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Understanding Medicare and Supplemental Insurance Options …

Understanding Medicare and Supplemental Insurance Options …. Part A Hospital Insurance. Part B Medical Insurance. Medicare Government- Health Insurance Program. Medicare Part A covers…. Inpatient Hospital Inpatient Skilled Nursing Facility Care Home Health Care Hospice Care Blood.

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Understanding Medicare and Supplemental Insurance Options …

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  1. Understanding Medicare and Supplemental Insurance Options…

  2. Part A Hospital Insurance Part B Medical Insurance Medicare Government- Health Insurance Program

  3. Medicare Part A covers… • Inpatient Hospital • Inpatient Skilled Nursing Facility Care • Home Health Care • Hospice Care • Blood

  4. Medicare Part B covers… • Doctor’s Care • Surgery • Outpatient care • Lab Tests and X-rays • Home Health Care • Durable Medical Equipment • Other Medically Necessary Services & Supplies • Preventive Benefits

  5. Here’s how Medicare Part A works… Inpatient Hospital Days You PayMedicare Pays 1-60 $992 100% after deductible 61-90 $248/day All additional eligible expenses 91-150 $496/day All additional eligible expenses 150+ All Expenses No Coverage

  6. Medicare Part A –Inpatient Skilled Nursing Facility Care Days You PayMedicare Pays 1-20 $0 100% of eligible expenses 21-100 $124/day All additional eligible expenses 100+ All expenses No coverage

  7. Medicare Part A - also covers… • Home Health Care - 100% Medicare eligible • Hospice Care-Including outpatient drugs and respite care • Blood Deductible - Does not pay for the first 3 pints

  8. Medicare Part A leaves you to pay… • All deductibles • All co-payments • All hospital expenses after day 151 • First three pints of blood • All SNF care after day 100 • All personal comfort items

  9. You Pay $131.00 Deductible $93.50 Monthly Premium 20% of all eligible expenses and any excess charges Medicare Pays 80% of eligible charges… Medicare approved charges Medicare Part B…

  10. Accepts Assignment Doctors fee $230.00 Pays 80% x $200= $160.00 Insurance 20% x $200= $40.00 $30.00 excess charge is waived Doesn’t Accept Assignment Doctors fee $230.00 Pays 80% x $200 = $160.00 Insurance 20% x $200= $40.00 $30.00 excess +$40.00 = $70.00 Medicare Approved Charges…$200.00

  11. 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 these excess charges • Either way, the doctor files your claim by law • BCBS provides the crossover benefit

  12. Non-eligible medical expenses • Dental Exams • Hearing Aids and Hearing tests • Eyewear and Eye Exams • Health Care Outside the United States • Prescription Drugs • With Blue Cross, we offer our members a Members First “free” discount program

  13. Medicare Preventive Services... • Colorectal Cancer Screenings • Bone Density Measurements • Flu and Pneumonia Shots • Mammograms • Prostate Cancer Screenings • Diabetes education and supplies • Glaucoma screening • Pap smears • Cardiovascular Disease Screening • Diabetes Screening

  14. In 2007, Medicare added: • Smoking Cessation Program • Ultrasound for aortic abdominal aneurysm… if detected during “Welcome to Medicare Physical Exam”

  15. 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

  16. Group Coverage...still working after 65 • Sign up for Medicare Part A • Check with your plan Administrator… you may be eligible to delay enrolling in Medicare Part B until you actually retire

  17. What You Should Know… • You need both Medicare Part A and Part B to buy a Supplemental Insurance policy • “Guaranteed issue” if insured within six months of Medicare eligibility…otherwise, you will be considered for coverage if you are age 65 or over, reside in Texas and have Medicare Part A and Medicare Part B.

  18. 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 Why Blue Cross and Blue Shield

  19. Basic Benefits…A-F Supplemental Plans • Co-payments in the hospital days 61-150 • 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.

  20. Medicare Supplemental InsuranceStandardization Effective 1992… Today you can purchase Plans lettered A-L 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 Blue Shield, we offer Medicare Supplement plans A,D and F and K & L. A High Deductible Plan F.

  21. Introducing…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, co-payments and deductibles (50%-Plan K; 75%-Plan L) • Annual out-of-pocket limit ($4,140 Plan K; $2,070 Plan L) then • Pays 100% coinsurance, co-payments, and deductibles for the rest of the calendar year

  22. Plans K & L Cost Sharing Benefits Medicare Part A KL 50% Part A Deductible 75% Part A 50% Hospice Cost Sharing 75 Hospice Cost Sharing

  23. Plans K & L Cost Sharing Benefits Medicare Part B K 50% Coinsurance 50% Blood L 75% Coinsurance 75% Blood

  24. At Blue Cross & Blue Shield… • No fees to sign up • No pre-existing condition waiting period • Take it with you when you travel or move • Added values: Members First, Easy Payment Plans, “Service In The Neighborhood for Seniors”, Lifetimes, and Medicare Part D Drug Plans…

  25. Member’s First – What you should know… • Prescription Drug Discount 3-30% at Participating Pharmacies • Mail Order Option for additional savings • Discounts on dental, vision, hearing, chiropractic, vitamins and more… • Card is free to members

  26. Medicare Reform- Drug Benefit • Part D: Effective 1/1/06 • Voluntary • $265 deductible per year

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

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

  29. Blue Medicare Rx StandardBenefits

  30. Blue MedicareRx Value Plan Benefits Generic Preferred Brand Brand

  31. Blue MedicareRx Plus Plan Benefits Generic Preferred Brand Brand

  32. Most Medications Are Covered • Available only by prescription • Prescription drugs, biologicals, insulin • Medical supplies associated with injection of insulin • Brand name and generic drugs will be in each formulary 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 8:00AM to 8:00PM or go towww.bcbstx.comtolearn more

  33. What Happens Next… • Look at which benefits best meet your clients needs... • Then complete and submit their application…

  34. Now, let us answer your questions… Thank you for your time. We look forward to serving you. www.bcbstx.com

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