2010 Medicare 2010 Medicare UpdateUpdate

AGENDAAGENDA

Original Medicare Parts A, B, C & D Update & Original Medicare Parts A, B, C & D Update & OverviewOverview

Medicare Supplement InsuranceMedicare Supplement Insurance Medicare Advantage Plan DetailsMedicare Advantage Plan Details Medicare Prescription DrugMedicare Prescription Drug

Cookie Break (10 Minutes)Cookie Break (10 Minutes)

Smilebuilderz FREE Discount Dental PlanSmilebuilderz FREE Discount Dental Plan Pavelko Senior Consulting ServicesPavelko Senior Consulting Services Benefits Check-upBenefits Check-up

Original MedicareOriginal Medicare

All of the information All of the information for this section or our for this section or our presentation comes presentation comes from Medicare & You from Medicare & You 20102010

You should receive a You should receive a Medicare & You 2010 Medicare & You 2010 booklet at home booklet at home directly from directly from Medicare (one Medicare (one booklet per booklet per household)household)

Additional copies are Additional copies are available this eveningavailable this evening

What is Medicare?What is Medicare?Page 12Page 12

Medicare is health insurance for Medicare is health insurance for the following:the following:– People Age 65 or OlderPeople Age 65 or Older– People Under Age 65 with Certain People Under Age 65 with Certain

DisabilitiesDisabilities– People of Any Age with End Stage People of Any Age with End Stage

Renal Disease (requiring dialysis or Renal Disease (requiring dialysis or kidney transplant)kidney transplant)

Parts of MedicareParts of MedicarePage 12Page 12

Part A – HospitalizationPart A – Hospitalization

Part B – Medical InsurancePart B – Medical Insurance

Part C – Medicare Advantage Part C – Medicare Advantage

(i.e. PPO or HMO)(i.e. PPO or HMO)

Part D – Medicare PrescriptionPart D – Medicare Prescription

Medicare Part AMedicare Part AHospitalizationHospitalization

Medicare Part A - Medicare Part A - CoverageCoveragePage 16Page 16

Inpatient hospital careInpatient hospital care– Critical care hospitalsCritical care hospitals– Inpatient rehab facilitiesInpatient rehab facilities– Long term care hospitalsLong term care hospitals

Inpatient care in a skilled nursing Inpatient care in a skilled nursing facilityfacility– NOT custodial careNOT custodial care

HospiceHospice Home Health CareHome Health Care

Medicare Part A – CostMedicare Part A – CostPage 16 & 119Page 16 & 119

You usually don’t pay anything for You usually don’t pay anything for Medicare Part A if you and/or your Medicare Part A if you and/or your spouse paid Medicare taxes while spouse paid Medicare taxes while workingworking

If you are not eligible for premium-free If you are not eligible for premium-free Medicare Part A, you may be able to Medicare Part A, you may be able to purchase Part A coveragepurchase Part A coverage

For those who must pay for Part A, the For those who must pay for Part A, the 2010 premium will be $461 / month or 2010 premium will be $461 / month or moremore

Medicare Part A – 2010 Medicare Part A – 2010 BenefitsBenefitsPage 120Page 120

Blood Blood – If the hospital receives blood from the If the hospital receives blood from the

blood bank for free, it is free to youblood bank for free, it is free to you– If the hospital must purchase blood for If the hospital must purchase blood for

you, you will be responsible to pay for (or you, you will be responsible to pay for (or replace) the first 3 pintsreplace) the first 3 pints

Home Health CareHome Health Care– You pay $0 for home health care servicesYou pay $0 for home health care services– You pay 20% for durable medical You pay 20% for durable medical

equipmentequipment

Medicare Part A – 2010 Medicare Part A – 2010 BenefitsBenefitsPage 120Page 120

HospiceHospice– You pay $0 for Hospice careYou pay $0 for Hospice care– You pay up to $5 per prescription for You pay up to $5 per prescription for

outpatient prescription drugs for outpatient prescription drugs for pain and symptom managementpain and symptom management

– You pay 5% for inpatient respite You pay 5% for inpatient respite carecare

Medicare Part A – 2010 Medicare Part A – 2010 BenefitsBenefitsPage 120Page 120

Inpatient Hospital CareInpatient Hospital Care– You will pay a deductible of $1100 You will pay a deductible of $1100

and no coinsurance for days 1 – 60 of and no coinsurance for days 1 – 60 of each benefit period in 2010each benefit period in 2010

– You pay $275 per day for days 61 – 90 of You pay $275 per day for days 61 – 90 of each benefit periodeach benefit period

– You pay $550 per lifetime reserve day You pay $550 per lifetime reserve day after day 90 of each benefit periodafter day 90 of each benefit period

– You have up 60 lifetime reserve daysYou have up 60 lifetime reserve days– You pay ALL COSTS after lifetime reserve You pay ALL COSTS after lifetime reserve

days are exhausteddays are exhausted

Medicare Part A – 2010 Medicare Part A – 2010 BenefitsBenefitsPage 120Page 120

Skilled Nursing FacilitySkilled Nursing Facility– You pay $0 for days 1 – 20 per You pay $0 for days 1 – 20 per

benefit periodbenefit period– You pay $137.50 for days 21 – 100 You pay $137.50 for days 21 – 100

per benefit periodper benefit period– You pay ALL COSTS for days 101+ You pay ALL COSTS for days 101+

per benefit periodper benefit period– Custodial care is NOT covered by Custodial care is NOT covered by

MedicareMedicare

Medicare Part BMedicare Part BMedical InsuranceMedical Insurance

Medicare Part B - Medicare Part B - CoverageCoveragePage 25Page 25

Medically necessary servicesMedically necessary services– Services and supplies necessary to Services and supplies necessary to

diagnose a medical conditiondiagnose a medical condition– Treatment of medical conditionsTreatment of medical conditions

Preventive carePreventive care– Health care to prevent illnessHealth care to prevent illness– Health care to diagnose illness at an Health care to diagnose illness at an

early stage when treatments will be early stage when treatments will be most effectivemost effective

Medicare Part B – CostMedicare Part B – CostPage 119Page 119

If your yearly income in 2008 wasIf your yearly income in 2008 was You PayYou Pay

Individual Tax Individual Tax ReturnReturn

Joint Tax ReturnJoint Tax Return

< / = $85,000< / = $85,000 < / = $170,000< / = $170,000 $110.50 / Mo. *$110.50 / Mo. *

$85,001 - $107,000$85,001 - $107,000 $170,001 - $170,001 - $214,000$214,000

$154.70 / Mo.$154.70 / Mo.

$107,001 - $107,001 - $160,000$160,000

$214,001 - $214,001 - $320,000$320,000

$221.00 / Mo.$221.00 / Mo.

$160,001 - $160,001 - $214,000$214,000

$320,001 - $320,001 - $428,000$428,000

$287.30 / Mo.$287.30 / Mo.

> $214,000> $214,000 > $428,000> $428,000 $353.60 / Mo.$353.60 / Mo.* Most people will continue to pay the 2009 Part B premium of $96.40 in 2010. Call Social Security at 800-772-1213 with

questions about your 2010 premium.

Medicare Part B – CostMedicare Part B – CostFrom AARP Bulletin TodayFrom AARP Bulletin Today

2010 Premiums Explained by AARP2010 Premiums Explained by AARP– Hold harmless provision of federal law Hold harmless provision of federal law

protects most Medicare Beneficiaries protects most Medicare Beneficiaries from the premium increase in 2010from the premium increase in 2010

– No increase to COLA (Cost of Living No increase to COLA (Cost of Living Adjustment) means no increase in Adjustment) means no increase in premium for Part B for 75% of premium for Part B for 75% of Medicare BeneficiariesMedicare Beneficiaries

Medicare Part B – CostMedicare Part B – CostFrom AARP Bulletin TodayFrom AARP Bulletin Today

2010 Premiums Explained by AARP 2010 Premiums Explained by AARP (cont.)(cont.)– The Hold Harmless provision does NOT The Hold Harmless provision does NOT

apply to the following Medicare apply to the following Medicare Beneficiaries:Beneficiaries:

Those who do not have their Part B premiums Those who do not have their Part B premiums withheld from Social Security Checkswithheld from Social Security Checks

Those who pay a higher Part B premium based Those who pay a higher Part B premium based on incomeon income

Those who are newly enrolled in Part B on or Those who are newly enrolled in Part B on or after January 1, 2010after January 1, 2010

Medicare Part B – 2010 Medicare Part B – 2010 BenefitsBenefitsPage 121Page 121

Major Medical CareMajor Medical Care– You will pay an annual deductible of You will pay an annual deductible of

$155 for Part B covered items and $155 for Part B covered items and services in 2010services in 2010

– You pay 20% of the Medicare-approved You pay 20% of the Medicare-approved amount for most doctor services, amount for most doctor services, outpatient therapy, most preventive outpatient therapy, most preventive services and durable medical equipmentservices and durable medical equipment

– You pay 45% of the Medicare-approved You pay 45% of the Medicare-approved amount for most outpatient mental health amount for most outpatient mental health carecare

Medicare Part B – 2010 Medicare Part B – 2010 BenefitsBenefitsPage 121Page 121

Major Medical Care (cont.)Major Medical Care (cont.)– You pay a coinsurance or copayment You pay a coinsurance or copayment

that varies for outpatient hospital that varies for outpatient hospital servicesservices

– You pay $0 for Medicare-approved You pay $0 for Medicare-approved clinical laboratory servicesclinical laboratory services

– You pay $0 for Medicare-approved You pay $0 for Medicare-approved home health care serviceshome health care services

Medicare Part B – 2010 Medicare Part B – 2010 BenefitsBenefitsPage 27Page 27

Preventive CarePreventive Care– Bone Mass measurementBone Mass measurement– Cardiovascular blood testing for Cardiovascular blood testing for

cholesterol, lipids and triglyceridescholesterol, lipids and triglycerides– Colorectal Cancer screeningsColorectal Cancer screenings– Diabetes screeningsDiabetes screenings– EKG screening if it is referred as part EKG screening if it is referred as part

of your “Welcome to Medicare” of your “Welcome to Medicare” physical examphysical exam

Medicare Part B – 2010 Medicare Part B – 2010 BenefitsBenefitsPage 27Page 27

Preventive Care (cont.)Preventive Care (cont.)– PSA screeningPSA screening– Flu shotFlu shot– Pneumococcal shotPneumococcal shot– Hepatitis B shotHepatitis B shot– Glaucoma testingGlaucoma testing– MammogramsMammograms– Pap test, pelvic exam and breast Pap test, pelvic exam and breast

examexam

Medicare Part B – 2010 Medicare Part B – 2010 BenefitsBenefitsPage 27Page 27

Preventive Care (cont.)Preventive Care (cont.)– ““Welcome to Medicare” physical Welcome to Medicare” physical

exam within 12 months of your Part exam within 12 months of your Part B effective dateB effective date Let the scheduler know that your Let the scheduler know that your

appointment is for your “Welcome to appointment is for your “Welcome to Medicare” physical – it will be a longer Medicare” physical – it will be a longer appointmentappointment

Schedule it as soon as possible – you Schedule it as soon as possible – you may have to wait to get an appointmentmay have to wait to get an appointment

Medicare Part CMedicare Part CMedicare AdvantageMedicare Advantage

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50Page 50

A Medicare Advantage plan is A Medicare Advantage plan is another health coverage choice another health coverage choice that you may have as that you may have as part of part of MedicareMedicare

Known asKnown as– Part CPart C– ““MA” PlansMA” Plans

Offered by private insurance Offered by private insurance companies that are approved by companies that are approved by MedicareMedicare

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50Page 50

If you join a Medicare Advantage plan, it If you join a Medicare Advantage plan, it will provide all of your Part A and Part B will provide all of your Part A and Part B coveragecoverage

Medicare Advantage must provide Medicare Advantage must provide coverage for emergency and urgent coverage for emergency and urgent carecare

Medicare Advantage plans must cover Medicare Advantage plans must cover all the services that Original Medicare all the services that Original Medicare covers, except hospice carecovers, except hospice care

Hospice care is still covered by Original Hospice care is still covered by Original Medicare if you are enrolled in a Medicare if you are enrolled in a Medicare Advantage planMedicare Advantage plan

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50Page 50

Medicare Advantage plans are Medicare Advantage plans are NOT considered supplemental NOT considered supplemental coveragecoverage

Medicare Advantage plans may Medicare Advantage plans may offer extra benefits, such as:offer extra benefits, such as:– Vision coverageVision coverage– Dental coverageDental coverage– Hearing coverageHearing coverage– Health and Wellness programsHealth and Wellness programs

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50Page 50

Most Medicare Advantage plans Most Medicare Advantage plans INCLUDEINCLUDE Medicare prescription Medicare prescription drug coveragedrug coverage

You pay your Medicare Part B You pay your Medicare Part B premium premium ANDAND the premium for the premium for the Medicare Advantage plan, if the Medicare Advantage plan, if there is a premium for the plan there is a premium for the plan you chooseyou choose

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50Page 50

Medicare pays a fixed amount every Medicare pays a fixed amount every month to the Medicare Advantage month to the Medicare Advantage company that you enroll withcompany that you enroll with

Medicare Advantage companies must Medicare Advantage companies must follow rules set by Medicarefollow rules set by Medicare

Each Medicare Advantage plan may Each Medicare Advantage plan may charge different out-of-pocket costs and charge different out-of-pocket costs and have different rules for accessing have different rules for accessing coverage, i.e. referrals may be required coverage, i.e. referrals may be required or you may need to use a network of or you may need to use a network of doctors doctors

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 50 - 51Page 50 - 51

Types of Medicare Advantage plans:Types of Medicare Advantage plans:– HMO (Health Maintenance Organization)HMO (Health Maintenance Organization)– PPO (Preferred Provider PPO (Preferred Provider

Organization)Organization)– POS (Point of Service)POS (Point of Service)– PFFS (Private Fee For Service)PFFS (Private Fee For Service)– MSA (Medical Savings Account)MSA (Medical Savings Account)– SNP (Special Needs Plan)SNP (Special Needs Plan)– PSO (Provider Sponsored Organization)PSO (Provider Sponsored Organization)

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 51Page 51

You still have Medicare rights and You still have Medicare rights and protections in a Medicare Advantage planprotections in a Medicare Advantage plan

You must follow plan rules to avoid higher You must follow plan rules to avoid higher costscosts

Medicare Advantage plans are not Medicare Advantage plans are not standardized – they have different benefitsstandardized – they have different benefits

You may join a Medicare Advantage plan You may join a Medicare Advantage plan even if you have pre-existing conditions, even if you have pre-existing conditions, except for End Stage Renal Diseaseexcept for End Stage Renal Disease

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 52Page 52

There are only certain times of the There are only certain times of the year when you may join or leave a year when you may join or leave a Medicare Advantage planMedicare Advantage plan

If the Medicare Advantage plan that If the Medicare Advantage plan that you’ve chosen stops participating in you’ve chosen stops participating in Medicare, you will have Special Medicare, you will have Special Enrollment rights to join another Enrollment rights to join another Medicare Advantage plan or return to Medicare Advantage plan or return to Original MedicareOriginal Medicare

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 52Page 52

You usually get prescription drug You usually get prescription drug coverage through the Medicare coverage through the Medicare Advantage planAdvantage plan

If you enroll for a stand-alone If you enroll for a stand-alone Prescription Drug plan after enrolling in Prescription Drug plan after enrolling in a Medicare Advantage plan that includes a Medicare Advantage plan that includes prescription drug coverage, you will be prescription drug coverage, you will be disenrolleddisenrolled from the Medicare from the Medicare Advantage plan and returned to Original Advantage plan and returned to Original MedicareMedicare

Medicare Part C – Medicare Medicare Part C – Medicare AdvantageAdvantagePage 52Page 52

You do not need a separate Medicare You do not need a separate Medicare Supplement plan if you have a Medicare Supplement plan if you have a Medicare Advantage planAdvantage plan

You cannot be sold a separate Medicare You cannot be sold a separate Medicare Supplement plan if you have a Medicare Supplement plan if you have a Medicare Advantage planAdvantage plan

You may join a Medicare Advantage plan You may join a Medicare Advantage plan if:if:– You have Medicare Parts A and B; andYou have Medicare Parts A and B; and– You live in the Service Area of the plan; andYou live in the Service Area of the plan; and– You do not have End Stage Renal DiseaseYou do not have End Stage Renal Disease

Medicare Part DMedicare Part DPrescription DrugPrescription Drug

Medicare Part D – Medicare Part D – Prescription DrugPrescription DrugPage 62Page 62

Available to everyone who has Available to everyone who has MedicareMedicare

Offered by private insurance Offered by private insurance companiescompanies

Each plan will vary in benefits and Each plan will vary in benefits and costcost

Each plan may use a different drug Each plan may use a different drug formulary – list of preferred or formulary – list of preferred or covered drugscovered drugs

Medicare Part D – Medicare Part D – Prescription DrugPrescription DrugPage 62Page 62

It is your choice to enroll in a It is your choice to enroll in a Medicare Part D plan:Medicare Part D plan:– If you do not enroll when you are If you do not enroll when you are

first eligible and you do not have first eligible and you do not have creditable coverage from another creditable coverage from another source, you will pay a late source, you will pay a late enrollment penalty if you choose to enrollment penalty if you choose to enroll laterenroll later

– Penalty accrues at 1% per month for Penalty accrues at 1% per month for every month that you wait to enrollevery month that you wait to enroll

Medicare Part D – Medicare Part D – Prescription DrugPrescription DrugPage 63Page 63

To join a Medicare Part D Plan you To join a Medicare Part D Plan you must have Medicare Part A or Part Bmust have Medicare Part A or Part B

You must live in the service area of You must live in the service area of the Medicare Part D Plan that you the Medicare Part D Plan that you want to joinwant to join

Based on your income, you may Based on your income, you may qualify for additional help in paying qualify for additional help in paying for your prescriptions or Part D Planfor your prescriptions or Part D Plan

Medicare Part D – Medicare Part D – Prescription DrugPrescription DrugPage 63Page 63

You may join a Medicare Part D Plan You may join a Medicare Part D Plan at the following times:at the following times:– When you are first-eligible for MedicareWhen you are first-eligible for Medicare– Between November 15 – December 31 Between November 15 – December 31

each year for coverage to begin on the each year for coverage to begin on the following January 1following January 1

– You may CHANGE your Part D Plan You may CHANGE your Part D Plan between January 1 – March 31 each yearbetween January 1 – March 31 each year

– Anytime Anytime ifif you qualify for additional help you qualify for additional help in paying for your Medicare Part D Planin paying for your Medicare Part D Plan

Medicare Part D – Medicare Part D – Prescription DrugPrescription DrugPage 63Page 63

The “Standard” Medicare Part D Plan operates like The “Standard” Medicare Part D Plan operates like this:this:

1. Yearly 1. Yearly DeductibleDeductible

2. Copayment or 2. Copayment or CoinsuranceCoinsurance

3. Coverage Gap 3. Coverage Gap (Donut Hole)(Donut Hole)

4. Catastrophic 4. Catastrophic CoverageCoverage

You pay the first You pay the first $310$310 of drug of drug costs before the costs before the plan starts to plan starts to pay its sharepay its share

You pay a You pay a copayment and copayment and your plan pays a your plan pays a share for each share for each covered drug covered drug until a until a COMBINEDCOMBINED total total of of $2,830$2,830 is is spent by spent by YOU YOU AND THE PLANAND THE PLAN (this includes (this includes the deductiblethe deductible

Once Once $2,830$2,830 is is spent, you will spent, you will pay the full cost pay the full cost of your drugs of your drugs until until YOUYOU have have spent a total of spent a total of $$4,5504,550 out of out of YOURYOUR pocket pocket

You pay a small You pay a small copayment for copayment for your drugs until your drugs until the end of the the end of the yearyear

Starts over everyJanuary 1

Medicare Part D – Medicare Part D – Prescription DrugPrescription Drug

You should shop for Medicare Part You should shop for Medicare Part D Prescription Drug coverage D Prescription Drug coverage EVERY yearEVERY year

The following things may change The following things may change EVERY year:EVERY year:– PremiumPremium– CopaymentsCopayments– Formulary TiersFormulary Tiers– Your Prescription NeedsYour Prescription Needs

Medicare Medicare SupplementsSupplementsFilling the “Gaps” in Original Filling the “Gaps” in Original MedicareMedicare

Medicare Supplement Medicare Supplement InsuranceInsurancePage 74Page 74

Sold by private insurance Sold by private insurance companiescompanies

Standardized plan designsStandardized plan designs Helps to pay for many of the Helps to pay for many of the

“gaps” in Medicare, i.e. deductible “gaps” in Medicare, i.e. deductible or coinsuranceor coinsurance

Pays based on Medicare and Pays based on Medicare and Medicare AssignmentMedicare Assignment

Medicare Supplement Medicare Supplement InsuranceInsurancePage 74Page 74

Currently available – Standardized Currently available – Standardized Plans A – LPlans A – L

Available June 1, 2010 – NEW Available June 1, 2010 – NEW Standardized Plans M & NStandardized Plans M & N

Effective June 1, 2010 you will no Effective June 1, 2010 you will no longer be able to purchase Plans E, H, I longer be able to purchase Plans E, H, I or Jor J

If you have a Plan E, H, I or J you will If you have a Plan E, H, I or J you will be able to keep itbe able to keep it

Medicare Supplement Medicare Supplement InsuranceInsurancePage 74Page 74

Insurance companies may charge Insurance companies may charge different premiums for EXACTLY different premiums for EXACTLY the same Medicare Supplement the same Medicare Supplement coveragecoverage

Differences to note:Differences to note:– Premium you payPremium you pay– Service you receiveService you receive– Financial stability of the insurance Financial stability of the insurance

companycompany

Medicare Supplement Medicare Supplement InsuranceInsurancePage 75Page 75

To get a Medicare Supplement To get a Medicare Supplement policy, you must:policy, you must:– Have Medicare Parts A and BHave Medicare Parts A and B– Pay the plan premiumPay the plan premium– Purchase a separate policy for your Purchase a separate policy for your

spouse (no joint coverage)spouse (no joint coverage)– Be eligible for the insuranceBe eligible for the insurance

Through Initial Enrollment Period or Through Initial Enrollment Period or Special Enrollment PeriodSpecial Enrollment Period

With good healthWith good health

Medicare Supplement Medicare Supplement Insurance & Medicare Insurance & Medicare

AdvantageAdvantage Page 75Page 75

If you have a Medicare If you have a Medicare Supplement and want to enroll for Supplement and want to enroll for Medicare Advantage, you may Medicare Advantage, you may keep your Supplement plan, but it keep your Supplement plan, but it cannot pay for any of the cost-cannot pay for any of the cost-sharing components of the sharing components of the Medicare Advantage planMedicare Advantage plan

If you want to cancel your If you want to cancel your Medicare Supplement, you must Medicare Supplement, you must contact the insurance companycontact the insurance company

Medicare Supplement Medicare Supplement Insurance & Medicare Insurance & Medicare

AdvantageAdvantage Page 75Page 75

If you have a Medicare Advantage plan If you have a Medicare Advantage plan it is illegal for anyone to sell you a it is illegal for anyone to sell you a Medicare Supplement plan unless you Medicare Supplement plan unless you are switching back to Original Medicareare switching back to Original Medicare

The first time that you enroll for a The first time that you enroll for a Medicare Advantage plan, if you do not Medicare Advantage plan, if you do not like it, you may have a Special like it, you may have a Special Enrollment Period to move back to Enrollment Period to move back to Original Medicare and a Supplement Original Medicare and a Supplement within 12 months of joiningwithin 12 months of joining

Medicare AdvantageMedicare AdvantagePlan Details for 2010Plan Details for 2010

Medicare Medicare Prescription DrugPrescription DrugIndividual Recommendations Individual Recommendations RequiredRequired

Medicare Prescription Medicare Prescription DrugDrug It is important to review your Part It is important to review your Part

D Prescription Drug benefits D Prescription Drug benefits EVERYEVERY year year

Medicare.gov – Medicare Medicare.gov – Medicare Prescription Drug Plan FinderPrescription Drug Plan Finder

How we make a recommendation How we make a recommendation specific to your needsspecific to your needs

Medicare Prescription Medicare Prescription Drug ExampleDrug Example Female / DiabetesFemale / Diabetes 5 Generic Medications & 1 Brand 5 Generic Medications & 1 Brand

MedicationMedication– Metformin / 2000 mg DailyMetformin / 2000 mg Daily– Glimepiride / 8 mg DailyGlimepiride / 8 mg Daily– Simvastatin / 20 mg DailySimvastatin / 20 mg Daily– Lisinopril / 2.5 mg DailyLisinopril / 2.5 mg Daily– Fluoxetine / 40 mg DailyFluoxetine / 40 mg Daily– Januvia / 100 mg DailyJanuvia / 100 mg Daily

Medicare Prescription Medicare Prescription Drug ExampleDrug Example 2009 Recommended Plan2009 Recommended Plan

– Highmark Blue Rx Plus @ $49.10 / monthHighmark Blue Rx Plus @ $49.10 / month– Estimated annual drug cost $1507 / Year Estimated annual drug cost $1507 / Year

at Retail Pharmacyat Retail Pharmacy– Estimated annual drug cost $1189 / Year Estimated annual drug cost $1189 / Year

at Mail Order Pharmacyat Mail Order Pharmacy– Monthly cost at the Pharmacy will be Monthly cost at the Pharmacy will be

approximately $60.00approximately $60.00– Expect to reach the Coverage Gap in Expect to reach the Coverage Gap in

November, 2009November, 2009

Medicare Prescription Medicare Prescription Drug ExampleDrug Example 2010 Plan “Renewal”2010 Plan “Renewal”

– Highmark Blue Rx Plus @ $51.30 / monthHighmark Blue Rx Plus @ $51.30 / month– Estimated annual drug cost $1698 / Year Estimated annual drug cost $1698 / Year

at Retail Pharmacyat Retail Pharmacy– Estimated annual drug cost $1276 / Year Estimated annual drug cost $1276 / Year

at Mail Order Pharmacyat Mail Order Pharmacy– Monthly cost at the Pharmacy will be Monthly cost at the Pharmacy will be

approximately $75.00approximately $75.00– Expect to reach the Coverage Gap in Expect to reach the Coverage Gap in

November, 2010November, 2010

Medicare Prescription Medicare Prescription Drug ExampleDrug Example 2010 Recommended Plan2010 Recommended Plan

– Aetna Rx Plus @ $36.70 / MonthAetna Rx Plus @ $36.70 / Month– Estimated annual drug cost $1145 / Year Estimated annual drug cost $1145 / Year

at Retail Pharmacyat Retail Pharmacy– Estimated annual drug cost $1100 / Year Estimated annual drug cost $1100 / Year

at Mail Order Pharmacyat Mail Order Pharmacy– Monthly cost at the Pharmacy will be Monthly cost at the Pharmacy will be

approximately $60.00approximately $60.00– Expect to reach the Coverage Gap in Expect to reach the Coverage Gap in

December, 2010December, 2010

Medicare Prescription Medicare Prescription DrugDrug Collect your specific demographic and Collect your specific demographic and

drug informationdrug information Enter drugs and demographic Enter drugs and demographic

information into the Medicare.gov information into the Medicare.gov Prescription Drug Plan FinderPrescription Drug Plan Finder

Look for $0 - $100 Deductible PlansLook for $0 - $100 Deductible Plans Review / compare the three lowest-Review / compare the three lowest-

cost options that fit our parameters for cost options that fit our parameters for a good plana good plan

Every person will have a different Every person will have a different recommendationrecommendation

The Smilebuilderz The Smilebuilderz Discount Dental PlanDiscount Dental PlanFree to our clientsFree to our clients

The Smilebuilderz The Smilebuilderz Discount Dental PlanDiscount Dental Plan Applies at the Smilebuilderz Dental Applies at the Smilebuilderz Dental

practice, Lancasterpractice, Lancaster Smilebuilderz is a unique and innovative Smilebuilderz is a unique and innovative

dental practice that includes all dental dental practice that includes all dental specialties under one roofspecialties under one roof

Plan includes free x-rays and examsPlan includes free x-rays and exams Plan includes adult teeth cleanings for $55Plan includes adult teeth cleanings for $55 Plan includes discounts of 20% - 50% on all Plan includes discounts of 20% - 50% on all

dental procedures received at dental procedures received at SmilebuilderzSmilebuilderz

The Smilebuilderz The Smilebuilderz Discount Dental PlanDiscount Dental Plan Tell us that you want the Tell us that you want the

Smilebuilderz Discount PlanSmilebuilderz Discount Plan We will enroll you with We will enroll you with

Smilebuilderz for January 1, 2010Smilebuilderz for January 1, 2010 You will receive ID Cards and full You will receive ID Cards and full

plan detailsplan details The plan discounts apply to your The plan discounts apply to your

entire householdentire household

The Smilebuilderz The Smilebuilderz Discount Dental PlanDiscount Dental Plan Not ready to leave your dentist?Not ready to leave your dentist? Use Smilebuilderz for specialty Use Smilebuilderz for specialty

servicesservices– EndodonticsEndodontics– PeriodonticsPeriodontics– ProsthodonticsProsthodontics

You will receive discounts on You will receive discounts on whatever services you use at whatever services you use at Smilebuilderz when you present your Smilebuilderz when you present your ID CardID Card

The Smilebuilderz The Smilebuilderz Discount Dental PlanDiscount Dental Plan Discounts may not be combined Discounts may not be combined

with insurance unless you pay with insurance unless you pay cash and submit your own claims cash and submit your own claims for reimbursementfor reimbursement

This program came from the This program came from the requests of our clients for a good, requests of our clients for a good, affordable dental planaffordable dental plan

Smilebuilderz is NOT insuranceSmilebuilderz is NOT insurance

Pavelko Senior Pavelko Senior Consulting ServicesConsulting ServicesSenior Transitions SpecialistSenior Transitions Specialist

Benefits Check-upBenefits Check-upFinding Additional BenefitsFinding Additional Benefits

Benefits Check-upBenefits Check-up

Available on your own at Available on your own at www.benefitscheckup.com/coventrywww.benefitscheckup.com/coventry

We can provide the Benefits Check-We can provide the Benefits Check-up Report for youup Report for you– Complete the QuestionnaireComplete the Questionnaire– Return it to your AgentReturn it to your Agent– Receive a detailed report back by mail Receive a detailed report back by mail

or review in person at your or review in person at your appointmentappointment

Benefits Check-upBenefits Check-up

Learn if you are eligible forLearn if you are eligible for– Medicare Savings ProgramMedicare Savings Program– PACE / PACENETPACE / PACENET– Property Tax / Rent RebateProperty Tax / Rent Rebate– Food StampsFood Stamps– Home Energy AssistanceHome Energy Assistance– Weatherization AssistanceWeatherization Assistance– Transportation AssistanceTransportation Assistance– Food / Meal SupplementsFood / Meal Supplements

ConclusionConclusionNext Steps…Next Steps…

Next steps…Next steps…

Think about your options for 2010Think about your options for 2010– Original Medicare AloneOriginal Medicare Alone– Original Medicare + Medicare Supplement Original Medicare + Medicare Supplement

and/or Part D Rxand/or Part D Rx– Medicare AdvantageMedicare Advantage– Special Enrollment Period Availability (?)Special Enrollment Period Availability (?)

Discuss your options with an AgentDiscuss your options with an Agent Enroll for the plan(s) of your choice by Enroll for the plan(s) of your choice by

December 31, 2009December 31, 2009

Questions?Questions?

Thank you!Thank you!