Humana Group Medicare Advantage

Transcription

1 Humana Group Medicare Advantage Plans that go the extra mile. Bradley University GHHHWTDEN_16BRAD5 1

2 Agenda Objective Discuss how Humana can partner with you to achieve your healthcare goals. Our Partnership with You Improved network coverage Availability of comprehensive programs Benefits of Humana Pharmacy Learn About Medicare Explanations of Original Medicare and Medicare Advantage differences and similarities Understand Your Plan What you will need to pay for care Learn About Enrollment How to enroll in a Humana plan and what to expect from Humana during that process Use Your Plan What you need to do to start using your new plan and all the extra benefits that are included at no cost to you 2

3 Making Healthcare Decisions: What You Need to Know In today s meeting we will focus on answering the questions you may have about your new Humana plan and what the change means for you. What We Will Discuss Today: How does Medicare work, and how is it different from Medicare Advantage? What is our new plan, and what does the change mean for me? What do I do next? What do I have to do to enroll in this plan? What happens after I enroll? 3

4 Learn About Medicare: Medicare and Medicare Advantage Healthcare, and especially Medicare, can be confusing. With so many different elements, choosing the right benefits can be difficult. Medicare Advantage plans combine all the elements into one plan, meaning you don t need to get Medicare coverage anywhere else. Medicare Medicare Advantage Members with Original Medicare often choose to get a Medicare Supplement plan to get additional coverage Possibility to have up to 3 different providers and 3 different cards A one stop shop No need for supplemental coverage One card and one place to call with questions 4

5 Learn About Medicare: Humana Medicare Advantage At Humana, we help you get through the confusing aspects of Medicare and make your benefits easy to select, enroll in and use. About Humana: Dedicated to communities around the country for more than 50 years One Card and One Place to Call With Questions: 6.9 million Medicare members, just like you, across all 50 states Providing Medicare plans to beneficiaries since 1987 Easily find a doctor with our nationwide network of providers Humana Group Medicare Advantage 5

6 Humana s Organizational Goals Humana s dedication to communities across the country doesn t stop with providing healthcare plans. We strive to make a difference at multiple levels from the health of all Americans all the way to the individual retiree. Increased Health Our goal is improve the health of the communities we serve 20% by Community Assistance Continue our dedication to communities across the country Individual Focused Provide personalized care with coaching, assistance and clinical programs 6

7 Understand Your Plan: What is a PPO? A Preferred Provider Organization (PPO) allows members to go to any provider that accepts Medicare that also agrees to Humana s terms and conditions in other words, they agree to bill Humana. PPO See any provider that accepts Medicare and agrees to bill Humana Provider Flexibility No Copayment for Preventive Care Out Of Pocket Maximum Worldwide Emergency Coverage 7

8 Understand Your Plan: Your PPO With your PPO plan, you will pay the same amount whether you go in or out of network for care. Hospital Care Outpatient Hospital Visits Emergency Room Care Inpatient Hospital Days % of the cost $65 $200 Non Hospital Care Primary Care Physician Specialist Outpatient Ambulatory Surgical Center Durable Medical Equipment $5 $20 10% of the cost 15% Other plan information Annual Deductible Annual Maximum Out of Pocket $0 $3,000 8

9 Understand Your Plan: Your Part D Coverage Humana s Part D coverage is spread between four groupings based on the drug type also called tiers. It covers every drug that is covered through Medicare. What You Can Expect to Pay If you pick up your medication in person and in network (30 day supply): Tier 1 (Generic/Preferred Generic) Tier 2 (Preferred Brand) Tier 3 (Non Preferred Brand) Tier 4 (Specialty) $4 $25 $40 33% If you use a mail delivery pharmacy (90 day supply): $0 $50 $80 N/A Common medications that fall into each tier: Levothyroxine Sodium Simvastatin Omeprazole Synthroid Zocor Prilosec Enbrel Procrit 9

10 Understand Your Plan: Your Rx Drug Phases Humana s Part D coverage is designed to help you manage your out of pocket costs. Coverage Gap Initial Coverage Coverage gap Catastrophic Coverage Initial Coverage: Your plan gives you coverage for your drugs, up to a certain point. Coverage Gap: Begins after the total yearly drug cost (including what your plan has paid and what you have paid) reaches $3,310. Catastrophic Coverage: Once your yearly out of pocket costs reach $4,850 you will be close to fully covered again. 10

11 Rx Mail Delivery With your new plan, you have access to network mail delivery pharmacies, including Humana Pharmacy mail delivery. It brings convenience and support to your medication needs. Not only will Humana Pharmacy ship your medications to your door, but will remind you when it is time to refill your prescriptions and often with cost savings for you. Accuracy & Safety Two pharmacists check every order to ensure your safety Convenience Avoid timely trips to the pharmacy get your medication shipped right to your home, work or doctor s office Support You Need A team of pharmacists and technicians are only a phone call away Reminders Humana Pharmacy will remind you when it is time to refill your medicines by phone, or text message. *Other Pharmacies are available in our network 11

12 Use Your Plan: Available Programs Humana s Group Medicare plans address the full spectrum of your health needs from overcoming a chronic condition to learning how to eat healthier and taking strides toward better health. Clinical Programs: Get the right care in place to help manage chronic condition(s) Health Coaching Programs: Health & Wellness Programs: Humana At Home can help keep you out of the hospital: 42% fewer hospitalizations 1 39% fewer 30 day readmissions 2 Begin your journey to a healthier lifestyle with a certified health coach who helps you set and reach goals through a personalized action plan. Stay active with support from fellow members. Get rewarded for making progress on your health and wellness. 1 Source: Humana at Home HCCP Member Results, 1/ / Source: Humana at Home Transitions Member Results, 1/ /

13 Use Your Plan: Understanding Your Health You will receive your SmartSummary and SmartSummaryRx, a comprehensive overview of your personal health benefits and health spending on medical and prescriptions, throughout the year. Stay Informed: Know what you re spending and the benefits you re using with a 12 month claims history Your SmartSummary And SmartSummaryRx Clear and Detailed Financials: Identify patterns and find savings opportunities with all your plan information in one place Health Record to Take to Your Doctor: Use this one document to take with you to the doctor s office Prescription Information: Take this to your pharmacist as a one stop shop for your prescription history 13

14 Use Your Plan: Stay Connected With Humana There are many ways to interact with Humana after you enroll in a plan many are available to you 24 hours a day and 7 days a week. I have a question about my Humana plan: I have a medical question: Use MyHumana as an online tool access your benefits information anytime. Potential uses include: Check benefits and claims Find an in network doctor Make premium payments Available as a mobile app. Look for this icon: I have a general question: Your group will have a dedicated customer care team to help you with anything related to your Humana plan. The number for your group is HumanaFirst* is a toll free, 24 houra day Nurse Advice Line. A registered nurse will be able to answer your questions and help you avoid unnecessary doctors visits. *HumanaFirst should not be used in emergency situations 14

15 Use Your Plan: What s Next There are a few things you need to do after moving to your Humana plan. What do I do with my Medicare card? * Provide your Humana card to doctors from now on, but keep your Medicare card in a safe place Use this card now * Keep, but don t use * What do I need to do after I enroll? * Read through the materials Humana sends you and expect to receive a call from Humana within 90 days to discuss your health goals How do I know if I can keep going to my doctor/physician/hospital? * Go to Humana.com/PhysicianFinder and follow the simple instructions to see if your doctor is in Humana s network 15

16 Frequently Asked Questions Q: Do I still have to pay my Medicare Part B Premium even though my Medicare Advantage plan will replace my Original Medicare plan? A: Yes, you must have both Medicare Part A and Part B and continue to pay your Part B premium to have a Medicare Advantage plan. Medicare Advantage gives you all the same coverage, but Humana administers the plan and CMS reimburses Humana for members claims. Q: What will I receive in the mail from Humana after I enroll? A: After you enroll we will mail you your Humana ID card, details of your benefits (or evidence of coverage), and a letter confirming your enrollment. Q: When will I get my Humana ID card? A: You will receive your Humana ID card prior to your coverage effective date (determined by your employer). Q: Who and when can I call Humana s customer service? A: The Humana Customer Service number is and the hours of operation are 8 a.m. to 9 p.m., Monday through Friday Eastern Standard Time. 16

17 Thank You Humana is a Medicare Advantage PPO organization with a Medicare contract/humana is a standalone prescription drug plan with a Medicare contract. Enrollment in this Humana plan depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/co insurance may change from year to year. Enrollment in this Humana plan depends on contract renewal. The pharmacy network and provider network may change at any time. You will receive notice when necessary. Other pharmacies are available in our network. You should get your new prescription by mail in 7 10 days after Humana Pharmacy has all the necessary information. It may take longer if Humana Pharmacy calls you or your healthcare provider with questions about the order. If you do not receive your order in 7 10 days, please call (TTY: 711), Monday Friday, 8 a.m. 11 p.m., and Saturday, 8 a.m. 6:30 p.m., Eastern time. This information is available for free in other languages. Please call our customer care number at (TTY: 711). You can call Monday Friday, from 8 a.m. 9 p.m., Eastern time. Esta información está disponible gratuitamente en otros lenguajes. Póngase en contacto con nuestro Departamento de Atención al Cliente al (TTY: 711). Los representantes están disponibles de lunes a viernes de 8 a.m. a 9 p.m., hora del Este. 17