Medicare Part D: Better understanding the nuances of the prescription drug benefit
|
|
- Christian Hawkins
- 5 years ago
- Views:
Transcription
1 Medicare Part D: Better understanding the nuances of the prescription drug benefit Rajul A. Patel, Pharm.D, Ph.D. TJL School of Pharmacy & Health Sciences University of the Pacific July 26 th, 2018
2 Today s Agenda Part B vs. Part D coverage of prescription drugs 2019 Standard Part D Benefit Tiering, cost-sharing ceilings, specialty tier drugs Pharmacy Networks and how PBMs work
3 The Parts of Medicare Part A Hospital Insurance Part B Medical Insurance Part C Medicare Advantage Plans (like HMOs/PPOs) Includes Part A, Part B and sometimes Part D coverage Part D Medicare Prescription Drug Coverage
4 What does Part B cover? Covers outpatient medical services Physician visits Outpatient care Durable Medical Equipment (DME) Preventative services
5 Medicare Part B Physician Visits Welcome to Medicare visit Annual Wellness Visit (complete a Health Risk Assessment ) Routine visits Outpatient care Ambulance service Dialysis ER services Mental health care (depression/anxiety) Lab services Diagnostic tests (e.g., x-rays, MRIs) Drugs* (in limited situations)
6 Medicare Part B Durable Medical Equipment (DME) Diabetes supplies Nebulizers Prosthetic/Orthotic items Oxygen Wheelchairs Walkers
7 Medicare Part B Preventative services Bone mineral density Cardiovascular Depression screening Diabetes screenings Eye exam* Mammograms Prostate screening Smoking Cessation Vaccinations and many more
8
9 Drugs Billed to Part B Drugs used via a nebulizer at home Antigens administered for allergy testing Hemophilia clotting factors that are selfadministered An injectable drug that is provided and administered by your doctor and NOT usually self-administered
10 Part B Part D
11 Medicare Part B vs. Part D Some drugs/drug categories may be covered by either Part B or Part D depending on the situation Drug classes where such uncertainty exists: Insulin Vaccines Hepatitis B vaccine Immunosuppressants Oral anti-cancer drugs Oral anti-emetic drugs Erythropoietin
12 Medicare Part B vs. Part D Coverage Determination Coverage category: Insulin Scenario: Beneficiary would like to fill their insulin Community pharmacy setting billing: Part B- Administered with an insulin pump Part D- All other situations
13 Medicare Part B vs. Part D Coverage Determination Coverage category: Vaccines Scenario: Prophylactic Vaccines Community pharmacy setting billing: Part B- flu, pneumococcal, and Hepatitis B (medium-high risk individuals) vaccines Part D- for all other vaccines
14 Medicare Part B vs. Part D Coverage Determination Coverage category: Hepatitis B vaccine Scenario: Beneficiary would like to receive the Hepatitis B vaccine series Community pharmacy setting billing: Part B- Medium/High risk beneficiary Part D- All other beneficiaries
15 Hepatitis B Risk Categories Intermediate risk groups Staff in institutions for the mentally handicapped Workers in health care professions who have frequent contact with blood/blood-derived body fluids during routine work. High risk: ESRD Hemophilia Clients of institutions for the mentally handicapped Those who live in the same household as a HBV carrier Homosexual men Illicit injectable drug abusers. Diabetes
16 Medicare Part B vs. Part D Coverage Determination Coverage category: Immunosuppressants Scenario: Drugs used for immunosuppressive therapy in a beneficiary that received a transplant from a Medicare-approved facility Community pharmacy setting billing: Part B- for Medicare covered transplant Part D- for all other situations
17 Medicare Part B vs. Part D Coverage Determination Coverage category: Oral chemotherapy agents used in cancer treatment Scenario: Oral chemotherapy drugs for which there is an infusible version of the drug Community pharmacy setting billing: Part B- for cancer treatment Part D- for all other indications
18 Medicare Part B vs. Part D Coverage Determination Coverage category: Oral anti-emetic drugs Scenario: Oral anti-nausea drugs used in cancer treatment as replacement for IV anti-emetic drugs before, at, or within 48 hours of chemotherapy Community pharmacy setting billing: Part B- within 48 hours of receiving chemo Part D- for all other situations
19 Medicare Part B vs. Part D Coverage Determination Coverage category: Erythropoietin Scenario: Treatment of anemia for a person with ESRD who is on dialysis Community pharmacy setting billing: Part B- treatment of anemia for beneficiaries with chronic renal failure undergoing dialysis Part D- for all other situations
20
21 Standard Coverage Plan sponsors contract with Medicare to provide prescription drug benefits At minimum, plan sponsors must offer a plan that is equivalent ( actuarially equivalent ) to the standard benefit plan Yearly deductible Co-insurance (or co-pays) Coverage gap Catastrophic coverage
22 Standard Benefit Package- Effective January 1 st 2019 Out-of-pocket spending Medicare Part D Benefit (4) Pt. pays 5% of drug costs Catastrophic Coverage $7, (3) Pt. pays % of drug costs Coverage Gap (Donut Hole) $2,950 Gap ( donut hole ) $3,820 (2) Pt. pays 25% of drug costs (1) Pt. pays $415 deductible Total Drug Costs -> $415 $0
23 Deductible (2019) Definition: $ that must be spent by the patient before coverage begins Yearly deductible- MAXIMUM allowable amount $415 (2019) $405 (2018) $400 (2017) $360 (2016) $320 (2015)
24 25% Coinsurance (2019) Definition (Coinsurance): a % of the drug s cost that the patient must pay 25% coinsurance payment for plan covered drugs after the annual deductible is met Up to the next $3,405 in covered drug expenses
25 25% Coinsurance (2019) In this window (from $415 to $3,820), the beneficiary is responsible for up to $ and the plan sponsor would responsible for the rest (up to $2,553.75) Patient: 25% of $3,405 ($3,820 - $415) = $ Plan: 75% of $3,405 ($3,820 - $415)= $2,553.75
26 Co-payment Definition: a set $ amount that you pay Tiered co-pays (EXAMPLE) CMS 2019 Threshold Values Maximum co-pay: $100 Maximum co-insurance: 50%
27 Specialty Tier Unique, high-cost drugs >$670/month Co-insurance range: 25%-33%
28 Coverage Gap (2019) Donut hole Once total drug costs (patient + plan) reach $3,820, up to the next $3, in covered drug expenses occur during the coverage gap phase
29 Coverage Gap (2019) Once total drug costs (patient + plan) reach $3,820, up to the next $3, in covered drug expenses occur during the coverage gap (aka Donut Hole ) phase So, the Donut Hole occurs when total drug costs are between $3,820 - $7, % discount off covered brand name drugs 56% discount off covered generic drugs % discount off covered brand name drugs 63% discount off covered generic drugs
30 Closing the Gap Brands Generics
31 Catastrophic Coverage (2019) Before catastrophic coverage kicks in, beneficiaries: Must reach the $5,100 TrOOP threshold OR Total drug costs (patient + plan) must reach $7, During catastrophic coverage, the patient pays 5% of the covered drug cost or $3.40 for covered generic drugs or $8.50 for covered brand name drugs
32 Dissecting the 2019 Standard Benefit- Patient vs. Plan Total Drug Costs $0 $415 $3,820 $7, Deductible 25% Coinsurance (Next $3,405) Coverage Gap Catastrophic Coverage Patient Pays Plan Pays
33 The Choices Each MA-PD and PDP can have its own: Monthly premium Deductible Cost sharing structure Co-insurance, Co-pays Formulary Tiers Restrictions processes (Utilization Management Techniques) Pharmacy Networks
34
35 Pharmacy Benefit Management (PBM) Pharmacy services are often carved out because: Pharmacy is an easily defined benefit Pharmacy has a defined patient population High or rising costs Inappropriate utilization PBMs often manage the prescription drug benefit for PDP and MA-PD plan sponsors
36 Key PBM Activities for Part D Plans Benefit Design Rebate Contracting Formulary Management Utilization management Claims Processing Drug Utilization Review Network Maintenance Customer Service Creating Pharmacy Networks Mail/Specialty pharmacy Star Rating Measures
37 Pharmacy Network Definition: A contracted group of pharmacies that provide incentivized rates to a managed care organization/pbm, thus lowering costs for those entities and patients. Standard vs. Preferred Pharmacy contracts Lower reimbursement rates e.g., (AWP - 12%) + dispensing fee Increased volume of business
38 Drug Company Co-pay or Co-insurance Rebate contracts Supply drugs/device Retail Pharmacies Mail order Pharmacies Specialty Pharmacies Marketing Reimburse PBM Provide drugs/device Payers Medicare/MA-PDs Employersponsored plans Fixed PMPM Employers Share Premium Premium Beneficiaries Reimburse Co-pay or Co-insurance Providers Hospitals Physician practices Provide service Services rendered Funding (Payment) Influence
39 DRUG COMPANY PBM Retail Pharmacies Provide drugs/device Co-pay Payers Consumers (Members) Services rendered Funding (Payment) Influence
40 Review! As easy as 1 2 3: 1.Go to Kahoot.it 2. Enter Game PIN 3. Type your nickname
Today s Options PFFS. Medicare Advantage Private Fee-for-Service Plan. Benefit Package 1. January 1, 2010 December 31, 2010
2010 Summary of s Advantage Private Fee-for-Service Plan Package 1 January 1, 2010 December 31, 2010 H3333 and H5421 M0018 SB_COR_BenePkg1_0809 CMS 082809 PFS SUMOFBENB1 0909 Section I Introduction to
More informationSummary of Benefits January 1, 2015 December 31, 2015
BLUECROSS BLUESHIELD SENIOR BLUE 601, BLUECROSS BLUESHIELD SENIOR BLUE HMO SELECT AND BLUECROSS BLUESHIELD SENIOR BLUE HMO 651 PARTD (a Medicare Advantage Health Maintenance Organization offered by HEALTHNOW
More informationBlueMedicare HMO 2009 Summary of Benefits
A Medicare Advantage HMO Plan BlueMedicare HMO 2009 Summary of Benefits Broward and Miami-Dade Counties (H1026 001) (H1026 038) Section 1- Introduction to the Summary of Benefits for BlueMedicare HMO January
More informationBlueMedicare PPO 2009 Summary of Benefits
A Medicare Advantage PPO Plan BlueMedicare PPO 2009 Summary of Benefits Broward and Palm Beach Counties (H5434 001) Okaloosa and Osceola Counties (H5434 018) Counties (H5434 016) Marion County (H5434 015)
More informationCentral Health Medicare Plan (HMO)
Central Health Medicare Plan (HMO) MONTHLY PREMIUM, DEDUCTIBLE, AND LIMITS ON HOW MUCH YOU PAY FOR COVERED SERVICES How much is the monthly premium? How much is the deductible? Is there any limit on how
More informationSummary of Benefits for MediBlue Value SM (HMO), MediBlue Plus SM (HMO) and MediBlue Select SM (HMO)
Summary of s for Value SM (HMO), Plus SM (HMO) and Select SM (HMO) Available in Fairfield, Hartford and New Haven Counties in Connecticut A health plan with a contract. In Connecticut, Anthem Blue Cross
More informationSummary of Benefits 'Ohana Coordinated Care Plans
2010 Summary of Benefits 'Ohana Coordinated Care Plans HAWAII Honolulu County WellCare Health Insurance of Arizona, Inc. H2491 01/01/10-12/31/10 'Ohana Value (HMOPOS) Plan 002 M0012_NA010133_WCM_SOB_ENG_FINAL_30
More informationSummary of Benefits for Blue Cross Senior Secure Plan I SM (HMO)
Summary of Benefits for Blue Cross Senior Secure Plan I SM (HMO) Available in Kern, Riverside, San Bernardino, Santa Barbara and San Diego Counties in California A health plan with a Medicare contract.
More informationBlueMedicare PFFS 2010 Summary of Benefits
2010 PLANS A Medicare Advantage PFFS Plan BlueMedicare PFFS 2010 Summary of Benefits State of Florida M0052_30081 0609 SP A: 08/2009 BMPFFS 001 Section 1 Introduction to the Summary of Benefits for BlueMedicare
More informationSummary of Benefits. for Anthem MediBlue Select (HMO) Available in Hartford county, CT
Summary of Benefits for Available in Hartford county, CT Anthem Blue Cross and Blue Shield is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.
More informationSummary of Benefits. for Anthem MediBlue Select (HMO) Available in Hartford county, CT
Summary of Benefits for Available in Hartford county, CT Anthem Blue Cross and Blue Shield is an HMO plan with a Medicare contract. Enrollment in Anthem Blue Cross and Blue Shield depends on contract renewal.
More informationSummary of Benefits for Anthem Senior Advantage Value (HMO)
Summary of Benefits for Anthem Senior Advantage Value (HMO) Available in Select Counties in Ohio A health plan with a Medicare contract. In Ohio, Anthem Blue Cross and Blue Shield is the trade name of
More informationExploring the Interaction between Medicare Part B and Medicare Part D
The National Medicare Prescription Drug Congress Exploring the Interaction between Medicare Part B and Medicare Part D Jennifer Breuer, Esq. Gardner, Carton & Douglas 191 N. Wacker Drive Chicago, IL 60606
More informationBlue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Kern (partial) County January 1, 2016 to December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
More information2016 Benefits Overview
2016 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
More information2016 Senior Blue HMO H3384. Summary of Benefits
2016 Senior Blue HMO H3384 Summary of Benefits BLUECROSS BLUESHIELD SENIOR BLUE HMO 601 (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by HEALTHNOW NEW YORK INC. with a Medicare
More information2016 Summary of Benefits. Classic Rx (HMO)
2016 Summary of s Classic Rx (HMO) Summary Of s January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we cover, or list
More informationSummary of Benefits. Aetna Medicare SM. Plan (HMO) H0523. Riverside and San Bernardino Counties. January 1, 2010 to December 31, 2010
January 1, 2010 to December 31, 2010 Summary of s Aetna SM Plan (HMO) H0523 Riverside and San Bernardino Counties 18.06.360.1-CA2 E M0001_M_PE_SB_90709 (08/2009) Visit us www.aetnamedicare.com Summary
More informationFRESENIUS TOTAL HEALTH (HMO SNP)
Summary of Benefits FRESENIUS TOTAL HEALTH (HMO SNP) (a Medicare Advantage Health Maintenance Organization (HMO) offered by FRESENIUS HEALTH PLANS OF NORTH CAROLINA, INC. with a Medicare contract) Available
More informationSummary of Benefits. for CareMore ESRD (HMO SNP) Available in San Bernardino County (partial) SBSBESRD16 Y0114_16_081547A CHP CMS Accepted ( )
Summary of Benefits for CareMore ESRD (HMO SNP) Available in San Bernardino County (partial) SBSBESRD16 Y0114_16_081547A CHP CMS Accepted (08222015) Summary of Benefits January 1, 2016 - December 31, 2016
More information2016 Summary of Benefits. Preferred Rx (PPO)
2016 Summary of s Preferred Rx (PPO) January 1, 2016 - December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we cover, or list every limitation
More informationBlue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Contra Costa County (partial) January 1, 2016 to December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every
More informationBlue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Los Angeles County (partial) & Orange County January 1, 2016 to December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn
More informationSummary of Benefits. for CareMore Touch (HMO SNP) Available in Los Angeles and Orange Counties (partial)
Summary of Benefits for CareMore Touch (HMO SNP) Available in Los Angeles and Orange Counties (partial) SBLAOCTCH15 Y0017_15_081476A CHP CMS Accepted (09082014) Section I: Introduction to Summary of Benefits
More informationBlue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Los Angeles County (partial) & Orange County January 1, 2015 to December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn
More informationMemorial Hermann Advantage (PPO)
Memorial Hermann Advantage (PPO) INTRODUCTION TO SUMMARY OF BENEFITS January 1, 2015 December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
More informationPLAN DESIGNS AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY INC
Aetna Pharmacy Management Custom RX PLAN FEATURES Deductible (per calendar year) $250 Deductible Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Member Coinsurance
More informationMedicare Congress: Fee for Service Trends: A Look at Medicare Part B
Medicare Congress: Fee for Service Trends: A Look at Medicare Part B November 1, 2005 Lauren Geyer Barnes Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Three
More information2016 Forever Blue Medicare PPO
2016 Forever Blue Medicare PPO H5526 Summary of Benefits FOREVER BLUE MEDICARE PPO VALUE (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare
More informationbenefits Summary of BlueMedicare SM Regional PPO A Medicare Advantage Regional PPO Plan State of Florida
2016 Summary of benefits BlueMedicare SM Regional PPO A Medicare Advantage Regional PPO Plan State of Florida Florida Blue is a trade name of Blue Cross and Blue Shield of Florida Inc., an Independent
More informationMemorial Hermann Advantage (HMO)
Memorial Hermann Advantage (HMO) INTRODUCTION TO SUMMARY OF BENEFITS January 1, 2015 December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service
More informationSummary of Benefits. for Anthem Senior Advantage Basic (HMO)
Summary of Benefits for Anthem Senior Advantage Basic (HMO) Available in Ashland, Clermont, Cuyahoga, Darke, Fairfield, Franklin, Fulton, Geauga, Lake, Licking, Lorain, Madison, Medina, Ottawa, and Warren
More informationSummary of Benefits Boone County
Summary of Benefits 2017 Boone County Y0027_16-093_EN CMS Accepted 08/30/2016 Summary of Benefits January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It
More informationBENEFITS 2015 EmblemHealth Essential (HMO), EmblemHealth VIP (HMO) and EmblemHealth VIP High Option (HMO). Nassau January 1, December 31, 2015
SUMMARY OF S 2015 EmblemHealth Essential (HMO), EmblemHealth and EmblemHealth VIP High Option (HMO). Nassau January 1, 2015 - December 31, 2015 H3330_124613 Accepted 09/09/2014 SECTION I - INTRODUCTION
More informationSECTION I - INTRODUCTION TO SUMMARY OF BENEFITS For PUP Simple (HMO) and PUP Rewards (HMO)
SECTION I - INTRODUCTION TO SUMMARY OF S For PUP Simple (HMO) and PUP Rewards (HMO) January 1, 2012 December 31, 2012 Marion and Sumter Counties Thank you for your interest in PUP Simple (HMO) and PUP
More informationSummary of Benefits. Section I - Introduction to Summary of Benefits
summary of benefits 2015, and. Bronx, Kings, New York, Queens and Richmond January 1, 2015 - December 31, 2015 H3330_124612 Accepted 9/8/14 Section I - Introduction to Summary of s You have choices about
More informationSummary of BenefitS. Cigna-HealthSpring Preferred (Hmo) H Cigna H0354_15_19948 Accepted
Summary of BenefitS Coverage Cigna-HealthSpring Preferred (Hmo) H0354-001 2014 Cigna H0354_15_19948 Accepted SeCtion i - introduction to Summary of BenefitS you have choices about how to get your medicare
More information2019 Summary of Benefits
2019 Summary of Benefits CHRISTUS Health Plan Generations H1189, Plan 001 This is a summary of drug and health services covered by CHRISTUS Health Plan Generations, January 1, 2019 December 31, 2019. CHRISTUS
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Gold Select (HMO) Riverside and San Bernardino counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0182 CMS Accepted 09092015
More informationExplorer Rx 7 (PPO) Summary of Benefits
Explorer Rx 7 (PPO) Summary of Benefits Coos and Curry Counties, Oregon January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service
More informationbenefits Summary of BlueMedicare SM HMO A Medicare Advantage HMO Plan Broward County
2016 Summary of benefits BlueMedicare SM HMO A Medicare Advantage HMO Plan Broward County Florida Blue HMO is the trade name of Health Options, an HMO affiliate of Florida Blue. These companies are Independent
More informationY0021_H3864_MRK1945_CMS Accepted PacificSource Community Health Plans, Inc. is an HMO/PPO plan with a Medicare contract.
Y0021_H3864_MRK1945_CMS Accepted 09022013 PacificSource Community Health Plans, Inc. is an HMO/PPO plan with a Medicare contract. Enrollment in PacificSource Medicare depends on contract renewal. Section
More informationSummary of Benefits: Essentials Rx 26 (HMO) Coos County Curry County Lane County
Summary of Benefits: Essentials Rx 26 (HMO) Coos County Curry County Lane County January 1, 2018 December 31, 2018 This is a summary of drug and health services covered by PacificSource Medicare Essentials
More informationMyCare Rx 23 (HMO) Summary of Benefits
MyCare Rx 23 (HMO) Summary of Benefits Southwestern Idaho January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover
More informationMedical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area
Medical Benefits Comparison Book 2018 Medicare Retirees in the Rochester Area Human Resources Finance & Administration Rochester Institute of Technology Medical Benefit Comparison This information provides
More information2019 Summary of Benefits
2019 Summary of Benefits CHRISTUS Health Plan Generations Plus H1189, Plan 002 This is a summary of drug and health services covered by CHRISTUS Health Plan Generations Plus, January 1, 2019 December 31,
More informationbenefits Summary of BlueMedicare SM HMO A Medicare Advantage HMO Plan Palm Beach County
2016 Summary of benefits BlueMedicare SM HMO A Medicare Advantage HMO Plan Palm Beach County Florida Blue HMO is the trade name of Health Options, an HMO affiliate of Florida Blue. These companies are
More informationSummary of Benefits. Paramount Elite Enhanced Medical and Drug (HMO) (H ) Paramount Elite Standard Medical and Drug (HMO) (H )
JANUARY 1, 2014 DECEMBER 31, 2014 Summary of Benefits Paramount Elite Enhanced Medical and Drug (H3653-004) Paramount Elite Standard Medical and Drug (H3653-015) PARAMOUNT ELITE IS AN HMO PLAN WITH A MEDICARE
More information2015 Summary of Benefits
2015 Summary of Benefits Health Net Ruby Select (HMO) San Francisco County, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0280 CMS Accepted 09032014
More informationSummary of BenefitS. Cigna-HealthSpring Preferred (Hmo) H Cigna H0150_15_19876 Accepted
Summary of BenefitS Coverage Cigna-HealthSpring Preferred (Hmo) H0150-024 - 2 2014 Cigna H0150_15_19876 Accepted SeCtion i - introduction to Summary of BenefitS you have choices about how to get your medicare
More information2013 Summary of Benefits
2013 Summary of Benefits PPO Plan, Contract H3832, Plans 001 and 006 Effective January 1, 2013 H3832_1065_2025_0315 CMS Accepted Introduction to the For AKAMAI ADVANTAGE (PPO) January 1, 2013 December
More information2018 Medicare Program Overview
2018 Medicare Program Overview State College of Florida Florida College System Risk Management Consortium #78800 Retirees Eligible for Medicare Florida Blue is an Independent Licensee of the Blue Cross
More information2019 Summary of Benefits
2019 Summary of Benefits CHRISTUS Health Plan Generations H1189, Plan 003 This is a summary of drug and health services covered by CHRISTUS Health Plan Generations, January 1, 2019 December 31, 2019. CHRISTUS
More informationAnother choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Value Rx Plan (HMO)).
Summary of Benefits Report SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare
More informationMedicare at a Glance. Are you Eligible for Medicare?
Medicare at a Glance Medicare is the federal health insurance program for Americans age 65 and older and for younger adults with permanent disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral
More informationHNE Medicare Value (HMO)
2016 Medicare Advantage Summary of Benefits January 1, 2016 - December 31, 2016 H8578_2016_453 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have
More informationSummary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Healthy Heart (HMO) Los Angeles and Orange counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0179 CMS Accepted 09082015
More informationAnother choice is to get your Medicare benefits by joining a Medicare health plan (such as Senior Care Plus: Freedom Rx Select Plan (PPO)).
SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS You have choices about how to get your Medicare benefits One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare).
More informationSummary of Benefits: MyCare Rx 29 (HMO) Yellowstone County
Summary of Benefits: MyCare Rx 29 (HMO) Yellowstone County January 1, 2018 December 31, 2018 This is a summary of drug and health services covered by PacificSource Medicare MyCare Rx 29 (HMO). The benefit
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Ruby Select (HMO) Placer (partial county) and Sacramento counties, CA Benefits effective January 1, 2016 H0562 Health Net of California, Inc. H0562_2016_0183 CMS Accepted
More informationSummary of Benefits. for Empire MediBlue Freedom I SM
Summary of Benefits for SM Available in Albany, Clinton, Essex, Fulton, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties in New York A health plan with a Medicare
More informationTrue Blue Freedom HMO
True Blue Freedom HMO 2012 Summary of Benefits You think about finding the perfect health insurance plan. We think about providing you with seamless service and affordable benefits. Serving Ada & Canyon
More informationFIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct HMO Plus (HMO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct HMO Plus (HMO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties P age 1 SECTION I - INTRODUCTION TO SUMMARY
More informationBlue Shield 65 Plus Choice Plan (HMO) Blue Shield 65 Plus (HMO) summary of benefits
summary of benefits Los Angeles (partial) & Orange Counties January 1, 2016 to December 31, 2016 This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we
More informationSummary of Benefits: MyCare Rx 32 (HMO) Southwestern Idaho
Summary of Benefits: MyCare Rx 32 (HMO) Southwestern Idaho January 1, 2018 December 31, 2018 This is a summary of drug and health services covered by PacificSource Medicare MyCare Rx 32 (HMO). The benefit
More informationWelcome to Medicare 2013
Welcome to Medicare 2013 1 Agenda Basics of Original Medicare Obtaining coverage What is covered (Part A, B) Prescription drug coverage (Part D) Supplementing Original Medicare Medigap plans Alternatives
More informationSummary of Benefits. Y0027_16-092_EN CMS Accepted 08/30/2016
Summary of Benefits 2017 Y0027_16-092_EN CMS Accepted 08/30/2016 Summary of Benefits January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It doesn t list
More informationSummary of Benefits. Southeast Community Care-Plus (HMO)
2012 Summary of s Carteret, Craven, Edgecombe, Greene, Jones, Lenoir, Onslow, Pamlico, Pitt and Wayne Counties, NC January 1, 2012 December 31, 2012 20-SECC-NC-CA H2899_SECCNC_MKT006 CMS Approved (09/27/2011)
More information2012 Summary of Benefits Optional Supplemental Benefits Extra Services and Programs
2012 Summary of Benefits Optional Supplemental Benefits Extra Services and Programs Humana Gold Plus H2949-012 (HMO) Y0040_GNHH4HGHH_12_File & Use 10012011 H2949012SBVAS12 1101 2012 Summary of Benefits
More informationSummary of Benefits. for Blue Medicare Access Value SM (Regional PPO) Available in Indiana and Kentucky
Summary of Benefits for SM Available in Indiana and Kentucky Anthem Blue Cross and Blue Shield is a Health plan with a Medicare contract. Anthem Insurance Companies, Inc. (AICI) is the legal entity that
More information2017 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS
2017 SUMMARY OF BENEFITS MEDICARE ADVANTAGE PLANS Florida Hernando, Hillsborough, Miami-Dade, Pasco, Pinellas H1032 January 1, 2017 - December 31, 2017 WellCare Essential (HMO-POS) Plan 174 H1032_FL034473_WCM_SOB_ENG
More informationSection I Introduction to Summary of Benefits
Section I Introduction to Summary of Benefits Thank you for your interest in Rx Classic (PPO), or. Our plans are offered by Regence BlueCross BlueShield of Utah, a Medicare Advantage Preferred Provider
More informationBooklet Contents. Senior Blue (HMO) (H3384) Summary of Benefits. Forever Blue Medicare (PPO) (H5526) Summary of Benefits
MEDICARE ADVANTAGE 2017 Booklet Contents Senior Blue (HMO) (H3384) Summary of Benefits Forever Blue Medicare (PPO) (H5526) Summary of Benefits Optional Supplemental Dental Benefits Summary of Benefits
More informationSUMMARY OF BENEFITS. Community HealthFirst Medicare Advantage Premium Plan (HMO-POS) H5826_MA_198_2011_v_01_SB011 CMS Approved
2011 SUMMARY OF BENEFITS Advantage Premium Plan (HMO-POS) H5826_MA_198_2011_v_01_SB011 CMS Approved 09.02.10 Section I Community HealthFirst Medicare January 1, 2011 - December 31, 2011 Thank you for your
More informationSUMMARY OF BENEFITS. Unlimited. Lifetime Maximum Applies to all Part A and Part B expenses. Unlimited
SUMMARY OF BENEFITS Connecticut General Life Insurance Company For Retirees of Colby College Plan Name: Medicare Surround Custom Plan Effective: January 1, 2018 through December 31, 2018 Lifetime Maximum
More information2015 Benefits Overview
2015 Benefits Overview ASPIRE HEALTH ADVANTAGE VALUE (HMO) BENEFIT Monthly Plan Premium Out-of-Pocket Limit (In-Network Medicare-covered benefits) Annual Part C Deductible (all services except for Prescription
More informationCDPHP BASIC RX (HMO) CDPHP VALUE RX (HMO) CDPHP CHOICE (HMO) CDPHP CHOICE RX (HMO)
Introduction to the Summary of Benefits Report for CDPHP BASIC RX (HMO) CDPHP VALUE RX (HMO) CDPHP CHOICE (HMO) CDPHP CHOICE RX (HMO) January 1, 2015 December 31, 2015 CAPITAL REGION OF NEW YORK STATE
More information2014 CDPHP Medicare Choices Group PPO Benefit Summary
2014 CDPHP Medicare Choices Group PPO Benefit Summary Services In-Network Out-of-Network Physician Services Primary care physician visits $10 copayment $10 copayment Specialty visits $15 copayment $15
More informationSummary of Benefits. for Anthem MediBlue Select (HMO) Available in Milwaukee and Waukesha Counties, WI
Summary of Benefits for Available in Milwaukee and Waukesha Counties, WI Anthem Blue Cross and Blue Shield is a Health plan with a Medicare contract. Anthem Blue Cross and Blue Shield is the trade name
More informationEssentials Choice Rx 24 (HMO-POS) Summary of Benefits
Essentials Choice Rx 24 (HMO-POS) Summary of Benefits Southwestern Idaho January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service
More informationBenefits Summary of. BlueMedicare SM Preferred HMO A Medicare Advantage HMO Plan. Pinellas County
Summary of 2017 BlueMedicare SM HMO A Medicare Advantage HMO Plan Pinellas County HMO coverage is offered by BeHealthy Florida, Inc., DBA Florida Blue HMO, an affiliate of Blue Cross and Blue Shield of
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationCDPHP Medicare Choices Group Plan 2014 PPO Renewal Information
CDPHP Medicare Choices Group Plan 2014 PPO Renewal Information Paperwork Due Date: Return on or before 10/31/2013 Health Benefits Administrator Group Number: 10006176 Otsego County Chamber of Commerce
More informationMedicare Prescription Drug Coverage 1
2015 National Training Program Medicare Prescription Drug Coverage Under Part A, Part B, and Part D July 2015 Lesson 1 Inpatient Prescription Drug Coverage Inpatient status Medicare prescription drug coverage
More informationSummary of Benefits. Prime (HMO-POS), Value Plus (HMO), and Value (HMO) January 1, 2016 December 31, 2016 G ENERATIONS A DVANTAGE
Summary of s Prime (HMO-POS), Value Plus (HMO), and Value (HMO) January 1, 2016 December 31, 2016 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website
More informationSummary of Benefits. BlueMedicare SM HMO A Medicare Advantage HMO Plan. Miami-Dade County. Y0011_ CMS Accepted
2015 Summary of Benefits BlueMedicare SM HMO A Medicare Advantage HMO Plan Miami-Dade County Y0011_32459 0814 CMS Accepted (HMO) Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives
More informationSCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits. Y0057_SCAN_9240_2015F File & Use Accepted
SCAN Classic (HMO) San Joaquin County 2016 Summary of Benefits Y0057_SCAN_9240_2015F File & Use Accepted SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health
More informationBlue Shield 65 Plus (HMO) summary of benefits
Blue Shield 65 Plus (HMO) summary of benefits Group Medicare Advantage-Prescription Drug Plan for CalPERS retirees January 1, 2015 to December 31, 2015 Blue Shield of California is a HMO plan with a Medicare
More informationSummary of Benefits: Explorer Rx 9 (PPO) Eastern Idaho
Summary of Benefits: Explorer Rx 9 (PPO) Eastern Idaho January 1, 2018 December 31, 2018 This is a summary of drug and health services covered by PacificSource Medicare Explorer Rx 9 (PPO). The benefit
More informationSummary of Benefits: Explorer Rx 11 (PPO) Northern Idaho
Summary of Benefits: Explorer Rx 11 (PPO) Northern Idaho January 1, 2018 December 31, 2018 This is a summary of drug and health services covered by PacificSource Medicare Explorer Rx 11 (PPO). The benefit
More informationSummary of Benefits. for CareMore Breathe (HMO SNP), CareMore Heart (HMO SNP) and CareMore Reliance (HMO SNP)
Summary of Benefits for CareMore Breathe (HMO, CareMore Heart (HMO and Available in Los Angeles and Orange Counties (partial) SBLAOCBRTHRTREL15 Y0017_15_081478A CHP CMS Accepted (09082014) Section I: Introduction
More informationMAPD HMO Summary of Benefits
MAPD HMO Summary of Benefits January 1, 2015 December 31, 2015 Call toll-free 1-877-795-6131 8 a.m. to 8 p.m. daily TTY/TDD 711 HealthAllianceRetiree.org/SOI ste-statemedsob-0914 SECTION I INTRODUCTION
More informationSummary of Benefits. for CareMore Breathe (HMO SNP), CareMore Heart (HMO SNP) and CareMore Diabetes (HMO SNP) Available in Stanislaus County
Summary of Benefits for, CareMore Heart (HMO and Available in Stanislaus County SBSTANBRTHRTDBT15 Y0017_15_081488A CHP CMS Accepted (09082014) Section I: Introduction to Summary of Benefits You have choices
More informationSummary of Benefits. (HMO) and Empire MediBlue Select SM
Summary of Benefits for Plus SM (HMO) and Select SM (HMO) Available in Nassau County, NY Empire BlueCross BlueShield is a Health plan with a Medicare contract. Services provided by Empire HealthChoice
More informationOur service area includes these counties in: Nevada: Clark, Nye.
2018 SUMMARY OF BENEFITS Overview of your plan Senior Dimensions Southern Nevada (HMO) H2931-002 Look inside to learn more about the health services and drug coverages the plan provides. Call Customer
More information2017 Group Retiree Medicare Plans
2017 Group Retiree Medicare Plans Standard Health Maintenance Organization (HMO) Plans Empire BlueCross BlueShield is an HMO and PDP plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield
More information2018 SUMMARY OF BENEFITS
2018 SUMMARY OF BENEFITS Overview of your plan UnitedHealthcare Group Medicare Advantage (PPO) H2001-816 Group Name (Plan Sponsor): CalPERS with Dental and Vision Look inside to learn more about the plan
More information2019 MEDICAL PLAN SUMMARY Arlington County Government/AmWINS Medicare Plan
Out of Pocket Maximum: $1,500 Lifetime Maximum: Unlimited MEDICARE (PART A) HOSPITAL SERVICES PER BENEFIT PERIOD HOSPITALIZATION * Semiprivate room and board, general nursing, and miscellaneous services
More information2018 Summary of Benefits Advantage Silver NY, Plan 019. H2m _ QHPNY0984 Accepted
2018 Summary of Benefits Advantage Silver NY, Plan 019 H2m _ QHPNY0984 Accepted IMPORTANT INFORMATION Proposed Effective Date Your Primary Care Provider (PCP) Name Address Phone Number Important Numbers:
More information