Frequently AskedQuestions. Y For Your 2014 Medicare Enrollment

Transcription

1 Frequently AskedQuestions Y For Your 2014 Medicare Enrollment

2 Frequently Asked Questions For Your 2014 Medicare Insurance Enrollment As of November 8, 2013 TOPICS Enrollment Appointments/When to Call Prescription Profiler Plan Availability and Costs Qualifying for Your HRA Funding and Billing Based on feedback from IBM retirees, we are sharing the following information to help you better understand certain aspects of the enrollment process that are different and more heavily regulated than the process of signing up through the IBM Employee Service Center for IBM s group coverage. We hope that the following information will help make the transition into individual insurance plans as easy as possible. Enrollment Q: How long is the process to enroll with an Extend Health benefit advisor? A: Because the benefit advisors work with you personally, the duration of calls varies. Allow at least one hour per person to complete your enrollment; longer if you have not completed your online personal profile. Completing your personal profile before your call will save time. You will be asked to confirm your personal information by your benefit advisor to ensure that all the information is accurate, but this part of the call will take longer if the benefit advisor also has to enter the information for you. Most people are able to complete their enrollment in one call if they are ready to make a decision. You do not have to make a decision on your first call. Q: I ve heard about long wait times from some of my retiree friends. A: Some retirees experienced longer wait times early in the enrollment period, but that issue has been addressed and we apologize for any lengthy wait times. Monday call volume is typically higher, so we encourage you to call another day, when call volume is lower and you likely will have shorter wait times, if you do not have an appointment. Q: I have an appointment with Extend Health to complete my enrollment. What can I expect on that call? A: During your scheduled appointment, your benefit advisor will first verify your information, ask questions about your current plan and future needs, and talk to you about your Health Reimbursement Arrangement (HRA), if you are eligible for one. The benefit advisor will make recommendations based upon your needs and budget. This part of the process will take about 45 minutes because it is highly personalized. 2 Frequently Asked Questions (TTY: 711)

3 Once you have selected a plan or plans, an application data processor (ADP), who is an enrollment specialist, will work with you to complete the process. The ADP will let you know approximately how long the applications will take to complete. The length of time will be dependent upon the number of applications that need to be completed. The approximate length of time is 20 minutes per application. Instead of using a paper enrollment process, which takes time and introduces errors, Extend Health uses a real-time, automated enrollment process. This takes time, but it avoids the mailing, completion and processing of paper forms. While this process is long and your patience is appreciated, you will not have to complete any additional paperwork. The ADP, by law, is required to review your plan selections with you and confirm that you do want to enroll in the selected plans. For each application, you will be required to state your full name, address, Social Security Number (if applicable), date of birth as well as the date you would like the coverage to become effective. For most of you, that date will be January 1, This information is required by the Centers for Medicare and Medicaid Services (CMS) for enrollment in Medicare plans, and by the insurance carriers. Medicare regulations require the ADP to read through the plan benefits before completing the enrollment. If you have additional questions about your plan, or decide you would like to look at another plan, the ADP will conference in a benefits specialist to answer any further benefits questions that you have. At the end of each application, you will be required to approve the enrollment by verbally acknowledging that you agree to enroll in the selected plan. You will also be required to listen to a series of statements, called voice disclaimers, for each plan application. Disclaimers, which are the same as the legal language you would find on a paper application or contract, give you important information about your plan and are designed to protect you as a consumer. If you accept the disclaimer and later decide that you may have done that in error, your enrollment can be voided but you will have to start over with another application. Extend Health will transmit your application to the insurance company within 24 hours after it is complete. Once you have completed all your applications, your ADP will give you an enrollment confirmation number. Within two weeks you will receive written confirmation of your enrollment selections in the mail from Extend Health. Q: Why do I have to repeat my personal information so many times? A: In order to protect seniors, the federal government heavily regulates the advertisement and sale of individual Medicare plans and products. The rules and regulations that our ADPs and benefit advisors must follow in assisting you on the phone are quite extensive, including the requirements to follow only pre-approved verbal scripts. These scripts require our ADPs and benefit advisors to provide you with multiple disclosures, disclaimers and certain informationgathering questions designed to not only assist you in making your plan choice, but also in verifying your identity. Just as your medical provider asks for your name and information several times before a medical procedure, the confirmation process reduces the possibility of errors. Multiple confirmations of your personal information are necessary to ensure that you are accurately enrolled, and that your application is legally compliant. 3 Frequently Asked Questions (TTY: 711)

4 Q: What are voice disclaimers? A: Voice disclaimers are a series of statements for each application that we are legally required to read to you when you enroll in a Medicare plan. Disclaimers give you important information about your plan and are designed to protect you as a consumer. When you sign your application over the phone, you will be required to acknowledge that you have heard and understood the disclaimers associated with your plan. The reading of each disclaimer takes anywhere from four to seven minutes. Each type of Medicare plan Medicare Advantage, Medicare Supplement (also known as Medigap), Medicare Part D prescription drug as well as dental plans, has its own unique disclaimer. If you or your spouse enrolls in multiple Medicare plans, we are required to read you the disclaimers associated with each plan. For example, if you enroll in a Medicare Supplement plan and a Medicare Part D prescription drug plan, you will hear two disclaimers one for each plan. Q: Who requires the disclaimers? A: Disclaimers are required by the Centers for Medicare and Medicaid Services, your insurance company and your state s Department of Insurance. Q: Are the disclaimers recorded or will they be read by the benefit advisor? A: Voice disclaimers are pre-recorded to ensure that you hear all of the legally required statements that are associated with your Medicare plan. Q: Why are the disclaimers so long? A: Voice disclaimers must provide all of the legally required statements associated with your Medicare plan. The language in each disclaimer was created by the Centers for Medicaid and Medicare Services or your state s Department of Insurance, depending on the Medicare plan you choose. Q: I m an Access-Only participant and read in the newsletter that if I don t enroll in coverage through Extend Health for 2014, I will not be able to enroll in future years. Is this true? A: To clarify, the Extend Health Medicare exchange is available to all Medicare-eligible individuals. Therefore, you will be able to use Extend Health s services to enroll in individual Medicare plans through our Medicare exchange in the future, even if you do not remain continuously enrolled in coverage under Extend Health individual plans. Appointments/When to Call Q: When are the best times to call to minimize wait time? A: In general, our service center is busiest on Mondays and Tuesdays, with call volume lower at the end of the week. On Saturdays, we are open only for scheduled enrollment appointments and do not take calls from individuals who do not have an appointment. Our service center is closed on Sundays. The busiest day of the year for our service center is the Monday after Thanksgiving, which falls on December 2 in Unless you have a scheduled appointment, we suggest that you avoid calling on that day. 4 Frequently Asked Questions (TTY: 711)

5 If you do not yet have an appointment, we recommend going online or calling us (best days to call are Wednesday through Friday) to schedule one. Scheduling an appointment is not required but is recommended to minimize your wait time. Customers with appointments are prioritized to receive service first, followed by those without appointments. Please be aware that appointments scheduled ahead of yours may take longer than expected, which can result in a longer wait time for you. We know your time is valuable and we apologize in advance if this happens to you. Q: Will I have to hold for a benefit advisor when I call for my scheduled appointment? A: We respect your time and know that it is valuable. We make every effort to connect you with a benefit advisor licensed in your state as quickly as we can, and we apologize for any inconvenience. Customers with appointments are prioritized to receive service first, followed by those without appointments. Please be aware that appointments scheduled ahead of yours may take longer than expected, which can result in some wait time for you. Our policy is to spend as much time with a retiree as needed so sometimes appointments take longer than expected and this affects the next appointment. The benefit advisor who assists you in selecting your chosen health plan must be individually licensed by the particular state in which you reside. This requirement sometimes results in unavoidable delays as we attempt to manage the flow of calls from retirees from different states, in particular in pairing up each individual caller with the appropriately licensed benefit advisor. Q: My appointment isn t until December. Will this cause my insurance coverage to be delayed? A: If you complete your enrollment application by December 31, 2013, we guarantee you uninterrupted health care coverage. If you enroll after December 10, you may not have your ID card on January 1 but your coverage will still be in effect. PLEASE NOTE that, if required, Extend Health can provide information that will enable you to access medical services before you receive an ID card. Q: I missed my appointment. What do I do now? A: If you missed your appointment with a licensed benefit advisor and need to reschedule, log into My Account to schedule a new appointment. You are also welcome to call Extend Health s toll-free number and one of our customer service representatives will be happy to set up a new appointment for you. Prescription Profiler Q: What is Prescription Profiler? A: All Medicare Advantage plans that include prescription drug coverage and Medicare Part D prescription drug plans offer varying levels of prescription drug coverage. Prescription Profiler will help you find plan options with the lowest estimated annual out-of-pocket cost by comparing the coverage each plan offers with the medications you take. It is critical to ensure the plan you choose covers most or all of the prescription medications you need. Prescription Profiler uses information provided by Medicare and by our insurance carriers to estimate your out-of-pocket costs using the plan premium amount and the amount you would pay out of pocket for each of your prescription drugs. The analysis includes how much you will pay and different costs when you enter and exit the coverage gap (also known as the donut hole) and catastrophic coverage levels. 5 Frequently Asked Questions (TTY: 711)

6 Q: What do I need to do to get an accurate estimate of my medication expenses using Prescription Profiler? A: Prescription Profiler results are an estimate calculated from the prescription drug data entered in your profile. It is important to provide accurate information about medication name, dose, and frequency. Entering the information for medications in pill form is usually straightforward; however, if your prescription is a gel, cream, injection, or drop, it is essential to enter the packaging and dosage correctly to get an accurate estimate. Q: Do I need to include my over-the-counter (OTC) medications? A: You do not need to enter your OTC medications. Over-the-counter medications are not covered by Medicare and are not calculated as part of the out-of-pocket cost estimate. Q: What are the coverage gap (donut hole) and catastrophic coverage? A: In 2014, the coverage gap begins once total prescription drug costs reach $2,850 and ends after an individual s total out-of-pocket costs exceed $4,550. In the gap, you are responsible for paying 47.5% of the plan s cost for covered brand-name prescription drugs, and 72% of the plan s cost for generic prescription drugs. If you take numerous and/or expensive prescription medications, you may enter the prescription drug coverage gap (the donut hole) or reach catastrophic coverage levels. If your plan does not offer gap coverage you will be responsible for a larger portion of the cost until you are out of the coverage gap. Once your out-of-pocket costs exceed $4,550 in a calendar year you enter the catastrophic coverage level. While in catastrophic coverage you pay the greater of 5% or $2.55 for generic drug and the greater of 5% or $6.35 for all other drugs. After your total drug costs in a calendar year exceed $100,000 (including what you pay, what Medicare pays, and what your insurance plan pays), IBM will reimburse you for 100% of any subsequent drug expenses. To be reimbursed at this level of expense, you will need to contact Extend Health to request a catastrophic kit, which will include a claim form. You must show an Explanation of Benefit (EOB) as proof that this amount has been reached. Q: How can I view my monthly out-of-pocket drug cost estimate? A: To view your estimated monthly out-of-pocket costs, click the Prescription Profiler link at the top of the quote results page. On the Prescription Profiler page you can also view formulary tiers, quantity limits, prior authorization, and step therapy details for each plan. Q: How can I view the prescriptions in my profile? A: Log in to your account and from the home page click the Prescription Profiler link in the Important Messages section. If a benefit advisor entered your prescriptions on the phone, the prescriptions will display in this section once you have created an account and logged in. Q: Can entering my medications into Prescription Profiler before my appointment save time on the phone? A: Yes. By completing your prescription profile before your appointment, you can save a significant amount of time on the phone. During your appointment the benefit advisor will verify each medication, but will not need to enter or make changes unless information needs to be updated. 6 Frequently Asked Questions (TTY: 711)

7 Q: Why is Prescription Profiler not available at times? A: Prescription Profiler is available all year except for the first couple of weeks in October. We receive data for the next year s Medicare Advantage and Part D prescription drug plans in the first week of October. It takes a week or two to test and load the data before we can make it available to our participants. Q: What happens when I save my prescriptions into Prescription Profiler? A: As a registered user who has logged in, the prescriptions you enter into the Prescription Profiler will be saved and used to calculate your estimated annual out-of-pocket cost. Your benefit advisor will also have access to this information, which will decrease the length of your enrollment call. Your prescription information is protected by HIPAA laws and is not accessible by anyone but you and your benefit advisor. Q: Is mail order pricing available? A: Once you enroll in a prescription drug plan, you will have access to mail order pricing. Mail order pricing is not currently available through Prescription Profiler. However, your benefit advisor can provide you with the co-pays for prescriptions that you receive through mail order to compare with pharmacy co-pays. Q: How do I know if my medication is generic or brand name? A: When you enter the name of your prescription medication in Prescription Profiler, if a generic version is available you will see its name listed alongside the brand-name drug and be asked if you prefer to change to the generic version. When your physician prescribes a prescription medication, he will often write the prescription for a brand name drug, but allow the pharmacy to fill it with a generic equivalent. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug, but are most often less expensive. In some cases a plan will cover generic equivalents, but not the brandname medication, which can result in higher out-of-pocket costs. If you are taking a brand-name medication or are unsure, ask your doctor or pharmacist about a generic equivalent. Plan Availability and Costs Q: How do the plans available through Extend Health differ from those I can purchase on the individual market? A: The plans available through the Extend Health Medicare exchange are also available on the individual market at the same price. There may be additional plans available to you on the individual market that are not available through Extend Health. For 2014, since your IBM group plans are ending, there is no evidence of insurability required of a retiree or dependent for enrolling in any plan. This is not the case for other seniors enrolling in these plans. One of the reasons IBM chose Extend Health is because the company believes Extend Health delivers a value-added service with expert, independent benefit advisors and tools to assist you in comparing and choosing your health plans. 7 Frequently Asked Questions (TTY: 711)

8 Q: Why can t I see all the plans available in my area? A: Extend Health contracts with each insurance company that has plans listed on our web site. A few of the reasons you may not see a plan of interest to you on our exchange include: Some insurance companies have chosen not to participate in our exchange. Some insurance companies will offer one type of plan Medicare Supplemental, for example but not others. Other insurance providers may not have the technical capabilities required to offer their plans through an online exchange such as Extend Health. Occasionally, Extend Health will remove an insurer s plans from our web site because they no longer meet our qualification criteria. Q: How often do you add new plans? Will there be new plans added to the exchange this season? A: We add new insurance companies and plans to our exchange occasionally; since the beginning of this open enrollment period we have added plans in a number of areas. We continue to work to add new plans to provide you with both national and regional plan choices. If you are satisfied with the selection you may have already made, no action is required. You can review these options on the Extend Health website at or call to set an appointment to discuss your coverage needs at Plans added since the beginning of enrollment period: October: Capital Blue Cross Medigap plans added in Pennsylvania. Caremore Medicare Advantage plans added in Arizona and California. Coventry prescription drug plans in several states were unavailable early in the season but all were back on line by October 15. Rocky Mountain Health Care Services Cost / Medicare Advantage plans added in Colorado. November (available as of 11/15): Healthspring Medicare Advantage plans added in North Carolina, Arkansas, Indiana, Oklahoma, South Carolina, and Texas. HCSC Medicare Advantage plans added in Illinois, New Mexico, Oklahoma and Texas. (All HCSC Medigap plans were available starting October 1.) Independence Blue Cross Medicare Advantage plans in New Jersey and West Virginia. MVP Health Care Medicare Advantage plans in Vermont. Wellcare Medicare Advantage plans available in all states except Georgia, Maryland, and New York. Coming later in November: Universal American (UAM) Medicare Advantage plans available in New York and Texas. Wellcare Medicare Advantage plans available in Georgia, Maryland, and New York. 8 Frequently Asked Questions (TTY: 711)

9 Q: If a plan is not on your web site, how can I get information about it? A: The best way to learn about plans not on the web site is to visit Medicare.gov and use their search features to find plans. Q: Why can t I see information about AARP plans online? A: Extend Health, along with other insurance exchanges, is not allowed by UnitedHealthcare to show plan designs or pricing for these plans on its web site. However, AARP plans are available to you and will be discussed with you during your appointment. You can get information, including premiums, on AARP plans by calling an Extend Health benefit advisor at (TTY: 711) Monday to Friday 8 a.m. 9 p.m. Eastern Time. Q: Why did the Extend Health benefit advisor tell me that the rates quoted during my enrollment could change? A: If a participant elects to enroll in a Medigap plan, Extend Health is legally obligated to read a statement that rates may change. Medigap carriers are not regulated by CMS, but by the state; therefore they can change their rates up to 30 days prior to the policy becoming effective. Not all carriers do this, but because some do Extend Health is required to share the statement. Q: The information I received suggested my health care costs would be lower, but I m going to be paying more. Why? A: For most retirees, a plan is available on the Extend Health Medicare exchange that delivers equal or better value than under the current IBM group plan options, at a lower cost. We don t expect every retiree to duplicate exactly what they had in the IBM group plans, but to use their IBM-subsidized HRA to pick the plans that best meet their needs. In some cases, the price for similar plans on the open market through the exchange will be higher than IBM plans. If you are not satisfied with the cost of the plan you selected and other options are available to you, please call an Extend Health benefit advisor at Monday through Friday, 8 a.m. to 9 p.m. Eastern Time, to explore other plans that meet your budget. Qualifying for Your HRA Q: What is an HRA? A: A Health Reimbursement Arrangement (HRA) is an account that has been established for you and funded by IBM. You can use the funds in your HRA to receive reimbursements for eligible health care expenses up to the allocated amount. The HRA is tax-free that is, you do not owe any taxes on the money in your HRA. IBM has established certain requirements that you must meet in order to qualify for the HRA funding, which are explained in the next answer. Q. How do I qualify for the Health Reimbursement Account (HRA)? A: If you are eligible for an HRA, you must enroll in a Medicare Advantage, Medicare Supplement (Medigap) plan, or Medicare Part D prescription drug plan (PDP) through the Extend Health Medicare exchange to receive an HRA contribution. If you live outside the United States, or if you are currently enrolled in a Kaiser Permanente group plan through IBM and you enroll in a Kaiser Permanente individual plan for 2014, contact Extend Health and you will receive the HRA, if eligible. The HRA will be available starting on January 1, Frequently Asked Questions (TTY: 711)

10 Important: Medicare Advantage plans usually, but not always, include prescription drug coverage. Medicare rules prohibit enrolling in an MA plan with drug coverage AND a Part D plan. This means that if you choose an MA plan with drug coverage outside the Extend Health exchange, you will not be able to qualify for the HRA. Some MA plans do not include prescription drug coverage. If you enroll in an MA plan without drug coverage, you will need to choose a Part D plan on the Extend Health exchange to qualify for the HRA. When you research Medicare Advantage plans that are not on the Extend Health exchange, make sure to confirm that they do not include prescription drug coverage before you enroll. Q. I am enrolled in a medical or prescription drug plan on my own. Can I get the HRA if I enroll in a dental or vision plan through Extend Health? A: No. IBM is providing an HRA only if you enroll through Extend Health for a Medicare Advantage, Medicare Supplement (Medigap) plan, or prescription drug plan (PDP), or you are a current Kaiser Permanente member enrolled through the IBM group plan and enroll in a Kaiser Permanente plan, or you live outside the United States. If you want to qualify for the HRA, please work with an Extend Health benefit advisor to find a medical or prescription drug plan option that meets your needs. Q. Due to my military service, I have coverage under TRICARE or the VA. Do I still have to enroll in a plan via the Extend Health Medicare exchange (Medigap, Medicare Advantage or prescription drug) to get my IBM HRA? A: In recognition of your military service, IBM retirees who are eligible for health coverage under TRICARE or from the VA do not need to enroll in a plan via the Extend Health Medicare exchange to receive access to their IBM HRA (if eligible). Please call Extend Health at (TTY: 711) to let us know. If you have already enrolled in a Medigap, Medicare Advantage or prescription drug plan and wish to disenroll, you can do this by calling Extend Health no later than December 31, Please note that if you received a survivor election form, you will still need to make an election and submit the form by the deadline. Funding and Billing Q. What can I use my HRA for? A: If eligible for an HRA and you enroll via Extend Health in a Medigap, Medicare Advantage, or prescription drug plan or if you are currently enrolled in a Kaiser Permanente plan and you enroll in a Kaiser Permanente individual plan for 2014, or you live outside the United States and contact Extend Health to activate your HRA your HRA can be used for coverage premiums, co-pays, co-insurance and deductibles for any tax qualified expenses. This includes Medicare Parts B and D premiums, long-term care premiums, and premiums for other plans you or your spouse purchase on your own (including dental and vision) on a post-tax basis. This also includes premiums paid to IBM for your pre-65 dependent coverage, if applicable. 10 Frequently Asked Questions (TTY: 711)

11 Q: Why did I have to pay my new insurance company right away, even though my coverage hasn t started yet? A: When your first insurance premium is due varies depending upon which kind of plan you have selected. Here are some general guidelines to help you know what to expect: Medicare Supplement (Medigap) plans: Most Medigap applications require payment of the first premium at the time of the application. If you did not pay at the time of the application, you will receive a bill before your coverage begins. Medicare Advantage and prescription drug coverage (PDP) plans: Your insurance company will first need to process and approve your application. Once that has been completed, typically the first bill will arrive in December. Vision plans: VSP usually requires a first premium payment at the time of the application. If you did not pay at the time of the application, you will receive a bill before your coverage begins. Dental plans: Dental plans usually require a first premium payment at the time of the application. If you did not pay at the time of the application, you will receive a bill before your coverage begins. Q: If I ve already paid my first insurance premium, can I submit a claim for reimbursement from my HRA now? A: If you have qualified for an HRA, your account will be established on January 1, No claims can be reimbursed prior to January. You will receive an HRA Welcome Guide from Extend Health in mid- to late-december that will explain how to access and manage your account. If you have elected auto-reimbursement for the premiums you pay to your elected health plans then your reimbursement will be automatic beginning in early Automatic reimbursement means you will not have to file claims with our funding department to be reimbursed for your premium payments for health plans you are enrolled in through Extend Health. If you elect to submit claims manually, you can do that after you receive the HRA Welcome Guide from Extend Health. 11 Frequently Asked Questions (TTY: 711)