humana medicare advantage and prescription drug plans 2014 presentation y0040_spm_spre_mapd_14...
TRANSCRIPT
Humana Medicare Advantage and Prescription Drug Plans
2014 Presentation
Y0040_SPM_SPRE_MAPD_14 Approved GNHH31KHH_14
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• Are you eligible?
• Choosing the right Humana plan for you
• Your Medicare coverage options
• Humana’s plans and extras
• How to enroll
Let’s talk about . . .
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Medicare/Medicaid Coverage (Dual-Eligible):Do you qualify?
• Contact Humana for more informationon all of the special benefits and services available to you through Humana’s Dual Eligible Special Needs Plans (SNP).
• If you choose to enroll in a cost share protected Dual-Eligible SNP, you will notbe responsible for paying any premiums, deductibles, coinsurances or copayments associated with this plan’s medical services.
Medicare/Medicaid Coverage (Dual-Eligible):
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Are you eligible for a Medicare Advantage Plan?
• Enrolled in Medicare Part A and Part B?
• Permanent resident in service area?
• Have End-Stage Renal Disease (ESRD)?– End Stage Renal Disease is permanent kidney failure usually requiring dialysis or a kidney
transplant. People with ESRD stay with Original Medicare.
– Federal law won’t let us accept anyone with End-Stage Renal Disease – often called kidney failure – unless you:
1.Have another health plan from the same organization within the same state, or
2.Were enrolled in a Medicare Advantage plan that was terminated or discontinued after Dec. 31, 1998, and this is your first election since that happened.
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2014 Plan Year - Medicare Timeline
Compare plans so you’ll be ready to enroll beginning Oct. 15.
Pre-Enrollment: Oct. 1 – Oct. 14, 2013
Annual Election:Oct. 15 – Dec. 7, 2013
Annual Disenrollment: Jan. 1 – Feb. 14, 2014
Feb. 15 – Oct. 14, 2014
Note: This information doesn’t apply to Medicare Supplement Plans
If you’re eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan with or without prescription drug coverage. Or you may choose to enroll in a stand-alone prescription drug plan.
Medicare Advantage plan members may disenroll from theirMA plan and return to Original Medicare. They may also elect enrollment in a stand-alone drug plan
You can’t make a plan change unless special circumstances arise (e.g., you move, you qualify for or lose eligibility for Medicaid).
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Humana offers a wide range of productsand services that incorporate an integrated approach to lifelong well-being.
Dedication to the community• More than 50 years of helping people
of all ages
Financial stability•Fortune 100 company
National coverage• Providing Medicare plans in 50 states,
Puerto Rico, and the District of Columbia
Experience behind the coverage
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• What type of plan do you have now?
• What do you like about your coverage?
• What would you add to your current coverage to make it ideal for you?
• Who helps you make decisions about your healthcare?
The right Humana plan for you
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Medicare Today
Original MedicareID Card
Medicare Supplement ID Card
Medicare Part D ID Card
All you need with Medicare Advantage is one card.
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You receive a service, you pay a fee
• Usually pay a monthly premium for Part B
• You will have access to any doctor or provider that accepts Medicare
• Out-of-pocket costs include hospital and medical deductible and coinsurance
• May want to purchase separate Medicare Supplement insurance and Prescription DrugPlan to cover gaps
Original Medicare
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Medicare Supplement insurance (also referred to as a Medigap policy)
•Purchased from private insurance companies
•Supplements Original Medicare coverage
•Covers some costs Original Medicare doesn’t pay
•Original Medicare pays before the Medicare Supplement plan provides payment
•Plans are standardized and can be purchased with varying coverage options
•Medicare Supplement plans have no provider networks
Original Medicare + Medicare Supplement insurance
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What are Medicare Advantage (MA) health plans?
• Private insurance companies approved by Medicare provide this coverage
• Provides Medicare beneficiaries a choice in how they receive Medicare coverage
• MA plans are not Medicare Supplement insurance plans
• These plans must offer all benefits of Original Medicare and can include Part D prescription drug coverage
• All plans offer maximum out-of-pocket protections
• MA plans include emergency coverage when traveling outside the US
Humana.com
Why choose Medicare Advantage?
• Most plans offer health and drug coverage
• Most plans have lower out-of-pocket costs than Original Medicare
• Extra benefits and savings* – Mail-order pharmacies – Prescription medicine discounts – Dental, vision and hearing care
discounts – Nurse advice line – Fitness programs – Care management programs
• Very little paperwork compared to Original Medicare
* Not all benefits listed are available on all plans
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More plan choices with Medicare Advantage
Medicare Advantage (MA) plans
• Health Maintenance Organization (HMO) FIND OUT MORE
• Preferred Provider Organization (PPO) FIND OUT MORE
• Private-Fee-for-Service (PFFS) FIND OUT MORE
Part D Medicare PrescriptionDrug coverage
• May be purchased as a stand-alone plan; or
• As part of a Medicare Advantage Prescription Drug Plan (MAPD)
All plans must meet minimum coverage level set by Medicare
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Health Maintenance Organization (HMO)
• Defined network of providers
• Primary care physician (PCP) coordinatesall of your care
• You may have to receive a referral from your PCP to see a specialist
• In most cases, you must use network providers for all scheduled care. There is no coverage for out-of-network care, except for emergency or urgent care
• Out-of-pocket costs may be significantly lower than Original Medicare
Is an HMO right for you?
Go to: Is a Stand-Alone drug plan right for you?
Humana.com
Dual Eligible Special Needs Plan (SNP)
• Additional benefits over Medicaid• Enhanced care management services• Defined network of providers• Primary care physician (PCP) coordinates all of your care• Individualized care plan that caters to your needs• In most cases, you must use network providers for all scheduled care• No coverage for out-of-network care, except for emergency or urgent care
Go to: Is a Stand-Alone drug plan right for you?
Humana.com
Chronic Condition Special Needs Plan (SNP)
• Additional benefits tailored to members with certain chronic conditions• Enhanced care management services• Defined network of providers• Primary care physician (PCP) coordinates all of your care • Individualized care plan that caters to your needs• In most cases, you must use network providers for all scheduled care. • No coverage for out-of-network care, except for emergency or urgent care
Go to: Is a Stand-Alone drug plan right for you?
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Preferred Provider Organization (PPO)
• Defined network of providers
• Flexibility to use providers who aren’t part of the network
• Out-of-pocket costs may increase significantly when you use out-of-network providers, facilities or labs, except for emergency care*
• You may save more when you use network providers because the plan pays a larger share of the cost
* In some cases, the costs are the same in- and out-of-network
Is a PPO right for you?
Go to: Is a Stand-Alone drug plan right for you?
Humana.com
Private-Fee-for-Service (PFFS)
• No referral needed to see any doctor
• Most plans include provider networks, but any provider can participate under the following conditions:
– Your doctor must agree to accept the Private-Fee-for-Service plan’s payment terms and conditions
– For plans with Rx, you must use network pharmacies to obtain prescription drugs, except in emergencies or urgent situations
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Is a PFFS right for you?
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PFFS plan review
Private-Fee-for-Service (PFFS)
• Before seeing a provider, you should consider...
– A Private Fee-for-Service plan is not a Medicare supplement plan. Providers who do not contract with our plan are not required to see you except in an emergency.
– If they choose to provide services, they must bill the Private-Fee-for-Service plan for your covered healthcare services. They may not bill you.
– If your PFFS plan has a network, you can still receive services from non-network providers, but you may pay more to see a doctor or other healthcare professional who isn’t in our network.
– Private-Fee-for-Service plans do not pay after Medicare pays its share.
– You’re required to pay the appropriate deductibles, copayments, and coinsurance
Humana.com
PFFS plan review
Private-Fee-for-Service (PFFS)
• We have network providers – providers who have signed contracts with our plan – for all services covered under Original Medicare in our fully networked plans.
• For partial network plans, contracted providersare limited to certain Durable Medical Equipment providers, home health providers, and some freestanding labs. These providers have agreedto see members of our plan.
• Providers can find the plan’s terms and conditionsof payment on our website:
https://www.humana.com/medicare/products-and-services/medicare-advantage/humana-gold-choice/humana-gold-choice-terms
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Go to: Is a Stand-Alone drug plan right for you?
Humana.com
Is a stand-alone drug plan right for you?
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Medicare Part D Prescription Drug Plans (PDP)
• Plans offered by private companies under contract with Medicare
• Companies may offer plans with different levels of coverage
• Check your prescription drug needs with the plan’s coverage and drug list as well as with your cost for those drugs
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The basic plan (defined by Medicare). All Part D plans are required by law to offer benefits equal to or better than:
Basic prescription benefit
* See Coverage in the Gap on following slide** Annual Out-of-Pocket Amount doesn’t include monthly premiums.
2014 Medicare Prescription Drug Plan - Basic Coverage
2014 Basic Benefits You Pay
Deductible $310 100% of first $310
Initial Coverage Limit $2,850 25% of the next $2,540 ($635)
Coverage Gap* $3,60547.5% of covered brand name and 72% of generic drugs of the next $3,605 until the cumulative out-of-pocket costs reach $4,550
Annual Out-of-Pocket Amount $4,550**
Catastrophic Coverage Medicare and Plan 95%$2.55 for generic/multiple-source drug and $6.35 for all other drugs; or 5% coinsurance, whichever is greater
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Get to Know the Coverage Gap
* applies only to drugs covered by the selected plan**some plans have additional coverage while the member is in the gap.
Chances are, you’ve heard of the Medicare prescription drug “coverage gap” - also called the “donut hole.” The coverage gap is the period when you
have to pay part of your drug costs - and before additional Medicare coverage kicks in.
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Do you wonder if you can afford your prescription medicines?
• Call to see if you may qualify for money the Federal government has set aside to help people with their drug expenses:
— 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, seven days a week
— The Social Security office at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. - 7 p.m., Monday – Friday
— Your state Medicaid office
Extra help
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Find out about your Humana benefits
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In-Network Providers
Like Medicare, Humana cannot guarantee that your provider is in or will remain part of a plan network. Here are two ways you can determine whether your provider accepts your Humana Medicare Advantage Plan:• Use Humana’s online provider look-up,
Physician Finder• Call your provider’s billing department
and ask if the provider accepts the specific Humana plan you are considering
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You have unique needs for staying healthy. That’s why Humana offers optional supplemental benefits* (OSBs).
OSBs are extra benefits not included in Original Medicare that:•Provide choices that make it easier for you to get coverage you want •Control costs and personalize your benefit needs•Can be added when you enroll in Medicare Advantage or any time during the year
These benefits have an extra premium, which is combined with your Medicare Advantage plan premium.
* May not be available on all plans
Add optional benefits
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Availability of all varies by plan:
• Mail-order pharmacies, like Humana-owned RightSource®*
• Fitness program
• 24-hour nurse advice line
• SmartSummary®
• Humana Active Outlook® (HAO)
• Personal health coaching
• Online tools on Humana.com and m.humana.com
* Other pharmacies are available in our network
Enjoy extra value and possible savings
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If you choose to enroll with Humana
Complete an application
In the next two weeks:
If you choose to enroll with Humana
Receive your Humana member identification (ID) card
Member Benefit Package arrivesin your mailbox
Welcome Call - We’ll contactyou about completing a health questionnaire
Humana processes your application and confirms your eligibility
You’ll receive a verification call for each enrollee in the household
Medicare confirms your enrollment
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In the months to come:• Your Humana agent calls you
• Receive your Evidence of Coverage
• Annual Wellness Visit
• Use your preventive benefits
• Find out if you can save by using a mail-order pharmacy
When enrolled, you can expect the next steps
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Any questions?Where to find information:• “Medicare and You 2014” handbook
(available in October or November 2013)
• www.medicare.gov
• Your local State Health InsuranceProgram (SHIP)
• Humana-Medicare.com
• Humana offers Member kickoff meetings
– Bring the Humana Guide from your Member Benefit Package
Thanks for your time and attention
Humana is a Medicare Advantage organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in this Humana plan depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Humana MyOption Optional Supplemental Benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1 each year.
This information is available for free in other languages. Please contact our Customer Care number at 1-800-457-4708 (TTY: 711) for additional information. Hours are 8 a.m. to 8 p.m., seven days a week through Feb. 15, 2014 and 8 a.m. – 8 p.m. Monday – Friday the rest of the year.
Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al 1-800-457-4708 (TTY: 711) si desea mayores informes. El horario es de 8 a.m. a 8 p.m., los siete días de la semana hasta el 15 de febrero de 2014 y de 8 a.m. a 8 p.m. de lunes a viernes por el resto del año.
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