08 Care Plans Product Guide Maximize Medicare with a GUIDESTONE CARE PLAN Are you planning to retire and transition to Medicare when you turn 65? If so, choose your Care Plan inside.
GuideStone cares about your health in retirement. GuideStone s Care Plans can help you make the most of Medicare. Retirement represents a new beginning for you, and it s when you want to focus on your future plans not on financial considerations. Our Care Plans combine the convenience of medical and prescription drug coverage all in one plan. They coordinate with Original Medicare (Parts A & B) to bring value from a provider that shares your values. Of course, GuideStone Care Plans allow you to choose any doctor who accepts Medicare. ELIGIBILITY Care Plans coordinate with Original Medicare (Parts A & B) Medical and Part D prescription coverage are all in one plan Choose any doctor who accepts Medicare Our experts will walk you through our enrollment process Enrollment in GuideStone s Medicare-coordinating Care Plans is available to retirees age 65 and older eligible to enroll in Original Medicare (Parts A and B). Our Care Plans are available to the following retirees: Those previously enrolled in a GuideStone health or retirement plan (excluding investment accounts) prior to turning age 65, including spouses. Those retired from or who previously worked for a church/agency/ministry affiliated with, or that shares common religious bonds with, the Southern Baptist Convention (for at least five consecutive years or a total of 0 interrupted years).
T W O A L T E R N A T I V E S CARE TODAY and CARE BASIC B O T H B U I L T A R O U N D C A R E. SO WHICH PLAN SHOULD I CHOOSE? GuideStone s Care Plans offer a pair of Medicare-coordinating plans with all the advantages mentioned on the previous page. Both are designed to minimize your out-of-pocket expenses by providing prescription drug coverage and coordinating with your Medicare medical coverage. On this and the following page we take you through factors to help you decide which plan is right for you. The Care Today rate is based on your age, so it increases as you get older. Care Basic has a flat rate for everyone that may increase year to year but doesn t increase because of your age. YOUR FIRST DECIDING FACTOR: MEDICAL BENEFITS The Care Plans medical benefits coordinate with your Medicare coverage. To help decide between plans, you ll need to think about: Your health over the last year and your overall well-being (helps you estimate future needs). Diagnoses (newly diagnosed chronic conditions can dramatically change your needs). GuideStone s Care Plans offer the following medical benefits: PLAN NAME COVERAGE TYPE YOU MIGHT CONSIDER THIS PLAN IF: Care Today Plan Covers: Medicare Part A (hospitalization), Part B* (physician) and Part D (prescription drug) You visit the doctor frequently. You have a chronic condition that requires specialized care and/or supplies. You d rather spend more for your plan each month so you re protected from unexpected costs at the doctor s office. Care Basic Plan Covers: Medicare Part A (hospitalization) and Part D (prescription drug) only You are generally healthy and primarily want coverage for hospital stays. You need a plan with a lower monthly cost. *It is very important that you purchase Medicare Part B coverage. Without Medicare Part B coverage, your out-of-pocket expenses will increase since you will be responsible for all of your physician claims.
WHICH PLAN SHOULD I CHOOSE? (CONTINUED) YOUR SECOND DECIDING FACTOR: PRESCRIPTION DRUG BENEFITS Medicare Part D is a part of traditional Medicare that covers some of the cost of prescription drugs. The Care Today and Care Basic plans include Part D benefits so every plan year, your prescription drug coverage has three stages. 3 Initial Coverage Stage You pay co-pays for generics, preferred brand-name, non-preferred brand-name and specialty drugs. You stay in this stage until the total drug spend (that is, member co-pays + plan payment for drugs) reaches $3,750. Coverage Gap Stage or the Donut Hole In Care Today, you pay 44% of drug costs for generic drugs. In Care Basic, you pay the generic drug co-pay for Tier generics, and you pay 44% for all other generic drugs. You pay the remaining 35% of preferred and non-preferred drug costs after a 50% pharmaceutical manufacturer discount and 5% plan benefit. You stay in this stage until your total, annual out-of-pocket costs plus 50% of your brandname drug costs reach $5,000 (this includes the amount you spent during the Initial Coverage Stage). Catastrophic Coverage Stage While in this stage, you pay a relatively small co-pay or a small co-insurance percentage for covered drugs. Participants who reach this stage pay the greater of 5% of the cost of the drug or $3.35 for generic/$8.35 for brand-name for the duration of the plan year. 3
HOW CAN I FIND OUT HOW MY DRUGS ARE COVERED? WE LL HELP WITH THAT, TOO. To find out how your prescription drugs are covered on the Care Today and Care Basic plans: Gather the following information: What drugs do you take regularly? Make a list of your current medications (note brand-name vs. generic). Check with your doctor to see if you can save money with more generic equivalents. Which prescriptions are covered now? Document which of your drugs are covered by your current prescription plan. All plans have a formulary, or a list of covered medications, and most have coverage tiers, which can substantially affect prices. However, GuideStone has enriched the Care Plans by covering additional drugs not usually covered on a Part D plan. Call Express Scripts at -866-544-976 or -800-76-33 (TTY-TDD, 4 hours a day, seven days a week). Gather your prescription information to discuss with an Express Scripts customer service representative, including the name of the drug, strength and dosage. You can ask questions about the formulary, co-pays and other useful drug information. 4
Care Today Plan The Care Today Plan provides coverage for Medicare Part B (medical and supplies) as well as Part A (hospital stays). It also includes Part D prescription drug coverage. Though this plan has a higher monthly rate, it may help you better manage your overall out-of-pocket costs. Be sure to consider your total cost of care (monthly premiums plus expenses) when choosing a plan. Effective January, 08 MEDICAL BENEFITS Part A hospital per benefit period (as defined by Medicare) Hospital stays: Semi-private room and board General nursing Other hospital and supplies Medicare pays Care Today Plan pays You pay 00% days 60 (after deductible) Costs over $335/day for days 6 90 Costs over $670/day for days 9 50 (lifetime reserve days) 00% of Part A deductible (for every benefit period) $335/day for days 6 90 $670/day for days 9 50 (lifetime reserve days) 00% after reserves are depleted All costs after 50 days Nothing Blood First three pints Additional amounts 00% Skilled nursing facility care 00% days 0 Costs over $67.50/day for days 00 Hospice care Available as long as you meet Medicare s requirements, your doctor certifies you are terminally ill and you elect to receive these All but very limited co pay/co-insurance for outpatient drugs and inpatient respite care 00% 0% for days 0 $67.50/day for days 00 Medicare co-pay/ co-insurance Nothing for days 00 00% after 00 days for hospice care You are responsible for 00% of any charges not covered by Medicare Part A or that are above the Medicare Part A approved amount. The Part A deductible is paid for every benefit period, which begins when you are admitted and ends when you have not received hospital or skilled nursing facility treatment for 60 days in a row. If you go into the hospital or skilled nursing facility after one benefit period has ended, a new benefit period begins. 5
CARE TODAY PLAN MEDICAL BENEFITS Effective January, 08 MEDICAL BENEFITS Part B medical per calendar year (as defined by Medicare) Preventive care For recommended preventive care, including an annual wellness visit Medicare pays Care Today Plan pays You pay 00% Nothing Nothing Blood First three pints Additional amounts 00% 00% Medical & supplies Doctors Inpatient and outpatient medical and surgical /supplies Physical and speech therapy Diagnostic tests Durable medical equipment and other 80% of Medicareapproved covered 00% of Part B deductible Remaining 0% of Medicare-approved covered Nothing Outpatient mental health 80% of Medicareapproved covered Remaining 0% of Medicare-approved covered Nothing Clinical laboratory service Tests for diagnostic 00% of Medicareapproved covered Nothing Nothing Part B excess charges Up to 5% above Medicareapproved amounts 00% Parts A and B Medicare pays Care Today Plan pays You pay Home health care Medicare-approved Durable medical equipment 00% medically necessary, skilled care and medical supplies 80% of Medicareapproved amounts (after deductible) for durable medical equipment Nothing Remaining 0% of Medicare-approved durable medical equipment for home health care for Medicareapproved durable medical equipment You are responsible for 00% of any charges not covered by Medicare Part B or that are greater than 5% above the Medicare Part B approved amount. For those enrolled in Medicare Part B, Medicare pays 00% of costs for recommended preventive care (including an annual wellness visit), per Your Guide to Medicare Preventive Services. You may find a copy of this guide at Medicare.gov. 6
CARE TODAY PLAN MEDICAL BENEFITS Effective January, 08 OTHER BENEFITS NOT COVERED BY MEDICARE Foreign travel emergency NOT COVERED BY MEDICARE Medically necessary, emergency care beginning during the first 60 days of each trip outside the USA Medicare pays Care Today Plan pays You pay CARE TODAY PLAN PRESCRIPTION BENEFITS $50,000 lifetime maximum 80% co-insurance after $50 overseas deductible 0% co-insurance after $50 deductible PRESCRIPTION DRUG BENEFITS Initial Coverage Stage Member pays co-pays for covered drugs (brandname and generic). Plan pays balance of drug costs. The total of these costs (member co-pays plus plan payment for drugs) adds up toward the Coverage Gap. When the total drug spend equals $3,750, you move into the Coverage Gap. Coverage Gap ( donut hole ) Member pays 44% of drug costs for generics. Member pays remaining 35% of preferred and non-preferred drug costs after a 50% pharmaceutical manufacturer discount and 5% plan benefit. The total of member co-pays and the 50% discount on the brand-name drugs add up toward the Catastrophic Coverage Stage. Total of year-to-date member out-of-pocket cost plus the 50% brand-name drug cost equals $5,000 (annual). Catastrophic Coverage Stage Member pays the greater of $3.35 or 5% of the total cost for a generic drug (with the maximum not to exceed the standard co-payment during the Initial Coverage Stage). Member pays the greater of $8.35 or 5% of the total cost for a brandname drug (with the maximum not to exceed the standard co payment during the Initial Coverage Stage). Plan pays the balance of drug costs for the remainder of plan year. Plan resets to Initial Coverage Stage each January. Mail Order Retail Pharmacy 7 Prescription Drug Co-pays in Initial Coverage Stage Quantity (days supply) 3 60 90 Tier : Generic $0 $0 $30 Tier : Preferred $40 $80 $0 Tier 3: Non-preferred $65 $30 $95 Tier 4: Specialty $75 $50 $5 Tier : Generic $8 $6 $4 Tier : Preferred $30 $60 $90 Tier 3: Non-preferred $50 $00 $50 Tier 4: Specialty $75 $50 $5 Co-pays apply only in the Initial Coverage Stage. Learn more over the phone. Call us toll-free at -844-INS-GUIDE (-844-467-4843) or visit GuideStone.org/Retiree.
Care Basic Plan If most of your health care dollars go toward hospital stays, you visit the doctor only once in a while or you live on a modest fixed income, the Care Basic Plan may work best for you. The Care Basic Plan does not cover Medicare Part B but provides coverage for Medicare Part A (hospital stays). The monthly rate is more affordable, and the plan provides solid hospital and Part D prescription drug coverage. Be sure to consider your total monthly cost of care. Effective January, 08 MEDICAL BENEFITS Part A hospital per benefit period (as defined by Medicare) Hospital stays: Semi-private room and board General nursing Other hospital and supplies Medicare pays Care Basic Plan pays You pay 00% days 60 (after deductible) Costs over $335/day for days 6 90 Costs over $670/day for days 9 50 (lifetime reserve days) 50% of Part A deductible (for every benefit period) $335/day for days 6 90 $670/day for days 9 50 (lifetime reserve days) 00% after reserves are depleted All costs after 50 days 50% of the Part A deductible Blood First three pints Additional amounts 00% Skilled nursing facility care 00% days 0 Costs over $67.50/day for days 00 Not a covered benefit 00% Not a covered benefit $67.50/day for days 00 00% after 00 days Hospice care Available as long as you meet Medicare s requirements, your doctor certifies you are terminally ill and you elect to receive these All but very limited co-pay/co-insurance for outpatient drugs and inpatient respite care Not a covered benefit Co-pay/co-insurance for outpatient drugs and inpatient respite care You are responsible for 00% of any charges not covered by Medicare Part A or that are above the Medicare Part A approved amount. You must pay 50% of the Part A deductible for every benefit period, which begins when you are admitted and ends when you have not received hospital or skilled nursing facility treatment for 60 days in a row. 8
CARE BASIC PLAN MEDICAL BENEFITS Effective January, 08 MEDICAL BENEFITS Part B medical per calendar year (as defined by Medicare) Preventive care For recommended preventive care, including an annual wellness visit Medical & supplies Doctors Inpatient and outpatient medical and surgical /supplies Physical and speech therapy Diagnostic tests Durable medical equipment and other Outpatient mental health Clinical laboratory service Tests for diagnostic Part B excess charges Up to 5% above Medicareapproved amounts Medicare pays Care Basic Plan pays You pay 00% Nothing Nothing 80% of Medicareapproved covered 80% of Medicareapproved covered 00% of Medicareapproved covered Not a covered benefit 00% Part B deductible 3 Remaining 0% of Medicare-approved covered Not a covered benefit Remaining 0% of Medicare-approved covered Not a covered benefit Costs above Medicareapproved amounts or not covered by Medicare Not a covered benefit All costs Parts A and B Medicare pays Care Basic Plan pays You pay Home health care Medicare-approved Durable medical equipment 00% medically necessary, skilled care and medical supplies 80% of Medicareapproved amounts Not a covered benefit Not a covered benefit for home health care Remaining 0% of Medicare-approved durable equipment You are responsible for 00% of any charges not covered by Medicare or that are above the Medicare-approved amount. For those enrolled in Medicare Part B, Medicare pays 00% of costs for recommended preventive care (including an annual wellness visit), per Your Guide to Medicare Preventive Services. You may find a copy of this guide at Medicare.gov. 3 You pay the Part B deductible once a year. 9
CARE BASIC PLAN MEDICAL BENEFITS Effective January, 08 OTHER BENEFITS NOT COVERED BY MEDICARE Foreign travel emergency NOT COVERED BY MEDICARE Medically necessary, emergency care beginning during the first 60 days of each trip outside the USA CARE BASIC PLAN PRESCRIPTION BENEFITS Medicare pays Care Basic Plan pays You pay $ 0 Not a covered benefit 00% PRESCRIPTION DRUG BENEFITS Initial Coverage Stage Member pays co-pays for covered drugs (brand name and generic). Plan pays balance of drug costs. The total of these costs (member co-pays plus plan payment for drugs) adds up toward the Coverage Gap. Coverage Gap ( donut hole ) Member pays the same co-pay as in the Initial Coverage Stage for Tier generics. Member pays 44% of all other covered generic drugs. Member pays remaining 35% of preferred and non-preferred drug costs after a 50% pharmaceutical manufacturer discount and 5% plan benefit. Member out-of-pocket costs plus the 50% pharmaceutical manufacturer discount add up toward the Catastrophic Coverage Stage. Catastrophic Coverage Stage Member pays the greater of $3.35 or 5% of the total cost for a generic drug (with the maximum not to exceed the standard co-payment during the Initial Coverage Stage). Member pays the greater of $8.35 or 5% of the total cost for a brandname drug (with the maximum not to exceed the standard co-payment during the Initial Coverage Stage). Plan pays the balance of drug costs for the remainder of plan year. When the total drug spend equals $3,750, you move into the Coverage Gap. Total of year-to-date member out-of-pocket cost plus the 50% brand-name drug cost equals $5,000 (annual). Plan resets to Initial Coverage Stage each January. Mail Order Retail Pharmacy Prescription Drug Co-pays Quantity (days supply) 3 60 90 Tier : Generic $0 $0 $30 Tier : Preferred $40 $80 $0 Tier 3: Non-preferred $65 $30 $95 Tier 4: Specialty $75 $50 $5 Tier : Generic $8 $6 $4 Tier : Preferred $30 $60 $90 Tier 3: Non-preferred $50 $00 $50 Tier 4: Specialty $75 $50 $5 08 Monthly Rate $33.68/month per person Learn more over the phone. Call us toll-free at -844-INS-GUIDE (-844-467-4843) or visit GuideStone.org/Retiree. Generic drug co-pays apply in both the Initial Coverage Stage and the Coverage Gap. 0
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