Important Phone Numbers Vince Kelly Medicare Insurance Specialist Phone number 310-625-1837 e-mail: vince@medicarebabyboomer.com Important Phone Numbers Medicare: 1-800-633-4227 Social Security: 1-800-772-1213

What is Medicare? Federal health insurance program Began in 1965, as a result of the “Medicare Act”

Medicare Part A – Hospital Insurance Most people do not pay a monthly premium Covers Hospital Stays and Home Health Care/DME $1068 Hospital Deductible days 1-60 each “Benefit Period” additional daily fees for days 61-150. Covers 100 days in a Skilled Nursing Facility $0 per days 1-20 $133.50 per days 21 - 100

Medicare Part B – Medical Insurance 2009 Monthly Premium for most people $96.40 ($289.20 quarterly) Covers Doctor Services $135 annual deductible Covers 80% of costs, YOU PAY 20%

Medicare Enrollment Periods Initial Enrollment – Begins 3 months before 65th birthday and ends 3 months after. Special Enrollment Period – Anytime, depending upon when the individual stops working and/or coverage from a Group Health Plan is terminated. Annual Election Period – Nov 15th- Dec 31st Open Enrollment Period – Jan1st – March 31st.

Medicare Prescription Drug Coverage (Part D) Medicare HMO and PPO plans include Part D Original Medicare only or Medi-Gap should consider enrolling in a “Stand-Alone Drug Plan” Part D Late-Enrollment Penalty – Multiply 1% of the “national base premium” ($30.36) by the number of months you were eligible to join. Example: 12 months equals $3.60/monthly penalty.

Medicare Part D Standard Coverage as required by law beneficiary pays for… $30.36 monthly premium (national average) $295 annual deductible 25% coinsurance for drug costs between $ 295 - $ 2,700 100% (donut hole) coinsurance for drug costs between $ 2,700 - $4,350 TrOOP costs do not include $30.36/month premium TrOOP costs do not include non-formulary drugs once $ 4,350 in drug costs have been reached, catastrophic coverage begins: beneficiary pays for… 5% coinsurance for drug costs of $ 4,350 and up (greater of $2.40 generic/$6.00 brand or 5% coinsurance)

Medicare Does Not Cover Acupuncture Chiropractic services (except to correct a subluxation) Custodial care/Long Term Care (nursing home) Dental care and Dentures Hearing Aids Routine Vision and Glasses (except after cataracts) Prescription drugs Out of Country travel coverage

Medicare Health Plan Choices Part C (Medicare Advantage – MA) provides Medicare Parts A & B through private insurance companies approved by Medicare. Medicare Advantage (MAPD) HMO – Includes Rx Medicare Supplement (Medi-Gap) – No Rx MAPD Private Fee-For-Service (PFFS) – Includes Rx MAPD PPO – Includes Rx Original Medicare – 80% Coverage – No Rx

Medicare Advantage –PPO or PFFS $0 Monthly Premium PPO - $1050 Deductible PFFS – Various Copayments Providers bill the insurance company NOT Medicare Includes a Medicare Part D drug plan “Freedom” Choice of Doctors and Hospitals No need to pick a PCP (Primary Care Physician)

Medicare Supplement (Medi-Gap) You pay Monthly Premiums, varies by Insurance Co. 12 Medicare Standardized Plans (Plans A through L) Plan “F”- Most Popular - Covers Part B Excess Complete Freedom of Doctors and Providers

How Medicare Supplements Plans Work Medicare pays the Medicare-Approved Amount first, then your Medicare Supplement plan pays all or part of the balance, depending on which plan you choose. EXAMPLE: Total Cost of Physician’s service is: $2000 Medicare-approved amount is: $1800 Medicare pays 80% of approved amount: $1,440 Medicare Supplement pays 20% $360 If a physician does not accept Medicare assignment, you must pay the difference between the total amount and the Medicare-approved amount. Legally the physician may not bill for more than 115% of Medicare-approved charges. In this example, you would pay $200, UNLESS you have Plan F, I, or J, which covers the Excess Part B charges.

Medicare Advantage - HMO Over 10 Medicare HMO’s in the South Bay $0 Monthly premiums (must maintain Part B) Various co-payments or co-insurance for Services and Drugs Must pick a PCP (Primary Care Physician) Usually need referrals and authorizations for services Specific list of Physicians and Hospitals Low Cost Option, Will save you $$$

Why Me? No cost – I’m “Free” Availability – Includes Annual Insurance Review Objective Advice –Represent Most Plans Over 22 Years of Experience Local Resident and Knowledge Monthly Meetings – Listed on my website www.MedicareBabyBoomer.com

Next Steps Month Medicare Starts_________________ Name: ___________________________________ Address: ___________________________________ Phone: _______________________ E-Mail Address _____________________________ Receive the Torrance Hospital IPA Newsletter? YES or NO Will continue with Group Health Insurance? YES or NO If NO, circle one or more interested options: HMO PPO Medi-Gap PFFS What date would you like me to call? __________________ COMMENTS: