Blue Cross Medicare Supplement Insurance Plans. This information is a solicitation for insurance.

Transcription

1 Blue Cross Medicare Supplement Insurance Plans This information is a solicitation for insurance. ILMEDSUPP

2 It s your Blue At Blue Cross and Blue Shield of Illinois (BCBSIL), we re helping you get the most out of your health plan with affordable, quality coverage. 2

3 Here for you. We re here to help you make an informed decision about selecting a Medicare Supplement Insurance Plan. Licensed Agent of Blue Cross and Blue Shield of Illinois 3

4 What are Medicare Supplement Insurance Plans? Medicare Supplement Insurance plans, also referred to as Medigap Plans, are offered by private insurance companies and help supplement Original Medicare (Parts A and B). Medigap Plans assist with out-of-pocket gaps in Medicare coverage, like copayments and coinsurance costs that are not covered by Original Medicare. 4

5 What Medicare Doesn t Cover Dental Routine eye exams & eyewear Hearing aids & hearing tests Personal or custodial care Non-emergency transportation Health care outside the United States Private-duty nurse Outpatient prescription drugs 5

6 Are You Eligible for a Medigap Plan? TO BE ELIGIBLE FOR MEDIGAP YOU MUST BE: Eligible for Medicare based on your age or an eligible disability Enrolled in Medicare Parts A and B GUARANTEED ISSUE: For Medicare Beneficiaries 65 years of age and better, BCBSIL offers guaranteed issue 6

7 When to Enroll The best time to buy a Medigap plan is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you re both 65 or older and enrolled in Medicare Part B. You may be able to buy a Medigap policy after your Medigap Open Enrollment Period ends; however, your options may be limited and more costly or you may be denied Medigap coverage. 7

8 Medicare Supplement Insurance Plan Basics

9 About Your Policy THE BASICS: Medigap plans are identified by letters A, B, C, D, F, F- HD, G, G-HD, K, L, M, N. Each letter represents a different policy with different levels of benefits and costs. Plans C, F and high-deductible Plan F 6 are not available if you are Medicare eligible on or after January 1, o o Does not affect beneficiaries who are already enrolled in plans, C, F or high-deductible F or become Medicare eligible before January 1, If you have/had Plans C, F or high-deductible Plan F previously, you may still be eligible for these plans. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you will be required to buy separate Medigap policies. All policies offer the same basic benefits, but some plans offer additional benefits allowing you to choose a policy that meets your individual needs. 9

10 The Basic Benefits B Medicare Part A hospital coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) Medicare Part B 20% coinsurance or copayment* Blood (first 3 pints)* Part A hospice inpatient respite care coinsurance or copayment* *These benefits are covered as basic benefits in all Medicare Supplement Insurance plans; however, plans K, L and N pay for some of the basic benefits differently. 10

11 Benefits Overview

12 Medicare Costs MEDICARE BENEFITS Part A Deductible Part A Hospital Days ($352/day) Days ($704/day) Part A Skilled Nursing Facility Days ($176/day) WITHOUT A MEDICARE SUPPLEMENT INSURANCE PLAN YOU MAY PAY $1,408 per benefit period $10,560 for 30 days $42,240 for 60 days $14,080 for 80 days Part B Annual Deductible $198 Part B Medical Insurance Excess Charges (any amount not paid by Medicare) Total uncovered expenses that could be payable by YOU Generally, you pay 20% of the Medicare-approved amount after the yearly Part B deductible is met No coverage; you pay 100% of excess charges $68,486* (based on an unusual or unique claim) *Without a Medicare Supplement Insurance Plan 12

13 Medicare Supplement Insurance Costs MEDICARE BENEFITS WITHOUT A MEDICARE SUPPLEMENT INSURANCE PLAN YOU MAY PAY WITH A BLUE PLAN G, YOU PAY Part A Deductible $1,408 per benefit period $0 Part A Hospital Days ($352/day) Days ($704/day) $10,560 for 30 days $42,240 for 60 days $0 $0 Part A Skilled Nursing Facility Days ($176/day) $14,080 for 80 days $0 Part B Annual Deductible $198 $198 Part B Medical Insurance Excess Charges (any amount not paid by Medicare) Total uncovered expenses that could be payable by YOU Generally, you pay 20% of the Medicare-approved amount after the yearly Part B deductible is met No coverage; you pay 100% of excess charges $68,486* (based on an unusual or unique claim) $0 $0 $198 *Without a Medicare Supplement Insurance Plan 13

14 Other Medical Expenses MEDICARE BENEFITS MEDICARE PAYS BLUE MEDICARE SUPPLEMENT PLAN G PAYS YOU PAY Emergency Care in a Foreign County* (Medically Necessary) $0 80% of eligible expenses up to $50,000 lifetime maximum** $250 deductible, 20% and amounts after the $50,000 lifetime maximum * In most situations, Medicare won t pay for health care or supplies you get outside the United States. ** You are responsible for any remaining charges not covered by the Foreign Travel Emergency Coverage. 14

15 How Blue Protects You Medicare provides basic coverage. It does not pay all your medical expenses. A simple accident or illness could bring unexpected medical bills. A Blue Medicare Supplement Insurance Plan can help reduce the impact of unexpected expenses!

16 Medicare Supplement Insurance Plans

17 Blue Medicare Supplement SM Insurance Plan Options Plan A Plan B Plan G High Deductible Plan G 6 Plan K 7 Plan L 7 Plan N Reduced Premium Medicare Select Option Available 1,2 (eligibility based on ZIP code) Basic Benefits Skilled Nursing Coinsurance 50% 75% Part A Deductible 50% 75% Part B Excess 3 Foreign Travel Emergency Care 4 100% / 50% 100% / 75% Copay applies 8 Annual Out-of-Pocket Limit 5 $5,880 $2,940 Household Discount You may be eligible for a household discount if at least two members reside in the same household and are enrolled in a Blue Cross and Blue Shield of Illinois Medicare Supplement Insurance Plan effective on or after May 1,

18 Blue Medicare Supplement Insurance Plan Options 1. Network restrictions apply. Only certain hospitals are network providers under this policy. Check with your physician to determine if he or she has admitting privileges at the network hospital. If he or she does not, you may be required to pay for all expenses. 2. You must live within 30 miles of a participating Medicare Select hospital to be eligible. 3. Not to exceed any charge limitation established by the Medicare program or state law. 4. Plans cover medically necessary emergency care services needed immediately because of an injury or illness of sudden and unexpected onset, beginning during the first 60 days of each trip outside the USA. There is a deductible of $250 and a lifetime maximum benefit of $50, The out-of-pocket annual limit may increase each year for inflation (2019 limits shown). 6. Plans F and G also have a high deductible option, which require first paying a plan deductible of $2,340 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G does not cover the Medicare Part B deductible. However, high deductible plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 7. Plans K and L provide for different cost-sharing for items and services than the other plans we offer. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare approved amounts, called excess charges. You will be responsible for paying excess charges. 8. Plan N requires a copayment of up to $20 for office visits and a copayment of up to $50 for ER. 18

19 High Deductible Option Plan G Annual deductible must be met before the plan pays anything o Includes a Foreign Travel Emergency deductible Has lower premiums Out-of-pocket costs may be higher High Deductible Plan G deductible is $2,340 in

20 Medicare Select Med-Select is a money-saving option that is NOT an HMO Offers the same benefits as our standard option, but costs less when Med Select hospitals are used for non-emergency care To qualify for Med-Select, you must live in the approved service area within 30 miles of any Med-Select network hospital With Med-Select, you are covered for urgent and emergency care at any hospital Med-Select Plan requires that you use BCBSIL contracting Med-Select hospitals for non-emergency admissions to receive coverage for the Medicare Part A deductible. In an emergency, the $1,408 deductible is covered at any hospital from which you receive care. Note: Med-Select is available only in certain Illinois counties. 20

21 Medigap Plans K and L PLAN K PLAN L PLAN PAYS 50% 75% OUT-OF-POCKET LIMIT $5,880 $2,940 Pay only partial costs after Medicare Annual out-of-pocket maximums o Once you meet the annual limit, plan will pay: 100% of your Medicare Part A and Part B copayments and coinsurance for the rest of the calendar year Part B deductible (if it has not already been paid) 21

22 Medicare Supplement Insurance Plan Key Points You must have Medicare Part A and Part B You must continue to pay Medicare Part B premium You must pay the insurance company a monthly premium for your Medicare Supplement insurance policy You cannot have a Medicare Advantage Plan and a Medicare Supplement Insurance Plan at the same time 22

23 Medicare Supplement Insurance Plan Key Points Enrolling in a Medicare Supplement insurance plan is optional o o Each policy covers one person Spouses can each pick a different plan to match their individual coverage needs You may be eligible for a household discount if at least two members reside in the same household and are enrolled in a Blue Cross and Blue Shield of Illinois Medicare Supplement Insurance Plan effective on or after May 1,

24 Why Choose a Blue Medicare Supplement Insurance Plan

25 The Benefits of Having Blue Original Medicare does NOT cover everything May lower your out-of-pocket costs Get more health insurance coverage Choose any doctor who accepts Medicare 25

26 Every Policy is Backed by 80+ Years of Experience Guaranteed acceptance for Illinois residents 65 and better no health questions asked Ability to switch between BCBSIL plans Freedom to choose any doctor or specialist who accepts Medicare Guaranteed renewability regardless of changes in your health 26

27 Every Policy is Backed by 80+ Years of Experience* Coverage guaranteed to match Medicare s cost increases year after year 97% of our subscribers say they are satisfied* Nation s largest customer-owned health insurance company A (Excellent) Rating A.M. Best & Company** *Source: Continuous Tracking Program 2018; DSS Research, HCSC **Updated 3/21/17 27

28 Service begins the moment you enroll Locate an Authorized Independent Insurance Agent at: PHONE a.m. 8 p.m., Central Time, Monday Friday ONLINE 28

29 Tools to help you Blue Access for Members SM Online wellness tools and resources Education Connect member newsletter Seminars: Health fairs Community events 29

30 Help is always available. Medicare Resources Social Security MEDICARE ( ) and for TTY users, 24 hrs/day, 7 days a week and for TTY users, Monday Friday, 7 a.m. 7 p.m. 30

31 Additional Information Not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare Supplement insurance plans are offered by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. 31

32 Additional Information Blue Cross and Blue Shield of Illinois complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Illinois does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. BLUE CROSS AND BLUE SHIELD OF ILLINOIS: Provides free aids and services to people with disabilities to communicate effectively with us, such as: o o Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o o Qualified interpreters Information written in other languages If you need these services, contact Civil Rights Coordinator. 32

33 Additional Information If you believe that Blue Cross and Blue Shield of Illinois has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, , TTY/TDD: , Fax: , Civilrightscoordinator@hcsc.net. You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, Civil Rights Coordinator is available to help you. U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone. 33

34 Additional Information 34

35 Additional Information 35

36 Questions + Discussion