MEDICARE ADVANTAGE PLANS Get more benefits than Original Medicare!

Transcription

1 MEDICARE ADVANTAGE PLANS 2015 Get more benefits than Original Medicare!

2 Ronald L. Peoples Health plan member - A self taught musician, Ronald plays eight different musical instruments, but he built a robot to play this guitar. 2

3 Meet Ronald L. Artist. Inventor. Cancer survivor. Peoples Health plan member. If I didn t have my Peoples Health plan, says Ronald, I am quite sure I wouldn t be here today. I wouldn t be among the living today. Because I was on my way out. Peoples Health saved my life. When he was 68 years old, Ronald says he took some advice and got a checkup. I d never had a physical, he says, because I ve always felt good. But thanks to that checkup, Ronald learned he had an issue with his prostate. His primary care doctor coordinated care with a specialist who confirmed that Ronald had cancer. On a scale from one to being the highest this disease that I had, I was a seven, Ronald says. And Peoples Health, with their fine doctors and hospitals and service, they saved my life. I m in excellent shape. Enhanced Primary Care At Peoples Health, we provide our doctors with resources to help care for our plan members. Our regional teams of nurse navigators, nurse practitioners, social workers, dietitians and other clinical professionals allow for coordinated care tailored to each member s needs. See page 9 for more information about how we help our doctors help our members. Ronald is now an advocate of getting a regular physical no matter how good you feel. And Peoples Health agrees. We encourage all of our plan members to get an annual exam. Our plan members are at the center of everything we do, and we want to do all we can to help each of our members enjoy the best health possible. On the pages that follow, we ll introduce more of our members, describe the Peoples Health approach to care and tell how Peoples Health fits in the world of Medicare. About our photographs We d like to thank our plan members who gave their time and of themselves for our photographs. They are the people of Peoples Health, and their health and vitality are inspirational. 1

4 We are Peoples Health The choice of over 57,000 Medicare beneficiaries in Louisiana. + Medicare Fact Nearly 16 million people get their Medicare benefits through a Medicare Advantage plan.* Peoples Health is a Louisiana-based company with a Medicare contract to offer Medicare Advantage plans, including Medicare special needs plans. Medicare Advantage plans are also known as Medicare Part C plans. How do these plans work? Medicare pays the Medicare Advantage organization a fixed amount every month to cover the cost of your care. Your doctor, hospital or service provider then bills the health plan rather than Medicare for services you receive. As you can imagine, the more a health plan can keep you healthy, the lower the costs. The lower the costs, the more we can put back into benefits. At Peoples Health, we believe that by working closely with you, we can do more to keep you healthy or get you well. Founded in 1994 by medical providers in the New Orleans area, Peoples Health remains guided by physicians. Our corporate headquarters are in Metairie, but our Medicare health teams have regional offices across our service area. 2 + CMS Monthly Enrollment by Plan, August, * Henry J. Kaiser Family Foundation Issue Brief Medicare Advantage 2014 Spotlight: Enrollment Market Update, (April 2014, page 1).

5 Carole C. Peoples Health plan member There s something about being outdoors and active that makes Carole happy. Maybe what makes her happy also helps keep her healthy. 3

6 Sherry and William M. Peoples Health plan members Sherry and William are making the most of their retirement enjoying the extra time they get to spend together and with friends. 4

7 Your Medicare Health Team The benefits of being local. In our 20 years of serving people with Medicare, we ve learned that what works is teamwork. Every one of our plan members has a Medicare health team made up of local healthcare professionals to assist with care. From simple reminders about annual screenings to more complex care coordination, we work with our plan members to help them enjoy the best health possible. Sometimes health can be complicated by factors other than specific medical conditions, so we have dietitians, social workers and nurses ready to help. Our regional teams also include physicians and pharmacists, nurse practioners and other clinical professionals all available to meet face-to-face with our plan members when and where needed. One of the places members can meet with their health team is at our regional service centers. These community-based centers provide a range of services from flu shots to pharmacist consultations, wellness assessments to educational presentations. It s good to be local. Center for Healthcare Advancement This alliance between LSU Health Sciences Center* and Peoples Health is focused on overcoming chronic health issues that affect seniors in Louisiana. Through the Center for Healthcare Advancement, doctors, medical care givers, researchers and managed care experts collaborate to define paths of care for complex conditions. This alliance was specifically built to help Peoples Health plan members, but our goal is solutions that offer a positive, sustainable impact on the health of all Louisianians. *Other providers are available in our network. 5

8 Meet Judith F. Have you ever been thrilled to wash dishes? Ever? What do you want out of your health plan? Some people just want confidence that they re covered in case they get sick. Some people want better health and, with it, a greater ability to enjoy the little things in life. Whatever your goals are, the Peoples Health personalized approach to care may be just what you re looking for. At 75 years old, Judith F. was losing her fight against a chronic condition that was attacking her central nervous system. Walking became increasingly difficult. Standing at her kitchen sink was out of the question. Day-to-day life had gotten so hard that hope slipped into reflection on a life that had been good. I had given up, she said. But Judith s primary care doctor was not at all ready to give up. He prescribed physical therapy and connected Judith with a neurologist. The neurologist put her on a new regimen of drugs, and the physical therapist came to my house three times a week for about three months, Judith says. Now she says, I am walking. I cannot stand out here and dance for you, but I can walk. Plus, an MRI recently showed that the spread of her condition had slowed, if not stopped. Not long ago, standing at her kitchen sink, Judith realized how good it was to wash dishes again to perform a chore she never would have expected to miss. She thought about the coordination of care that gave her help and hope and got her to her feet. She recalls telling her friend Mack about it: It is a miracle and the miracle is Peoples Health. Miracle or not, at Peoples Health, each of our plan members has the support of a Peoples Health Medicare health team. These teams of community-based professionals enhance the care provided by our primary care physicians and allow for a more comprehensive approach to care coordination. Sometimes it s the comprehensive approach that makes all the difference. 6

9 Judith F. Peoples Health plan member Judith is a writer, and she s thankful that the coordinated care she s gotten from Peoples Health has given her a renewed ability to follow her passions. 7

10 Walter S. and Debbie H. Peoples Health plan member and Peoples Health nurse navigator Walter is in great shape, but he s glad to know he has the support of a health team that can provide an extra level of help if he needs it. 8

11 Beyond Benefits Enhanced Primary Care Preventive care and early detection are such lifesavers, we can t stress enough the value of regular screenings and visits with your primary care physician. To better serve our members, a number of our doctors now have Peoples Health employees such as nurse navigators or nurse practitioners working in their offices to help coordinate necessary information and services or assist in other ways. All of our doctors have access to electronic resources that help them understand the medical histories and screening results of our plan members. These resourses can help the doctors design and monitor individualized care for their patients our members. For members that need care across different healthcare settings such as the transition from hospital to home their health team care coordinators can meet with and assist them. From facilitating wound care services or therapy to scheduling follow-up appointments, our health teams are on hand to help. At Peoples Health, the benefits are just the beginning. When it comes down to it, individual results are what really count. Our Community. Our Commitment. In September 2014, in conjunction with the Jefferson Council on Aging and the City of Gretna, we opened a new wellness center just across the river from New Orleans. The Gretna Senior and Wellness Center pilot project offers fun, food and friendship for Gretna residents who are age 60 or older. Peoples Health provides educational programming and events at the center. Plans are in place to open similar wellness centers across our service area. 9

12 Special Needs Plans Additional benefits for people with both Medicare and Medicaid. Medicaid and Peoples Health If you have Medicare and you get medical assistance from the state of Louisiana (such as help paying your Medicare Part B premium), you may qualify for a Peoples Health special needs plan. At least one in four people with Medicare in Louisiana also gets medical assistance from the state through Medicaid. It s one of the highest percentages in the country. Medicare calls these beneficiaries dual eligibles. If you re dual eligible, Peoples Health offers what Medicare calls special needs plans to provide you with greater assistance. In Louisiana, more people with Medicare and Medicaid have chosen a Peoples Health plan than any other Medicare Advantage special needs plan.* For countless reasons, many of our dual eligible plan members face tremendous hurdles to good health. Our special needs plans are designed to help remove those hurdles through benefits and coordinated care. If you have Medicare and some level of Louisiana Medicaid assistance, ask Peoples Health about: Free comprehensive physical exams Free tests and screenings Free rides to doctors appointments + Free fitness center membership + Routine vision coverage + Routine dental coverage + Prescription drug coverage, including coverage for brand-name drugs A Peoples Health plan ID card that s widely accepted and easy to use 10 These special needs plans are available to anyone who has both medical assistance from the state and Medicare. The Henry J. Kaiser Family Foundation report Medicare s Role for Dual Eligible Beneficiaries, (April 2012, p. 11). * CMS enrollment report by contract, plan, state and county, August May not be available in all Louisiana parishes.

13 Gloria B. Peoples Health plan member Gloria loves crafts and is active in senior social groups. She and her friends had a great time last Mardi Gras making festive hats out of paper bags. 11

14 Kelly C. and Kathryn J. Peoples Health social worker and Peoples Health plan member Thinking back over the years since she joined her Peoples Health plan, Kathryn said: That was the best day of my life when I joined Peoples Health. 12

15 Meet Kathryn J. I ve been through so much, and Peoples Health has really helped me. A few years ago, Kathryn J. was having a particularly difficult time struggling with loss and grief. One of our care coordinator social workers went to Kathryn s house to see how she could help. Eventually, talk turned to Kathryn s physical health and the screenings she should get. She was due for a mammogram. Thanks to the encouragement of her Peoples Health social worker, Kathryn got that screening. She was diagnosed with cancer. She needed surgery. Her Peoples Health social worker introduced Kathryn to another member of her health team: her care coordinator nurse who helped her through the process. Kathryn is a survivor. Kathryn was well under 65 when she joined Peoples Health. At that age, she didn t even know it was an option. She had Medicare through disability. She had her red, white and blue Medicare card. But she thought you had to be 65. Fortunately, someone in her church told her to look into it. She s glad she did. Things to Do Whether you re a Peoples Health plan member or not, ask your doctor what screenings you need. Regular checkups and screenings help your doctor monitor your health and identify health concerns early. Early detection is key to better treatment. I don t think I d make it without Peoples Health, Kathryn says. She says she s grateful for Peoples Health grateful for her social worker, who helps her through tough times grateful for her care coordinator nurse when she was battling her physical challenges. She s grateful for her transportation benefit and for the reminder phone calls she gets. Peoples Health is like my family, she says. It makes you feel good to know that people really listen and people really care. It s not all about money. They really care. 13

16 Hillary and Shirley K. Peoples Health plan members Hillary and Shirley simply love being together. They look forward to travelling more, learning more and making more and more wonderful memories. 14

17 The ABCs of Medicare Medicare has four parts: Part A is hospital insurance covering inpatient hospital services, skilled nursing facility care, home health and hospice care. Part B is medical insurance covering doctor, outpatient hospital, home health and preventive services, as well as other services Part A does not cover. Part C is Medicare Advantage. Medicare contracts with private insurers to administer your benefits. Part D is outpatient prescription drug coverage. It is optional coverage provided by private health insurance plans that contract with Medicare. Peoples Health offers Medicare Advantage plans (Part C) that include Medicare Part D prescription drug coverage. Did you know? If you only have Original Medicare (parts A and B), there are deductibles you must pay before Medicare starts paying for most servies. For example, Medicare s inpatient hospital deductible for 2014 is $1,216. If you want to add prescription drug coverage under Medicare Part D, you have to join a prescription drug plan with a monthly premium and often another deductible. Medicare Milestones: n n n n n Established in 1965 as a federal health insurance program for people 65 and older Expanded in 1972 to include people with disabilities Balanced Budget Act of 1997 created Medicare Part C, now known as Medicare Advantage Medicare Modernization Act of 2003 created Medicare Part D (effective in 2006) Patient Protection and Affordable Care Act of 2010 increased focus on quality All Peoples Health Medicare plans include Part D prescription drug coverage. There s no need to pay for a separate plan. 15

18 Questions and Answers How can Peoples Health plans offer so much coverage? Our Medicare Advantage plans are contracted by the Centers for Medicare & Medicaid Services, the federal agency that administers Medicare. When you join one of our plans, Medicare pays Peoples Health to administer your Medicare benefits. Peoples Health saves money by keeping people healthy. Healthier people have lower healthcare costs, which is why we put so much emphasis on wellness programs, early detection, preventive medicine and coordination of care. We pass the savings back to our members through enhanced benefits. Do I need to be 65 to enroll in a Peoples Health plan? Are there any special requirements to enroll? You do not need to be 65 to enroll. Many of our members have Medicare due to a disability. The only requirements to enroll are: A) You must reside in the plan service area. B) You must have both Medicare Part A and Part B. C) In general, you must not have end-stage renal disease (ESRD). Does Peoples Health replace my Medicare coverage? No. When you enroll with Peoples Health, you are still enrolled in Medicare, but Peoples Health will administer your Medicare benefits. That s why you must continue to pay your Medicare Part B premium. When can I switch plans? In general, Medicare beneficiaries can change the way they receive their Medicare benefits for next year during the Annual Enrollment Period from October 15 through December 7. There are exceptions for instance, if you are eligible for Medicaid, you can switch plans anytime. There is also a disenrollment period from January 1 through February 14 if you would like to return to Original Medicare. Do I need a physical exam to enroll in Peoples Health? No. You are not required to take a physical exam. You cannot be refused enrollment with Peoples Health for any pre-existing condition except ESRD. That said, we encourage you to get a physical every year even if you feel great. What if I m already enrolled in a Part D drug plan? All Medicare Advantage plans from Peoples Health include Medicare Part D drug coverage. Medicare does not allow you to be enrolled in two Part D plans at once. When you enroll with Peoples Health, Medicare will transfer your Part D enrollment from your previous plan to your Peoples Health plan. If you were paying a monthly premium for your previous Part D plan, you may now be able to save that money. Do Peoples Health plans provide drug coverage through the doughnut hole? Yes. All Peoples Health plans provide continuous coverage through the Medicare Part D coverage gap (also called the doughnut hole) for many generic drugs. 16

19 Marjorie P. Peoples Health plan member Marjorie has a keen interest in geneology. She enjoys the detective work involved in finding her ancestors and others she s connected with. 17

20 Dale V. Peoples Health plan member Dale goes after life with everything he s got. And he s glad he didn t wait til he turned 65 to join his Peoples Health plan. It s easy to learn more or to enroll. If you would like to learn more, call us or visit us online. We can even have a licensed representative come to you to discuss your options. There s no obligation. Not 65? You don t have to be 65. Thousands of Peoples Health members have Medicare through disability. If you have a red, white and blue Medicare card, call us to see if you d benefit from having a Peoples Health card. Call 6 a.m. to 11 p.m., seven days a week, toll-free: ( TTY: 711) If you would prefer to call a local number, dial: (504) (225) (985) ( TTY: 711) Peoples Health Three Lakeway Center 3838 N. Causeway Blvd. Suite 2200 Metairie, LA H1961_PH2015OVBRO Accepted Peoples Health is a Medicare Advantage organization with a Medicare contract to offer HMO plans. Enrollment depends on annual Medicare contract renewal. 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. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.