What's New for 2014?

Transcription

1 HEALTH CARE SERVICE CORPORATION (HCSC) Blue Cross Blue Shield of Illinois (BCBSIL) Blue Cross Blue Shield of Texas (BCBSTX) Blue Cross Blue Shield of Oklahoma (BCBSOK) Blue Cross Blue Shield of New Mexico (BCBSNM) 2014 MAPD AND PDP PLANS (PRELIMINARY)

2 MAPD PRODUCTS

3 MEDICARE PRODUCT THEMES FOR 2014 Range of products available that can be sold to a variety of customers (Medicare Advantage, Prescription Drug, and Medicare Supplement plans) Both Medicare Advantage & PDP products will be better in 2014 Lower cost sharing Competitive pricing Increased Compensation Supplemental benefits Dental Vision Hearing SilverSneakers Fitness Program Travel benefit Worldwide emergency care 3

4 IL MEDICARE ADVANTAGE - MA HMO Service area will continue to be 4 counties in Chicago area (Cook, DuPage, Will and Kane) Name Benefit New for 2014: SilverSneakers Fitness Program Hearing benefit Travel benefit Worldwide emergency coverage IL Plan Landscape Current 2013 IL HMO Plan Proposed 2014 IL HMO Plan Comparison Blue Cross Advantage Basic (HMO) Plan Number H H Premium $0 $0 - MOOP $3,400 $3,400 - Hosp Inpatient $240 Copay (days 1-7) $225 Copay (days 1-7) + Primary Care Physician $7 $5 + Specialist $45 $35 + Hosp Outpatient $300 $200 + PT/SP Therapy $50 $35 + Cardiac/Pul Rehab $50 $30 + RX (Preferred/Non-Preferred) Ded $325 $3/$11/$45/$95/25% $0-$5/$2-$7/$39-$44/$85- $95/33% + 4

5 IL MEDICARE ADVANTAGE MORE CHOICE Benefit Proposed HMO-POS IL Plan Landscape Proposed Premium HMO-POS Name $0 (POS plan) Basic HMO network with POS option Higher out of pocket costs than HMO (escape hatch) $38 (POS plan) Basic HMO network with POS option Richer benefits than $0 POS (escape hatch) Blue Cross Medicare Advantage Basic Plus (POS) Blue Cross Advantage Premier Plus (POS) Plan Number H H Premium $0 $38 MOOP $3,800 $3,500 Hosp Inpatient $250 Copay (days 1-7) $225 Copay (days 1-7) Primary Care Physician $10 $5 Specialist $45 $40 Hosp Outpatient $300 $250 PT/SP Therapy $40 $40 Cardiac/Pul Rehab $40 $40 RX (Preferred/Non-Preferred) $0-$5/$2-$7/$39-$44/$85- $95/33% $0-$5/$2-$7/$39-$44/$85- $95/33% 5

6 IL MEDICARE ADVANTAGE NETWORK ADVANTAGE Key network partners, physician and system, responsible and accountable for the quality and cost of patient care. Physician led, patient centered care. Integrated, team based, coordinated care services across provider specialties and settings anchored by primary care physicians meeting the Medicare population needs. Aligned incentives designed to promote delivery of cost effective care and improve health outcomes while maintaining high patient satisfaction. Note: Adding Hinsdale Physician Health to our MA network. Allows us to cover DuPage County more effectively than before. 6

7 NM MEDICARE ADVANTAGE - MA HMO Service area will expand into 2 additional counties in the Albuquerque area (Bernalillo, Sandoval, Torrance, Valencia) - MA PPO Service area will expand into 12 counties (Bernalillo, Sandoval, Torrance, Valencia, Cibola, Guadalupe, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Socorro) Benefit Current 2013 NM HMO Plan NM Plan Landscape Proposed 2014 NM HMO Plan Comparison Name Blue Cross Medicare Advantage Basic (HMO) Plan Number H H Premium $0 $0 MOOP $3,000 $2,400 + Hosp Inpatient $200 Copay (days 1-4) $150 Copay (days 1-5) $750 annual max + Primary Care Physician $5 $0 + Specialist $30 $20 + Ambulatory Surgical Centers (ASCs) $375 $150 + PT/SP Therapy $30 $5 + Cardiac/Pul Rehab $25 $25 - RXRX (Preferred/Non- Preferred) Ded $325 $3/$12/$45/$95/25% $0/5-$2/7-$35/40-$85/95-33% + * Counties in bold are new in

8 NM MEDICARE ADVANTAGE MORE CHOICE Name Benefit Proposed 2014 NM Premium HMO Plan Blue Cross Medicare Advantage Premier (HMO) NM Plan Landscape Proposed 2014 NM Buy Down HMO Plan Current 2013 NM HMO-POS Plan Blue Cross Medicare Advantage Value Blue Cross Medicare Advantage (HMO) Premier Plus (HMO-POS) Proposed 2014 NM PPO Plan Blue Cross Medicare Advantage (PPO) Plan Number H H H H Premium $32 $0 $37 $27 MOOP $1,500 $2,800 $2,350 $4,500 $6,500 Hosp Inpatient $100 Copay (days 1-4) $300 Copay (days 1-4) $200 Copay (days 1-4) $150 Copay (days 1-7) Primary Care Physician $0 $5 $5 $10 30% Specialist $15 $20 $20 $35 30% Ambulatory Surgical Centers (ASCs) $150 $200 $200 $125 30% PT/SP Therapy $5 $25 $25 $40 30% $300 Copay (days 1-7) Cardiac/Pul Rehab $10 $30 $30 $45 30% RXRX (Preferred/Non-Preferred) $0/5-$2/7-$35/40-$85/95-33% $0/5-$2/7-$35/40-$85/95-33% $0/5-$2/7-$35/40-$85/95- $0/5-$2/7-$35/40-$85/95-33% 33% $32 premium HMO Basic HMO network plan with richer benefits than than the $0 HMO plan HMO Buy down plan (Part B buy-down of $10) Basic HMO network Leaner benefits than the $0 HMO, but HCSC contributes to the members Part B premium $37 HMO-POS Basic HMO network with POS option Similar benefits to the HMO, but with the ability to go out of network (escape hatch) $27 Blue Cross Medicare Advantage Choice (PPO) will be offered Large PPO network Competitive plan for people who like a PPO out of network option Also new in 2014, an HMO-SNP plan: Blue Cross Medicare Advantage Dual Care (HMO-SNP) Eligible for Centennial Care Enrolled in HCSC Centennial Care Buy-Down of All Medicare A/B Cost Share Includes Supplemental Benefits (Dental, Vision, Hearing aid allowance and SilverSneakers Fitness Program 8

9 NM MEDICARE ADVANTAGE NETWORK ADVANTAGE Key physician network partner with ABQ Health Partners Physician led, patient driven centering around patient s needs Team approach network of nurses, specialists, case managers, diagnostic team members and others, all working in sync to help our patients stay healthy Total Care Model is a patient-centered comprehensive model designed to help carefully manager our patient s health Proven to increase quality outcomes and patient satisfaction while still reducing healthcare costs 9

10 TX MEDICARE ADVANTAGE - MA PPO Service area will continue in 15 counties in the Dallas, Austin, and Houston area (Collin, Dallas, Denton, Tarrant, Fort Bend, Harris, Montgomery, Bastrop, Burnet, Caldwell, Fayette, Hays, Lee, Travis, Williamson) Benefit Supplemental benefits included on the Texas PPO plans: Dental Vision Hearing SilverSneakers Fitness Program Travel benefit Worldwide emergency care TX Landscape Current 2013 TX PPO Plan Proposed 2014 TX PPO Plan (high) Proposed 2014 TX PPO Plan (low) Comparison Plan Number H to 003 H to 003 H to 006 Premium $69.90 $54 $ IN OON IN OON IN OON MOOP $3,400 $5,000 $3,400 $5,000 $3,400 $5,100 - Hosp Inpatient $250 Copay (days 1-7) $250 Copay (days 1-7) $250 Copay (days 1-7) $400 Copay (days 1-7) $300 Copay (days 1-7) 40% - Primary Care Physician $15 30% $5 30% $10 40% + Specialist $45 30% $35 30% $40 40% + Ambulatory Surgical Centers (ASCs) $125 30% $125 30% $125 40% - PT/SP Therapy $45 30% $40 30% $40 40% + Cardiac/Pul Rehab $45 30% $40 30% $40 40% + RX Ded $325 $3/$10/$43/$95/25% $0-$5/$2-$7/$39-$44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85-$95/33% + 10

11 OK MEDICARE ADVANTAGE - MA HMO Service area will expand into 8 counties in the OKC area (Canadian, Cleveland, Grady, Lincoln, Logan, McClain, Oklahoma, Pottawatomie) - MA PPO Service area will expand into 10 counties in the OKC area (Comanche, Canadian, Cleveland, Garfield, Grady, Lincoln, Logan, McClain, Oklahoma, Pottawatomie Benefit Proposed 2014 OK HMO Plan OK Plan Landscape Proposed 2014 OK HMO-POS Plan $0 Basic HMO plan Basic HMO network plan with competitive benefits A $39 HMO-POS plan Basic HMO network with POS option Similar benefits to the HMO, but has the ability to go out of network (escape hatch) A $54 PPO plan Large PPO network Competitive plan for people who like a PPO out of network option Proposed 2014 OK PPO Plan Name Blue Cross Medicare Blue Cross Medicare Advantage Blue Cross Medicare Advantage Advantage Basic (HMO) Premier Plus (HMO-POS) Choice (PPO) Plan Number H H H Premium $0 $39 $54 IN OON IN OON MOOP $4,500 $4,500 $3,400 $5,000 Hosp Inpatient $250 Copay (days 1-4) $250 Copay $250 Copay $325 Copay $400 per day (days 1-5) (days 1-7) (days 1-7) Primary Care Physician $5 $10 $50 $10 30% Specialist $35 $35 $50 $35 30% Ambulatory Surgical Centers (ASCs) $175 $175 40% $175 30% PT/SP Therapy $35 $40 40% $35 30% Cardiac/Pul Rehab $35 $35 40% $35 30% RX (Preferred/Non-Preferred) $0-$5/$2-$7/$39- $44/$85-$95/33% $0-$5/$2-$7/$39-$44/$85- $95/33% $0-$5/$2-$7/$39-$44/$85- $95/33% 11

12 PDP PRODUCTS

13 OVERVIEW OF NEW BASIC PLANS AND IMPROVED VALUE AND PLUS OFFERINGS Blue Cross MedicareRx Basic (PDP) SM (NEW PRODUCT FOR 2014) Value Propositions: Provides a low cost option to the healthier Age In population and a less expensive alternative for those that combine Part D with Medicare Supplement. Only about 40% of our Med Supp members have our Part D Benefits & Sales Stories: Monthly premiums at about 50% of the cost of our current Basic Plan offerings; most Tier 1 & 2 drugs can be obtained for $2 or less; products to compete with United and Humana low cost options Blue Cross MedicareRx Value (PDP) SM Value Propositions: Lower cost enhanced offering with better benefits than the previous Value Plans. Offers our largest client base a product with lower deductibles, cost sharing and monthly premiums. Benefits & Sales Stories: Monthly premiums are about $2 less than the current Value Plans; all Tier 1 & 2 drugs can be obtained for $2 or less; lower initial deductible than Value Plans in 2013 Blue Cross MedicareRx Plus (PDP) SM Value Propositions: Improved high end option, that provides less expensive cost sharing levels and coverage on all generics as well as some brands in the gap. Benefits & Sales Stories: All Tier 1 & 2 drugs can be obtained for $2 or less; gap coverage extended from all generics to include some brands; possible to have $0 cost share until the catastrophic phase with Tier 1 drugs at Preferred Pharmacies 13

14 ISSUES ADDRESSED WITH THE 2014 BLUE CROSS MEDICARERX (PDP) SM PRODUCT DESIGNS 2013 Issue or Competitive Deficiency 2014 PDP Plan Solution No Low Cost option to compete with Humana and United s Plans Value Plans are not competitive in terms of premium Opportunity for members to fill prescriptions at a preferred pharmacy for a discount Robust offering of Tier 1 generics and deductible only counting on Tiers 3-5, were not as beneficial as anticipated HISC will offer Basic Plans that are competitive on benefits and premium to United and Humana For 2014 there will be an inexpensive Basic offering and the Value Plans will be about $2 cheaper per month with better benefits than 2013 Members will save at least $5 per 30 day on Tiers 1-4 at CVS, Wal-Mart/Sam s Club, a local grocer and an independent pharmacy group The Basic offerings have a deductible on all tiers and Value/Plus Plans have narrower Tier 1 formulary; similar to competitors offerings 14

15 NEW PREFERRED NETWORK PHARMACIES FOR ALL STATES IN 2014 The preferred network option has no impact on whether a member can fill at any of the 63,000+ network pharmacies nationwide Members can save at least $5 per 30 day fill on all three PDP Plans, if they fill at a preferred pharmacy versus any other network pharmacy Tier 1 & 2 drugs on all three PDP Plans can be obtained for $2 or less at a preferred pharmacy during the initial coverage period (OK is $4 or less on the Basic Plan) Discounts not applicable to deductibles, but do apply to gap coverage on the Plus Plans Preferred Network Pharmacies for 2014: CVS Wal-Mart/Sam s Club SuperValu (Jewel/Osco), HEB & Albertson s Good Neighbor Independent Pharmacies and PPOK 15

16 BLUE CROSS MEDICARERX BASIC (PDP) SM OFFERING DETAILS FOR 2014 We currently don t have a plan that competes with the price point of the AARP United and Humana Wal-Mart Plans New for 2014 HISC will be introducing a low cost option that will compete well in the marketplace with existing low cost plans Meets the needs of a wider spectrum of the over 65 population Matches United's and beats Humana s Tier 1 & 2 pricing at Preferred Pharmacies Premium range from $14 to $26 for 2014, which is in line with other similar offerings Highlights and Sales Points on the New Blue MedicareRx Basic Plan in Illinois: Most premiums are in the low to mid $20 s, in line with United and Humana Basic Plan Offerings; NM is $14.90 Members can obtain Tier 1 & 2 drugs for $2 or under at Preferred Pharmacies; in OK it is for $4 or under Provides another option to use in tandem sales with Medicare Supplement Offerings Provides alternative to the healthier Age-In population that had be unaddressed 16

17 CHANGES TO BLUE CROSS MEDICARERX VALUE (PDP) SM IN Value Plan 2014 Value Plan $325 deductible only counts towards Tiers 3-5 Tier 1 drugs were $3 and Tier 2 were $10-$14 at any Pharmacy No discounted cost sharing for Preferred Pharmacies No Insulin option on Tier 1 or 2 Premiums in high $30 s to low $40 s in all States Broad range of generics on Tier 1 $200 or $275 deductible only counts towards Tiers 3-5 Tier 1 drugs are $0 and Tier 2 are $2 at Preferred Pharmacies Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 Insulin option available on Tier 2 Premiums around $2 cheaper per month in all States Narrow more focused set of generics on Tier 1 With the addition of the Blue Cross MedicareRx Basic (PDP) SM Plan, the Value plan is now an Enhanced Alternative under CMS guidelines Members will not be moved if they are currently a part of the Value Plan Deductible is $200 in NM and TX and $275 in IL and OK 17

18 CHANGES TO BLUE CROSS MEDICARERX PLUS (PDP) SM IN Plus Plan 2014 Plus Plan All generics covered in the gap Tier 1 drugs were $3 and Tier 2 were $10 at any Pharmacy No discounted cost sharing for Preferred Pharmacies No Insulin option on Tier 1 or 2 Premiums under $100 in all States Broad range of generics on Tier 1 All generics and some brands covered in the gap Tier 1 drugs are $0 and Tier 2 are $2 at Preferred Pharmacies Out of Preferred Pharmacies, Tier 1 is only $5 and Tier 2 is $7 Insulin option available on Tier 2 Premiums around $100 in all States, with better benefits Narrow more focused set of generics on Tier 1 Since there will be two Enhanced Alternatives in 2014, the Plus Plan now includes coverage of some brand drugs in addition to all generics in the coverage gap Tier 1 generics are now more narrowly focused on major CMS disease states for both the Plus and Value Plans 18