Benefit Highlights. H5826_MA_031_2018_v_02_BeneHiEng Accepted

Transcription

1 Get More Than Original Medicare 2018 Benefit Highlights H5826_MA_031_2018_v_02_BeneHiEng Accepted

2 Your preventive care is our focus. We cover 100% of the following services: Bone Mass Measurements Colorectal Screening Exams Immunizations Mammograms Pap Smears and Pelvic Exams Prostate Cancer Screenings MA Special Needs Plan 014 (HMO SNP)* MA Plan 006 (HMO) MA Pharmacy Plan 008 (HMO) MA Pharmacy Plan 009 (HMO) Covers different counties. $0/mo $30/mo $67/mo $93/mo Enhanced Medicare and Medicaid coverage. To qualify, you must be eligible for both Medicare and full Medicaid. Enhanced Medicare coverage Plan includes coverage for routine eyewear, dental services. Does not include prescription drug coverage. (Part D) Enhanced Medicare coverage. Plan includes coverage for routine eyewear, dental services, and prescription drugs. Enhanced Medicare coverage. Plan includes coverage for routine eyewear, dental services, and prescription drugs. MA Extra Plan 010 (HMO) $20.90/mo Enhanced Medicare coverage plus routine eyewear and prescription drug coverage.

3 San Juan Island Whatcom Skagit Okanogan Ferry Stevens Pend Oreille Clallam Snohomish Chelan Kitsap King Douglas Lincoln Spokane Grays Harbor Mason Thurston Pierce Kittitas Grant Adams Whitman Wahkiakum Cowlitz Lewis Skamania Yakima Benton Franklin Walla Walla Columbia Asotin Clark Klickitat When you choose TM, you choose a statewide network of more than 14,500 primary care doctors and specialists and 100+ hospitals. You get access to the services you need when and where you need them. Your Plan Options MA Special Needs Plan (014)* MA Plan (006) MA Pharmacy Plan (008) MA Pharmacy Plan (009) MA Extra Plan (010) Our plans vary by county. To enroll, you must reside in our service area.

4 Compare MA Special Needs Plan (014)* MA Plan (006) Premium $0** $30 Out-of-Pocket Maximum Part A Inpatient Hospital Part B 201 Deductible $6,700 calendar year $0 per day for days 1-90 $6,700 per calendar year $450 per day for days 1-4 Primary Care (per visit) Specialist Care (per visit) $40 copay Medicare-covered Lab Services Urgent Care (per visit) Emergency Care (per visit) $80 copay Ambulance (per service) $300 copay Diabetic Supplies Supplemental Podiatry Services Supplemental Routine Eye Exam Supplemental Eyewear (up to 4 supplemental (up to 1 supplemental routine exam every year) $130 every year (up to 4 supplemental (up to 1 supplemental routine eye exam every year) $100 every two years Supplemental Dental Services Chiropractic (per Medicare-covered visit) Acupuncture and Naturopathy (per visit) Part D Prescription Copays $1,800 benefit every year ($250 limit every year) $0 or $1.25 or $3.35 (generic) $0 or $3.70 or $8.35 (all other drugs) $500 benefit every year $20 copay ($250 limit every year) This plan does not include coverage for prescription drugs

5 MA Pharmacy Plan (008) MA Pharmacy Plan (009) Covers different counties than 008 MA Extra Plan (010) $67 $93 $20.90 $6,700 per calendar year $450 per day for days 1-4 $6,700 per calendar year $450 per day for days 1-4 $6,700 per calendar year $450 per day for days 1-4 $10 copay $40 copay $40 copay $45 copay $10 copay $80 copay $80 copay $80 copay $300 copay $300 copay $325 copay (up to 4 supplemental (up to 1 supplemental routine eye exam every year) $100 every two years (up to 4 supplemental (up to 1 supplemental routine eye exam every year) $100 every two years (up to 4 supplemental (up to 1 supplemental routine eye exam every year) $100 every two years $500 benefit every year $500 benefit every year No supplemental coverage $20 copay $20 copay 2 ($250 limit every year) $2/ $20 / $47 / 25% / 33% (Tier 1/2/3/4/5) Not covered $2/ $20 / $47 / 25% / 33% (Tier 1/2/3/4/5) Not covered $2/ $20 / $47 / 25% / 33% (Tier 1/2/3/4/5)

6 Premium Compare Out-of-Pocket Maximum Part A Inpatient Hospital Part B 2018 Deductible Primary Care (per visit) Specialist Care (per visit) Medicare-covered Lab Services Urgent Care (per visit) Emergency Care (per visit) Ambulance (per service) Diabetic Supplies Supplemental Podiatry Services Supplemental Routine Eye Exam Supplemental Eyewear Supplemental Dental Services Chiropractic (per Medicare-covered visit) Acupuncture and Naturopathy (per visit) Part D Prescription Copays How do you enroll? Apply by Phone Call today and a licensed TM Medicare Advantage expert will be happy to help you enroll over the phone. Call (TTY Relay: dial 7-1-1) between the hours of 8:00 a.m. and 8:00 p.m., 7 days a week. Apply in Person Medicare can be difficult to tackle alone. If you prefer to meet face-to-face with one of our Medicare Advantage experts please call us to schedule a free appointment. Apply by Mail Simply complete the enrollment application and return it using the postage-paid orange envelope. If you do not already have an enrollment application, call us and we will be happy to help you complete your application. Apply Online Visit to apply online. We will receive your application electronically. You may also apply to enroll in a Community HealthFirst TM plan through the Centers for Medicare and Medicare Services Online Enrollment Center, at Benefits shown are in network and administered by VSP and allows a number of options to receive frames and basic lenses within this benefit amount. * All cost sharing on this plan, including premiums, medical, and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with the State or another plan for Medicaid benefits, TM will help you resolve any billing issues. Your doctor cannot bill you for cost sharing covered under your Medicaid benefits. Your doctor must accept TM plan payment as payment-in-full or bill the correct Medicaid source. * * Your monthly plan premium of $34.60 is paid for by Washington State Medicaid or another third party because you qualify for Extra Help.

7 Important questions to ask when choosing your Medicare Advantage plan. Cost How much will you pay out of your own pocket for things such as monthly premiums and cost sharing on health care services or prescription drugs? Benefits Do you have coverage for vision and dental services? Does your current plan provide enough coverage to make up for the gaps in your Original Medicare coverage? Choice Can you see the doctor you want to see or go to the hospital you need to go to? Are the doctors in the plan accepting new patients? Convenience How often do you see your doctor? Are the doctors in the plan easy for you to get to? Prescription drugs Are the prescription drugs you need on the plan s list of covered drugs (formulary)? Can you go to the pharmacy of your choice to get prescriptions filled? Do you qualify for the Low-Income Subsidy (LIS) program? People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. To see if you qualify for extra help, call: MEDICARE ( ). TTY users should call , 24 hours a day, 7 days a week; the Social Security Office at between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users should call ; or your Medicaid office. Having trouble choosing? Let us help. We are your Medicare Advantage Experts. Contact us at (TTY Relay: Dial 7-1-1) between the hours of 8:00 a.m. and 8:00 p.m., 7 days a week. Offered by

8 Contact Information Prospective Members: Current Members: TTY Relay: Dial :00 a.m. to 8:00 p.m. 7 days a week Web: Mailing Address: Community Health Plan of Washington ATTN: rd Ave, Suite 400 Seattle, WA Community Health Plan of Washington is an HMO plan with a Medicare contract and a contract with the Washington State Medicaid program. Enrollment in Community Health Plan of Washington depends on contract renewal. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, Limitations, copayments, and restrictions may apply. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium (the Part B premium is covered for full-dual members). The benefit information provided herein is a brief summary, not a complete description of benefits. Attention: This information is also available for free in alternative formats such as Braille, large print, or audio. Call (TTY: 7-1-1). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY:7-1-1). Offered by