1 This is an advertisement. Kaiser Permanente Senior Advantage for Federal Members (HMO) Your Guide to Choosing a Kaiser Permanente Medicare Health Plan INCREASE YOUR COVERAGE without increasing your FEHB premium.
2 Make the most of your health coverage. This guide will help you understand your Kaiser Permanente Medicare health plan options so you can make a decision about the level of coverage that s right for you. The good news is that when you re eligible for Medicare benefits, you have an option that allows you to get better benefits than with your Federal Employees Health Benefits (FEHB) coverage alone, including paying lower cost sharing for covered services. It s called Kaiser Permanente Senior Advantage for Federal Members. 2
3 The information provided here will give you an overview of the different parts of Medicare and how they work together. You ll also find out how you can get the richest benefits available to you as an FEHB member so you can make an informed decision. To learn more, visit us online at kp.org/feds. If you have any questions, or if you re ready to enroll in Senior Advantage, please call one of our licensed sales specialists at (TTY 711), Monday through Friday, 8 a.m. to 7 p.m. For Member Services, call (TTY 711), seven days a week, 8 a.m. to 8 p.m. 3
4 What are the different parts of Medicare? Medicare has four parts: PART A Medicare Part A covers inpatient hospital care, skilled nursing facility care, and hospice care. Generally, you re eligible for Medicare Part A when you become 65 and have at least 10 years of creditable employment. If you re not yet 65, certain disabilities may also qualify you for Part A. You automatically qualify if you were a Federal employee on January 1, 1983, and you have worked at least 10 years. If you can get Part A premium-free, you should take it, even if you are still working. PART B Medicare Part B covers physician services, outpatient care, certain self-administered drugs, and other services that aren t covered by Part A. You must pay a monthly premium for Part B. Your premium is typically deducted from your Social Security check. Members with higher incomes may have higher premiums. You are eligible to enroll in Kaiser Permanente Senior Advantage for Federal Members if you have Medicare Parts A and B and are currently an FEHB Kaiser Permanente member. For more information about enrolling in Part B, please call Social Security at (TTY ), Monday through Friday, 7 a.m. to 7 p.m. You can also visit the FEHB website at kp.org/feds. 4
5 PART C Medicare Part C, also known as Medicare Advantage, is offered by private insurance companies that are approved by Medicare and includes both Part A and Part B. Kaiser Permanente Senior Advantage for Federal Members is a Medicare Advantage plan. If you decide to enroll in our Medicare health plan, you ll get additional coverage, such as lower cost-sharing and better benefits. Note: For Federal members, enrollment in Parts B or C isn t required if you want to continue your current coverage under the FEHB program. However, you do get better benefits by enrolling in Senior Advantage. You do not need to suspend your FEHB coverage to enroll in Senior Advantage for Federal Members. PART D Medicare Part D covers prescription drugs. Some Medicare Advantage plans include Part D prescription drug coverage for an extra cost. If you decide to join Kaiser Permanente Senior Advantage for Federal Members, you will automatically get Part D in your plan. There is no increase to your FEHB or Kaiser Permanente premium when you enroll in Kaiser Permanente Senior Advantage for Federal Members. What is Creditable Coverage? If you currently have Kaiser Permanente High Option or Standard Option as your health plan, your prescription drug coverage is already, on average, as good as or better than standard Medicare Part D and is considered Creditable Coverage. As a member, that means that if you choose not to join a Medicare drug plan when you re first eligible, you won t have to pay a late enrollment penalty if you join later, as long as you ve had continuous FEHB coverage. However, you don t lose any prescription drug benefits when you enroll in Senior Advantage for Federal Members. 5
6 What s the ADVANTAGE to enrolling in a Kaiser Permanente Medicare health plan? If you decide to enroll in Senior Advantage for Federal Members, you ll get richer benefits than with your FEHB coverage alone. You ll get all of your FEHB benefits plus: No copayments for most office visits on the High Option A and no copayments or reduced copayments on the High Option B or Standard Option for most office visits; No copayments or reduced copayments for most other services, such as inpatient hospital, outpatient surgery, urgent and emergency care, and lab, X-ray, and specialty scans; Membership in Silver&Fit Fitness Program at no additional charge; Monthly reimbursement up to the standard Medicare Part B premium (High Option B only). If you join Kaiser Permanente FEHB High Option, the subscriber will choose between Senior Advantage for Federal Members High Option A and High Option B for all family members who enroll in Senior Advantage for Federal Members. High Option B has lower cost-sharing and additional benefits, plus we ll reimburse you monthly up to Medicare s standard Part B premium. A healthy extra With Kaiser Permanente Senior Advantage for Federal Members, you ll be able to exercise at any Silver&Fit fitness center at no additional cost to your monthly health plan premium. For more information, call Silver&Fit toll free at (TTY/TDD 711), or visit kp.org/silverandfit. 6
7 Is there a penalty for not enrolling in Medicare Parts A or B when I m eligible? Generally, there is no penalty if you choose not to take advantage of Part A when you meet the eligibility requirements for Medicare. If you choose not to enroll in Part B when you are first eligible and you or your spouse are both retired, you may have permanently increased costs if you decide to enroll later on. Your Part B premiums could go up by 10 percent for each 12-month period that you delay your enrollment in Part B. However, if you or your spouse continues to work, you may be able to delay your Part B enrollment without a penalty. This penalty is subject to change. For current FEHB Kaiser Permanente members: If you would like to switch to Senior Advantage for Federal Members, you must choose the plan option that corresponds to the Kaiser Permanente FEHB option in which you re currently enrolled. For example, if you re a Kaiser Permanente High Option member, you must enroll in the Senior Advantage for Federal Members High Option plan. You may be able to change your enrollment when you become eligible for Medicare. Please refer directly to opm.gov and your employing agency or retirement office for more information about when you can make plan changes outside of Open Season. 7
8 Take a look at your options. This 2014 benefit summary allows you to make a side-by-side comparison of your choices. Your Benefits Summary for 2014 Kaiser Permanente Kaiser Permanente Senior Advantage (HMO) for Federal Members Out-of-Pocket Maximum Services High Option Standard Option 5 High Option A High Option B Standard Option These benefits and services are NOT subject to applicable plan deductibles Office visits Urgent care Prescription drugs $1,000 person/ $2,000 family $2,250 person/ $4,500 family $600 per person $1,000 per person $750 per person Preventive care and prenatal care $0 $0 $0 $0 $0 Primary care, hearing and vision exams, mental health, and chemical dependency $20 $30 $0 $15 $5 Specialty care $30 $40 $0 7 $15 7 $5 7 Labs and X-rays $5 $20 $0 $0 $0 MRI/CT/PET scans $100 $100 $0 $100 $0 At network facilities or outside the service area, for qualifying care $35 $45 $0 $30 $10 Generic drugs, up to a 30-day supply (mail-order up to 90-day supply for two copays) $15 formulary $20 formulary $15 $15 $20 Brand drugs, up to a 30-day supply (mail-order up to 90-day supply for two copays) $40 formulary $40 formulary $60 non-formulary $60 non-formulary $30 $40 $40 Lenses or frames, contact lenses instead of Eyewear The cost less $150 eyeglasses, every 24 months 1 The cost less $150 1 The cost less $150 1 The cost less $150 1 The cost less $150 1 Self-referred Up to 20 visits per calendar year from network $20 $30 $20 $20 $20 chiropractic care providers Health/fitness CHP Active and Healthy discounts 4 Includes Silver&Fit with full membership privileges at designated facilities. 3 These benefits and services ARE subject to applicable plan deductibles. Emergency Room Ambulance Inpatient hospital services Outpatient surgery Dental care at Kaiser Permanente dental offices Please refer to page 11 for disclaimers. Covered services provided in and out of the service area Medically necessary transport in a licensed ambulance per trip No limit on number of days for covered, medically necessary services Procedures performed in an ambulatory surgery center or hospital Routine and preventive care, including oral exams, X-rays, and teeth cleanings Basic and major restorative services, including routine fillings, simple extractions, endodontics, periodontics (including follow-up cleaning visits), removable prosthetic appliances, crowns, bridges, inlays, and oral surgery Emergency or urgent dental care at Kaiser Permanente dental offices No deductible $250 person/ $500 family 6 No deductible No deductible No deductible $100 $125 $50 $65 $50 $100 $125 $75 $100 $75 $200 per admit $500 per admit $0 $200 per admit $100 per admit $50 $100 $0 $50 $50 $15 Not covered $0 $15 Not covered $15 per visit, then $50 deductible plus 50% of charges up to $3,000 per year Not covered $0 per visit, then $50 deductible plus 50% of charges up to $3,000 per year $15 per visit, then $50 deductible plus 50% of charges up to $3,000 per year Not covered $25 supplemental charge 2 Not covered $25 supplemental charge 2 $25 supplemental charge 2 Not covered 8 9
9 Better benefits, same great care Not all Medicare Advantage plans are the same. By enrolling in Senior Advantage, you get better benefits than with your FEHB coverage alone. Here are just a few of the reasons why Kaiser Permanente Medicare health plans stand out from the rest: MEDICARE Highly rated quality and service The Centers for Medicare & Medicaid Services (CMS) rates the excellence of Medicare health and prescription drug plans based on major categories that include: Preventive Care, Chronic Care, Prescription Drug Services, Customer Service, and Member Satisfaction. To learn more and to see how highly we re rated, visit kp.org/medicarestars.* Your choice of doctors All of our available physicians accept Medicare health plan members. Choose from our network of great doctors with the freedom to select a new doctor anytime. Connected, personalized care Our comprehensive electronic medical record system securely connects your entire Kaiser Permanente medical team to each other and to you. So you ll have peace of mind knowing everyone on your team including you has instant access to your most up-to-date health information.** Convenient services that save time In addition to your doctor s office, many other Kaiser Permanente services such as pharmacy, lab, and X-ray are often available at one location. An advice nurse is also available by phone 24 hours a day, seven days a week. 10 * Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. ** When receiving care at a Kaiser Permanente facility. All online features may not be available in some areas.
10 I ve made my decision. What s next? To learn more about Medicare benefits and eligibility requirements, please call the Social Security Administration at (TTY ), Monday through Friday, 7 a.m. to 7 p.m. If you re ready to enroll in Kaiser Permanente Senior Advantage for Federal Members, give us a call so we can help walk you through the enrollment process. After you ve submitted your enrollment form and your status is verified, you will receive a letter of confirmation and a new Kaiser Permanente ID card. If you want to enroll in High Option B, the FEHB subscriber (not a spouse or dependent) must complete the FEHB High Option B Enrollment Application. When we approve a subscriber s enrollment in High Option B, the subscriber and any of his or her covered dependents who are enrolled in Senior Advantage for Federal Members will be eligible to receive reimbursement for the standard monthly Medicare Part B premium he or she pays. For questions or help with the enrollment process, call one of our licensed sales specialists at (TTY 711), Monday through Friday, 8 a.m. to 7 p.m. For Member Services, call (TTY 711), seven days a week, 8 a.m. to 8 p.m. Disclaimers reference chart on pages 8 9. Additional information about benefits is available to assist you in making a decision about your coverage. Before making a final decision, please read our Federal brochure, RI Benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure and in the applicable Senior Advantage Evidence of Coverage (EOC). Members 1 under 18 may select from a specified collection of frames and contact lenses at no charge. Plus 2 other copayments that normally apply. Members are also eligible for discounts 3for wellness and entertainment activities with our CHP Active and Healthy program. Visit CHPActiveandHealthy.com for more information. 4These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees and family members who become members of Kaiser Foundation Health Plan of the Northwest. You 5 pay 20% coinsurance after deductible for outpatient administered medications. The 6 deductible is $250 per person under the Standard Option. The deductible is considered met under Self and Family enrollment when enrolled family members pay a combined $500 (Standard Option). Includes 7 Medicare-covered treatment for subluxation of spine with referral. 11
11 Kaiser Foundation Health Plan of the Northwest 3500 NE Multnomah Street Suite 100 Portland, OR kp.org/feds Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare Health Plan, you must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. Benefits, formulary, pharmacy network, provider network, premiums and copayments/coinsurance may change on January 1 of each year and at other times in accord with your group s contract with us. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. Enrolling in Senior Advantage for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply. FEHB Program coverage is described in FEHB brochure RI Kaiser Foundation Health Plan of the Northwest Please recycle. MOM _NW 09/2013
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