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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. - PowerPoint PPT Presentation
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Understanding Medicare and Supplemental Insurance
Options…
Medicare Government- Health Insurance Program
Medicare Government- Health Insurance Program
Part AHospital Insurance
Part BMedical Insurance
Medicare Part A covers…Medicare Part A covers…
Inpatient Hospital
Inpatient Skilled Nursing Facility Care
Home Health Care
Hospice Care
Blood
Medicare Part B covers… 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
Here’s how Medicare Part A works… Inpatient Hospital Here’s how Medicare Part A works… Inpatient Hospital
Days You Pay Medicare 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
Medicare Part A –Inpatient Skilled Nursing Facility
Care
Medicare Part A –Inpatient Skilled Nursing Facility
CareDays You Pay Medicare Pays
1-20 $0 100% of eligible expenses
21-100 $124/day All additional eligible expenses
100+ All expenses No coverage
Medicare Part A - also covers…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
Medicare Part A leaves you to pay…
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
Medicare Part B…Medicare Part B…
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 Approved Charges…$200.00
Medicare Approved Charges…$200.00
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 Claims Process…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
Non-eligible medical expensesNon-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
Medicare Preventive Services...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
In 2007, Medicare added:In 2007, Medicare added:
Smoking Cessation Program
Ultrasound for aortic abdominal aneurysm… if detected during “Welcome to Medicare Physical Exam”
What Are Your Choices…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
Group Coverage...still working after 65
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
What You Should Know…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.
Why Blue Cross and Blue ShieldWhy Blue Cross and Blue Shield
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
Basic Benefits…A-F Supplemental Plans
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.
Medicare Supplemental Insurance
Standardization Effective 1992…
Medicare Supplemental Insurance
Standardization 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.
Introducing…Medicare Supplemental Plans K & L
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
Plans K & L Cost Sharing Benefits Medicare Part A
Plans K & L Cost Sharing Benefits Medicare Part A
K L50% Part A Deductible 75% Part A
50% Hospice Cost Sharing 75 Hospice Cost Sharing
Plans K & L Cost Sharing Benefits Medicare Part B
Plans K & L Cost Sharing Benefits Medicare Part B
K50% Coinsurance
50% Blood
L75% Coinsurance
75% Blood
At Blue Cross & Blue Shield… 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…
Member’s First – What you should know…
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
Medicare Reform- Drug BenefitMedicare Reform- Drug Benefit
Part D: Effective 1/1/06
Voluntary
$265 deductible per year
1. Initial Enrollment Period
2. Annual Coordinated Election Period (AEP)
3. Special enrollment Period (SEP)
There are Three Enrollment Periods
Blue Cross and Blue Shield of Texas offers:
Blue Cross and Blue Shield of Texas offers:
Blue MedicareRx
3 choices to best fit your needs:
Standard Plan
Value Plan
Plus Plan
Blue Medicare Rx Standard BenefitsBlue Medicare Rx Standard Benefits
Deductible $265
Annual drug costs up to $2,400 You pay 25%
Annual drug costs exceeding $2,400 (up to
$3,850 out-of-pocket maximum)
You pay 100%
After your out-of-pocket annual drug costs exceed
$3,850
You pay the greater of $2.15 for generic or
preferred brand drug that is a multi-
source drug and $5.35 for all other drugs,
or 5% coinsurance.
Monthly Plan Premium$28.70
Blue MedicareRx Value Plan BenefitsBlue MedicareRx Value Plan Benefits
Deductible $0
Annual drug costs up to $2,400 $ 5 $40 $60
co-pay co-pay co-pay
Annual drug costs exceeding $2,400 (up to $3,850out-of-pocket
maximum) You pay 100%
After your out-of-pocket annual drug costs exceed $3,850
You pay the greater of $2.15 for generic or
preferred brand drug that is a multi-
source drug and $5.35 for all other drugs,
or 5% coinsurance.
Monthly Plan Premium
$29.60
GenericPreferred
Brand Brand
Blue MedicareRx Plus Plan BenefitsBlue MedicareRx Plus Plan Benefits
Deductible $0
Annual drug costs up to $2,400 $ 3 $20 $50
co-pay co-pay co-pay
Annual drug costs exceeding $2,400 (up to $3,850 out-of-pocket
maximum) $5 co-payment for Generics. You pay 100% for Preferred Brand, Brand and Specialty Drugs.
After your out-of-pocket annual drug costs exceed $3,850
You pay the greater of $2.15 for generic or
preferred brand drug that is a multi-
source drug and $5.35 for all other drugs,
or 5% coinsurance.
Monthly Plan Premium
$55.60
GenericPreferred
BrandBrand
Most Medications Are CoveredMost 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 to www.bcbstx.com to learn more
What Happens Next…What Happens Next… Look at which benefits best meet your clients needs...
Then complete and submit their application…
Now, let us answer your questions…
Now, let us answer your questions…
Thank you for your time.
We look forward to serving you.
www.bcbstx.com