Medicare 101

Meeting will start promptly at 6:30p.m.

Medicare 101Educational Program

Medicare 101

Our members’ healthcare and satisfaction come first!

Torrance Memorial IPA

Presents:

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Medicare 101

Moderated by:

Norman Panitch, MD

Chairman

Torrance Memorial IPA, Physician Council

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Medicare 101

Housekeeping items

1. If you lose your internet connection, we ask that you re-join the meeting using the same Meeting ID: 550 271 0842

and Password: 156096

2. Due to our large audience, our meeting host will mute everyone during the presentation. At the end of each section we

will have time for Q/A.

3. Should any unwanted guests enter our Zoom meeting, our host will temporarily end the meeting. You can re-join

by using the same meeting ID: 550 271 0842 and Password: 156096

4. Please access the materials for today’s presentation on TorranceMemorialipa.org

Agenda

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Today’s program has 2 parts

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What is it?

How does it work?

What are my choices?

Which option may be right for me?

What is an IPA?

What is Torrance Memorial IPA?

What can it do for me?

What is coordinated care?

Medicare 101

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About Medicare

About Torrance Memorial IPA

Vince KellyCa License #0B99231

(310) 625-1837www.MedicareBabyBoomer.com

Rose StraubCa License #0K48128

(310) 715-2300www.YMA Insurance.com

Independent Health Insurance AgentsSpecializing in Medicare

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Personal guidance withMedicare Part A&B enrollment, time frames, and coverage options.

Finding plans accepted by your preferred physicians and hospitals.

Finding plans that cover your prescription drugs (Part D).

Medicare Supplement plans

Medicare Advantage plans

HMO’s & PPO’s

There are no fees for our services!

Medicare 101Version 4.1 3/15/19

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Medicare 101

Medicare Health Insurance Offices18411 Crenshaw Blvd. 4th Floor

Torrance, CA 90504

Crenshaw Blvd. & 405 Freeway

What is MedicareFederal Health Insurance Program

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Medicare 101

A single-payer government program that provides

health insurance coverage for people who are 65 or

older or with certain disabilities.

• Became law in 1965

• A result of the Medicare Act

• Signed by President Lyndon Johnson

• Former President & First Lady Truman

were the 1st recipientsFormer President & First Lady Truman received the

1st Medicare Insurance Cards

How to get my Medicare Card

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Medicare 101

Turning 65

• Receiving SS Benefits = Card is automatically sent USPS

• Delaying SS Benefits = Must request Parts A&B from Social Security Office

Under 65• Receiving SSDI with certain disabilities for over 24 months = Automatically

• End-Stage Renal Disease (ESRD) = Depends on circumstances

ESRD = Kidney failure requiring dialysis or kidney transplant

Items to watch for in the mailOfficial government publications & documentation

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Medicare 101

Trusted ResourcesOfficial government agencies and websites

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Medicare Resources

When to sign up for Medicare or make a change

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Medicare Enrollment Periods

Enrollment Periods

Initial Enrollment Period

Annual Enrollment Period

Special Enrollment Period

General Enrollment Period

Coverage begins January 1st

Turning 65

No late enrollment penalty for Part B

Late enrollment penalty for Part B

Coverage begins July 1st

Up to 8 months after leaving agroup health plan or moving

out of the service area.

October 15th - December 7th

January 1st - March 31st

The 4 Main Parts of Medicare

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Hospital Insurance

• Inpatient Care

• Skilled Nursing

• Hospice

Original Medicare

Parts of Medicare

Medical Insurance

• Outpatient Care

• Diagnostics

• Doctor Services

• Medical Supplies

Medicare Advantage

• Private Insurance takes over

Parts A&B

• HMO or PPO services

• Regulated by Medicare

Rx Drug Coverage

• Private Insurance

• Stand Alone or combined with

Part D = (MA+PD)

• Regulated by Medicare

In Patient Hospital Insurance, Skilled Nursing, and Hospice Care

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Part A Premium• Most people do not pay a premium = $0 per month• If you paid Medicare taxes for less than 40 quarters = $458 per month

Hospital Coverage

• Days 1-60 = $1,408 (deductible)

• Days 61-90 = $352 per day each benefit period

• Days 91-150 = $704 per day each benefit period (up to 60 days of your “Lifetime Reserve Days”)

• Days 151+ = you pay all costs

Skilled Nursing Facility Coverage

• Days 0-21 = $0

• Days 21-100 = $176 per day

• Days 101+ = you pay all costs

Parts of Medicare

Medicare Part A

Medical Insurance: Outpatient Care, Diagnostics, Doctor Services, and Medical supplies

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$144.60 monthly premium• Taken out of Social Security, or billed quarterly ($433.80/quarter)

• Higher incomes pay higher Part B Premiums

• Lower incomes may qualify for Medi-cal premium assistance

• Enrolling in Medicare may trigger a redetermination of Medi-cal

Covers 80% of all services

• You pay for 20% share of costs on all services with no cap

(including most inpatient hospital doctor services)

• $198 annual deductible

Parts of Medicare

Medicare Part B

3 Health Plan Options

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Parts of Medicare

• Medicare Supplement Plan (Medigap) + Rx Plan

• Medicare Advantage HMO Plan

• Medicare Advantage PPO Plan (not popular in LA county)

Medicare Supplement or Medicare Advantage

Medicare Supplement Insurance

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Medicare Supplement

aka Medigap Policy

Original Medicare Pays 80%

Hospital Insurance Medical Insurance

+

Medigap Policy Covers 20%

Most popular

is Plan G

(est $180.00 per month)

Medicare Prescription Drug Coverage (PDP), $40 per month on average

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The amount a plan will cover is based on a Formulary (list of prescription drugs)

• Consider how your prescriptions are covered before choosing a plan

• Tier 1 = $

• Tier 2 = $$

• Tier 3 = $$$, etc.

Parts of Medicare

Drug coverage is an optional benefit• If you decide not to get Rx coverage when you’re 1st eligible, you may pay a penalty

• unless you have creditable drug coverage or get extra help

• you will pay this penalty for as long as you have Rx coverage

• Coverage Gap - aka the Donut Hole

Medicare Rx Part D

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Parts of Medicare

Coverage Gap aka The Donut Hole

Medicare Rx Part D

$4,020 $6,350

Parts of Medicare

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Medicare Advantage Plans are offered by private insurance companies

• Plans are regulated by Medicare

• Takes over Parts A+B+D

• You must choose a Medical Group and Insurance Company

Medicare Advantage Plans with Prescription Drug Coverage (MAPD)

Medicare Advantage Part C

Original Medicare

+ + =

Parts of Medicare

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• Over 32 drug plans in LA County

• Monthly premiums average $40

• May have annual deductible up to $435

Part D stand-alone Rx Drug Plan

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Medicare Advantage + Rx Drug Plan

• Medicare Advantage Plan (Parts A+B)

• Combined with Rx Drug Coverage (Part D)

• aka MAPD (Parts C+D)

There are 2 ways to get Medicare Prescription Drug Coverage (PDP)

Medicare Rx Part D

Medicare Advantage

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• We contract with all of the major Insurance Companies

that offer accredited Medicare Advantage plans

Choose Insurance Company:

The Parts of Medicare Advantage HMO Plans

• Torrance Memorial IPA *

• Healthcare Partners

• UCLA Health

• + many others

Choose Medical Group:

Torrance Memorial Medical Center – rated most outstanding hospital in the South Bay and recently chosen

most outstanding non-teaching hospital in the United States

Torrance Memorial IPA voted best medical group in the South Bay for 7 years

Routine Care is all done within the Medical Group

ER/Urgent Care covered worldwide

Monetary Advantages –many benefits at low cost

…and many other advantages that Dr. Panitch will talk about later

Case Study

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Case Study

A female, 65 years old, in 1 calendar year• Has 12 doctor visits

• Spent 4 days in the hospital for a minor surgical procedure

• She also takes 3 generic prescription drugs per month

After paying a monthly $144.60 premium for Medicare Part B, under the following scenarios she may have also paid:

Group retirement plans or Medi-Cal have different cost structures

* Additional costs for out of network providers may apply

$2,676*

Medicare AdvantagePPO

$4,462

Original MedicareParts A+B

$2,616$180/mo + $40 average

Medicare SupplementWith Plan G + Drug Coverage

$0 - $300

Medicare AdvantageHMO

Meet Heidi

Options to considerChoosing Medicare coverage

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Medicare 101

•No Drug Coverage

•Freedom to choose any doctor that accepts Medicare nationwide

•No limit to out of pocket costs

•Freedom to choose any doctor that accepts Medicare nationwide

•Out of pocket costs limited to monthly premiums only

•Added benefits - Health club, vision discounts, nurse help-lines

•Includes drug coverage

•Low or no co-payments or co-insurance

•Must use in-network doctors, specialists and hospitals

•Coordination of care, patient advocate, care management

•Added benefits - Health club, vision discounts, nurse help-lines

•Includes drug coverage

•Monthly premiums + co-payments + co-insurance applies

•Out of network providers = higher costs

•Annual deductible if out of network providers are used

•High maximum out of pocket costs

Original Medicare A+B

Medicare + Supplement + Rx Medicare Advantage PPOMedicare Advantage HMO

Q & A

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Medicare 101

TORRANCE Memorial IPAA non-profit multi-specialty physician network and a division of Torrance Memorial Health System, that has been taking care of the South Bay for more than 35 years

26Medicare 101

On April 1, 2020,Torrance Health IPA (THIPA) changed its name to Torrance Memorial IPA. We changed our name to better reflect our relationship with the nationally known Torrance Memorial Medical Center.

Medicare 101

Experience the Torrance Memorial IPA differenceHow we help our members stay healthy

Over *500 Primary Care Physicians & Specialists in all sub-specialties of Medicine

Over 35 years in the South Bay and a division of Torrance Memorial Health System

Convenience! The Only IPA offering Member Self-Referral to select specialties

Now affiliated with Cedars-Sinai Medical Center!

* TorranceMemorialipa.org/find-a-doctor

Medicare 101

• The ONLY medical group in the South Bay offering direct access or

“Member Self-Referral” and open access to these specialties:

✓ Cardiology

✓ Dermatology

✓ Gastroenterology

✓ GYN

✓ Podiatry

✓ Pulmonology

✓ Urology

✓ Care Management –

for members with chronic health conditions

The Torrance Memorial IPA Difference: Convenient Access

Medicare 101

Medicare Advantage Transportation

Some Medicare Advantage plans cover non-emergency transportation. In fact, some Medicare Advantage plans partner with ride-sharing services such as Lyft to provide transportation to members.

Torrance Memorial IPA Awards and Recognition

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Torrance Memorial Medical Center Recognized for Quality

Newsweek names Torrance

Memorial tenth best hospital in

California and top non-Academic

hospital in the nation!

Medicare 101

Torrance Memorial Medical Center has once again been recognized as a Best Hospital for 2020-21 for the ninth straight year by U.S. News & World Report, placing the hospital in the top 3% in the state.

Medicare 101

Torrance Memorial Medical Center Recognized for Quality

Torrance Memorial Medical Center has received certification from DNV GL - Healthcare as a Comprehensive Stroke Center, reflecting the highest level of competence for treatment of serious stroke events.

Medicare 101

Torrance Memorial Medical Center Recognized for Quality

Torrance Memorial Medical Center Recognized for Quality

36Medicare 101Medicare 101

Cedars-Sinai Affiliation: What it Means

Cedars-Sinai AffiliationWhat it is and Means for Torrance Memorial IPA:

• Strong clinical partner

– Neurosurgery/Endovascular procedures

– Cardiothoracic Surgery

• Cancer Clinical Trials

• Strong specialty/quaternary care coordination

What it is Not:

• Consolidation or combination of provider networks

Medicare 101

Cardiology

COR Healthcare Medical Associates

Azam, Salman, MDBanka, Gaurav, MDBauer, Brenton, MD

Chhabra, Ankush, MDCastleman, Eric, MDFrench, James, MD

Matchison, J. Christopher, MDReddy, Ram, MD

Wyman, Ray, Michael, MDYang, Ted, MD

Torrance Location2841 Lomita Blvd. #100

Torrance, CA 90505

Torrance Memorial Physician Network

South Bay HeartCarlson, L. Douglas, MD

Cohen, David, I., MDShin, Victoria Y., MD

Torrance Location2841 Lomita Blvd. #235

Torrance, CA 90505

Redondo Beach LocationJackson, Bruce, MD

520 N Prospect Ave. #300Redondo Beach, CA 90277

Averill, William K., MD3400 Lomita Blvd. #603

Torrance, CA 90505

Khaleeli, Emad, MD3475 Torrance Blvd. #D

Torrance, CA 90503

Lopez, Joseph, MD3475 Torrance Blvd. #D

Torrance, CA 90503

* See Torrance Memorial IPA Physician Directory for details

Medicare 101

Orthopedic SurgeryOrthopedic Surgical Specialists

Frisancho, Juan, MDLorman, Peter, MDStriplin, Donald MD

23600 Telo Ave. #180,Torrance, CA, 90505

Torrance Memorial Physician NetworkOrthopedic and Spine Center

Andrawis, John, MDHoshino, Christopher, MD

Lim, Andrew, MDNuccion, Stephen, MD

Sanders, Don, MDZickur, Keri Reese, MD

Zinar, Daniel, MD705 Pier Ave., Suite B

Hermosa Beach, CA 90505

23550 Hawthorne Blvd.,#120Torrance, CA 90505

23560 Crenshaw Blvd., #102Torrance, CA, 90505

* See Torrance Memorial IPA Physician Directory for details

Medicare 101

Member Services TeamHelp is just a phone call away!

A major advantage to you!

• Single Point of Contact: Helping members

navigate the system easier and faster

• Calls answered by a local rep

• Help with customer service needs: • Assistance in finding a doctor

• Verify eligibility

• Billing issues

• Check authorization status of medical treatments

Medicare 101

Toll-Free: 866-568-4472|TTY: 711Monday - Friday 8:30am - 5pmTorranceMemorialipa.org

Comprehensive Care Programs

• Case Managemento Nurses and Social Workers

o FREE for Members

o Members with Chronic Health Conditions

• Care Coordination Center

• Health Coach

• Can self-refer to Case Management

without any authorization

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Ujjwala S. Dheeriya,

MD

Palliative Care

Medicare 101

Sina Samie, MD

Interventional Pain Medicine

Primary Office:

23550 Hawthorne Bl., Suite 120

Torrance, CA 90505

Secondary Office:

23560 Crenshaw Bl., Suite 102

Torrance, CA 90505

Medicare 101

Torrance Memorial IPA Senior Advisory Board

•We listen to our members!

•Torrance Memorial IPA members

meet with leadership quarterly to

share feedback and provide valuable

suggestions to management

Standing: Gayle, Noel, Bernie, Dr. Panitch, Gary, Robert, ArturoSitting: Christie, Sheila, Renee, Mike

Medicare 101

Convenient Urgent Care Centers

Torrance Manhattan Beach

Effective October 14th, the Torrance Urgent Care will be relocatingto 2900 Lomita Blvd., Torrance

Torrance Memorial IPA is NOT Your Insurance Company

We contract with major Insurance Companiesthat offer Medicare Advantage plans approved by CMS

They provide the benefits & Torrance Memorial IPA provides the care

For a complete listing of plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/ 7 days a week or consult www.medicare.gov.

Medicare 101

Circle of Health

Medicare 101

Medicare 101

Our New Primary Care Physicians

New To Medicare?

Join one of many

Medicare Advantage Plans

Ready To Join Torrance Memorial IPA?

Call the Torrance Memorial IPA Resource Center

and speak to Linda 310-257-7239

TorranceMemorialipa.org/learnmore

Medicare 101

Already have a Medicare Advantage Plan?

Switch your medical group to Torrance Memorial

IPA today!

Saturday, October 24th, 202010:00 a.m. – Noon

Medicare 101

2021 Medicare Advantage Benefit Highlights Webinar

TorranceMemorialipa.org

Thank You for attending!

Torrance Memorial IPA Mascot: Bella Panitch

Medicare 101

Vince KellyCa License #0B99231

(310) 625-1837www.MedicareBabyBoomer.com

Rose StraubCa License #0K48128

(310) 715-2300www.YMA Insurance.com

Independent Health Insurance AgentsSpecializing in Medicare

52

Personal guidance withMedicare Part A&B enrollment, time frames, and coverage options.

Finding plans accepted by your preferred physicians and hospitals.

Finding plans that cover your prescription drugs (Part D).

Medicare Supplement plans

Medicare Advantage plans

HMO’s & PPO’s

There are no fees for our services!

Medicare 101

Q & A

Medicare 101