MEDICAREIN PICTURES

Provider Number: 33714 Course Number: 25461

Eric Johnson – Agent Allies, LLC

Medicare is for:

Started in 1965 by LBJ

Truman: first enrollee

Governed by CMS

BCBS Has Evolved

But Not Medicare

$1,100

deduct.

$550per day

$275per day

$137.50 per

day

HOSPITAL

$1,100per admission

deductible

$275 per daydays 61-90

$550 per daydays 91-150

No coverage after 150 days

SNF

$0 days 1-20

$137.50 per daydays 21-100

$155 deduc

t.

20% coins.

15% exces

s

PART B

$155calendar year deductible

20%Coinsurance

NO OUT OF POCKET MAXIMUM

up to 15%excess charges if provider

does not accept assignment

Medicare Supplements – fill in the holes in Original Medicare

Medicare Advantage Plans – take over the administration of Medicare Part A and B for the government

Medicare Part D Prescription Plans – only offered through private insurance companies

Private Insurance to the Rescue!

$1,100

deduct.

$550 per day

$275 per day

$137.50 per

day

$155 deduc

t.

20% coins.

15% exces

s

$0

$0 $0

$0

$0

$0

$0

A b c d e f g h I j k l

A b c d e f g h I j k l

I fill in most of the gaps in

Original Medicare, including all hospital costs, all SNF

copays, the Part B deductible, Part B

coinsurance, and Part B excess charges.

Out with the old, in with the new

Two new Medicare Supplement plans will be introduced on June 1, 2010, and will be added to the other current standardized plans.  The new additions will be Plans N and M.  Plan N will offer similar benefits to Plan F along with a $20 copayment for doctor visits and a $50 copayment for visits to the emergency room.  Plan N will cost approximately 70 percent of the current Plan F depending on where you live.

Medicare Supplement Plans being eliminated: Plans E, H, I and J will no longer be offered as of June 1, 2010.  the preventive care and at-home recovery benefits will also be eliminated from the standardized Medicare Supplement options.

Medicare Supplement (Medigap) plans have been the same since 1992, when they became federally standardized.  However, the June 1, 2010 addition of plans M and N will be the first major changes to the Medicare Supplement marketplace since 1992.  Additional changes will be to the current plans A through G, which will be phased out, and a new set of A through G plans will be phased in.  This is a little confusing because the beneficiaries who are currently enrolled in plans A through G can either stay in their current option or migrate to one of the new A through G plans.  Hospice care will be added to all standardized plans, and the preventive and at-home recovery benefits eliminated.

YES!

NO!

YES!

OR

Guarantee-issue for first 6 months

After 6 months, applicants will have to answer medical

questions and the carrier can decline coverage.

Supplement

$150+ per month

Part B:

$96.40+per month

Part D:

$28per

month

Source: PacifiCare Product Resource Manual / CMS Office of Research & Development

Over 40% of Medicare

Beneficiaries have annual

incomes below $15,000

Clinton: BBA of 1997

Medicare Advantage

Private Insurance paid for by Medicare

Eligibility

Less expensive than a supplement –

some plans have $0 premium.

Guaranteed issue for people who live in service area, have A&B, and no ESRD

YES!

Covers everything Medicare does and

may also cover:

From companies you know

Distribution of Medicare Beneficiaries and Total Drug Expenditures, 2003(40 million total beneficiaries)

Source: Kaiser Family Foundation

Over 40% of Medicare Beneficiaries have annual

incomes below $15,000

Donut hole starts here

Average Total Rx Spending: $2,322

per Medicare Beneficiary

26.9% of Medicare Beneficiaries spend >$3k on Rx per year

Prescription Usage

Bush: MMA of 2003

Eligibility

OR

Member pays first $310

Member pays 25%

Plan pays 75%

Member

pays 5%

Plan pays 95%

Member pays 100%

Deductible

Coinsurance

CoverageGap

CatastrophicCoverage

$2830Drug Cost

$4550

TROOP

Deductible may or may not be waived

Member pays

copays

Plan pays difference between copay and drug cost (4 tier

formulary)

Member

pays 5%

Plan pays 95%

Member pays 100%Generics may be

covered

Deductible

Coinsurance

CoverageGap

CatastrophicCoverage

$2830Drug Cost

$4550

TROOP

To find the best Part D plan for your clients, go to

www.Medicare.gov.

SiCKO (2007)

Medicare for All Provisions

Free for all Americans – no premiums, paid by taxes

Everything would be covered, no cost sharingPrivate insurance companies would be illegalThose displaced by the move to a

national program would be re-trained and hired into the public sector (we’d all become government employees)

88 co-sponsors in the House

Health Reform

Sets Medicare Advantage payments based on the average of the bids from Medicare Advantage plans in each market.

New Bidding Process

Creates performance bonus payments based on a plan’s level of care coordination and care management and achievement on quality rankings.

New Bonus Payments

Provides a four-year transition to new benchmarks beginning in 2011.

Four-Year

Transition to New Payment System

New bidding process is expected to cut $120 billion in funding to the MA program.

$120 billion

Savings to Pay for Health Reform

Prohibits Medicare Advantage plans from charging beneficiaries cost sharing for covered services that is greater than what is charged under the traditional fee-for-service program.

ADVANTAGEADVANTAGE

Cost-Sharing – No More than Medicare

Requires plans that provide extra benefits to give priority to cost sharing reductions, wellness and preventive care, and then benefits not covered under Medicare.

1.Cost Sharing Reductions

2.Wellness & Preventive Care

3.Benefits Not Covered Under Medicare

Prioritizing

Slightly extends the Medicare annual election period for Medicare Advantage and Part D enrollees by seven days and also moves it up to slightly earlier in the year, so that it will be Oct. 15 – Dec. 7, rather than Nov. 15 – Dec. 31.

Change in Annual Election Period

Eliminates the traditional MA OEP, but allows Medicare beneficiaries enrolled in MA or MA-PD plans to return to original Medicare in the first 45 days of the Calendar Year.

No More Open Enrollment Period

Enhances penalties for those who do not comply with the Medicare Advantage rules, including the marketing requirements.

Stronger Penalties

Provides protections against Medicare Advantage benefit cuts to residents of New York, Pennsylvania and Florida.

Sweetheart Deals

For Medicare beneficiaries, allows for coverage of an annual health risk assessment and expanded preventive care coverage.

Expanded Preventive Care

No More Donut Hole

Businesses that receive subsidies for providing prescription drug plans valued at as much as Medicare Part D for their retirees no longer would be allowed to exclude the subsidy payments from their gross income under the bill.

Eliminates Part D Deduction

Increases the Medicare payroll tax from 2.9 percent to 3.8 percent for wages and self-employment income above $200,000 ($250,000 married). Current 2.9 percent rate retained for wages and self-employment income below this amount.

In addition there will be a new 3.8% Medicare contribution on certain unearned income from individuals with AGI over $200k ($250k for joint filers).

Tax the Rich!

Breaking News

The AP (4/14, Kennedy) reports, "Medicare fraud suspects would face longer prison sentences under a US House bill proposed Tuesday that also advocates biotechnology such as fingerprint scanning to ensure patients are getting the goods the government is billed for."

Breaking News – New Proposal

Law enforcement officials "have warned Medicare fraud, an estimated $60 billion annual crime, is now more lucrative than dealing drugs. Until now the penalties have been far less severe." But, the "Medicare Fraud Enforcement and Prevention Act will double prison sentences from 5 to 10 years and fines from $25,000 to $50,000 for Medicare fraud-related crimes," and "create a new crime for illegally distributing patients' Medicare or Medicaid IDs or billing information, which would carry a maximum 3-year sentence."

Questions?