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Welcome 2010 Univera Healthcare Medicare Plans Workshop (Sales Rep’s Name) Medicare Sales Consultant Univera Healthcare contracts with the Federal Government.

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Presentation on theme: "Welcome 2010 Univera Healthcare Medicare Plans Workshop (Sales Rep’s Name) Medicare Sales Consultant Univera Healthcare contracts with the Federal Government."— Presentation transcript:

1 Welcome 2010 Univera Healthcare Medicare Plans Workshop (Sales Rep’s Name) Medicare Sales Consultant Univera Healthcare contracts with the Federal Government and is a Medicare 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 Part 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: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, and Wyoming counties, NY) You do not have End-Stage Renal Disease (ESRD)

13 13 Medicare Advantage Plan Enrollment Periods 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. 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

14 14 Medicare Advantage Plan Enrollment Periods 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 information regarding Medicare Advantage Plan Enrollment Periods you can call our Customer Service Department at 1-800-558-4320. TTY/TDD 1-800- 421-1220, 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.

15 15 HMO vs. PPO HMO Health Maintenance Organization PPO Preferred Provider Organization Primary Care Physician (PCP) is required Primary Care Physician (PCP) not required Referral required to see a specialist No 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) *Univera Healthcare provides reimbursement for all covered benefits regardless of whether theyare received in-network, as long as they are medically necessary.

16 16 Medicare Advantage Plan Options HMO Plans SeniorChoice ® Value (HMO) SeniorChoice ® Value Plus (HMO) SeniorChoice ® Secure (HMO) SeniorChoice ® Select (HMO) PPO Plan Univera Medicare PPO SM Plan 102 (PPO) For full information on our SeniorChoice and/or our Univera Medicare PPO benefits, call our Customer Service Department at 1-800-558-4320, TTY/TDD 1-800-421-1220 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, 2011. Please contact Univera Healthcare for details.

17 17 Benefit ® SeniorChoice ® Value (HMO) 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 brand drugs 25% coinsurance for Tier 4 specialty drugs SeniorChoice ® Value (HMO) $16 1 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 then 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 Benefit ® SeniorChoice ® Value Plus (HMO) 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 SeniorChoice ® Value Plus (HMO) $46 1 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 then 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 Benefit ® SeniorChoice ® Secure (HMO) 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 SeniorChoice ® Secure (HMO) $86 1 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 then 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 SeniorChoice ® Select (HMO) $55 1 Benefit ® SeniorChoice ® Select (HMO) 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 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. See Summary of Benefits for more details.

21 21 Univera Medicare PPO SM 102 (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 visit30% 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 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 then 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 www.univerahealthcare.com/medicare 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, and mail order prescription drug service call: 1-800-659-1986 TTY/TDD 1-800-421-1220 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 us at: Univera Healthcare, PO Box 546, Buffalo, NY 14201 You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

24 24 You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is greater) Catastrophic Coverage Univera Healthcare pays the balance Coverage Gap All costs are out-of-pocket You Pay Your copays/coinsurance Initial Coverage Period Univera Healthcare 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 $4,550 1. No coverage when total drug spend exceeds $2,830 1 until your true out of pocket spending reaches $4,550 1. Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2,830 1. You must pay your deductible, if applicable, before you start getting your prescription drug coverage. Medicare Prescription Drug Plan (Part D) 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, 2011. Contact Univera Healthcare for details.

25 25 Medicare Prescription Drug Plan (Part D) Some prescription drugs may have additional requirements or limits. 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.

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: 1)1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/ 7 days a week 2)The Social Security Office at 1-800-772-1213 between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call 1-800-325-0778; or 3)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 coinsurance. 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 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048. 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: www.health.state.ny.us/health_care/epic 1-800-332-3742 Department of Veterans Affairs Provides coverage to veterans Call the VA in your area if you believe that you may be eligible

29 29 Coverage While Traveling SeniorChoice (HMO): Emergency: Nationwide and Worldwide Urgent Care: Nationwide Routine Care: Covered under the Travel Benefit on SeniorChoice ® Secure (HMO) and Select (HMO) plans. Univera Medicare PPO: Emergency: Nationwide and Worldwide Urgent Care: Nationwide

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

31 31 Valuable Extras 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.

32 32 Enhanced Web Tools Our Enhanced Web site Allows members and prospective members to: Estimate annual costs Compare our plans Learn more about cost-cutting options Enroll online* …and more! www.univerahealthcare.com/medicare *Medicare beneficiaries may enroll in Univera Healthcare Medicare Advantage Plans throughthe Centers for Medicare & Medicaid Services Online Enrollment Center, located atwww.medicare.gov. For more information, contact Univera Healthcare at 1-800-659-1986,TTY/TDD 1-800-421-1220, Monday – Friday, 8:00 a.m. – 8:00 p.m. From November 15 –March 1, 8:00 a.m. – 8:00 p.m., 7 days a week.

33 33 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

34 34 Why Univera Healthcare? More than 3,000 Participating Providers In business for over 30 years Offering plans that fit your needs and budget Commitment to our local community

35 35 How To Contact Us Call us: Medicare Sales Representative: 1-800-659-1986 TTY/TDD 1-800-421-1220 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: 1-800-558-4320 TTY/TDD 1-800-421-1220 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: Univera Healthcare P.O. Box 546 Buffalo, NY 14201 Visit us on the web at: www.univerahealthcare.com/medicare

36 36 Important Numbers Centers for Medicare & Medicaid Services (CMS) 1-800-633-4227 TTY/TDD 1-877-486-2048 24 hours a day, 7 days a week www.medicare.gov To apply for Low Income Subsidy Social Security Administration:1-800-772-1213 TTY/TDD 1-800-325-0778 Monday – Friday 7:00 am – 7:00 pm www.ssa.gov

37 37 Questions ?

38 38 Thank You! H3351, H3335 1775_0 (10/2009)


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