Premera Blue Cross Medicare Advantage HMO Plans 2018 Premera Blue Cross
Meeting agenda Medicare basics Your Medicare options Premera Blue Cross Medicare Advantage Plans Enrolling is easy! The new customer experience what to expect
Who qualifies for Medicare? To qualify for Medicare you need to be a U.S. citizen or resident and: Age 65 or older OR Under age 65 and disabled* OR Living with end-stage renal disease (ESRD) *Permanently disabled for 24 months or more.
Your Medicare card Contact your local Social Security office at 800-772-1213 or ssa.gov to enroll in Medicare. Your Medicare card will arrive in the mail after you are enrolled. You will only be automatically enrolled in Parts A and B if you receive Social Security or Railroad Retirement benefits. If you are automatically enrolled, your red, white, and blue Medicare card will arrive three months before your 65 th birthday or on your 25 th month of receiving disability benefits.
Enrollment periods Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65 th birth month Annual Enrollment Period: October 15 December 7 Special Enrollment Period: Example: Loss of employer coverage or moving to new service area Open Enrollment Period: January 1 March 31
Original Medicare Part A and Part B
When should you enroll? What is your current situation? Are you covered by: Employer coverage Union coverage Coverage through spouse Are you retired, planning to retire or retiring late? Enrolling in Medicare is easy! Premera can help.
Original Medicare: Part A Part A Hospital Insurance Part A is free for most people There is a $1,340 Part A deductible per benefit period After 60 days in the hospital, you pay: $335 per day copay for 61-90 days $670 per day copay for 91-150 days* After day 150, you pay all hospital costs FIGURES ARE FOR 2018 *Days 91-150 are lifetime reserve days. They are only covered once in a lifetime.
Original Medicare: Part B Part B Medical Insurance There is a $134 standard monthly premium* There is a $183 annual deductible Original Medicare covers 80% of most Part B costs, leaving you to pay the other 20% for services like: Most physician services Outpatient therapies Durable medical equipment Home health care FIGURES ARE FOR 2018 *Higher incomes may pay a higher premium
Late enrollment penalties Part B (medical insurance) Penalty An additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Not planning to retire at age 65? You can decline Part B without a penalty if you or your spouse have group insurance from an employer.
Prescription Coverage Part D
Prescription coverage: Part D Part D Prescription Drug Plans Voluntary program run by private companies Some may pay penalty for late Part D enrollment You pay a monthly premium You pay a portion of the drug cost Coverage varies from plan to plan Plan designs must be equal to or better than standard Medicare benefit designed by CMS
Prescription coverage: Part D benefit 1 Deductible 2 Initial Coverage 3 Coverage Gap 4 Catastrophic $415 $3,820 $5,100 5% COPAY YOU 100% PLAN 0% YOU 25% PLAN 75% BRAND GENERIC YOU 25% YOU 37% YOU 5% PLAN 95% FIGURES ARE FOR 2019 YOU pay $3.40/Generic and $8.50/Brand or 5% This is an example of how Medicare Part D works and is not intended to portray a specific plan. In some instances, these costs will be approximate amounts.
Prescription coverage: Extra Help Extra Help or Low Income Subsidy, is the name of the Part D drug program to help beneficiaries pay for drug costs. Extra Help is available from the government if you meet certain requirements. Those that qualify may get help paying monthly premiums, copays, coinsurance, and deductibles. Do you qualify? You don t know unless you apply.
Common drug list terms Formulary A list of drugs covered by the health plan. Prior Authorization (PA) For some covered drugs, you will need to get approval from the plan before you fill your prescriptions. Without approval, your drug may not be covered. Quantity Limits (QL) For some covered drugs, the plan may place limits on the amount of the drug provided for each prescription or for a defined period of time. Step Therapy (ST) For some covered drugs, the plan may require you to try certain drugs to treat your condition before the plan covers another drug for that condition. Transition Supply A temporary supply of your prescription drugs that allows you to transition to a new prescription covered by your plan drug list. The drug list (formulary) may change at any time. You will receive notice when necessary.
Your Medicare coverage options
Medicare coverage options START with Original Medicare DECIDE if you want more coverage Option 1 Option 2 Part A (hospital insurance) + Part B (medical insurance) Medicare Supplement Insurance Plan and/or Medicare Part D Prescription Drug Plan OR Medicare Advantage Plan Combines Parts A & B Many cover prescription drugs and may include extra benefits Monthly payment as low as $0
Premera Blue Cross Medicare Advantage Plans
Medicare Advantage (Part C) Part C Medicare Advantage Plans Medicare Advantage plans offered by private companies Combine Parts A and B Often include extras like fitness and wellness, dental, vision, and hearing Many also offer Part D drug coverage Monthly premiums as low as $0
Plan service area Snohomish County King County Pierce County Thurston County Spokane County NEW FOR 2019 Whatcom County Skagit County Lewis County Stevens County
Medicare Advantage eligibility To qualify, you must: Have Medicare Parts A & B Continue to pay your Part B premium Not have end-stage renal disease (in most cases) Have a valid enrollment period Live in the plan service area
2019 Medicare Star Rating Premera Blue Cross (HMO) and Classic (HMO) The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. For 2019, these Premera Blue Cross Medicare Advantage plans received an overall of 3 out of 5 Star Rating from Medicare. *Every year, Medicare evaluates plans based on a 5-star rating system.
2019 Premera Blue Cross Medicare Advantage plans Lewis County HMO Premera Blue Cross Medicare Advantage (HMO) Classic HMO Premera Blue Cross Medicare Advantage Classic (HMO)
Let s review Premera Blue Cross Medicare Advantage plans
Medicare Advantage HMO plans Referrals: In most situations, your network PCP must give you approval in advance before you can use other providers in the plan's network, such as specialists, hospitals, skilled nursing facilities, or home health care agencies. Prior authorizations: Some services are only covered if your doctor or other network provider get approval in advance.
Premera Blue Cross Medicare Advantage (HMO) HMO plan benefits Monthly plan premium $0 Doctor s visit / specialist visit Preventive services $0 In-network only $15 copay / $45 copay Inpatient hospital $450 copay (days 1 4) / $0 copay (days 5-90+) Outpatient services Home health care Ambulance Ambulatory surgical center: 15% coinsurance Outpatient hospital: 20% coinsurance $0 copay $300 copay/each one-way trip Emergency care Urgently needed care Gym membership $75 copay (waived if admitted), worldwide coverage $50 copay, worldwide coverage $0 copay Maximum out of pocket $6,300 You must continue to pay your Medicare Part B premium.
Premera Blue Cross Medicare Advantage (HMO) HMO plan benefits Prescription drugs Drug coverage Preferred / Standard pharmacy (retail) Drug deductible (applies to tiers 3-5) $300 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred drug Tier 5 Specialty $4 copay / $15 copay ($0 deductible) $12 copay / $20 copay ($0 deductible) $42 copay / $47 copay 35% coinsurance 27% coinsurance Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at 888-850-8526 (TTY/TDD:711). You can call Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, October 1-March 31). Search online at premera.com/ma
Premera Blue Cross Medicare Advantage (HMO) optional rider HMO plan benefits Preventive dental optional rider Annual dental deductible $0 Monthly dental premium $26 Routine oral exams Routine cleanings / periodontal maintenance Fluoride treatment Bitewing X-rays (set of 4) Panoramic or complete series X-rays Emergency exam Preventive dental coverage ($0 copays from a preferred network dentist) $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay (1 set every 60 months) $0 copay (1 every year) Add Dental Coverage You may add the optional dental rider within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. Coverage starts the first of the month following the date we receive your completed enrollment form. Search online at premera.com/ma
Premera Blue Cross Medicare Advantage Classic (HMO) Classic HMO plan benefits Monthly plan premium $55 Doctor s visit / specialist visit Preventive services $0 In-network only $10 copay / $40 copay Inpatient hospital $450 copay (days 1 4) / $0 copay (days 5-90+) Outpatient services Eyewear Home health care Ambulance Ambulatory surgical center: $250 copay Outpatient hospital: $350 copay $150 hardware reimbursement $0 copay $300 copay/each one-way trip Emergency care $75 copay (waived if admitted), worldwide coverage Gym membership $0 copay Maximum out of pocket $5,600 You must continue to pay your Medicare Part B premium.
Premera Blue Cross Medicare Advantage Classic (HMO) Classic HMO plan benefits Prescription drugs Drug coverage Preferred / Standard pharmacy (retail) Drug deductible (applies to tiers 3-5) $200 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred drug Tier 5 Specialty $3 copay / $12 copay ($0 deductible) $12 copay / $20 copay ($0 deductible) $42 copay / $47 copay 35% coinsurance 29% coinsurance Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at 888-850-8526 (TTY/TDD:711). You can call Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, Oct. 1-Mar. 31). Search online at premera.com/ma
Premera Blue Cross Medicare Advantage Classic (HMO) Classic HMO plan benefits Preventive dental coverage Preventive dental ($0 copays from a preferred network dentist) Annual dental deductible $0 Monthly dental premium $0 (embedded) Routine oral exams $0 copay (2 every year) Routine cleanings / periodontal maintenance $0 copay (2 every year) Fluoride treatment $0 copay (1 every year) Bitewing X-rays (set of 4) $0 copay (1 set every year) Panoramic or complete series X-rays $0 copay (1 set every 60 months) Emergency exam $0 copay (1 every year) Search online at premera.com/ma
Medical network With thousands of local doctors in our Medicare Advantage network, you ll be sure to find a doctor that s right for you and close to home. Western Washington Providers ü CHI Franciscan ü EvergreenHealth ü Overlake Medical Center and Clinics ü MultiCare Health System ü Northwest Physicians Network ü PeaceHealth (Whatcom Co.) ü Physicians of Southwest Washington ü Providence Health & Services ü Swedish Health Services ü The Everett Clinic ü The Polyclinic ü UW Medicine ü Virginia Mason Medical Center ü Western Washington Medical Group Eastern Washington Providers ü MultiCare Health System ü Providence Health and Services ü Rockwood Clinic ü Spokane Internal Medicine ü Doctors Clinic Search online at premera.com/ma The above list is not a complete list of standard and/or preferred providers.
Pharmacy network Premera Blue Cross (HMO) and Classic (HMO) Preferred Pharmacies Standard Pharmacies ü Albertsons ü QFC Pharmacy ü Bi-Mart Pharmacy ü Bartell Drugs ü Rosauers Pharmacy ü Bob Johnson's United Drugs ü Costco Pharmacy ü Safeway Pharmacy ü ReliantRx LLC ü CVS (including inside Target stores) ü Sam's Club Pharmacy ü Rite Aid Pharmacy ü Fred Meyer Pharmacy ü Sav-On Pharmacy ü Walgreens ü Haggen Pharmacy ü Pharmaca ü Walmart Pharmacy ü Yoke s Pharmacy Premera contracts with national pharmacy chains and many independent and local pharmacies. Preferred pharmacies allow customers to pay the lowest cost for covered generic medications. Search online at premera.com/ma The above list is not a complete list of standard and/or preferred pharmacies.
Enrolling is easy!
Four things to remember 1. Choose a plan that fits you and your budget including the $0 premium plan 2. Receive care from a broad network of providers you know and trust 3. Travel with worldwide coverage for emergencies 4. Get your questions answered quickly and easily with support from a team focused on you
Enroll today Enroll today in one of Premera Blue Cross Medicare Advantage Plans. BY MAIL using a paper application OVER THE PHONE by calling 888-868-7767 (TTY/TDD: 711)* ONLINE at premera.com/ma *Monday Friday, 8 a.m. to 8 p.m. (7 days a week, 8 a.m. to 8 p.m., from October 1 March 31).
The new customer experience
The new customer experience Welcome kit Welcome call Premera ID card Outbound enrollment verification Fitness ID card Health Risk Assessment Your membership generally starts on the first day of the following month. Plans start as of January 1 for enrollees in October, November and December (during the Annual Enrollment Period).
Important plan information Premera Blue Cross is an HMO plan with a Medicare contract. This information is not a complete description of benefits. Contact the plan for more information. Enrollment in Premera Blue Cross depends on contract renewal. This information is not a complete description of benefits. For more information call 888-850-8526 (TTY/TDD: 711) Monday Friday, 8 a.m. to 8 p.m. (7 days a week, 8 a.m. to 8 p.m., from October 1 March 31). Every year, Medicare evaluates plans based on a 5-star rating system. Premera Blue Cross is an Independent Licensee of the Blue Cross and Blue Shield Association. 047266 (10-20-2018) H7245_PBC1639_M
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