>Days 21-100 are covered with daily co-pays of $137.50 for 2010 </li></ul><ul><li>No coverage after day 100 </li></ul>
    5. 5. Medicare only <ul><li>Part B </li></ul><ul><li>Coverage starts after a calendar year deductible $155 for 2010 </li></ul><ul><li>Coverage for doctor office visits: </li></ul><ul><li>Office charge – 80% co-insurance coverage </li></ul><ul><li>Clinical laboratory services – 100% coverage </li></ul><ul><li>Annual physicals, routine eye and hearing exams – not covered, except for one physical exam when you first become eligible for Part B </li></ul>
    6. 6. Medicare only <ul><li>Part B </li></ul><ul><li>Coverage for chiropractic care: </li></ul><ul><li>80% co-insurance coverage </li></ul><ul><li>Other outpatient services: </li></ul><ul><li>Generally covered at 80% </li></ul>
    7. 7. Medicare only summary <ul><li>You must pay the monthly Medicare Part B premium. </li></ul><ul><ul><li>This is paid through a monthly deduction from your Social Security check. </li></ul></ul>
    8. 8. Medicare only summary <ul><li>Out-of-pocket costs can be very high. </li></ul><ul><ul><li>$1100 deductible per benefit period for hospitalizations – you could be required to pay several deductibles in one year. </li></ul></ul><ul><ul><li>20% of most outpatient charges, including surgeries, secondary provider, rehabilitation, oxygen, diabetic supplies, etc. </li></ul></ul><ul><ul><li>Large daily co-pays for extended hospital and nursing home stays. </li></ul></ul>
    9. 9. Medicare only summary <ul><li>In general, prescription drug coverage is not provided. </li></ul><ul><li>You have the freedom to choose your own doctor or hospital. </li></ul>
    10. 10. Medicare Advantage <ul><li>The Medicare Advantage plan replaces original Medicare. </li></ul>
    11. 11. Medicare Advantage <ul><li>Insurance companies contract with Medicare to offer plans and Medicare reimburses the company for each member enrolled. </li></ul>
    12. 12. Medicare Advantage <ul><li>Premiums can vary widely and can be as low as $0. </li></ul>
    13. 13. Medicare Advantage <ul><li>Coverage is subject to change or termination every January 1. </li></ul><ul><li>There is lock-in period each year. Trial 12-month period during first time in Medicare Advantage plan. </li></ul>
    14. 14. Medicare Advantage <ul><li>State-mandated benefits are not required with these plans. </li></ul><ul><ul><li>This could affect coverage for chiropractic, diabetes, home health care and other services. </li></ul></ul>
    15. 15. Medicare Advantage <ul><li>You cannot purchase a Medicare supplement to pay your out-of-pocket costs. </li></ul><ul><li>Benefits vary widely from plan to plan. </li></ul>
    16. 16. Medicare Advantage <ul><li>Out-of-pocket costs vary widely from plan to plan. </li></ul><ul><ul><li>This can vary from $500 to $5,900 per year*, though on some plans the actual out-of-pocket cost can be as high as $10,000 per year**, or may have no specific limit for some services. </li></ul></ul><ul><li>* Source: 2006 Medicare Advantage Costshare </li></ul><ul><li>Report, Milwaukee Area Comparison </li></ul><ul><li>** Source: www.Medicare.gov </li></ul>
    17. 17. Medicare Advantage <ul><li>The OCI warns that you may also be responsible for paying your doctor or hospital bills if you do not follow the Medicare Advantage plan’s rules.*** </li></ul><ul><li>These plans are not under the jurisdiction of the State of Wisconsin (OCI). </li></ul><ul><li>*** Source: State of Wisconsin Office of the </li></ul><ul><li>Commissioner of Insurance Medicare Advantage- </li></ul><ul><li>Questions and Answers, September, 2006 </li></ul>
    18. 18. Medicare Advantage <ul><li>For some plans you have to obtain a referral from a primary care doctor before you can see a specialist. </li></ul>
    19. 19. Medicare Advantage <ul><li>Out-of-area coverage can be limited to emergency care needed to diagnose and stabilize your condition. </li></ul>
    20. 20. Medicare Advantage <ul><li>If you see a provider who does not accept the plan’s fee schedule, you will not be covered and will be responsible for the entire amount charged by the provider. </li></ul>
    21. 21. Medicare Advantage <ul><li>You can only receive care (except in emergencies) from providers that accept the terms and conditions of the plan. </li></ul>
    22. 22. Medicare Advantage <ul><li>These plans must have benefits at least equivalent to Medicare only, but not necessarily any better than Medicare by itself. </li></ul>
    23. 23. Medicare Advantage <ul><li>Funding of Medicare Advantage plans will be reduced in the future.* Based on past experience, this may cause significant changes in benefits and premiums.** </li></ul><ul><li>* Source: Congressional Budget Office Cost Estimate for H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008 </li></ul><ul><li>** Daily Health Policy Report – kaisernetwork.org -1/2003 </li></ul>
    24. 24. Medicare Advantage summary <ul><li>Out-of-pocket costs can be very high. </li></ul><ul><li>There are no protections and guarantees from the State of Wisconsin. </li></ul><ul><li>The least expensive plan is not necessarily the best option for you. </li></ul>
    25. 25. Medicare Advantage summary <ul><li>The Board on Aging and Long Term Care offers the following perspective on Medicare Advantage and Part D plans: </li></ul><ul><ul><li>“If it sounds too good to be true, it probably is.”* </li></ul></ul><ul><li>* Source: Board on Aging and Long Term Care press </li></ul><ul><li>release, September 2006. </li></ul>
    26. 26. Medicare Supplement <ul><li>You must be covered by original Medicare Parts A and B. </li></ul><ul><li>The supplement pays out-of-pocket costs for services covered by Medicare. </li></ul>
    27. 27. Medicare Supplement <ul><li>Five optional coverage riders are available: </li></ul><ul><li>1. Part A deductible </li></ul><ul><li>2. Part B deductible </li></ul><ul><li>3. Part B excess charges </li></ul><ul><li>4. Additional home health care </li></ul><ul><li>5. Foreign travel </li></ul>
    28. 28. Medicare Supplement <ul><li>Plan prices vary widely from company to company. </li></ul><ul><li>Long-term rate stability varies for each plan. </li></ul>
    29. 29. Medicare Supplement <ul><li>The options you choose for your plan will create variations in cost. </li></ul><ul><li>The least-expensive plan is not necessarily the best long-term option for you. </li></ul>
    30. 30. Medicare Supplement <ul><li>Medicare supplements are guaranteed renewable. </li></ul><ul><li>Plans can be purchased with no co-payments or deductibles. </li></ul>
    31. 31. Medicare Supplement <ul><li>There is no paperwork to handle. </li></ul><ul><li>Freedom to use any doctor or hospital based on the network. </li></ul>
    32. 32. MercyCare Senior <ul><li>Has been providing coverage since 1994 </li></ul><ul><li>Coordinates all aspects of health care to ensure patients receive the most effective care at the lowest possible cost </li></ul>
    33. 33. MercyCare Senior <ul><li>MercyCare Senior covers the five optional coverage riders </li></ul><ul><li>1. Part A deductible </li></ul><ul><li>2. Part B deductible </li></ul><ul><li>3. Part B excess charges </li></ul><ul><li>4. Additional home health care </li></ul><ul><li>5. Foreign travel </li></ul>
    34. 34. MercyCare Senior <ul><li>Provides: </li></ul><ul><li>$25 Stay Healthy Benefit </li></ul><ul><li>Chiropractic Services </li></ul><ul><li>Equipment and some diabetic supplies </li></ul><ul><li>No pre- examination </li></ul><ul><li>No Waiting periods </li></ul><ul><li>Routine physical exams, including eye and hearing </li></ul>
    35. 35. Summary <ul><li>All benefits mandated by the state of Wisconsin are included in the policy </li></ul><ul><li>State mandated benefits are not required with these plans. </li></ul><ul><li>There is no lock in period – you can leave the plan whenever you choose </li></ul><ul><li>There is lock-in period each year. This means that between April 1 and December 31 of each year you cannot change to another plan </li></ul><ul><li>The plan cannot terminate your coverage as long as you continue to pay your premiums when they are due </li></ul><ul><li>Coverage is subject to terminations each January 1 st – the plan can drop you at the end of the year if it doesn’t renew its contract with Medicare </li></ul><ul><li>You keep your original Medicare coverage along with gap coverage to pick up out of pocket expenses </li></ul><ul><li>You are no longer covered under the original Medicare program. An insurance company contracted with Medicare provides benefits in place of Medicare </li></ul>Medicare Supplement Plans Medicare Advantage
    36. 36. Summary <ul><li>Some things to keep in mind about all your Medicare plan alternatives: </li></ul><ul><li>Just because a plan has no monthly premium, doesn’t mean it’s not going to cost a lot of money. </li></ul>
    37. 37. Summary <ul><li>Don’t be pressured. </li></ul><ul><ul><li>- Don’t let a sales person pressure you into enrolling. </li></ul></ul><ul><ul><li>- Don’t be pressured to enroll at a seminar. </li></ul></ul><ul><ul><li>- Take time to think about your decision. </li></ul></ul>
    38. 38. Summary <ul><li>Get advice from professionals if you have any concern about a plan being offered to you. </li></ul>
    39. 39. Summary <ul><li>Make certain your decision is good for the long term, not just for now. </li></ul>
    40. 40. Questions? <ul><li>If you have any questions or are interested in MercyCare’s Medicare Supplement Plan, </li></ul><ul><li>Contact me anytime at: </li></ul><ul><ul><li>Josh Mummery </li></ul></ul><ul><ul><li>608-758-7738 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Thank You! </li></ul>

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