Helping You Prepare For Your Upcoming Health Insurance Enrollment
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1 Helping You Prepare For Your Upcoming Health Insurance Enrollment
2 Who We Are Transitions Can Be A Good Thing! OneExchange For Your Benefit A Deeper Dive Benefit Advisors, Private Exchange, Optimize Savings, Health Reimbursement for You Next Steps 2
3 About OneExchange Retiree Towers Watson over 100 years experience Over 1-million retirees served across 540+ employers Licensed advisor provides guidance and ongoing advocacy Personalized options with plans from a nationwide network of carriers More Choice, More Flexibility Better Value No fees for our service Our 10th annual enrollment season Founded in 2004 First and Largest private Medicare Exchange 3
4 Our Service Centers Operating hours: Monday Friday, 5:00 a.m. until 6:00 p.m. Pacific Time Salt Lake City, UT Irving, TX Dallas, TX 100% Domestic Workforce No Outsourcing! 4
5 Plans and Partners All Plan Types Medicare Advantage Medicare Supplement (Medigap) Prescription Drug (Part D) Wide selection of plans from leading national / regional carriers 5
6 Your Future Coverage 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.
7 Your Future Coverage Primary Coverage Medicare A and B Additional Coverage (your choice) Medicare Advantage with Prescription Drug (MAPD) or Medigap + Prescription Drug Optional Coverage (your choice) Dental Plans Vision Plans 7
8 OPTION 1 Medicare Advantage Plan with Prescription Drug Coverage (MAPD)* HMO MEDICARE ADVANTAGE PPO * Note that Medicare Advantage plans are generally network based plans. 8
9 OPTION 2 Medigap Plan + Part D Plan MEDIGAP PLAN PART D PLAN Note: You may need to pay your first month s premium when you enroll in coverage. 9
10 MediGap Lettered Plans Medicare Supplement Insurance (Medigap) Plans Benefits A B C D F G K L M N Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) Medicare Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A hospice care coinsurance or copayment Skilled nursing facility care coinsurance 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100% Part B deductible 100% 100% Part B excess charges 100% 100% Foreign travel emergency (up to plan limits) Source: CMS 80% 80% 80% 80% 80% 80% Out-of-Pocket limit in 2015 $4,940 $2,470 10
11 Part D Plans 5 Tiers of Co-Pays A prescription drug plan will typically break the formulary into tiers. The tiers correspond to the copayment or coinsurance the beneficiary will pay. Cost-sharing increases with the tier number. Tier 1 is the least expensive, tier 4 or 5 is the most expensive. Tier descriptions: Tier 1 preferred generic Tier 2 non-preferred generic Tier 3 preferred brand Tier 4 non-preferred brand Tier 5 specialty drugs or injectable medicine 11
12 Medicare Prescription Drug Coverage 2016 You Pay Full Retail Until Deductible is Met $0 to $360 You pay 45% of Brand Name and 58% of Generics until your out of pocket costs reach $4850; Pharmaceutical contributions will count towards the $4850 TrOOP Deductible Initial Coverage Coverage Gap Catastrophic Coverage You pay copays for your plan coverage for the first $3310 in actual costs of Medications Only 25% reach Donut Hole Only 4% reach Catastrophic You Pay $2.95 for Generics and $7.40 for Brand Name or 5% - whichever is greater ** 12
13 A Deeper Dive Into Our Process 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.
14 The Transition Process Consultative Process Simplified Selection Effortless Enrollment Ongoing Advocacy 14
15 Education Enrollment Guide: Prepare for Your Enrollment Consultation Review Medicare basics What to expect on your enrollment call FAQs Appointment confirmation Medicare.OneExchange.com/LLNS 15
16 Benefit Advisors Licensed / Certified / Appointed OneExchange University Objective and unbiased 100% domestic workforce Benefit advisors are available: Monday Friday, 5:00 a.m. until 6:00 p.m. Pacific Time
17 Decision Support Tools Prescription Profiler Medicare.OneExchange.com/LLNS 24/7 access to your information Load in your prescriptions - Shorten your time on the phone with us! 17
18 Decision Support Tools Help Me Choose Comparison Tool 18
19 Enrollment Process Benefit Advisors can discuss coverage options with anyone Telephonic enrollment 2 part process 100% of calls are recorded We ve got your BAC: Benefit Advisors Application Data Processors Customer Service Reps 19
20 Selection Confirmation Notice You may review the plan(s) that you selected will be sent shortly after you enroll. 20
21 Personal Guidance An Ongoing Advocate Navigation Enrollment Prescription changes Affordability concerns Reimbursement issues Late enrollment HRA Annual plan review The plans you select continue on year to year. No need to re-enroll in the fall unless you want to make a plan change. 21
22 Health Reimbursement Arrangement (HRA) 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.
23 Health Reimbursement Arrangement You may be reimbursed up to the amount available in the HRA!
24 Health Reimbursement Arrangement Reimbursement Options 1 2 Automatic Reimbursement (including recurring premiums) Manual Reimbursement Participant Reimbursements are up to the amount available in the HRA $ $ Participant OneExchange Insurance Carrier OneExchange Insurance Carrier 24
25 Localized Slides Livermore, CA Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 25
26 Plans Available in Alameda County Plan Type Number of Plans Offered 2016 Monthly Premium Carriers Medicare Advantage 5 $21 - $221 BS of CA, AARP, Humana, Scan, Health Net Medigap / Medicare Supplement 20 $66 - $259 Health Net, AARP, Humana, BS of CA, Anthem BC of CA, Cigna Prescription Drug (Part D) 20 $18 - $132 AARP, Aetna, CIGNA, Express Scripts, Humana, SilverScript, WellCare, BS of CA, Anthem BC of CA 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 26
27 Plans Available in Alameda County Plan Type Number of Plans Offered 2016 Premium Carriers Vision 1 $168 annual / $14 mo Annual eye exam: $5 Coverage for eye glasses, lenses and frames Dental 4 $32 - $63 monthly $0 - $75 deductible $0 - $1500 annual maximum Vision Service Plan (VSP) Security Life, MetLife Dental Renaissance, Vision plans and Dental plans are not Medicare plans 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 27
28 Medicare Advantage Plan Benefit Cost 2016 Premium $21 Network HMO Deductible $0 Doctor Copay $0 Specialist Copay $10 Hospital Days 1 5: $175 per day Emergency Room $75 Rx Deductible Copay Tiers $0 $0 / $5 / $40 / $90 / 33% 30 days Mail Order $5 / $10 / $80 / $ days 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 28
29 Medigap Plan F + PDP (75-year old male) Benefit Cost 2016 Premium Network Deductible $0 Doctor Copay $0 Specialist Copay $0 Hospital $0 Emergency Room $0 Rx Deductible Copay Tiers $208 ($185 Medical + $23 pdp) Not Applicable $0 $3 / $17 / $46 / 47% / 33% 30 days Mail Order $7 / $42 / $115 / 47% 90 days 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 29
30 Localized Slides Tracy, CA Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 30
31 Plans Available in San Joaquin County Plan Type Number of Plans Offered 2015 Monthly Premium Carriers Medicare Advantage 2 $50 - $61 Humana, Scan Medigap / Medicare Supplement 26 $80 - $259 Health Net, AARP, Humana, Cigna, Anthem BC of CA, BS of CA Prescription Drug (Part D) 20 $18 - $132 AARP, Aetna, CIGNA, Express Scripts, Humana, SilverScript, WellCare, BS of CA, Anthem BC of CA 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 31
32 Plans Available in San Joaquin County Plan Type Number of Plans Offered 2015 Premium Carriers Vision 1 $168 annual / $14 mo Annual eye exam: $5 Coverage for eye glasses, lenses and frames Dental 4 $32 - $63 monthly $0 - $75 deductible $0 - $1500 annual maximum Vision Service Plan (VSP) Renaissance, MetLife Dental, Security Life Vision plans and Dental plans are not Medicare plans 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 32
33 Medicare Advantage Plan Benefit Cost 2015 Premium $50 Network HMO Deductible $10 Doctor Copay $15 Specialist Copay $25 Hospital Days 1 8: $175 per day Emergency Room $75 Rx Deductible Copay Tiers $0 $7 / $10 / $47 / $100 / 33% 30 days Mail Order $14 / $20 / $131 / $ days 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 33
34 Medigap Plan F + PDP (75-year old male) Benefit Cost 2015 Premium Network Deductible $0 Doctor Copay $0 Specialist Copay $0 Hospital $0 Emergency Room $0 Rx Deductible Copay Tiers $206 ($183 Medical + $23 pdp) Not Applicable $0 $3 / $17 / $46 / 47% / 33% 30 days Mail Order $7 / $42 / $115 / 47% 90 days 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only. 34
35 Next Steps 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.
36 What You Need To Do: Action Required! We are Ready! Contact OneExchange Call now to complete your profile and schedule an enrollment appointment You will need your Medicare card, prescription list, and doctor and hospital information
37 Call Now, We Are Ready!
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