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1 SIERRA OPTIMA SELECT “ Medicare Your Way” PRIVATE-FEE-FOR-SERIVCE 2007.

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Presentation on theme: "1 SIERRA OPTIMA SELECT “ Medicare Your Way” PRIVATE-FEE-FOR-SERIVCE 2007."— Presentation transcript:

1 1 SIERRA OPTIMA SELECT “ Medicare Your Way” PRIVATE-FEE-FOR-SERIVCE 2007

2 2 What is a Private-Fee- For- Service! The Sierra Optima Select is a Medicare Advantage Plan where Medicare individuals can join and have access to any doctors, specialists and hospitals that accepts Sierra Optima Select.

3 3 Who can join the Sierra Optima Select? Must be enrolled in Medicare Parts A/B. ESRD (End Stage Renal Disease), individuals are not eligible to join

4 4 Monthly Premium? $ Zero Premium Must continue to pay premium for Part “B” of medicare.

5 5 Service Area (s) Arizona La Paz Mohave Idaho Ada, Adams, Bannock, Bear Lake, Benewah, Bringham, Blaine, Boise, Bonner, Bonneville, Boundary, Butte, Camas, Canyon, Caribou, Cassia, Clark, Clearwater, Custer, Elmore, Fremont, Gem, Gooding Idaho, Jefferson, Franklin, Jerome, Kootenai, Latah, Lemhi, Lewis, Lincoln, Madison, Minidoka, Nez Pierce, Oneida, Owyhee, payette, Power, Shoshone, Teton Twin Falls, Valley, Washington. Utah Beaver, Box Elder, Cache, Carson, Daggett, Davis, Duchesne, Emery Garfield, Grand, Iron, Juab, Kane Millard, Morgan, Piute, Rich, Salt Lake, San Juan, Sanpete, Sevier, Summit, Tooele, Uintah, Utah, Wasatch, Washington, Wayne, Weber

6 6 Is there Medical Underwriting? Because this is a Medicare Advantage plan, there is no Medical Underwriting.

7 7 Qualifiying Events Because this is a Medicare Advantage program, the Fee-For-Service plan will follow the “lock-in” guidelines for members to enroll.

8 8 Does the Sierra Optima Select include prescriptions? The Sierra Optima Select does not cover prescriptions. Members will be responsible for 20% of drugs covered under Medicare Part B (Original Medicare). Members can elect a the Sierra RX plan, or other PDP plans.

9 9 Benefits! BenefitOriginal MedicareSierra Optima Select Premium$ Part B for 2007 (Amt. may vary) Out of Pocket Max. (Annually) $3,000 (Refer to summary, certain services apply) Inpatient Hosp.$992 days 1-60; $248 days 61-90; $ st day after $180 days 1-6; $0 days (60 lifetime reserve days) Inpatient Mental Health Care $992 days 1-60; $248 days 61-90; $ st day after. (Medicare beneficiaries may only receive 190 days in a Psychiatric Hosp.) $180 days 1-6; $0 days (Medicare beneficiaries may only receive 190 days in a Psychiatric Hosp.)

10 10 Benefits! Skilled Nursing Facility $0 days 1-20; $124 days th. $0 days 1-10; $180 days Home Health Care100% Hospice100% Doctor Office Visits20%$12/Primary visit

11 11 Benefits! Specialist Visits$131 Deductible; 20% Medicare Approved amount. $40 Specialist visit Chiropractic Services$131 Deductible; 20% medicare approved amount. $40 for each medicare covered amt. (manual manipulation of the spine). Podiatry Services$131 Deductible; 20% medicare approved amount. $40 for each medicare covered amt. Outpatient Mental/Substance Abuse $131 Deductible; 20% medicare approved amount. $40 for each medicare covered amt.

12 12 Benefits! DME$131 Deductible; 20% Medicare Approved Amt. 20% of cost for medicare covered item. Outpatient Surgery$131 Deductible; 20% Medicare Approved Amt. $100 for each visit to an ambulatory surgical ctr. Ambulance Services$131 Deductible; 20% Medicare Approved Amt. $100 for Ambulance Services. Emergency20% facility; 20% physician charge $50 for Medicare emergency room visit. (Worldwide)

13 13 Benefits! Urgently Needed Care$131 Deductible; 20% Medicare Approved Amt. You pay $12 to $40 for each Medicare covered urgently needed visit. Outpatient Rehab Svcs.$131 Deductible; 20% Medicare Approved Amt. $40 per visit (Physical, Speech,Language, and Occupational Theraphy.) Diagnostic Tests, X- Rays/Lab $131 Deductible; 20% Medicare Approved Amt. $0 to $200 for each Medicare-covered clinical/diagnostic lab svcs. 20% of cost for Radiation 20% of cost X-Ray visit Bone Mass ;Pap Smear, Colorectal Screening; Mammograms, Prostate Cancer $131 Deductible; 20% Medicare Approved Amt. 20% of cost for each Medicare covered services.

14 14 Benefits! Dental Services100% for preventive100% Preventive; $40 for each medicare covered dental benefit Hearing Services100% for preventive; 20% for medicare approved diagnostic hearing exam. 100% for preventive; $40 for each medicare diagnostic hearing exam. Vision ServicesYou are covered for one pair of eyeglasses or contact lenses after each cataract surgery. (Annual deductible and coinsurance apply) 100% for routine; $40 for each medicare covered eye exam; 20% of cost for medicare covered eye glasses, and contact lenses following cataract surgery. Physical Exams If your coverage to Medicare Part B begins on or after Jan. 1, 2005, you may receive a one time physical exam within the first six months of your new Part B coverage.

15 15 Enrollment An Enrollment Application must be completed. Agent Checklist must be included when application is submitted. (See drafts of Application & Agent Checklist).

16 16 Competitors Secure Horizons Humana Sterling Mutual Protective (Medico)

17 17 Other Sierra Optima Plans Available! Sierra OptimaVary by State and Service Area. Sierra Optima Plus (Grp. 1)Vary by State and Service Area. Sierra Optima Plus (Grp. 2)Vary by State and Service Area. Sierra Optima SelectArizona, Idaho, Utah Sierra Optima ChoiceState of Washington


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