2018 EMBLEMHEALTH VIP MEDICARE PLANS. New York City, Nassau, Orange, Rockland, Suffolk and Westchester

Transcription

1 2018 EMBLEMHEALTH VIP MEDICARE PLANS New York City, Nassau, Orange, Rockland, Suffolk and Westchester

2 NO MATTER WHAT YOUR NEEDS, WE HAVE A PLAN FOR YOU. Based on more than 80 years of experience, we know that different people have different needs. That is why we offer you a choice of Medicare plans. We want to make it easy for you to select the Medicare plan that is right for you. At EmblemHealth, keeping you healthy is one of our priorities.

3 Medicare Plans EmblemHealth offers many Medicare Health Maintenance Organization (HMO) plans that give you all the benefits of Original Medicare and more. One is sure to meet your needs and budget! Value (HMO) EmblemHealth VIP Value gives you services through our Medicare Essential Network, which includes leading doctors and hospitals. You will pay $0 each month for the plan a $0 premium. With Value you will pay $30 to see your primary care doctor, and $50 to see specialists. It also includes Part D prescription drugs. This plan is not available in the Bronx and Kings County. Essential (HMO) Essential provides coverage through our Medicare Essential Network, which includes leading doctors and hospitals. Depending on where you live, you will pay either $0 each month or a low set amount each month (a premium). You will pay $10 to see your primary care doctor and $40 to see specialists. You will also get benefits Medicare does not cover. Like comprehensive dental, hearing aids, vision and a SilverSneakers membership. You also get Part D prescription drugs. Gold (HMO) EmblemHealth VIP Gold provides coverage through our extensive VIP Prime Network. You will pay $0 to see your primary care doctor and $25 to see specialists. You will also get benefits Medicare does not cover. Like comprehensive dental, hearing aids, vision and a SilverSneakers membership. You also get Part D prescription drugs. Gold Plus (HMO) Gold Plus gives you services through our extensive VIP Prime Network. You will pay $0 for many medical services, such as when you see your primary care doctor, specialists or get urgently needed services. You will also get benefits Medicare does not cover. Like comprehensive dental, hearing aids, vision and a SilverSneakers membership. You also get Part D prescription drugs. Dual (HMO SNP) Dual is a special needs plan for people enrolled in both Medicare and New York State Medicaid. It provides coverage through our extensive VIP Prime Network. You may pay as little as $0 each month for this plan based on your Low Income Subsidy (LIS) level. You pay $0 for covered services in this plan. You will also get benefits Medicare does not cover. Like comprehensive dental, hearing aids, vision, 48 acupuncture visits, 24 one-way transportation visits to approved health care locations, a SilverSneakers membership and a $1,200 over-the-counter items debit card. You will also get prescription drugs. Our HMO plans each work with a network, which is a group of health care professionals and facilities that contract with the plan. You are usually only covered for care and services you get from this network. In an emergency, you can go to any doctor or hospital. Which plan is right for you? Call us at , 8 am to 8 pm, seven days a week, to find out more about the wide range of plans available to you. If you use a TTY, please call 711, 8 am to 8 pm, seven days a week 1

4 Medicare Plans MEDICAL PLANS EmblemHealth VIP Value (HMO) 1 Monthly Premium The amount you pay for your insurance every month Essential (HM0) 1 Bronx/Kings/New York/Queens $0 Richmond/Nassau $46 $0* Suffolk $124 Orange/Rockland/Westchester $59 What Our Plan Covers Primary Care Doctor Visit $30 $10 Specialist Doctor Visit $50 $40 Preventive Care (Services that keep you healthy) $0 $0 Urgently Needed Services $65 $50 Emergency Care $75 $75 Inpatient Hospital Coverage $275 per day 1 7 $275 per day 1 7 Diagnostic Services/Labs/Imaging 2 You pay 20% of the cost You pay $0 or 20% of the cost Foot Care 3 $50 $40 Dental Services (No annual dollar limit) Preventive Comprehensive and Preventive Hearing Aid Not Covered $1,800 every 3 years Routine Eyewear $0 per year 5 $0 per year 5 Prescription Drug Yes Yes Additional Benefits 24-Hour Nurse Hotline Yes Yes SilverSneakers Not Covered Yes Acupuncture Not Covered Not Covered Transportation 4 Not Covered Not Covered 1 Members of this plan must use providers in our Medicare Essential Network % coinsurance (The percentage you pay for health services.) applies when services are provided in an Outpatient Hospital. * This plan is not available in Bronx and Kings County.

5 New York City, Nassau, Orange, Rockland, Suffolk and Westchester Gold (HMO) Gold Plus (HMO) Dual (HMO SNP) Premiums may be reduced based on Low Income Subsidy (LIS) level, see page 6 $78 $109 $245 $297 $0 $237 $0 $0 $0 $25 $0 $0 $0 $0 $0 $35 $0 $0 $75 $75 $0 $195 per day 1 10 $195 per day 1 10 $0 You pay $0 or 20% of the cost You pay $0 or 20% of the cost $0 $25 $0 $0 Comprehensive and Preventive Comprehensive and Preventive Comprehensive and Preventive $2,400 every 3 years $3,000 every 3 years $1,500 every 3 years $0 per year 5 $0 per year 5 $0 per year 5 Yes Yes Yes Yes Yes Yes Yes Yes Yes Not Covered Not Covered 48 visits yearly at no cost Not Covered Not Covered 24 one-way trips at no cost 3 Medically necessary foot care is a Medicare-covered benefit. In addition, members are also covered for up to four routine visits a year. Approval may be needed one-way visits to approved health care professionals and facilities. 5 Yearly plan limits vary by county. 3

6 EmblemHealth Prescription Drug Coverage Included in VIP Medical Plans PART D DRUG COVERAGE Value (HM0)* Essential (HMO) Preferred/Non-Preferred Pharmacy Annual Deductible (The amount you pay before the plan starts to pay) 1 $250 Initial Coverage Limit (Total drug cost paid by $3,595 the member and plan) Tier 1: Preferred Generic Drugs $0/$4 Tier 2: Generic Drugs $16/$20 Tier 3: Preferred Brand Drugs $42/$47 Tier 4: Non-Preferred Drugs $95/$100 Tier 5: Specialty Tier 28% of the cost Catastrophic Drug Coverage (After your out-of-pocket cost reaches $5,000) Generic and brand drugs are treated as generic All Other Drugs Over-the-Counter Drugs No EmblemHealth s preferred pharmacy includes: Duane Reade EmblemHealth Pharmacies Rite Aid Walgreens Walmart Over-the-Counter Mobile Stores And more The cost of the drug will be lower if you use a preferred pharmacy. EmblemHealth s Medicare home delivery pharmacy is managed by Express Scripts Inc (ESI). The amount you pay for home delivery is the same amount you pay for a preferred pharmacy. 4

7 Gold (HMO) Preferred/Non-Preferred Pharmacy Gold Plus (HMO) Dual (HMO SNP) All Participating Pharmacies $200 $0 $83 $3,545 $3,750 $0/$3 $10/$20 $40/$47 $95/$100 Generics: $0/$1.25/$3.35/ 15% of the cost Brands: $0/ $3.70/$8.35/ 15% of the cost 29% of the cost The greater of $3.35 or 5% of the cost for generic drugs The greater of $8.35 for all other drugs or 5% of the cost No $1,200 annual $100 per month 1 Annual Deductible is for Tier 3, Tier 4 and Tier 5 drugs only. * This plan is not available in Bronx and Kings County. 5

8 EmblemHealth Medicare Premiums and Low Income Subsidy (LIS) Premium Reduction If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help will determine your total monthly plan premium as a member of our plan. For more information about LIS, please call Social Security at , Monday through Friday, 7 am to 7 pm. If you use a TTY: Your Level of Extra Help Essential (HMO) Bronx/Kings/ New York/Queens Essential (HMO) Richmond/ Nassau Essential (HMO) Suffolk Essential (HMO) Orange/Rockland and Westchester 0% (Full Premium) $0.00 $46.00 $ $ % $0.00 $36.80 $ $ % $0.00 $27.70 $ $ % $0.00 $18.50 $96.50 $ % $0.00 $9.30 $87.30 $22.30 Your Level of Extra Help Gold (HMO) Bronx/ Kings/New York/ Queens Gold (HMO) Richmond/ Nassau EmblemHealth VIP Gold (HMO) Suffolk EmblemHealth VIP Gold (HMO) Orange/Rockland/ Westchester 0% (Full Premium) $78.00 $ $ $ % $68.30 $99.30 $ $ % $58.50 $89.50 $ $ % $48.80 $79.80 $ $ % $39.00 $70.00 $ $ Your Level of Extra Help Gold Plus (HMO) Bronx/Kings/ New York/Queens Gold Plus (HMO) Richmond/ Nassau Gold Plus (HMO) Suffolk Gold Plus (HMO) Orange/Rockland/ Westchester 0% (Full Premium) $ $ $ $ % $ $ $ $ % $ $ $ $ % $ $ $ $ % $ $ $ $ Your Level of Extra Help Dual (HMO SNP) All Counties 0% (Full Premium) $ % $ % $ % $ % $0.00 6

9 My Information Doctors: Prescription Drugs: Notes: 7

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12 55 Water Street, New York, New York emblemhealth.com/medicare Take the next step to better manage your health care. Simply call , 8 am to 8 pm, seven days a week. If you use a TTY, please call 711, 8 am to 8 pm, seven days a week. Visit us online at emblemhealth.com/ medicare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium. Premium, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Our Medicare Special Needs Plan is for people with both Medicare and Medicaid. Your eligibility to enroll in this plan may depend on your Medicaid status. The SilverSneakers fitness program is provided by Tivity Health, Inc., an independent company All rights reserved. HIP Health Plan of New York (HIP) is a HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company. HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies. H3330_126769r Accepted 09/19/ /17