WELCOME. We re glad you re here!

Transcription

1 WELCOME We re glad you re here!

2 Premera Blue Cross Medicare Advantage HMO and HMO-POS Plans This year do what s right for you.

3 Meeting agenda Medicare basics Your Medicare coverage options Premera Blue Cross Medicare Advantage Plans The new member experience what to expect Enrolling is easy!

4 Medicare basics

5 Who qualifies for Medicare? Citizen or U.S. resident and Age 65 and older, or Under age 65 and disabled,* or Living with end-stage renal disease (ESRD) *Permanently disabled for 24 months or longer.

6 Medicare Enrollment Periods Initial Enrollment Period (IEP): 3 months before, the month of, and 3 months after your 65 th birth month Annual Enrollment Period (AEP): October 15 December 7 Medicare Advantage Disenrollment Period (MADP): January 1 February 14 Special Enrollment Period (SEP): Example: Loss of employer coverage or moving to new service area

7 Know your A, B, Cs and D Part A & Part B Original Medicare

8 Know your A, B, Cs and D Part A Hospital Insurance Part A is free for most people There is a $1,260 Part A deductible per benefit period After 60 days in the hospital, you pay: ü $315 per day copay for days ü $630 per day copay for days ü After day 150, you pay all hospital costs FIGURES ARE FOR 2015

9 Know your A, B, Cs and D Part B Medical Insurance There is a $ standard per monthly premium* There is a $147 annual deductible Original Medicare covers 80% of most Part B costs, leaving you to pay the other 20% for services like: ü Most physician services ü Outpatient therapies ü Durable medical equipment ü Home health care FIGURES ARE FOR 2015 *Varies for higher income consumers.

10 Know your A, B, Cs and D Part C Medicare Advantage plans Medicare Advantage plans are offered by private companies Cover some of the costs not covered by Medicare Often include extras like fitness and wellness programs Many also offer Part D prescription drug coverage

11 Know your A, B, Cs and D Part D Prescription Drug Coverage Voluntary program and run by private companies You pay a monthly premium You pay a portion of the drug cost Plan designs must be equal to or better than standard Medicare benefit designed by CMS Coverage varies from plan to plan Some may pay penalty for late Part D enrollment

12 How Medicare Part D 4 1 phases work annually 3 2 YOU pay $2.95/Generic and $7.40/Brand or 5% 5% COPAY $4,850 $3,310 $360 4 Catastrophic YOU 5% PLAN 95% 3 Coverage Gap YOU 45% YOU 58% BRAND GENERIC 2 Initial Coverage YOU 25% PLAN 75% 1 Deductible YOU 100% PLAN 0% FIGURES ARE FOR 2016 This is an example of how Medicare Part D works and is not intended to portray a specific plan. In some instances, these costs will be approximate amounts.

13 Part D Extra Help Extra Help (or Low Income Subsidy [LIS]) is the name of the Part D drug program to help beneficiaries pay for drug costs. Extra Help is available from the government if you meet certain requirements. Those that qualify may get help paying monthly premiums, copays, coinsurance and deductibles.* Do you qualify? You don t know unless you apply. *Premiums, copayments, coinsurance and deductibles may differ depending upon the level of help for which beneficiaries may qualify.

14 Common formulary terms Formulary A list of drugs covered by the health plan. Prior Authorization (PA) For some covered drugs, you will need to get approval from the plan before you fill your prescriptions. Without approval, your drug may not be covered. Quantity Limits (QL) For some covered drugs, the plan may place limits on the amount of the drug that we cover per prescription or for a defined period of time. Step Therapy (ST) For some covered drugs, the plan may require you to try certain drugs to treat your condition before we will cover another drug for that condition. Transition Supply A temporary supply of your prescription drugs that allows you to transition to a new prescription covered by your plan formulary. The formulary may change at any time. You will receive notice when necessary.

15 Your Medicare coverage options

16 Medicare coverage options START with Original Medicare DECIDE if you want more coverage Option 1 Option 2 Part A (hospital insurance) + Part B (medical insurance) Medicare Part D Prescription Drug Plan and / or Medicare Supplement Insurance Plan Medicare Advantage Plan Combines Parts A & B Many cover prescription drugs and may include extra benefits Your monthly plan premium could be as low as $0

17 Premera Blue Cross Medicare Advantage Plans

18 Medicare Advantage eligibility To enroll, you must: Have Medicare Parts A & B Continue to pay your Part B premium Not have ESRD (in most cases) Live in plan service area Have a valid enrollment period

19 Plan service area Snohomish Spokane King Pierce Thurston

20 Premera Blue Cross is proud to present our 2016 Medicare Advantage plans Option 1 HMO Premera Blue Cross Medicare Advantage (HMO) Option 2 HMO-POS Premera Blue Cross Medicare Advantage (HMO-POS) Option 3 HMO Plus Premera Blue Cross Medicare Advantage Plus (HMO)

21 Let s review our Medicare Advantage plans This year do what s right for you.

22 Our most POPULAR plan no monthly premium HMO Plan Benefits Premera Blue Cross Medicare Advantage (HMO) In-network only Monthly plan premium $0 Medical deductible $0 Annual out-of-pocket maximum $6,700 Primary care provider visit Specialist visit Inpatient hospital care Outpatient hospital care Ambulance Emergency care (worldwide coverage) Urgent care (worldwide coverage) Lab services X-rays Preventive care Annual physical exam Annual routine eye exam Eyewear allowance SilverSneakers fitness program You must continue to pay your Medicare Part B premium. $18 copay $50 copay $440 copay (days 1 4) $0 copay (days 5+) 20% coinsurance $300 copay/each one-way trip $75 copay (waived if admitted) $50 copay $20 copay $20 copay $0 copay $0 copay Not covered Not covered Not covered

23 Prescription coverage HMO Plan Benefits Prescription drugs Premera Blue Cross Medicare Advantage (HMO) Drug Coverage (30-day supply from a preferred network pharmacy) Drug deductible (applies to tiers 2-6) $285 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred brand Tier 5/6 Injectable/Specialty $4 copay (deductible waived) $12 copay $45 copay $100 copay 25% coinsurance Transition Supply Period As a new Premera Medicare Advantage member, your plan will cover a temporary supply of your drugs during the first 90 days of membership. A temporary supply of your prescription drugs allows you to transition to a new prescription covered by your plan formulary. Search online at premera.com/ma

24 Preventive dental coverage optional rider HMO Plan Benefits Preventive dental optional rider Premera Blue Cross Medicare Advantage (HMO) Preventive Dental Coverage ($0 copays from a preferred network dentist) Monthly dental premium $26 Routine oral exams Cleanings Fluoride treatments Bitewing x-rays (set of 4) Periapical x-rays Panoramic or complete series x-rays $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay $0 copay (1 set every 60 months) Add Dental Coverage You may add the optional dental rider within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. Coverage is effective the first of the month following the date we receive your completed enrollment form. Search online at premera.com/ma

25 Enhanced network FREEDOM and extra benefits HMO-POS Plan Benefits Premera Blue Cross Medicare Advantage (HMO-POS) In-network Monthly plan premium $69 Medical deductible $0 Annual out-of-pocket maximum $6,700 Out-of-network Primary care provider visit $18 copay 40% coinsurance Specialist visit $50 copay 40% coinsurance Inpatient hospital care $440 copay (days 1 4) $0 copay (days 5+) 40% coinsurance Outpatient hospital care 20% coinsurance 40% coinsurance Ambulance Emergency care (worldwide coverage) Urgent care (worldwide coverage) $300 copay/each one-way trip $75 copay (waived if admitted) $50 copay Lab services $20 copay 40% coinsurance X-rays $20 copay 40% coinsurance Preventive care $0 copay 40% coinsurance Annual physical exam $0 copay 40% coinsurance Annual routine eye exam $50 copay 40% coinsurance Eyewear allowance $150 reimbursement SilverSneakers fitness program $0 You must continue to pay your Medicare Part B premium.

26 Prescription coverage HMO-POS Plan Benefits Prescription drugs Premera Blue Cross Medicare Advantage (HMO-POS) Drug Coverage (30-day supply from a preferred network pharmacy) Drug deductible (applies to tiers 2-6) $200 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred brand Tier 5/6 Injectable/Specialty $4 copay (deductible waived) $12 copay $45 copay $100 copay 25% coinsurance Transition Supply Period As a new Premera Medicare Advantage member, your plan will cover a temporary supply of your drugs during the first 90 days of membership. A temporary supply of your prescription drugs allows you to transition to a new prescription covered by your plan formulary. Search online at premera.com/ma

27 Preventive dental coverage included HMO-POS Plan Benefits Preventive dental included Premera Blue Cross Medicare Advantage (HMO-POS) Preventive Dental Coverage ($0 copays from a preferred network dentist) Monthly dental premium $0 Routine oral exams Cleanings Fluoride treatments Bitewing x-rays (set of 4) Periapical x-rays Panoramic or complete series x-rays $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay $0 copay (1 set every 60 months) Search online at premera.com/ma

28 Lower out-of-pocket costs PLUS extra benefits HMO Plus Plan Benefits Premera Blue Cross Medicare Advantage Plus (HMO) In-network only Monthly plan premium $121 Medical deductible $0 Annual out-of-pocket maximum $5,000 Primary care provider visit Specialist visit Inpatient hospital care Outpatient hospital care Ambulance Emergency care (worldwide coverage) Urgent care (worldwide coverage) Lab services X-rays Preventive care Annual physical exam Annual routine eye exam Eyewear allowance $10 copay $40 copay $350 copay (days 1 4) $0 copay (days 5+) $250 copay $200 copay/each one-way trip $75 copay (waived if admitted) $40 copay $0 copay $0 copay $0 copay $0 copay $40 copay $150 reimbursement SilverSneakers Fitness Program $0 You must continue to pay your Medicare Part B premium.

29 Prescription coverage HMO Plus Plan Benefits Prescription drugs Premera Blue Cross Medicare Advantage Plus (HMO) Drug Coverage (30-day supply from a preferred network pharmacy) Drug deductible $0 Tier 1 Preferred generic Tier 2 Generic Tier 3 Preferred brand Tier 4 Non-preferred brand Tier 5/6 Injectable/Specialty $4 copay $12 copay $45 copay $100 copay 33% coinsurance Transition Supply Period As a new Premera Medicare Advantage member, your plan will cover a temporary supply of your drugs during the first 90 days of membership. A temporary supply of your prescription drugs allows you to transition to a new prescription covered by your plan formulary. Search online at premera.com/ma

30 Preventive dental coverage - included HMO Plus Plan Benefits Preventive dental included Premera Blue Cross Medicare Advantage Plus (HMO) Preventive Dental Coverage ($0 copays from a preferred network dentist) Monthly dental premium $0 Routine oral exams Cleanings Fluoride treatments Bitewing x-rays (set of 4) Periapical x-rays Panoramic or complete series x-rays $0 copay (2 every year) $0 copay (2 every year) $0 copay (1 every year) $0 copay (1 set every year) $0 copay $0 copay (1 set every 60 months) Search online at premera.com/ma

31 Medical network With thousands of local doctors in our Medicare Advantage network, you ll be sure to find a provider that s right for you and close to home. Western Washington Providers ü CHI Franciscan Health ü EvergreenHealth ü MultiCare Health System ü Overlake Medical Center ü Pacific Medical Centers ü Providence Health & Services ü Swedish Medical Center ü The Everett Clinic ü The Polyclinic ü Virginia Mason ü UW Medicine Eastern Washington Providers ü Columbia Medical Associates ü Deaconess Medical Center ü Providence Health and Services Providence Holy Family Hospital Providence Sacred Heart Medical Center & Children s Hospital ü Rockwood Clinic ü Valley Hospital The above list is not a complete list of participating and/or preferred providers. Search online at premera.com/ma

32 Pharmacy network Premera contracts with national pharmacy chains and many independent and local pharmacies. Preferred pharmacies allow members to pay the lowest cost for covered generic medications. Preferred Pharmacies Standard Pharmacies ü Bartell Drugs ü Providence Pharmacy ü The Medicine Shoppe ü Bi-Mart Pharmacy ü QFC Pharmacy ü Rite-Aid Pharmacy ü Costco Pharmacy ü Safeway Pharmacy ü Target Pharmacy ü Franciscan Pharmacy ü Savon Pharmacy ü Wal-Mart Pharmacy ü Fred Meyer Pharmacy ü Haggan Pharmacy ü Hi-School Pharmacy ü Walgreens Pharmacy ü Yokes Pharmacy The above list is not a complete list of participating and/or preferred pharmacies. Search online at premera.com/ma

33 The new member experience

34 The new member experience Your new member welcome kit with important plan information about covered benefits and services will be mailed to you. To learn more about the entire provider network, visit premera.com/ma. Your plan membership ID card will be mailed separately in a Premera envelope. Your ID card must be used when accessing covered medical and plan services. Your welcome call will give you an opportunity to ask us questions. You ll receive an Outbound Enrollment Verification (OEV) communication confirming your intent in enrolling in the Medicare Advantage plan you selected. SilverSneakers will send you an ID card for use at participating gyms and fitness centers if you elect the HMO-POS or HMO Plus plan. A Health Risk Assessment (HRA) survey will also be mailed to you with basic questions about your overall health. A prepaid envelope will allow you to return the survey at no cost to you. Your membership will generally become effective on the first day of the following month. Plans will become effective as of January 1 for enrollees in October, November and December (during the Annual Enrollment Period).

35 Enrolling is easy!

36 Five things to remember 1. You have a choice of Premera plans including a $0 premium 2. Plans with extra benefits, dental, vision, SilverSneakers and out-of-network access 3. Providers you know and trust 4. We re part of your community (for 80+ years) 5. You have a local team focused on you

37 Enroll today

38 Important plan information Premera Blue Cross is an HMO and HMO-POS plan with a Medicare contract. This information is not a complete description of benefits. Contact the plan for more information. Enrollment in Premera Blue Cross depends on contract renewal. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. Members must continue to pay Medicare Part B premiums. Premera Blue Cross is too new to be rated with a Medicare Star rating. Premera Blue Cross is an Independent Licensee of the Blue Cross and Blue Shield Association ( ) H7245_PBC0544_Accepted