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Welcome 2010 Excellus BlueCross BlueShield Medicare Plans Workshop A nonprofit independent licensee of the Blue Cross Blue Shield Association (Sales Rep’s.

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Presentation on theme: "Welcome 2010 Excellus BlueCross BlueShield Medicare Plans Workshop A nonprofit independent licensee of the Blue Cross Blue Shield Association (Sales Rep’s."— Presentation transcript:

1 Welcome 2010 Excellus BlueCross BlueShield Medicare Plans Workshop A nonprofit independent licensee of the Blue Cross Blue Shield Association (Sales Rep’s Name) Medicare Sales Consultant Excellus BlueCross BlueShield contracts with the Federal government and is aMedicare Advantage Organization with a Medicare contract.

2 2 Our Vision “…to be a best in class Medicare Program, providing Medicare beneficiaries with a range of products and services that meet their needs for health coverage at an affordable price.”

3 3 Agenda  Medicare Basics  Plan Options & Benefits  Valuable Extras  Enhanced Web Tools  Questions

4 4 Medicare Basics There are two parts to Original Medicare: Part A and Part B Part A  Helps cover inpatient care in hospitals.  Helps cover skilled nursing facility, hospice and home health care.  You pay deductibles, coinsurance and copays.  You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

5 5 Medicare Basics Part B  Helps cover doctor’s services and outpatient care.  Helps cover some preventive care.  With Part B you pay premium, deductible, coinsurance and copays.  $96.40 monthly standard Medicare Part B premium generally deducted from Social Security check  $135 Part B annual deductible  20% coinsurance on most services

6 6 Medicare Basics Part C: Medicare Advantage Plans Part D: Prescription Drug Plans Medicare Supplement: Medigap Plans

7 7 Your Plan Options  Medicare Supplement Plans (Medigap)  Secondary payer to Original Medicare  Do not include Part D Drug Coverage Can purchase Part D separately  Medicare Advantage Plans  Medical Coverage with Part D Drug Coverage (MA-PD)  Medical Coverage without Part D Drug Coverage (MA)

8 8 What is a Medicare Supplement Plan? (Medigap)  A Medicare Supplement (Medigap) policy is designed to supplement the Original Medicare Plan  Fills gaps in Original Medicare  Medicare Part D drug coverage not included

9 9 Medicare Supplement Plans (Medigap) Plan A  Basic benefits only Plan B  Basic benefits  Part A deductible under Original Medicare Plan Plan C  Basic benefits  Parts A & B deductibles under Original Medicare Plan  Foreign travel emergency  Skilled Nursing Facility (SNF) coinsurance

10 10 Medicare Supplement Plans (Medigap) Plan F / High Deductible F+  Basic benefits  Parts A & B deductibles under the Original Medicare Plan  Foreign travel emergency  Part B excess charges  Skilled Nursing Facility (SNF) coinsurance  F+ has $2,000 deductible (deductible subject to change annually) Plan H  Basic benefits  Part A deductible under Original Medicare Plan  Skilled Nursing Facility (SNF) coinsurance  Foreign travel emergency

11 11 How Do Medicare Advantage Plans Work?  Provides Part A (Hospital) and Part B (Medical) Benefits  You pay affordable copays/coinsurance  Offers extra benefits such as: Vision Exam Hearing Exam Health and Wellness Preventive Services

12 12 Eligibility and Service Area You are eligible to join one of our Medicare Advantage HMO or PPO Plans if:  You have Medicare Part A (Hospital) and are enrolled in Medicare Part B (Medical)  You are a legal resident in the service area of the plan (includes: Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties, NY)  You do not have End-Stage Renal Disease (ESRD)

13 13 Medicare Advantage Plan Enrollment Periods Annual Enrollment Period (AEP)  Runs from November 15 – December 31, each year  Can change Medicare Advantage or stand-alone Prescription Drug Plans  Can add or drop prescription drug coverage  Can return to Original Medicare  Enrollment changes take effect on January 1 Open Enrollment Period (OEP)  Runs from January 1 – March 31, each year  Can change Medicare Advantage Plans  Cannot add or drop prescription drug coverage  One opportunity to change to a similar plan (No-drug plan to no-drug plan – OR – drug plan to drug plan)  Enrollment or disenrollment becomes effective the month after the application is received There are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage or stand-alone Prescription Drug Plan.

14 14 Initial Enrollment Period (IEP )  3 months before you turn age 65 to 3 months after the month you turn age 65  If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability  Can join a Medicare Advantage or stand-alone Prescription Drug Plan  Enrollment changes take effect on the first day of your birth month Special Enrollment Period (SEP)  Change of residence into or out of the service area  Loss of employer coverage  Qualify for Low Income Subsidy To obtain more information regarding Medicare Advantage Enrollment Periods you can contact our Customer Service Department at TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m. Medicare Advantage Plan Enrollment Periods

15 15 HMO vs. PPO HMO Health Maintenance Organization PPO Preferred Provider Organization Primary Care Physician (PCP) is requiredPrimary Care Physician (PCP) not required Referral required to see a specialistNo referral required to see a specialist Must use In-Network providers (You must use plan providers except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis.) Can use In-Network & Out-of-Network providers* (Out-of-pocket costs may be higher when you use an Out- of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis) *Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless ofwhether they are received in-network, as long as they are medically necessary.

16 16 Medicare Advantage Plan Options  HMO Plans  Medicare Blue Choice Value SM (HMO)  Medicare Blue Choice Value Plus SM (HMO)  Medicare Blue Choice Optimum SM (HMO)  Medicare Blue Choice Platinum SM (HMO)  PPO Plan  Medicare Blue PPO SM Plan 201 (PPO) For full information on our Medicare Blue Choice and/or our Medicare Blue PPO Plan benefits, call our Customer Service Department at or TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, Please contact Excellus BlueCross BlueShield for details.

17 17 Medicare Blue Choice Value SM (HMO) $ BenefitMedicare Blue Choice Value (HM0) Inpatient Hospital Care (unlimited days each benefit period) $500 copay for each Medicare-covered stay at a network hospital; Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full Primary Care Physician$20 copay per visit Specialist$40 copay per visit Outpatient Hospital Services 2 $0 - $125 copay per visit Radiology20% coinsurance Outpatient Prescription Drugs 3 (Part D) Part D with $150 annual deductible; Before total annual drug costs reach $2,830, for each 30 day supply you pay: $5 for Tier 1 generic drugs $30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred drugs 25% coinsurance for Tier 4 specialty drugs 1 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3 rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non- surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

18 18 Medicare Blue Choice Value Plus SM (HMO) $41 1 BenefitMedicare Blue Choice Value Plus (HM0) Inpatient Hospital Care (unlimited days each benefit period) $350 copay for each Medicare-covered stay at a network hospital; Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full Primary Care Physician$20 copay per visit Specialist$35 copay per visit Outpatient Hospital Services 2 $0 - $100 copay per visit Radiology10% coinsurance Outpatient Prescription Drugs 3 (Part D) Part D with $150 annual deductible; Before total annual drug costs reach $2,830, for each 30 day supply you pay: $5 for Tier 1 generic drugs $30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs 25% coinsurance for Tier 4 specialty drugs 1 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non- surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

19 19 Medicare Blue Choice Optimum SM (HMO) $101 1 BenefitMedicare Blue Choice Optimum (HM0) Inpatient Hospital Care (unlimited days each benefit period) $250 copay for each Medicare-covered stay at a network hospital; Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full Primary Care Physician$15 copay per visit Specialist$30 copay per visit Outpatient Hospital Services 2 $0 - $50 copay per visit Radiology$30 copay Outpatient Prescription Drugs 3 (Part D) Part D with $0 annual deductible; Before total annual drug costs reach $2,830, for each 30 day supply you pay: $5 for Tier 1 generic drugs $30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs 33% coinsurance for Tier 4 specialty drugs 1 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

20 20 Medicare Blue Choice Platinum SM (HMO) $ You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. See Summary of Benefits for more details. BenefitMedicare Blue Choice Platinum (HM0) Inpatient Hospital Care (unlimited days each benefit period) $100 copay for each Medicare-covered stay at a network hospital; Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full Primary Care Physician$10 copay per visit Specialist$25 copay per visit Outpatient Hospital Services 2 $0 - $35 copay per visit Radiology$25 copay

21 21 Medicare Blue PPO SM Plan 201 (PPO) $36 1 Benefit In NetworkOut of Network Inpatient Hospital Care (unlimited days each benefit period) $500 copay for each Medicare-covered stay at a network hospital; Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full 30% coinsurance per visit Primary Care Physician $20 copay per visit$25 copay per visit Specialist $40 copay per visit$45 copay per visit Outpatient Hospital Services 2 $0 - $125 copay per visit 30% coinsurance per visit Radiology 20% coinsurance30% coinsurance Outpatient Prescription Drugs 3 (Part D) Part D with $150 annual deductible; Before total annual drug costs reach $2,830, for each 30 day supply you pay: $5 for Tier 1 generic drugs $30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs 25% coinsurance for Tier 4 specialty drugs Emergency Benefit Only 1 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

22 22 Medicare Prescription Drug Plan (Part D) 2 ways to get Medicare Prescription Drug Coverage:  Join a stand-alone Medicare Prescription Drug Plan (PDP)  Join a Medicare Advantage Prescription Drug Plan (MA-PD)

23 23 Medicare Prescription Drug Plan (Part D) Formulary  List of drugs that are covered under your Part D drug plan  To obtain a copy of our formulary go to our Web site at Network  About 60,000 pharmacies nationwide  Retail, mail order, long term care, home infusion, Indian/Tribal/Urban pharmacies included  For additional information regarding our pharmacy network, quantity limits or mail order prescription drug service call TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.  You may write to us at: Excellus BlueCross BlueShield PO Box 546 Buffalo, NY You must use network pharmacies to access your prescription drug benefit,except under non-routine circumstances when you cannot reasonably usenetwork pharmacies.

24 24 Medicare Prescription Drug Plan (Part D) You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is greater) Catastrophic Coverage Excellus BlueCross BlueShield pays the balance Coverage Gap All costs are out-of-pocket You Pay Your copays/coinsurance Initial Coverage Period Excellus BlueCross BlueShield pays the balance Deductible is out-of-pocket $0 or $150 2 Medicare Drug BenefitOut Of Pocket 4 Coverage Phases Catastrophic Coverage begins when you or others on your behalf have spent $4, No coverage when total drug spend exceeds $2,830 1 until your true out of pocket spending reaches $4, Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2, You must pay your deductible, if applicable, before you start getting your prescription drug coverage. 1 Coverage limits for all phases of the Part D benefit change annually. 2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, Contact Excellus BlueCross BlueShield for details.

25 25  Prior Authorization  In some cases, we require you to obtain prior approval from us before you fill your prescription.  Step Therapy  In some cases, we require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition.  Quantity Limits  For certain drugs, we limit the amount of the drug that we will cover per prescription. Medicare Prescription Drug Plan (Part D) Some prescription drugs may have additional requirements or limits.

26 26 Medicare Prescription Drug Plan (Part D) 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 2.The Social Security Office at between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call Your State Medicaid office

27 27 People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:  seventy-five percent of drug costs including monthly prescription drug premiums,  annual deductibles, and  co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.  Many people are eligible for these savings and don’t even know it.  For more information about this Extra Help, contact your local Social Security office or call MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call Medicare Prescription Drug Plan (Part D)

28 28 Other Government Insurance EPIC - Elderly Pharmaceutical Insurance Coverage New York State residents that are 65 or older, and have an annual income of $35,000 or less if single, or $50,000 or less if married New York State Department of Health: Department of Veterans Affairs Provides coverage to veterans Call the VA in your area if you believe that you may be eligible

29 29 Medicare Blue Choice:  Emergency: Nationwide and Worldwide  Urgent Care: Nationwide  Routine Care: Covered under the Travel Benefit on Medicare Blue Choice Optimum (HMO) and Platinum (HMO) plans. Medicare Blue PPO:  Emergency: Nationwide and Worldwide  Urgent Care: Nationwide Coverage While Traveling

30 30 GoGetters ® Flexible Fitness Benefit Up to $650 per calendar year* Qualified fitness facility membership fees Qualified weight management program membership fees Included in Medicare Blue Choice (HMO) and Medicare Blue PPO plans * This benefit does not cover any ancillary services or items that are not part of a membership fee. Health and Wellness

31 31 Blue365 offers access to savings and discounts on items that members may purchase directly from independent vendors. Blue365 may also be used in conjunction with the GoGetters ® Benefit.  Fitness- save on membership, monthly fees and other services at Gold’s Gym ®, Curves ®, Snap Fitness TM and Global Fit TM  Nutrition- Save on programs, products and consultations at eDiets ®, Kronos Optimal Health ® and Jenny Craig ®  Elective procedures- Save on vision products and services at Davis Vision ®, QualSight LASIK ®, LasikPlus ® and TruVision TM  Hearing aids- Save on products from Beltone TM and TruHearing The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Excellus BlueCross BlueShield grievance process. Note: Not all vendors that have provided discounts for Blue365 are qualified fitness facilities or weight management programs for purposes of our GoGetters ® benefit. Valuable Extras

32 32  24-hour Personal Health Coaching Line  Provides education and programs on nutrition, weight management and much more.  Disease & Case Management  Clinical staff work with you to make informed choices on your health care and prescriptions. Valuable Extras

33 33 Our Enhanced Web site Allows members and prospective members to:  Estimate annual costs  Compare our plans  Learn more about cost-cutting options  Enroll online* Enhanced Web Tools …and more! *Medicare beneficiaries may enroll in Excellus BlueCross BlueShield MedicareAdvantage Plans through the Centers for Medicare & Medicaid Services OnlineEnrollment Center, located at For more information, contact Excellus BlueCross BlueShield at , TTY/TDD , 8:00a.m. – 8:00 p.m., Monday – Friday. From November 15 – March 1, 8:00 a.m. – 8:00p.m., 7 days a week.

34 34 How to Enroll  Complete application form  One application per person  You must continue to pay your Medicare Part B premium  You may need to cancel your other insurance carrier  Effective date of coverage is determined by enrollment period and when application is signed and received

35 35 Why Excellus BlueCross BlueShield?  Power of Blue- One of the most recognized healthcare insurers  More than 3,000 Participating Providers  In business for over 70 years  Offering plans that fit your needs and budget  Commitment to our local community

36 36 How to Contact us Call us: Medicare Sales Representative: TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. For full information on our Medicare benefits call a Medicare Customer Service Representative: TTY/TDD Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m. Write us: Excellus BlueCross BlueShield P.O. Box 546 Buffalo, NY Visit us on the Web at

37 37 Important Numbers Centers for Medicare & Medicaid Services (CMS) TTY/TDD hours a day, 7 days a week To apply for Low Income Subsidy Social Security Administration: TTY/TDD Monday – Friday 7:00 am – 7:00 pm

38 38 Questions ?

39 Thank You! H3351, H _0 (10/2009)


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