1. Medicare and Supplemental Insurance Options

2. 2 In 1965 … The birth of Medicare was formed by the federal government.

3. 3 Medicare Government Health Insurance Program ● Part A Hospital Insurance ● Part B Medical Insurance

4. 4 Medicare Part A ● Inpatient Hospital ● Inpatient Skilled Nursing Facility Care ● Home Hospice Care, Medicare Approved Services ● Hospice Care ● Blood

5. 5 Inpatient Hospital DaysYou PayMedicare Pays 1 – 60$992100% after deductible 61 – 90$248 per dayAll additional eligible expenses 91 – 150$496 per dayAll additional eligible expenses 150+All expensesNo coverage

6. 6 Inpatient Skilled Nursing Facility Care DaysYou PayMedicare Pays 1 – 20$0100% of eligible expenses 21 – 200$124 per dayAll additional eligible expenses 100+All expensesNo coverage

7. 7 Also Covered Under Medicare Part A ● Home Health Care – 100% of Medicare eligible ● Hospice Care – including outpatient drugs and respite care ● Blood Deductible – does not pay for the first three pints

8. 8 Medicare Part A leaves you to pay… ● All deductibles ● All copayments ● All hospital expenses after day 151 ● First three pints of blood ● All Skilled Nursing Facility care after day 100 ● All personal comfort items

9. 9 Medicare Part B ● Doctor’s Care ● Surgery ● Outpatient Care ● Lab Tests and X-rays ● Home Health Care ● Durable Medical Equipment ● Other Medically Necessary Services & Supplies ● Preventive Benefits, For Medicare Covered Services

10. 10 Medicare Part B ● Medicare Pays –80% of eligible charges –Medicare approved charges ● You Pay –$131 annual deductible –Monthly premium –20% of all eligible expenses and any excess charges

11. 11 Example of Medicare Approved Charges of $200 Accepts AssignmentDoesn’t Accept Assignment Doctors fee $230 Pays 80% x $200 = $160 Your portion 20% x $200 = $40 $30 excess charge is waived$30 excess + $40 = $70

12. 12 Medicare Claims Process ● The majority of providers accept Medicare assignment ● If they do not accept assignment, they cannot charge more than 15% over the approved amount. Plan F pays for these excess charges ● Either way, the doctor files your claim by law ● BCBS provides the crossover benefit

13. 13 Non-eligible Medicare Expenses ● Dental ● Routine eye exams ● Eyewear ● Hearing aids ● Hearing tests ● Health care outside the United States

14. 14 Medicare Preventive Services ● Colorectal cancer screenings ● Bone density measurement ● Flu and pneumonia shots ● Mammograms screening ● Pap smears ● Diabetes education and supplies ● Prostate cancer screenings ● Cardiovascular screening ● Diabetes screening ● Glaucoma screening ● New Enrollees – “Welcome to Medicare” physical examination

15. 15 In 2007, Medicare added: ● Smoking Cessation Program ● Ultrasound for aortic abdominal aneurysm. If detected during “Welcome to Medicare Physical Exam”

16. 16 What Are Your Choices? ● Traditional Medicare ● Traditional Medicare without Group Retiree plan ● Traditional Medicare with a Supplemental Insurance Policy ● Medicare HMO or PPO only available in limited areas

17. 17 Group Coverage – over 65 active employees ● Sign up for Medicare Part A ● Check with your plan Administrator, you may be eligible to delay enrollment in Medicare Part B until you actually retire

18. 18 What You Should Know ● You need both Medicare Part A and Part B to buy a Supplemental Insurance policy ● As long as you are a Texas resident, age 65 or older, have Medicare Part A and are within the six months following your enrollment for Medicare Part B, your acceptance is guaranteed. If you are a Texas resident, under age 65, have Medicare Part A and are within the six months following your enrollment for Medicare Part B, your acceptance is guaranteed for Plan A. If you are a Texas resident turning age 65, were previously enrolled in Medicare Parts A and B, and apply within six months of turning age 65, your acceptance is guaranteed.

19. 19 Why Blue Cross and Blue Shield ● A better value ● Freedom to choose ● No claim forms ● No waiting period ● Security and stability ● Widely recognized ● Keeps pace with Medicare ● A name you can trust

20. 20 Basic Benefits, A – F Supplemental Plans ● Copayments in the hospital days 61 – 90 ● 100% for Part A eligible hospital expenses after Medicare benefits are exhausted ● First three pints of blood ● Coverage for 20% coinsurance for Part B after deductible is met

21. 21 Medicare Supplemental Insurance Standardization Effective 1992 Today you can purchase plans lettered A – J from insurance companies and the plan benefits are the same; however, not all companies are the same nor are the premiums they charge for their plans. At Blue Cross and Blue Shield of Texas, we offer Medicare Supplement plans A, D, F, K, and L

22. 22 Medicare Supplemental Plans K & L ● Plans K & L – part of the Medicare Modernization Act of 2003 ● Low cost, cost-sharing ● Benefits are comparable to other plans with coinsurance, copayments and deducibles (50% Plan K; 75% Plan L) ● Annual out-of-pocket limit ($4,140 Plan K; $2,070 Plan L) ● Pays 100% coinsurance, copayments and deductibles for the rest of the calendar year

23. 23 Plans K & L Cost Sharing Benefits Medicare Part A ● Plan K –50% Part A Deductible –50% Hospice Cost Sharing ● Plan L –75% Part A Deductible –75% Hospice Cost Sharing

24. 24 Plans K & L Cost Sharing Benefits Medicare Part B ● Plan K –50% Coinsurance –50% Blood ● Plan L –75% Coinsurance –75% Blood

25. 25 At Blue Cross and Blue Shield of Texas ● No fees to sign up ● No pre-existing condition waiting period ● Take it with you when you travel ● Added values: Easy Payment Plans, “Service in the Neighborhood for Seniors”, and Lifetimes www.bcbstx.com 1-800-654-9370

26. 26 Medicare Reform – Drug Benefit ● Part D: Effective 1-1-06 ● Voluntary ● $265 Annual Deductible

27. 27 There are Three Enrollment Periods ● Initial Enrollment Period ● Annual Coordinated Election Period (AEP) ● Special Enrollment Period (SEP)

28. 28 Blue Cross and Blue Shield of Texas offers: Blue MedicareRx Three choices to best fit your needs: 1. Standard Plan 2. Value Plan 3. Plus Plan

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31. 31 Contact Information Blue MedicareRx covers an extensive list of both generic and brand name drugs Call 1-888-579-9373 (TTY Users: 1-888-579-9375) Monday – Sunday 8:00 am – 8:00 pm Or go to www.bcbstx.com to learn morewww.bcbstx.com

32. 32 Questions?