This document provides an overview of Medicare and insurance options from Boone Insurance Associates. It defines key terms like deductible and coinsurance. It describes the main parts of Medicare including Part A for hospital coverage, Part B for medical coverage, Part C for Medicare Advantage plans, and Part D for prescription drug coverage. It also outlines some options for supplemental coverage through Medigap plans. The document discusses factors to consider when analyzing and choosing a health insurance plan, and lists the different enrollment periods for making changes.

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MEDICARE MADE SIMPLE
BIA
Boone Insurance Associates Education Guide: Current 10/20/2014

2. About Boone Insurance Associates
 Boone Insurance Associates provides health and life insurance products to clients all over
Oregon.
 We work directly with the companies to resolve any of your claim, benefit, & premium
questions.
 Unlike a captive insurance producer who represents that insurance company alone, we are
independent of a specific insurance company and represent a variety of different
companies and products.
 Boone Insurance Associates provides this educational program today to help inform you.
There is no obligation for you to purchase services from us.
“Our pledge is to provide our clients with superior customer service and product knowledge in
order to guide them in making the most informed decisions."
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3. Companies We Represent
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• Aetna
• Cigna
• Coventry
• Equitable Life and Caul
• Health Net
• Lifewise
• MODA
• Pacific Source
• Providence
• Regence Blue Cross Blue
Shield
• Sentinel

4. Terminology
 Deductible: A specific dollar amount that your health insurance company may
require that you pay out-of-pocket each year before your health insurance plan
begins to make payments for claims.
 Coinsurance: The amount that you are obliged to pay for covered medical
services after you've satisfied any co-payment or deductible required by your
health insurance plan. Coinsurance is typically expressed as a percentage of the
charge or allowable charge for a service rendered by a healthcare provider. For
example, if your insurance company covers 80% of the allowable charge for a
specific service, you may be required to cover the remaining 20% as coinsurance.
 Maximum Out of Pocket (OOP): An annual limitation on all cost-sharing
for which patients are responsible under a health insurance plan. This limit does not
apply to premiums, balance-billed charges from out of network health care
providers or services that are not covered by the plan.
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5. Parts of Medicare
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 A Hospital
 B Physicians
 C Medicare Advantage
 D Prescription Drug Benefit
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6. Original Medicare
 No Benefits while traveling outside the USA
 Deductibles and co-insurance
 Part A Deductible $1184 (first 60 days)
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 Part B Deductible $147
 Part B Coinsurance 20%
 Unlimited liability for you
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7. Medicare Supplement (Medigap) Plans
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 Standardized A – N
 Can see any provider that will see you as a Medicare
patient
 Does NOT include Part D
 Prices vary widely from company to company.
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8. Medicare Advantage Plans
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 HMO
 PPO
 SNP’s
 PFFS
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9. Part D – RX Coverage
 Voluntary/Penalty
 Model Plan
 Plan Designs
 Formulary
 Pharmacies
 Do you need to shop?
 Donut Hole
 Gap issues
 Gap solutions
 Low Income Subsidy
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10. 2013
Medicare Part D “Buckets”
Deductible ICL Donut Hole Catastrophic 1 2 3 4
Deductible Initial Coverage Limit (ICL) Donut Hole or Coverage
Gap
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Catastrophic
$0 to $310 $2850 $4550 Insurance will pay 95%
Does your plan have a
deductible?
A credit of money which is
reduced each time you fill
a prescription
Money you spend out of
your pocket from buckets
1, 2 &3
of covered medications
through December 31st
Copayments and
coinsurance apply here
Maximum out of your
pocket is $4550
You pay 5%
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11. Plan Analysis
 Cost – What will my monthly premium and out-of-pocket
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costs be?
 Benefits – Do I want extra benefits and services,
like eye exams, routine physical exams, preventive
dental or alternative care?
 Doctor Choice – Can I see the doctor(s) I want to
see? Do I need a referral to see a specialist?
 Convenience – Where are the doctor’s offices? Is
there paperwork? Do I have to file claims myself?
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12. Enrollment Periods
 IEP-Initial Enrollment Period
 AEP-Annual Election Period 10/15 - 12/07
 ADP-Annual Dis-Enrollment Period 1/1- 2/14
 SEP-Special Enrollment Period
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10/20/2014