2016 medicare presentation

RLee Insurance Solutions

RLee Insurance Solutions“Using Common Sense”

RLee Insurance SolutionsWho are we?...

Providing the right information to help make the right decisions “Having worked in the senior market for years I was continually frustrated with the way seniors were treated by both agents and their companies. There was always the assumption that they were incapable of making the decision that would be best for them on their own and they were often pressured into products that may not have been in truly their best interest. I have always found seniors to be more than capable of making the right decision when given all the facts. I believe if I provide the right information making the right decisions just becomes a matter of “common sense”

Robin LeePresident


President Johnson signing the Medicare program into law, July 30, 1965. Shown with the President (on the right in the photo) are (left to right) Mrs. Johnson; former President Harry Truman; Vice-President Hubert Humphrey; and Mrs. Truman.

At the bill-signing ceremony President Johnson enrolled President Truman as the first Medicare beneficiary and presented him with the first Medicare card. This is President Truman's application for the optional Part B medical care coverage, which President Johnson signed as a witness.

Back then:The average person retiring was male and his average life expectancy was only 68 years!Part B cost just $3.00 a month!19 million people signed up that first year.

In the Beginning…

RLee Insurance SolutionsToday…

Today there are 47 million people on MedicareBy 2030 that number will rise to 79 million!

People are living much longer, and life expectancy keeps going up!

RLee Insurance SolutionsWhat are my cost?...

Part A cost:For 2013, for those that don’t get Part A at no cost they pay $407.00/month

Part B cost:If your yearly income in 2014 was You pay in

2015

File individual return File a joint return

$85,000 or less $170,000 or less $104.90

Above $85,00 up to $107,000 Above $170,00 up to $214,000 $146.00

Above $107,000 up to $160,000 Above $214,000 up to $320,000 $209.80

Above 160,00 up to $214,000 Above $320,000 up to $428,000 $272.70

Above $214,000 Above $428,000 $335.70


When you areHospitalized for: Medicare Covers: You pay:

(per benefit period)

1-60 days Most confinement cost after

the required Medicare Deductible.

$1,216 Deductible

61-90 daysAll eligible expenses, after the patient pays a per-day

copayment.

$304 A DAY COPAYMENT

as much as $9,120

91-150 daysAll eligible expenses, after

patient Pays a per-day copayment (Theses Are

Lifetime Reserve Days whichmay never be used again).


as much as $36,480

151 or more days NOTHING YOU PAY ALL COST

At least 3 days and enter A Medicare approved

SKILLED NURSINGFACILITY within 30 days After hospital discharge

All eligible expenses, for the first20 days; then all eligible expenses for 21-100, after

patient pays a per-day copayment.

After 20 days $152.00 A DAY COPAYMENT as much as

$12,160


When you areHospitalized for: Medicare Covers: You pay:

(per benefit period)

1-60 days Most confinement cost after

the required Medicare Deductible.

$1,260 Deductible

61-90 daysAll eligible expenses, after the patient pays a per-day

copayment.


as much as $9,450

91-150 daysAll eligible expenses, after

patient Pays a per-day copayment (Theses Are

Lifetime Reserve Days whichmay never be used again).


as much as $37,800

151 or more days NOTHING YOU PAY ALL COST

At least 3 days and enter A Medicare approved

SKILLED NURSINGFACILITY within 30 days After hospital discharge

All eligible expenses, for the first20 days; then all eligible expenses for 21-100, after

patient pays a per-day copayment.

After 20 days $157.50 A DAY COPAYMENT as much as

$12,600


On expensesIncurred for:

Medicare Covers: You pay $147Annual Deductible

PLUS:

Medical ExpensesPhysician’s services, inpatient, outpatient medical/surgical services, physical/speech

therapy, diagnostic test and durable medical equipment

Generally 80% of approvedAmount

(subject to Part B deductible)

Generally 20% ofApproved amount

Clinical Laboratory ServicesBlood test for diagnostic services

Generally 100% ofApproved amount

(not subject to Part B deductible)

Nothing for services

Home Health CarePart-time or intermittent skilled care,

home health aide services, durable medical supplies and other services.

100% of the approved amount(not subject Part B deductible)

80% of the approved amount for durable medical equipment

(subject to part B deductible)

Nothing for services;20% of approved amount for Durable medical equipment

Outpatient Hospital TreatmentServices for the diagnosis or treatment

Of an illness or injury

Generally 80% or approvedAmount (subject to Part B deductible)

Generally, 20% of billed amount

BloodAfter first three pints of blood,

80% of approved amount(subject to part B deductible)

First three pints plus 20% Of approved amount for additional pints

RLee Insurance SolutionsWhat are the gaps?...

They include…

·Part A deductible·Part B deductible·Part B 20% including the first 3 pints of blood ·Part B excess charge (15% of Medicare approved amount) ·Foreign travel emergency care·Skilled nursing facility co-pay·Drug coverage


Example of Medicare Basics at Mayo

Mayo Clinic Charge $115.00

Medicare approved amount $100.00

Medicare pays 80% of approved amount $80.00

Secondary insurance pay 20% or approved amount $20.00

Total paid by Medicare and Secondary insurance $100.00

Patient responsibility $15.00

Medicare assigns a price for any and all covered procedures. If the doctor or hospital accepts this price they are accepting Medicare “assignment” . If they choose to not accept assignment they can charge 15% more than the Medicare approved amount only.

What is Part B excess?

“Mayo Clinics don’t currently accept assignment, here is an example of how it could effect

your bill”.

“How can Excess Charges effect a major

hospital stay”?

"Imagine a major health issue...how would a bill for thousands of dollars affect your ability to pay"?

RLee Insurance SolutionsWill excess charges be a factor?

Scheduled cuts to doctors and hospitals where mounting as

the "can was being kicked down the road"

RLee Insurance SolutionsRecent changes to the Medicare laws you need to know about

The White HouseOffice of the Press SecretaryFor Immediate Release April 16, 2015Statement by the Press Secretary on H.R. 2

On Thursday, April 16, 2015, the President signed into law:

H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015,” which permanently replaces Medicare's sustainable growth rate system for physician payments and reforms Medicare physician payment policies to encourage efficient, high-quality care; extends for two years funding for the Children's Health Insurance Program; extends numerous other expiring health provisions and the Secure Rural Schools program; and removes Social Security numbers from Medicare cards and makes other Medicare improvements.

Also known as the "Doctor Fix"

RLee Insurance SolutionsWhat are the impacts on Medicare from H.R. 2?...

1. Qualified Individual (QI) program is now permanent. Provides low income folks help paying for part B. To qualify for QI, your monthly income cannot exceed $1,325 if you are single ($15,890/yr.) or $1,793 ($21,506/yr.) if you are part of a couple.

2. No more Social Security numbers on Medicare cards. Provides $320 million in funding to remove Social Security numbers from beneficiaries’ Medicare cards and come up with a new numbering system within the next 4 years.

3. Exceptions process for Medicare therapy caps extended 2 years. The new law provides for extending the Medicare therapy cap exceptions process for another 2 years.

4. How the new law affects beneficiary costs. Over the next 8 years the standard Part B premium is projected to increase from $104.90 to $156.20, a difference of over $50.

5. Higher Part B & D premiums for higher income beneficiaries. Starting in 2018, individuals with annual incomes of $133,501 to $160,000 (for couples, annual income from$267,001 to $320,000) will pay 65% of program costs for their Part B and D premiums instead of the 50% they currently pay. Individuals with annual incomes of $160,001 and above (couples $320,001 and above) will pay 80% of program costs for their Part B and D premiums.

6. Restrictions on Medigap policy benefits. Effective January 1, 2020, any newly eligible Medicare beneficiary will not be able to buy Medigap plans C or F with Part B deductible coverage.

RLee Insurance SolutionsWhat about the very near future?...

In 2015 the monthly Part B premium rate is $104.90, which is unchanged from the 2014 monthly premium. For determining an individual’s monthly premium rate, there is a hold-harmlessprovision in the law that limits the dollar increase in the premium to the dollar increase in an individual’s Social Security benefit. This provision applies to most beneficiaries who have their premium deducted from their Social Security benefit, or roughly 70 percent of Part B enrollees. Without the hold-harmless provision, beneficiaries would face a premium of $120.70 for 2016.

However, because the cost of-living adjustment for Social Security benefits is expected to be0.0 percent for 2016, premiums would not increase from the 2015 level for those beneficiaries to whom the provision applies. Under current law, Part B premiums for other beneficiaries must be raised substantially to offset premiums foregone due to the hold-harmless provision, to prevent asset exhaustion, and to maintain a contingency reserve that accommodates normal financial variation. Accordingly, under the intermediate economic assumptions, the estimated monthly premium for 2016 is $159.30, which is matched by general revenue transfers.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2015.pdf


Who will see increases in 2016?

*About 30 percent of Part B enrollees that are in these categories…

1. New enrollees during the year.2. Enrollees who do not receive a Social Security benefit check.3. Enrollees with high incomes who are subject to the income-related premium adjustment are not eligible for the hold-harmless provision. 4. State Medicaid programs pay the full premium for dual Medicare-Medicaid beneficiaries.

*https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2015.pdf


1. It is our belief, as well as others in the industry, that as the cost of the Part B premiums rise so will the Part B deductible from it’s current $147.00/year level to as high as *$185.00/year by 2020

2. Many folks may select to go the Medicare Advantage route to cover their healthcare needs.

*https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2014.pdf

RLee Insurance SolutionsWhat are your current Medigap options?...

With a Medicare supplement policy…

Plan A Plan F Plan G Plan N Part D

Basic Benefits

Skilled nursing co-pay

Part A deductible

Part B deductible

Part B excess charges

Foreign Travel

Drug coverage

Plan N has a $20 copayment per office visit and a $50 copayment each ER visit.

RLee Insurance SolutionsWhat are my cost?...

Part D cost:If your yearly income in 2014 was You pay in 2015

File individual return File a joint return

$85,000 or less $170,000 or less Your plan premium

Above $85,00 up to $107,000 Above $170,00 up to $214,000 $11.60 + your plan premium

Above $107,000 up to $160,000 Above $214,000 up to $320,000 $29.90 + your plan premium

Above 160,00 up to $214,000 Above $320,000 up to $428,000 $48.30 + your plan premium

Above $214,000 Above $428,000 $66.60 + your plan premium

RLee Insurance Solutions2015 Part D coverage ...

2015 Basic Medicare Drug Coverage

2015 Basic Benefits You Pay

Deductible $320 100% of first $320

Initial Coverage Limit $2640 25% of the next $2640 ($660.00)

Coverage Gap $2960.00 100% of the drug cost

Annual – out- of- pocket amount $4700

Catastrophic Coverage Medicare and Plan 95%

5%

RLee Insurance Solutions2016 Part D coverage ...

2016 Basic Medicare Drug Coverage

2016 Basic Benefits You Pay

Deductible $360 100% of first $360

Initial Coverage Limit $2950 25% of the next $2950 ($737.50)

Coverage Gap $3310.00 100% of the drug cost

Annual – out- of- pocket amount $4850

Catastrophic Coverage Medicare and Plan 95%

5%


“How will the new healthcare law benefit me?” …

New benefits in 2011...

RLee Insurance SolutionsWhat are your options?...

Original Medicare

Original Medicare Part A &B

Medicare Supplement

Medicare Part D

One or the other

Medicare Advantage Plans

Part C

Part D

RLee Insurance SolutionsWhat is part C or Advantage Plans?…

What Are Advantage Plans?•Medicare Advantage (MA) plans are health plan options that are part of the Medicare program•MA plans are not the same as Medicare Supplement insurance•Medicare pays the plan (the insurance company) a set amount every month for your care•MA plans must offer all benefits of Original Medicare and can include Part D prescription drug coverage

RLee Insurance SolutionsWhat is part C or Advantage Plans?…

• Most plans offer health and drug coverage, as well as extra benefits

• Most have lower out-of-pocket costs than with Original Medicare

• You may have to use certain healthcare providers

• You do not need a Medicare Supplement

RLee Insurance SolutionsWhat are your choices with Advantage Plans?…

Choices in Medicare Advantage (MA) Plans• Health Maintenance Organization (HMO)

• Preferred Provider Organization (PPO)

• Private-Fee-For-Service (PFFS)

Plus, Part D Medicare Prescription Drug Coverage• May be purchased as a stand-alone plan; or

• As part of a Medicare Advantage Prescription Drug plan (MAPD)

• All plans must meet minimum coverage level set by Medicare

•You should evaluate your prescription drug needs in relation to those covered by the plan, and your cost for those drugs

RLee Insurance SolutionsIs an Advantage Plan right for You?…

Things to consider before deciding on an Advantage Plan•What is the current state of your health?

•How often do you visit the doctor or hospital?

• Will the cost savings in monthly premium offset the co-pays?

• Where is the plan coverage area?

•Are the added benefits important to you?

•Can you return to “traditional Medicare” if you are not happy?

RLee Insurance SolutionsIs an Advantage Plan right for You?…

Things to consider before deciding on an Advantage PlanThe truth is per gov’t. guides, MA plans have to be “actuarial equivalent to traditional Medicare’s benefit package”. MA plans are required to cover at least all of the medically-necessary services (e.g., Part A and Part B benefits) that are covered under the FFS program, but they are allowed to charge different copayments, coinsurance, and deductibles, as long as the benefit design does not discriminate against sicker beneficiaries.Translated means MA plans have to cover what the average person would spend a year for health care if they had part A and B …ONLY. They do not cover the all inclusive benefits of a Medigap plan.

RLee Insurance SolutionsThings to consider...

… with your healthcare.Does your current doctor accept assignment?If so, will he be likely to continue to do so in the future?How often do you visit the doctor?How often do you visit the ER?

… with your agent.Can I trust the agent?Who do I call with my questions and concerns?How well do they understand Medicare and my concerns?Are they local?

… with the company.Is my policy Guaranteed Renewable?Will they pay my bills quickly?Who will take care of all the paperwork?Is the plan accepted in my area?

RLee Insurance SolutionsSomething not to consider...


SERVICES AVAILABLEMedicare Supplements

Medicare Advantage PlansPart D Drug Cards

Dental, Vison, and HearingLife Insurance

AnnuitiesShort Term Care

Long Term Care InsuranceSupplemental Health

Travel Insurance

Our Full line of Services… Making your healthcare decisions

A matter of “using common sense”

2016 medicare presentation

Presentations & Public Speaking