WELCOME Y0107_18_07 Approved

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Katrina Shepherd
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1 WELCOME Y0107_18_07 Approved

Enrollment. You have questions and we have answers.

2 TODAY S DISCUSSION LET S TALK MEDICARE Medicare Questions? Answered. Your Needs. Your Decision. Medicare Advantage Care N Care. Enrollment. You have questions and we have answers. We want to hear from you so don t hesitate to ask questions throughout the presentation. 1

3 Let s talk Medicare! Who we are The ABCs (and Ds) of Medicare Your Medicare Options Enrollment Eligibility Medicare Advantage Care N Care Plans Enrollment 2

4 A Texas-based local plan. Care N Care is a local Medicare Advantage option for residents of the Dallas/Fort Worth area located in Fort Worth, Texas. The Mission of Care N Care is: To be the most loved healthplan in the communities we serve Care N Care is an affordable alternative to Medicare Supplement insurance that offers Medicare Advantage Plans starting at $0 monthly premium. Our goal is to assist our members in living healthier and happier lives. 3

5 The ABCs of Medicare Part A Part A of Medicare covers hospital stays. Part B Part B of Medicare covers doctor s visits and in many cases has a monthly premium. Part D Part D of Medicare covers prescription drugs. 4

6 The ABCs of Medicare (cont.) Part C Part C of Medicare is a Medicare Advantage Plan. It covers Parts A, B, and sometimes Part D of Medicare. Medicare Part C plans are commonly referred to as Medicare Advantage (MA) plans. Private insurance companies contracted with Medicare provide this coverage. Many plans offer health and drug coverage, as well as extra benefits. Medicare pays Medicare Advantage Plans a set amount every month for your health plan needs. MA plans must offer all of the current benefits offered through Medicare, and can include prescription drug coverage (Part D). Many Medicare Advantage plans have lower out-of-pocket costs than Original Medicare and Supplement plans. 5

7 Original Medicare Part A - Inpatient Hospital Part A Deductible (per benefit period) $1, (per event) Days 1-60 $0 Days $ (per day) Days (lifetime reserve days) $ (per day) Days 151+ You pay 100% of the cost Part A - Skilled Nursing Facility Days 1-20 $0 (per day) Days $ (per day) Days 101+ You pay 100% of the cost Part B - Coverage Part B Deductible $ (annually) After Deductible Medicare Pays 80% - You pay 20% NO MAXIMUM OUT OF POCKET, NO DRUG COVERAGE 6 Costs shown for 2017 Medicare Guidelines

Medicare Advantage with Part D Original Medicare +

8 MEDICARE OPTIONS Original Medicare Only Original Medicare + Part D Drug Plan Medicare Advantage Medicare Advantage with Part D Original Medicare + MedSupplement 7 Original Medicare + MedSupplement + Part D Drug Plan

9 Part D Drug Plans Twenty-Three Plans in DFW Which one is right for you? Premiums range from $17-$170 a month. Deductibles range from $0 to $400 a year. Copays based on drugs taken. 8

10 Part D Important Reminders Failure to Enroll in a Part D Plan or Maintaining Credible Coverage will result in a late enrollment penalty in the future. Some Drugs have special requirements such as Step Therapy, Quantity Limits, and Prior Authorization. You may qualify for Extra Help in paying for Rx Drugs. Part D Plans Include a Coverage Gap where you may be responsible for much of the cost of your Prescription Medications. 9

This chart shows basic information about the different benefits that Medigap policies cover.

11 Medicare Supplements (Medigap Plans) Designed by CMS to provide specific benefits to fill the gaps of Medicare. This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you re responsible for the rest. 10 Costs shown for 2017 Medicare Guidelines

12 Initial Enrollment Period 11

13 Eligibility Requirements Original Medicare Medicare Supplement Entitled to Part A. Must enroll into Part B and pay any required Part B Premiums. No underwriting questions, if enrolled during initial enrollment period. Must pass underwriting questions after initial enrollment period. No drug coverage included. Must purchase a standalone Part D plan if you want Rx Coverage. 12

Medicare Advantage IMPORTANT POINTS & COMMON MISCONCEPTIONS Medicare Advantage plans are contracted through the Centers for Medicare and Medicaid Services (CMS).

14 Medicare Advantage IMPORTANT POINTS & COMMON MISCONCEPTIONS Medicare Advantage plans are contracted through the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage plans are NOT Medicare Supplement Plans. Medicare Supplements are additional insurance products purchased to work with Original Medicare. 13 You are still a part of Medicare. You receive the same benefits offered under Original Medicare. Private companies will pay for your health care services, not Medicare.

15 Medicare Advantage Plans 1 HMO (Health Maintenance Organization) 2 PPO (Preferred Provider Organization) 3 PFFS (Private Fee-For-Service) 14 Plus Part D Medicare prescription drug coverage as part of a Medicare Advantage Prescription Drug (MAPD) Plan

16 Are you eligible for Medicare Advantage? 15 You must: 1. Be entitled to Medicare Part A 2. AND Be enrolled in Medicare Part B (premium may be required) 3. Must be a US Citizen or Lawful Resident 4. Be a permanent resident of the service area 5. Not have End-Stage Renal Disease (ESRD)

17 Medicare Enrollment Periods 16

This depends on certain events happening in your life Retire Change where you live Lose your

18 Special Enrollment Period You may be able to enroll in a Medicare plan outside of the Initial Enrollment Period or Open Enrollment. This depends on certain events happening in your life Retire Change where you live Lose your current coverage Chance to get other coverage 17 Speak to your licensed sales representative about other life events that qualify for the Special Enrollment Period.

19 YOUR NEEDS. YOUR DECISION

20 Designed for North Texans by North Texans Care N Care is a local Medicare Advantage plan offering both HMO and PPO products. Coverage includes nationwide and foreign travel. Prescription drug coverage on most plans. 19

Choosing a Health Plan is a Big Decision What type of coverage

Consider the areas that you would like changes. Assistance.

Review your options that best fit your needs.

21 Choosing a Health Plan is a Big Decision What type of coverage do you currently have? Evaluate the parts you like about it. Consider the areas that you would like changes. Assistance. Does anyone help you make healthcare decisions? Review your options that best fit your needs. Enroll into the best solution for you! Work with your licensed agent to make sure We Care for you! 20 6

22 CHOOSING THE RIGHT PLAN FOR YOU

23 2018 Plans PPO + PPO HMO + PPO Plans with Prescription Drug Coverage PPO Plans without Prescription Drug Coverage HMO Plans with Drug Coverage Care N Care Choice Premium $119 Care N Care Choice Plus $49 Care N Care Choice $0 Care N Care Choice MA-Only $0 Care N Care Classic $0 22

Our network arrangements allow us to create savings that we share with you.

24 Care N Care HMO Plan HOW DOES AN HMO PLAN WORK? You choose network providers and facilities to receive your healthcare services. You choose a Primary Care Physician who will help navigate your healthcare needs. Our network arrangements allow us to create savings that we share with you. If you need emergency or urgent services, go to the emergency room closest to you! You may need a referral to see specialists and receive certain services. Lower out-of-pocket costs. You have the ability to select a different Primary Care Physician as needed. 23

Care N Care PPO Plans HOW DOES AN PPO PLAN WORK? You have a network of doctors, specialist and facilities contracted with the plan to provide services. You can see providers out-of-network.

24 You should expect to pay more if you choose to use out-of-network providers. Referrals are not necessary, but some services may require plan authorization prior to receiving the service.

25 Care N Care PPO Plans HOW DOES AN PPO PLAN WORK? You have a network of doctors, specialist and facilities contracted with the plan to provide services. You can see providers out-of-network. Reminder, providers that do not contract with us are not obligated to treat you, except in emergency situations. Cost-sharing will be lower at in-network providers. 24 You should expect to pay more if you choose to use out-of-network providers. Referrals are not necessary, but some services may require plan authorization prior to receiving the service. Your Primary Care Physician will continue to help coordinate healthcare services. PPO plans may not impose prior authorization requirements for Out-of-Network services but member or provider can request an advance determination of coverage.

At Care N Care, the HCC can help: Explain health plan benefits Coordinate healthcare services with an

26 Your Local Healthcare Concierge At Care N Care, we work hard to provide our members excellent customer service. Whenever a member has a question, we are always just a phone call or away. At Care N Care, the HCC can help: Explain health plan benefits Coordinate healthcare services with an In-Network doctor Verify health plan coverage with a participating provider Find a healthcare facility nearest to the member. And much more! 25

27 Silver&Fit Fitness Program Access to a fitness club or exercise center Such as YMCA, Curves, 24 Fitness, Gold s Gym and more! Group classes made for older adults where offered Web tools like a facility search, health articles, challenges, and more Equipment to use at home 26 Healthy aging materials

28 Prescription Drug Benefit Part D No annual deductible Convenient pharmacy locations, local and nationwide, offering $0 co-pay for many generics on some plans Mail order program is available 3 Month Supply for 2 Month Copay At Pharmacy OR Mail Order! 27

Your licensed sales agent will review the Summary of Benefits and Formulary with you.

29 Choosing the Right Plan for You Next Steps Now your agent will take a few minutes to explain key benefits and features to you about our plan. Your licensed sales agent will review the Summary of Benefits and Formulary with you. If you decide Care N Care is a good fit, your licensed sales agent can help you complete the enrollment form. 28

30 29 ENROLLMENT 2018

plan benefits and decide on the Care N Care health plan that best fits your

31 Enrollment SIMPLE AS 1, 2, Review your enrollment kit with a licensed sales agent to learn more about plan benefits and decide on the Care N Care health plan that best fits your needs. 2. Complete the enrollment form. 3. Submit! Your licensed sales agent will submit your enrollment form to Care N Care.

After CMS approves your enrollment, we ll send you a letter confirming your membership with Care N Care.

32 Enrollment WHAT HAPPENS NEXT? Once Care N Care receives your enrollment form, we ll confirm your Medicare eligibility with CMS. After CMS approves your enrollment, we ll send you a letter confirming your membership with Care N Care. You will receive a welcome call from your Healthcare Concierge. In the following few weeks, you ll receive important plan material about your coverage. Member Identification Cards Formulary (if enrolled in a plan with prescription coverage) Evidence of Coverage 31

33 Thank you! Care N Care is a Medicare Advantage Organization with a Medicare contract. Enrollment in Care N Care depends on contract renewal. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B Premium. Out-of-network/non-contracted providers are under no obligation to treat Care N Care members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. For 2017 Care N Care received a rating of 3.5 Stars. Care N Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak Spanish or Vietnamese, language assistance services, free of charge, are available to you. Call (TTY:711). Care N Care cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). Care N Care tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính. CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). 32

Medicare Questions? Answered.

Medicare Questions? Answered. A Resource to help you navigate Medicare Advantage Medicare Questions Answered is a FREE enrollment guide providing answers to your Medicare questions, and how a Medicare