Vince Kelly Medicare Insurance Specialist Phone number 310-625-1837 e-mail: [email protected] 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”.
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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
2009 Monthly Premium for most people
$96.40 ($289.20 quarterly)
Covers Doctor Services
$135 annual deductible
Covers 80% of costs, YOU PAY 20%
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 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.
Chiropractic services (except to correct a subluxation)
Custodial care/Long Term Care (nursing home)
Dental care and Dentures
Routine Vision and Glasses (except after cataracts)
Out of Country travel coverage
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
Over 10 Medicare HMO’s in the South Bay
$0 Monthly premiums
Various co-payments for Services and Drugs
Need to pick PCP (Primary Care Physician)
Need to get referrals and authorizations for services
Limited choice of Physicians and Hospitals
Low Cost Option, Will save you $$$
SNP (Special Needs Plans), Medi-Medi’s and “Chronic illness” Plans
$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)
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 WorkMedicare 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: $2000Medicare-approved amount is: $1800Medicare pays 80% of approved amount: $1,440Medicare Supplement pays 20% $360If 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.
Month Medicare Starts_________________
E-Mail Address _____________________________
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? __________________