MINNESOTA 2018 MEDICARE PLANS ENROLLMENTS ON OR AFTER DEC. 8, MEDICA PRIME SOLUTION (COST) Coverage Details. Y0088_4844b CMS Accepted

Transcription

1 MINNESOTA 2018 MEDICARE PLANS ENROLLMENTS ON OR AFTER DEC. 8, 2017 MEDICA PRIME SOLUTION (COST) Coverage Details Y0088_4844b CMS Accepted

2 PERSONALIZED COVERAGE YOU CAN AFFORD. PRIME SOLUTION HAS ALL THE OPTIONS YOU NEED. It s your choice. Choosing the right Medicare coverage is easy with Medica Prime Solution. Select from a range of plan options - with or without Part D prescription drug coverage. Find the one that is just the right fit for your needs and budget. Talk with an expert consultant you can trust. Call (TTY: 711) to speak with a Medicare consultant who can help you evaluate your situation and make the best coverage choice for you and your budget. Attend a free Medicare Workshop. To find a workshop near you, visit medica.com/ MedicareWorkshops. You ll learn everything you need to know about Medicare and affordable plan options from Medica. We know you want affordability and options. We also know you want to choose your doctor. Medica Prime Solution is designed to let you personalize your coverage to meet your unique needs and preferences. Go with the plan that fits you. Get the details online. Visit medica.com/medicare for valuable information and resources to help you make the best coverage decisions.» Premiums as low as $49» Broad range of coverage levels to choose from» Option to bundle your medical and Part D drug coverage together in one plan» $0 medical deductible with most plans Two Medicare plans is too many. It s more convenient to bundle your medical and Part D prescription drug coverage together. One bundled plan. One combined premium. One less worry. Get the plan features that count.» The Prime Solution provider network is broad and includes major hospitals, clinics and providers in Medica s four-state service area (Minnesota, North Dakota, South Dakota and Wisconsin)» Nationwide travel and snowbird coverage from any provider that accepts Medicare» Vision and hearing benefits» Free fitness center membership through SilverSneakers» More than 64,000 network pharmacies nationwide (for bundled medical and Part D plans) 3

3 Choose one plan for both medical and drug coverage. Take advantage of the convenience of combining your medical and Part D drug coverage in one plan for Our Prime Solution Cost plan gives you a range of coverage levels to choose from so it s easy to find a plan that fits your unique needs. PRIME SOLUTION MEDICAL + PART D BUNDLED PLAN OPTIONS 2018 Original Thrift Value Basic Enhanced Medicare with Rx with Rx with Rx2 with Rx with Rx2 with Rx with Rx2 Monthly Premium $134 for Part B $77.40 $94.40 $ $ $ $ $ Medical Deductible $183 for Part B $50 $0 $0 $0 $0 $0 $0 Medical Benefits YOU PAY YOU PAY Preventive Services $0 $0 $0 $0 $0 Primary Care / Convenience Care 20% 20% $10 $0 $0 Specialist Office Visit 20% 20% $30 $20 $10 Urgent Care 20% $25 $10 - $30 $0 - $20 $0 - $10 Chiropractic* 20% 20% $20 $20 $10 Eye & Hearing Exams - Routine Annual 100% 100% $30 $0 $0 Diagnostic Tests / X-Ray 20% 20% 10% $10 $0 Diagnostic / Therapeutic Radiology 20% 20% 10% $25 $10 Lab Services $0 $0 $0 $0 $0 Diabetes Supplies / Durable Medical Equipment 20% 20% 20% 20% $0 Part B Drugs 20% 20% 20% 20% 20% Outpatient Surgery 20% 20% $125 $50 $0 Ambulance 20% 20% $50 $25 $0 Emergency Care 20% $50 $50** $50** $50** Inpatient Hospital Days 1-60: $1,340 total Days 1-4: $300/day Days 1-8: $150/day Days 1-8: $100/day Days 61-90: $335/day Days 5-90: $0/day Days 9-90: $0/day Days 9-90: $0/day Days : $670/day $0 per stay Skilled Nursing Facility Days : $167.50/day Days 101+: 100% Days : $167.50/day Days : $75/day Days : $50/day Days : $25/day Annual Maximum Out-of-Pocket (medical) n/a $6,700 $4,000 $3,400 $3,000 Part D Prescription Drug Coverage YOU PAY (30-Day Retail) Part D Deductible n/a $260 $260 $0 $260 $0 $215 $0 Level One - Initial Coverage (Shared drug costs $0 to $3,750) Tier 1 - Commonly Prescribed Generic 100% Up to $2 Up to $2 Up to $2 Up to $2 Up to $2 Up to $2 Up to $2 Tier 2 - Low-Cost Generic 100% Up to $6 Up to $6 Up to $8 Up to $6 Up to $8 Up to $6 Up to $8 Tier 3 - More Expensive Generic & Brand 100% Up to $28 Up to $31 Up to $35 Up to $27 Up to $35 Up to $25 Up to $35 Tier 4 - Higher-Priced Generic & Brand 100% 50% 50% 50% 50% 50% 50% 50% Tier 5 - Generic or Brand for Complex Conditions 100% 27% 27% 33% 27% 33% 28% 33% Level Two - Coverage Gap Donut Hole (Member-only drug costs up to $5,000) Generic at 44% and Covered Brand at 35% for all plan options Level Three - Catastrophic Coverage (Shared drug costs $5,000 and up) Generic at $3.35 or 5%*** and Other Drugs at $8.35 or 5%*** for all plan options *Medicare-covered visit for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) / **Worldwide / ***Whichever is greater You must continue to pay your Medicare Part B premium. 4 5

4 Want medical coverage only? You have great options. If you want to supplement your Original Medicare with a Prime Solution medical-only plan, you re on the right track. It s a great way to keep your doctor and health care costs affordable. Consider your health needs, as well as whether you ll need help with things like routine vision and hearing exams. PRIME SOLUTION MEDICAL-ONLY PLAN OPTIONS 2018 Original Medicare Thrift Value Basic Enhanced Monthly Medical Only Premium $134 for Part B $49 $67 $79 $157 Medical Deductible $183 for Part B $50 $0 $0 $0 Medical Benefits YOU PAY YOU PAY Preventive Services $0 $0 $0 $0 $0 Primary Care / Convenience Care 20% 20% $10 $0 $0 Specialist Office Visit 20% 20% $30 $20 $10 Urgent Care 20% $25 $10 - $30 $0 - $20 $0 - $10 Chiropractic* 20% 20% $20 $20 $10 Eye & Hearing Exams - Routine Annual 100% 100% $30 $0 $0 Diagnostic Tests / X-Ray 20% 20% 10% $10 $0 Diagnostic & Therapeutic Radiology 20% 20% 10% $25 $10 Lab Services $0 $0 $0 $0 $0 Diabetes Supplies 20% 20% 20% 20% $0 Durable Medical Equipment 20% 20% 20% 20% $0 Part B Drugs 20% 20% 20% 20% 20% Outpatient Surgery 20% 20% $125 $50 $0 Ambulance 20% 20% $50 $25 $0 Emergency Care 20% $50 $50** $50** $50** Inpatient Hospital Skilled Nursing Facility Days 1-60: $1,340 total Days 61-90: $335/day Days : $670/day Days : $167.50/day Days 101+: 100% Days 1-4: $300/day Days 5-90: $0/day Days : $167.50/day Days 1-8: $150/day Days 9-90: $0/day Days : $75/day Days 1-8: $100/day Days 9-90: $0/day Days : $50/day $0 per stay Days : $25/day Annual Maximum Out-of-Pocket n/a $6,700 $4,000 $3,400 $3,000 YOUR PLAN TRAVELS WITH YOU. With all Prime Solution plans, you ll enjoy nationwide travel and snowbird coverage. So you can take your coverage with you when you travel anywhere within the United States and enjoy access to your full in-network benefits for up to nine consecutive months. Whether it s a quick trip or an extended stay, you re covered. *Medicare-covered visit for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) **Worldwide You must continue to pay your Medicare Part B premium. 6 7

5 OUR EXTRAS MAKE A HEALTHY PLAN EVEN HEALTHIER. A great Medicare plan is only one piece of the puzzle when it comes to maintaining your health. So we provide you with extra resources you need to stay healthy each and every day. SilverSneakers makes it easy to stay active. Prime Solution Value, Basic and Enhanced include a FREE SilverSneakers membership. This program helps people age 65 and over improve their well being through a variety of fitness options.» More than 13,000 participating fitness locations nationwide» Enroll at multiple locations any time» Access to classes, exercise equipment and other amenities» Track your fitness progress online and find useful health information. Visit SilverSneakers.com for a complete list of facilities and options. Your Personal Advocate is ready to help. HealthAdvocate has your back if you have questions about your Medica plan coverage, or need help navigating the medical system. Our trained Personal Health Advocates can help you tackle health-related questions from finding the right doctor to resolving claims questions. They can even help you make an appointment with a hard-to-reach doctor. The service is confidential and provided to you at no additional cost. NurseLine is available 24/7. You and your family have a place to turn for trusted advice and information when you need it most. Highly-trained nurses are available to help answer your questions about symptoms, medications and health conditions, and offer self-care tips for non-urgent concerns. The service is included with all Prime Solution plans at no additional cost. Get reimbursed for eyewear and hearing aids. If you are enrolled in Basic or Enhanced, you are eligible to receive reimbursement for prescription eyewear and hearing aids. For prescription eyewear, you are reimbursed up to $125 per year with Enhanced and $75 with Basic. For hearings aids, receive up to $400 in reimbursement annually for hearing aids and evaluations/fittings with Basic and Enhanced. The health information you need is in the mail. As a Medica member, you will receive our Focus on Health newsletter three times a year. It is full of practical information to help you maintain or improve your well being, including content on topics like:» Preventive care» Common health conditions» Safety tips» Healthy recipes» Medicare updates and more! You can depend on our preventive care support. Did you know you re eligible for a variety of immunizations and health screenings as a Medicare member? We can help you stay up-to-date on all the services that are available to you. All new members receive a Quick Reference Guide, that includes a handy list of recommended screenings and immunizations you can review with your doctor and use to track the dates you received applicable services. 8 9

6 THE ADDED SUPPORT YOU NEED Convenience and drug savings through mail order. Download our handy pharmacy app. If you re on the go, no problem. As a Medica Part D member, you have access to a mobile app which is powered by CVS Caremark, the administrator of our pharmacy program. This app can help you save money and manage your prescriptions wherever you are. It s free and available for both Android and ios phones. The app is easy to download and easy to use. Just one more way we meet the changing needs of our members. Access tools at mymedica.com Mymedica.com is a one-stop member resource that puts your health plan benefits and activity at your fingertips. Take advantage of an array of self-service tools that give you access to your Medica plan information 24/7, 365 days a year. LOCAL CUSTOMER SERVICE At Medica, you ll always receive the caring, personal service you deserve from our local Medicare experts. Our health plan specialists can answer your questions and help you maximize your coverage. It s another reason to choose the plan that listens to you. CVS Caremark Mail Service Pharmacy YOU PAY Tier 1 3 prescription drugs 2 copays for 3 month supply Once you enroll, you can register to:» Pay only two copays for a three-month supply of eligible prescription drugs through CVS Caremark Mail Service Pharmacy» Track medical or pharmacy claims» Find a network doctor or pharmacy» Order your refills online anytime, anywhere it is fast and easy» Order a replacement ID card» Set up handy automatic refills for most maintenance medications» Check prescription drug prices» Track your order in real time and typically receive in just one to four days 10 11

7 HOW TO ENROLL IN MEDICA PRIME SOLUTION Important Enrollment Periods Initial Enrollment Period (IEP) This is when you first become eligible for Medicare at around age 65. You have a seven-month window during which you can sign up for Medicare: three months before your birthday month, during your birthday month and three months after your birthday month. What to expect after you enroll Once you have submitted your application, you can expect to receive the following communications from us: 1 Acknowledgement Letter Within about a week, you will receive a letter letting you know that your application has been received. Medica Prime Solution eligibility You are eligible to enroll in Medica Prime Solution if you have Medicare Part A and Part B (or Part B only), you do not have End-Stage Renal Disease (ESRD) and your permanent residence is in a Minnesota county that offers Prime Solution. Counties where we are accepting new enrollments* (on or after Dec. 8, 2017): There are three ways to enroll in a Prime Solution plan. Choose the one that works best for you: Submit your completed paper forms via mail, fax or web. Mail to: Medica Medicare Solutions PO Box 6300 Eau Claire, WI Or fax to: Or upload securely at: Call (TTY: 711) for fast and easy enrollment over the phone. Go to medica.com/medicare to complete your enrollment online. Complete and sign a paper application and submit via mail, fax or web. (You can request a paper application by calling (TTY: 711).) medica.com/enrollmentupload Annual Election Period (AEP) Medicare open enrollment is October 15 December 7 each year for January 1 coverage. All enrollment, disenrollment or plan change options are available to you at this time. Special Enrollment Period (SEP) A Special Enrollment Period allows you to make changes to your Medicare coverage that normally you can only make during your Initial Enrollment Period or the Annual Election Period. There are many types of events that can trigger a Special Enrollment Period ID Card Within one to two weeks, you will receive your ID card. (NOTE: Your ID card is not included in your member packet it is sent separately.) Member Packet Within two weeks, you will receive your member packet, which will contain your Evidence of Coverage, member guide and other important materials that you will want to read and keep for future reference. Verification Communication Medicare requires that we contact you to verify that you are familiar with the terms of your new plan. Confirmation Letter This letter confirms Medicare s approval of your enrollment in Medica Prime Solution. Aitkin, Carlton, Cook, Goodhue, Itasca, Kanabec, Koochiching, Lake, Le Sueur, McLeod, Meeker, Mille Lacs, Pine, Pipestone, Rice, Rock, Sibley, St. Louis, Stevens, Traverse and Yellow Medicine. * Counties are subject to change. Visit medica.com/medicare for the most up-to-date information. NOTE: Some exceptions could apply that would allow you to enroll in Prime Solution even if you live in a Minnesota county not listed above. Call Medica or talk to a broker to learn more

8 IMPORTANT PLAN INFORMATION Prime Solution Provider Network You can use any provider who is currently part of the Medica Prime Solution network. The providers in network can change at any time. You do not need a referral to use a network provider. Visit medica.com/primesolutionproviders to search our online directory. Or call us for a printed Provider Directory at (TTY: 711). Pharmacy Network We have a broad nationwide pharmacy network of over 64,000 pharmacies, including all major chains and thousands of independent pharmacies. With Medica, there are no preferred pharmacies you pay the same copay no matter which network pharmacy you choose. Covered Drugs The Medica Prime Solution formulary is a list of drugs that are covered by your plan if you have selected the optional Part D rider. It includes more than 3,200 prescription drugs. You can check online to see if your drugs are covered at medica.com/medicare. To request a printed formulary (covered drug list), you can call Medica at (TTY: 711). Broad Provider Network Choose any provider currently part of our extensive network of doctors, clinics and hospitals. No referrals needed. 12 CHA B_PmeSolBro_PostAEP_MN_8.5x11_FINAL_ indd /3/18 8:54 PM

9 MEDICA. THE FIRST WORD IN MEDICARE. Call toll free at (TTY: 711) Hours of operation: October 1 February 14 8 a.m. to 8 p.m. Central, seven days a week February 15 September 30 8 a.m. to 8 p.m. Central, Monday-Friday Visit us online to learn more at medica.com/medicare. Locate a Medicare Workshop near you at medica.com/medicareworkshops. Find a broker in your community at medica.com/medicare. Centers for Medicare & Medicaid Services (CMS) Toll free at MEDICARE ( ) (TTY ) Hours of operation: 24 hours a day, seven days a week medicare.gov Social Security Administration Toll free at (TTY ) Hours of operation: 7 a.m. to 7 p.m., Monday-Friday ssa.gov Follow Medica: This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medica is a Cost plan with a Medicare contract. Enrollment in Medica depends on contract renewal. The SilverSneakers fitness program is provided by Tivity Health, an independent company. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. HealthAdvocate is a trademark of Health Advocate, Inc Medica. Medica and Medica Prime Solution are registered service marks of Medica Health Plans. Medica refers to the family of health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company, Medica Self-Insured and Medica Health Management, LLC. CHA B