Medicare coverage options

Transcription

1 Medicare coverage options Contact your authorized Blue Shield broker at the number listed above. You will be directed to a licensed insurance broker. Y0118_17_455B Approved

2 Agenda What is Medicare? Your Medicare coverage choices at a glance Medicare prescription drug coverage (Part D) What it is and how it works Blue Shield Medicare Advantage HMOs Blue Shield 65 Plus SM (HMO), Blue Shield 65 Plus Choice Plan (HMO), and Blue Shield Trio Medicare (HMO) Medicare Supplement plans (Medigap) What they are, buying plans, switching plans and what s not covered Blue Shield Medicare Supplement plans What sets us apart Blue Shield Medicare Prescription Drug Plans What Blue Shield offers 2

3 Medicare What is Original Medicare? Health insurance for people age 65 or older; people under age 65 with certain disabilities; people of any age with end-stage renal disease (ESRD) Helps cover out-of-pocket expenses on certain services You can go to any doctor or hospital that accepts Medicare 3

4 The different parts of Medicare Medicare Part A (hospital insurance) automatic Helps cover inpatient care in hospitals Helps cover skilled nursing facility, hospice and home health care Medicare Part B (medical insurance) requires a premium Helps cover physician services, hospital outpatient care and home health care Helps cover many preventive services to help maintain your health and to keep certain illnesses from getting worse Medicare Part C (also known as Medicare Advantage) Offers health plan options run by Medicare-approved private insurance companies like Blue Shield of California Combines benefits and services covered under Part A and Part B, and often Part D; some also include extra benefits Medicare Part D (Medicare prescription drug coverage) A prescription drug option run by Medicare-approved private insurance companies Helps cover the cost of prescription drugs 4

5 Medicare Original Medicare does not cover (not a complete list) Routine vision or foot care 1 Routine dental care Routine hearing exams and hearing aids Custodial care at home or in a nursing home Health care outside of the United States except in very rare situations Copayments, coinsurance and deductibles There is no maximum out-of-pocket amount Because Medicare has limited hospital coverage, and because copayments, coinsurance and deductibles can be expensive, some Medicare beneficiaries choose Medicare Supplement plans to help fill in the gaps that Original Medicare doesn t cover, or a Medicare Advantage HMO Plan. For more information To learn more about Medicare, the different parts of Medicare and Medicare enrollment periods, visit and read the Medicare & You handbook. You can also call (800) MEDICARE [(800) ], 24 hours a day/seven days a week. TTY users should call (877) Medicare covers medically necessary foot care, including care for medical conditions affecting the lower limbs. 5

6 Your Medicare coverage choices at a glance There are two main ways to get your Medicare coverage: Original Medicare, which can be supplemented by a Medicare Supplement plan, or a Medicare Advantage Plan. 6 Source: 2018 Medicare & You handbook,

7 Blue Shield Medicare Advantage HMOs Blue Shield 65 Plus, Blue Shield 65 Plus Choice Plan, and Blue Shield Trio Medicare (Part C) Includes Part A (hospital insurance), Part B (medical insurance) and Part D prescription drug coverage (a separate Medicare Prescription Drug Plan is not necessary). You must use plan doctors, hospitals and other providers except in certain situations we have a large network of primary care physicians and specialists, so chances are you can keep seeing your doctor. Plan premiums vary by county (you must continue to pay Medicare Part B premium). There is a yearly cap on how much you will spend on Part A and Part B services (amount varies by plan and service area). Includes extra benefits like vision coverage 1 and basic gym access 2 at no additional cost. Let s go through the Summary of Benefits to learn about the benefits for the plan(s) available in this area. 1 Vision coverage is not included as part of the Blue Shield 65 Plus plan benefits in San Luis Obispo (partial) and Santa Barbara (partial) counties. 2 Basic gym access is not included as part of the Blue Shield 65 Plus plan benefits in Kern (partial), San Luis Obispo (partial) and Santa Barbara (partial) counties. 7

8 Medicare Supplement plans (also known as Medigap) blueshieldca.com Member John Doe ID# XEAJ Plan Part B Deductible F Y Group# X Effective 09/01/2016 Members: In California send claims to P O Box , Chico, CA Providers: For Please file all claims with your local BCBS licensee in whose service area the member received services or, when Medicare is primary, file all claims with Medicare. Benefits, contract limitations, and exclusions are set forth in the service agreement or contract under which the member is enrolled. This card is issued for use by the member only and is not otherwise transferable. This card becomes void when the member becomes ineligible. Monday - Thursday: 8 a.m p.m. Friday: 9 a.m. - 5 p.m. (800) Customer Service (877) NurseHelp 24/7, 711 TTY/TDD Medicare Supplement PPO Blue Shield of California is an independent member of the Blue Shield Association. You must have both Medicare Parts A and B. Ten standardized plans with varying benefits, plus a highdeductible option for Plan F. Designed to cover the gaps of Original Medicare, including some deductibles and coinsurance of Medicare-allowed amounts for covered healthcare expenses. Freedom to choose any doctor, specialist and hospital that accepts Medicare anywhere you travel in the United States. Offered by private health plans like Blue Shield of California. You must pay monthly plan premiums in addition to Medicare Part B premium. 8

9 Medicare Supplement plan tips A great time to enroll in a Medicare Supplement plan is when you are new to Medicare. You have six months to enroll when you are new to Medicare Part B and will qualify for guaranteed acceptance meaning you don t need to answer health questions or go through medical underwriting. Your Annual Open Enrollment is your birthday month you may change to any Medicare Supplement plan that offers benefits that are equal to or less than those of your current plan without going through underwriting. Blue Shield s Special Enrollment Period allows you to change to any Blue Shield Medicare Supplement plan that offers benefits that are equal to or less than those of your current plan without going through underwriting until December 31, If you joined a Medicare Advantage Plan when you first became eligible for Medicare, and disenrolled within 12 months, you have guaranteed acceptance. Other guaranteed acceptance scenarios include moving to a different state, losing employer coverage and losing your Medicare Advantage Plan, among others. Refer to the Blue Shield Guaranteed Acceptance Guide for all the details. Standard Medicare Supplement plans cover what Original Medicare Part A and Part B cover only. Medicare Supplement plans do NOT include: Part D prescription drug coverage, routine vision care, routine dental care and hearing aids. 9

10 Why choose Blue Shield? We are a California-based, nonprofit plan with over 75 years of experience providing Californians like you with access to quality care at an affordable price. A diverse range of Medicare Supplement plans to choose from SilverSneakers fitness program included Outstanding customer service Additional ways to save, including the Welcome to Medicare Rate Savings Convenience of getting other types of coverage from the same health plan Medicare Part D Prescription Drug Plans offered Two dental PPO plans and one combination PPO dental + vision care package 1 to choose from that are specifically designed for Blue Shield Medicare Supplement plan members 1 Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life). 10

11 More reasons to select Blue Shield of California $25 Welcome to Medicare Rate Savings You can save $25 each month for the first 12 months of coverage in a Blue Shield Medicare Supplement plan if you re 65 or older and we receive your application within six months of the date you first enrolled in Part B. 1 New member dental or dental + vision plan savings You can save $3 each month for the first six months on your dental or dental + vision plan rates if you enroll in a dental or dental + vision plan at the same time you enroll in any Blue Shield Medicare Supplement plan. 1 Household Savings If you and another member of your household are both interested in enrolling in the same plan type, you could save 7% off the combined individual plan rates for both members of your party through our Household Savings Program. 1,2 Easy$Pay SM Save $3 per month by paying your monthly dues through automatic checking or savings account debits. 1 1 Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. The Welcome to Medicare Rate Savings does not apply to High Deductible Plan F, Plan K or Plan N. 2 The Household Savings Program does not apply to High Deductible Plan F or Plan K. The Household Savings Program does not apply to tobacco users and is not available to those 64 or younger. 11

12 Blue Shield of California Medicare Supplement plans If a check mark appears in a plan s column below, that plan covers 100% of the described benefit. If a column lists a number, the plan covers that percentage of the benefit. If a column is blank, the plan doesn t cover that benefit. Medicare Supplement benefits 1 Blue Shield also offers High Deductible Plan F that offers the same benefits as Plan F after you have paid a calendar-year $2,200 deductible in This amount may change for After you meet your out-of-pocket yearly limit ($5,120 in 2017) and your yearly Part B deductible ($183 in 2017), the plan pays 100% of covered services for the rest of the calendar year. These amounts may change for Except up to $20 per office visit and up to $50 per emergency room visit. 12 Plan A Plan C Plan D Plan F 1 Plan G Plan K 2 Plan N Medicare Part A coinsurance hospital cost up to an additional 365 days after Medicare benefits are used up Medicare Part B coinsurance or copayment 50% 3 Blood (first 3 pints) 50% Part A hospice care coinsurance or copayment 50% Skilled nursing facility care coinsurance 50% Medicare Part A deductible 50% Medicare Part B deductible Medicare Part B excess charges Foreign travel emergency (up to plan limits) Medicare preventive care Part B coinsurance Basic gym access through SilverSneakers

13 SilverSneakers Exercise, education and social activities are very important to your health and well-being, which is why Blue Shield of California offers the SilverSneakers fitness program at no additional cost! SilverSneakers includes the following: Access to more than 14,000 1 locations nationwide (including women-only locations) where you can use equipment and take group exercise classes 2 SilverSneakers FLEX classes including tai chi, yoga, dance and walking groups offered in your favorite neighborhood locations such as parks, recreation centers and adult-living communities Fun social activities and events, plus health education presentations To find your closest SilverSneakers locations and SilverSneakers FLEX classes, order an at-home kit or get additional information, visit silversneakers.com. Remember, when you travel you can use any SilverSneakers location in the nation! Get started today and be one step closer to a healthier lifestyle. 1 Tivity Health Data and Analytics, August At-home kits are offered for members who want to start working out at home or for those who can t get to a fitness location due to injury, illness or being homebound. Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries Tivity Health, Inc. All rights reserved. 13

14 Blue Shield s Medicare Supplement plan rates for ages 65 to 66 (effective January 1, 2018) Single-party non-tobacco monthly rates. 1 For rates for other age bands and other regions, see the rate matrix in your presale kit. Plans: A C D F Hi-F G K N Region 1 Los Angeles County except ZIP codes 91711, 91759, 91765, 91766, 91767, 93535, 93544, $125 $171 $146 $184 $61 $168 $78 $117 and Ages Region 2 Orange County Ages $125 $171 $146 $190 $61 $173 $78 $117 Region 3 San Diego, Sonoma, San Bernardino, Kern counties and LA ZIP codes 91711, 91759, 91765, 91766, $110 $148 $126 $160 $48 $146 $61 $ , 93535, 93544, and Ages Region 4 Riverside and Ventura counties $121 $165 $141 $178 $59 $162 $68 $113 Ages Region 5 San Joaquin, Santa Barbara and Stanislaus counties $103 $138 $119 $150 $50 $137 $60 $95 Ages Region 8 Includes San Francisco, San Mateo, Fresno and Santa Clara counties $102 $139 $118 $150 $45 $137 $58 $95 Ages Region 9 Sacramento, Amador, Calaveras, Colusa, El Dorado, Tehama and Marin counties Ages $100 $141 $116 $152 $46 $139 $56 $98 1 These rates do not include the $25 Welcome to Medicare Rate Savings that would apply to the first 12 months of your enrollment and the new member dental or dental + vision plan savings of $3 each month for the first 6 months of enrollment if qualified. The $25 Welcome to Medicare Rate Savings do not apply to High Deductible Plan F, Plan K and Plan N. 14

15 Blue Shield of California Medicare Part D Prescription Drug Plans Blue Shield Rx Plus (PDP) $82.50 monthly premium (must continue to pay Part B premium) $405 annual deductible does not apply to Tier 1: Preferred Generic Drugs Some coverage through the coverage gap Lower cost-sharing than our Blue Shield Rx Enhanced (PDP) Blue Shield Rx Enhanced (PDP) $ monthly premium (you must continue to pay your Medicare Part B premium) $0 annual deductible Blue Shield Rx Enhanced (PDP) (includes some drugs not on the Blue Shield Rx Plus (PDP) formulary) Some coverage through the coverage gap You may want to consider this option if you take drugs on the Blue Shield Rx Enhanced (PDP) formulary and don t want an annual deductible 15

16 Blue Shield of California Medicare Part D Prescription Drug Plans (continued) All Blue Shield Medicare Prescription Drug Plans You can choose to get your prescriptions filled at any of the nearly 6,000 network pharmacies contracted with Blue Shield. You pay less at network pharmacies that offer preferred costsharing than you do at network pharmacies that offer standard cost-sharing. Pharmacies that offer preferred cost-sharing include: Costco CVS Pharmacy (including CVS Pharmacy at Target) Safeway and Vons Albertsons/Sav-on/Osco Ralphs, Walmart And many more. Receive a 90-day supply of covered drugs for the cost of two 30-day supplies from a network pharmacy that offers preferred cost-sharing or through our mail service pharmacy. (Note: Tier 6: Specialty Tier Drugs are available only at a 30-day supply.) 16

17 Dental plans at a glance for Medicare Supplement plan subscribers (effective April 1, 2016) This chart is only an at-a-glance summary. For a complete list of the benefits, exclusions and limitations, please refer to the Evidence of Coverage and Health Service Agreement. Plan type Dental PPO 1000 Dental PPO 1500 Specialty Duo SM dental PPO + vision package 1,2 Monthly plan premium $35.90 $47.40 $58.60 Calendar-year deductible Calendar-year maximum $75 $50 $50 $1,000 $1,500 $1,500 Dental benefits using network dentists Diagnostic and preventive care for Plan covers 100% Plan covers 100% Plan covers 100% annual exam and six-month checkup 3 Basic services 4 Plan covers 50% Plan covers 80% Plan covers 80% Major services 5 Plan covers 50% Plan covers 50% Plan covers 50% 1 The Specialty Duo package includes a comprehensive vision plan. Plan includes $0 copayment annual eye exam, $25 copayment for lenses and low-vision aids, and $100 frame allowance. 2 The Specialty Duo package is underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life). Specialty Duo vision plan is administered by MESVision, Inc. 3 Deductible does not apply to diagnostic and preventive services including oral exam, X-rays and cleanings. 4 Deductible applies to basic services including anesthesia, palliative treatment and minor restorative dentistry. 5 Twelve-month waiting period. Deductible applies to major services including, endodontics, periodontics, oral surgery, crowns, bridges and dentures. 17

18 Does the Affordable Care Act (ACA) impact Medicare? Yes. The ACA, or ObamaCare, impacts Medicare in several ways: Provides prescription drug relief in the donut hole or coverage gap. Mandates preventive care at no cost. What will happen if the ACA is repealed? Depends on the replacement plans. What if I am on Covered California and become eligible for Medicare? You must enroll in Medicare. If you stay in Covered California and receive subsidies, subsidies can be recouped. 18

19 Three sample monthly cost summaries Plan F $ Welcome to Medicare Rate Savings 1 -$25 Total Medicare Supplement plan cost $ Blue Shield Rx Enhanced (PDP) (Part D plan) $ TOTAL monthly cost 2 $ Plan N $ Easy$Pay savings 1 -$3 Total Medicare Supplement plan cost $ Blue Shield Rx Plus (PDP) (Part D plan) $82.50 Dental PPO 1000 $35.90 TOTAL monthly cost 2 $ Blue Shield Medicare Advantage Plan (Medicare Advantage HMO) $ TOTAL monthly cost 2 $ 1 Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. The Welcome to Medicare Rate Savings does not apply to High Deductible Plan F, Plan K or Plan N. 2 Costs reflect monthly plan premiums only. Does not include monthly Part B premium. Does not include any deductibles that you may need to meet before coverage begins. 19

20 Joining a Blue Shield of California Medicare Supplement plan Complete the Blue Shield application including the dental PPO plan section if you re interested in dental or dental + vision coverage options specifically designed for Blue Shield Medicare Supplement plan members. Other Blue Shield dental plans are available and require separate application. Take advantage of the Easy$Pay savings on your Medicare Supplement plan dues and fill out the Easy$Pay authorization section of your enrollment form. 1 If you re accepted, you will receive your Medicare Supplement plan new-member welcome kit, including your ID card, before your coverage begins. If you want to enroll in a Blue Shield Medicare Prescription Drug Plan, complete that application (you must have Medicare Part A and/or Part B). Let Blue Shield be your one-stop shop for all your health coverage needs. 1 Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. 20

21 Thank you for attending today. Talk directly with your authorized Blue Shield broker. Contact your authorized Blue Shield broker at Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. 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 copayments/ coinsurance may change on January 1 of each year. The Formulary and pharmacy network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: MEDICARE ( ). TTY users should call , 24 hours a day/seven days a week; The Social Security office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call ; or Your Medicaid office. Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries Tivity Health, Inc. All rights reserved. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. Blue Shield of California is an independent member of the Blue Shield Association A44322-PR-FF (10/17)