1. 2016 California H & H Anthem MediBlue Coordination Plus (HMO) Medicare Advantage Plan
Y0114_16_26325_R_002 CMS Approved 12/09/ MUSENMUB _002
4/20/2018

2. Medicare/Medicaid Dual Eligibility Addendum
Continuing Education Course
4/20/2018

3. Medicare/Medicaid Dual Eligibility
Many markets have specialized HMO plans developed and marketed for Dual Eligible members. These are called Dual Special Needs Plans, or DSNPs.
In some markets, however, DSNPs are not permitted, and dual eligibles are confused as to their options.
Some newer HMO plans may be a good option for these members, and they may be able to utilize their Medicare and Medicaid benefits for maximum coverage without incurring out of pocket costs.
It’s important to understand how these plans work and how dual eligible members must coordinate their benefits.
There are several examples of these plans in the market:
Anthem has the Anthem MediBlue Coordination Plus HMO
United Healthcare and Scan Healthcare have similar plan styles available.

4. Why Are Plans Like This Offered?
Below are two states in which plans have been developed to serve the dual eligible population in places where DSNP plans are not possible, and why alternative plans have been developed.
Examples in 2016:
CA: A 3-year demonstration program between the state Medi-Cal program and the federal Medicare program, called Cal MediConnect, precludes DSNP expansion in certain counties within the sate.
NH: State administrators not interested in offering DSNPs

5. Who Will Benefit From These New Plans?
While these plans are not marketed in such a way that is mistaken for a DSNP (Dual Special Needs Plan), members with both Medicare and Medicaid eligibility will see the strongest benefits given the way these plans are designed.
It is important that customers with only Medicare eligibility be shown the costs associated with all plans so they fully understand the cost share for which they will be responsible.
The Summary of Benefits and Explanation of Coverage will not show the accurate cost share of full dual eligibles. It is important for brokers and agents to explain how these plans will work for them.

6. Compliance Considerations
Make sure no marketing is leading consumers to think that a plan is a Dual Special Needs Plan (DSNP) if it offered in an area where new DSNP plans are not permitted.
Do not use the words “duals” or “special needs” in the consultative selling process.
BE AWARE: As a reminder, the SB (Summary of Benefits) and EOC (Explanation of Coverage) in most cases won’t explicitly show the cost-share for full dually eligible members. Make sure the members are prepared for the correspondence they will receive.
Dual Eligible members must present their plan card as well as their Medicaid card so the provider knows to bill Medicaid instead of the member after the Medicare HMO plan pays.

7. How Does an HMO Plan Affect a Member’s Medicaid Eligibility?
The short answer is: It doesn’t!
Medicaid eligible members retain their eligibility and it works in conjunction with their Medicare HMO plan.
Where necessary, members will make a Medicaid election (Ex. LA Care/Health Net in Los Angeles Co. CA)
If no Medicaid election is made, an eligible resident will be assigned a Medicaid plan by their state, enrolling eligible residents in Medicaid plans using an alternating manner.
It is important members are advised NOT to disenroll from their Medicaid plan. They will still be eligible for and receive services from Medicaid in addition to their Medicare HMO plan.

8. Network Considerations
Medicare A&B benefits are filed the same as Medicare FFS with a 20% co-insurance
This will be visible to the provider and the member on the ID Card and other materials as these types of HMO plans are not DSNP plans
Majority of members will have a level of Medicaid and Part D Extra Help that protects them from paying cost-share (co-pay, co-insurance, deductible and premiums)
Remember: it’s crucial that members are instructed to show their Medicare HMO card AND their Medicaid/Medi-Cal card whenever receiving provider services. This will insure both plans are billed appropriately and limit the bills dual eligible members receive in error.

9. Network Considerations
Provider Billing Process:
Members will need to present both their Medicare HMO card and Medicaid card to the provider. (Provider must accept Medicare/Medicaid)
Provider should bill the Medicare HMO plan for Medicare covered service
After receipt of Explanation of Payment (EOP) the provider should send to Medicaid plan for any additional amount owed.
The provider MUST have a Medicaid ID in order to bill the state for the member responsibility portion of this plan
The provider CANNOT bill the member if the member has Medicaid (that protects them from cost-sharing). They must accept the Coordination Plan and Medicaid payment as payment in full
The provider CAN bill the member if the member does not have Medicaid or is not eligible for cost-sharing protections

10. 2016 California H & H Anthem MediBlue Coordination Plus (HMO) Medicare Advantage Plan
Y0114_16_26325_R_002 CMS Approved 12/09/ MUSENMUB _002
4/20/2018

11. Why Anthem Blue Cross? Trust Experience Local
With nearly 69 million people served by its affiliated companies, including more than 37 million enrolled in its family of health plans, our parent company is one of the nation's leading health benefits companies.
Experience
Provider of health care benefit plans since Medicare began.
Local
We have local offices in every state we serve.
4/20/2018

12. Are you eligible for Medicare?
You are eligible to join if 1 of these 3 items applies to you:
You are 65 or older, or
You are under 65 with certain disabilities, or
You are any age with end-stage renal disease – permanent kidney failure requiring dialysis or kidney transplant.
And, both of these items describe you:
You or your spouse worked and paid Social Security taxes for at least 10 years, and
You are a permanent resident of the U.S. or a legal citizen who has lived in the U.S. for five years in a row.
You may also be eligible for $0 cost sharing if:
You are enrolled in the Medi-Cal program
4/20/2018

13. We care about your total health care needs.
4/20/2018

14. How our Medicare Advantage Plans work
The federal government pays us to manage your Medicare benefits and we pass the savings on to you.
Anthem plans have low monthly plan premiums.
You pay low or no copays or coinsurance for your health care services.
Once you’ve reached your deductible amount for certain services, you’ll pay nothing more for those services for the rest of the year.
You may also be eligible for $0 cost-sharing (premiums, coinsurances, copays and deductibles) if you are enrolled in the Medi-Cal program.
4/20/2018

15. Our Anthem MediBlue Coordination Plus (HMO) plan
When you join our Medicare Advantage plan, you’ll receive the benefits of coordinated care. This means you get all your Medicare hospital, medical health care services, and prescription drug coverage through our plan.
We offer all your Medicare health care services through a single plan and can help you manage your different services and providers.
We may make it easier for you to follow your doctor’s orders related to diet and prescription drug use.
If you are enrolled in the Medi-Cal program:
You may be eligible for $0 cost-sharing
4/20/2018

16. Plan Highlights Your Medical Coverage Plan Highlight
Medicare Only Eligibility
Medicare and Medi-Cal Eligibility
Monthly Plan Premium
$31 monthly plan premium
$0 monthly plan premium
Plan Deductible
$360 deductible
$0 deductible
Primary Care Physician Copay
20% coinsurance
$0 copay
Specialist Copay
X-Rays
4/20/2018

17. Plan Highlights Your Extra Benefits – At no additional cost to you:
Dental Care: Routine and comprehensive dental coverage
Hearing Care: Routine hearing coverage and an allowance for hearing aids
Vision Care: Routine vision coverage and an allowance for eyewear
Podiatry Care: Routine podiatry coverage
Rides to the Doctor: Transportation services are available with advance scheduling
Monthly SilverSneakers® membership at no additional cost
An allowance to spend on approved over-the-counter health items
24/7 access to nurses with Nurse HelpLine
Online access to board-certified doctors on your computer or mobile device
Customer service, case management and community relations employees to help meet your needs
4/20/2018

18. Prescription Drug Benefits
Built into the plan at no additional premium.
Available at retail pharmacies or through mail order.
Allows you to control costs by selecting generic drugs where available.
If you have low income subsidy (LIS), you will pay the LIS amount or the Part D copay, whichever is lower. You will never pay more than your LIS co-pay amount.
4/20/2018

19. 2016 Medicare Standard Part D Coverage1
Deductible: $360 may vary by plan
Initial: Up to $3,3102 Plan pays: 75%
Gap: $3,3102 – $4,8503 During this stage, you pay 45% of the price (plus the dispensing fee) for brand-name drugs and 58% of the price for generic drugs.
Catastrophic: More than $4,8503
You pay greater of: $2.95 copay generic or 5% coinsurance
$7.40 copay brand or 5% coinsurance
• <5%> coinsurance
The amount you pay will vary based on if you receive Extra Help. Please see the Summary of Benefits for details.
1-Base coverage on a Part D plan; minimum set by Medicare 2-Includes total cost of insured’s prescription drugs in the calendar year 3-Includes insured’s out-of-pocket cost for prescription drugs in the calendar year
Enter Filename Here
4/20/2018

20. Plan Enrollment Enrollment is quick and easy.
Complete and sign an enrollment application form today.
Once you have completed your application . . .
Anthem Blue Cross will contact you by mail to confirm we received your application.
You’ll receive your enrollment kit in the mail, if approved for our plan.
You’ll receive your member ID card in the mail within 14 business days of acceptance notification from CMS.
4/20/2018

21. Can I Enroll in this Medicare Advantage Plan?
How can I qualify for this Medicare Advantage Plan?
Have Medicare Parts A & B
Live in Service Area
No End-Stage Renal Disease (ESRD)
How can I qualify for $0 cost-sharing?
You may qualify for $0 cost-sharing if you are enrolled in the Medi-Cal program and have coverage for Medicare cost sharing.
When can I enroll?
During Initial Eligibility Period
Your initial enrollment period (IEP) lasts seven months.
During Annual Election Period
Between October 15 and December 7
During a Special Election Period (SEP)
4/20/2018

22. Interested?
Let’s take a look at the enrollment form.
SAMPLE
SAMPLE

23. Additional Information
This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
We renew our contract with Medicare annually.
 Anthem Blue Cross renews its contract with Medicare (the federal government) each year on January 1. Premiums and benefits may change at that time, but not during the year, unless the change is to your advantage. In addition, the plan may reduce its service area and no longer offer services in the area where the beneficiary resides. If we do not renew our contract, we’ll tell you at least 90 days in advance. You may then switch to a standard Medigap plan (A, B, C, F, K or L) that won’t deny coverage because of a pre- existing condition. It will normally go into effect the day after your Medicare Advantage membership ends.

24. Additional Information
You must continue to pay your Medicare Part B premium.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Amounts are for one-month supply at a preferred retail pharmacy/standard retail pharmacy.
The SilverSneakers Fitness Program is provided by Healthways, Inc., an independent company. Healthways and SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. LiveHealth® Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross.
Anthem Blue Cross is a Medicare Advantage Organization and a Prescription Drug Plan with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are the trade names of Blue Cross of California. Independent licensee of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.
Y0114_16_26325_R_002 CMS Approved 12/09/ MUSENMUB _002

25. Anthem MediBlue Coordination Plus (HMO) Additional Information
Anthem MediBlue Coordination Plus (HMO) Uses specific providers only. Not all participating provider groups and their affiliated primary care providers (PCPs) and facilities are available to you in your service area for this plan. If your provider of choice is not available through this plan, the provider may be available through a different Anthem plan offering.
4/20/2018