MEDICARE IN PICTURES

1. MEDICAREIN PICTURES Eric Johnson – Agent Allies, LLC Provider Number: 33714 Course Number: 25461

2. Medicare is for:

3. Started in 1965 by LBJ

4. Truman: first enrollee

5. Governed by CMS

6. Once upon a time…

7. Blue Cross Blue Shield

8. BCBS Has Evolved

9. But Not Medicare

10. Original Medicare A B

11. Part APart B

12. A – HospitalB – Medical Payroll Deductions 40 Quarters SS Check Deductions $96.40+ / mo.

15. A – HospitalB – Medical Coverage for: Hospital Rehab Center Home Health Hospice

16. A – HospitalB – Medical Coverage for: Doctors (in/out) Diagnostic Tests Outpatient Svcs. DME

17. No Coverage For:

18. Lots of holes… HOSPITAL $1,100 per admission deductible $275 per day days 61-90 $550 per day days 91-150 No coverage after 150 days $1,100 deduct. $275 per day $550 per day $137.50 per day SNF $0 days 1-20 $137.50 per day days 21-100

19. Lots of holes… PART B $155 calendar year deductible 20% Coinsurance NO OUT OF POCKET MAXIMUM up to 15% excess charges if provider does not accept assignment $155 deduct. 20% coins. 15% excess

20. Private Insurance to the Rescue! • 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

21. $1,100 deduct. $155 deduct. $275 per day $550 per day 20% coins. 15% excess $137.50 per day

22. Medicare Supplements (Medigap)fill in the holes in Medicare $0 $0 $0 $0 $0 $0 $0

23. 12Standardized Plans A b c d e f g h I j k l

24. Our recommendation 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.

25. 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.

26. Ready….Set….Go!! NO! After 6 months, applicants will have to answer medical questions and the carrier can decline coverage. OR YES! YES! Guarantee-issue for first 6 months

27. Prices are sky high Part B: $96.40+ per month Part D: $28 per month Supplement $150+ per month

28. Not everyone can afford a supplementAnnual Income of People with Medicare Over 40% of Medicare Beneficiaries have annual incomes below $15,000 Source: PacifiCare Product Resource Manual / CMS Office of Research & Development

29. Clinton: BBA of 1997

30. Medicare Advantage Plans:a more affordable option Medicare Advantage Private Insurance paid for by Medicare A Service Area, No ESRD Eligibility C B

31. What’s the Advantage? Guaranteed issue for people who live in service area, have A&B, and no ESRD Covers everything Medicare does and may also cover: Less expensive than a supplement – some plans have $0 premium. YES!

32. Regular Plans H.M.O. PPO PFFS From companies you know

33. Comparison of Advantage Plans

34. Prescription Usage Average Total Rx Spending:$2,322 per Medicare Beneficiary Donut hole starts here 26.9% of Medicare Beneficiaries spend >$3k on Rx per year Over 40% of Medicare Beneficiaries have annual incomes below $15,000 Distribution of Medicare Beneficiaries and Total Drug Expenditures, 2003 (40 million total beneficiaries) Source: Kaiser Family Foundation

35. Bush: MMA of 2003

36. Part D Plans A Service Area Eligibility B D OR

37. Standard Medicare Part D Plan Design(Creditable Coverage) Member pays first $310 Deductible Member pays 25% Plan pays 75% Coinsurance $2830 Drug Cost Member pays 100% Coverage Gap $4550 TROOP Member pays 5% Plan pays 95% Catastrophic Coverage

38. How private plans differ fromstandard plan Deductible may or may not be waived Deductible Member pays copays Plan pays difference between copay and drug cost (4 tier formulary) Coinsurance $2830 Drug Cost Member pays 100% Generics may be covered Coverage Gap $4550 TROOP Member pays 5% Plan pays 95% Catastrophic Coverage

39. Part D: A Huge Success Story

40. To find the best Part D plan for your clients, go to www.Medicare.gov.

41. Enrollment & Penalties A B C D

42. SiCKO (2007)

44. Medicare for All Provisions • Free for all Americans – no premiums, paid by taxes • Everything would be covered, no cost sharing • Private insurance companies would be illegal • Those 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

45. Health Reform

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

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

48. Transition to New Payment System Provides a four-year transition to new benchmarks beginning in 2011. Four-Year

49. Savings to Pay for Health Reform New bidding process is expected to cut $120 billion in funding to the MA program. $120 billion

50. Cost-Sharing – No More than Medicare 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. ADVANTAGE