bia medicare 101 presentation short form
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MEDICARE MADE SIMPLEBIABoone Insurance Associates Education Guide: Current10/20/2014
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About Boone Insurance Associates
Boone Insurance Associates provides health and life insurance products to clients all overOregon.
We work directly with the companies to resolve any of your claim, benefit, & premiumquestions.
Unlike a captive insurance producer who represents that insurance company alone, we areindependent of a specific insurance company and represent a variety of differentcompanies and products.
Boone Insurance Associates provides this educational program today to help inform you.There is no obligation for you to purchase services from us.
“Our pledge is to provide our clients with superior customer service and product knowledge inorder to guide them in making the most informed decisions."
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Companies We Represent
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• Aetna• Cigna• Coventry• Equitable Life and Caul• Health Net• Lifewise• MODA• Pacific Source• Providence• Regence Blue Cross Blue
Shield• Sentinel
Terminology
Deductible: A specific dollar amount that your health insurance company mayrequire that you pay out-of-pocket each year before your health insurance planbegins to make payments for claims.
Coinsurance: The amount that you are obliged to pay for covered medicalservices after you've satisfied any co-payment or deductible required by yourhealth insurance plan. Coinsurance is typically expressed as a percentage of thecharge or allowable charge for a service rendered by a healthcare provider. Forexample, if your insurance company covers 80% of the allowable charge for aspecific service, you may be required to cover the remaining 20% as coinsurance.
Maximum Out of Pocket (OOP): An annual limitation on all cost-sharingfor which patients are responsible under a health insurance plan. This limit does notapply to premiums, balance-billed charges from out of network health careproviders or services that are not covered by the plan.
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Parts of Medicare
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A Hospital B Physicians C Medicare Advantage D Prescription Drug Benefit
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Original Medicare
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No Benefits while traveling outside the USA
Deductibles and co-insurance
Part A Deductible $1184 (first 60 days)
Part B Deductible $147 Part B Coinsurance 20% Unlimited liability for you
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Medicare Supplement (Medigap) Plans
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Standardized A – N
Can see any provider that will see you as a Medicarepatient
Does NOT include Part D
Prices vary widely from company to company.
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Medicare Advantage Plans
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HMO
PPO
SNP’s
PFFS
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Part D – RX Coverage
Voluntary/Penalty Model Plan Plan Designs Formulary Pharmacies Do you need to shop?
Donut Hole Gap issues Gap solutions Low Income Subsidy
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2013Medicare Part D “Buckets”
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Deductible ICL Donut Hole Catastrophic1 2 3 4
Deductible Initial Coverage Limit (ICL) Donut Hole or CoverageGap
Catastrophic
$0 to $310 $2850 $4550 Insurance will pay 95%
Does your plan have adeductible?
A credit of money which isreduced each time you filla prescription
Money you spend out ofyour pocket from buckets1, 2 &3
of covered medicationsthrough December 31st
Copayments andcoinsurance apply here
Maximum out of yourpocket is $4550
You pay 5%
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Plan Analysis
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Cost – What will my monthly premium and out-of-pocket costs be?
Benefits – Do I want extra benefits and services,like eye exams, routine physical exams, preventivedental or alternative care?
Doctor Choice – Can I see the doctor(s) I want tosee? Do I need a referral to see a specialist?
Convenience – Where are the doctor’s offices? Isthere paperwork? Do I have to file claims myself?
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Enrollment Periods
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IEP-Initial Enrollment Period
AEP-Annual Election Period 10/15 - 12/07
ADP-Annual Dis-Enrollment Period 1/1- 2/14
SEP-Special Enrollment Period
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