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- 2. Solving the Medicare Puzzle InsurancePros, Inc.
- 3. What is Medicare? Nationalhealthcare program for those 65 or older (est. 1965) Also covers those younger than 65 who qualify for Social Security Disability If you or your spouse have paid into the Medicare system through payroll taxes, you are eligible for benefits. You can enroll up to 3 months prior to the month of your 65th birthday, the month of your 65th birthday and three months after. This is called your “Initial Eligibility Period” or IEP. What if I am still employed with group coverage at age 65?
- 4. The Parts ofMedicare
- 5. Part A Hospitalization Insurance Nocost to you in most cases Coverage is guaranteed for taxpayers Provides coverage for Inpatient hospital care Inpatient skilled nursing care Hospice care services Home health care services Some other inpatient benefits
- 6. Part B -2021 Income Levels for IRMAA Premium Individual Married filing Jointly $207.90 $88,001 to $111,000 $176,001 to $222,000 $297.00 $111,001 to $138,000 $222,001 to $276,000 $386.10 $138,001 to $165,000 $276,001 to $330,000 $475.20 $165,001 to $499,999 $330,001 to $749,999 $504.90 $500,000 and above $750,000 and above Medical Insurance Cost is $148.50 per month in most cases Coverage is guaranteed for taxpayers Provides coverage for Medically-necessary services Preventive services
- 7. Part B -2022 Income Levels for IRMAA Premium Individual Married filing Jointly $238.10 $91,001 to $114,000 $182,001 to $228,000 $340.20 $114,001 to $142,000 $228,001 to $284,000 $442.30 $142,001 to $170,000 $284,001 to $340,000 $544.30 $170,001 to $499,999 $340,001 to $749,999 $578.30 $500,000 and above $750,000 and above Medical Insurance Cost is $170.10 per month in most cases Coverage is guaranteed for taxpayers Provides coverage for Medically-necessary services Preventive services
- 8. Your Medicare IDCard
- 9. Part D -2022 Outpatient Prescription Drug Coverage Purchased through private insurance companies approved by Medicare Plans can range from $6.60 to $101.40 per month and there are 22 plans in our area. Part D plans can be found on www.medicare.gov Income Levels for IRMAA Premium Individual Married filing Jointly $12.40 $91,001 to $114,000 $182,001 to $228,000 $31.90 $114,001 to $142,000 $228,001 to $284,000 $51.40 $142,001 to $170,000 $284,001 to $340,000 $70.90 $170,001 to $499,999 $340,001 to $749,999 $77.40 $500,000 and above $750,000 and above
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- 11. Missing Pieces inthe Medicare Puzzle
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- 15. Part A Deductible ($1,556per benefit period) Day 1-60 Part A—Missing Pieces - 2022 Hospital Coinsurance ($371 per day) Day 61-90 Hospital Coinsurance ($742 per day) Day 91 and beyond ( up to 60 lifetime reserve days) $185.50/Day Skilled Nursing (21-100) Hospice Care coinsurance
- 16. Part B— MissingPieces - 2022 Annual Deductible ($233) 20% of the Medicare Approved Amount Excess charges First 3 pints of blood
- 17. Providing the MissingPieces: Medicare Supplement Plans
- 18. Medicare Supplement Plans PlanPlan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P* Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,940 $2,470
- 19. Medicare Supplement Plans MedicareSupplement Plan A is a popular and low-cost choice Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P$20 Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,800 $2,400
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- 21. Medicare Supplement Plans MedicareSupplement Plan N encompasses additional coverage at an additional cost Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P$20 Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,660 $2,330
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- 23. Medicare Supplement Plans MedicareSupplement Plan F is by far the most comprehensive plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P$20 Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,800 $2,400
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- 25. MACRA - 2020 ThoseTurning 65 in 2020 and beyond are not eligible to purchase Plans C and F. Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P$20 Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,800 $2,400
- 26. Medicare Supplement Plans PlanG has eclipsed Plan F in popularity. Plan Plan Plan Plan Plan Plan Plan Plan Plan Plan Benefits A B C D F G K L M N Basic Benefits -- Hospitalization P P P P P P P P P P Medicare Part B Coinsurance P P P P P P 50% 75% P P$20 Blood (First 3 Pints) P P P P P P 50% 75% P P Part A Hospice Coinsurance P P P P P P 50% 75% P P Medicare Part A Deductible P P P P P 50% 75% 50% P Skilled Nursing Coinsurance P P P P 50% 75% P P Medicare Part B Deductible P P Medicare Part B Excess Charges Benefits P P Foreign Travel Emergency P P P P P P Out-of-pocket Annual Limit $4,800 $2,400
- 27. Medicare Supplement Plans: SampleRates Rates for John Doe, A 65 year old male residing in ZIP Code 66205 Supplement Plan Local Blue Company American Retirees Association Pharmacy Mergers Company Omaha Nebraska Company A $75.00 $108.94 $101.36 $96.95 C $182.00 -- $137.71 $136.12 F $182.00 $152.06 $141.03 $142.59 N $146.00 -- $99.74 $106.23 See Actual Rates Based on Your Age, Gender, and Geography
- 28. Medicare Supplement Plans: Benefits Workwith your Medicare Parts A & B to offer more complete coverage No network limitations—you go to any doctor that accepts Medicare (there are “Medicare Select” plans that limit your hospital network for a discount) Little to no out of pocket expense for services No requalifying—your coverage doesn’t change (also, plans are guaranteed renewable)
- 29. Part A Part B Part D Combining the Pieces: MedicareAdvantage Plans
- 30. Medicare Advantage Plans Aprivate health insurance carrier administers coverage and manage the whole claim You still pay the Social Security Administration for Part B You pay the insurance company for all other services combined Inpatient outpatient prescription Relatively low cost: $0 to $80 per month
- 31. Medicare Advantage Plans: Differencesfrom Medicare Supplements Part A Part B Part D
- 32. Medicare Advantage Plans: Differencesfrom Medicare Uses a limited network Limited or no out-of-network coverage in non- emergency situations Part A Part B Part D Part A Part B Part D
- 33. Medicare Advantage Plans: Comparedto Medicare Supplements Reincorporates co-payments (examples only): $5 Doctor’s office visit $40 Specialist’s office visit $50 Urgent Care $90 ER Visits $150 MRIs/CT Scans $300 per day in the hospital (usually 5-7 days max) Plan Out of Pocket Maximum $5,000 per year
- 34. Medicare Advantage Plans: Comparedto Medicare Supplements Many plans offer discount programs Dental coverage included Gym memberships or discounts Other discounts
- 35. Medicare Advantage Plans: Comparingthe Cost Medicare Supplement Medicare Advantage $0 $170.10 $120.00 $20.00 $310.10 Part A Part B Supplement Part D $0 $170.10 $ 0.00 $170.10 Part A Part B Advantage Savings of $140 per month!
- 36. What can youdo with $140 per month or $1680 per year? Buy $75,000 Life Insurance Put it in the bank Go on a cruise Pay for cable with HBO & high speed internet GIVE IT TO YOUR BROKER!
- 37. Medicare Advantage Plans: WhoShould Consider Them? Low utilizers of healthcare services Individuals who value managed care Individuals whose providers are in-network Doctors Hospitals Individuals who value the savings from the price of a Medicare supplement and Part D
- 38. Medicare Advantage Plans: PotentialDrawbacks Annual Changes to Plan Designs Yearly changes in funding from federal government No guarantee of qualifying for Medicare supplements later (after trial period)
- 39. Medicare Advantage Plans: Availability MedicareAdvantage Plans & Prescription Drug Plans are exclusively sold and enrolled by CMS certified agents in order to protect the rights of seniors.
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- 42. FAQs What if Iwant to change plans after enrolling? All plans allow changes without penalty within the first 30 days. If you decide after the 30 days that you want to change plans, you’ll need to wait until your next open enrollment period.
- 43. FAQs How can MedicareAdvantage Plans be offered at no cost?
- 44. What if Iwait to enroll so I have more time to assess my needs? “There are penalties associated with not enrolling in Medicare when you are first eligible. In addition to percentage penalties, you may be subject to underwriting when you do apply and may face paying a much higher rate.” FAQs
- 45. What are thepenalties? “Waiting to enroll in Part B can result in a penalty of 10% for each 12 months of not electing coverage.” “Waiting to enroll in Part D can result in a penalty of 1% per month (of the national base beneficiary premium) after the initial eligibility period.” (more than 62 days without creditable coverage) FAQs
- 46. What are thepenalties? FAQs
- 47. What is theprescription donut hole? • This is the point at which the total spending for a Part D plan on drugs by the beneficiary and the plan reaches $4,130. At this point, the beneficiary pays for 25% of generic drug costs and 25% of brand name drug undiscounted costs. Once the beneficiary expenditures (including drug manufacturer discounts) reach a total of $6,550, the beneficiary is through the coverage gap and reaches “catastrophic coverage” where the beneficiary will assume only a nominal cost for any future prescriptions (usually 5%). FAQs
- 48. I have apre-existing condition. How will that affect my rates? “If you enroll when you are first eligible, there will be no impact on your rates. All companies are required to issue your policy at the same rate that is offered to everyone else regardless of your medical history or condition.” FAQs
- 49. I want toknow exactly what my monthly expenses will be. What is the best option for me? •“Although your prescription costs may vary based on which plan you select, choosing Supplement F will provide the most comprehensive level of coverage with virtually no out of pocket expenses for Medicare covered claims.” FAQs
- 50. Why doesn’t BlueCross Blue Shield of KC have an S&P or AM Best Rating? “We are not required to post our ratings in S&P and AM Best. Companies have to pay to have their ratings published in them.” FAQs
- 51. Recent Increase HistoryExample FAQs
- 52. Recent Increase HistoryExample FAQs
- 53. Recent Increase HistoryExample FAQs
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Editor's Notes
- #4 Point 3: and coverage will begin on the first day of the month of your 65th birthday unless your birthday is on the first. Then it will begin on the first of the month prior to the month of your birthday.
- #6 Part A mainly covers facilities. REMINDER: Doctors charge under Part B even when in the hospital. See Medicare & You Handbook. Sect. 2 P. 27.
- #9 Important to note that observation while in a hospital falls under Part B.
- #10 Important to note that observation while in a hospital falls under Part B.
- #11 Important to note that observation while in a hospital falls under Part B.
- #12 Important to note that observation while in a hospital falls under Part B.
- #15 We primarily work with AARP for Part D which is administered by UnitedHealthcare. The plans provide tremendous value to our clients.
- #16 .
- #17 .
- #18 .
- #19 .
- #21 Fly in Cover up pieces all at one time on A (5) , B (4)
- #25 Have puzzle piece arrive WITH wording
- #26 Have puzzle piece arrive WITH wording
- #27 REMINDER: Doctors charge under Part B.
- #28 REMINDER: Doctors charge under Part B.
- #29 REMINDER: Doctors charge under Part B.
- #30 REMINDER: Doctors charge under Part B.
- #31 REMINDER: Doctors charge under Part B.
- #50 Pict come with wording
- #54 Change to Use completed picture
- #55 Change to Completed puzzle, use a darker haze around for out of network