2019 Alliance Medicare Supplement Brochure

Transcription

1 2019 Supplement Brochure MED SUPP 2019 PRODUCT BROCHURE

2 Find the right plan for you. Supplement offers a choice of plans Plan A, Plan C, Plan F, Plan G and Plan N. The benefits of each of these plans are standardized by the federal government. Plan A provides basic benefits. Plans C, F, G and N provide coverage over and above the basic benefits. Take a look at the chart in your Outline of Coverage and choose the plan that best meets your needs. The deductibles, coinsurance and copay amounts listed in this booklet are based upon the 2018 CMS approved values and are subject to change in All five plans offer the basic benefits. The basic benefits include: Hospitalization: Coverage for Medicare Part A daily copays, plus 365 additional days (lifetime) after Medicare benefits end Medical expenses: Coverage for Medicare Part B coinsurance (20 percent of Medicareapproved costs) or copays for doctors services, hospital outpatient services and other medical services Blood: First three pints of blood each year Hospice: Coinsurance for inpatient respite care and copays for hospice outpatient prescription drugs Note: Plans do not include Medicare Part D prescription drug benefits. Take a closer look at HAP s Supplement plans. Supplement plan is not connected with or endorsed by the United States government or the federal Medicare program. Neither Supplement nor its agents are connected with Medicare. The Outline of Coverage in the back of this brochure is thorough but does not cover every detail. Contact your local Social Security office or consult the booklet Medicare & You for more details. 2

3 Supplement helps f ill the gaps in Original Medicare. With Original Medicare, you are covered for many hospital and medical expenses, but there are some gaps in that coverage that you may have to pay such as deductibles, coinsurance and copays and those costs can add up quickly: Medicare Part A has an upfront deductible of $1,340 for hospitalization a deductible you pay each benefit period before your Medicare coverage begins. If you stay in the hospital more than 60 days, you begin paying a copay of $335 per day. You pay 20 percent coinsurance for most doctors services after you pay your Part B deductible each year. You pay 100 percent for emergency care received outside the U.S., except under limited circumstances. After 90 days in the hospital, your copay increases to $670 per day. Protect your health with Supplement. With Supplement (Medigap) plans, you can fill the coverage gaps listed above and know that you are protected with a plan from Alliance Health and Life Insurance Company (Alliance). With Supplement, you can receive care anyplace in the U.S. that accepts Medicare, and with some plans, you have emergency care anywhere in the world. A dependable, Michigan-based partner. Medicare beneficiaries have relied on us and our Medicare plans for over 25 years. By listening carefully to our members, we have been able to make our health plans and services more responsive. With Alliance, you ll have the comfort that comes from knowing you have a partner in Michigan that is dedicated to delivering inspired customer service. Alliance is a wholly owned subsidiary of Health Alliance Plan (HAP), a Michigan-based company that has been serving the community for more than 50 years. 3

4 Reliable, easy-to-use coverage. Freedom and choice. With an Supplement plan, you are covered wherever you go. You can visit any doctor, specialist or hospital that participates in Medicare, anywhere in the U.S. No referrals are necessary or required to see a specialist. Your benefits start on day one there is no waiting period for protection to begin.* You get worldwide emergency coverage.** Convenient and simple. When you enroll in an Supplement plan: There is virtually no paperwork for you with our automatic claims processing. Your health claims are processed quickly. Your benefits through Supplement change automatically when Original Medicare deductibles, coinsurance or copays change, so you know you re covered. Your coverage renews automatically every year as long as you continue to pay your premiums. *If you delay enrollment and have a health problem that is diagnosed before your Medigap policy starts, the insurance company can refuse to cover that health problem for up to six months. However, you will still be covered under Original Medicare. ** Plan C, Plan F, Plan G and Plan N. 4

5 Inspired customer service. Customer service is deeply rooted in the HAP culture. It is what each HAP employee strives for each day with every phone call, every , every member touchpoint. We make it easy for you to focus your attention on doing what s best for you and your family. Our Medicare Customer Service representatives specialize in Medicare, work right here in Michigan, and can access your plan records immediately to help provide assistance, answer questions and explain plan details. Whenever you need help, your HAP Medicare Customer Service representative is always just a phone call away. 5

6 Answers to some of the top questions. How do I know if I am eligible for Supplement? Generally, if you are a Michigan resident enrolled in both Medicare Parts A and B, you are eligible for Alliance Medicare Supplement. You will have to continue to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium for your Supplement policy. When can I sign up for Supplement? You can purchase Supplement at any time. The best time to purchase your policy is when you become eligible for Medicare and enroll in Medicare Part B. Am I covered when I travel? Yes. Your coverage goes with you anywhere in the United States. With Plan C, Plan F, Plan G and Plan N, you also have worldwide emergency coverage, with limitations. 6

7 Do I need a referral to see a specialist? No. Referrals are not required. You can see any doctor or specialist who participates in Medicare. Can my coverage be denied? When you turn 65, participate in Medicare Part A and enroll in Medicare Part B, you have a guaranteed right to buy an Supplement plan for six months. You cannot be refused if you sign up during this open enrollment period. If you try to enroll in a Medicare Supplement plan after your first six months of eligibility, an insurance company can refuse to sell you a policy or charge you higher premiums based on certain health conditions. In some cases, if you have a health problem that was diagnosed before your Medicare Supplement policy starts, the insurance company can refuse to cover that health problem for up to six months. This is called a pre-existing condition waiting period. The insurance company can only use this kind of waiting period if your health problem was diagnosed or treated during the six months before the policy started. If you buy a Medigap policy when you have special Medigap protections or guaranteed issue rights, you will not be subject to a pre-existing condition waiting period. Can I keep my Supplement policy if I move out of state? You must be a permanent resident of the State of Michigan and physically reside in Michigan at least six (6) months of every year. Do Supplement plans include prescription drug coverage? No. Medigap plans do not offer prescription drug coverage. If you are interested in a type of plan that may also cover prescription drugs, just give us a call at (800) (TTY: 711). We will be happy to discuss your options with you.* Or, you may call your State Health Insurance Assistance Program. Once you are enrolled in a Medicare Supplement plan, your coverage will continue to be renewed as long as you pay the premium. * These plans are subject to CMS enrollment period restrictions. 7

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9 Enroll today. To enroll in our Medicare plan, you can use one of the following four options: 1. Enroll online at the HAP website at hap.org/medicare 2. Call a licensed HAP Medicare sales representative at: (800) (TTY: 711) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 March 31) 8 a.m. to 6 p.m. ET, Monday through Friday (April 1 Sept. 30) 3. Come to a HAP Medicare seminar, where you can talk with other Medicare beneficiaries. Call or go online to find out about seminar dates and information. A licensed, Michigan-based HAP Medicare salesperson will be present with information and applications to assist you. Call us for dates and locations or for accommodation for persons with special needs at sales meetings: (800) (TTY: 711) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 March 31) 8 a.m. to 6 p.m. ET, Monday through Friday (April 1 Sept. 30) 4. Mail a completed enrollment form to: HAP Medicare Division 2850 W. Grand Blvd. Detroit, MI 48202

10 Outline of Coverage for Plans A, C, F, G and N Medicare Supplement 2019 MED SUPP [2018] Outline PROD of Coverage BRO Revised September, 2018

11 Understanding Your Options. Health Alliance Plan (HAP) offers many resources to help you make sense of important Medicare decisions. In this booklet, you ll find important premium information, as well as details on Supplement Plans and extras you can expect when you decide on a HAP Medicare Solution. Important premium and plan information...p. 2 Premium information...p. 4 Medicare Supplement plans...p. 6 1

12 Important things to know about Supplement. Supplement premiums. The following charts can help you determine your Supplement plan premium. For Supplement plans, certain factors may affect your monthly premium. Your premium is based on the area you live in, your age, gender and whether you use tobacco. The deductibles, coinsurance and copay amounts listed in this booklet are based upon the 2018 CMS approved values and are subject to change in How to determine your monthly premium: Refer to the charts inside and follow these steps: 1. Select the chart for Nonsmoker or Smoker 2. Choose your plan: A, C, F, G or N 3. Scan for your age (as of January 1, 2019) 4. Select Male or Female This amount will be included on the billing statement you receive in December for January The entire amount due will include your premium payment plus Michigan s state tax. We can only raise your premium if we raise the premium for all policies like yours in this state. Need help choosing a plan? Call (800) (TTY: 711) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 March 31) 8 a.m. to 6 p.m. ET, Monday through Friday (April 1 Sept. 30) Policy replacement If you are replacing another health insurance policy, do not cancel it until you have actually received your new policy and are sure you want to keep it. Disclosure Use the charts in the booklet to compare benefits and premiums among policies, certificates and contracts. Please read your policy very carefully This booklet is only an outline describing your policy s most important features. The policy is your insurance contract. You should read the policy itself to understand all of the rights and duties of both your insurance company and you. Right to return policy If you find that you are not satisfied with your policy, you may return it to: HAP Membership & Billing Government Programs 2850 W. Grand Blvd. Detroit, MI If you send the policy back to us within 30 days after you receive it, we will treat the policy as if it had never been issued and return all of your payments. Notice This policy may not fully cover all of your medical costs. Neither Supplement nor its agents are connected with Medicare and are not connected with or endorsed by the United States government or the federal Medicare program. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security office or consult the booklet Medicare & You for more details. Fill out the application completely When you fill out the application for your new policy, be sure to answer, truthfully and completely, all questions about your medical and health history. Alliance reserves the right to cancel your policy and refuse to pay any claims if you leave out or falsify important medical information. Review the application carefully before you sign it. Be certain that all information has been properly recorded. 2 3

13 Premium information. 1 4 Plan A Nonsmoker Plan C Nonsmoker Plan F Nonsmoker Plan G Nonsmoker Plan N Nonsmoker Age Male Female Male Female Male Female Male Female Male Female 64 and under $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Plus $ $ $ $ $ $ $ $ $ $ Medicare beneficiaries younger than age 65 are only eligible to apply for Plan A or Plan C. 1 Premiums include the tax required under Michigan s Health Insurance Claims Assessment (HICA) Act (Public Act 142 of 2011). Plan A Smoker Medicare beneficiaries younger than age 65 are only eligible to apply for Plan A or Plan C. 1 Premiums include the tax required under Michigan s Health Insurance Claims Assessment (HICA) Act (Public Act 142 of 2011). Plan C Smoker Plan F Smoker Plan G Smoker Plan N Smoker Age Male Female Male Female Male Female Male Female Male Female 64 and under $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Plus $ $ $ $ $ $ $ $ $ $

14 Benefits included in all Medicare Supplement plans. Benefits Inpatient hospital services Medicare Part A daily copayments plus an additional 365 days of coverage after Medicare benefits end Hospice care Medicare Part A coinsurance and copayments Medicare preventive care Medicare Part B coinsurance when applicable Medicare expenses Medicare Part B coinsurance Blood First 3 pints under Medicare Parts A and B Skilled nursing facility care Medicare Part A daily copayments 2018 Medicare values are listed. They may change for All benefits listed are covered at 100% unless the chart indicates otherwise. The Medicare Supplement plan covers copayments/coinsurances only after the deductible is met unless the plan covers the deductible. * This high deductible plan pays the same benefits as plan F after you have paid a calendar year ($2,240) deductible. Benefits from the high deductible plan F will not begin until out-of-pocket expenses are $2,240. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes Medicare deductibles for part A and part B, but does not include the plan s separate foreign travel emergency deductible. ** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission. 6 Plans A B C D F* G K** L** M N*** 50% 75% 50% 75% 100% except up to a $20 office visit copayment and up to a $50 emergency visit copayment 50% 75% 50% 75% Medicare Part A deductible 50% 75% 50% Medicare Part B deductible Medicare Part B excess charges Foreign travel Emergency services 80% 80% 80% 80% 80% 80% Out-of-pocket annual limit $5,240 $2,620 Supplement Plan A Plan C Plan F Plan G Plan N Plan A is the most basic Medigap plan. It helps fill some of the gaps in Medicare s coverage. Plan A covers: Basic benefits (see the list at the left) Plan C provides more extensive coverage than Plan A. It may be the right plan for you if most of your doctors accept Medicare. Plan C covers: Basic benefits, plus: Skilled nursing facility copay Part A deductible Part B deductible Worldwide emergency coverage*** Plan F may be a good choice if some of your doctors do not accept Medicare s approved amount as payment in full. Plan F covers: Basic benefits, plus: Skilled nursing facility copay Part A deductible Part B deductible Worldwide emergency coverage*** Part B excess charges (the amount a doctor charges in excess of the Medicareapproved amount) Plan G* may also be a good choice if some of your doctors do not accept Medicare s approved amount as payment in full. Plan G covers: Basic benefits, plus: Skilled nursing facility copay Part A deductible Worldwide emergency coverage*** Part B excess charges (the amount a doctor charges in excess of the Medicareapproved amount) * Plan G pays 100 percent of Part B services except the Part B deductible. Plan N** has a low monthly premium and copays for visits to the doctor s office and the emergency room. Plan N covers: Basic benefits, plus: Skilled nursing facility copay Part A deductible Worldwide emergency coverage*** ** Plan N pays 100 percent of Part B services except the Part B deductible. Member pays up to $20 copay for doctor s office visits and up to $50 for emergency room visits. *** $250 deductible each year. Lifetime maximum of $50,000. Subscriber pays all amounts over $50,000. 7

15 Supplement Plan Comparison Medicare Supplement A Supplement C Supplement F Supplement G Supplement N Medicare Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Hospital Services - per benefit period 1 Semi-private room and board, general nursing and miscellaneous services and supplies First 60 days 61st thru 90th day 91st day and after (while using 60 lifetime reserve days) All but $335 a day All but $670 a day $1,340 (Part A $1,340 (Part A $1,340 (Part A $1,340 (Part A $1,340 (Part A $335 a day $335 a day $335 a day $335 a day $335 a day $670 a day $670 a day $670 a day $670 a day $670 a day Once lifetime reserve days are used; additional 365 days 100% of Medicareeligible expenses 2 100% of Medicareeligible expenses 2 100% of Medicareeligible expenses 2 100% of Medicareeligible expenses 2 100% of Medicareeligible expenses 2 Beyond the additional 365 days All costs All costs All costs All costs All costs Skilled Nursing Facility Care - per benefit period 1,3 First 20 days 100% 21st thru 100th day All but $ a day Up to $ a day Up to $ a day Up to $ a day Up to $ a day Up to $ a day 101st day and after All costs All costs All costs All costs All costs Part A Blood First three pints All costs All costs All costs All costs All costs Additional Amounts 100% Hospice Care 4 Hospice Care All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Medicare copayment/ coinsurance Medicare copayment/ coinsurance Medicare copayment/ coinsurance Medicare copayment/ coinsurance continued u 8 9

16 Supplement Plan Comparison (continued) Part B Blood First three pints All costs All costs All costs All costs All costs Next $183 of Medicare approved amounts Remainder of Medicare approved amounts Clinical Laboratory Services Tests for diagnostic lab services Medicare Supplement A Parts A & B Home Health Care Medicare approved services Supplement C Supplement F Supplement G Supplement N Medicare Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Medicare (Part B) Medical Services, per calendar year 5 First $183 of Medicare approved amounts Remainder of Medicare approved amounts Part B Excess Charges (above Medicare approved amounts) 80% 20% 20% 20% 20% 20% 100% 80% 20% 20% 20% 20% 20% $20 MD/$50 ER All costs All costs 100% 100% All costs Medically necessary skilled care services and medical supplies/ Durable medical equipment (First $183 of Medicare approved amounts) Remainder of Medicare approved amounts 80% 20% 20% 20% 20% 20% continued u 10 11

17 Supplement Plan Comparison (continued) Medicare Other Benefits Not covered by Medicare Supplement A Supplement C Supplement F Supplement G Supplement N Medicare Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Foreign Travel Not covered by Medicare, medically necessary emergency care services beginning during the first 60 days of each trip outside the USA. First $250 each year/ Remainder of charges (except under limited circumstances) $0/80% to a lifetime maximum of $50,000 $250/20% and amounts over the $50,000 lifetime maximum $0/80% to a lifetime maximum of $50,000 $250/20% and amounts over the $50,000 lifetime maximum $0/80% to a lifetime maximum of $50,00 $250/20% and amounts over the $50,000 lifetime maximum 80% to a lifetime maximum of $50,000 $250/20% and amounts over the $50,000 lifetime maximum 1 A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facilities for 60 days in a row. 2 NOTICE: When your Medicare Part A hospital benefits are exhausted, HAP stands in the place of Medicare and pays whatever amount Medicare would have paid for up to an additional 365 days. During this time the hospital can t bill you for the balance based on any difference between its billed charges and the amount Medicare would have paid. 3 You must meet Medicare s requirements, including having been in a hospital for at least three days, and enter a Medicare-approved facility within 30 days after leaving the hospital. 4 You must meet Medicare s requirements including a doctor s certification of terminal illness. 5 Medical expenses In or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical services and surgical services, physical and speech therapy, diagnostic tests, durable medical equipment. 20% except up to a $20 office visit and up to a $50 emergency visit copay. Once you have been billed $183 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. 12

18 Ask. Learn. Understand your Medicare. With a little help from HAP. hap.org/medicare 2018 Health Alliance Plan of Michigan. A Nonprofit Company..5M 9/2018

19 Prospective Members: If you have questions, or if you are looking for more information about our benefits or enrollment periods, just call a licensed, Michigan-based HAP Medicare sales representative at: (800) (TTY: 711) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 March 31) 8 a.m. to 6 p.m. ET, Monday through Friday (April 1 Sept. 30) Current Members: If you have questions, contact Customer Service at (800) (TTY: 711). For your convenience, our Customer Service office hours are: Monday through Friday, 8 a.m. to 8 p.m. ET Outside of those business hours, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Medicare Customer Service representative will return your phone call the next business day. You can also mail your questions to: HAP Customer Service Attn: Medicare 2850 W. Grand Blvd. Detroit, MI Or visit us on the web at hap.org/medicare This is a solicitation of Supplement insurance and you may be contacted by a licensed, authorized HAP Medicare salesperson.

20 Ask. Learn. Understand your Medicare. With a little help from HAP. hap.org/medicare 2018 Health Alliance Plan of Michigan. A Nonprofit Company..5M 9/2018