2. Today’s Agenda
• The ABC’s of Medicare & Gaps In Coverage
• What Is A Medicare Supplement
3. Medicare ABC’S
• Part A:
-Eligible at age 65 & most people automatically enroll
-Covers most costs for inpatient Hospital Care
-Initial deductible of $1,132 with $283 & $566 co-payments
-Covers skilled nursing facilities for up to 100 days
• Part B:
-Must sign up for it &most pay a monthly premium
-Deductible of $162 in 2011
-Helps cover doctors’ visits & outpatient hospital care expenses
• Part C:
-Medicare Advantage health plans options approved by Medicare
-Run by private companies & usually offer additional benefits
-May provide specialized care for people in need
-Replaces Medicare Parts A and B.
• Part D:
-Prescription Drug Plans for Medicare A&B clients’
-Charge a monthly premium that varies by plan
-Allows clients to get the coverage needed at the best price possible.
4. Gaps In Coverage
Original Medicare “Parts A&B”
-Covers a portion of approved medical expenses
-Individual is reasonable for the remaining share
Part A Part B
– $1,132 deductible for days
Hospital Stays 1 – 60
Deductible $162 per year
– $283 per day for days 61 –
90
– $566 per day for days 91 –
150
– $0 for first 20 days
Skilled Nursing – Up to $141.50 per day for
Facility days 21 – 100
20% coinsurance
Doctor &
– 100% after day 100 Copayments for
Care Outpatient
Services hospital
outpatient services
– 100% for first 3 pints
– 20% for additional pints
Blood
5. Covering The Gaps
• Medicare Supplement Polices
-Helps individuals reduce financial liability.
- May give discounts on vision.
-Coverage level depends on the plan you
buy.
- Costs are in addition to original Medicare
premiums.
6. Additional No Coverage Gaps
• Not covered under Medicare Supplement
or Medicare
- Dental
- Vision
- Long Term Care
- Eyeglasses
- Private – Duty Nursing
7. Medicare Supplements Glance
• Supplement Basics
- Sometimes called Medigap
- Offered through Private Companies
- Follows Federal & State Laws
- Most states only offer “standardized”
- All plans regardless of company must offer
same benefits
- Price & customer service “Only” difference
8. Medicare Plans
• Plan Identification Letters
- A,B,C,D,E,F,G,H,I,J,K,L,M,N
• Plans No Longer Available
- E,H,I,J
Note;
• New Plans In 2010 Carries May
- N and M Choose To Offers
Select Plans
10. Plan Premiums
• Factors That Effect Costs;
1. Plan
2.*Company
3.Where you live “zip code”
4.**Age
* Benefits remain the same regardless
of company.
** Individuals can’t be single out for an
increase based on age. The increase
must be given to entire age group in
that zip code.
11. Important Changes To Know
• Policies effective on-after June 1st 2010
- Hospice Part A “Covered”
- K- covers 50% and L- covers 75%
• Plans K,L,N
- May require cost share in Part B Coinsurance
• Plans D and G
- Sold before June 1, 2010 “Old Benefits”
- Purchased after June 1, 2010 “New Benefits”
• All Medicare Supplement Carriers
- Must offer plan A
- Also have to carry either plan C or F as option.
13. Enrollment Denied
• * People On Medicare Under 65
- Generally can’t purchase medigap “If offered it’s costly”
- End-Stage Renal Disease
• Individuals over 65 not in GI under certain situations
-That can’t pass medical underwriting.
* Some states require carries to sell
to under 65 Medicare beneficiaries
such as “North Carolina”.
14. Understanding The Individuals Needs
Medicare Supplement Additional Products
• Confused about healthcare options?
- Page 5 “2010 Medigap Book” • Are you concerned about the cost
involved in recuperating from a sickness
• Can you explain the changes CMS made in or injury?
2010
- New Plans
- Benefit Changes • Do you know anyone with cancer?
- 59.4% cancer cost are non-medical
• Is their coverage guaranteed renewable?
- Page 36 “2010 Medigap Book”.
• Have you consider paying for Final
• Is a network important? Expenses?
- Do they travel? - If so, what do you have set aside?
• Are out-of-pocket costs a concern?
• Ask about other concerns or questions.
- Hospital stays
- Doctor visits
• What would they change about current
insurance carrier?
• What do they look for in an insurance
company?
- Price
- Service
- Financial Security
15. Who Can Buy & When
When??
Who??
Individuals enrolling in
Individuals with Medicare Parts A and B
Medicare Parts A and B - 65th Birthday
- Generally only people
65 and older • During Guaranteed issue
period
Medicare members in - Up to 6 month before
your open enrollment birthday
period - Up to 6 months after
birthday
People covered under a
guaranteed issue right • If on Medicare Advantage
Plan
- Leaving service area.
16. Questions You May Get Asked
• Can I get a Medicare Supplement with drugs?
- No! Page 7 “2010 Medigap Book”.
• What plans can I get during guaranteed issue?
- Page 23-26 “2010 Medigap Book”.
• What documents will the company ask for during guaranteed issue period?
- Page 26 “2010 Medigap Book”.
• Can I switch Medicare supplement plans? “Yes”
- Although, companies do NOT have to appect you outside “GI”
- *Some cases allow you to switch from Medicare Select to regular plan if
relocated outside service area.
* Plan must have
same benefits.
18. Additional Options
• Medicare Advantage Plans
- Can be issued to individuals under 65
- Some come with Rx coverage
- Costs as little as 0 in addition to Part B
- Flexible underwriting
19. Why David Crotts Agent Support
• One-day turnaround on all individual and group quotes.
• The most up-to-date market information
• Product and sales training, personalized to meet your
agency's needs.
• Professional representative will work with you to close
your business accounts across the state.
• Interactive on-line agent tools.
20. Our Commitment ToYou….
As your General Agency’ is to bring you
the best the insurance industry has to
offer, including unsurpassed personalized
service and the latest in online interactive
agent tools.
21. Agent Support Staff
David Crotts
“President”
Kara Chastain Kathy Clarke
“Marketing Manager” “Support Specialist”
Chris Johnson LaNelle Grubbs
“Marketing Representative” “Senior Products Specialist”
22. The Extra Mile For You
At our Agency we understand the value of deep
client relationship. The more you can assist a
client the better the value your offering. With that
in mind we developed an investment division
dedicated to providing you the agent with a
trusted source to refer your clients to help them
with all their financial planning needs. This
includes helping them understand how to
organize, control and accumulate their wealth.
23. Products
• Health “Group & • Medicare Advantage
Individual”
• Medicare Supplements
• Life “Group &
Individual” • Prescription Drug Plans
• Short Term Disability • Long Term Care
• Long Term Disability • Critical Illness
24. The Next Step
As your Agent Support Liaison team, we will
partner with you to develop a marketing
strategy that will enhance and grow your
current organization.
No matter the size or stage of your business,
we will enhance your product portfolio,
solidify your client relationships, and lock
out the competition, maximizing your profit
potential.
Call: 1-(800)-803-7873 Ext: 237
422 Montague Avenue, Suite #7 ● Greenwood, SC 29649-1961
864-223-8788 ● 1-800-803-7873 ● Fax: 864-229-7392
Email: chris.johnson@dcrotts.com ● Web Page: www.dacagentsupport.com
