Providence Health Assurance

Transcription

1 Providence Health Assurance v

2 Providence Medicare Advantage Plans 2019 Plan Year Changes Medicare - Align Group Plan + Rx (HMO) The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100 Medicare Flex Group Plan + Rx (HMO-POS) The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100 Non-Medicare The Core Value and Select Value plans are no longer available

3 Providence Health Assurance Medicare Advantage Plans

4 The Value of the Providence Medicare Advantage Plans and PHIP Partnership Medical Lower cost shares, examples: Hospital, outpatient surgery, ambulance and ER Lower out-of-pocket maximum Benefit stability Pharmacy No Part D deductible No coverage gap/donut hole No catastrophic coverage phase; the PHIP Rx plan has a true out-ofpocket maximum A not to exceed per prescription cape of $250 for a month supply

5 Providence Medicare Advantage Plans Enrollment Service Area Oregon Benton, Clackamas, Columbia, Crook, Deschutes, Hood River, Jefferson, Lane, Linn, Marion, Multnomah, Polk, Washington, Wheeler and Yamhill Washington Clark County

6 Providence Medicare Advantage Plan Options Both plans provide the same: Covered services Network of contracted providers Part D prescription drug program Differences between the plans, outside of the monthly premium: Amounts paid at time of service and overall out-of-pocket cost How you access a service (in or out-ofnetwork with or without a referral) Features Align Group Flex Group Type of Plan Monthly Premium Out-of-Pocket Costs Provider Access Primary Care Physician Referral Requirement HMO Higher Premium Low In-Plan Only Required Referral Required HMO-POS Lower Premium Moderate In-Plan or Out-of-Plan Required Referral Optional

7 Providence Medicare Advantage Plan Options Benefit Coverage Align (HMO) Plan Flex (HMO-POS) Plan Member Responsibility In-Network Out-of-Network Deductible None None None Out-of-Pocket Maximum $1,500 per individual $3,000 per individual Primary Care Office Visit $15 copay $20 copay $30 copay Specialist Office Visit $20 copay $25 copay $35 copay Inpatient Hospitalization $100 copay per day $500 maximum per admit $125 copay per day $500 max per admit Outpatient Surgery $75 copay $150 copay 20% Lab Tests $0 $0 20% X-ray 10% 10% 20% Pharmacy Pharmacy Out-of-Pocket Maximum 20% 40% of charge up to $250 maximum per 31-day supply $5,100 per individual

8 Providence Medicare Advantage Plans Emergency and Travel Benefits Service Align Group Flex Group Urgent Care* (Worldwide coverage) Emergency Room* (Worldwide coverage) Ambulance* (Worldwide, air or ground) $25 copay $25 copay $50 copay $65 copay $50 copay $50 copay Travel Benefit (Nationwide, must use a Medicare Provider) Follow-up Care $1,000 allowance Providence pays 80% Member pays 20% $30 copay for a doctor visit $35 copay for a specialist visit 20% for all other services *No coverage limit on Emergency, Urgent Care or Ambulance

9 Providence Medicare Advantage Plans Extra Benefits Care Management Assistance No lifetime reserve days limit on hospitalization Streamlined skilled nursing facility admission $500 annual benefit for health and wellness classes Annual Routine vision exam covered Align plan $15 copay Flex plan $20 copay $100 frame allowance once every 2 years No-cost fitness center membership For a list of contracted facilities visit

10 Providence Medicare Advantage Plans Special Attributes 5 Star plan Our Medicare plans for 2018 received Medicare s highest possible rating, 5 out of 5 stars Over 11,000 in-network providers and growing Providers closed to Medicare; may be open to see you with a Providence Medicare Advantage Plan No balance billing

11 Providence Medicare Advantage Plans Special Attributes Quality of service Local customer service; based in Beaverton Oregon Dedicated service team for prospective members Free Nurse Advice Line available 24 hours a day 7 days a week Nurse Care Managers who personally assist with complex medical needs Online resources Physician finder Rx formulary Benefit specific detail Value added services and discounts myprovidence Mobile ID App Visit

12 Providence Medicare Advantage Plans Extra Benefits Alternative ways to receive care Providence Express Care Virtual $0 Cost Share on all Plans Video visit with a Providence care provider on a smartphone, tablet or computer No appointment necessary Available 8am to Midnight, 7 days a week virtual.providence.org Providence Express Care Clinics Less expensive than urgent care - Same cost as a PCP visit Available from 8am to 8pm or 7am to 7pm seven days a week To locate an Express Clinic, visit:

13 Providence Health Assurance Part D Prescription Drug Plan

14 Pharmacy Network Benefit Providence PHIP Formulary Covers a broad list of medications Formulary available online at Included Medication Therapy Management (MTM) MTM services are associated with improved medication use, lower drug costs, improved disease management, reduced hospitalizations and reduced hospital readmissions Free service for our Medicare members Pharmacies Over 34,000 participating pharmacies to choose from throughout the nation Two types of contracted pharmacies: work Pharmacies Preferred Network & Mail Order Pharmacies Deeper discounts, to help save you money Over 90% of our pharmacies are preferred Examples of Preferred Network Pharmacies* Walgreens Fred Meyer Safeway Costco Target Wal-Mart Rite Aid Bi-Mart *Not all contracted network pharmacies are listed. Pharmacies contracted with your health plan may change at any time. Your health plan will notify you if your pharmacy is no longer included in the network. Please contact your health plan for more details.