2019 medicare presentation

RLee Insurance Solutions
“Using Common Sense”

Who 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 Lee
President

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…

Today…
Today there are over 62 million
people on Medicare
By 2030 that number will rise to
79 million!
People are living much longer, and life
expectancy keeps going up!
Here's Why Life Expectancy in the
U.S. Dropped Again This Year

What are my cost?...
Part A cost:
For 2019, for those that don’t get Part A at no cost they pay $437.00/month
Part B cost:
Tax Filing Status 2017 Part B Premiums 2019
Single
Married
Less than $85,001
Less than $170,001
$135.50
Single
Married
$85,001 - $107,000
$170,001 - $214,000
$189.60
Single
Married
$107,001 - $133,500
$214,001 - $267,000
$270.90
Single
Married
$133.501 - $160,000
$267,001 - $320,000
$352.20
Single
Married
$160,001 - $499,999
$320,001 - $749,999
$433.40
Single
Married
$500,000 and above
$750,000 and above
$460.50

Part B Late Enrollment Penalty
In most cases, if you don't sign up for Part B when
you're first eligible, you'll have to pay a late
enrollment penalty for as long as you have Part B.
Your monthly premium for Part B may go up 10%
for each full 12-month period that you could have
had Part B, but didn't sign up for it. Also, you may
have to wait until the General Enrollment Period
(from January 1 to March 31) to enroll in Part B, and
coverage will start July 1 of that year.

When you are
Hospitalized for:
Medicare Covers:
You pay:
(per benefit period)
1-60 days
Most confinement cost after
the required Medicare
Deductible.
$1,340 Deductible
61-90 days
All eligible expenses, after
the patient pays a per-day
copayment.
$335 aDAY COPAYMENT
as much as $10,050
91-150 days
patient Pays a per-day
copayment (Theses Are
Lifetime Reserve Days which
may never be used again).
$670A DAY COPAYMENT
as much as $40,200
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 $167.50 A
DAY COPAYMENT as much as
$13,400

When you are
Hospitalized for:
Medicare Covers:
You pay:
(per benefit period)
1-60 days
Most confinement cost after
the required Medicare
Deductible.
$1,364 Deductible
61-90 days
the patient pays a per-day
copayment.
$341 A DAY COPAYMENT
as much as $10,230
91-150 days
patient Pays a per-day
copayment (Theses Are
Lifetime Reserve Days which
may never be used again).
$682A DAY COPAYMENT
as much as $40,920
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 $170.50 A
DAY COPAYMENT as much as
$13,640

On expenses
Incurred for:
Medicare Covers:
You pay $185
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

What are the gaps?...
They include…
Part A deductibles ($1364.00+)
Part B deductible ($185.00)
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

Example of Medicare Basics at Mayo
Mayo Clinic Charge $215.00
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 (15% of $100)
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”.
“How can Excess Charges effect a major
hospital stay”?
Keeping excess charges in mind, the plan YOU choose could effect
the quality of the healthcare you receive for the rest of your life!

Will excess charges be a
factor?
Scheduled cuts to doctors
and hospitals where
mounting as the "can was
being kicked down the road“
Congress needed to act!

RLee Insurance SolutionsRecent changes to the
Medicare laws you need
to know about
The White House
Office of the Press Secretary
For Immediate Release April 16, 2015
Statement by the Press Secretary on H.R. 2
On Thursday, April 16, 2015, the President signed into law:
H.R. 2, the “Medicare Access and CHIP Reauthorization Act of
2015,” which permanently replaces Medicare's sustainable
growth rate system for physician payments and reforms
Medicare physician payment policies to encourage efficient,
high-quality care; extends for two years funding for the
Children's Health Insurance Program; extends numerous other
expiring health provisions and the Secure Rural Schools
program; and removes Social Security numbers from Medicare
cards and makes other Medicare improvements.

What are the impacts on
Medicare from H.R.
2?...
1. Qualified Individual (QI) program is now permanent.
Provides low income folks help paying for part B. To qualify for QI, your monthly income cannot
exceed $1,325 if you are single ($15,890/yr.) or $1,793 ($21,506/yr.) if you are part of a couple.
2. No more Social Security numbers on Medicare cards.
Provides $320 million in funding to remove Social Security numbers from beneficiaries’ Medicare cards
and come up with a new numbering system within the next 4 years.
3. Exceptions process for Medicare therapy caps extended 2 years.
The new law provides for extending the Medicare therapy cap exceptions process for another 2 years.
4. How the new law affects beneficiary costs.
Over the next 8 years the standard Part B premium is projected to increase from $104.90 to $156.20, a
difference of over $50.
5. Higher Part B & D premiums for higher income beneficiaries.
Starting in 2018, individuals with annual incomes of $133,501 to $160,000 (for couples, annual income
from$267,001 to $320,000) will pay 65% of program costs for their Part B and D premiums instead of the
50% they currently pay. Individuals with annual incomes of $160,001 and above (couples $320,001 and
above) will pay 80% of program costs for their Part B and D premiums.
6. Restrictions on Medigap policy benefits.
Effective January 1, 2020, any newly eligible Medicare beneficiary will not be able to buy Medigap plans
C or F with Part B deductible coverage.

What about the very
near future?...
The July annual report of the Medicare Trustees to Congress on the financial state of the program
shows no projected 2018 increase in the standard Medicare premium, which is $134 today; indeed,
the Part B premium may fall. But, two groups of people with Medicare are projected to pay a higher
2018 Part B premium. People with 2017 Medicare monthly premiums of $109 are likely to pay
higher premiums in 2018 because their Social Security benefits are projected to increase. And, some
people with annual incomes above $85,000 also will likely pay higher premiums because the income
level for paying more than the standard 25 percent of income contribution will be adjusted
downward in 2018.
A projected 2 percent increase in people’s Social Security checks–an average monthly increase of
$27.20–means that people paying the standard 2018 Medicare monthly premium of $134 will likely
see a reduction in their Part B premium. But, the 70 percent of people with Medicare who have
paid a lower premium because their Social Security benefits have barely increased over the last two
years–people who have been paying an average monthly premium of $109–will likely see an
increase in their Part B premium.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2017.pdf

What about the very
near future?...
On 09/14/2017 the CMS revealed the new design for the new Medicare cards with your
new Medicare number called your “Medicare Beneficiary Identifier” and it contains 11
digits composed of randomly selected numbers and capital letters.
current card new card
CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to
meet the statutory deadline for replacing all existing Medicare cards by April 2019.
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-09-14.html

What about the very
near future?...
Medicare Supplement Plan C & F are being discontinued.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed by Congress
and signed into law on April 16, 2015 changed the law on various aspects of health care,
including some Medicare Supplement plans. The new law states that on or after January
1, 2020, a Medicare Supplement policy that provides coverage of the Part B deductible
may not be sold or issued to a newly eligible Medicare beneficiary. That means that
people whose birthday is December 31, 1954 (turning 65 on December 31, 2019) may be
the last group able to enroll in Medicare Supplement Plans C or F. After January 1, 2020,
you will not be able to enroll in Medicare Supplement Plans C or F since they both cover
the Part B deductible. If you already have either Plan, you can keep it. The law only
affects new enrollees.
https://www.congress.gov/bill/114th-congress/house-bill/2

What are your current
Medigap options?...
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.

Part D cost:
If your yearly income in 2017 was You pay in 2019
File individual return File a joint return
$85,000 or less $170,000 or less Your plan
premium
$85,001 up to $107,000 $170,001 up to $214,000 $12.40 + your
plan premium
$107,001 up to $133,500 $214,001 up to $267,000 $31.90 + your
plan premium
$133,501 up to $160,000 $267,001 up to $320,000 $55.40 + your
plan premium
$160,001 up to $499,999 $320,001 up to $749,999 $70.90 + your
plan premium
$500,000 and above $750,000 and above $77.40 + your
plan premium

Part D Penalty
The cost of the late enrollment penalty depends on how
long you went without Part D or creditable prescription
drug coverage.
Medicare calculates the penalty by multiplying 1% of the
"national base beneficiary premium" ($33.19 in 2019)
times the number of full, uncovered months you didn't
have Part D or creditable coverage. The monthly premium
is rounded to the nearest $.10 and added to your
monthly Part D premium.
The national base beneficiary premium may increase
each year, so your penalty amount may also increase
each year.

2018 Part D coverage ...
2018 Basic Medicare Drug Coverage
2018 Basic Benefits You Pay
Deductible $405 100% of first $405
Initial Coverage Limit $3345 25% of the next $3345 ($836.25)
Coverage Gap $3750 100% of the drug cost
Annual – out- of- pocket amount $5000
Catastrophic Coverage Medicare and Plan
95%
5%
“Keep in mind, this is the minimum coverage a
plan has to include as required by the government,
MOST do better in this competitive market.”

2019 Part D coverage ...
2019 Basic Medicare Drug Coverage
2019 Basic Benefits You Pay
Deductible $415 100% of first $415
Initial Coverage Limit $3405 25% of the next $3405 ($851.25)
Coverage Gap $3820 100% of the drug cost
Annual – out- of- pocket amount $5100
Catastrophic Coverage Medicare and Plan
95%
5%
“Keep in mind, this is the minimum coverage a
plan has to include as required by the government,
MOST do better in this competitive market.”

“How will the new
healthcare law
benefit me?” …
New benefits in 2011...

New benefits in 2019...
As a result of the Bipartisan Budget Act of
2018, the donut hole is going away for
brand-name meds. Costs for these
medications will shift to the drug
manufacturers beginning in 2019.

What about the very
near future?...
It is our belief, as well as others in the industry, that as the cost of the Part B premiums
rise so will the Part B deductible from its current $183.00 a year level. Many folks may
select to go the Medicare Advantage route to cover their healthcare needs in trying to
Reduce their "upfront" cost.

What 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

What 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

What 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

What are your choices with
Advantage 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

Is 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?
**Remember, in most cases, you must use the card from your Medicare Advantage
Plan to get your Medicare-covered services. Keep your Medicare card in a safe place
because you’ll need it if you ever switch back to Original Medicare.
**2018 Medicare and You pg. 65

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?
Is the plan accepted in my area?

Something not to consider...

SERVICES AVAILABLE
Medicare Supplements
Medicare Advantage Plans
Part D Drug Cards
Dental, Vison, and Hearing
Life Insurance
Annuities
Short Term Care
Long Term Care Insurance
Supplemental Health
Travel Insurance
Our Full line of Services…
Making your healthcare decisions
A matter of “using common sense”

2019 medicare presentation

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2019 medicare presentation