Welcome to America's 1st Choice! We want to thank you for considering America's 1st Choice for your Medicare coverage.
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- Kerrie Flowers
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2 Welcome to America's 1st Choice! We want to thank you for considering America's 1st Choice for your Medicare coverage. America s 1st Choice Insurance Company of North Carolina is a health plan with a Medicare contract. America s 1 st Choice is a Medicare Advantage Private Fee For Service (PFFS) Plan and is approved in all counties in the State of North Carolina.
3 What We ll Discuss Today Introduce America's 1st Choice: Discuss Your Current Coverage & Eligibility to Enroll Compare Medicare Advantage to Original Medicare Explain How a PFFS works Explain the benefits of the America's 1st Choice plans & help you decide the health plan that best meets your needs Answer Your Questions and Show you how to enroll today! Please hold your questions until the end of the presentation.
4 Who is America's 1st Choice? We are a physician owned (Medicare Advantage) insurance company which sets us apart from the competition We are locally-operated to ensure that we understand your healthcare concerns We are committed to excellence
5 Your Current Coverage What do you have now in addition to Medicare Parts A and B? Is there a cost to your plan? What do you like about your plan? What would you like to change about your plan? What type of plan would you prefer? Comprehensive coverage with more benefits A plan that will reduce your out-of-pocket expenses Unique services outside traditional Medicare
6 What is a Medicare Advantage Plan? Medicare Advantage Plans are health plan options approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called Part C or MA Plans. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Source: Medicare & You 2009, Centers for Medicare and Medicaid Services
7 What is a Private Fee-For-Service plan? PFFS is a type of Medicare Advantage plan offered by a private insurance company like America s 1 st Choice Insurance Company of North Carolina, Inc. It is not the same as the Original Medicare plan that is offered by the Federal Government It is not a Medicare supplement, Medigap, Medicare Select, or Prescription Drug Plan
8 Medicare Advantage Plan Guarantees: If you join a Medicare Advantage Plan: You are still in the Medicare program You still have Medicare rights and protections including the right to appeal. You still get all your regular Medicare-covered services You may be able to get extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage.
9 Are you Eligible? Do you have Medicare Parts A & B? Is your permanent residence here in this county? Do you have end stage renal disease?
10 Plans Offered By America s 1 st Choice Insurance Co of North Carolina America s 1st Choice offers customized plans that fit your unique needs which match the benefits provided by Medicare plus offers additional benefits for less cost to you. Medicare Advantage PFFS with Prescription Drug Coverage Patriot Plus (PFFS) Presidential Plus (PFFS) Medicare Advantage PFFS with NO Prescription Drug Coverage Patriot (PFFS) Presidential (PFFS)
11 Formulary Please see the Formulary I am holding up. I am going to explain how to determine your potential cost by showing you how to locate your prescriptions in the formulary using two different methods. However, when you sit one to one with one of our agents they will go through each of your prescriptions personally with you. There are two different ways to look up your prescriptions: Alphabetically by Index in back of book and Categorized by drug classification (analgesics, ointments etc.) to find drugs by drug class
12 Added Benefits of our Medicare Advantage PFFS Plans All the benefits that you currently receive from Medicare, plus much more including No deductibles* Routine physicals Brand and generic Rx coverage on the Patriot Plus and Presidential Plus plans* Nationwide emergency/urgent care and out of area renal dialysis Physicians and Specialists without Referral No need to buy (and can t be sold) a Medicare supplement (Medigap) policy Additional services including dental, vision and hearing * You must continue to pay your Medicare Part B premium. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help call: 1-(800)-medicare ( ). TTY users should call , 24 hours a day/7 days a week; the Social Security office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call ; or your State Medicaid Office.
13 Department of Health & Human Services Centers for Medicare and Medicaid Services 16
14 Compare Your Health Care Options Original Medicare benefits plus no Medicare deductibles. Additional benefits for prescriptions, extra coverage for dental, vision and hearing. No Medigap supplement needed. America s 1 st Choice Medicare Advantage Plan Coverage for all Medicare deductibles and coinsurance A common Medicare supplement - Plan C Office visits when you are sick Original Medicare Hospitalization This table is a brief overview comparing Original Medicare, a popular Medicare supplement and America s 1 st Choice Medicare Advantage plans. The Plan Overview will go into more detail about benefits.
15 How does PFFS work? Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies and out of area renal dialysis.
16 How does PFFS work? If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies and out of area renal dialysis. Providers can find the plan s terms and conditions on our website at
17 How does it work? America s 1 st Choice pays instead of Medicare. You will pay amounts that the PFFS Plan does not pay, which are called co-payments and/or co-insurance. Original Medicare will not pay for your healthcare while you are enrolled in a Private Fee-for-service plan.
18 How do you obtain services from a PFFS Plan? You may receive healthcare services from any provider allowed to bill Medicare who agrees to accept the Private Fee-for-service plan s payment terms and conditions. You must use network pharmacies to obtain prescription drugs, except in emergencies or urgent situations. You will receive a PFFS Brochure which explains what both you and your provider need to know about PFFS plans and how they work.
19 Before seeing a provider, you should Verify that your provider will accept the America s 1 st Choice PFFS Plans: -Patriot (PFFS) -Patriot Plus (PFFS) -Presidential Plan (PFFS) -Presidential Plus (PFFS) Your healthcare providers have the right to choose whether to accept a Private Fee-forservice plan s payment terms and conditions every time you see your providers.
20 When you go to the doctor or hospital: Show your America s 1 st Choice ID card and tell them that you have chosen either the -Patriot (PFFS) -Patriot Plus (PFFS) -Presidential (PFFS) -Presidential Plus (PFFS) Do not show your red, white and blue Medicare card. Pay any America s 1 st Choice co-payments or co-insurance at the time of service.
21 What if? If your provider decides not to accept the plan, you will need to find another provider that will. They should not provide services to you except in an emergency and out of area renal dialysis. If they choose to provide services, they may not bill you. They must bill the Private Fee-forservice plan for your covered healthcare services. You must pay the appropriate copayments and co-insurance.
22 Don t worry about payments The doctor or hospital will bill America s 1 st Choice for the rest. Healthcare providers must bill the Private Fee-for-service plan (America s 1 st Choice).
23 You are in control with a Medicare Advantage Private Fee For Service (PFFS)
24 Plan Benefits For the next few minutes, your America's 1st Choice Representative will present the specifics of the America's 1st Choice Medicare Advantage plan benefits, using the Medicare Approved Plan Overview. 21
25 Before we finish Can we answer any questions?
26 t Would you like to enroll today? To enroll, we need to complete an enrollment form today. You may enroll in a plan only during specific times of the year. Pease contact customer service department to obtain more information. An agent will be able to help you determine your eligibility to enroll today. Once you are approved on the Plan, you will receive a welcome package and your member identification card. Your (proposed) effective date will be: T h e 1 s t o f
27 Thank You and Share the Good News Many of our members have been referred by their friends. Who do you know that could benefit from our Plan? Call Toll Free: TTY/TDD: :00 am 8:00 pm 7 days (Nov 15 Mar 1) 8:00 am 8:00 pm Mon- Fri (Mar 2 Nov 14)
28 Additional Information The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan. On Part B payback plans, you must continue to pay your Medicare Part B premium. If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it take effect and you will ultimately be held responsible for those premiums; For full information on America s 1 st Choice Health Plans benefits, call our Customer Service Department at from 8am to 8pm, 7 days (Nov 15 Mar 1) and 8am to 8pm, Mon-Fri (Mar 2 Nov 14) TTY/TDD
29 IF YOU NEED EXTRA HELP People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don t even know it. For more information about this Extra Help, contact your local Social Security office or call MEDICARE ( ), 24 hours per day, 7 days per week. TTY users should call
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