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Medicare Overview

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OverviewFor Medicare-eligible individuals the most common health insurance options are:

Medicare onlyMedicare Advantage planMedicare with a Medicare supplementMedicare with an employer-

sponsored plan

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Medicare onlyPart A

Coverage begins after a deductible, which is $1100 for 2010

Hospital coverage: The first 60 days of a hospitalization are covered

with no co-pays Days 61-150 are covered with daily co-pays of

$275-$550 for 2010 No coverage after day 150

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Medicare onlyPart A

Skilled nursing facility coverage: The first 20 days in a skilled nursing facility are

covered with no co-pays Days 21-100 are covered with daily co-pays of

$137.50 for 2010 No coverage after day 100

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Medicare onlyPart B

Coverage starts after a calendar year deductible $155 for 2010

Coverage for doctor office visits: Office charge – 80% co-insurance coverage Clinical laboratory services – 100% coverage Annual physicals, routine eye and hearing exams –

not covered, except for one physical exam when you first become eligible for Part B

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Medicare onlyPart B

Coverage for chiropractic care: 80% co-insurance coverage

Other outpatient services: Generally covered at 80%

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Medicare only summary You must pay the monthly Medicare Part B

premium.This is paid through a monthly deduction from

your Social Security check.

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Medicare only summary Out-of-pocket costs can be very high.

$1100 deductible per benefit period for hospitalizations – you could be required to pay several deductibles in one year.

20% of most outpatient charges, including surgeries, secondary provider, rehabilitation, oxygen, diabetic supplies, etc.

Large daily co-pays for extended hospital and nursing home stays.

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Medicare only summary In general, prescription drug coverage is not

provided.

You have the freedom to choose your own doctor or hospital.

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Medicare Advantage The Medicare Advantage plan replaces original

Medicare.

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Medicare AdvantageInsurance companies contract with

Medicare to offer plans and Medicare reimburses the company for each member enrolled.

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Medicare AdvantagePremiums can vary widely and can be as

low as $0.

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Medicare Advantage

Coverage is subject to change or termination every January 1.

There is lock-in period each year. Trial 12-month period during first time in Medicare Advantage plan.

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Medicare Advantage

State-mandated benefits are not required with these plans.- This could affect coverage for chiropractic,

diabetes, home health care and other services.

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Medicare Advantage

You cannot purchase a Medicare supplement to pay your out-of-pocket costs.

Benefits vary widely from plan to plan.

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Medicare Advantage Out-of-pocket costs vary widely from plan to plan.

This can vary from $500 to $5,900 per year*, though on some plans the actual out-of-pocket cost can be as high as $10,000 per year**, or may have no specific limit for some services.

* Source: 2006 Medicare Advantage Costshare Report, Milwaukee Area Comparison** Source: www.Medicare.gov

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Medicare Advantage The OCI warns that you may also be responsible

for paying your doctor or hospital bills if you do not follow the Medicare Advantage plan’s rules.***

These plans are not under the jurisdiction of the State of Wisconsin (OCI).

*** Source: State of Wisconsin Office of the Commissioner of Insurance Medicare Advantage- Questions and Answers, September, 2006

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Medicare Advantage

For some plans you have to obtain a referral from a primary care doctor before you can see a specialist.

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Medicare Advantage

Out-of-area coverage can be limited to emergency care needed to diagnose and stabilize your condition.

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Medicare Advantage

If you see a provider who does not accept the plan’s fee schedule, you will not be covered and will be responsible for the entire amount charged by the provider.

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Medicare Advantage

You can only receive care (except in emergencies) from providers that accept the terms and conditions of the plan.

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Medicare Advantage

These plans must have benefits at least equivalent to Medicare only, but not necessarily any better than Medicare by itself.

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Medicare Advantage

Funding of Medicare Advantage plans will be reduced in the future.* Based on past experience, this may cause significant changes in benefits and premiums.**

* Source: Congressional Budget Office Cost Estimate for H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008

** Daily Health Policy Report – kaisernetwork.org -1/2003

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Medicare Advantage summary

Out-of-pocket costs can be very high. There are no protections and guarantees from the

State of Wisconsin. The least expensive plan is not necessarily the best

option for you.

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Medicare Advantage summary

The Board on Aging and Long Term Care offers the following perspective on Medicare Advantage and Part D plans: “If it sounds too good to be true, it probably is.”*

* Source: Board on Aging and Long Term Care press release, September 2006.

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Medicare Supplement

You must be covered by original Medicare Parts A and B.

The supplement pays out-of-pocket costs for services covered by Medicare.

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Medicare Supplement

Five optional coverage riders are available:1. Part A deductible2. Part B deductible3. Part B excess charges4. Additional home health care5. Foreign travel

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Medicare Supplement

Plan prices vary widely from company to company.

Long-term rate stability varies for each plan.

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Medicare Supplement

The options you choose for your plan will create variations in cost.

The least-expensive plan is not necessarily the best long-term option for you.

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Medicare Supplement

Medicare supplements are guaranteed renewable.

Plans can be purchased with no co-payments or deductibles.

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Medicare Supplement

There is no paperwork to handle.Freedom to use any doctor or hospital based

on the network.

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MercyCare Senior

Has been providing coverage since 1994Coordinates all aspects of health care to

ensure patients receive the most effective care at the lowest possible cost

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MercyCare Senior

MercyCare Senior covers the five optional coverage riders 1. Part A deductible

2. Part B deductible

3. Part B excess charges

4. Additional home health care

5. Foreign travel

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MercyCare Senior

Provides: $25 Stay Healthy Benefit Chiropractic Services Equipment and some diabetic supplies No pre- examination No Waiting periods Routine physical exams, including eye and

hearing

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SummaryMedicare Advantage Medicare Supplement Plans

You are no longer covered under the original Medicare program. An insurance company contracted with Medicare provides benefits in place of Medicare

You keep your original Medicare coverage along with gap coverage to pick up out of pocket expenses

Coverage is subject to terminations each January 1st – the plan can drop you at the end of the year if it doesn’t renew its contract with Medicare

The plan cannot terminate your coverage as long as you continue to pay your premiums when they are due

There is lock-in period each year. This means that between April 1 and December 31 of each year you cannot change to another plan

There is no lock in period – you can leave the plan whenever you choose

State mandated benefits are not required with these plans.

All benefits mandated by the state of Wisconsin are included in the policy

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Summary

Some things to keep in mind about all your Medicare plan alternatives:

Just because a plan has no monthly premium, doesn’t mean it’s not going to cost a lot of money.

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Summary

Don’t be pressured. - Don’t let a sales person pressure you

into enrolling. - Don’t be pressured to enroll at a

seminar. - Take time to think about your decision.

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Summary

Get advice from professionals if you have any concern about a plan being offered to you.

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Summary

Make certain your decision is good for the long term, not just for now.

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Questions?

If you have any questions or are interested in MercyCare’s Medicare Supplement Plan,

Contact me anytime at: Josh Mummery 608-758-7738 jmummery@mhsjvl.org

Thank You!