Common Sense Solutions for Medicare Planning
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Common Sense Solutions for Medicare Planning
- 1. RLee Financial Solutions “Common Sense Solutions”
- 2. RLee Financial Solutions Who are we?... Providing the right information to help make the right decisions “Having worked in the insurance industry for years I was continually frustrated with the way consumers 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 people 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 decision just becomes a matter of common sense, putting us truly in the business of providing “common sense solutions” . Robin Lee President
- 3. RLee Financial Solutions 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…
- 4. RLee Financial Solutions Today… * Today there are over 50 million people on Medicare By 2030 that number will rise to 80 million! * People are living much longer, and life expectancy keeps going up!
- 5. RLee Financial Solutions When you are Hospitalized for: Medicare Covers: You pay: (per benefit period) 1-60 days Most confinement cost after the required Medicare Deductible. $1,184 Deductible 61-90 days All eligible expenses, after the patient pays a per-day copayment. $296 A DAY COPAYMENT as much as $8,880 91-150 days All eligible expenses, after patient Pays a per-day copayment (Theses Are Lifetime Reserve Days which may never be used again). $592A DAY COPAYMENT as much as $35,520 151 or more days NOTHING YOU PAY ALL COST At least 3 days and enter A Medicare approved SKILLED NURSING FACILITY 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 $148.00 A DAY COPAYMENT as much as $11,840
- 6. RLee Financial Solutions On expenses Incurred for: Medicare Covers: You pay $162 Annual Deductible PLUS: Medical Expenses Physician’s services, inpatient, outpatient medical/surgical services, physical/speech therapy, diagnostic test and durable medical equipment Generally 80% of approved Amount (subject to Part B deductible) Generally 20% of Approved amount Clinical Laboratory Services Blood test for diagnostic services Generally 100% of Approved amount (not subject to Part B deductible) Nothing for services Home Health Care Part-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 Treatment Services for the diagnosis or treatment Of an illness or injury Generally 80% or approved Amount (subject to Part B deductible) Generally, 20% of billed amount Blood After 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
- 7. RLee Financial Solutions What 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
- 8. RLee Financial Solutions 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”. Heart Surgery $150,000 Medicare Assignment $100,000 Part B pays 80% $80,000 Supplement pays 20% $20,000 Part B Excess Charge 15% $15,000 “How can Excess Charges effect a major hospital stay”?
- 9. RLee Financial Solutions Why Will Excess Charges be a Factor?... The AMA explains that the cost to run a medical practice has risen every year while reimbursements from Medicare go down every year. Where will it end?
- 10. RLee Financial Solutions AMA ONLINE SURVEY OF PHYSICIANS The Impact of Medicare Physician Payment on Seniors Access’ To Care May 2010 Key Findings from a new AMA online survey of 9,000+ physicians who care for Medicare patients. About one in five physicians overall (17%) are currently restricting the number of Medicare patients in their practice. The top two reasons they gave*: • Medicare payment rates are too low (85%) • ongoing threat of future payment cuts makes Medicare an unreliable payer (78%)Looking at just primary care physicians**, nearly one-third (31 percent) currently restrict the number of Medicare patients in their practice. The top two reasons they gave: • Medicare payment rates are too low (83%) • ongoing threat of future payment cuts makes Medicare an unreliable payer (82%) In response to this year’s two short-term delays to the 21% Medicare physician payment cut, nearly two-thirds (60%) of physicians looked into opting out of Medicare and treating patients through the private contracting option. Other actions included: • Delayed payments for supplies, rent and/or other expenses (39%) • Took out a loan or line of credit in order to continue paying bills (17%) • Held up paychecks or laid off/furloughed staff (17%) • Cancelled or postponed scheduled services to Medicare patients (14%) • Temporarily closed practice to new appointments with Medicare patients (13%) Asked about temporary proposals under consideration by Congress, physicians say that the short-term actions will impact patients’ access to care. If Congress enacts a 4-7 month Medicare payment freeze with a 21% payment cut, physicians say they will: • Restrict the number of Medicare patients they treat (54%) • Stop taking new Medicare patients (50%) • Stop taking any Medicare patients (31%) If Congress enacts a 3-5 year increase in Medicare payments with a 21% payment cut to physicians in the future, physicians say they will: • Restrict the number of Medicare patients they treat (48%) • Stop taking new Medicare patients (42%) • Stop taking any Medicare patients (26%) What Do Doctors Think?... *Physicians in this survey were asked to check all answers that apply. **Primary care is defined as Family Practice, General Practice, Internal Medicine, and Obstetrics/Gynecology.
- 11. RLee Financial Solutions Physician Medicare Cuts Delayed Til 2014 Well, they did it again. The press is congratulating Congress on the "success" of coming up with a New Year's Night deal on that no one likes. For physicians, this deal contains a delay in the 27% cut in Medicare payments to physicians according to the Sustainable Growth Rate (SGR). For full coverage of this story, I encourage you to read articles from Medpage Today, Kaiser Health News, and Modern Healthcare. (Photo credit: New York Times) The 26.5% cut in Medicare reimbursement mandated by the sustainable growth rate (SGR) formula was averted in a literal 11th hour vote Tuesday in the House of Representatives. The House vote to pass the "fiscal cliff" bill OK'd earlier by the Senate delays the SGR cuts for a year. The bill cleared the House by a vote of 257-167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote. While Congress has put another Band-Aid on the SGR problem, a long term solution is still needed, because when December 31, 2013 comes, we'll be going through this thing all over again, and the potential cuts will probably be in the 30% range. Medical organizations will again be out encouraging their members to lobby congress for a long term Medicare payment solution. How effective will they be? We'll see.. http://familymedicinerocks.com/blog/2013/1/1/physician-medicare-cuts- delayed-til-2014 What about the very near future?... The bill cleared the House by a vote of 257- 167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote.
- 12. RLee Financial Solutions We can fill those gaps!... 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.
- 13. RLee Financial Solutions 2013 Part D coverage ... 2013 Basic Medicare Drug Coverage 2013 Basic Benefits You Pay Deductible $325 100% of first $325 Initial Coverage Limit $2840 25% of the next $2645 ($661.25) Coverage Gap $2970.00 100% of the $2970.00 Annual – out- of- pocket amount $4750 Catastrophic Coverage Medicare and Plan 95% 5%
- 14. RLee Financial Solutions “How will the new healthcare law benefit me?” … New benefits in 2013...
- 15. RLee Financial Solutions What are your options?... Original Medicare Original Medicare Part A &B Medicare Supplement Medicare Part D One or the other Medicare Advantage Plans Part C (may include drug coverage) *Creditable Prescription Drug Coverage *Could include employer provided drug coverage, union, or even VA drug benefits
- 16. RLee Financial Solutions What 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
- 17. RLee Financial Solutions What 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
- 18. RLee Financial Solutions What 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
- 19. RLee Financial Solutions Is 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?
- 20. RLee Financial Solutions Things 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? What is the insurance company’s rating? Is the plan accepted in my area?
- 21. RLee Financial Solutions Something not to consider...
- 22. RLee Financial Solutions SERVICES AVAILABLE Medicare Supplements Medicare Advantage Plans Part D Drug Cards Life Insurance Annuities Long Term Care Insurance Supplemental Health Our Full line of Services… Providing you with “common sense solutions”