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There’s So Much More to Medicare, Let’s Talk Humana Medicare Advantage Health and Prescription Drug Plans M0006_GH210S6RR KC0906
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Do you know how much Humana is projected to save its 4.5 million Medicare Advantage and Prescription Drug Plan members in 2006? $3.8 Billion *This number is based on CMS published average savings per member per year of $1,100. In the first six months of 2006 Humana saved its Medicare Advantage and Prescription Drug Plans members over $1.5 billion dollars.
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Welcome! There’s so much more to Medicare… Let’s Talk
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Before we get started Make sure you’re comfortable Pens and pencils ready Turn off your cell phones and pagers Keep your needs in mind
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Let’s talk about… Humana – Experience Behind The Coverage What’s Important to YOU Your Options Under Medicare Coverage Options For 2007 Specific Plan Benefits How To Enroll
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Who is Humana? A Company You Can Trust Your Healthcare Solution
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Enrolled in Medicare Part B and entitled to Part A? Permanent resident in service area? Do you have End Stage Renal Disease (ESRD)? Are you eligible? Federal law will not allow us to accept anyone who has end stage renal disease (kidney failure), unless you: (1) Are a member of another health plan or offered by Humana within the same state, or (2) Were enrolled in a Medicare Advantage plan which was terminated or discontinued after December 31, 1998 and this is your first election following that plan termination or discontinuance.
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How Do I Choose The Right Plan for My Needs? What type of plan do I currently have? What do I like about my current coverage? If I could, what would I change about my current coverage? Do I need a Part D prescription drug plan or does my current plan include RX? What are my goals? –Comprehensive Coverage, including other services –Reduce my out-of-pocket expenses –Freedom to choose my own physician –Coverage while I travel –Services outside of traditional health benefits Do I rely on anyone to assist me in these types of decisions?
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Today’s Medicare Environment Includes More Coverage Choices
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What are Medicare Advantage Health Plans? Includes all the benefits of: Original Medicare (Part A - Hospital) (Part B - Medical) Today’s Medicare Environment Includes More Coverage Options for you! Medicare Advantage health plan only (MA only) MA only with stand - alone Part D MAPD - MA health plan with Part D included 1 plan, 1 plan premium, 1 company
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Today’s Medicare Environment - More Choices What are Medicare Advantage (MA) health plans? They are health plan options that are part of the Medicare program Medicare pays the plan a set amount every month for your care MA plans must offer all benefits of Original Medicare and coverage can include Part D prescription drug coverage You may have to use providers that participate with the plan In most plans, there are generally extra benefits and out-of- pocket costs that are lower that with Original Medicare
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How Can Medicare Advantage Plans Offer More Coverage How can Medicare Advantage plans offer more benefits for little or no monthly plan premiums* When you choose to receive your Medicare benefits through a company like Humana The Company basically becomes “Medicare” for you Medicare pays a company like Humana to provide your benefits The company Negotiates to draw down prices that provide lower premiums and more benefits for you * You must continue to pay applicable Medicare premiums
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Today’s Medicare Environment Offers More Plan Choices Original Medicare Coverage Fee-for-service – you receive a service, you pay a fee Access to any doctor or provider that accepts Medicare Out-of-pocket costs may be significantly higher as more services are used May want to purchase separate supplemental insurance to cover gaps Medicare Supplement Insurance Purchased separately from private insurance companies Supplements Original Medicare coverage Covers costs that Original Medicare doesn’t pay up to what Medicare allows All plans are standardized and can be purchased with varying coverage options
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Today’s Medicare Environment Offers More Plan Choices Types of Medicare Advantage (MA) Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-For-Service (PFFS) Plus, Medicare Prescription Drug Coverage – Part D May be purchase as a stand-alone plan As a part of an MAPD plan
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Today’s Medicare Environment Offers More Plan Choices So which type of plan is best for me? Health Maintenance Organization (HMO) Defined network of providers Primary Care Physician (PCP) manages all of your care You must have a referral from your PCP to see a Specialist You must use network providers for all scheduled care Out-of-pocket costs may be significantly lower with an HMO plan
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Today’s Medicare Environment Offers More Plan Choices So which type of plan is best for me? Preferred Provider Organization (PPO) Defined network of providers Allows flexibility to use providers who are not part of the network No referral needed to see any doctor However, out-of-pocket costs increase significantly when out-of-network providers are used Greatest saving for use of network providers because the plan pays a larger share of the cost
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Today’s Medicare Environment Offers More Plan Choices So which type of plan is best for me? Private Fee-For-Service (PFFS) No plan network Plan works similar to Original Medicare except the insurance company pays for your services, not Medicare Freedom to use any provider that accepts Medicare and, agrees to the plan’s payment terms You should check with your providers to make certain that they are willing to accept the PFFS plan’s terms Out-of-pocket costs may be lower than with Original Medicare coverage
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Today’s Medicare Environment Offers More Plan Choices So which type of plan is best for me? Medicare Prescription Drug Plans - Part D (PDP) Plans offered by insurance companies May be offered as stand-alone plan or, as part of an MAPD plan All plans must meet minimum coverage level set by Medicare Companies may offer plans with increased coverage You should evaluate your prescription drug needs in relation to those covered by the plan, and your cost for those drugs
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Today’s Medicare Environment Offers More Plan Choices So… how do I choose? There are three basic factors to weigh when choosing a plan: Cost – Compare the out-of-pocket costs for the plan with what you are currently paying including plan premium and copayment and coinsurance amounts. Providers – Will the plan allow me to see the providers I need or want to see? Benefits – Does the plan offer you the coverage and benefits you need? Keep In Mind: No matter which plan you choose to join, you are still a part of the Medicare program. With all of these plans you must continue to pay your applicable Medicare premiums.
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2007 Prescription Drug Plan By law, all plans must offer at least the basic benefits required by Medicare, outlined below. Any plan can offer more benefits, but no plan can offer less. *You pay the greater of $2.15 for generic (including brand-name drugs treated as generic drugs) and $5.35 for all other drugs,OR 5% coinsurance 2007 Medicare Prescription Drug Plan Basic Coverage 2007 Basic BenefitsYou Pay Deductible$265100% of first $265 Initial Coverage Limit$2,40025% of the next $2,135 ($533.75) Coverage Gap$3,051.25100% of next $3,051.25 Annual Out-of-Pocket Amount$3,850.00 Catastrophic CoverageMedicare and Plan 95%5%*
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Here’s What is Available in Your Area
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Is a Humana plan suitable for you?
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Basic All the benefits of Original Medicare Part D Coverage (Majority of Humana plans include this) Unlimited doctor/specialist/hospital visits Emergency service & ER/Ambulance availability Affordable premiums Basic + Extra Benefits All the benefits of Original Medicare RightSource SM SmartSummary SM MyHumana www.humana-medicare.com & Rx Calculator SM Basic + Extra Benefits + Humana Active Outlook + + +
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Silver Sneakers
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Humana Medicare Advantage & Prescription Drug Plans
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Note: This information does not apply to Medicare Supplement Plans. Important Dates for 2007 For 2007DescriptionIn 2006 Oct 1 st - Nov 14 th Plans can begin to share new benefits for coming year Nov 15 th - May 15 th (180 days) January 1 st New plan coverage begins January 1 st Jan 1 st - March 31 st (3 months) Can make one change - Medical portion only Jan 1 st - Jun 30 th (6 months)
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Where To Find More Information “Medicare and You 2007” handbook (available in October or November 2006) www.medicare.gov www.medicare.gov Your local State Health Insurance Program (SHIP) www.humana.com www.humana.com Humana 1-800-337-0953 Seven days a week, 8 a.m. to 8 p.m. local time. If you have a speech or hearing impairment and use a TTY, call 1-877-833-4486 seven days a week, 8 a.m. to 8 p.m. local time.
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How do I enroll? Application process Effective date Medicare card Emergency contact information Understanding your plan Verification process
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Silver Sneakers * Discuss only in applicable markets What happens next?
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When you become a member
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HUMANA Guidance When You Need It Most Medicare approved HMO, PPO, and PFFS plans available to anyone enrolled in both Part A and Part B of Medicare through age or disability. A Medicare approved Prescription Drug Plan available to anyone entitled to Part A and/or enrolled in Part B of Medicare through age or disability. Copayment, service area, and benefit limitations may apply. You must continue to pay your Medicare applicable premiums. A sales representative will be present with information and applications. You must use network providers and pharmacies. "This presentation is also available in alternative formats." M0006_GH210S6RR KC0906
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