Medicare presentation for 2015

1. RLee Insurance Solutions
“Using Common Sense”

2. RLee Insurance Solutions
Who are we?...
Providing the right information to help make the right decisions
“Having worked in the senior market for years I was continually frustrated with the way
seniors 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 seniors 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 decisions just becomes a matter of “common sense”
Robin Lee
President

3. RLee Insurance 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 Insurance Solutions
Today…
Today there are 47 million people on Medicare
By 2030 that number will rise to 79 million!
People are living much longer, and life expectancy
keeps going up!

5. RLee Insurance Solutions
What are my cost?...
Part A cost:
For 2013, for those that don’t get Part A at no cost they pay $407.00/month
Part B cost:
If your yearly income in 2014 was You pay in
2015
File individual return File a joint return
$85,000 or less $170,000 or less $104.90
Above $85,00 up to $107,000 Above $170,00 up to $214,000 $146.00
Above $107,000 up to $160,000 Above $214,000 up to $320,000 $209.80
Above 160,00 up to $214,000 Above $320,000 up to $428,000 $272.70
Above $214,000 Above $428,000 $335.70

6. RLee Insurance Solutions
When you are
Hospitalized for:
Medicare Covers:
You pay:
(per benefit period)
1-60 days
Most confinement cost after
the required Medicare
Deductible.
$1,216 Deductible
61-90 days
All eligible expenses, after
the patient pays a per-day
copayment.
$304 A DAY COPAYMENT
as much as $9,120
91-150 days
All eligible expenses, after
patient Pays a per-day
copayment (Theses Are
Lifetime Reserve Days which
may never be used again).
$608A DAY COPAYMENT
as much as $36,480
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 $152.00 A
DAY COPAYMENT as much as
$12,160

7. RLee Insurance Solutions
When you are
Hospitalized for:
Medicare Covers:
You pay:
(per benefit period)
1-60 days
Most confinement cost after
the required Medicare
Deductible.
$1,260 Deductible
61-90 days
All eligible expenses, after
the patient pays a per-day
copayment.
$315 A DAY COPAYMENT
as much as $9,450
91-150 days
All eligible expenses, after
patient Pays a per-day
copayment (Theses Are
Lifetime Reserve Days which
may never be used again).
$630A DAY COPAYMENT
as much as $37,800
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 $157.50 A
DAY COPAYMENT as much as
$12,600

8. RLee Insurance Solutions
On expenses
Incurred for:
Medicare Covers:
You pay $147
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

9. RLee Insurance 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

10. RLee Insurance 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”?

11. RLee Insurance 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?

12. RLee Insurance 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.

13. RLee Insurance 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..
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.

14. RLee Insurance 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.

15. RLee Insurance Solutions
What are my cost?...
Part D cost:
If your yearly income in 2014 was You pay in 2015
File individual return File a joint return
$85,000 or less $170,000 or less Your plan
premium
Above $85,00 up to $107,000 Above $170,00 up to $214,000 $11.60 + your
plan premium
Above $107,000 up to $160,000 Above $214,000 up to $320,000 $29.90 + your
plan premium
Above 160,00 up to $214,000 Above $320,000 up to $428,000 $48.30 + your
plan premium
Above $214,000 Above $428,000 $66.60 + your
plan premium

16. RLee Insurance Solutions
2014 Part D coverage ...
2014 Basic Medicare Drug Coverage
2014 Basic Benefits You Pay
Deductible $310 100% of first $310
Initial Coverage Limit $2540 25% of the next $2540 ($635.00)
Coverage Gap $2850.00 100% of the drug cost
Annual – out- of- pocket amount $4550
Catastrophic Coverage Medicare and Plan
95%
5%

17. RLee Insurance Solutions
2015 Part D coverage ...
2015 Basic Medicare Drug Coverage
2015 Basic Benefits You Pay
Deductible $320 100% of first $320
Initial Coverage Limit $2640 25% of the next $2640 ($660.00)
Coverage Gap $2960.00 100% of the drug cost
Annual – out- of- pocket amount $4700
Catastrophic Coverage Medicare and Plan
95%
5%

18. RLee Insurance Solutions
“How will the new
healthcare law
benefit me?” …
New benefits in 2011...

19. RLee Insurance 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
Part D

20. RLee Insurance 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

21. RLee Insurance 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

22. RLee Insurance 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

23. RLee Insurance 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?

24. RLee Insurance 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?

25. RLee Insurance Solutions
Something not to consider...

26. RLee Insurance Solutions
SERVICES AVAILABLE
Medicare Supplements
Medicare Advantage Plans
Part D Drug Cards
Life Insurance
Annuities
Short Term Care
Long Term Care Insurance
Supplemental Health
Travel Insurance
Our Full line of Services…
Making your healthcare decisions
A matter of “using common sense”