Transcript Document
2014 Presentation
Humana Medicare Advantage and Prescription Drug Plans
Y0040_SPM_SPRE_MAPD_14 Approved GNHH31KHH_14
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Let’s talk about . . .
• Are you eligible?
• Choosing the right Humana plan for you • Your Medicare coverage options • Humana’s plans and extras • How to enroll Humana.com
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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
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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
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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
2014 Plan Year - Medicare Timeline
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Pre-Enrollment: Oct. 1 – Oct. 14, 2013 Annual Election: Oct. 15 – Dec. 7, 2013 Annual Disenrollment: Jan. 1 – Feb. 14, 2014
Compare plans so you’ll be ready to enroll beginning Oct. 15.
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 stand alone drug plan
Feb. 15 – Oct. 14, 2014
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 Humana.com
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Experience behind the coverage
Humana offers a wide range of products and services that incorporate an integrated approach to lifelong well-being. •
Dedication to the community
More than 50 years of helping people of all ages •
Financial stability
Fortune 100 company •
National coverage
Providing Medicare plans in 50 states, Puerto Rico, and the District of Columbia Humana.com
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The right Humana 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
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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
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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
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Original Medicare + Medicare Supplement insurance
Medicare Supplement insurance
(also referred to as a Medigap policy) • P urchased 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
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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
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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*
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Mail-order pharmacies
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Prescription medicine discounts
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discounts Dental, vision and hearing care
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Nurse advice line
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Fitness programs Care management programs Very little paperwork compared to Original Medicare * Not all benefits listed are available on all plans Humana.com
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More plan choices with Medicare Advantage
Medicare Advantage (MA) plans
• Health Maintenance Organization (HMO)
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Preferred Provider Organization (PPO)
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Private-Fee-for-Service (PFFS)
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 Humana.com
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Is an HMO right for you?
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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
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
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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-of network 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 in and out-of-network
Go to: Is a Stand-Alone drug plan right for you?
Humana.com
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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
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PFFS plan review
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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
PFFS plan review
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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-and services/medicare-advantage/humana-gold choice/humana-gold-choice-terms
Go to: Is a Stand-Alone drug plan right for you?
Humana.com
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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
Basic prescription benefit
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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 Initial Coverage Limit Coverage Gap*
$310 $2,850 $3,605 100% of first $310 25% of the next $2,540 ($635) 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
$4,550
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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
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.
23 * applies only to drugs covered by the selected plan **some plans have additional coverage while the member is in the gap.
Humana.com
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Extra help
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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
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Find out about your Humana benefits
Humana.com
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In-Network Providers
Like Medicare, Humana 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
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Add optional benefits
You have unique needs for staying healthy. That’s why Humana offers 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
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Enjoy extra value and possible savings
Availability of all varies by plan:
• • • • • • Mail-order pharmacies, like Humana-owned RightSource®* Fitness program 24-hour nurse advice line SmartSummary ® Humana Active Outlook ® Personal health coaching (HAO) • Online tools on
Humana.com
and
m.humana.com
* Other pharmacies are available in our network Humana.com
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If you choose to enroll with Humana
If you choose to enroll with Humana
Complete an application
In the next two weeks:
Humana processes your application and confirms your eligibility You’ll receive a verification call for each enrollee in the household Medicare confirms your enrollment Receive your Humana member identification (ID) card Member Benefit Package arrives in your mailbox Welcome Call - We’ll contact you about completing a health questionnaire Humana.com
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When enrolled, you can expect the next steps
In the months to come:
• Your Humana agent calls you • 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
Thanks for your time and attention
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Any questions?
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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-Medicare.com
Humana offers Member kickoff meetings – Bring the Humana Guide from your Member Benefit Package 31 Humana.com
Humana is a Medicare Advantage organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in this Humana plan depends on contract renewal. 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. Benefits, formulary, pharmacy network, premium and/or co payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Humana MyOption Optional Supplemental Benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1 each year.
This information is available for free in other languages. Please contact our Customer Care number at 1-800 457-4708 (TTY: 711) for additional information. Hours are 8 a.m. to 8 p.m., seven days a week through Feb. 15, 2014 and 8 a.m. – 8 p.m. Monday – Friday the rest of the year. Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al 1-800-457-4708 (TTY: 711) si desea mayores informes. El horario es de 8 a.m. a 8 p.m., los siete días de la semana hasta el 15 de febrero de 2014 y de 8 a.m. a 8 p.m. de lunes a viernes por el resto del año. GNHH31KHH_14