Annual Notice of Changes for 2018

Transcription

1 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Aetna Medicare SM Plan (PPO) Offered by Aetna Life Insurance Company Annual Notice of Changes for 2018 November 2017 What to do now 1. ASK: Which changes apply to you Check the changes to our benefits and costs to see if they affect you. It s important to review your coverage now to make sure it will meet your needs next year. Do the changes affect the services you use? Look in Sections 1.4 for information about benefit and cost changes for our plan. Check to see if your doctors and other providers will be in our network next year. Are your doctors in our network? What about the hospitals or other providers you use? Look in Section 1.3 for information about our Provider & Pharmacy Directory. Think about your overall health care costs. How much will you spend out-of-pocket for the services and prescription drugs you use regularly? How much will you spend on your premium and deductibles? 2. COMPARE: Learn about other plan choices - Your coverage is offered through the UAW Retiree Medical Benefits Trust. It is important that you carefully consider your decision before changing your group retiree coverage. This is important because you may permanently lose benefits you currently receive under the UAW Retiree Medical Benefits Trust retiree group coverage if you switch plans.

2 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Contact the UAW Retiree Medical Benefits Trust to see if there are other options are available. Check coverage and costs of individual Medicare health plans in your area. Use the personalized search feature on the Medicare Plan Finder at website. Click Find health & drug plans. Review the list in the back of your Medicare & You handbook. Look in Section 4 to learn more about your choices. 3. CHOOSE: Decide whether you want to change your plan If you want to keep the same Aetna Medicare plan, the UAW Retiree Medical Benefits Trust will give you instructions if there is any action you need to take to remain enrolled. You can change your coverage during the UAW Retiree Medical Benefits Trust's open enrollment period. The UAW Retiree Medical Benefits Trust will tell you what other plan choices might be available to you under your group retiree coverage. You can switch to an individual Medicare health plan or to Original Medicare; however, this would mean dropping your group retiree coverage. As a member of a group Medicare plan, you are eligible for a special enrollment period if you leave the UAW Retiree Medical Benefits Trust plan. This means that you can enroll in an individual Medicare health plan or Original Medicare at any time. Look in Section 3.2 to learn more about your choices. 4. ENROLL: To change plans, call the UAW Retiree Medical Benefits Trust of your information. Additional Resources This document is available for free in Spanish. Please contact Customer Service at for additional information. (TTY users should call 711.) Hours are 8 a.m. to 6 p.m. local time, Monday through Friday. This document may be made available in other formats such as Braille, large print or other alternate formats. Please contact Customer Service for more information. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-ofnetwork service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

3 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Coverage under this Plan qualifies as minimum essential coverage (MEC) and satisfies the Patient Protection and Affordable Care Act s (ACA) individual shared responsibility requirement. Please visit the Internal Revenue Service (IRS) website at for more information on the individual requirement for MEC. About Aetna Medicare Plan (PPO) Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. When this booklet says we, us, or our, it means Aetna Medicare. When it says plan or our plan, it means Aetna Medicare Plan (PPO).

4 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Summary of Important Costs for 2018 The table below compares the 2017 costs and 2018 costs for our plan in several important areas. Please note this is only a summary of changes. It is important to read the rest of this Annual Notice of Changes and review the enclosed Evidence of Coverage and Schedule of Cost Sharing (SOC) to see if other benefit or cost changes affect you. Cost 2017 (this year) 2018 (next year) Deductible In-Network: $245 In-Network: $245 Primary out-of-pocket amounts The primary out-of-pocket limit applies to certain covered plan benefits and includes any plan deductible Maximum out-of-pocket amounts This is the most you will pay out-of-pocket for your covered medical services. (See Section 1.2 for details.) Doctor office visits Combined In- and Out-of- Network Deductible: $490 From In-Network providers: $630 From in-network and outof-network providers combined: $1,395 From network providers: $1,500 From in-network and out-of-network providers combined: $1,500 In-Network: Primary care visits: You pay a $20 copay per visit. Specialist visits: You pay a $25 copay per visit. Out-of-network: Primary care visits: You pay 50% of the total cost. Combined In- and Out-of- Network Deductible: $490 From In-Network providers: $630 From in-network and outof-network providers combined: $1,395 From network providers: $1,500 From in-network and out-of-network providers combined: $1,500 In-Network: Primary care visits: You pay a $20 copay per visit. Specialist visits: You pay a $25 copay per visit. Out-of-network: Primary care visits: You pay 50% of the total cost. Specialist visits: You pay 50% of the total cost. Specialist visits: You pay 50% of the total

5 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Cost 2017 (this year) 2018 (next year) cost. Inpatient hospital stays Includes inpatient acute, inpatient rehabilitation, long-term care hospitals and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor s order. The day before you are discharged is your last inpatient day. In-Network: 10% of the cost per stay. Out-of-network: 30% of the cost per stay. In-Network: 10% of the cost per stay. Out-of-network: 30% of the cost per stay.

6 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Annual Notice of Changes for 2018 Table of Contents Think about Your Medicare Coverage for Next Year... 1 Summary of Important Costs for SECTION 1 Changes to Benefits and Costs for Next Year... 7 Section 1.1 Changes to the Monthly Premium (if applicable)... 7 Section 1.2 Changes to Your Maximum Out-of-Pocket Amounts... 7 Section 1.3 Changes to the Provider Network... 8 Section 1.4 Changes to Benefits and Costs for Medical Services SECTION 2 Administrative Changes SECTION 3 Deciding Which Plan to Choose Section 3.1 If you want to stay in Aetna Medicare Plan (PPO) Section 3.2 If you want to change plans SECTION 4 Deadline for Changing Plans SECTION 5 Programs That Offer Free Counseling about Medicare SECTION 6 Programs That Help Pay for Prescription Drugs SECTION 7 Questions? Section 7.1 Getting Help from Aetna Medicare Plan (PPO) Section 7.2 Getting Help from Medicare... 13

7 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for SECTION 1 Changes to Benefits and Costs for Next Year Section 1.1 Changes to the Monthly Premium (if applicable) Your coverage is provided through a contract with the UAW Retiree Medical Benefits Trust. The plan the UAW Retiree Medical Benefits Trust will provide you with information about your plan premium (if applicable). You must continue to pay your Medicare Part B premium unless it is paid for you by Medicaid. Section 1.2 Changes to Your Maximum Out-of-Pocket Amounts To protect you, Medicare requires all health plans to limit how much you pay out-of-pocket during the year. These limits are called the maximum out-of-pocket amounts. Once you reach this amount, you generally pay nothing for covered services for the rest of the year. Cost In-network primary out-of-pocket amount for certain medical services The primary out-of-pocket limit applies to certain covered plan benefits and includes any plan deductible. Out-of-network primary out-ofpocket amount for certain medical services 2017 (this year) 2018 (next year) $630 $630 $1,395 $1,395

8 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Cost In-network maximum out-of-pocket amount Your costs for covered medical services (such as copays, coinsurance, and deductibles, if applicable) from network providers count toward your in-network maximum out-of-pocket amount. Your plan premium (if applicable) does not count toward your maximum out-of-pocket amount. Combined maximum out-of-pocket amount Your costs for covered medical services (such as copays, coinsurance, and deductibles, if applicable) from in-network and outof-network providers count toward your combined maximum out-ofpocket amount. Your plan premium does not count toward your maximum out-of-pocket amount (this year) 2018 (next year) $1,500 $1,500 Once you have paid $1,500 out-of-pocket for covered services, you will pay nothing for your covered services from network providers for the rest of the calendar year. $1,500 $1,500 Once you have paid $1,500 out-of-pocket for covered services, you will pay nothing for your covered services from in-network or out-of-network providers for the rest of the calendar year. Section 1.3 Changes to the Provider Network There are changes to our network of providers for next year. An updated Provider Directory is located on our website at Please call Customer Service at (For TTY assistance please dial 711.)You may also call Customer Service for updated provider information or to ask us to mail you a Provider Directory. Please review the 2018 Provider Directory to see if your providers (primary care provider, specialists, hospitals, etc.) are in our network. It is important that you know that we may make changes to the hospitals, doctors and specialists (providers) that are part of your plan during the year. There are a number of reasons why your provider might leave your plan but if your doctor or specialist does leave your plan you have certain rights and protections summarized below:

9 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Even though our network of providers may change during the year, Medicare requires that we furnish you with uninterrupted access to qualified doctors and specialists. When possible we will provide you with at least 30 days notice that your provider is leaving our plan so that you have time to select a new provider. We will assist you in selecting a new qualified provider to continue managing your health care needs. If you are undergoing medical treatment you have the right to request, and we will work with you to ensure, that the medically necessary treatment you are receiving is not interrupted. If you believe we have not furnished you with a qualified provider to replace your previous provider or that your care is not being appropriately managed you have the right to file an appeal of our decision. If you find out your doctor or specialist is leaving your plan please contact us so we can assist you in finding a new provider and managing your care. Section 1.4 Changes to Benefits and Costs for Medical Services We are changing our coverage for certain medical services next year. The information below describes these changes. For details about the coverage and costs for these services, see the 2018 Medical Benefits Chart (Schedule of Cost Sharing) included in this package. Cost Routine hearing services Hearing aid reimbursement Health and wellness education programs Teladoc 2017 (this year) In Network: $25 copay Out-of-network: You pay 30% of the total cost of the service. In Network: $2,000 once every 36 months Out-of- Network: $2,000 once every 36 months In Network: Not covered. Out-of-Network: Not covered (next year) In Network: Not Covered. Out-of-network Not covered. In Network: Not covered. Out-of- Network: Not covered. In Network: Covered. In Network: Covered.

10 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for SECTION 2 Administrative Changes Process Fax number for Medical Appeals Fax number for Medical Complaints Additional Resources and Support 2017 (this year) 2018 (next year) Not available. Resources For Living helps connect you to resources in your community such as senior housing, adult daycare, meal subsidies, community activities and more. SECTION 3 Deciding Which Plan to Choose Section 3.1 If you want to stay in Aetna Medicare Plan (PPO) The UAW Retiree Medical Benefits Trust will tell you if you need to do anything to stay enrolled in your Aetna Medicare Plan. Section 3.2 If you want to change plans We hope to keep you as a member. However, if you want to change your plan, here are your options: Step 1: Learn about and compare your choices You can join a different Medicare health plan. The UAW Retiree Medical Benefits Trust will let you know what options are available to you under your group retiree coverage. You can switch to an individual Medicare health plan. -- OR-- You can change to Original Medicare. If you change to Original Medicare, you will need to decide whether to join a Medicare drug plan and whether to buy a Medicare supplement (Medigap) policy. It is important that you carefully consider your decision before dropping your group retiree coverage. This is important because you may permanently lose benefits you

11 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for currently receive under the UAW Retiree Medical Benefits Trust retiree group coverage if you switch plans. Call the UAW Retiree Medical Benefits Trust for information. To learn more about Original Medicare and the different types of Medicare plans, read Medicare & You 2018, call your State Health Insurance Assistance Program (see Section 5), or call Medicare (see Section 7.2). You can also find information about plans in your area by using the Medicare Plan Finder on the Medicare website. Go to and click Find health & drug plans. Here, you can find information about costs, coverage, and quality ratings for Medicare plans. As a reminder, Aetna offers other Medicare health plans and Medicare prescription drug plans. These other plans may differ in coverage, monthly premiums, and cost-sharing amounts. Step 2: Change your coverage To change to a different Medicare health plan, enroll in the new plan. You will automatically be disenrolled from our plan. o To change to Original Medicare with a prescription drug plan, enroll in the new drug plan. You will automatically be disenrolled from our plan. To change to Original Medicare without a prescription drug plan, you must either: o Send us a written request to disenroll. Contact Customer Service if you need more information on how to do this (phone numbers are in Section 7.1 of this booklet). o or Contact Medicare, at MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call SECTION 4 Deadline for Changing Plans You may be able to change to a different plan during the UAW Retiree Medical Benefits Trust s open enrollment period. Your plan may allow you to make changes at other times as well. The UAW Retiree Medical Benefits Trust will let you know what other plan options may be available to you. Are there other times of the year to make a change? As a member of a group Medicare plan, you are eligible for a special enrollment period if you leave the UAW Retiree Medical Benefits Trust s plan. This means that you can enroll in an individual Medicare health plan or Original Medicare. It is important that you carefully consider your decision before dropping your group retiree coverage. This is important because you may permanently lose benefits you currently receive under the UAW Retiree Medical Benefits Trust retiree group coverage if you switch plans. Call the UAW Retiree Medical Benefits Trust for information.

12 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for SECTION 5 Programs That Offer Free Counseling about Medicare The State Health Insurance Assistance Program (SHIP) is a government program with trained counselors in every state. SHIPs are independent (not connected with any insurance company or health plan). They are state programs that get money from the Federal government to give free local health insurance counseling to people with Medicare. SHIP counselors can help you with your Medicare questions or problems. They can help you understand your Medicare plan choices and answer questions about switching plans. You can call your SHIP at the phone number in Addendum A at the back of the Evidence of Coverage. SECTION 6 Programs That Help Pay for Prescription Drugs You may qualify for help paying for prescription drugs. Below we list different kinds of help: Extra Help from Medicare. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty. Many people are eligible and don t even know it. To see if you qualify, call: o MEDICARE ( ). TTY users should call , 24 hours a day/7 days a week; o The Social Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, (applications); or o Your State Medicaid Office (applications). Help from your state s pharmaceutical assistance program. Many states have state pharmaceutical assistance programs (SPAPs) that help people pay for prescription drugs based on their financial need, age, or medical condition. Each state has different rules. To learn more about the program, check with your State Health Insurance Assistance Program (the name and phone numbers for this organization are in Addendum A at the back of the Evidence of Coverage). What if you have coverage from an AIDS Drug Assistance Program (ADAP)? The AIDS Drug Assistance Program (ADAP) helps ADAP-eligible individuals living with HIV/AIDS have access to life-saving HIV medications. Medicare Part D prescription drugs that are also covered by ADAP qualify for prescription cost-sharing assistance. Note: To be eligible for the ADAP operating in your state, individuals must meet certain criteria, including proof of state residence and HIV status, low income as defined by the State, and uninsured/under-insured status.

13 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for If you are currently enrolled in an ADAP, it can continue to provide you with Medicare Part D prescription cost-sharing assistance for drugs on the ADAP formulary. In order to be sure you continue receiving this assistance, please notify your local ADAP enrollment worker of any changes in your Medicare Part D plan name or policy number. Contact information for your state ADAP is shown on Addendum A at the back of the Evidence of Coverage. For information on eligibility criteria, covered drugs, or how to enroll in the program, please call your state ADAP (the name and phone numbers for this organization are in Addendum A at the back of the Evidence of Coverage). ). SECTION 7 Questions? Section 7.1 Getting Help from Aetna Medicare Plan (PPO) Questions? We re here to help. Please call Customer Service at (TTY only, call 711.) We are available for phone calls 8 a.m. to 6 p.m. EST, Monday through Friday. Calls to these numbers are free. Read your 2018 Evidence of Coverage (it has details about next year's benefits and costs) This Annual Notice of Changes gives you a summary of changes in your benefits and costs for For details about your plan, look in the 2018 Evidence of Coverage and the Schedule of Cost Sharing. The Evidence of Coverage is the legal, detailed description of your plan benefits. It explains your rights and the rules you need to follow to get covered services. A copy of the Evidence of Coverage is included in this envelope. The Schedule of Cost Sharing lists the out of pocket cost share for your plan, a copy is included in this envelope. Visit our Website You can also visit our website at As a reminder, our website has the most up-to-date information about our provider network (Provider Directory). Section 7.2 Getting Help from Medicare To get information directly from Medicare: Call MEDICARE ( ) You can call MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call

14 Aetna Medicare SM Plan (PPO) Annual Notice of Changes for Visit the Medicare Website You can visit the Medicare website ( It has information about cost, coverage, and quality ratings to help you compare Medicare health plans. You can find information about plans available in your area by using the Medicare Plan Finder on the Medicare website. (To view the information about plans, go to and click on Find health & drug plans. ) Read Medicare & You 2018 You can read Medicare & You 2018 Handbook. Every year in the fall, this booklet is mailed to people with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. If you don t have a copy of this booklet, you can get it at the Medicare website ( or by calling MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call