Annual Notice of Changes for 2018

Transcription

1 WeCare Advance (HMO-POS) offered by Harmony Heath Pan, Inc. Annua Notice of Changes for 2018 You are currenty enroed as a member of WeCare Advance (HMO). Next year, there wi be some changes to the pan s costs and benefits. This booket tes about the changes. You have from October 15 unti December 7 to make changes to your Medicare coverage for next year. What to do now 1. ASK: Which changes appy 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 wi meet your needs next year. Do the changes affect the services you use? Look in Sections 2.1, 2.2, and 2.4 for information about benefit and cost changes for our pan. Check to see if your doctors and other providers wi be in our network next year. Are your doctors in our network? What about the hospitas or other providers you use? Look in Section 2.3 for information about our Provider Directory. Think about your overa heath care costs. How much wi you spend out-of-pocket for the services and prescription drugs you use reguary? How much wi you spend on your premium and deductibes? How do your tota pan costs compare to other Medicare coverage options? Think about whether you are happy with our pan. Form CMS ANOC/EOC (Approved 05/2017) H1416_WCM_01857E CMS Accepted OMB Approva (Expires: May 31, 2020) AR8IMRANC01857E_0027

2 2. COMPARE: Learn about other pan choices Check coverage and costs of pans in your area. Use the personaized search feature on the Medicare Pan Finder at website. Cick Find heath & drug pans. Review the ist in the back of your Medicare & You handbook. Look in Section 3.2 to earn more about your choices. Once you narrow your choice to a preferred pan, confirm your costs and coverage on the pan s website. 3. CHOOSE: Decide whether you want to change your pan If you want to keep your pan, you don t need to do anything. You wi stay in your pan. To change to a different pan that may better meet your needs, you can switch pans between October 15 and December ENROLL: To change pans, join a pan between October 15 and December 7, 2017 If you don t join by December 7, 2017, you wi stay in WeCare Advance (HMO-POS). If you join by December 7, 2017, your new coverage wi start on January 1, Additiona Resources This booket is aso avaiabe in different formats, incuding arge print, audio compact disc (CD), and Braie. Pease ca Customer Service if you need pan information in another format (phone numbers are printed on the back cover of this booket). Coverage under this Pan quaifies as minimum essentia coverage (MEC) and satisfies the Patient Protection and Affordabe Care Act s (ACA) individua shared responsibiity requirement. Pease visit the Interna Revenue Service (IRS) website at for more information. About WeCare Advance (HMO-POS) WeCare (HMO-POS) is a Medicare Advantage Organization with a Medicare contract. Enroment in WeCare depends on contract renewa.

3 When this booket says we, us, or our, it means Harmony Heath Pan, Inc. When it says pan or our pan, it means WeCare Advance (HMO-POS)

4 WeCare Advance (HMO-POS) Annua Notice of Changes for Summary of Important Costs for 2018 The tabe beow compares the 2017 costs and 2018 costs for WeCare Advance (HMO-POS) in severa important areas. Pease note this is ony a summary of changes. It is important to read the rest of this Annua Notice of Changes and review the encosed Evidence of Coverage to see if other benefit or cost changes affect you. Cost 2017 (this year) 2018 (next year) Monthy pan premium $0.00 $0.00 Maximum out-of-pocket amount This is the most you wi pay out-of-pocket for your covered Part A and Part B services. (See Section 2.2 for detais.) Doctor office visits Inpatient hospita stays Incudes inpatient acute, inpatient rehabiitation, ong-term care hospitas and other types of inpatient hospita services. Inpatient hospita care starts the day you are formay admitted to the hospita with a doctor s order. The day before you are discharged is your ast inpatient day. $4,500 $4,500 Primary care visits: $10 per visit Speciaist visits: $35 per visit You pay a $325 co-pay per day for Days 1-5 $0 co-pay per day for Days 6-90 $0 co-pay for additiona hospita days. No imit to the number of days covered by the pan. Cost share appies Per admission. Primary care visits: $5 per visit Speciaist visits: $35 per visit You pay a $325 co-pay per day for Days 1-5 $0 co-pay per day for Days 6-90 No additiona hospita days. Cost share appies Per admission.

5 WeCare Advance (HMO-POS) Annua Notice of Changes for Annua Notice of Changes for 2018 Tabe of Contents Summary of Important Costs for SECTION 1 We Are Changing the Pan's Name... SECTION 2 Changes to Benefits and Costs for Next Year... Section 2.1 Changes to the Monthy Premium... Section 2.2 Changes to Your Maximum Out-of-Pocket Amount.. Section 2.3 Changes to the Provider Network Section 2.4 Changes to Benefits and Costs for Medica Services... SECTION 3 Deciding Which Pan to Choose... Section 3.1 If you want to stay in WeCare Advance (HMO-POS)... Section 3.2 If you want to change pans... SECTION 4 Deadine for Changing Pans... SECTION 5 Programs That Offer Free Counseing about Medicare... SECTION 6 Programs That Hep Pay for Prescription Drugs... SECTION 7 Questions?... Section 7.1 Getting Hep from WeCare Advance (HMO-POS)... Section 7.2 Getting Hep from Medicare

6 WeCare Advance (HMO-POS) Annua Notice of Changes for Section 1 We are Changing the Pan's Name On January 1, 2018, our pan name wi change from WeCare Advance (HMO) to WeCare Advance (HMO-POS). You wi receive a new ID Card in the mai that wi dispay the new pan name on or before December 31, Going forward, a other communications regarding your 2018 pan and benefits wi aso refect the new name. SECTION 2 Changes to Benefits and Costs for Next Year Section 2.1 Changes to the Monthy Premium Cost 2017 (this year) 2018 (next year) Monthy premium (You must aso continue to pay your Medicare Part B premium.) $0.00 $0.00 Section 2.2 Changes to Your Maximum Out-of-Pocket Amount To protect you, Medicare requires a heath pans to imit how much you pay out-of-pocket during the year. This imit is caed the maximum out-of-pocket amount. Once you reach this amount, you generay pay nothing for covered Part A and Part B services for the rest of the year.

7 WeCare Advance (HMO-POS) Annua Notice of Changes for Cost 2017 (this year) 2018 (next year) Maximum out-of-pocket amount Your costs for covered medica services (such as co-pays) count toward your maximum out-of-pocket amount. $4,500 $4,500 Section 2.3 Changes to the Provider Network Once you have paid $4,500 out-of-pocket for covered Part A and Part B services, you wi pay nothing for your covered Part A and Part B services for the rest of the caendar year. There are changes to our network of providers for next year. An updated Provider Directory is ocated on our website at You may aso ca Customer Service for updated provider information or to ask us to mai you a Provider Directory. Pease review the 2018 Provider Directory to see if your providers (primary care provider, speciaists, hospitas, etc.) are in our network. It is important that you know that we may make changes to the hospitas, doctors, and speciaists (providers) that are part of your pan during the year. There are a number of reasons why your provider might eave your pan but if your doctor or speciaist does eave your pan you have certain rights and protections summarized beow: Even though our network of providers may change during the year, Medicare requires that we furnish you with uninterrupted access to quaified doctors and speciaists. We wi make a good faith effort to provide you with at east 30 days notice that your provider is eaving our pan so that you have time to seect a new provider. We wi assist you in seecting a new quaified provider to continue managing your heath care needs. If you are undergoing medica treatment you have the right to request, and we wi work with you to ensure, that the medicay necessary treatment you are receiving is not interrupted.

8 WeCare Advance (HMO-POS) Annua Notice of Changes for If you beieve we have not furnished you with a quaified provider to repace your previous provider or that your care is not being appropriatey managed, you have the right to fie an appea of our decision. If you find out your doctor or speciaist is eaving your pan, pease contact us so we can assist you in finding a new provider and managing your care. Section 2.4 Changes to Benefits and Costs for Medica Services We are changing our coverage for certain medica services next year. The information beow describes these changes. For detais about the coverage and costs for these services, see Chapter 4, Medica Benefits Chart (what is covered and what you pay), in your 2018 Evidence of Coverage. Cost 2017 (this year) 2018 (next year) INPATIENT SERVICES Inpatient Hospita Stays You pay a $325 co-pay per day for Days 1-5 $0 co-pay per day for Days 6-90 $0 co-pay for additiona hospita days. No imit to the number of days covered by the pan. You pay a $325 co-pay per day for Days 1-5 $0 co-pay per day for Days 6-90 No additiona hospita days. Cost share appies Per admission OUTPATIENT SERVICES Cost share appies Per admission Primary Care Physician Visit You pay a $10 co-pay You pay a $5 co-pay

9 WeCare Advance (HMO-POS) Annua Notice of Changes for Cost 2017 (this year) 2018 (next year) Other Heath Care Professiona Visit (such as nurse practitioner, physician assistant or cinica nurse speciaist) Urgenty Needed Services and Emergency Care You pay a $5 co-pay for services performed in a primary care physician's office. You pay a $35 co-pay for services performed in a speciaist s office. Emergency Care You pay a $75 co-pay Wordwide Coverage (for Emergency or Urgenty Needed Services) ADDITIONAL SERVICES You pay a $75 co-pay Over-the-Counter Items You receive $20 every month for approved over-the-counter items through mai service. You pay a $0 co-pay for services performed in a primary care physician's office. You pay a $35 co-pay for services performed in a speciaist s office. You pay a $80 co-pay You pay a $80 co-pay You receive $100 every quarter for approved over-the-counter items through mai service. Non-Emergency Medica Transportation (to/from pan-approved ocations) Persona Emergency Response System (Medica Aert) You pay a $0 co-pay per one-way trip for 24 One-way trips every year. Trips are imited to 50 mies, one-way, uness approved by the pan. Persona Emergency Response System is not covered. You pay a $0 co-pay per one-way trip for 24 One-way trips every year. Trips are imited to 75 mies, one-way, uness approved by the pan. You pay a $0 co-pay.

10 WeCare Advance (HMO-POS) Annua Notice of Changes for Cost 2017 (this year) 2018 (next year) Point-of-Service (POS) (see your Evidence of Coverage for a compete ist of covered services) POS benefit is not covered. You pay 20% of the tota cost out-of-network. SECTION 3 Deciding Which Pan to Choose Section 3.1 If you want to stay in WeCare Advance (HMO-POS) To stay in our pan you don t need to do anything. If you do not sign up for a different pan or change to Origina Medicare by December 7, you wi automaticay stay enroed as a member of our pan for Section 3.2 If you want to change pans We hope to keep you as a member next year but if you want to change for 2018 foow these steps: Step 1: Learn about and compare your choices You can join a different Medicare heath pan, -- OR-- You can change to Origina Medicare. If you change to Origina Medicare, you wi need to decide whether to join a Medicare drug pan. To earn more about Origina Medicare and the different types of Medicare pans, read Medicare & You 2018, ca your State Heath Insurance Assistance Program (SHIP) (see Section 5), or ca Medicare (see Section 7.2). You can aso find information about pans in your area by using the Medicare Pan Finder on the Medicare website. Go to and cick Review and Compare Your Coverage Options. Here, you can find information about costs, coverage, and quaity ratings for Medicare pans. Step 2: Change your coverage

11 WeCare Advance (HMO-POS) Annua Notice of Changes for n n n To change to a different Medicare heath pan, enro in the new pan. You wi automaticay be disenroed from WeCare Advance (HMO-POS). To change to Origina Medicare with a prescription drug pan, enro in the new drug pan. You wi automaticay be disenroed from WeCare Advance (HMO-POS). To change to Origina Medicare without a prescription drug pan, you must either: Send us a written request to disenro. Contact Customer Service if you need more information on how to do this (phone numbers are in Section 7.1 of this booket). or Contact Medicare, at MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenroed. TTY users shoud ca SECTION 4 Deadine for Changing Pans If you want to change to a different pan or to Origina Medicare for next year, you can do it from October 15 unti December 7. The change wi take effect on January 1, Are there other times of the year to make a change? In certain situations, changes are aso aowed at other times of the year. For exampe, peope with Medicaid, those who get Extra Hep paying for their drugs, those who have or are eaving empoyer coverage, and those who move out of the service area are aowed to make a change at other times of the year. For more information, see Chapter 8, Section 2.3 of the Evidence of Coverage. If you enroed in a Medicare Advantage pan for January 1, 2018, and don t ike your pan choice, you can switch to Origina Medicare between January 1 and February 14, For more information, see Chapter 8, Section 2.2 of the Evidence of Coverage. SECTION 5 Programs That Offer Free Counseing about Medicare The State Heath Insurance Assistance Program (SHIP) is a government program with trained counseors in every state. You can find the name, phone number and address of your state s State Heath insurance

12 WeCare Advance (HMO-POS) Annua Notice of Changes for Assistance Program isted in the Appendix at the back of your Evidence of Coverage. SHIPs are independent (not connected with any insurance company or heath pan). It is a state program that gets money from the Federa government to give free oca heath insurance counseing to peope with Medicare. SHIP counseors can hep you with your Medicare questions or probems. They can hep you understand your Medicare pan choices and answer questions about switching pans. You can ca your SHIP at the contact information isted in the Appendix at the back of the Evidence of Coverage. SECTION 6 Programs That Hep Pay for Prescription Drugs You may quaify for hep paying for prescription drugs. Extra Hep from Medicare. Peope with imited incomes may quaify for "Extra Hep" to pay for their prescription drug costs. If you quaify, Medicare coud pay up to 75% or more of your drug costs incuding monthy prescription drug premiums, annua deductibes, and coinsurance. Additionay, those who quaify wi not have a coverage gap or ate enroment penaty. Many peope are eigibe and don't even know it. To see if you quaify ca: MEDICARE ( ). TTY users shoud ca , 24 hours a day/7 days a week; The Socia Security Office at between 7 am and 7 pm, Monday through Friday. TTY users shoud ca, (appications); or Your State Medicaid Office (appications). What if you have coverage from an AIDS Drug Assistance Program (ADAP)? The AIDS Drug Assistance Program (ADAP) heps ADAP-eigibe individuas iving with HIV/AIDS have access to ife-saving HIV medications. Medicare Part D prescription drugs that are aso covered by ADAP quaify for prescription cost-sharing assistance through your State's ADAP (the name and phone numbers for this organization are isted in the appendix in the back of the Evidence of Coverage.) Note: To be eigibe for the ADAP operating in your State, individuas must meet certain criteria, incuding proof of State residence

13 WeCare Advance (HMO-POS) Annua Notice of Changes for and HIV status, ow income as defined by the State, and uninsured/under-insured status. If you are currenty enroed in an ADAP, it can continue to provide you with Medicare Part D prescription cost-sharing assistance for drugs on the ADAP formuary. In order to be sure you continue receiving this assistance, pease notify your oca ADAP enroment worker of any changes in your Medicare Part D pan name or poicy number. The name and phone numbers for your State s ADAP are isted in the appendix in the back of the Evidence of Coverage. For information on eigibiity criteria, covered drugs, or how to enro in the program, pease ca your State's ADAP (the name and phone numbers for this organization are isted in the appendix in the back of the Evidence of Coverage.). SECTION 7 Questions? Section 7.1 Getting Hep from WeCare Advance (HMO-POS) Questions? We re here to hep. Pease ca Customer Service at (TTY ony, ca 711.) We are avaiabe for phone cas Monday-Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are avaiabe Monday-Sunday, 8 a.m. to 8 p.m. Cas to these numbers are free. Read your 2018 Evidence of Coverage (it has detais about next year's benefits and costs) This Annua Notice of Changes gives you a summary of changes in your benefits and costs for For detais, ook in the 2018 Evidence of Coverage for WeCare Advance (HMO-POS). The Evidence of Coverage is the ega, detaied description of your pan benefits. It expains your rights and the rues you need to foow to get covered services and prescription drugs. A copy of the Evidence of Coverage is incuded in this enveope. Visit Our Website You can aso visit our website at As a reminder, our website has the most up-to-date information about our provider network (Provider Directory).

14 WeCare Advance (HMO-POS) Annua Notice of Changes for Section 7.2 Getting Hep from Medicare To get information directy from Medicare: Ca MEDICARE ( ) You can ca MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca Visit the Medicare Website You can visit the Medicare website ( It has information about cost, coverage, and quaity ratings to hep you compare Medicare heath pans. You can find information about pans avaiabe in your area by using the Medicare Pan Finder on the Medicare website. (To view the information about pans, go to and cick on Find heath & drug pans ) Read Medicare & You 2018 You can read Medicare & You 2018 Handbook. Every year in the fa, this booket is maied to peope with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequenty asked questions about Medicare. If you don t have a copy of this booket, you can get it at the Medicare website ( or by caing MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca