2017 Individual CareSource Competitive Analysis - Cathy
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1 2017 Individual CareSource Competitive Analysis - Cathy
2 Bronze Benefit Comparison Sales Talking Points: Anthem has lower deductible and lower ER Copay. Bronze Benefit Comparison CareSource CareSource Anthem Metal Level/Plan Type Bronze New Bronze Standardized Bronze Deductible (Single/Family) $6,650/$13,300 $6,650/$13,300 $5,000/$10,000 OOP $6,850/$13,700 $7,150/$14,300 $7,150/$14,300 Coinsurance (Network/Non-Network) 40%/NA 50%/NA 40%/NA PCP Office Visits $35 Copay $45 Copay $50 Copay for first 2, then Ded /Coins Specialist Office Visits $75 Copay Ded/Coins Ded/Coins Urgent Care $100 Copay Ded/Coins Ded + $50 Copay + Coins ER Ded + $500 Copay + 40% Ded/Coins Ded + $300 Copay + Coins IP Hospital Facility $250 per day for days 1-5, $0 per day for days Ded/Coins Ded + $500 Copay + 50% Coins Rx Tier 1 Generic: $25 Tier 2 Preferred: $100 Tier 3 Non-Preferred: $250 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Tier 1 Generic: $35 Tier 2 Preferred: Ded + 35% Tier 3 Non-Preferred: Ded + 40% Tier 4 Specialty: 45% Level 1 40% Coins Level 2 50% Coins Louisville Rate (non-smoker) Lexington Rate (non-smoker) Single Age 25 $ $ $ Single Age 45 $ $ $ Couple Age 55 $ $ $ Single Age 25 $ $ $ Single Age 45 $ $ $ Couple Age 55 $ $ $
3 Silver Benefit Comparison Sales Talking Points: - Anthem s New Tiered Pharmacy network offers $5 copay for Tier 1 generics. - Anthem s new Silver plan provides lower Tier 2 copay and lower deductible/oop than CareSource s New Low premium plan. Silver Benefit Comparison Silver Benefit Comparison CareSource CareSource Anthem Anthem CareSource Metal Level/Plan Type New Silver Standardized Silver Silver New Silver New Silver Low Prem Deductible (Single/Family) $3,500/$7,000 $3,300/$6,600 $3,500/$7,000 $5,300/$10,600 $6,150/$12,300 OOP $7,150/$14,300 $6,400/$12,800 $5,850/$11,700 $6,750/$13,500 $7,000/$14,000 Coinsurance (Network/Non-Network) 20%/NA 30%/NA 25%/NA 25%/NA 15%/NA PCP Office Visits $30 Copay No Copay $30 Copay $35 Copay $30 Copay Specialist Office Visits $65 Copay $50 Copay $50 Copay Ded/Coins $50 Copay Urgent Care $75 Copay $75 Copay $90 Copay Ded + $50 Copay + Coins $100 Copay ER Ded + $400 Copay + Coins Ded + $500 Copay + Coins Ded/Coins Ded + $500 Copay + Coins Ded/Coins IP Hospital Facility Ded/Coins Rx Tier 1 Generic: $15 Tier 2 Preferred: $50 Tier 3 Non-Preferred: $100 Tier 4 Specialty: 40% coins $250 per day for days 1-5, $0 per day for days Ded + $500 Copay + 50% Coins Ded + $500 Copay + 50% Coins Ded/Coins Tier 1 Generic: $0 Tier 2 Preferred: $60 Tier 3 Non-Preferred: $130 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Level 1 Tier 1: $5 Tier 2: $1000 Ded + $40 Tier 3: $1000 Ded + 40% Tier 4: $1000 Ded + 40% Level 2 Tier 1: $15 Tier 2: $1000 Ded + $50 Tier 3: $1000 Ded + 50% Tier 4: $1000 Ded + 50% Level 1 Tier 1: $10 Tier 2: $40 Tier 3: Ded + 40% Tier 4: Ded + 40% Level 2 Tier 1: $20 Tier 2: $50 Tier 3: Ded + 50% Tier 4: Ded + 50% Tier 1 Generic: $10 Tier 2 Preferred: $50 Tier 3 Non-Preferred: Ded + 15% Tier 4 Specialty: Ded + 15% Tier 5 Specialty Non-Pref: Ded + 15% Louisville Rate (non-smoker) Lexington Rate (non-smoker) Single Age 25 $ $ $ $ $ Single Age 45 $ $ $ $ $ Couple Age 55 $ $ $1, $1, $ Single Age 25 $ $ $ $ $ Single Age 45 $ $ $ $ $ Couple Age 55 $ $ $1, $1, $781.41
4 Gold Benefit Comparison Gold Benefit Comparison Sales Talking Points: Anthem s New Tiered Pharmacy network offers $5 copay for Tier 1 generics. Anthem has all inclusive $90 Urgent Care copay (not subject to deductible). Gold Benefit Comparison CareSource CareSource Anthem Metal Level/Plan Type Gold New Gold Standardized Gold Deductible (Single/Family) $1,000/$2,000 $1,250/$2,500 $1,450/$4,350 OOP $2500/$5000 $4,750/$9,500 $4,100/$8,200 Coinsurance (Network/Non-Network) 20%/NA 20%/NA 20%/NA PCP Office Visits No Copay $20 Copay $30 Copay Specialist Office Visits $40 Copay $50 Copay $50 Copay Urgent Care Ded + $75 Copay $65 Copay $90 Copay ER Ded + $250 Copay Ded + $250 Copay + Coins Ded/Coins IP Hospital Facility $150 per day for days 1-5, $0 per day for days Ded/Coins Ded + $500 Copay + 50% Coins Rx Tier 1 Generic: $0 Tier 2 Preferred: $120 Tier 3 Non-Preferred: $160 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Tier 1 Generic: $10 Tier 2 Preferred: $30 Tier 3 Non-Preferred: $75 Tier 4 Specialty: 30% coins Level 1 Tier 1: $5 Tier 2: $600 Ded + $35 Tier 3: $600 Ded + 40% Tier 4: $600 Ded + 40% Level 2 Tier 1: $15 Tier 2: $600 Ded + $45 Tier 3: $600 Ded + 50% Tier 4: $600 Ded + 50% Louisville Rate (non-smoker) Lexington Rate (non-smoker) Single Age 25 $ $ $ Single Age 45 $ $ $ Couple Age 55 $1, $ $1, Single Age 25 $ $ $ Single Age 45 $ $ $ Couple Age 55 $1, $1, $1,537.46
5 2017 Anthem/CareSource Network Comparison Regions 1 & 2 Individual RA Areaname Hospital 1 Paducah Blue Access Anthem Pathway Pathway CareSource Baptist Health Paducah X X X Caldwell Medical Center X X Crittenden Co Hospital X X Jackson Purchase Medical Center X X X Livingston Hospital and Healthcare Services X X Lourdes Inc X X Marshall County Hospital X Murray-Calloway County Hospital X X Total Hospital Count Total PCP Count Total SPC Count Owensboro Baptist Health Madisonville X X X Jennie Stuart Medical Ctr X X X Methodist Hospital X X X Methodist Hospital Union County X X X Ohio County Hospital X X X Owensboro Health Muhlenberg Community Hospital X Owensboro Health Regional Hospital X X Trigg County Hospital X X Total Hospital Count Total PCP Count *Note: CareSource not offering plans in Region 1 Total SPC Count *Note: CareSource not offering plans in Region 2 5
6 2017 Anthem/CareSource Network Comparison Regions 3 & 4 Individual Blue Access Pathway Pathway Caresource Caresource Baptist Health Lagrange X X X Baptist Health Louisville X X X Breckinridge Memorial Hospital X X Carroll County Memorial Hospital X X Flaget Memorial Hospital X X X X Hardin Memorial Hospital X X X Jewish Hospital X X X X 3 Louisville Jewish Hospital Shelbyville X X X X Kosair Children's Hospital X X X X Norton Audubon Hospital X X X X Norton Brownsboro Hospital X X X X Norton Hospital X X X X Norton Suburban Hospital X X X X Saints Mary and Elizabeth Hospital X X X X Spring View Hospital X X X Twin Lakes Reg Medical Ctr X X University of Louisville Hospital X X Total Hospital Count Total PCP Count Total SPC Count 1,212 1,156 1, Casey County Hospital X X Caverna Memorial Hospital X Clinton County Hospital X X Cumberland Co Hospital X X Greenview Regional Hospital X X Jane Todd Crawford Memorial Hospital X 4 Lake Cumberland Regional Hospital X X X X Bowling Green- Logan Memorial Hospital X X Monroe County Medical Center X Campbellsville-Somerset Russell County Hospital X X X T J Samson Community Hospital X X Taylor Regional Hospital X X X The Medical Center at Bowling Green X X X The Medical Center At Franklin X X X The Medical Center at Scottsville X X X Wayne County Hospital X X Westlake Regional Hospital X X Total Hospital Count Total PCP Count Total SPC Count Anthem 6
7 2017 Anthem/CareSource Network Comparison Regions 5 & 6 Individual 5 Frankfort-Lexington Baptist Health Lexington X X X Baptist Health Richmond X X X Bluegrass Community Hospital X X X Bourbon Community Hospital X X X Clark Regional Medical Center X X X Ephraim McDowell Regional Medical Center X X Fort Logan Hospital Frankfort Regional Medical Center X X Georgetown Community Hospital X X X Harrison Memorial Hospital X X James B Haggin Memorial Hospital X X Marcum and Wallace Memorial Hospital X X New Horizons Medical Center X X Rockcastle Regional X X X Saint Joseph Berea X X X X Saint Joseph East X X X X Saint Joseph Hospital X X X X Saint Joseph Mount Sterling X X X X Uk Healthcare Hospitals X X X Total Hospital Count Total PCP Count Total SPC Count Cincinnati KY-OH St Elizabeth Healthcare X X X X Christ Hospital X X X Total Hospital Count Total PCP Count X Total SPC Count
8 2017 Anthem/CareSource Network Comparison Regions 7 & 8 Individual 7 Northeast KY Fleming Medical Center X X Kings Daughters Medical Center X X X Meadowview Regional Medical Center X X X Morgan County ARH X X X Our Lady of Bellefonte X X St Claire Regional Medical Center Three Rivers Medical Center X X Total Hospital Count Total PCP Count Total SPC Count Corbin-London ARH Regional Medical Center Hazard X X X Baptist Health Corbin X X X Harlan ARH X X X Highlands Regional Medical Center X X Kentucky River Medical Center X X Mary Breckinridge ARH Hospital X X X McDowell ARH X X X Memorial Hospital Middlesboro ARH X X X Paul B Hall Regional Medical Center X X Pikeville Medical Center X X Pineville Community Hospital X X Saint Joseph London X X X X Saint Joseph Martin X X X X Tug Valley Arh Regional Medical Center X X X Whitesburg ARH X X X Total Hospital Count Total PCP Count X X Total SPC Count
9 Individual Competitive Landscape - Harry
10 Anthem / 2017 Coverage Area Map no longer offered in the 74 counties where is available. will remain in 46 counties where is not available. Individual plans change to limited Blue Card urgent/emergency care coverage only out-of-state 10
11 Region 1 Counties Counties Ballard Caldwell Calloway Carlisle Crittenden Fulton Graves Hickman Livingston Lyon McCracken Marshall Product offered 11
12 Region 2 Counties Counties Christian Daviess Hancock Henderson Hopkins McLean Muhlenberg Ohio Todd Trigg Union Webster Product offered 12
13 Region 4 Counties Counties Adair Allen Barren Butler Casey Clinton Cumberland Edmonson Green Hart Logan McCreary Metcalfe Monroe Pulaski Russell Simpson Taylor Warren Wayne Product offered 13
14 Region 3 Counties Counties Bullitt Breckinridge Carroll Grayson Hardin Henry Jefferson Larue Marion Meade Nelson Oldham Shelby Spencer Trimble Washington Product offered 14
15 Region 6 Counties Counties Campbell Gallatin Grant Kenton Pendleton Boone Product offered 15
16 16 16 Region 5 Counties Counties Product offered Anderson Bourbon Boyle Clark Estill Fayette Franklin Garrard Harrison Jackson Jessamine Lincoln Madison Mercer Montgomery Nicholas Owen Powell Rockcastle Scott Woodford
17 Region 7 Counties Counties Bath Boyd Bracken Carter Elliott Fleming Greenup Lawrence Lewis Mason Menifee Morgan Robertson Rowan Product offered 17
18 Region 8 Counties Counties Bell Breathitt Clay Floyd Harlan Johnson Knott Knox Laurel Lee Leslie Letcher Magoffin Martin Owsley Perry Pike Whitley Wolfe Product offered 18
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