Transcript Document
2014 Presentation Medicare Advantage and Prescription Drug Plans Y0040_SPM_SPRE_MAPD_14 Approved GNHH31KHH_14 Let’s talk about . . . • Are you eligible? • Your Medicare coverage options • Humana’s plans and extras • How to enroll Humana.com 2 Medicare/Medicaid Coverage (Dual-Eligible): Do you qualify? Medicare/Medicaid Coverage (Dual-Eligible): • Contact Humana for more information on all of the special benefits and services available to you through Humana’s Dual Eligible Special Needs Plans (SNP). • If you choose to enroll in a cost share protected Dual-Eligible SNP, you will not be responsible for paying any premiums, deductibles, coinsurances or copayments associated with this plan’s medical services. Humana.com 3 Are you eligible for a Medicare Advantage Plan? • Enrolled in Medicare Part A and Part B? • Permanent resident in service area? • Have End-Stage Renal Disease (ESRD)? – End Stage Renal Disease is permanent kidney failure usually requiring dialysis or a kidney transplant. People with ESRD stay with Original Medicare. – Federal law won’t let us accept anyone with End-Stage Renal Disease – often called kidney failure – unless you: 1.Have another health plan from the same organization within the same state, or 2.Were enrolled in a Medicare Advantage plan that was terminated or discontinued after Dec. 31, 1998, and this is your first election since that happened. Humana.com 4 2014 Plan Year - Medicare Timeline Pre-Enrollment: Oct. 1 – Oct. 14, 2013 Compare plans so you’ll be ready to enroll beginning Oct. 15. Annual Election: Oct. 15 – Dec. 7, 2013 Annual Disenrollment: Jan. 1 – Feb. 14, 2014 Feb. 15 – Oct. 14, 2014 If you’re eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan with or without prescription drug coverage. Or you may choose to enroll in a stand-alone prescription drug plan. Medicare Advantage plan members may disenroll from their MA plan and return to Original Medicare. They may also elect enrollment in a standalone drug plan You can’t make a plan change unless special circumstances arise (e.g., you move, you qualify for or lose eligibility for Medicaid). Note: This information doesn’t apply to Medicare Supplement Plans 5 Humana.com The right plan for you • What type of plan do you have now? • What do you like about your coverage? • What would you add to your current coverage to make it ideal for you? • Who helps you make decisions about your healthcare? Humana.com 6 Medicare Today Original Medicare ID Card Medicare Supplement ID Card Medicare Part D ID Card All you need with Medicare Advantage is one card. Humana.com 7 Original Medicare You receive a service, you pay a fee • Usually pay a monthly premium for Part B • You will have access to any doctor or provider that accepts Medicare • Out-of-pocket costs include hospital and medical deductible and coinsurance • May want to purchase separate Medicare Supplement insurance and Prescription Drug Plan to cover gaps Humana.com 8 Original Medicare + Medicare Supplement insurance Medicare Supplement insurance (also referred to as a Medigap policy) • Purchased from private insurance companies • Supplements Original Medicare coverage • Covers some costs Original Medicare doesn’t pay • Original Medicare pays before the Medicare Supplement plan provides payment • Plans are standardized and can be purchased with varying coverage options • Medicare Supplement plans have no provider networks Humana.com 9 What are Medicare Advantage (MA) health plans? • Private insurance companies approved by Medicare provide this coverage • Provides Medicare beneficiaries a choice in how they receive Medicare coverage • MA plans are not Medicare Supplement insurance plans • These plans must offer all benefits of Original Medicare and can include Part D prescription drug coverage • All plans offer maximum out-of-pocket protections • MA plans include emergency coverage when traveling outside the US Humana.com 10 Why choose Medicare Advantage? • Most plans offer health and drug coverage • Most plans have lower out-of-pocket costs than Original Medicare • Extra benefits and savings* – Mail-order pharmacies – Prescription medicine discounts – Dental, vision and hearing care discounts – Nurse advice line – Fitness programs – Care management programs • Very little paperwork compared to Original Medicare * Not all benefits listed are available on all plans Humana.com 12 More plan choices with Medicare Advantage Medicare Advantage (MA) plans • Health Maintenance Organization (HMO) FIND OUT MORE • Preferred Provider Organization (PPO) FIND OUT MORE • Private-Fee-for-Service (PFFS) FIND OUT MORE Part D Medicare Prescription Drug coverage • May be purchased as a stand-alone plan; or • As part of a Medicare Advantage Prescription Drug Plan (MAPD) All plans must meet minimum coverage level set by Medicare 12 Humana.com Is an HMO right for you? Health Maintenance Organization (HMO) • Defined network of providers • Primary care physician (PCP) coordinates all of your care • You may have to receive a referral from your PCP to see a specialist • In most cases, you must use network providers for all scheduled care. There is no coverage for out-of-network care, except for emergency or urgent care • Out-of-pocket costs may be significantly lower than Original Medicare Go to: Is a Stand-Alone drug plan right for you? Humana.com 13 Dual Eligible Special Needs Plan (SNP) • • • • • • • Additional benefits over Medicaid Enhanced care management services Defined network of providers Primary care physician (PCP) coordinates all of your care Individualized care plan that caters to your needs In most cases, you must use network providers for all scheduled care No coverage for out-of-network care, except for emergency or urgent care Go to: Is a Stand-Alone drug plan right for you? Humana.com Chronic Condition Special Needs Plan (SNP) • • • • • • • Additional benefits tailored to members with certain chronic conditions Enhanced care management services Defined network of providers Primary care physician (PCP) coordinates all of your care Individualized care plan that caters to your needs In most cases, you must use network providers for all scheduled care. No coverage for out-of-network care, except for emergency or urgent care Go to: Is a Stand-Alone drug plan right for you? Humana.com Is a PPO right for you? Preferred Provider Organization (PPO) • Defined network of providers • Flexibility to use providers who aren’t part of the network • Out-of-pocket costs may increase significantly when you use out-ofnetwork providers, facilities or labs, except for emergency care* • You may save more when you use network providers because the plan pays a larger share of the cost * In some cases, the costs are the same inand out-of-network Go to: Is a Stand-Alone drug plan right for you? Humana.com 16 Is a PFFS right for you? Private-Fee-for-Service (PFFS) • No referral needed to see any doctor • Most plans include provider networks, but any provider can participate under the following conditions: – Your doctor must agree to accept the Private-Fee-for-Service plan’s payment terms and conditions – For plans with Rx, you must use network pharmacies to obtain prescription drugs, except in emergencies or urgent situations Humana.com 17 PFFS plan review Private-Fee-for-Service (PFFS) • Before seeing a provider, you should consider... – A Private Fee-for-Service plan is not a Medicare supplement plan. Providers who do not contract with our plan are not required to see you except in an emergency. – If they choose to provide services, they must bill the Private-Fee-for-Service plan for your covered healthcare services. They may not bill you. – If your PFFS plan has a network, you can still receive services from non-network providers, but you may pay more to see a doctor or other healthcare professional who isn’t in our network. – Private-Fee-for-Service plans do not pay after Medicare pays its share. – You’re required to pay the appropriate deductibles, copayments, and coinsurance Humana.com 18 PFFS plan review Private-Fee-for-Service (PFFS) • We have network providers – providers who have signed contracts with our plan – for all services covered under Original Medicare in our fully networked plans. • For partial network plans, contracted providers are limited to certain Durable Medical Equipment providers, home health providers, and some freestanding labs. These providers have agreed to see members of our plan. • Providers can find the plan’s terms and conditions of payment on our website: https://www.humana.com/medicare/products-andservices/medicare-advantage/humana-goldchoice/humana-gold-choice-terms Go to: Is a Stand-Alone drug plan right for you? Humana.com 19 Is a stand-alone drug plan right for you? Medicare Part D Prescription Drug Plans (PDP) • Plans offered by private companies under contract with Medicare • Companies may offer plans with different levels of coverage • Check your prescription drug needs with the plan’s coverage and drug list as well as with your cost for those drugs Humana.com 20 Basic prescription benefit The basic plan (defined by Medicare). All Part D plans are required by law to offer benefits equal to or better than: 2014 Medicare Prescription Drug Plan - Basic Coverage 2014 Basic Benefits You Pay Deductible $310 100% of first $310 Initial Coverage Limit $2,850 25% of the next $2,540 ($635) $3,605 47.5% of covered brand name and 72% of generic drugs of the next $3,605 until the cumulative out-of-pocket costs reach $4,550 Coverage Gap* $4,550** Annual Out-of-Pocket Amount Catastrophic Coverage Medicare and Plan 95% $2.55 for generic/multiple-source drug and $6.35 for all other drugs; or 5% coinsurance, whichever is greater * See Coverage in the Gap on following slide ** Annual Out-of-Pocket Amount doesn’t include monthly premiums. Humana.com 21 Get to Know the Coverage Gap Chances are, you’ve heard of the Medicare prescription drug “coverage gap” - also called the “donut hole.” The coverage gap is the period when you have to pay part of your drug costs - and before additional Medicare coverage kicks in. * applies only to drugs covered by the selected plan **some plans have additional coverage while the member is in the gap. 22 Humana.com Extra help Do you wonder if you can afford your prescription medicines? • Call to see if you may qualify for money the Federal government has set aside to help people with their drug expenses: — 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week — The Social Security office at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. - 7 p.m., Monday – Friday — Your state Medicaid office Humana.com 23 Find out about your benefits Humana.com 24 In-Network Providers Like Medicare, Medicare insurer 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 Humana.com 25 Add optional benefits You have unique needs for staying healthy. That’s why we offer optional supplemental benefits* (OSBs). OSBs are extra benefits not included in Original Medicare that: •Provide choices that make it easier for you to get coverage you want •Control costs and personalize your benefit needs •Can be added when you enroll in Medicare Advantage or any time during the year These benefits have an extra premium, which is combined with your Medicare Advantage plan premium. * May not be available on all plans Humana.com 26 Enjoy extra value and possible savings Availability of all varies by plan: •Mail-order pharmacies •Fitness program •24-hour nurse advice line •SmartSummary® •Humana Active Outlook® (HAO) •Personal health coaching • Online tools • * Other pharmacies are available in our network Humana.com 27 When enrolled, you can expect the next steps In the months to come: • Receive your Evidence of Coverage • Annual Wellness Visit • Use your preventive benefits • Find out if you can save by using a mail-order pharmacy Humana.com 28 Thanks for your time and attention Any questions? Where to find information: • “Medicare and You 2014” handbook (available in October or November 2013) • www.medicare.gov • Your local State Health Insurance Program (SHIP) Humana.com 29