Premera Blue Cross Medicare Advantage HMO Plans Premera Blue Cross

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1 Premera Blue Cross Medicare Advantage HMO Plans 2017 Premera Blue Cross

2 Meeting agenda Medicare basics Your Medicare options Premera Blue Cross Medicare Advantage Plans Enrolling is easy! The new customer experience what to expect

3 Who qualifies for Medicare? To qualify for Medicare you need to be a U.S. citizen or resident and: Age 65 or older OR Under age 65 and disabled* OR Living with end-stage renal disease (ESRD) *Permanently disabled for 24 months or more. If you haven t already, you can apply for Medicare at a Social Security office, by calling or

4 When should you enroll? What is your current situation? Are you covered by: Employer coverage Union coverage Coverage through spouse Are you retired, planning to retire or retiring late?

5 Enrollment periods Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65 th birth month Annual Enrollment Period: October 15 December 7 Medicare Advantage Disenrollment Period: January 1 February 14 Special Enrollment Period: Example: Loss of employer coverage or moving to new service area

6 Late enrollment penalties Part B (medical insurance) penalty: An additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Part D (prescription drug) penalty: An additional 1% of the average monthly premium each month, for as long as you are enrolled in a Part D plan.

7 Original Medicare Part A and Part B

8 Original Medicare: Part A Part A Hospital Insurance Part A is free for most people There is a $1,340 Part A deductible per benefit period After 60 days in the hospital, you pay: $335 per day copay for days $670 per day copay for days After day 150, you pay all hospital costs FIGURES ARE FOR 2018

9 Original Medicare: Part B Part B Medical Insurance There is a $134 standard per monthly premium* There is a $183 annual deductible Original Medicare covers 80% of most Part B costs, leaving you to pay the other 20% for services like: Most physician services Outpatient therapies Durable medical equipment Home health care FIGURES ARE FOR 2018 *Higher incomes may pay a higher premium

10 Prescription Coverage Part D

11 Prescription coverage: Part D Part D Prescription Drug Plans Voluntary program run by private companies You pay a monthly premium You pay a portion of the drug cost Plan designs must be equal to or better than standard Medicare benefit designed by CMS Coverage varies from plan to plan Some may pay penalty for late Part D enrollment

12 Prescription coverage: Part D phases 1 Deductible 2 Initial Coverage 3 Coverage Gap 4 Catastrophic $405 $3,750 $5,000 5% COPAY YOU 100% PLAN 0% YOU 25% PLAN 75% BRAND GENERIC YOU 35% YOU 44% YOU 5% PLAN 95% FIGURES ARE FOR 2018 YOU pay $3.35/Generic and $8.35/Brand or 5% This is an example of how Medicare Part D works and is not intended to portray a specific plan. In some instances, these costs will be approximate amounts.

13 Common drug list terms Formulary A list of drugs covered by the health plan. Prior Authorization (PA) For some covered drugs, you will need to get approval from the plan before you fill your prescriptions. Without approval, your drug may not be covered. Quantity Limits (QL) For some covered drugs, the plan may place limits on the amount of the drug provided for each prescription or for a defined period of time. Step Therapy (ST) For some covered drugs, the plan may require you to try certain drugs to treat your condition before the plan covers another drug for that condition. Transition Supply A temporary supply of your prescription drugs that allows you to transition to a new prescription covered by your plan drug list. The drug list (formulary) may change at any time. You will receive notice when necessary.

14 Prescription coverage: Extra Help Extra Help or Low Income Subsidy, is the name of the Part D drug program to help beneficiaries pay for drug costs. Extra Help is available from the government if you meet certain requirements. If you qualify, you may get help paying monthly premiums, copays, coinsurance, and deductibles. Do you qualify? You don t know unless you apply.

15 Your Medicare Coverage Options

16 Medicare coverage options START with Original Medicare DECIDE if you want more coverage Option 1 Option 2 Part A (hospital insurance) + Part B (medical insurance) Medicare Part D Prescription Drug Plan and/or Medicare Supplement Insurance Plan OR Medicare Advantage Plan Combines Parts A & B Many cover prescription drugs and may include extra benefits Monthly payment as low as $0

17 Premera Blue Cross Medicare Advantage Plans

18 Medicare Advantage (Part C) Part C Medicare Advantage Plans Medicare Advantage plans offered by private companies May cover some costs not covered by Medicare Often include extras like fitness and wellness Many also offer Part D drug coverage

19 Medicare Advantage eligibility To qualify, you must: Have Medicare Parts A & B Continue to pay your Part B premium Not have end-stage renal disease (in most cases) Live in the plan service area Have a valid enrollment period

20 Plan service area Snohomish Spokane King Pierce Thurston

21 2018 Medicare Star Rating The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. The ratings help you know how good a job our plan is doing. For 2018, Premera Blue Cross Medicare Advantage received an overall of 4 out of 5 Star Rating from Medicare. *Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

22 2018 Premera Blue Cross Medicare Advantage plans Spokane County Option 1 HMO Premera Blue Cross Medicare Advantage (HMO) Option 2 Total Health HMO Premera Blue Cross Medicare Advantage Total Health (HMO)

23 Let s review Premera Blue Cross Medicare Advantage plans

24 Our most POPULAR plan no monthly premium HMO Plan Benefits Premera Blue Cross Medicare Advantage (HMO) In-network only Monthly plan premium $0 Medical deductible $0 Annual out-of-pocket maximum $6,200 Primary care provider visit Specialist visit Inpatient hospital care Outpatient hospital care Ambulatory surgical center Outpatient hospital center Ambulance Emergency care (worldwide coverage) Urgent care (worldwide coverage) X-rays and Lab services Preventive care Annual physical exam Annual routine eye exam Eyewear allowance Fitness benefit program $15 copay $45 copay $450 copay (days 1 4) $0 copay (days 5+) 15% coinsurance 20% coinsurance $300 copay/each one-way trip $75 copay (waived if admitted) $50 copay $20 copay $0 copay $0 copay Not covered Not covered Not covered You must continue to pay your Medicare Part B premium.

25 Prescription coverage HMO Plan Benefits Prescription drugs Premera Blue Cross Medicare Advantage (HMO) Drug Coverage (30-day supply from a preferred network pharmacy) Drug deductible (applies to tiers 3-5) $340 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred drug Tier 5 Specialty $5 copay ($0 deductible) $15 copay ($0 deductible) $42 copay 35% coinsurance 26% coinsurance Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at (TTY: 711). You can call from Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, Oct. 1-Feb. 14). Search online at premera.com/ma

26 Preventive dental coverage optional rider HMO Plan Benefits Preventive dental optional rider Premera Blue Cross Medicare Advantage (HMO) Preventive Dental Coverage ($0 copays from a preferred network dentist) Monthly dental premium $26 Routine oral exams Routine cleanings / Periodontal maintenance Fluoride treatments Bitewing X-rays (set of 4) Panoramic or complete series X-rays Emergency exam $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay (1 set every 60 months) $0 copay (1 every year) Add Dental Coverage You may add the optional dental rider within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. Coverage starts the first of the month following the date we receive your completed enrollment form. Search online at premera.com/ma

27 New for Spokane County in 2018 Total Health HMO Plan Benefits Premera Blue Cross Medicare Advantage Total Health (HMO) In-network only Monthly plan premium $24 Medical deductible $0 Annual out-of-pocket maximum $5,500 Primary care provider visit Specialist visit Inpatient hospital care Outpatient hospital care Ambulatory surgical center Outpatient hospital center Ambulance Emergency care (worldwide coverage) Urgent care (worldwide coverage) X-rays and Lab services Preventive care Annual physical exam Annual routine eye exam Eyewear allowance $10 copay $50 copay $450 copay (days 1 4) $0 copay (days 5+) 15% coinsurance 20% coinsurance $300 copay/each one-way trip $75 copay (waived if admitted) $50 copay $20 copay $0 copay $0 copay $50 copay $150 reimbursement Fitness benefit program $0 You must continue to pay your Medicare Part B premium.

28 Prescription coverage Total Health HMO Plan Benefits Prescription drugs Premera Blue Cross Medicare Advantage Total Health (HMO) Drug Coverage (30-day supply from a preferred network pharmacy) Drug deductible (applies to tiers 3-5) $180 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred drug Tier 5 Specialty $2 copay ($0 deductible) $10 copay ($0 deductible) $42 copay 35% coinsurance 29% coinsurance Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at (TTY: 711). You can call from Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, Oct. 1-Feb. 14). Search online at premera.com/ma

29 Preventive dental coverage included Total Health HMO Plan Benefits Preventive dental included Premera Blue Cross Medicare Advantage Total Health (HMO) Preventive Dental Coverage ($0 copays from a preferred network dentist) Monthly dental premium $0 Routine oral exams Routine cleanings / Periodontal maintenance Fluoride treatments Bitewing X-rays (set of 4) Panoramic or complete series X-rays Emergency exam $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay (1 set every 60 months) $0 copay (1 every year) Search online at premera.com/ma

30 Medical network With thousands of local doctors in our Medicare Advantage network, you ll be sure to find a provider that s right for you and close to home. Western Washington Providers Eastern Washington Providers EvergreenHealth The Everett Clinic Columbia Medical Associates MultiCare Health System The Polyclinic MultiCare Health System Northwest Physicians Network with hundreds of doctors in Pierce County Overlake Medical Center and Clinics Pacific Medical Centers Providence Health & Services Swedish Health Services UW Medicine Virginia Mason Medical Center Western Washington Medical Group with nearly one hundred doctors in Snohomish County Providence Health and Services Rockwood Clinic Spokane Internal Medicine Search online at premera.com/ma The above list is not a complete list of participating and/or preferred providers.

31 Pharmacy network Premera contracts with national pharmacy chains and many independent and local pharmacies. Preferred pharmacies allow customers to pay the lowest cost for covered generic medications. Preferred Pharmacies Standard Pharmacies Albertsons QFC Pharmacy Bi-Mart Pharmacy Bartell Drugs Rosauers Pharmacy Bob Johnson's United Drugs Costco Pharmacy Safeway Pharmacy ReliantRx LLC CVS (including inside Target stores) Sam's Club Pharmacy Rite Aid Pharmacy Fred Meyer Pharmacy Sav-On Pharmacy Walgreens Haggen Pharmacy Pharmaca Walmart Pharmacy Yoke s Pharmacy Search online at premera.com/ma The above list is not a complete list of standard and/or preferred pharmacies.

32 Enrolling is easy!

33 Five things to remember 1. Choose a plan that fits you and your budget including the $0 premium plan 2. Receive care from a broad network of providers you know and trust 3. Choose from our plans with fitness benefits at a local gym near you 4. Travel with worldwide coverage for emergencies 5. Get your questions answered quickly and easily with support from a team focused on you

34 Enroll today Enroll today in one of Premera Blue Cross Medicare Advantage Plans. By mail using a paper application Over the phone by calling (TTY: 711) Online at premera.com/ma

35 The new customer experience

36 The new customer experience Welcome kit Welcome call Premera ID card Outbound enrollment verification Fitness ID card Health Risk Assessment Your membership generally starts on the first day of the following month. Plans start as of January 1 for enrollees in October, November and December (during the Annual Enrollment Period).

37 Important plan information Premera Blue Cross is an HMO plan with a Medicare contract. This information is not a complete description of benefits. Contact the plan for more information. Enrollment in Premera Blue Cross depends on contract renewal. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The drug list (formulary), pharmacy network and provider network may change at any time. You will receive notice when necessary. You must continue to pay your Part B premium. For 2018, Premera Blue Cross Medicare Advantage plans received an overall 4 out of 5 Star Rating from Medicare. Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next. Premera Blue Cross is an Independent Licensee of the Blue Cross and Blue Shield Association ( ) H7245_PBC1458_Approved

38 Thank you! Questions?

Premera Blue Cross Medicare Advantage HMO Plans Premera Blue Cross

Premera Blue Cross Medicare Advantage HMO Plans 2018 Premera Blue Cross Meeting agenda Medicare basics Your Medicare options Premera Blue Cross Medicare Advantage Plans Enrolling is easy! The new customer