Presentation on theme: "2014 Medicare Advantage Plans Introduction Eligibility Basics of Medicare: 4 Parts: Original Medicare basics (Parts A and B) and limitations Medicare."— Presentation transcript:
2014 Medicare Advantage Plans Introduction Eligibility Basics of Medicare: 4 Parts: Original Medicare basics (Parts A and B) and limitations Medicare Advantage – Part C Medicare prescription drug – Part D Enrollment periods Plan specific information Today’s Topics
You are eligible to join if one of these three 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 Must be entitled to Part A and enrolled in Part B, and permanently reside in the plan’s service area. Original Medicare: Eligibility
And, both of these items describe you: 1. You or your spouse worked and paid Social Security taxes for at least 10 years. 2. 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. Original Medicare: (Continued) Eligibility
Medicare has 4 parts: Original Medicare: Part A & Part B Part C Part D – prescription drug coverage The Basics
Inpatient care in hospitals and skilled nursing facilities (not custodial or long-term care). Hospice and some health care services. Medicare Part A is hospital coverage that helps cover the costs for: *Late enrollment penalty may apply.
Doctors’ services, hospital outpatient care and home health care services, as well as lab tests and durable medical equipment. Most preventive services, including a yearly wellness exam. Medicare Part B is medical care coverage that helps cover the costs for: *Late enrollment penalty may apply.
* Some of these additional benefits may require an additional fee. Is offered by private insurers that have been approved by Medicare. Offers similar coverage to Part A (hospital) and Part B (medical), and typically offers additional benefits.* Some plans may include prescription drug coverage, vision, dental, and fitness and wellness programs. Replace Medicare Parts A and B with Medicare Part C, also called Medicare Advantage. Medicare Part C:
Most of these plans can be purchased either as an HMO, PPO or stand-alone plan, with an option to add supplemental benefits for an additional monthly fee.* You must continue to pay your Medicare Part B premium. HMO PPO LPPO RPPO Part C (Medicare Advantage) Plan Options
HMO vs. PPO HMO vs. PPO Health Maintenance Organization (HMO) Must receive all routine care from network providers (except for emergency and urgent care) Monthly premiums generally lower than other plan types Set copays for most covered services Most plans include Part D prescription drug coverage
Preferred Provider Organization (PPO) Local Preferred Provider Organization (LPPO) Use network providers for savings Freedom to see out-of-network providers (may cost more unless it’s an emergency) Regional Preferred Provider Organization (RPPO) See network and out-of- network providers Larger service area than an LPPO (continued) HMO vs. PPO HMO vs. PPO
Medicare Part C: Annual Deductible 1 For plans offering deductibles, the deductible will only need to be met once during the year. The deductible may be met through any qualifying expenses. The plan deductible does not apply to the following services: – Doctor office visits (PCP and Specialist) – Basic lab services – Basic X-rays – Preventive services 2 (e.g., mammogram screening, Pap/pelvic exam, prostate cancer screening, colorectal screening, immunization, etc.) 1 Not all Medicare Advantage Plans include a deductible. 2 These services are $0 cost to a member and will not apply to the deductible.
Medicare Part D is only offered by private insurers approved by Medicare. These plans: Help pay for many brand-name and generic prescribed drugs. Give you access to retail drugstores across the country and mail-order options. Medicare Part D is prescription drug coverage *Late enrollment penalty may apply.
2014 Medicare Standard Part D Coverage 1 1Base coverage on a Part D plan; minimum set by Medicare 2Includes total cost of insured’s prescription drugs in the calendar year 3Includes insured’s out-of-pocket cost for prescription drugs in the calendar year Deductible: $310 May vary by plan Initial Up to $2,850 2 Plan pays: 75% Gap $2,850 2 – $4,550 3 During this stage, you pay 47.5% of the price (plus the dispensing fee) for brand-name drugs and 72% of the price for generic drugs. Catastrophic More than $4,550 3 You pay greater of: $2.55 copay generic and $6.35 other 5% coinsurance
Medicare Basics OR Piecing the “Parts” together: Medicare Advantage Plans Part D Prescription Drug: can be combined with Part C; can be stand-alone if combined with PFFS or MSA* Part C Combines Parts A and B, and sometimes Part D Requires only one ID card * Stand-alone Part D with Private Fee For Service (PFFS) or Medicare Medical Savings Account (MSA) requires separate ID cards. Original Medicare Plan Part B Medical + Part D Stand-alone Prescription Drug + Medicare Supplement (Medigap) Requires three ID Cards Part A Inpatient Hospital
– When can I enroll? – Timing matters! Enrollme nt
Initial enrollment period: * 7 months surrounding your Medicare eligibility: This is the 3 months before you turn 65, the month when you turn 65, and the 3 months after. * Must be entitled to Part A and enrolled in Part B, and permanently reside in the plan’s service area Election Periods Election Periods
* Must be entitled to Part A and enrolled in Part B, and permanently reside in the plan’s service area Annual election period: * October 15 to December 7, 2013. The period you can enroll in or change your MA or MAPD plan. This is also the period you can enroll in, change or disenroll from a Part D plan. You may also switch to Original Medicare. New coverage will begin January 1, 2014. Election Periods Election Periods (continued)
Special enrollment period: * A common SEP is for those covered under their employer’s health plans who retire after 65. In this case, you can enroll with no penalty during the three months before your Part B takes effect. (continued) Election Periods Election Periods * Must be entitled to Part A and enrolled in Part B, and permanently reside in the plan’s service area
You may only be enrolled in one prescription drug plan at a time. If enrolled in a Medicare Advantage coordinated care (HMO or PPO) plan or an MA PFFS plan that includes Medicare prescription drugs, you may not enroll in a stand-alone prescription drug plan unless you disenroll from the HMO, PPO or Medicare Advantage PFFS plan. Additional Information
Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Additional Information
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.
Medicare Advantage 2014 The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Let’s examine some benefits
The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Anthem Blue Cross is a PPO plan, an HMO plan and a PDP with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees 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. Additional Information Y0071_14_18365_R_001 CMS Approved 9/30/201341241WPSENMUB_001 BROKER