Transcript Slide 1

Caremore
Special Needs Plans
Presenters: David Dietz & April Ford
4800 Linglestown Road
Suite 300
Harrisburg, PA 17112
www.RitterIM.com / 800-769-1847
About Ritter Insurance Marketing
• Ritter Insurance Marketing
– Medicare Supplement, Medicare Advantage,
Medicare Part D, Final Expense & Individual
Health.
– Online Services:
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Medicare Quote Engine
Ritter CRM
Online Licensing
Events Calendar
Medicareful.com
– 27 Staff members in house
• 800-769-1847
Special Needs Plan Basics
• Special Needs Plans (SNP’s)
– Dual Eligible- Medicare and Medicaid
– Chronic- Specific chronic diseases and conditions.
– Institutionalized
• Who is Eligible to join a Chronic or Dual SNP?
– Medicare A & B
– Live in the plan’s service area
– Meet one of the following
• Have one or more specific chronic conditions that are included in the plan
• Have both Medicare and Medicaid
• When can a Beneficiary enroll into a SNP?
– Dual Eligible
• You can enroll or change at any time
– Chronic
• Newly Eligible to Medicare (IEP)
• Annual Enrollment period (AEP)
• Have or develop a chronic condition (SEP)
– Change at any time but once you enroll in a plan, this SEP ends.
Caremore Online
• www.caremore.com
– Summary of Benefits
– Pharmacy search
– Evidence of coverage
– 2011 Drug Formulary
– Training Schedule
Caremore SNP Prescription Benefit
• Included in all Caremore SNP plans
– Prescription Drug Coverage
• Tier One - $0 co-pay with coverage through the gap
• Tier Two - $5 co-pay with coverage through the gap
• Tier Three - $0 co-pay with coverage through the Gap
– Many types of Insulin included at this tier
• Tiers 4, 5 and 6 – No coverage through the Gap
– LA and Orange Counties Full coverage through Gap
Plan Details –Arizona
• Maricopa County
– Plan Availability
• Heart, Diabetes and ESRD
– Plan Details
• Premium- $0
• Inpatient Hospital $100 days 1-5 (Diab/Heart) $175 days 1-5 (ESRD)
• Doctor Co-pays: $0 PCP and $25 Specialist
– $0 Co-pay Podiatry
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$100 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $80 every two years
Dental (Package 1 $14.80 month)
OTC Benefit
Transportation $0 Co-pay to Caremore Care Centers *Dialysis
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details –Arizona
• Pima County
– Plan Availability
• Heart, Diabetes and Breathe
– Plan Details
• Premium- $0
• Inpatient Hospital $100 days 1-5
• Doctor Co-pays: $0 PCP and $25 Specialist
– $0 Co-pay Podiatry
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$75 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $80 every two years
Dental (Package 1 $14.80 month)
OTC Benefit
Transportation $0 Co-pay for up to 24 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details - Nevada
• Clark County
– Plans Available
• Diabetes and Breathe
– Plan Details
• Premium- $0
• Inpatient Hospital $100 days 1-5
• Doctor Co-pays: $0 PCP and $20 Specialist
– $0 Co-pay Podiatry
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$25 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $80 every two years
Dental (Package 1 $7.30 month)
OTC Benefit
Transportation $0 Co-pay for up to 24 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details – California
• Santa Clara and Stanislaus County
– Plans Available
• Diabetes and Breathe
– Plan Details
• Premium- $59 monthly
• Inpatient Hospital $100 days 1-5
• Doctor Co-pays: $0 PCP and $15 Specialist
– $0 Co-pay Podiatry
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$100 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $100 every two years
Dental (Package 1 $12.90 month)
OTC Benefit
Transportation $0 Co-pay for Caremore Care Center visits
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details – California
• Riverside County
– Plans Available
• Diabetes
– Plan Details
• Premium- $0
• Inpatient Hospital $45 days 1-5
• Doctor Co-pays: $0 PCP and $0 Specialist
– $0 Co-pay Podiatry
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$45 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $100 every two years
Dental (Package 1 $9.50 month)
OTC Benefit
Transportation $0 Co-pay for up to 24 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details – California
• San Bernardino
– Plans Available
• Reliance (Diabetes), Breathe, ESRD and Connect
– Plan Details
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Premium- $0
Inpatient Hospital $75 days 1-4
Doctor Co-pays: $0 PCP and $0 Specialist
$0 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $100 every two years
Dental (Package 1 $9.50 month)
OTC Benefit
Transportation $0 Co-pay for up to 24 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details – California
• Los Angeles and Orange Counties
– Plans Available
• Reliance (Diabetes), Breathe, ESRD, Heart and Connect
– Plan Details
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Premium- $0
Inpatient Hospital $0 Co-pay
Doctor Co-pays: $0 PCP and $0 Specialist
$0 Co-pay Outpatient Surgery (Hospital Facility)
$0 Co-pay for Diabetic Supplies
Vision- $100 every two years
Dental (Package 1 $9.50 month)
OTC Benefit
Transportation $0 Co-pay for up to 50 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Plan Details – California
• Los Angeles & Orange Counties
– Caremore Connect (Dual Eligible)
– Plan Details
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Premium- $0
Vision- $150 every two years
Dental
OTC Benefit
Transportation $0 Co-pay for up to 50 one-way trips
Fitness – Shape Up, Levels Down
Healthy Start program
Marketing Special Needs Plans
• Marketing to Dual Eligibles
– 21% of Medicare Beneficiaries are dual eligible
• Varies widely by state 12% in Utah 41% in Maine
– www.statehealthfacts.org
– 36% of dual eligible are under 65, where as with
all Medicare Beneficiaries only 16% are under 65
– Traditional Marketing does not work
• Successful marketing requires more of a “grass roots”
approach. Building relationships with centers of
influence such as low income housing will be more
successful.
Marketing Special Needs Plans
• Marketing to Chronic SNP’s
– Chronic SNP's require similar specialized
marketing. Since the qualification to enroll in
these plans requires a particular medical
condition, keep this in mind as you develop your
marketing plan. In some cases you may find
events sponsored for those with Diabetes or
similar diseases which would be a good place to
market your services.
Question and Answer
Contact Ritter Insurance Marketing
Phone: 800-769-1847
Dave Dietz – 213
April Ford – 212
Carl Conrad – 223
Amy Shuman - 224
Email: [email protected]
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