there’s so much more to medicare, let’s talk
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There’s So Much More to Medicare, Let’s TalkThere’s So Much More to Medicare, Let’s Talk
Humana Medicare Advantage Health and Prescription Drug Plans
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Do you know how much Humana is projected tosave its 4.5 million Medicare Advantage andPrescription Drug Plan members in 2006?
$3.8 Billion
*This number is based on CMS published average savings per member per year of $1,100. In the first six months of 2006 Humana saved its Medicare Advantage and Prescription Drug Plans members over
$1.5 billion dollars.
Welcome!Welcome!
There’s so much more to Medicare…
Let’s Talk
Before we get startedBefore we get started
Make sure you’re comfortable
Pens and pencils ready
Turn off your cell phones and pagers
Keep your needs in mind
Let’s talk about…Let’s talk about…
Humana – Experience Behind The Coverage
What’s Important to YOU
Your Options Under Medicare
Coverage Options For 2007
Specific Plan Benefits
How To Enroll
Who is Humana?Who is Humana?
A Company You Can Trust Your Healthcare Solution
Enrolled in Medicare Part B and entitled to Part A?
Permanent resident in service area?
Do you have End Stage Renal Disease (ESRD)?
Are you eligible?Are you eligible?
Federal law will not allow us to accept anyone who has end stage renal disease (kidney failure), unless you: (1) Are a member of another health plan or offered by Humana within the same state, or (2) Were enrolled in a Medicare Advantage plan which was terminated or discontinued after December 31, 1998 and this is your first election following that
plan termination or discontinuance.
How Do I Choose The Right Plan for My Needs?How Do I Choose The Right Plan for My Needs?
What type of plan do I currently have? What do I like about my current coverage? If I could, what would I change about my current coverage? Do I need a Part D prescription drug plan or does my current
plan include RX? What are my goals?
– Comprehensive Coverage, including other services
– Reduce my out-of-pocket expenses
– Freedom to choose my own physician
– Coverage while I travel
– Services outside of traditional health benefits Do I rely on anyone to assist me in these types of decisions?
Today’s Medicare Environment Includes More Today’s Medicare Environment Includes More Coverage ChoicesCoverage Choices
What are Medicare Advantage Health What are Medicare Advantage Health Plans?Plans?
Includes all the benefits of:Original Medicare(Part A - Hospital)(Part B - Medical)
Today’s Medicare EnvironmentIncludes More Coverage Options for you!
Medicare Advantage health plan only (MA only)
MA only with stand - alone Part D
MAPD - MA health plan with Part D included
1 plan, 1 plan premium, 1 company
Today’s Medicare Environment - More Today’s Medicare Environment - More ChoicesChoices
What are Medicare Advantage (MA) health plans?
They are health plan options that are part of the Medicare program
Medicare pays the plan a set amount every month for
your care
MA plans must offer all benefits of Original Medicare and coverage can include Part D prescription drug coverage
You may have to use providers that participate with the plan
In most plans, there are generally extra benefits and out-of-pocket costs that are lower that with Original Medicare
How Can Medicare Advantage Plans Offer More Coverage
How can Medicare Advantage plans offer morebenefits for little or no monthly plan premiums*
When youchoose to receiveyour Medicarebenefits througha company like Humana
The Companybasically becomes“Medicare” for you
Medicare pays acompany like Humanato provide yourbenefits
The companyNegotiates to draw down prices that provide lowerpremiums andmore benefits for you
* You must continue to pay applicable Medicare premiums
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
Original Medicare Coverage Fee-for-service – you receive a service, you pay a fee Access to any doctor or provider that accepts Medicare Out-of-pocket costs may be significantly higher as more
services are used May want to purchase separate supplemental insurance to
cover gaps
Medicare Supplement Insurance Purchased separately from private insurance companies Supplements Original Medicare coverage Covers costs that Original Medicare doesn’t pay up to what
Medicare allows All plans are standardized and can be purchased with varying coverage options
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
Types of Medicare Advantage (MA) Plans Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Private Fee-For-Service (PFFS)
Plus, Medicare Prescription Drug Coverage – Part D May be purchase as a stand-alone plan As a part of an MAPD plan
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
So which type of plan is best for me?
Health Maintenance Organization (HMO) Defined network of providers Primary Care Physician (PCP) manages all of
your care You must have a referral from your PCP to see a
Specialist You must use network providers for all
scheduled care Out-of-pocket costs may be significantly lower
with an HMO plan
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
So which type of plan is best for me?
Preferred Provider Organization (PPO) Defined network of providers Allows flexibility to use providers who are not part of
the network No referral needed to see any doctor However, out-of-pocket costs increase significantly
when out-of-network providers are used Greatest saving for use of network providers because
the plan pays a larger share of the cost
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
So which type of plan is best for me?
Private Fee-For-Service (PFFS) No plan network Plan works similar to Original Medicare except the
insurance company pays for your services, not Medicare Freedom to use any provider that accepts Medicare and,
agrees to the plan’s payment terms You should check with your providers to make certain that
they are willing to accept the PFFS plan’s terms Out-of-pocket costs may be lower than with Original
Medicare coverage
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
So which type of plan is best for me?
Medicare Prescription Drug Plans - Part D (PDP) Plans offered by insurance companies May be offered as stand-alone plan or, as part of
an MAPD plan All plans must meet minimum coverage level set
by Medicare Companies may offer plans with increased
coverage You should evaluate your prescription drug
needs in relation to those covered by the plan, and your cost for those drugs
Today’s Medicare Environment Offers More Today’s Medicare Environment Offers More Plan ChoicesPlan Choices
So… how do I choose?
There are three basic factors to weigh when choosing a plan: Cost – Compare the out-of-pocket costs for the plan with what you
are currently paying including plan premium and copayment and coinsurance amounts.
Providers – Will the plan allow me to see the providers I need or want to see?
Benefits – Does the plan offer you the coverage and benefits you need?
Keep In Mind:
No matter which plan you choose to join, you are still a part of the Medicare program. With all of these plans you must continue
to pay your applicable Medicare premiums.
2007 Prescription Drug Plan2007 Prescription Drug Plan
By law, all plans must offer at least the basic benefits required by Medicare, outlined below. Any plan can offer more benefits, but no plan can offer less.
*You pay the greater of $2.15 for generic (including brand-name drugs treated as generic drugs) and $5.35 for all other drugs,OR 5% coinsurance
2007 Medicare Prescription Drug Plan Basic Coverage
2007 Basic Benefits You Pay
Deductible $265 100% of first $265
Initial Coverage Limit $2,400 25% of the next $2,135 ($533.75)
Coverage Gap $3,051.25 100% of next $3,051.25
Annual Out-of-Pocket Amount $3,850.00
Catastrophic Coverage Medicare and Plan 95% 5%*
Here’s What is Available in Your Area
Is a Humana plan suitable for you?
BasicBasic
• All the benefits of Original Medicare
• Part D Coverage (Majority of Humana plans include this)
• Unlimited doctor/specialist/hospital visits
• Emergency service & ER/Ambulance availability
• Affordable premiums
Basic + Extra BenefitsBasic + Extra Benefits
• All the benefits of Original Medicare
• RightSourceSM
• SmartSummarySM
• MyHumana
• www.humana-medicare.com & Rx CalculatorSM
Basic + Extra Benefits + Humana Active OutlookBasic + Extra Benefits + Humana Active Outlook
++
+
Silver SneakersSilver Sneakers
Humana Medicare Advantage & Humana Medicare Advantage & Prescription Drug PlansPrescription Drug Plans
Note: This information does not apply to Medicare Supplement Plans.
Important Dates for 2007Important Dates for 2007
For 2007 Description In 2006
Oct 1st - Nov 14th Plans can begin to share new benefits
for coming year
Nov 15th - May 15th
(180 days)
January 1st New plan coverage begins
January 1st
Jan 1st - March 31st
(3 months)
Can make one change - Medical
portion only
Jan 1st - Jun 30th
(6 months)
Where To Find More InformationWhere To Find More Information
“Medicare and You 2007” handbook (available in October or November 2006)
www.medicare.gov
Your local State Health Insurance Program (SHIP)
www.humana.com
Humana 1-800-337-0953 Seven days a week, 8 a.m. to 8 p.m. local time. If you have a speech or hearing impairment and use a TTY, call 1-877-833-4486 seven days a week, 8 a.m. to 8 p.m. local time.
How do I enroll?How do I enroll?
Application process
Effective date
Medicare card
Emergency contact information
Understanding your plan
Verification process
Silver Sneakers* Discuss only in applicable markets
What happens next?What happens next?
When you become a memberWhen you become a member
HUMANA Guidance When You Need It Most
Medicare approved HMO, PPO, and PFFS plans available to anyone enrolled in both Part A and Part B of Medicare through age or disability. A Medicare approved Prescription Drug Plan available to anyone entitled to Part A and/or enrolled in
Part B of Medicare through age or disability. Copayment, service area, and benefit limitations may apply. You must continue to pay your Medicare applicable premiums. A sales representative will be present with information and
applications. You must use network providers and pharmacies.
"This presentation is also available in alternative formats."M0006_GH210S6RR KC0906
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