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Important Phone Numbers Medicare: 1-800-633-4227 Social Security: 1-800-772-1213 - PowerPoint PPT Presentation

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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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Vince KellyMedicare Insurance SpecialistPhone number 310-625-1837e-mail:[email protected]

Important Phone Numbers

Medicare: 1-800-633-4227

Social Security: 1-800-772-1213

What is medicare
What is Medicare?

  • Federal health insurance program

  • Began in 1965, as a result of the “Medicare Act”

Medicare part a hospital insurance

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

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

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 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

Medicare Part D Standard Coverage as required by law

  • 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:

Medicare does not cover

Medicare Does Not Cover


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

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 hmo

Medicare Advantage - HMO

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

Medicare advantage ppo or pffs

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

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 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.

Why me
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

Next steps

Next Steps

Month Medicare Starts_________________

Name: ___________________________________

Address: ___________________________________

Phone: _______________________

E-Mail Address _____________________________

Will continue with Group Health Insurance? YES or NO

If NO, circle one or more interested options:


What date would you like me to call? __________________