Choose The Medicare Advantage Plan That s Right for You

Transcription

1 Choose The Medicare Advantage Plan That s Right for You Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS. H7220_IUHMA1601 CMS Approved

2 Choose a Medicare Advantage Plan That s Right For You Trust one of the highest-rated Medicare Advantage plans in the state* Indiana University Health Plans. Our Medicare Advantage program has received high ratings from the Centers for Medicare & Medicaid Services (CMS), the federal agency that evaluates Medicare Advantage plans. You ll find a wide range of valuable health benefits and improvement programs focused on keeping you healthy. We have been serving Hoosiers for more than 25 years, and more than 11,000 members trust our locally based plans because they are convenient, affordable and high quality, with resources and programs to help you live healthy and stay strong. Call us to find out more Contact the IU Health Plans Customer Solutions Center at TTY users call Relay Indiana at Customer Solutions Center Hours: Oct. 1 to Feb am to 8 pm seven days a week. Feb. 15 to Sept am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 8 pm, on weekends, and holidays. Also visit our website at IUHPlansforyou.org *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. 1

3 Explore Your Medicare Advantage Options As a Medicare beneficiary, you have many options for health coverage. Selecting a plan to meet all of your healthcare and wellness needs means evaluating these important factors: Cost n What will you pay out of pocket? Include monthly premium, deductibles, copays and coinsurance. n Does the plan have a reasonable maximum out-of-pocket (MOOP) level to limit how much you will spend in one year? Benefits n What extras are covered? n Is there coverage for dental and vision services? n Are there other wellness benefits? Choice of doctors and hospitals n Can you visit doctors you prefer? n Are the hospitals you like part of the plan? Convenience n Are the doctors offices and hospitals close to your home? n What about the pharmacies are local, national and mail-order pharmacies part of the plan? Prescription drugs n Are your drugs covered under the plan s formulary (list of covered drugs)? n What will your drugs cost under each plan? 2

4 Information to help you decide As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (fee-for-service) Standard Medicare plan. Another option is a Medicare Advantage plan like the three plan choices offered by IU Health Plans. No matter what you decide, you are still in the Medicare program. You may join or leave a plan only at certain times. Please call us for more information. STANDARD MEDICARE A B Part A helps with hospital costs. Part B helps with doctor and outpatient costs. ADDITIONAL POLICY D Part D assists with prescription drugs. OR MED SUPP Medicare Advantage (Part C) ONE POLICY is provided by private companies approved by Medicare. Medicare pays a fixed fee to the plan for your care. Then the plan pays the doctors and hospitals. A+B=C D + Part C one plan that covers hospital costs, doctor and outpatient care. Medicare (Parts A, B, C & D) Part D offered in many Medicare Advantage plans, drug coverage that is either built-in or can be an optional add-on. ADDITIONAL POLICY Medicare supplement insurance plans cover some costs not covered in Parts A & B. Additional benefits may be included, such as vision, dental and hearing services. Mark your calendar with these important dates Oct. 15 Dec. 7, 2015 Annual Election Period Time to choose or change your Medicare Advantage health or prescription drug plan coverage for There may be other times when you can switch your coverage. These are called Special Enrollment Periods. 3

5 With IU Health Plans, you re covered IU Health Plans offers comprehensive health benefits, personalized service and a dedicated focus on wellness and prevention. Our Medicare Advantage program, well known for quality and performance, offers: Affordable, flexible plans n Premiums as low as $0, reducing Part B premium up to $25/mo. n No medical or drug deductibles n Copays as low as $0 with affordable hospitalization, if needed n Plans with and without prescription drug coverage n Plan option that allows out-of-network care n Fitness center reimbursement, up to $200 per year n Maximum out-of-pocket protection Nationally recognized doctors and hospitals n Access to the top-ranked healthcare system in Indiana, where highly skilled doctors practice ( U.S.News & World Report) n A strong network of highly skilled IU Health primary care doctors as your everyday partner in health and wellness, as well as primary care experts across the state Local company, personal service n Enrollment and customer service handled close to home n Knowledgeable, friendly customer service associates and enrollment specialists n Personalized help with care coordination (medication, specialists, etc.) Compare IU Health Plans The charts on the following two pages will help you compare the three plans offered by IU Health Plans. Our members receive all the benefits of Original Medicare, plus some important extras. The charts list some, but not all available benefits. 4

6 Which Medicare Advantage Plan is right for me? Medicare-Covered Benefit Monthly Premium* Inpatient Hospital/Mental Health Skilled Nursing (No hospital stay required) WHAT IU HEALTH PLANS MEMBERS PAY Medicare Select Medicare Select Medicare Choice HMO-POS HMO Plus HMO In-Network Out-of-Network $0 Reduces your $42 $92 Part B premium up to $25 ea. month Annual Deductible $0 $0 $0 $0 $260 days 1-7 IP Hosp. $0 days 8-90 IP Hosp. $260 days 1-6 IP Ment. Hlth. $0 days 1-20 $160 days Inpatient/Home Health Care $260 days 1-7 IP Hosp. $0 days 8-90 IP Hosp. $260 days 1-6 IP Ment. Hlth. $0 days 1-20 $160 days $195 days 1-7 $0 days 8-90 $0 days 1-20 $105 days % 50% Home Health $0 $0 $0 50% Outpatient Care/Services/Supplies Primary Care $0 $10 $5 50% Physician Specialist $30 $40 $35 50% Chiropractor $20 $20 $20 50% Podiatry $15 $15 $10 50% Outpatient Surgery $285 $285 $195 50% Ambulance $225 $225 $225 50% Emergency $65 $65 $65 (worldwide) $65 (worldwide) Urgent Care $50 $50 $50 $50 Durable Medical 20% 20% 20% 50% Equipment Diabetic Supplies $0 $0 $0 50% Diag. Tests/Lab $10 $10 $0 50% X-rays/Therapeutic Radiology $25 $25 $25 50% Diagnostic Radiology $135 $135 $135 50% Part B Covered Drugs 20% 20% 20% 50% The benefits information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/co-insurance may change on January 1 of each year. *You must continue to pay your Medicare Part B premium.

7 WHAT IU HEALTH PLANS MEMBERS PAY Medicare-Covered Medicare Select Medicare Select Medicare Choice HMO-POS Benefit HMO Plus HMO In-Network Out-of-Network Preventive Services for Bone Mass Measurement, Pap/Pelvic Screening, Colorectal Cancer Screening, Mammogram, Flu/Pneumonia Vaccines, Prostate Cancer Screening and More Preventive $0 $0 $0 Not covered Screenings Annual Phys. Exam $0 $0 $0 Not covered Additional Benefits and Wellness Programs Fitness Center up to $200 up to $200 up to $200 N/A Membership reimbursement/yr. reimbursement/yr. reimbursement/yr. Preventive Dental $10 deductible $10 deductible $10 deductible Routine Vision Exam $0 $0 $0 Eyeglasses (lenses/frames) Hearing Aids* starting at $699 per hearing aid $40 $40 $40 Member Maximum Out-Of-Pocket Medical Cost Out-of-Pocket Cost Protection $4,850 $4,850 $4,600 Plan Limit No limit No limit No limit $10,000 Part D Prescription Drugs Annual Deductible $0 $0 $0 $0 Tier 1 (Generic) Not covered $6 30 day $18 90 day Tier 2 (Generic Non-Preferred) Not covered $15 30 day $44 90 day Tier 3 (Preferred) Not covered $45 30 day $ day Tier 4 (Non-Preferred) starting at $699 per hearing aid Not covered $95 30 day $ day starting at $599 per hearing aid $4 30 day $12 90 day $8 30 day $24 90 day $42 30 day $ day $95 30 day $ day Not covered Not covered Not covered Not covered Tier 5 (Specialty) Not covered 33% 30 day 33% 30 day Not covered Coverage Gap Not covered Tier 1 & 2 Gen. 58% Tier 1 Gen., lesser of Not covered after $3,310 Tier 3 & 4 Brand 45% $10 or 58% 30 day; until out-of-pocket $30 90 day is reached ($4,850) Tier 2 Gen. 58% Tier 3 & 4 Brand 45% Out-of-network options available Out-of-network reimbursement available *For TruHearing Chime products 6 Not covered

8 Eligibility who can join? Individuals must have both Part A and Part B to enroll in the IU Health Plans Medicare Advantage program. You must live in the service area, which includes these counties: Adams, Allen, Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Cass, Clay, Clinton, Crawford, Daviess, Decatur, DeKalb, Delaware, Dubois, Elkhart, Fayette, Fountain, Fulton, Gibson, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Huntington, Jackson, Jay, Jennings, Johnson, Knox, LaGrange, LaPorte, Lawrence, Madison, Marion, Marshall, Martin, Miami, Monroe, Montgomery, Morgan, Noble, Orange, Owen, Parke, Perry, Pike, Posey, Pulaski, Putnam, Randolph, Rush, Scott, Shelby, Spencer, St. Joseph, Starke, Steuben, Sullivan, Tippecanoe, Tipton, Union, Vanderburgh, Vermillion, Vigo, Wabash, Warren, Warrick, Wells, White and Whitley. Individuals with End Stage Renal Disease are generally not eligible to enroll unless they have had a successful kidney transplant. How can I get help with my prescription drug costs? People with limited incomes may qualify for Extra Help to pay for up to seventy-five (75) percent of their prescription drug costs. Many people are eligible for these savings. To see if you qualify for Extra Help, call 800.MEDICARE ( ). TTY users should call , 24 hours a day/7 days a week; the Social Security Office at between 7 am and 7 pm Monday through Friday. TTY users should call ; or Your Medicaid Office. 7

9 Frequently asked questions Get to know more about IU Health Plans Medicare Advantage plans. If you have other questions, please contact our Customer Solutions Center. Can I choose my doctors? Answer: Yes. You have access to the largest, most comprehensive health system in Indiana, plus a growing list of doctors, specialists and hospitals throughout the state. You may use any doctor who is part of our network. In some cases, you may also go to a doctor outside of our network. A current provider directory with an up-to-date list of network doctors is available at IUHPlansforyou.org. Will I still need to pay my Part B monthly premium? Answer: Yes. This is a Medicare requirement regardless of whether or not you enroll in a Medicare Advantage plan. However, IU Health Plans Select plan will reduce your Part B premium. If you have questions about your Part B premium, call Social Security at TTY users, call What are Part B drugs and how are they different from Part D drugs? Answer: Part B drugs are defined by Medicare and include certain chemotherapy drugs, some injections at your doctor s office and drugs you get at a dialysis facility. Part D drugs are ordered from a retail pharmacy or mail-order vendor and are listed on a formulary of covered drugs. Can I keep my current Part D plan? Answer: No. You can t have two Part D plans. Your premium with IU Health Plans includes Part D coverage with either the Choice or Select Plus options. (Note: You may have other prescription coverage (not Part D), like employer or union, military, or Veterans benefits.) 8

10 Frequently asked questions (continued) What is the gap? Answer: The coverage gap (also called the donut hole ) refers to the difference between your initial coverage limit and your catastrophic coverage threshold. That means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out of pocket for your prescriptions up to a yearly limit. Not everyone will reach the coverage gap. Once you reach your plan s out-of-pocket limit, you automatically get catastrophic coverage. At that point, you only pay a small coinsurance amount or copayment for the drugs for the rest of the year. IU Health Plans Medicare Choice will still cover generic drugs for a small copay during the gap. What happens if I get sick away from home or out of the coverage area? Answer: You are covered for urgent and emergency care for up to six months. Follow-up care must be authorized. IU Health Plans Medicare Choice offers coverage outside of the United States. Are hearing aids and dentures covered? Answer: Yes, hearing aids are covered as a benefit, however, dentures are not. What is Member Maximum Out-of-Pocket (MOOP) Cost Protection? Answer: It is a protection against how much you pay for healthcare each year. After this level is reached, you will have 100% doctor and hospital coverage for the remainder of the year. Part D prescription drugs do not count toward the limit. You continue to pay your monthly premium, if you have one. With the IU Health Plans Medicare Choice Point of Service (POS) plan, is there a maximum on how much the plan will pay for out-of-network care? Answer: Yes. Each year, your plan will pay up to $10,000 for Medicare-approved, out-of-network services. After that limit is reached, you will be responsible for 100% of charges for out-of-network services. Medicare beneficiaries may enroll in a plan only during specific times of the year. Contact IU Health Plans for details. 9

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12 950 N. Meridian St., Suite 200 Indianapolis, IN IUHPlansforyou.org If you have questions, we re here to help. Please call our Customer Solutions Center toll free at TTY users call Relay Indiana at Customer Solutions Center Hours: Oct. 1 to Feb am to 8 pm seven days a week. Feb. 15 to Sept am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 8 pm on weekends, and holidays IUHealth 9/15 IUH#20036