Benefit Highlights. Offered by. H5826_MA_031_2014_v_01_BeneHiEng ACCEPTED

Transcription

1 2014 Benefit Highlights Offered by H5826_MA_031_2014_v_01_BeneHiEng ACCEPTED

2 Your preventive care is our focus. We cover 100% of the following services: Bone Mass Measurements Colorectal Screening Exams Immunizations Mammograms Pap Smears and Pelvic Exams Prostate Cancer Screenings MA Special Needs Plan (005) (HMO SNP) (1) $0/mo Enhanced Medicare and Medicaid coverage. To qualify, you must be eligible for both Medicare and full Medicaid. (Full-Dual) MA Plan (006) (HMO) $0/mo Enhanced Medicare coverage with no added premium. Plan does not include prescription drug coverage. (Part D) MA Pharmacy Plan (008) (HMO) $34.80/mo Enhanced Medicare coverage with low premium. Plan includes coverage for routine eyewear, dental services, and prescription drugs. MA Pharmacy Plan (009)* (HMO) *Covers different counties. $77/mo Enhanced Medicare coverage with low premium. Plan includes coverage for routine eyewear, dental services, and prescription drugs. MA Extra Plan (HMO) $0/mo Enhanced Medicare coverage plus routine eyewear and prescription drug coverage. All for $0 premium. Offered by

3 When you choose, you choose a statewide network of more than 14,500 primary care doctors and specialists and 100+ hospitals. You get access to the services you need when and where you need them. Our plans vary by service area (county). To enroll, you must reside in one of our service areas. San Juan Island Whatcom Skagit Okanogan Ferry Stevens Pend Oreille Clallam Snohomish Chelan Kitsap King Douglas Lincoln Spokane Grays Harbor Mason Thurston Pierce Kittitas Grant Adams Whitman Wahkiakum Cowlitz Lewis Skamania Yakima Benton Franklin Walla Walla Columbia Asotin Clark Klickitat MA Special Needs Plan (005) (1) MA Plan (006) MA Special Needs Plan MA Pharmacy Plan (008) Your Plan Options MA Pharmacy Plan* (009) MA Extra Plan (010)

4 Compare MA Special Needs Plan (005) (1) MA Plan (006) Premium $0 $0 Out-of-Pocket Maximum $6,700 calendar year $3,400 per calendar year Part A Inpatient Hospital Initial deductible - $0 $0 per day for days 1-90 Plan covers 90 days each benefit period $250 per day for days 1-5 $0 copay per day for days 6-90 $0 for additional hospital days Part B 2014 Deductible NO DEDUCTIBLE NO DEDUCTIBLE Primary Care (per visit) 0% of the cost $0 copay Specialist Care (per visit) 0% of the cost $40 copay Medicare-covered Lab Services 0% of the cost 0% of the cost Emergency Care (per visit) $0 copay $65 copay Ambulance (per service) 0% of the cost $150 copay Diabetic Supplies 0% of the cost $0 copay Supplemental Podiatry Services Supplemental Routine Eye Exam 0% of the cost (up to 4 supplemental routine visits per year) Routine exam not covered. Covered by Medicaid $0 copay (up to 4 supplemental routine visits per year) $0 copay (up to 1 supplemental routine eye exam every year) Supplemental Eyewear $200 benefit every 2 years $100 benefit every 2 years Supplemental Dental Services Chiropractic (per Medicare-covered visit) $875 benefit every year, $0 copay for preventive, 0% of the cost on comprehensive dental benefits 0% of the cost $20 copay $500 benefit every year, $0 copay for preventive, 20% coinsurance on supplemental comprehensive dental benefit Acupuncture (per visit) $0 copay ($250 limit) $0 copay ($250 limit) Part D Prescription Copays (Tier 1/2/3) $0 or $1.20 or $2.55 (generic) $0 or $3.60 or $6.35 (all other drugs) This plan does not include coverage for prescription drugs (1) All cost sharing on this plan, including premiums, medical and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with the State or another plan for Medicaid benefits, will help you resolve any billing issues. Your doctor cannot bill you for cost sharing covered under your Medicaid benefits. Your doctor must accept plan payment as payment-in-full or bill the correct Medicaid source.

5 Compare MA Pharmacy Plan (008) MA Pharmacy Plan* (009) *Covers different counties than 008. Premium $34.80 $77 Out-of-Pocket Maximum $3,400 per calendar year $3,400 per calendar year Part A Inpatient Hospital $255 per day for days 1-5 $0 copay per day for days 6-90 $0 for additional hospital days $250 per day for days 1-5 $0 copay per day for days 6-90 $0 for additional hospital days Part B 2014 Deductible NO DEDUCTIBLE NO DEDUCTIBLE Primary Care (per visit) $0 copay $0 copay Specialist Care (per visit) $40 copay $40 copay Medicare-covered Lab Services 0% of the cost 0% of the cost Emergency Care (per visit) $65 copay $65 copay Ambulance (per service) $150 copay $150 copay Diabetic Supplies $0 copay $0 copay Supplemental Podiatry Services Supplemental Routine Eye Exam $0 copay (up to 4 supplemental routine visits per year) $0 copay (up to 1 supplemental routine eye exam every year) $0 copay (up to 4 supplemental routine visits per year) $0 copay (up to 1 supplemental routine eye exam every year) Supplemental Eyewear $100 benefit every 2 years $100 benefit every 2 years Supplemental Dental Services $500 benefit every year, $0 copay for preventive, 20% coinsurance on supplemental comprehensive dental benefit $500 benefit every year, $0 copay for preventive, 20% coinsurance on supplemental comprehensive dental benefit Chiropractic (per Medicare-covered visit) $20 copay $20 copay Acupuncture (per visit) $0 copay ($250 limit) Not covered Part D Prescription Copays (Tier 1/2/3) $10 / $50 / 33% $10 / $50 / 33% (1) All cost sharing on this plan, including premiums, medical and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with the State or another plan for Medicaid benefits, will help you resolve any billing issues. Your doctor cannot bill you for cost sharing covered under your Medicaid benefits. Your doctor must accept plan payment as payment-in-full or bill the correct Medicaid source.

6 Compare MA Extra Plan (010) Premium $0 How do you enroll? Out-of-Pocket Maximum Part A Inpatient Hospital Part B 2014 Deductible Primary Care (per visit) Specialist Care (per visit) Medicare-covered Lab Services Emergency Care (per visit) Ambulance (per service) Diabetic Supplies $3,400 per calendar year $400 per day for days 1-5 $0 copay per day for days 6-90 $0 for additional hospital days NO DEDUCTIBLE $10 copay $50 copay 0% of the cost $65 copay $185 copay $0 copay Apply by Phone Call today and a licensed Community HealthFirst Medicare Advantage expert will be happy to help you enroll over the phone. Call (TTY Relay: dial 7-1-1) between the hours of 8:00 a.m. and 8:00 p.m., 7 days a week. Apply in Person Medicare can be difficult to tackle alone. If you prefer to meet faceto-face with one of our Medicare Advantage experts please call us to schedule a free appointment. Supplemental Podiatry Services Supplemental Routine Eye Exam Supplemental Eyewear Supplemental Dental Services Chiropractic (per Medicare-covered visit) Acupuncture (per visit) Part D Prescription Copays (Tier 1/2/3) Routine services not covered $0 copay (up to 1 supplemental routine eye exam every year) $100 benefit every 2 years No supplemental coverage 20% of the cost Not covered $10 / $50 / 33% Apply by Mail Simply complete the enrollment application and return it using the postage-paid orange envelope. If you do not already have an enrollment application, call us and we will be happy to help you complete your application. Apply Online Visit to apply online. We will receive your application electronically. You may also apply to enroll in a Community HealthFirst plan through the Centers for Medicare and Medicare Services Online Enrollment Center, at (1) All cost sharing on this plan, including premiums, medical and prescription drug costs, is based upon your level of Medicaid eligibility. If you are enrolled with the State or another plan for Medicaid benefits, will help you resolve any billing issues. Your doctor cannot bill you for cost sharing covered under your Medicaid benefits. Your doctor must accept plan payment as payment-in-full or bill the correct Medicaid source.

7 Important questions to ask when choosing your Medicare Advantage plan. Cost How much will you pay out of your own pocket for things such as monthly premiums and cost sharing on health care services or prescription drugs? Benefits Do you have coverage for vision and dental services? Does your current plan provide enough coverage to make up for the gaps in your Original Medicare coverage? Choice Can you see the doctor you want to see or go to the hospital you need to go to? Are the doctors in the plan accepting new patients? Convenience How often do you see your doctor? Are the doctors in the plan easy for you to get to? Prescription drugs Are the prescription drugs you need on the plan s list of covered drugs (formulary)? Can you go to the pharmacy of your choice to get prescriptions filled? Do you qualify for the Low-Income Subsidy (LIS) program? People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. To see if you qualify for extra help, call: MEDICARE ( ). TTY users should call , 24 hours a day, 7 days a week; the Social Security Office at between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users should call ; or your Medicaid office. Having trouble choosing? Let us help. We are your Medicare Advantage Experts. Contact us at (TTY Relay: Dial 7-1-1).

8 Contact Information Prospective Members: Current Members: TTY Relay: Dial :00 a.m. to 8:00 p.m. 7 days a week Web: Mailing Address: Community Health Plan of Washington ATTN: 720 Olive Way, Suite 300 Seattle, WA is an HMO plan with a Medicare contract. Enrollment in Medicare Advantage Plans depends on contract renewal. Benefits, formulary, pharmacy network, premium and/ or copayments/coinsurance may change on January 1, Limitations, copayments, and restrictions may apply. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium (the Part B premium is covered for full-dual members). The benefit information provided herein is a brief summary, not a complete description of benefits. This information is available for free in other languages. Please contact us at (TTY Relay: Dial 7-1-1) for additional information. Esta información está disponible gratuitamente en otros idiomas. Por favor, contáctenos al para obtener información adicional.