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Medicare Advantage Plans 2015

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Today’s Topics

• Medicare Basics

• Medicare Advantage (MA) Plans

• Eligibility and Enrollment periods

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What is Medicare?

Medicare is a Health Insurance Program for those:

• Age 65 or better

• Under age 65 with certain disabilities

• Any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

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Two Paths to Medicare Coverage

1 You are free to use any hospital or physician that is a Medicare contracted provider.

2 You must use network hospitals and doctors for maximum coverage and in non-emergency situations.

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Two Paths to Medicare Coverage

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Medicare Advantage Plans

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What is a Medicare Advantage Plan?

• A Medicare Advantage Plan (Part C or MA Plan) is a private health insurance plan that replaces Original Medicare (Parts A & B)

• Some MA plans include prescription drug coverage (Part D) and are referred to as Medicare Advantage Prescription Drug plans (MAPD)

• Think of MAPD as your all-in-one plan, covering all of your hospital and medical insurance and prescription drugs

• Medicare Advantage Plans are not Medicare Supplement insurance plans; they are different from Medicare Supplement insurance

A B CD MAPDDHospital Medical Rx Drug Rx DrugHospital &

MedicalAll-In-One Coverage

+ + += =

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MAPD (Part C)Includes Both Parts A & B

Original Medicare andMedicare Advantage

Note: If you have a MA or MAPD Plan, you do not need and cannot be sold a Medicare Supplement Insurance (Medigap) Plan

Original MedicarePart A & Part B

Will need to purchase a separate prescription drug plan (Part D)

Includes prescription drug coverage if MAPD

Pay monthly Part B premium Pay monthly Part B minimum plus a monthly premium (depending on plan)

You choose doctors and hospitals that accept Medicare patients

In most plans, you need to use the plan’s doctors and hospitals or you pay more or all of the costs

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How is Medicare Advantage different from Medicare Supplement?

If you have an MA or MAPD Plan, you do not need and cannot purchase a Medicare Supplement Plan

MAPD Medigap

Includes physician office visits and hospital stays similar to Original Medicare

Helps pay remaining charges after a Medicare-covered service

Includes prescription drug coverage

Does NOT include prescription drug coverage

Requires you to use doctors and pharmacies that are part of the network to help keep cost lower

Choose any doctor that accepts Medicare

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Types of MAPD Plans

The most popular options include:

1. Health Maintenance Organization (HMO) plans

2. Preferred Provider Organization (PPO) plans

3. Private Fee-for-Service (PFFS) plans

Less common options include:

4. HMO Point-of-Service plans

5. Special Needs plans

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Medicare Advantage Plans

May include Extra Coverage:

1. Vision

2. Hearing

3. Dental

4. Health and Wellness

5. Prescription Drug Coverage

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How Much Does a Medicare Advantage Plan Cost?

Each Medicare Advantage Plan determines the out-of-pocket costs you will pay. Out-of-pocket expenses in a Medicare Advantage Plan can depend on:

• Whether the plan charges a monthly premium

• Whether the plan pays any of your monthly Part B premium

• Whether the plan has a yearly deductible or any additional deductibles

Note: You must continue to pay your Part B premium

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How Much Does a Medicare Advantage Plan Cost?

Out-of-pocket expenses in a Medicare Advantage Plan can depend on:

• How much you pay for each visit or service (copays or coinsurance)

• The type of health care services you need and how often you use them

• Whether you follow the plan’s rules, like using network providers

• Whether you need extra benefits and if the plan charges for them

• The plan’s yearly limit on your out-of-pocket expenses for all medical services

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Medicare Advantage Facts

• You are still in the Medicare program

• You still have Medicare rights and protections

• Plans cannot charge more than Original Medicare for certain services (e.g., chemotherapy and dialysis)

• Medicare Advantage Plans must cover all of the services covered by Original Medicare except hospice care

• You pay as you go

• Your Medicare services are NOT paid for by Original Medicare, but by the Medicare Advantage plan you choose

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How Medicare Advantage Plans Work

• When you go to the doctor, show your Medicare Advantage card from the plan you select – NOT your Medicare card

• You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan!

• All MA Plans must have an Annual Out-of-Pocket Expense (OPX) Limit

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What is an Annual Out-of-Pocket Expense (OPX) Limit?

• Medicare Advantage Plans have a cap on how much you pay for Part A and Part B services during the year

• This yearly maximum out of-pocket amount can be ‑different between Medicare Advantage Plans

• For MAPD plans, there is a separate out-of-pocket expense for prescription drug coverage

• You should consider this when you choose a plan

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Eligibility & Enrollment Periods

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Who is eligible to enroll in a Medicare Advantage Plan?

If you answer “yes” to both of the following questions, you are eligible to enroll in a Medicare Advantage plan:

• Are you enrolled in Part A and Part B?

• Is your primary residence in the plan’s service area?

Note: You cannot enroll if you have End-Stage Renal Disease (ESRD) unless you have been a member of that plan while receiving treatment

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When can you enroll in a Medicare Advantage Plan?

• Initial Enrollment Period (IEP)• Sign up when you first become eligible• The 7-month period starts 3 months

before the month you turn 65, includesthe month you turn 65, and ends 3 months after the month you turn 65

• Annual Enrollment Period (AEP)• October 15 to December 7• Enroll for the first time or switch plans• Note: If you like what you have, there is no need to switch

• Special Enrollment Period (SEP)• Enroll or switch plans due to special circumstances

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Disenrollment Period

January 1 to February 14:

During this period, you cannot do the following:

• Switch from Original Medicare to a Medicare Advantage Plan

• Switch from one Medicare Advantage Plan to another

• Switch from one Medicare Prescription Drug Plan to another

• **SEP Trial Rights

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Resources

Medicare• Visit www.medicare.gov for online tool• 1-800-MEDICARE (633-4227), 24 hours a day,

7 days a week• TTY/TDD 1-877-486-2048, 24 hours a day,

7 days a week

Social Security • Visit www.ssa.gov for online tool• 1-800-772-1213, Monday-Friday, 7 a.m. - 7 p.m.• TTY/TDD 1-800-325-0778, Monday-Friday, 7 a.m. - 7 p.m.

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Questions & Discussion

Call 1-877-592-3874

Sign up for future Medicare events:

www.bcbsil.com/medicare/seminars

Thank You!

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.