Presentation on theme: "Humana Medicare Plans. If youre considering a Humana plan: The person discussing plan options with you is either employed by or contracted with Humana."— Presentation transcript:
Humana Medicare Plans
If youre considering a Humana plan: The person discussing plan options with you is either employed by or contracted with Humana. The person may be compensated based on your enrollment in a plan. Medicare/Medicaid Coverage (Dual-Eligible): If you are covered by both Medicare and Medicaid, you may be eligible for a special kind of MAPD plan. You should contact your state Medicaid agency and your doctor to determine if a Special Needs Plan (SNP) for dual eligibles is a good option for you. If you choose to enroll in a dual-eligible SNP, you may be responsible for any premiums, deductibles, copayments, and coinsurance associated with the plans services, depending on the level of extra help and/or Medicaid coverage you receive. Getting started… 2
Are you eligible? 3 Enrolled in Medicare Part A and Part B through age or disability? Permanent resident in service area? Do you have End Stage Renal Disease (ESRD)? Federal law will not allow us to accept anyone who has End Stage Renal Disease (kidney failure), unless you: 1. Are a member of another health plan offered by the same organization within the same state, or 2. Were enrolled in a Medicare Advantage plan which was terminated or discontinued after December 31, 1998, and this is your first election following that plan termination or discontinuance.
Important dates. Important dates 2010 Plan Year Medicare Timeline 2011 Plan Year Medicare Timeline Pre-Enrollment: Oct. 1 – Nov. 14, 2009 Compare your plan options and costs, so youll be ready to enroll by November 15. No change in 2010 Annual Election: Nov. 15 – Dec. 31, 2009 If youre eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan with or without Prescription Drug Coverage or you can enroll in a stand-alone prescription drug plan. No change in 2010 Open Enrollment: Jan. 1 – Mar. 31, 2010 Youre allowed to make one change – Medical coverage only. Annual Disenrollment: Jan. 1 – Feb. 14, 2011 Medicare Advantage plan members can return to Original Medicare and can enroll in a stand-alone drug plan. You will no longer be able to switch Medicare Advantage carriers during this time. Lock In: Apr. 1 – Nov. 14, 2010 Youre not allowed to make a plan change unless special circumstances arise (e.g., you move, you qualify for or lose eligibility for Medicaid). Lock In: Feb. 15 – Oct. 14, 2011 Youre not allowed to make a plan change unless special circumstances arise (e.g., you move, you qualify for or lose eligibility for Medicaid). 4 Note: This information does not apply to Medicare Supplement Plans
Our journey today... 5 Lets talk about... Choosing the right plan for you Your Medicare coverage options Humanas plans and extras How to enroll
Dedication to the community Nearly 50 years of helping people during their pre-retirement and retirement years Financial Stability Fortune 100 Company National Coverage Providing Medicare plans in 50 states, Puerto Rico, and the District of Columbia Over 3 million Medicare Advantage and stand-alone prescription drug plan members Humana Experience behind the coverage 6
What type of plan do you currently have? What do you like about your coverage? What would you add to your current coverage to make it ideal for you? Who helps you make decisions about your healthcare coverage? How do I choose the right plan for my needs? 7
Todays Medicare environment 8 Original Medicare Supplemental Plan Medicare Part D
Original Medicare you receive a service, you pay a fee You usually pay a monthly premium for Part B Access to any doctor or provider that accepts Medicare Out-of-pocket costs include hospital and medical deductible and coinsurance May want to purchase separate Medicare Supplement insurance to cover gaps Original Medicare 9
Medicare Supplement Insurance (also referred to as Medigap policies) Purchased from private insurance companies Supplements Original Medicare coverage Covers some or most costs that Original Medicare does not pay Medicare pays before the Medicare Supplement pays Plans are standardized and can be purchased with varying coverage options Medicare Supplement plans have no provider networks Original Medicare + Medicare Supplemental Insurance 10
Medicare Advantage (MA) plans are called Medicare Part C. Private insurance companies approved by Medicare provide this coverage MA plans are not the same as Medicare Supplement insurance Medicare pays the plan (Humana) 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 What are Medicare Advantage (MA) health plans? 11
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 Less paperwork and fewer ID cards What are Medicare Advantage (MA) health plans? 12
Choices in Medicare Advantage (MA) Plans Health Maintenance Organization (HMO) LEARN MORE LEARN MORE Preferred Provider Organization (PPO) LEARN MORE LEARN MORE Private-Fee-For-Service (PFFS) LEARN MORE LEARN MORE 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 Medicare Advantage offers more plan choices 13
Health Maintenance Organization (HMO) Defined network of providers Primary Care Physician (PCP) coordinates all of your care You may have to receive a referral from your PCP to see a Specialist You must use network providers for all scheduled care. No coverage for out-of- network care, except for emergency or urgent care Out-of-pocket costs may be significantly lower Is an HMO plan right for you? 14 Go to: Is a Stand-Alone drug plan right for you?
Preferred Provider Organization (PPO) Defined network of providers No referral needed to see any doctor Flexibility to use providers who are not part of the network Out-of-pocket costs may increase significantly when out-of-network providers are used, except for emergency or urgent care Greater savings may be obtained when network providers are used because the plan pays a larger share of the cost Is a PPO plan right for you? 15 Go to: Is a Stand-Alone drug plan right for you?
Private-Fee-for-Service (PFFS) No referral needed to see any doctor Most plans include provider networks, but any provider can participate EXCEPT – Your doctor must agree to accept the Private-Fee-for-Service plans payment terms and conditions – For plans with Rx you must use network pharmacies to obtain prescription drugs, except in emergencies or urgent situations Is a PFFS plan right for you? 16
Private-Fee-for-Service (PFFS) Before seeing a provider you should consider... – If a provider decides not to accept the plan, you will need to find another provider who will – If they choose to provide services, they must bill the Private-Fee-for-Service plan for your covered healthcare services. They may not bill you. – If your PFFS plan has a network, you can still receive services from non-network providers, but you may pay more to see a doctor or other healthcare professional who is not in our network – Private-Fee-for-Service plans do not pay after Medicare pays its share – You are required to pay the appropriate deductibles, copayments, and coinsurance Is a PFFS plan right for you? 17
A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare Supplement plan. We have network providers (that is, providers who have signed contracts with our plan) for all services covered under Original Medicare in our fully networked plans. For partial network plans, contracted providers are limited to certain Durable Medical Equipment, home health providers, and some freestanding labs and hospitals. These providers have already agreed to see members of our plan. If youre able to obtain covered services from network providers, you may pay less even if your coinsurance is the same for both in-network and out-of-network services. Private-Fee-for-Service (PFFS) plan review 18
If your provider is not one of our network providers, or if you have a non-network plan, then the provider is not required to agree to accept the plans terms and conditions of payment, and they may choose not to provide healthcare services to you, except in emergencies. If this happens, you will need to find another provider that will accept our terms and conditions of payment. Providers can find the plans terms and conditions of payment on our website.website Private-Fee-for-Service (PFFS) plan review 19 Go to: Is a Stand-Alone drug plan right for you?
Medicare Part D Prescription Drug Plans (PDP) Plans offered by private companies under contract with Medicare Companies may offer plans with increased coverage Evaluate your prescription drug needs in relation to those covered by the plan, and your cost for those drugs Calculate your prescription drug costs here Is a Stand-Alone drug plan right for you? 20
The basic plan all Part D plans are required by law to offer benefits equal to or better than the following: Part D Prescription Drug plan 2011 Medicare Prescription Drug Plan Basic Coverage 2011 Basic BenefitsYou Pay Deductible$310100% of first $310 Initial Coverage Limit$2,840 25% of the next $2,530 ($632.50) Coverage Gap*$3, % of next $3, Annual Out-of-Pocket Amount$4,550 ** Catastrophic CoverageMedicare and Plan 95%5% *** *See Coverage in the Gap on following slide ** Annual Out-of Pocket Amount does not include monthly premiums. *** Member pays the greater of $2.50 for generic/preferred multiple-source drug and $6.30 for all other drugs, or 5 percent coinsurance. 21
Brand Coverage Discounts CMS will work with drug companies to provide a 50% discount on covered, brand-name drugs while in the coverage gap. People with Medicare who receive a low-income subsidy or are enrolled in an employer-sponsored retiree drug plan (with exception of employer groups with waivers) won't be eligible for this discount. Generic Coverage Discounts CMS will partner with healthcare plans to provide a 7% discount on generic drugs while in the coverage gap. Coverage in the Gap Starting January 1, 2011, Medicare is making changes to reduce the financial impact of the coverage gap "donut hole." 22
Learn about your Humana plan benefits 23
Mail-order pharmacy Fitness plan 24-hour nurse hotline SmartSummary ® What about when youre not sick? 24
How can Humana offer these benefits? 25
Complete an application and you will receive your ID card in about two weeks Complete Humanas Health Assessment you may qualify for special health programs Take full advantage of your plan and the extras Contact Humana or your Humana Agent any time you want What happens now? 26
Humana offers New Member Orientation Meetings for new members. Youll learn how to get the most from your Humana Medicare Advantage plan. Please join us for a meeting! You are invited... 27
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: MEDICARE ( ). TTY/TDD users should call , 24 hours a day/7 days a week; The Social Security office at between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, ; or Your state Medicaid office Extra help 28
Thanks for your time and attention. Any questions? Where to find information: Medicare and You 2011 handbook (available in October or November 2010) Your local State Health Insurance Program (SHIP) Questions? 29
The person that is discussing plan options with you is either employed by or contracted with Humana. The person may be compensated based on your enrollment in a plan. A Health plan with a Medicare contract, available to anyone enrolled in both Part A and Part B of Medicare. A stand-alone prescription drug plan with a Medicare contract, available to anyone entitled to Part A and/or enrolled in Part B of Medicare. Medicare beneficiaries, except for Group Medicare or Special Needs Plans, may enroll in the plan only during specific times of the year. Contact Humana for more details. You must use network pharmacies, except under non-routine circumstances. Quantity limitations and restrictions may apply. If you are a member of a qualified State Pharmaceutical Assistance Program, please contact the Program to verify that the mail order pharmacy will coordinate with that Program. This document is available in alternative formats or languages. Please call Customer Care at , if you use a TTY, call 711. Both numbers are available 8 a.m. to 8 p.m., seven days a week, Nov. 15, 2010 – Feb. 14, 2011 and 8 a.m. to 8 p.m., Monday-Friday, Feb. 15, 2011 – Oct 14, Este documento está disponible en formatos o lenguajes alternativos. Llame al Departamento de Servicio al Cliente al , si usted utiliza un dispositivo TTY, marque el 711. Ambos números están disponibles de 8 a.m. a 8 p.m., los siete días de la semana, del 15 de noviembre de 2010 al 14 de febrero de 2011; desde el 15 de febrero, hasta el 14 de octubre de 2011, de 8 a.m. a 8 p.m., de lunes a viernes. Y0040_GNA0587HH_MAPD_CMS Approved