Welcome. Why We re Here. Medicare Basics. Plan Benefits. Questions & Answers. How to Enroll 10/11/2013

Transcription

1 University of Arkansas System UnitedHealthcare Group Medicare Advantage (PPO) 2014 benefit plan Y0066_130717_ Welcome Why We re Here Medicare Basics Plan Benefits Questions & Answers How to Enroll 1

2 Why UnitedHealthcare? UnitedHealthcare is here for you. At UnitedHealthcare, you get help understanding how to get the most from your plan. You get connected to the care you need, when you need it. And you get the programs, resources and tools to help you live a healthier life. Medicare Basics 2

3 The ABCs of Medicare Medicare Parts A & B (Original Medicare) 3

4 Medicare Part B Medicare Part B Premium: You pay a premium each month for Medicare Part B (Medical Insurance) Most people pay the Part B premium of $ each month in 2013 However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more Medicare Part B Late Enrollment Penalty If you don't sign up for Part B when you're first eligible or if you drop Part B and then get it later, you may have to pay a late enrollment penalty for as long as you have Medicare You can sign up between January 1 March 31 each year. Your coverage will begin July 1 Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it Medicare Part C (Medicare Advantage Plans) 4

5 Medicare Part D (Prescription Drug Plans) When are you eligible for Medicare? You re eligible for Original Medicare (Parts A and B) if: You re 65 years old, or you re under 65 and qualify on the basis of disability or other special situation. -AND- You re a U.S. citizen or a legal resident who has lived in the United States for at least five consecutive years. 5

6 Plan Benefits Premiums What you pay today New starting SAVINGS Just you: $ (Classic) $ (POS) You and spouse are both on Medicare: $ (Classic) $ (POS) If your spouse is < 65 and not on Medicare $ $ x 2 = $ No change. They stay on the UA plan, same individual rates as current: $ (Classic) $ (POS) $ or $ per month $ or $ 1, per year $ or $ per month $ 1, or $ 2, per year NA 6

7 Important Enrollment Information Sample ID Card Front Back Put your Medicare card in a safe place 7

8 UnitedHealthcare Group Medicare Advantage (PPO) plan The advantages of a single plan. Medicare Advantage (Part C) plans are provided through private insurers, like UnitedHealthcare. They include Part A, Part B, and Part D all in one plan. Medicare Advantage plans also offer additional benefits beyond doctor and hospital visits. All the benefits of Part A (Medicare covered services) Hospital stays Skilled nursing Home health All the benefits of Part B (Medicare covered services) Doctor s visits Outpatient care Screenings and shots Lab tests Prescription drug coverage (Medicare Part D drugs) Included in the Medicare Advantage plan Additional benefits (non-medicare covered services) Included in the plan is non-medicare covered Podiatry, non-medicare covered eye exam, Bonus Prescription Drug List Medicare Advantage (PPO) We make things simple. Hospital costs, doctor and outpatient care in one plan. Benefits are the same whether you are in or out of the network Includes prescription drug coverage Vision, hearing and podiatry coverage No referral needed to see a specialist See any provider anywhere in the United States who accepts Medicare The provider does not have to be part of the UnitedHealthcare network Providers who have a contract with UnitedHealthcare (in-network) must accept this plan if you are a current patient Providers who do not have a contract with UnitedHealthcare (out-of-network) have the choice to accept the plan, except in the case of a medical emergency when they have to accept 8

9 Member Guide to Care UnitedHealthcare Group Medicare Advantage (PPO) plan You Pay Deductible (deductible does apply to annual out of pocket maximum) $500 Annual out-of-pocket maximum (this does not include prescription drug benefits) $1,000 9

10 UnitedHealthcare Group Medicare Advantage (PPO) plan Benefit Coverage Member Responsibility Primary care physician (PCP) office $25 copay Specialist office visit $40 copay Urgently needed care (waived if admitted within 24 hrs) $50 copay Emergency room (waived if admitted within 24 hrs) $65 copay Inpatient hospitalization / per admit Outpatient surgery $500 Deductible then $450 copay $500 Deductible then $200 copay UnitedHealthcare Group Medicare Advantage (PPO) plan Benefit Coverage Member Responsibility Clinical Lab Services Outpatient X-ray Services Diagnostic Procedure/Tests Diagnostic Radiology Services Therapeutic Radiology Services Influenza (Flu), Pneumococcal Pneumonia, Hepatitis B Vaccines Shingles Vaccine $0 copay $0 copay $500 Deductible then 20% coinsurance $500 Deductible then 20% coinsurance $500 Deductible then 20% coinsurance $0 copay Subject to applicable copay ($25 PCP and/or $70 pharmacy) 10

11 UnitedHealthcare Group Medicare Advantage (PPO) plan Benefit Coverage Member Responsibility Non-Medicare routine podiatry $500 Deductible then $40 copay / 6 visits per year Non-Medicare routine vision $40 copay Medicare-covered chiropractor $20 copay Medicare-covered vision services exam $40 copay Medicare-covered hearing services $40 copay Diabetic Supplies (blood glucose monitor, blood glucose test strips, lancet devices and lancets, and glucose-control solutions for checking the accuracy of test strips and monitors) $500 Deductible then 20% coinsurance Medicare Covered Preventive Care These services are Covered at 100%, no out of pocket cost to you! 11

12 Services that apply toward the annual deductible and out-of-pocket maximum Member Responsibility Annual Deductible Member Responsibility Annual Out of pocket Maximum Deductible ALL PHYSICIAN SERVICES Primary Care Physician (PCP)/Office Visit (includes Non-MD office visit in a PCP office) Specialist Office Visit (include Non-MD in specialist office) INPATIENT SERVICES Inpatient Hospital Stay - Facility Cost Share for Day Range 1 or Per Admit (Includes Inpatient Substance Abuse) $500 $1,000 Skilled Nursing Facility Care Inpatient Mental Health in a Psychiatric Hospital - Facility Cost Share Transplants - Cost Share (For MA Plans - related to Travel and Lodging Only. For Sr. Supp. Plans - Professional services in addition to Inpatient Hospital Services) Services that apply toward the annual deductible and out-of-pocket maximum Member Responsibility Annual Deductible Member Responsibility Annual Out of pocket Maximum $500 $1,000 OUTPATIENT SERVICES Outpatient Surgery Outpatient Hospital Services Outpatient Mental Health/Substance Abuse (Individual Visit) Outpatient Mental Health/Substance Abuse (Group Visit) Partial Hospitalization Comprehensive Outpatient Rehabilitation Faciity (CORF) Occupational Therapy Physical Therapy and Speech/Language Therapy Cardiac/Pulmonary Rehabilitiation Services Kidney Dialysis MEDICARE-COVERED SERVICES Chiropractic Visit (Medicare-covered) Podiatry Visit (Medicare-covered) Eye Exam, (Medicare-covered) Hearing Exam (Medicare-covered) Dental Services (Medicare-covered Smoking Cessation Visit (Medicare-covered) 12

13 Services that apply toward the annual deductible and out-of-pocket maximum AMBULANCE/EMERGENCY ROOM/URGENT CARE Ambulance Services Emergency Room (includes Worlwide Coverage) Member Responsibility Annual Deductible Member Responsibility Annual Out of pocket Maximum $500 $1,000 Urgently Needed Care (Contracted Providers) PART B DRUGS Blood DURABLE MEDICAL EQUIPMENT (DME) AND SUPPLIES Durable Medical Equipment Durable Medical Equipment purchased in a pharmacy Orthotics and Prosthetics Medical Supplies Diabetes Monitoring Supplies HOME HEALTHCARE AGENCY Home Health Services Hospice (Medicare-covered) PROCEDURES Diagnostic Procedure/Test Clinical Laboratory Services Outpatient X-ray Services Diagnostic Radiology Services Services that apply toward the annual deductible and out-of-pocket maximum PREVENTIVE SERVICES Cardiovascular Screenings (Medicare-covered) Immunizations Cervical and Vaginal Cancer Screening Prostate Cancer Screening Colorectal Cancer Screenings Bone Mass Measurements (Bone Density) Mammography Diabetes - Self Management Training Medical Nutrition Therapy Annual Wellness Visit (Physical Exam) and Onetime Welcome-to-Medicare Exam. (Medicarecovered) Member Responsibility Member Responsibility Annual Deductible Annual Out of pocket Maximum $500 $1,000 Annual Routine Physical Exam (Non Medicarecovered) ADDITIONAL BENEFITS/PROGRAMS - (Non Medicare-covered) Routine Podiatry (Non Medicare-covered) 13

14 Your New Prescription Drug Plan (PDP) More than 65,000 network pharmacies nationwide most national drugstore chains and independent pharmacies are included. Thousands of covered brand name and generic drugs. Generic drugs as low as $2 through our Pharmacy Saver program 2. (Wal-Mart and Sam s Club joining the network 1/1/2014) Bonus drug coverage in addition to Medicare Part D drug coverage. Your plan provides full coverage in the Coverage Gap (donut hole). Check your plan's drug list or call Customer Service to see if your prescription drugs are covered. Your New Prescription Drug Plan Bonus Drug List (BDL) This Bonus Drug List gives you additional coverage on some prescription drugs that are normally excluded from the Part D formulary The list is included in the Pre-Enrollment materials Additional covered drugs are not part of the Part D plan and do not count toward Medicare Part D out-of-pockets costs Included in the Bonus Drug List but not limited to: Analgesics, Antimigraine Agents, Dermatological Agents, Gastrointestinal Agents, Erectile Dysfunction drugs, Hormone Replacement Drugs, Nutritional Supplements, Otic Agents, Respiratory Tract Agents Drug cost is determined by cost-sharing tier 14

15 Your New Part D benefit highlights Tier Prescription Drug Type Your Costs Retail (30 day supply) Preferred Mail Order (90 day supply) Tier 1 Generic and some brands $10 copay $20 copay Tier 2 Preferred Brand and some generics $35 copay $70 copay Tier 3 Non-Preferred Brand and some generics $70 copay $140 copay Tier 4 Specialty Drugs and some generics $70 copay $140 copay Prescription Examples Prescription What I pay now in the UA plan NEW cost (mail order for 3 months) Crestor Nexium Diovan HCT Synthroid Vesicare Janumet $70 for 1 month $210 for 3 months $189 for 1 month $ 567 for 3 months (reference based pricing) $105 for 3 months $27 for 1 month $81 for 3 months $160 for 1 month $480 for 3 months (reference based pricing) Full cost ~ $77 for 1 month (not covered in our formulary) $70 for 3 months $70 for 3 months $70 for 3 months $70 for 3 months $70 for 3 months $70 for 3 months Both plans apply the lesser of logic. If a prescription drug is lesser than the copay amount, you will always pay the lesser amount. 15

16 More Prescription Examples Prescription Lexapro Premarin Lisinopril Zetia Cymbalta What I pay now in the UA plan NEW cost (mail order for 3 months) $70 for 1 month $210 for 3 months $105 for 3 months $4 for 1 month $12 for 3 months $70 for 1 month $210 for 3 months $105 for 3 months $70 for 1 month $140 for 3 months $70 for 3 months $4 for 1 month $8 for 3 months $70 for 3 months $70 for 3 months Both plans apply the lesser of logic. If a prescription drug is lesser than the copay amount, you will always pay the lesser amount Mail Service Pharmacy Your order enters OptumRx fulfillment system. A pharmacist reviews your information for drug interactions, allergies and dosage. For your security, another pharmacist reviews your medication for accuracy after it is dispensed. OptumRx seals your medication in a tamperevident package. They mail your medication to you and notify you when it has been shipped. 16

17 More ways you can save Review your medications. Review your prescription drugs with your doctor at least once a year. Ask, Do I still need them all? Can I stop taking the ones I don t need? Use your member ID card. Show your member ID card at the pharmacy to get the plan s discounted rates. Use participating network pharmacies. You ll get the greatest benefit, if you use in-network pharmacies. Take advantage of our Pharmacy Saver Program Prescriptions as low as $ Use mail service pharmacy. You ll save time and trips to the pharmacy. 2 Drugs and prices may vary between pharmacies and are subject to change during the plan year. Prices are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on their dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess of a limit, copay amounts may be higher. Income Related Monthly Adjustment Amount (IRMAA) In January of 2011, the Affordable Care Act established an income related monthly adjustment amount under the Part D program which is known as the Part D-IRMAA The Part D-IRMAA must be withheld from Social Security, RR Board or Office of Personnel Management benefit checks unless the monthly payment isn t enough to cover the entire amount owed. Otherwise member will receive a bill from Medicare Members will have to pay this extra amount each month, in addition to their monthly Part D plan premium, to keep Medicare prescription drug coverage Social Security will send affected members a letter if they have to pay an extra amount for their prescription drug coverage. The letter will explain how they determined the amount the member must pay UnitedHealthcare does not determine who will be subject to the Part D- IRMAA. If a member disagrees with the amount they are required to pay, they must contact Social Security If members do not pay the Part D-IRMAA, they will be disenrolled from the plan 17

18 Income Related Monthly Adjustment Amount (IRMAA) Fitness program Stay physically fit and active at no additional cost. Join SilverSneakers and enjoy: Stay active with SilverSneakers Fitness Program. Choose a fitness center from more than 11,000 participating locations. Find the nearest location at Classes, cardio equipment, resistance machines, free weights and heated pools (at certain locations). Amenities may vary at each location. Many women-only locations, including Curves, nationwide. 18

19 Fitness program Don t live near a fitness center? If the nearest fitness center is 15 miles or more away from your home, you can request the SilverSneakers steps program. Once you enroll in Steps, you may select one of the four kits that best fits your lifestyle and fitness level general fitness, strength, walking or yoga. The Steps wellness tools can help you get fit at home or on the go. NurseLine SM You re never alone. Whether you have questions about a medication or have a health concern in the middle of the night, with NurseLine a nurse is only a phone call away. Services include: Nurses answer your health questions 24 hours a day. They can: Help you choose a new doctor Provide tips on how to help control diabetes, blood pressure or high cholesterol Review your medication and look for generic options Connect you with community resources for exercise Provide easy ways you can add fruits and vegetable to your diet Provide tips to help stop smoking 19

20 Solutions for Caregivers Helping you care for a loved one. Solutions for Caregivers supports you, your family and those you care for. Services include: On-site assessment by a registered nurse A personalized care plan Connections to local resources The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the UnitedHealthcare grievance process. Hearing program In addition to your $500 hearing aid benefit you have access to deeply discounted hearing aids Hearing loss is the third most common chronic health condition among older Americans, and 40% of people age 65 or older are hearing impaired 3 Custom programmed hearing aids can address your personal hearing needs Batteries and ear tubes/wax guards, provided at no additional cost, that last most users six months 70-day no-risk trial period One-year manufacturer s warranty The convenience of delivery right to your home , or Hearing aids starting at $599 - $799 each, depending on the model you choose. 3 Epidemiology of Hearing Loss Study by the University of Wisconsin School of Medicine and Public Health The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the UnitedHealthcare grievance process. 20

21 Member Mailings and what to expect September 3, 2013 September 2013 November/December 2013 December 2013 Announcement Letter Sent to Retirees Pre-Enrollment Kits Sent to Retirees Letters Sent to Retirees Welcome Kits The Announcement Letter is sent out by UAS to announce the 2013 plan year benefit changes with UnitedHealthcare, The Pre-Enrollment booklets are sent out by UnitedHealthcare to each of the Retirees Households. These Pre-Enrollment booklets contain the following materials. Pre-booklet Cover Letter including opt out information Your Plan Explained Benefit Highlights Summary of Benefits Member Rights & Responsibilities Missing Enrollment Information Letter Confirmation of Enrollment Confirmation that UnitedHealthcare has sent the Retirees enrollment to CMS, and the enrollment has been accepted (or) confirmed with CMS. This letter includes the Retirees ID card. Required by CMS. Welcome Kits are sent to each of the Retirees Households. These Welcome kits contain the following materials. Welcome to Your Plan Getting Started Evidence of Coverage Formulary Mail Order Rx Form Provider Directory Pharmacy Directory 41 General Member Billing Information 21

22 Understand Medicare s Rules You must keep Medicare Parts A and B and continue to pay your Medicare Part B premium. You can only be in one Medicare Advantage plan at a time. Enrolling will automatically disenroll you from any other Medicare Advantage or prescription drug plan. Please read your Evidence of Coverage (EOC), including appeals and grievance rights. The EOC also covers specific plan benefits, copays, exclusions, limitations and other terms. Please review the full text of the Statement of Understanding in your 2014 enrollment kit. Questions & Answers 22