2016 Medicare Advantage PPO

Transcription

1 2016 Medicare Advantage PPO Medicare Plus Blue SM is a PPO plan with a Medicare contract. Enrollment in Medicare Plus Blue depends on contract renewal.

2 Joining is EASY as Review this packet. If you have questions, call :30 am to 8 pm. Eastern time, Monday through Friday. 2 Enroll by calling , 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday. TTY users should call 711. Refer to Page 16 for the enrollment schedule. 3 Begin enjoying the confidence of being covered by Medicare Plus Blue Group PPO along with our enhanced benefits.

3 Contents What you could SAVE reasons to change plans...4 ABCs of Medicare...6 Summary of frequently used benefits and cost sharing...8 Understanding important terms...9 Frequently asked questions...14 Ready to join? Here s what happens next...18 Contact information... Back cover 1

4 Look at the money you can keep in your pocket by choosing the Blue Cross Medicare Advantage PPO option Deductible, copayments, coinsurance and dollar maximums Physician office services Monthly contribution Deductible Coinsurance out-of-pocket maximum (including Office visit (primary care) Office visit (specialist) deductible) Traditional Care Network $17 per month ($204 per year) $385 in-network $755 in-network You pay 20% of covered charges after your Medicare Part B annual deductible is met You pay 20% of covered charges after your Medicare Part B annual deductible is met Your Medicare Advantage PPO option $0 per person $245 in-network $630 in-network $20 per visit in-network (not subject to Part B deductible) $25 per visit in-network (not subject to Part B deductible) Savings $17 per month ($204 per year * ) $140 * $125* $20 copay vs. 20% after your Part B deductible * $25 copay vs. 20% after your Part B deductible * 2 *Savings may vary based on when you enroll and how much you use your coverage.

5 Emergency medical care Outpatient diagnostic services Hospital and other services Beyond original Medicare Emergency care visit Urgent care visit Laboratory and pathology tests Inpatient hospital services Outpatient surgery Skilled nursing SilverSneakers Fitness membership Physical therapy $125 copay $50 copay 10% coinsurance after plan deductible is met 10% coinsurance after plan deductible is met Not a benefit $50 copay $25 copay 100% covered 10% coinsurance after plan deductible is met Free Included at no cost with your coverage $75 per visit * $25 per visit * 100% covered vs. 10% after your Traditional Care Network deductible is met * Lower deductible * saves you money Free fitness membership 3

6 6 reasons to change plans More than 63,000 of your fellow UAW Trust retirees have made the switch to the Medicare Advantage PPO plan from Blue Cross over the last three years. Here s why: 1 Your monthly contributions to 2 the Trust are waived in 2016 by joining Medicare Advantage PPO The Trust reviews benefits and contributions every year. In the fall, the Trust communicates any changes for the following year. If you join in 2016 and the Trust reinstates the monthly contribution in 2017, you can choose to change to another plan. You are not locked into this plan. 3 4 Lower in-network deductible Your plan starts paying a share of the cost sooner, so you save money. Lower copayments on emergency and urgent care visits Whether you re traveling across the country or around the world, emergency and urgent care coverage travels with you. No referrals required To visit the hospital or doctor or of your choice, including specialists. 4 Questions? Call :30 a.m. to 8 p.m. Eastern time, Monday through Friday. Or visit us online at

7 5 SilverSneakers Fitness program is built into your plan and includes a free fitness center membership at more than 14,000 locations across the U.S. For more information about SilverSneakers, visit or call TTY users call 711. You must use SilverSneakers facilities to obtain this benefit. 6 With Blue Cross Blue Shield, confidence comes with every card One ID card One comprehensive health care plan One explanation of benefits statement One dedicated customer service team * Blue Cross Blue Shield of Michigan does not control the SilverSneakers website referred to in this publication and is not responsible for its content. Healthways is an independent company not associated with the Blue Cross Blue Shield Association. Blue Cross Blue Shield of Michigan contracts with Healthways to offer the SilverSneakers fitness program benefit. SilverSneakers is a registered mark of Healthways, Inc. 5

8 The ABCs of Medicare Medicare Part A helps cover an inpatient stay at the hospital, skilled nursing facility or rehabilitation facility. Here are just a few of the costs that are covered through Part A: A semi-private hospital room Drugs, medical supplies and medical equipment as an inpatient Lab tests, X-rays and radiation treatment as an inpatient Operating room and recovery room services Some blood transfusions in a hospital or skilled nursing facility Rehabilitation services, such as physical therapy through home health care Original Medicare A Part Part C adds extra benefits 6 Medicare Part B goes hand-in-hand with Part A. It covers the cost of doctor visits including an annual wellness exam and other medical services. You can count on it for expenses such as: Visits to your physician and outpatient medical services Emergency services Clinical laboratory services, such as blood and urine tests Some preventive care, including flu shots Some preventive screenings such as mammograms, colorectal screenings and prostate cancer screenings If you decide to join the Medicare Advantage plan, you ll still need to pay your Part B premium. Original Medicare Part B

9 Are you turning 65, or becoming eligible for Medicare? You can easily enroll in Medicare Parts A and B before enrolling in a Medicare Advantage plan (Part C). Our Medicare Advantage PPO plan includes benefits you won t get from Original Medicare including: 100 percent coverage for an annual routine physical Annual EKG screening Annual Pap smear Online and live fitness coaching Everyday member savings Hearing aid coverage SilverSneakers Fitness program Call the Social Security Administration at between 7 a.m. and 7 p.m., Monday through Friday for an appointment. TTY users call Apply online at the official website*: ssa.gov/medicareonly/ Visit in person at your local Social Security office. If you already receive Social Security, you will be automatically enrolled in Medicare Parts A and B. * Blue Cross Blue Shield of Michigan does not control this website or endorse its general content. 7

10 2016 Summary of frequently used benefits and cost sharing In network Annual deductible per member per year $245 Coinsurance Deductible, copayments, coinsurance and dollar maximums Out of pocket maximum for deductible and coinsurance amounts for Medicare-covered medical services, per member per year Out-of-pocket maximum for copay-based services 10% coinsurance $630 You pay Out of network $490 In network and out of network combined $1,395 In network and out of network combined This is a safety net to ensure you do not pay more than $3,000 in copays in one year 8 This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

11 Understanding important terms Insurance pays 100% Out-of-pocket maximum met (coinsurance and deductible) $$$ $630 in-network Coinsurance (you and insurance share cost) Deductible met $$ $245 in-network Deductible (you pay) Medical costs Deductible the amount you pay annually before your plan begins to pay. This does not apply to services that require a copay. Coinsurance the percentage you pay for covered services after you have met your deductible. Out-of pocket maximum the most you will pay in deductibles and coinsurance during the year. Copay a fixed amount you pay to receive a medical service, usually at the time of service (office visits, emergency room, urgent care). In-network a provider contracted with Blue Cross Blue Shield to be in the Blue Cross Blue Shield Medicare Advantage PPO network. Out-of-network a provider who does not have a contract to be in the Blue Cross Blue Shield Medicare Advantage PPO network. 9

12 2016 Summary of frequently used benefits and cost sharing Preventive services In network You pay Out of network Abdominal aortic aneurysm screening (one per lifetime) Annual wellness visit Cardiovascular disease testing (once every five years) Annual EKG screening Immunizations (flu, pneumonia vaccines) Kidney disease education services Annual prostate cancer screening Annual mammography Annual Pap smear and pelvic exams Annual routine physical exam Screening and counseling for alcohol misuse and obesity Annual screening for depression, diabetes (twice per year if prediabetic) and glaucoma Annual screening for HIV and sexually transmitted infections for those at risk Bone mass measurement (every two years) Diabetes self management Nutrition therapy (for end-stage renal disease or diabetes) Annual screening for colorectal cancer Covered at 100% Covered at 100% Covered at 100% Physician office services In network You pay Out of network Office visits: primary care doctor and chiropractic $20 copay 50% coinsurance after deductible Office visits: specialists No referrals required $25 copay 50% coinsurance after deductible 10

13 Ambulance services medically necessary Urgent care Emergency medical care Emergency care copay waived if admitted. Inpatient hospital benefits apply, if admitted Worldwide emergency coverage outside of the U.S. and its territories In network You pay 10% coinsurance $25 copay $50 copay Out of network 20% coinsurance up to $25,000 or 60 consecutive days, whichever is reached first Outpatient diagnostic services In network You pay Out of network Laboratory and pathology tests Covered at 100% Covered at 100% Diagnostic procedures and tests, including X rays in office Diagnostic procedures and tests, including X rays in hospital Radiation therapy in office Primary care: $20 copay Specialist: $25 copay 10% coinsurance Primary care: $20 copay Specialist: $25 copay Hospital care In network You pay Out of network Inpatient hospital care 10% coinsurance Outpatient hospital services 10% coinsurance Questions? Call :30 a.m. to 8 p.m. Eastern time, Monday through Friday. Or visit us online at 11

14 2016 Summary of frequently used benefits and cost sharing Alternatives to hospital care You pay In network Out of network Skilled nursing facility (in a Medicare-certified skilled nursing facility) 10% coinsurance up to 100 days, renewable after 60 days without inpatient care; 100% coinsurance after 100 days up to 100 days, renewable after 60 days without patient care; 100% coinsurance after 100 days Hospice care Hospice services through a Medicare-certified hospice program are paid by Original Medicare Home health care Covered at 100% Surgical services Inpatient and outpatient surgery Human organ transplants (Medicare covered) In network 10% coinsurance You pay Out of network 12 Mental health and substance abuse treatment You pay In network Out of network Covered at 100%; Inpatient mental health care 190 day lifetime limit 190 day lifetime limit Inpatient substance abuse care Covered at 100% Covered at 100% up to Outpatient mental health care and substance abuse care, in hospital 20 visits; $25 copay for additional visits Outpatient mental health care and substance abuse care, in office Covered at 100% up to 20 visits; $20 copay (primary doctor) or $25 copay (specialist) for additional visits 50% coinsurance

15 Allergy injections Chiropractic spinal manipulations Outpatient audiology, cardiac, physical, respiratory, speech, and occupational therapy Durable medical equipment, prosthetics, orthotic appliances, diabetic monitoring supplies Medical supplies from a supplier or pharmacy Hearing aids Other services In network Primary care: $20 copay Specialist: $25 copay $20 copay 10% coinsurance Covered at 100% You pay Covered at 100% Out of network 50% coinsurance We pay up to our allowed amount, but not in excess of $2,000. Coverage is for up to two standard (analog or digital) hearing aids every 36 months. Routine hearing test and fitting/evaluation $25 copay Fitness club membership through SilverSneakers Covered at 100% You must use a SilverSneakers location to use this benefit. Prescription drugs Your UAW Trust prescription drug benefit is provided separately through Express Scripts. For more information on your drug coverage, contact Express Scripts at Express Scripts Inc. is an independent company. It is solely responsible for providing prescription drug coverage to UAW Retiree Medical Benefits Trust members. It does not provide Blue Cross Blue Shield of Michigan products or services to Trust members. 13

16 Frequently asked questions What is Medicare Plus Blue Group PPO? Medicare Plus Blue Group PPO is the name of our Blue Cross Blue Shield Medicare Advantage plan. It combines your Medicare Part A and Part B along with additional benefits into a convenient and comprehensive health care package. Our plan features a network of doctors, hospitals and other health care providers who provide health care to Medicare beneficiaries and follow the requirements of the PPO plan. You may choose your own doctors, including specialists. If you choose a provider who isn t part of the network, you re still covered by the plan, but you may pay more for some services. Medicare Plus Blue Group PPO is an all-in-one Medicare Advantage health plan. You will not be giving up your Medicare benefits by joining the Medicare Advantage plan. Blue Cross Blue Shield of Michigan is contracted with Medicare to administer all of your health benefits. Is Medicare Plus Blue Group PPO funded through the UAW Retiree Medical Benefits Trust? Yes. Does that make it a better choice for me than Original Medicare? The UAW Retiree Medical Benefits Trust offers you coverage with comprehensive health care benefits that go beyond Original Medicare. Medicare Advantage plans are regulated by the federal government and administered by Medicare-approved private insurance companies such as Blue Cross Blue Shield of Michigan. The Trust continues to offer the Medicare Advantage plan from Blue Cross as a Medicare Advantage health plan of choice for its Medicare-eligible members and their dependents. With a Medicare Advantage plan, you get the same hospital and medical benefits you d get from Original Medicare Parts A and B. You also get additional hearing benefits and many wellness benefits, such as SilverSneakers. 14

17 Am I eligible? You re eligible for the Medicare Advantage PPO if the following conditions are met: 1. You are enrolled in Medicare Part A and Part B 2. Your permanent residence is in any of 15 states where the Blue Cross Medicare Advantage PPO plan is offered through the Trust: Alabama, California, Florida, Indiana, Kentucky, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, North Carolina, South Carolina, Tennessee, Virginia or West Virginia. 3. You can only be enrolled in one Medicare Advantage plan at a time. What s the difference between the Blue Cross Blue Shield Medicare Advantage PPO plan and the Traditional Care Network plan? Both Traditional Care Network, also called TCN, and Medicare Advantage PPO are plans backed by the recognition and reputation of Blue Cross Blue Shield of Michigan. Each plan uses a different provider network. Both plans offer comprehensive medical coverage and help cover more than what Original Medicare pays for. TCN supplements your Original Medicare coverage while Medicare Advantage PPO packages all of your Original Medicare and extra benefits into one plan. Our Medicare Advantage plan operates under a contract with Medicare, and includes a fitness benefit and other extras. If you enroll in Medicare Plus Blue Group PPO, you re still a Blue Cross member. You ll also find it simpler: You use only your Medicare Plus Blue ID card when you have medical services, instead of using both a Medicare and a Blue Cross card. Medicare Advantage plans focus on health, not just health care, and can help you attain and maintain better health through coverage for preventive services as well as care and disease management programs. 15

18 Frequently asked questions What if I don t choose the Medicare Advantage PPO plan at this time? You can call to enroll anytime during the year. The sooner you enroll, the sooner you can start enjoying lower costs, easy paperwork, one explanation of benefits statement, one ID card, and many extras such as SilverSneakers. You can enroll in the plan two months before you become eligible for Medicare. Or you can call to enroll anytime throughout the year after you become eligible for Medicare. The schedule below provides the effective dates of your coverage based on when you enroll. If you enroll during Your coverage takes effect November 2015 January 1, 2016 December 2015 February 1, 2016 January 2016 March 1, 2016 February 2016 April 1, 2016 March 2016 May 1, 2016 April 2016 June 1, 2016 May 2016 July 1, 2016 June 2016 August 1, 2016 July 2016 September 1, 2016 August 2016 October 1, 2016 September 2016 November 1, 2016 If you re a Traditional Care Network member and you transfer to the Medicare Advantage PPO plan with an effective date after January 2016, you ll get credit for what you ve already paid toward your in-network deductible and out-of-pocket maximum for the months you were enrolled in TCN during We will transfer a credit toward your deductible of up to $245 per person for in-network services. We will transfer a credit toward your out-of-pocket maximum of up to $630 per person for in-network services. 16

19 Do I still pay the premium for Medicare Part B? Yes. You must continue to pay your Medicare Part B premium. What should I do with my Medicare card? Keep it in a safe place and do not destroy it. You will not need the Medicare card for as long as you are enrolled in the Medicare Advantage PPO plan. You should retain it for future use. We will give you a new Blue Cross Blue Shield of Michigan ID card. It s the only card you ll need when you get medical care. Will I have to switch doctors? No. We encourage our members to seek services from doctors who are in our provider network. If your doctor is not part of the network, and accepts Medicare and your Medicare Plus Blue Group PPO card, you may pay a higher cost for covered services. Do I give up my Medicare benefits to join a Medicare Advantage PPO plan? No. Medicare Advantage PPO plans provide the same benefits as Original Medicare. You get all your Original Medicare benefits plus many that Medicare doesn t offer, such as additional hearing benefits and a SilverSneakers fitness membership. How does my coverage work when I travel in the United States? Your benefits travel with you. You should get services from health care providers in the local Blue Cross Blue Shield Medicare Advantage PPO network (where available). If there isn t a Medicare Advantage network where you re traveling, you pay the same costshare for covered services as if you received them from a network provider. Be sure to show your new ID card when you visit a doctor s office or hospital. The card contains important information about your coverage and how to file claims. Does the Medicare Advantage PPO plan cover services outside the U.S.? Yes. Your plan covers urgent and emergency care outside the U.S. Do I have to enroll in a Medicare Advantage PPO for my health care coverage? No. You may stay in your current plan or enroll in the Medicare Advantage Group PPO plan the choice is yours. Whether or not you enroll in the Medicare Advantage PPO plan, you always have Original Medicare benefits and your additional coverage through the Trust. Am I locked into a plan? No. You can try the plan. If it doesn t work for you, you can switch back to the Traditional Care Network plan at any time. 17

20 Ready to join? Here s what happens next Enroll by calling , 8:30 a.m. to 4:30 p.m. Eastern time, Monday through Friday. TTY users should call 711. Once you re signed up, here s what you can expect. 1 We ll confirm your eligibility. Two to three weeks before your effective date, we ll make sure you re eligible for the plan before you re enrolled. 2 3 Look for your member ID card and welcome packet. You ll receive your new Blue Cross Blue Shield ID card and a welcome kit one to two weeks before your coverage date. The welcome kit will help you get the most out of your plan. It includes the Evidence of Coverage, a booklet that describes your benefits and how to use the plan, plus other materials you ll need to get started. Start using your plan and SilverSneakers participating facilities. Begin using your new Blue Cross Blue Shield ID card on your coverage effective date. Your SilverSneakers card will arrive separately four to six weeks after your coverage starts. Until it arrives, you may use your Blue Cross Blue Shield ID card at the SilverSneakers location of your choice. For more information about SilverSneakers, or to get your membership number, visit or call TTY users call

21 Notes

22 Multi-language interpreter services English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at Someone who speaks English/Language can help you. This is a free service. Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al Alguien que hable español le podrá ayudar. Este es un servicio gratuito. Chinese Mandarin: 我 们 提 供 免 费 的 翻 译 服 务, 帮 助 您 解 答 关 于 健 康 或 药 物 保 险 的 任 何 疑 问 如 果 您 需 要 此 翻 译 服 务, 请 致 电 我 们 的 中 文 工 作 人 员 很 乐 意 帮 助 您 这 是 一 项 免 费 服 务 Chinese Cantonese: 您 對 我 們 的 健 康 或 藥 物 保 險 可 能 存 有 疑 問, 為 此 我 們 提 供 免 費 的 翻 譯 服 務 如 需 翻 譯 服 務, 請 致 電 我 們 講 中 文 的 人 員 將 樂 意 為 您 提 供 幫 助 這 是 一 項 免 費 服 務 Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo. French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurance-médicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit. Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí. German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos. Korean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 번으로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다. 20

23 Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная. Arabic: ا إننا نقددمم خددماتت االمتررجمم االفوورريي االمجانيیة للا جابة عنن ا أيي ا أسي لة تتعلقق بالصحة ا أوو جددوولل االا ددوويیة لدديینا. للحصوولل على متررجمم فوورريي ليیسس عليیكك سووىى االاتصالل بنا على سيیقوومم شخصص ما يیتحددثث االعرربيیة بمساعددتكك. هھھھذذهه خددمة مجانيیة. Hindi: हम र य दव य जन क ब र आपक भ क जव ब द न क लए हम र प स द भ षय स व ए. एक द भ षय करन क लए, बस पर फ न. क ई ज ब लत ह मदद कर सकत ह. यह एक स व ह. Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito. Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito. French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis. Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer Ta usługa jest bezpłatna. Japanese: 当 社 の 健 康 健 康 保 険 と 薬 品 処 方 薬 プランに 関 するご 質 問 にお 答 えするため に 無 料 の 通 訳 サービスがありますございます 通 訳 をご 用 命 になるには にお 電 話 ください 日 本 語 を 話 す 人 者 が 支 援 いたします これは 無 料 のサー ビスです 21

24 Contact information Want to enroll? Call Retiree Health Care Connect :30 a.m. to 4:30 p.m., Eastern time, Monday through Friday. TTY users call 711. Prescription drug questions (Express Scripts) Open 24 hours a day, seven days a week (except Thanksgiving and Christmas) TTY users call 711. Questions prior to enrolling? :30 a.m. to 8 p.m., Eastern time, Monday through Friday. TTY users call SilverSneakers questions? TTY users call H9572_S_URMBTprekitbroc FVNR 0715 Blue Cross Blue Shield of Michigan is proudly represented by the UAW R039543