RLee Financial Solutions“Common Sense Solutions”
RLee Financial SolutionsWho are we?...Providing the right information to help make the right decisions“Having worked in the insurance industry for years I was continually frustrated with theway consumers were treated by both agents and their companies. There was alwaysthe assumption that they were incapable of making the decision that would be best forthem on their own, and they were often pressured into products that may not havebeen in truly their best interest. I have always found people to be more than capable ofmaking the right decision when given all the facts. I believe if I provide the rightinformation making the right decision just becomes a matter of commonsense, putting us truly in the business of providing “common sense solutions” .Robin LeePresident
RLee Financial SolutionsPresident Johnson signing theMedicare program into law, July 30,1965. Shown with the President (onthe right in the photo) are (left toright) Mrs. Johnson; formerPresident Harry Truman; Vice-President Hubert Humphrey; andMrs. Truman.At the bill-signing ceremony President Johnsonenrolled President Truman as the first Medicarebeneficiary and presented him with the first Medicarecard. This is President Trumans application for theoptional Part B medical care coverage, whichPresident 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 Financial SolutionsToday…* Today there are over 50 million people on MedicareBy 2030 that number will rise to 80 million!*People are living much longer, and life expectancykeeps going up!
RLee Financial SolutionsWhen you areHospitalized for:Medicare Covers:You pay:(per benefit period)1-60 daysMost confinement cost afterthe required MedicareDeductible.$1,184 Deductible61-90 daysAll eligible expenses, afterthe patient pays a per-daycopayment.$296 A DAY COPAYMENTas much as $8,88091-150 daysAll eligible expenses, afterpatient Pays a per-daycopayment (Theses AreLifetime Reserve Days whichmay never be used again).$592A DAY COPAYMENTas much as $35,520151 or more days NOTHING YOU PAY ALL COSTAt least 3 days and enterA Medicare approvedSKILLED NURSINGFACILITY within 30 daysAfter hospital dischargeAll eligible expenses, for thefirst20 days; then all eligibleexpenses for 21-100, afterpatient pays a per-daycopayment.After 20 days $148.00 ADAY COPAYMENT as much as$11,840
RLee Financial SolutionsOn expensesIncurred for:Medicare Covers:You pay $162Annual DeductiblePLUS:Medical ExpensesPhysician’s services, inpatient, outpatientmedical/surgical services, physical/speechtherapy, diagnostic test and durable medicalequipmentGenerally 80% of approvedAmount(subject to Part B deductible)Generally 20% ofApproved amountClinical Laboratory ServicesBlood test for diagnostic servicesGenerally 100% ofApproved amount(not subject to Part B deductible)Nothing for servicesHome Health CarePart-time or intermittent skilled care,home health aide services, durable medicalsupplies and other services.100% of the approved amount(not subject Part B deductible)80% of the approved amount for durablemedical equipment(subject to part B deductible)Nothing for services;20% of approved amount forDurable medical equipmentOutpatient Hospital TreatmentServices for the diagnosis or treatmentOf an illness or injuryGenerally 80% or approvedAmount (subject to Part B deductible)Generally, 20% of billed amountBloodAfter 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 Financial SolutionsWhat are the gaps?...They include…Part A deductiblePart B deductiblePart B 20% including the first 3 pints of bloodPart B excess charge (15% of Medicare approved amount)Foreign travel emergency careSkilled nursing facility co-payDrug coverage
RLee Financial SolutionsExample of Medicare Basics at MayoMayo Clinic Charge $115.00Medicare approved amount $100.00Medicare pays 80% of approved amount $80.00Secondary insurance pay 20% or approved amount $20.00Total paid by Medicare and Secondary insurance $100.00Patient responsibility $15.00Medicare assigns a price for any and all covered procedures. If thedoctor or hospital accepts this price they are accepting Medicare“assignment” . If they choose to not accept assignment they cancharge 15% more than the Medicare approved amount only.What is Part B excess?“Mayo Clinics don’t currentlyaccept assignment, here is anexample of how it could effectyour bill”.Heart Surgery $150,000Medicare Assignment $100,000Part B pays 80% $80,000Supplement pays 20% $20,000Part B Excess Charge 15% $15,000“How can Excess Charges effect a majorhospital stay”?
RLee Financial SolutionsWhy Will ExcessCharges be a Factor?...The AMA explains that thecost to run a medical practicehas risen every yearwhile reimbursements fromMedicare go down every year.Where will it end?
RLee Financial SolutionsAMA ONLINE SURVEY OF PHYSICIANS The Impact of MedicarePhysician Payment on Seniors Access’ To Care May 2010Key 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 Medicarepatients 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 unreliablepayer (78%)Looking at just primary care physicians**, nearly one-third (31 percent) currently restrict thenumber 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 physicianslooked 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 theshort-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 tophysicians 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 wereasked to check all answers thatapply. **Primary care is defined asFamily Practice, General Practice,Internal Medicine, andObstetrics/Gynecology.
RLee Financial SolutionsPhysician Medicare Cuts Delayed Til 2014Well, they did it again. The press is congratulating Congress onthe "success" of coming up with a New Years Night deal on thatno one likes. For physicians, this deal contains a delay in the27% cut in Medicare payments to physicians according to theSustainable Growth Rate (SGR). For full coverage of this story, Iencourage you to read articles from Medpage Today, KaiserHealth News, and Modern Healthcare. (Photo credit: New YorkTimes)The 26.5% cut in Medicare reimbursement mandated by thesustainable growth rate (SGR) formula was averted in a literal11th hour vote Tuesday in the House of Representatives. TheHouse vote to pass the "fiscal cliff" bill OKd earlier by theSenate delays the SGR cuts for a year. The bill cleared the Houseby a vote of 257-167; senators had passed the same bill in an89-8 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 December31, 2013 comes, well 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 theirmembers to lobby congress for a long term Medicare paymentsolution. How effective will they be? Well see..http://familymedicinerocks.com/blog/2013/1/1/physician-medicare-cuts-delayed-til-2014What about the verynear future?...The bill cleared the House by a vote of 257-167; senators had passed the same bill in an89-8 vote just after 2:00 a.m. vote.
RLee Financial SolutionsWe can fill those gaps!...With a Medicare supplement policy…Plan A Plan F Plan G Plan N Part DBasic BenefitsSkilled nursing co-payPart A deductiblePart B deductiblePart B excess chargesForeign TravelDrug coveragePlan N has a $20copayment per office visit anda $50 copayment each ERvisit.
RLee Financial Solutions2013 Part D coverage ...2013 Basic Medicare Drug Coverage2013 Basic Benefits You PayDeductible $325 100% of first $325Initial Coverage Limit $2840 25% of the next $2645 ($661.25)Coverage Gap $2970.00 100% of the $2970.00Annual – out- of- pocket amount $4750Catastrophic Coverage Medicare and Plan95%5%
RLee Financial Solutions“How will the newhealthcare lawbenefit me?” …New benefits in 2013...
RLee Financial SolutionsWhat are your options?...OriginalMedicareOriginalMedicarePart A &BMedicareSupplementMedicarePart DOne or the otherMedicareAdvantage PlansPart C(may includedrug coverage)*CreditablePrescription DrugCoverage*Could include employer provided drugcoverage, union, or even VA drug benefits
RLee Financial SolutionsWhat is part C orAdvantage Plans?…What Are Advantage Plans?•Medicare Advantage (MA) plans are health planoptions that are part of the Medicare program•MA plans are not the same as MedicareSupplement insurance•Medicare pays the plan (the insurance company)a set amount every month for your care•MA plans must offer all benefits of OriginalMedicare and can include Part D prescriptiondrug coverage
RLee Financial SolutionsWhat is part C orAdvantage Plans?…• Most plans offer health and drugcoverage, as well as extra benefits• Most have lower out-of-pocket coststhan with Original Medicare• You may have to use certain healthcareproviders• You do not need a Medicare Supplement
RLee Financial 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 thosecovered by the plan, and your cost for those drugs
RLee Financial SolutionsIs an Advantage Planright for You?…Things to consider before deciding on anAdvantage 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 Financial 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 Financial SolutionsSomething not to consider...
RLee Financial SolutionsSERVICES AVAILABLEMedicare SupplementsMedicare Advantage PlansPart D Drug CardsLife InsuranceAnnuitiesLong Term Care InsuranceSupplemental HealthOur Full line ofServices…Providing you with“common sense solutions”