Optimum HealthCare H5594_VideoScript_CMS Approved 2012-2013 Hello I m <Host) And I m <2 nd Host> Thank you for coming today to learn about Optimum Healthcare s Medicare Advantage H-M-O Point of Service, H-M-O Special Needs and H-M-O Point of Service Special Needs Plans. This is also an opportunity to look at your current coverage and compare Medicare Advantage plans to Original Medicare. Optimum Healthcare has a variety of benefit plan options. You ll hear about those today and this information will help you find a plan that fits you and your lifestyle. For more information please contact the plan. Before you leave today one of our benefit consultants can help you enroll in an Optimum Healthcare Medicare Advantage H-M-O Point of Service, H-M-O Special Needs or H-M-O Point of Service Special Needs Plan. Optimum Healthcare is a Coordinated Care plan with a Medicare Advantage contract and a contract with the Florida Medicaid Program. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/ coinsurance may change on January 1 of each year Please hold any questions you may have until after this presentation when our representative will be available to help you.
Let s start by explaining Medicare. As everyone here probably knows Medicare is federal health insurance for people 65 and older younger people with certain disabilities and people with end stage renal dialysis with limited exceptions. Part A is hospital insurance and helps cover the care of patients in hospitals skilled nursing facilities hospice or even home health care. Part B is medical insurance which helps cover doctor s services outpatient care or some preventive services. Part C is Medicare Advantage a health coverage option that is run by a private insurance company and may offer extra coverage. Medicare Advantage Plans are approved and under contract with Medicare. They include Part A Part B and usually prescription drug coverage which is known as Part D. Part D is also an option run by private companies approved by and under contract with Medicare to help cover the cost of prescription drugs. To be eligible for Medicare Advantage you must have Medicare Parts A and B. You must be a permanent resident in the area where the plan is offered and you must live there at least six months out of the year. People with End Stage Renal Disease are not eligible for Medicare Advantage with limited exceptions. If you are eligible you may enroll in an HMO plan only during specific times of the year. If you are eligible for an H-M-O Special Needs Plan you can enroll at any time of the year. You can contact the plan for more information. There are many reasons to choose Optimum Healthcare!
It is owned and operated by doctors who are focused on preventive care in other words, they don t just see you when you are sick or have a problem. Optimum Healthcare is headquartered in Tampa, Florida with convenient concierge centers across the state. Optimum Healthcare is accredited by N-C-Q-A and received a commendable rating. N-C-Q-A accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS the performance measurement tool used by more than 90% of the nation s health plans. Optimum Healthcare passed these rigorous standards and reported their performance in dozens of clinical areas to earn the N-C-Q-A seal of approval. HOST) Optimum HealthCare offers many plans so it s easy to find a plan that fits your lifestyle and needs. For instance there are Medicare Advantage H-M-O Plans with prescription drug coverage and a Point of Service Benefit. These include the Optimum Gold Rewards Plan (H-M-O P-O-S) and the Optimum Platinum Plan (H-M-O P-O-S). Optimum Healthcare also offers full and partial dual eligible special needs plan with drug coverage including the Optimum Emerald Partial and Optimum Emerald Full (H-M- O S-N-P) There are also Chronic Condition Special Needs Plans with drug coverage and a Point of Service Benefit including the Optimum Diamond Rewards (H-M-O P-O-S S-N-P) and Optimum Diamond Rewards C-O-P-D (H-M-O P-O-S S-N-P) These are designed for people with Cardiovascular Disorders Chronic Heart Failure Diabetes Mellitus or Chronic Lung Disorders. Dual Eligible H-M-O Special Needs Plans are available to anyone who has both Medical Assistance from the state and Medicare. Premiums co-pays co-insurance and deductibles may very based on the level of Extra Help that you may receive Here are what just some of our satisfied clients have to say Danny Young Howland is a member of our Optimum Gold Rewards Plan HMO POS (DANNY YOUNG HOWLAND)
People who have not got Optimum that are my age need to put it on the top of their list and to contact their people that represent Optimum in their area and get on the list and rest easier and feel better about being a senior citizen. Al Navickas is a member of our Optimum Gold Rewards Plan HMO POS (AL NAVICKAS) Our costs are nothing. I mean, so far what our needs have been are Rx and doctor s appointments and the costs have been, no cost. It s easy to get testimonials like these because Optimum Healthcare offers a variety of plans to fit almost every need. As mentioned, Medicare Special Needs Plans S-N-Ps are a type of Medicare Advantage coordinated care plan that is focused on individuals with special needs. Optimum Healthcare S-N-Ps are limited to people with specific chronic conditions or people eligible for both Medicare and Medicaid. If you qualify to join a Medicare S-N-P you get all of your Medicare hospital and medical health care services through that plan including Medicare prescription drug coverage. Optimum Healthcare offers two types of S-N-Ps. Chronic Care Special Needs Plans or C-S-N-Ps are for people with one or more of the following chronic or disabling conditions: Cardiovascular Disorders Chronic Heart Failure Diabetes Mellitus and Chronic Lung Disorders. To join an Optimum Healthcare C-S-N-P the plan will need to obtain verification of the chronic condition from your doctor. A response from your doctor s office is required within 60 days of enrollment. The second type of S-N-P offered by Optimum Healthcare is a Dual Eligible Special Needs Plan or D-S-N-P. These plans are for people who are eligible for both Medicare and Medicaid. You can contact the plan to confirm your eligibility or get your questions answered. If you lose eligibility or there are changes to your eligibility or qualifying condition you
will be dis-enrolled from your special needs plan but you will be eligible for a Special Election Period that will allow you to enroll in another plan. The bottom line is Optimum Healthcare offers more benefits and more savings which means a better value for you! Including zero cost Primary Care Visits zero cost Plan Premiums on most plans,.zero cost Preventive Services and zero cost Inpatient Services! You can also save with Medicare Advantage Prescription Drug Savings Plans. Participants can receive up to $96.40 of their Part B Premium back each month on the Optimum Gold Rewards HMO_POS Plan that s up to $1156.80 each year! And there are savings with Optimum Chronic Condition Special Needs Savings Plans too. Participants can receive up to $97.10 of their Part B Premium back each month on the Diamond Reward Plans HMO-SNP-POS or up to $1165.20 each year. All these savings vary by Plan selection and County and are based on a 12 month enrollment. You must continue to pay your Medicare Part B Premium. The Part B Premium is covered for full dual members of Special Needs Plans. Optimum Healthcare is also excited about our O-T-C Allowance that covers over- thecounter health items and supplies that most of us buy regularly. Plan participants can receive from $15 to $50 each month depending on your plan selection and where you live. Over the course of a year s enrollment this could mean from $180 to $600 savings. Plus you can order these supplies on-line or over the phone and have them delivered directly to your home at no cost to you! It s easy and hassle-free. Specifics vary by plan and county and limitations and restrictions may apply. (VICTOR RIVERA)
They get to order from a huge menu of different products. Call the 1-800-number, place the order and it s sent to them free. No charge. When it comes to prescription drugs there are four cost sharing tiers. Every drug on the plan s list can be found in one of these tiers. Cost sharing tier one covers preferred generic prescriptions. Cost sharing tier two covers preferred brand prescriptions. Cost sharing tier three is for non-preferred brand drugs. Cost sharing tier four is dedicated to specialty prescriptions. To find out which cost-sharing tier your drug is in look it up in the Plan s Formulary and then refer to the benefits section for specific cost sharing. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit except in non-routine circumstances. Quantity limits and restrictions may apply. There are two ways to find a drug within the Formulary. You can look it up depending on the type of medical conditions it is used to treat. For instance, drugs used to treat a heart condition can be found under the category Cardiovascular Agents. The Index of the Formulary also provides an alphabetical listing of all the drugs along with the page number where you can find coverage information. In general Cost-Sharing Tier 1 Drugs are the lowest tier and includes some Generic Drugs and some Brand Drugs, Tier 2 Drugs include Preferred Brand Drugs and some non-preferred Generic Drugs, Tier 3 Drugs include non-preferred Brand Drugs and nonpreferred Generic Drugs and Tier 4 Drugs are the highest tier and include Specialty Tier Drugs. How much you pay for your prescription drugs depends on your coverage stage. Stage 1 is the initial coverage stage and the plan will pay its share of the cost of your
drugs and you are responsible for your share. You will stay in this stage until your payments for the year PLUS the plan s payments equal $2,970. Stage 2 is the Coverage Gap stage but you may know it as the Donut Hole. In this stage you pay 79% of generic drug costs as well as discounted costs for brand drugs until your yearly out of pocket drug costs reach $4750. This total may be different if you are already getting Medicare Extra Help. For certain plans, you may pay zero for drugs in Tier 1 during the Coverage Gap or Donut Hole. You can contact the plan for more information. The third stage is the Catastrophic Coverage Stage. Once you have paid enough for your drugs to move into this last payment stage the plan will pay most of the cost of your drugs for the rest of the year. You will pay the greater of 5% or $2.65 for generic or preferred multi-source drugs and the greater of 5% or $6.60 for all other drugs. Another valuable feature of Optimum Healthcare plans is the Medical Home. Here your Primary Care Provider or P-C-P acts as your personal physician and coordinates all your health care needs. Your P-C-P focuses on wellness and prevention not just treating you when you are sick and this allows for a higher quality of overall service. Let s talk to Dr. Joseph Millin, a Freedom Health Network Physician: (JOSEPH MILLIN, DO) We re encouraged to see patients at least two times a year. Even if they re perfectly healthy, just to make sure they maintain a perfectly healthy status. You must use Optimum Healthcare providers except in emergent or urgent care situations out of area renal dialysis or other services.
If you choose to get routine care from an out of network provider neither Medicare nor Optimum Healthcare will be responsible for the cost. But the bottom line is Optimum Healthcare offers more benefits for less money than Original Medicare and that is more value for you! For instance there are no plan premiums on most plans and some Optimum Healthcare plans even provide a Part B premium refund. The Optimum Gold Rewards Plan HMO POS provides a refund of $96.40 each month. The Optimum Diamond Rewards Plan HMO-SNP -POS provides a refund of $97.10 each month. By joining Optimum Healthcare you can also receive from $15 to $50 each month in Over The Counter health related supplies at no cost! That s from $180 to $600 in savings each year! Savings vary by plan selection and county and are based on a 12 month enrollment. All Optimum Healthcare plans offer preventive care at zero cost to you including but not limited to Physical Exams Bone Mass Measurement Colorectal Screening Flu Shots Mammograms and the list goes on and on. There s also brand and generic prescription drug coverage available on plans that offer Part D coverage. Optimum Healthcare participants can expect predictable costs for easier budgeting and low out of pocket maximums. And all Optimum plans offer supplemental benefits like dental vision hearing health club and fitness memberships! (DANNY YOUNG HOWLAND) It s a win-win. Do I need to say anything more? It s a win-win with Optimum. I cannot say enough about it because it works and it s done for me and it ll do for everybody that sees this interview. It s important to understand exactly when you can enroll in a Optimum Healthcare plan it s called the Annual Enrollment Period or A-E-P. During that time people eligible for Medicare Advantage may enroll or end their enrollment in a Medicare Advantage Plan.
The 2012 A-E-P occurs October 15 th through December 7 th. Most enrollments submitted during this period will have an effective date of January 1 st, 20-13. If you have a special enrollment period or initial coverage election period you may be able to enroll with an earlier effective date. If you have questions please call our Member Services department for more information or refer to the Medicare and You handbook for more information on enrollment periods. After you enroll you will receive some important items from Optimum Healthcare including your I-D card and evidence of coverage a provider directory and if your plan offers Part D coverage a pharmacy directory and your formulary or list of covered drugs as well as other member materials. Here s a sample of an Optimum Healthcare I-D card and the information it provides. On the front you ll find your plan benefits for your pharmacist, if your plan offers Part D coverage your Optimum Healthcare identification number the year you joined Optimum the name of your Optimum Medicare Advantage Plan and your plan number. On the back are the up-front payments or co-pays for your plan benefits Member Services contact information as well as information for your doctor pharmacist or hospital. If you want questions about your benefits answered face to face we invite you to stop by one of our seven local concierge centers which are open Monday through Friday from 8 in the morning until 5 in the evening. Optimum Healthcare has offices in Casselberry Bradenton Spring Hill Ft. Myers Tampa Vero Beach and Ocala to best serve its members. At each location you ll find helpful staff licensed agents and a one hour resolution time. To find an address close to you go to our website at w-w-w dot optimum healthcare dot
com. (VICTOR RIVERA) Day in, day out, Optimum Healthcare means client focused. The most important person in the equation is our members so we really go above and beyond our duty to make sure that they re happy, to make sure that they re getting the things that they need. So that culture really is client focused, making sure that the members are getting the services that they deserve. There are more than a dozen important preventive services available to Optimum Healthcare members at zero cost. They include bone mass measurements cardiovascular colorectal and diabetes screenings flu shots glaucoma tests mammograms and the list goes on and on. Benefit limitations may apply so be sure to review your Evidence of Coverage or ask your representative for complete details of your coverage. Your health is important and it changes on a daily basis. Optimum Healthcare wants to help you track these changes by providing the Health Assessment Tool or HAT. Once you submit a HAT Optimum uses it to coordinate any specialized care that you may need or to qualify you for any specialized health and wellness programs or education available. The HAT will not be used to disqualify you and will not impact your enrollment with Optimum Healthcare. (2-SHOT/HOST) You may have questions about what you have learned here today. Optimum Healthcare has answers and we want to make finding those as easy as possible. We encourage you to meet with the benefit consultant who is with you now. Or you can always go to our website w-w-w dot optimum healthcare dot com or call Member Services at 1-866-245-5360.
T-T-Y T-D-D users should call 1-800-955-8771. These numbers are available seven days a week from 8 A-M to 8 P-M October 1st 20-12 through February 14 th 20-13. Or from February 15 th 20-13 through September 30 th 20-13 Monday through Friday 8 A- M to 8 P-M. And from October 1 st 20-13 through December 31 st 20-13 seven days a week from 8 A-M to 8 P-M. Thank you for your time today. Remember Optimum Healthcare is Care You Can Trust.