Agenda. Medicare Basics Parts of Medicare What is a Medicare Advantage Plan? How do Medicare Advantage Plans work?

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2 Agenda Medicare Basics Parts of Medicare What is a Medicare Advantage Plan? How do Medicare Advantage Plans work? Cost sharing, networks and eligibility MCHCP and Medicare Advantage Advantage? What is the Advantage? Why the change? Questions

3 Medicare Basics What is Medicare? Medicare is health insurance for people: Age 65 or older Under age 65 with certain disabilities Any age with End-Stage Renal Disease (ESRD) Administered by Centers for Medicare and Medicaid Services (CMS)

4 Medicare Basics Medicare Part A Hospital Insurance Medicare Part B Medical Insurance Medicare Part C Medicare Advantage Plans Part A + Part B and often Part D Medicare Part D Prescription Drug Coverage

5 Medicare Basics Medicare Part A Hospital Insurance Hospital Inpatient Care Skilled Nursing Facility (SNF) Home Health Care Hospice Care Blood

6 Medicare Basics Medicare Part B Medical Insurance Doctor services Outpatient hospital/surgery Diagnostic tests Outpatient Therapy Outpatient mental health Some prescriptions

7 Medicare Basics Medicare Part C Medicare Advantage Plans Renamed Medicare Advantage Plans Combine Parts A, Part B and sometimes Part D 1 in every 5 Medicare beneficiaries are enrolled in MA plans

8 Medicare Basics Medicare Part D Prescription Drug Coverage Helps pay for prescription drugs Coverage limits Donut Hole Part D is not automatic You decide to enroll or not May pay a penalty for late enrollment

9 MCHCP and Medicare Advantage Medicare Advantage Plans Administered by private companies United Health Care Approved by Medicare Must provide all benefits provided by Medicare May provide additional benefits Cannot enroll/use Medigap or supplemental policies Cannot enroll/use other Part D plans

10 MCHCP and Medicare Advantage How do Medicare Advantage Plans work? Get services covered by the health plan Still enrolled in Medicare Part A and B Must pay Part B premium Must pay MCHCP monthly premium Prescription drugs covered Cost sharing applies Additional benefits available Larger network Access providers that accept assignment for maximum benefits. Out-of-pocket maximums

11 What is Cost Sharing? Medicare Advantage and cost sharing: Premium Deductible Copayment Coinsurance Out-of-pocket maximum

12 MCHCP and Medicare Advantage MCHCP eligibility requirements continue Medicare eligibility requirements continue Must have Medicare Part A Must have Medicare Part B

13 MCHCP and Medicare Advantage All benefits of Medicare Part A Hospital stays, skilled nursing, home health Hospice continues to be covered by Part A All benefits of Medicare Part B Doctors visits, outpatient services, screenings, shots Additional benefits provided by the MCHCP Plan Eye care and glasses, dental care, hearing services, nurse helpline Care Management Programs Not currently offered to MCHCP Medicare members Lower cost share for members

14 What is Care Management? Providing coordinated care to our members Members with chronic diseases receive a considerable amount of medical care. Care managers focus on helping members receive well-coordinated care. Care managers help members get the care they need when they need it.

15 What is the Advantage? The convenience of a single plan Additional benefits such as dental and vision One ID card for medical and pharmacy plans One explanation of benefits Care management programs Claims filed to insurance plan not Medicare Lower cost for most services Worldwide emergency care

16 Why the Change? Allows MCHCP to continue to offer a viable health plan to Medicare Retirees. Benefit changes, premium increases, coordination of benefits with Medicare MCHCP s current plan is not sustainable due to rising health care costs Allows MCHCP to offer additional benefits Allows MCHCP to offer Care Management to Medicare Retirees

17 What are the next steps? HealthFactsNewsletters Pre-Open Enrollment Meetings Open Enrollment Meetings and information with Benefits/Premiums Automatic Enrollment during OE October 1, October 31, 2010 Effective January 1, 2011

18 QUESTIONS

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