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Welcome Gwinnett County Board of Commissioners Retirees The Humana Medicare Employer PPO Plan GHHHWTDEN_15.

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Presentation on theme: "Welcome Gwinnett County Board of Commissioners Retirees The Humana Medicare Employer PPO Plan GHHHWTDEN_15."— Presentation transcript:

1 Welcome Gwinnett County Board of Commissioners Retirees The Humana Medicare Employer PPO Plan

2 Let’s talk about Medicare Advantage Humana Medicare employer plans
Your employer-sponsored plan The plan’s extra benefits How to enroll

3 About Humana: Experience behind the coverage
Humana offers a wide range of products and services that use a holistic approach to lifelong well-being Dedication to the community More than 50 years of helping people of all ages Financial stability Fortune 100 company National coverage We offer Medicare plans in 50 states, including Puerto Rico and the District of Columbia Let me tell you about Humana, a company that helps people, where dedication to the community, financial stability, and national coverage are important descriptors. Talking Points for the presenter: Did you know Humana has been helping older adults since 1961 when we started with nursing homes? Medicare started providing benefits in 1965. We’ve been providing alternatives to Original Medicare since the 1980s. We were one of the first companies to offer Medicare HMOs in South Florida. When you work with Humana you also get me, your agent. I’m here to help. Many people trust someone else to help make healthcare decisions, a spouse, grown child, or close friend. We call this person a caregiver. If you provide consent to a caregiver he or she would be allowed to receive information on programs and services that are available for you. If you have a caregiver who helps you make these decisions I can provide you with a copy of the Personal Health Information consent form which can be found online at This consent form is different from granting medical power of attorney, which allows someone to make decisions about your care and is what’s required for someone other than you to enroll you in the plan.

4 Overview of Humana’s Medicare Advantage Plan
Medicare Advantage health plans are private insurance companies’ health plans approved by Medicare. Medicare Advantage plans include: All the benefits of Original Medicare plus extra coverage Maximum out-of-pocket protections Worldwide emergency coverage Secondary/ Supplement Plan Original Medicare Medicare Part D Or Medicare Advantage plan Part C and Prescription Drug (Part D) Plan Medicare Part C is available only to those enrolled in Parts A and B of Medicare through age or disability.

5 Your Humana member identification ID card
When you go to the doctor or hospital Show your Humana member ID card and tell the provider that Humana Medicare Employer PPO is your Medicare health plan Do not show your red, white, and blue Medicare card You will pay plan deductibles or copayments at your appointment or the provider may bill you later The doctor or hospital will bill Humana for the rest LPPO MAPD 5

6 Your Humana Medicare Employer PPO Plan
The Humana Medicare Employer Preferred Provider Organization (PPO) plan Gwinnett County Board of Commissioners and Humana teamed up to design a Medicare health plan just for you In this plan, you must have both Medicare Part A and B and continue to pay your Medicare Part B premium It’s important to note that when you join a Medicare Advantage plan, you don’t lose your Medicare benefits, and you don’t stop paying the premiums. What it does mean is that you’re agreeing to let the Medicare Advantage plan provide all your Medicare benefits, plus additional benefits. This is a custom plan for Gwinnett County Board of Commissioners retirees. It is not a Medicare Advantage plan that is available to the general public, so it will be different from your friends and neighbors’ plan. When you call Humana please let them know you are an Gwinnett County Board of Commissioners retiree and that you are eligible for their group plan.

7 Your Humana Medicare Employer PPO plan
Plan highlights Choose any doctor or hospital that accepts Medicare – who accepts Assignment and agrees to bill Humana No copayments for all preventive services/health screenings No referral needed to see any provider In all plans, there’s a limit to how much maximum out-of-pocket costs you pay One member ID card Extra benefits Affordable copayments for doctor visits Worldwide coverage for emergencies With a PPO, you can choose any healthcare provider that accepts Medicare; no referrals required. If you choose an in-network provider, you gain the advantage of a discounted price for services - a discount that’s already been negotiated between Humana and the provider. PPO plans may not be available in all areas. Like Medicare, Humana cannot guarantee that your provider is in or will remain part of a plan network. Here are two ways you can determine whether your provider accepts your Humana Medicare Advantage Plan: Use Humana’s online provider look-up, Physician Finder Call your provider’s billing department and ask if the provider accepts the specific Humana plan you are considering

8 Your Humana Medicare Employer PPO Plan
Benefit In Network Out of Network Annual Deductible Combined in and Out-of Network $150 Annual Maximum Out of Pocket* $3,400 Inpatient Hospital 100% after combined annual deductible and $500 copayment per admission Outpatient Ambulatory Surgical Center 100% per visit after $50 copayment Traditional LPPO Let’s talk about some “insurance words,” just to make sure you understand their meaning. Your deductible is the amount you must pay with your own money before the plan starts paying any of the cost. Then there’s coinsurance, which is a percentage of a cost. You pay a percentage, and the plan pays a percentage, and these two percentages always add up to 100 percent. Some plans have copayments. A copayment is a fixed amount you pay when you go to the doctor, hospital, etc. *If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

9 Your Humana Medicare Employer PPO Plan
Benefit In Network Out of Network Outpatient Hospital Visits 100% per visit after $0-$75 copayment or 20% of the cost (based on services received) Emergency Room Care 100% per visit after $50 copayment (waived if admitted within 72 hours) Primary Care Physician 100% per visit after $15 copayment Specialist 100% per visit after $30 copayment Durable Medical Equipment 10% Traditional LPPO

10 Your Part D Coverage Network Retail Pharmacies
A 30-day supply (A 90-day supply at three times your 30-day cost*) Mail-order Benefit* A 90-day supply Tier 1 Generic or Preferred Generic $10 copayment $15 copayment Tier 2 Preferred Brand $30 copayment $75 copayment Tier 3 Non-Preferred Brand $60 copayment $150 copayment Tier 4 Specialty 30%* coinsurance ($100 maximum per prescription) N/A* You can use any pharmacy you like. However, you’ll save money by using pharmacies that are in Humana’s network. And with nearly 65,000 pharmacy locations, you’re likely to find one in your area. You can also save a considerable amount by using our mail-order pharmacy service. Other mail-order pharmacies are available. *Specialty drugs are not available in a 90-day supply. Regardless of tier placement, Specialty drugs are limited to a 30-day supply.

11 How coverage works with Prescription Drug Schedule
Your Part D Coverage How coverage works with Prescription Drug Schedule Rx Rider 77 CAP $4,700 $0 - $4,700 – you pay a cost share Once your true out-of-pocket costs reach $4,700, you pay the greater of $2.65 for generics (including brand-name drugs treated as generic) and $6.60 for all other drugs, or 5 percent coinsurance

12 Prescription drug formulary
Group Plus formulary Open formulary – includes all prescription drugs approved by CMS Most* generics are in Tier 1 *Certain high-cost generics can fall out of Tier 1 Four-tier design Tier 1: Preferred generic Tier 2: Preferred brand Tier 3: Non-preferred brand Tier 4: Specialty The Group Plus Formulary is an open formulary. An open formulary will cover all Medicare approved drugs. Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: •Prior Authorization (PA): The Humana Medicare Employer Plan requires you or your doctor to get prior authorization for certain drugs. This means that you will need to get approval from the Humana Medicare Employer Plan before you fill your prescriptions. If you don't get approval, the Humana Medicare Employer Plan may not cover the drug. •Quantity Limits (QL): For certain drugs, the Humana Medicare Employer Plan limits the amount of the drug that we'll cover. The Humana Medicare Employer Plan might limit how many refills you can get, or how much of a drug you can get each time you fill your prescription. For example, if it is normally considered safe to take only one pill per day for a certain drug, we may limit coverage for your prescription to no more than one pill per day. Specialty drugs are limited to a 30-day supply regardless of tier placement. •Step Therapy (ST): In some cases, the Humana Medicare Employer Plan requires you to first try certain drugs to treat your medical condition before we'll cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, the Humana Medicare Employer Plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, the Humana Medicare Employer Plan will then cover Drug B. Part B versus Part D (B vs D): Some drugs may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and the place where you receive and take the drug so we can make the determination. For drugs that need prior authorization or step therapy or that fall outside of the noted quantity limits, your doctor can fax information about those drugs to the Humana Medicare Employer Plan at

13 Mail Order Pharmacy You will have access to mail order
pharmacies, including Humana’s owned, RightSource. With RightSource, you will have: Easy ordering Refill reminders Discounts and potential savings Visit After you become a Humana member, you can sign in with your MyHumana username and password or register to get started. You can also sign up by calling (TTY: 711) Monday – Friday, 8 a.m. – 8 p.m., and Saturday, 9 a.m. – 6 p.m., Eastern time. New prescriptions typically take 7-10 business days to receive. Call RightSource if you have questions. With RightSource, one of Humana's mail-order pharmacies that offer preferred cost-sharing, you’ll receive up to a three month supply of your medication mailed directly to your home. Simply mail in your prescriptions, or your doctor can call in or fax your order. RightSource will help you remember your refills with timely reminders by phone and day supplies of your medications mailed to you may save you money on some medications as well as trips to the pharmacy. Some specialty drugs are only available in a 30 day supply from mail-order. Two RightSource pharmacists review each new prescription for your safety. You should get your new prescription by mail in 14 days after RightSource has all the necessary information. Your refill should arrive within seven days. It may take longer if RightSource has to call you or your healthcare provider with questions about the order. You can call RightSource at (TTY: 711) if your mail-order Rx does not arrive within the estimated time frame. Visit for more information. Other mail-order pharmacies are also available in our network.

14 SmartSummary® mailed to your home
Statements that explain your health, benefits, claims and health care spending; issued each month you incur claims Statements list your past prescription drug purchases and medical claims and help you plan for the future SmartSummaryRx shows how much your plan and you personally have spent on health care, and how much is left before you reach the coverage gap Get these statements by mail or on the web at

15 Extra benefits

16 Humana Active Outlook®
A lifestyle enrichment program for Humana Medicare Members Humana Active Outlook helps you live a full, active, and productive life Enjoy health and wellness information through mailings, online content, individual health coaching, classes, and our member assistance program (MAP) Humana’s award-winning* Humana Active Outlook Magazine comes to you four times a year Get practical tips for living with chronic health conditions from Humana Active Outlook Digest *Humana Active Outlook has won more than 100 major national publishing awards, including the APEX Awards for Publication Excellence and the MarCom Awards. These awards were not given by Medicare. Humana Active Outlook® - A lifestyle enrichment program to help our members live better lives. You’ll get health and wellness information through the mail and online. You’ll also get individual health coaching, classes and a member assistance program (MAP). The MAP aims to make your life easier and can help you get through life’s challenges. MAP includes three telephone sessions with a MAP professional. You also get access to Web tools such as articles, tip sheets and booklets. You can speak confidentially on the phone with a counselor or specialist or look for information online.

17 Get fit your way™ with SilverSneakers® Fitness
Reach you goals with access to more than 11,000 fitness locations where you can: • Use fitness equipment, pools and saunas* • Take SilverSneakers classes* • Get help from a SilverSneakers Program AdvisorTM • Enjoy fun social activities *Classes and amenities vary by location.

18 SilverSneakers® Steps
SilverSneakers Steps® is a personalized fitness program for members who don’t have convenient access to a SilverSneakers location Sign up for SilverSneakers Steps® if you can’t get to a fitness location. Select a fitness kit that you can use at home or on the go. General fitness Walking Strength Yoga

19 HumanaVitality® Now there’s an easy way to stay in control of your health. Introducing HumanaVitality®, a wellness program just for Humana members. It’s included with your Humana Medicare plan at no extra cost. HumanaVitality was designed to help you get, and stay, on a healthier path – one small step at a time. HumanaVitality is a fun and engaging program that helps you find out more about your health. This makes it easier to find healthy options that work for you! HumanaVitality is based on a comprehensive lifestyle approach to wellness. It gives you personalized goals and activities to help improve your health. HumanaVitality not only rewards you with a healthier lifestyle, but also with great items like gift cards, movie tickets, and fitness apparel when you earn Vitality Bucks® for completing eligible activities. You will receive detailed information about HumanaVitality in your post-enrollment communication materials HumanaVitality is included in your Humana Medicare plan at no extra cost.

20 Smoking cessation program
A service to help you quit smoking Features include: Tips and advice from our experts, online or by phone A plan to quit tobacco, created just for you Two treatments to replace nicotine An online support group you can reach 24 hours a day, seven days a week QuitNet - an online smoking cessation web-site with personal programs, tips, advice, and an on-line community. You don’t have to quit alone!

21 Health management programs
Humana at Home® Humana at Home can help you manage the challenges specifically associated with chronic conditions like: Diabetes Congestive heart failure Coronary artery disease COPD Rheumatoid arthritis Multiple sclerosis Parkinson’s disease Case management Nobody wants to face a health crisis or major medical procedure. But if this happens, Humana’s case managers are here to help. Our nurses can help you follow your treatment plan on your return home. We also can connect you to other resources for more support. At times, some extra help is just what you need. That’s the idea behind the Humana at Home and case management services. Both services are yours at no extra cost through the Humana Medicare Advantage Plan. Members may receive a call to enroll in one of these programs if eligible or may self-refer through Humana by calling ; TTY: 711. We’re available 8 a.m. – 5:30 p.m., Eastern time.

22 MyHumana MyHumana is your online resource for personalized health benefits information. Review your plan benefits, use health and pharmacy tools, or look up medical and prescription claims. MyHumana Mobile app and website helps you access your information while on the go, sign in to your secure, mobile account or download our iPhone or Android app for details about your plan benefits, find a doctor in network, find a lower-cost drug alternative, review your claims and more. Have questions about your Humana plan? Get answers anytime – just go online to MyHumana and After you receive your Humana ID card in the mail, register for MyHumana on or MyHumana Mobile. MyHumana is your secure online account and allows you to access your specific plan details. Once inside MyHumana you can: • Check your benefits and claims • Find an in-network doctor • Search the current Drug List for your plan •.Choose how you want to receive information from us – by mail or • Read and download your plan documents • Find discounts and savings available through your plan Don’t have a computer or mobile phone? Ask a family member for help or visit your local library. They’re likely to have a computer you can use.

23 HumanaFirst® HumanaFirst® Nurse Advice Line is a toll-free, 24 hour-a-day health information line. A registered nurse can answer your general health questions and provide guidance on your medical needs. Find out about a medical condition. Discuss a sudden health concern. Learn how Humana can help you live a healthier life. HumanaFirst is a 24-hour nurse information line Humana makes available for you for medical questions that may help you avoid an unnecessary doctors visit (not to be used for emergency situations). Example for Medical Condition: For instance, if you're diagnosed with diabetes or cancer, we can guide you to available support, including Humana's clinical programs. Example for sudden health concern: For instance, if you've strained a muscle and don't know what to do, our nurses can help you decide if you can manage your care at home or need to see a doctor.

24 Next steps: enrollment
How you’ll enroll Enroll by employer Gwinnett County Board of Commissioners will get your information and enroll you in the Humana plan. Humana may ask for more information from you by mail or phone.

25 What happens after I enroll?
Humana processes your enrollment and confirms that you are eligible Medicare confirms your enrollment Your ID card arrives in your mailbox Member Benefit Package arrives in your mailbox Health Assessment We’ll contact you about filling out a health questionnaire

26 Where to find more information Group Medicare Customer Care Group Medicare Customer Care at (TTY: 711) Monday – Friday from 8:00 a.m. - 9:00 p.m., Eastern time. Our phone system may answer your call on Saturdays, Sundays, and holidays. Leave a message and we’ll call back by the end of the next business day.

27 Humana Group Medicare Questions?

28 Humana is a Medicare Advantage organization with a Medicare contract
Humana is a Medicare Advantage organization with a Medicare contract. You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change from year to year. Enrollment in this Humana plan depends on contract renewal. This information is available for free in other languages. Please call our customer care number at (TTY: 711). You can call Monday - Friday, from 8 a.m. - 9 p.m., Eastern time. Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al (TTY: 711). Los representantes están disponibles de lunes a viernes de 8 a.m. a 9 p.m., hora del Este.

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