Guiding you on the new road ahead

Transcription

1 Guiding you on the new road ahead Your 2015 retiree plan options Caltech Retiree Information Sessions

2 Today s focus: Your 2015 plan options Understanding the plans How to enroll in 2015 Aetna Marketplace

3 What s the Aetna Marketplace? New shopping experience for selecting your retiree coverage in 2015 Online marketplace that will empower you to compare and shop for plans based on your unique needs A variety of plan options available between Aetna and Kaiser Though you ll have more plan choices, live licensed plan specialists and Aetna Marketplace Service Advisors will be there to guide you every step of the way. You ll get one on one support both online through live chat or by phone. In the Aetna Marketplace, you will be able to view your Defined Dollar Credit provided by Caltech Aetna Marketplace 3

4 Get prepared Aetna Marketplace 4 Aetna Inc. 4

5 Take note of your health information Before you visit the Aetna Marketplace, take a few minutes to take note of important health information. This information will help you when it comes time to compare plans, enroll or when you re talking to a plan specialist. 1. Are you eligible for Medicare and enrolled in both Medicare Part A and Part B? If not, you can enroll in Medicare Part A and Part B, go to If you don t know, call us at , beginning November 3, 2014, so we can help determine if you are enrolled in both Medicare Part A and Part B. 2. Have your Medicare Health Insurance Claim Number for you and any eligible dependents on Medicare available. 3. What is the name of the pharmacy where you usually fill your prescriptions? 4. Do you primarily take brand name or generic prescription medications? 5. For what reasons do you see your current doctors? For example, basic preventive exams or an occasional health problem, or for chronic conditions. 6. Who are the doctors you see most often? 7. Think about what is most important to you when selecting health coverage? Low monthly premium Physician choice Low payment when admitted to the hospital Low payment for doctor office visit Aetna Marketplace 5

6 Aetna Marketplace Post 65 Retiree Plan Options Aetna Marketplace 6 Aetna Inc. 6

7 How Medicare works The four parts of Medicare Aetna Marketplace 7

8 How the Parts of Medicare work with your Current Anthem PPO plan ORIGINAL MEDICARE Anthem PPO Coordinates with Original Medicare Part A Hospital Insurance Part B Medical Insurance Anthem plan supplements or coordinates with Original Medicare Part D Prescription Drug Coverage (PDP) Deductible / Out of Pocket $0 / $2,000 Maximum Physician Coinsurance 20% Specialty Coinsurance 20% Inpatient Cost Share $250 Part D Deductible N/A Part D 30 Day Retail Scripts $15/$35 Access to any Medicare Certified provider for medical care You access care with two ID Cards : Your Medicare Card + Anthem ID Card Medicare pays medical claims first and Anthem pays secondary Aetna Marketplace 8

9 How the Parts of Medicare work with your Current Anthem and Kaiser HMO plans Medicare Advantage (MA) Referred to a Part C Plan Details Anthem Senior Secure MA HMO Kaiser MA HMO Deductible / Out of Pocket Maximum $0 / $3,400 $0 / $1,500 Part C Combines Part A, Part B and often Part D Physician Copay/Coinsurance Specialty Copay $15 $15 $15 $15 Inpatient Cost Share $250 $0 Part D Deductible N/A N/A Part D30 day Retail Scripts Access providers within the Anthem or Kaiser network only Must select a primary care provider Referrals required for most specialist (exception OB/GYN) One ID card $15/$35 $10/$20 Aetna Marketplace 9

10 In 2015 all plans offered to Medicare Eligible will be Medicare Advantage Plans HMO and PPO Options One plan, one ID card More than just insurance Management of Parts A & B Ongoing support for health and wellness Extra benefits and value Integrated Part D prescription drugs Medicare Part A Medicare Part C Medicare Part D Medicare Part B It s a complete relationship. Aetna Marketplace 10

11 Who is Eligible for Medicare Advantage Age 65 or older retired, and enrolled in Medicare Part A and Part B: Must continue to be enrolled in Medicare after enrolling in Medicare Advantage Age under 65 years, retired, and enrolled in Medicare Part A and Part B due to Medicare qualified disability: Must continue to be enrolled in Medicare after enrolling in Medicare Advantage Medicare Eligible due to End Stage Renal Disease: some limitations may apply for enrollment into Aetna and Kaiser Medicare Advantage plans Aetna Marketplace 11

12 A Little More on the new Aetna Medicare Advantage Offerings of more than and you must use, except for emergencies or out of area kidney dialysis. For the out of network. you have the 2 to use providers in or in and out of network; people over age 65 used by, including convenient Aetna RX Home Delivery (mail order services) 1 Based on an Aetna survey conducted with 2,776 Medicare Advantage plan members from 8 employer group plan sponsor organizations, January 2012 January Non network doctors or hospitals must be licensed, agree to accept your PPO plan before treating you, and be eligible to receive Medicare payment. Aetna Marketplace 12

13 Medicare prescription drug coverage (Part D) Medicare Part A Medicare Part B Medicare Part C Medicare Part D Aetna Marketplace 13

14 Standard Medicare Part D plan phases (cost levels) This is a guide only and not the Caltech Plan Phase 1 Deductible Standard Part D Medicare eligible pays all costs until they meet the 2015 Medicare Defined $320 deductible Phase 2 Initial Coverage Limit ICL Standard Part D Medicare eligible plan cost share plus the Part D plan drug payment (total cost of drugs) = $2,960 Phase 3 Medicare Coverage Gap Donut Hole Standard Part D Medicare eligible pays all costs (except for brand drug assistance) until your total (or combined total with brand drug assistance) = $4,700 Phase 4 Catastrophic Coverage Standard Part D Medicare eligible pays the greater of: $2.65 or 5% for generic drugs and $6.60 or 5% for brand drugs Aetna Marketplace 14

15 Medicare Advantage PPO Plan Comparison Aetna PPO plans no referrals and no member pre certification required Aetna Premier Medicare S02 ESA PPO with Part D RX 1337 Aetna Medium Medicare C01 PPO with Part D RX 1337 Aetna Low Medicare V02 PPO with Part D RX 1201 Unlimited Lifetime plan coverage You pay same cost share for In Network and Out of Network Providers You pay for In Network You pay for Out of Network You pay for In Network You pay for Out of Network Plan deductible $0 $0 $0 $0 $0 Annual Out of Pocket Max $6700 $6700 $10,000 $3400 $10,000 Primary Care Doctor Visit $25 15% 25% $15 30% Specialist Care Doctor Visit $25 15% 25% $40 30% In Patient Hospital $250/stay $500/stay 25% $200 d/1 7 30% Aetna Marketplace 15

16 Medicare Advantage PPO Plan Comparison Continued Prescription Drug Cost Phases Aetna Premier and Aetna Medium Medicare S02 and C01 PPO with Part D RX 1337 Phase I: Deductible $0 $260 Aetna Low Medicare V02 PPO with RX 1201 Note: Brand Tiers include some High cost Generics Phase II: Initial Coverage Limit (ICL) Phase III: Medicare Coverage Gap (Donut Hole) Phase IV: Catastrophic Coverage $0 Select Care Generics $5 Generics $30 Preferred Brand $60 Non Preferred Brand $0 Select Care Generics $5 Generics $30 Preferred Brand $60 Non Preferred Brand Greater of 5% or $2.65 Generics Greater of 5% or $6.60 for all other drugs $1 Select Care Generics 20% Generics 25% Preferred Brand 45% Non Preferred Brand 65% Generics 45% Brand Greater of 5% or $2.65 Generics Greater of 5% or $6.60 for all other drugs Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes Aetna Marketplace 16

17 Medicare Advantage ESA PPO Plan Comparison for Out of Area Retirees Extended Service Area (ESA) Aetna PPO plans no referrals and no member pre certification required Aetna Premier Aetna Medium Aetna Low Examples Of Out of Area: if you live in Kern, Santa Clara, and Sacramento Counties Medicare S02 ESA PPO with Part D RX 1337 Medicare C01 ESA PPO with Part D RX 1337 Medicare V02 PPO with RX 1201 Unlimited Lifetime plan coverage You pay same cost share for In Network and Out of Network Providers You pay same cost share for In Network and Out of Network Providers You pay same cost share for In Network and Out of Network Providers Plan deductible $0 $0 $0 Annual Out of Pocket Max $6700 $6700 $3400 Primary Care Doctor Visit $25 15% $15 Specialist Care Doctor Visit $25 15% $40 In Patient Hospital $250/stay $500/stay $200 d/1 7 Aetna Marketplace 17

18 Medicare Advantage ESA PPO Plan Comparison for Out of Area Retirees Extended Service Area (ESA) Continued Prescription Drug Cost Phases Aetna Premier & Medium Medicare S02 ESA and C01 ESA PPO with Part D RX 1337 Aetna Low Medicare V02 ESA PPO with RX 1201 Note: Brand Tiers include some High cost Generics Phase I: Deductible $0 $260 Phase II: Initial Coverage Limit (ICL) Phase III: Medicare Coverage Gap (Donut Hole) Phase IV: Catastrophic Coverage $0 Select Care Generics $5 Generics $30 Preferred Brand $60 Non Preferred Brand $0 Select Care Generics $5 Generics $30 Preferred Brand $60 Non Preferred Brand Greater of 5% or $2.65 Generics Greater of 5% or $6.60 for all other drugs $1 Select Care Generics 20% Generics 25% Preferred Brand 45% Non Preferred Brand 65% Generics 45% Brand Greater of 5% or $2.65 Generics Greater of 5% or $6.60 for all other drugs Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes Aetna Marketplace 18

19 Medicare Advantage HMO plan comparison Medicare Advantage HMO plans require utilization of plan network providers and selection of Primary Care Physician Kaiser MA HMO Senior Advantage Aetna MA HMO Medicare P02 HMO Unlimited Lifetime plan coverage You Pay You Pay Plan deductible $0 $0 Annual Out of Pocket Max $1500 $3400 Primary Care Doctor Visit $15 $10 Specialist Care Doctor Visit $15 $15 In Patient Hospital $0 $0 Aetna Marketplace 19

20 Medicare Advantage HMO plan comparison continued Prescription Drug Cost Phases Kaiser MA HMO Senior Advantage with Part D RX Aetna MA HMO Medicare P02 HMO with Part D RX 1505 Phase I: Deductible $0 $0 Phase II: Initial Coverage Limit (ICL) Phase III: Medicare Coverage Gap (Donut Hole) Phase IV: Catastrophic Coverage Most Generics $10/100days Most Brand $20/100days Most Generics $10/100days Most Brand $20/100days Most Generics $10/100days Most Brand $20/100days $0 Select Care Generics $5 Generics $25 Preferred Brand $45 Non Preferred Brand $0 Select Care Generics $5 Generics $25 Preferred Brand $45 Non Preferred Brand Greater of 5% or $2.65 Generics Greater of 5% or $6.60 for all other drugs Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes Aetna Marketplace 20

21 Sample Network Pharmacies Just a Few Pasadena Area Pharmacies Brown Welin United Good Drugs Ralphs Drugs Berry & Sweeney Michaels Rite Aide Buy Well Nova Target Cal Oaks Pasadena City Vons CVS Phoenix Plaza Washington Fair Oaks Pavilions Walgreens Aetna Marketplace 21

22 Enrollment details Aetna Marketplace 22 Aetna Inc. 22

23 Ready to get started? Create an account and log in User Name: Your first initial + last name + birthdate (YYYYMMDD) + R Example: John Smith, born October 13, 1948, has a user name of JSmith R Password: Your last name + the last four digits of your Social Security Number Remember, Medicare coverage is individual. If both you and your spouse are Medicare eligible, or you are not but your spouse is, each of you will need to create your own account to select your medical plan. Aetna Marketplace 23

24 Learn about your benefits enroll. Aetna Marketplace 24

25 Build your profile John Smith John Smith Text overlay Aetna Marketplace 25

26 Review your health plan options and see how your Defined Dollar Credit impacts the total cost Aetna Marketplace 26

27 Compare plans side by side Aetna Marketplace 27

28 Confirmation print or save your enrollment details Aetna Marketplace 28

29 What You Need to Do If you do not contact Aetna Marketplace with your health benefit decisions by December 7 th you will be automatically be enrolled in a 2015 Caltech Health Plan based on your 2014 plan enrollment Caltech 2014 Enrolled Plan Kaiser Pre 65/Non Medicare Kaiser Post 65/Medicare Caltech Auto Enrolled 2015 Plan Kaiser Pre 65/Non Medicare Kaiser Post 65/Medicare Anthem Pre 65/Non Medicare PPO Aetna Open Choice PPO High Option Network Plan Anthem Pre 65/Non Medicare HMO Aetna HMO Anthem Post 65/Medicare PPO Aetna Medicare SM Plan (PPO) Premier Plan Medicare S02 ESA PPO Plan with Rx 1337 Anthem Post 65/Medicare HMO Aetna Medicare SM Plan (HMO) Medicare P02 HMO Plan with Rx 1505 Aetna Marketplace 29

30 Recap of important details Beginning November 3rd Plan information will be available on to compare plans. Refer to your printed materials along with the Aetna Marketplace tools when shopping for your plan You can also call to speak to a licensed Aetna Marketplace Service Advisor days a week 5 a.m. 8 p.m. (PT) November 10 th to December 7 th Online and phone enrollment will be open Visit or call , toll free, 5 a.m. 8 p.m. (PT) to speak to a licensed Aetna Marketplace Service Advisor. November 10 th to 21 st You can schedule an individual consultation session on the Caltech campus (visit hr.caltech.edu/retirees) Aetna Marketplace 30

31 Aetna Marketplace Pre 65 Retiree Plan Options Aetna Marketplace 31 Aetna Inc. 31

32 Current Pre 65 plan comparison Unlimited Lifetime plan coverage 2014 Anthem PPO You Pay In Network After Deductible You Pay Out of Network After Deductible Plan deductible $750/$2250 $750/$2250 Out of Pocket Maximum $2000/$8,000 $4000/$16,000 Primary Care Doctor Visit $25 50% Specialist Care Doctor Visit $25 50% Inpatient Hospital $250, 20% $250, 50% Pharmacy Deductible N/A Generic $15 Brand $35 Aetna Marketplace 32

33 Current Pre 65 Anthem and Kaiser HMO HMO plans require utilization of plan network providers and selection of Primary Care Physician Kaiser HMO Traditional Anthem HMO Unlimited Lifetime Plan Coverage You pay You pay Plan deductible $0 $0 Annual Out of Pocket Maximum $1500 $1500 Primary Care Doctor Visit Most $15 $10 Specialist Care Doctor Visit Most $15 $10 Inpatient Hospital $250/stay $100/stay Pharmacy Generics Most at $10/100 days $15 Formulary / $40 Non Formulary 30 day supply Brands Most $20/100 days $25 Formulary / $40 Non Formulary 30 day Supply Aetna Marketplace 33

34 If you or your spouse is under 65, your new Aetna plan options will offer: Your preventive care is paid in full No deductible for preventive care if certain in network providers are used Out of network cap on expenses, then plan pays 100% Provider networks focused on quality care, efficiency and, where possible, improving health outcomes Medicare style case management Aetna Marketplace 34

35 Pre 65 Aetna PPO Plan comparison High Option Aetna Open Choice PPO Mid Option Aetna Open Choice PPO Low Option Aetna Aexcel Open Access Managed Choice POS Unlimited Lifetime Plan Coverage You pay In Network After Deductible You pay Out of Network After Deductible You pay In Network After Deductible You pay Out of Network After Deductible You pay In Network After Deductible You pay Out of Network After Deductible Plan deductible Single /Family Annual Max Out of Pocket Maximum Single/Family $1200/$2400 $4000/$8000 $3500/$7000 $5500/$11000 $3950/$79000 $3950/$79000 $2800/$5600 $7000/$14000 $6000/$12000 $10000/$20000 $6250/$12500 $10000/$30000 Primary Care 20% 40% 30% 50% 20% 40% Specialist Care 20% 40% 30% 50% 20% for designated specialist / 30% for nondesignated 40% Inpatient Hospital 20% 40% 30% 50% 20% 40% Aetna Marketplace 35

36 Pre 65 Aetna PPO Plan comparison continued High Option Aetna Open Choice PPO Mid Option Aetna Open Choice PPO Low Option Aetna Aexcel Open Access Managed Choice POS Unlimited Lifetime Plan Coverage You pay In Network After Deductible You pay Out of Network After Deductible You pay In Network After Deductible You pay Out of Network After Deductible You pay In Network After Deductible You pay Out of Network After Deductible Pharmacy Pharmacy Deductible $0 $0 Integrated Medical/Pharmacy Deductible applies Preferred Generic $10 $10 $0 Non Preferred Generics 40% 50% $0 Preferred Brand $40 $75 25% Non Preferred Brand Specialty 40% 50% 50% $70 Preferred Generic & Brand 40% Non Preferred Generic and Brand 50% Generics 50% Brands 0% Generics 50% Brands Aetna Marketplace 36

37 Pre 65 Aetna and Kaiser HMO Comparison HMO plans require utilization of plan network providers and selection of Primary Care Physician Aetna HMO Kaiser HMO Unlimited Lifetime Plan Coverage You pay You pay Plan deductible $0 $0 Annual Out of Pocket Maximum $1500/$3000 $1500/$3000 Primary Care Doctor Visit $10 $15 Specialist Care Doctor Visit $10 $15 Inpatient Hospital $100/stay $250/stay Pharmacy Generics $15 / 30 day supply $10 / 100 days Brands $25 Preferred $40 Non Preferred 30 day supply $35 / 100 days Aetna Marketplace 37

38 This is an advertisement. Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna Medicare depends on 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. Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. You must continue to pay your Medicare Part B premium. Health is a U.S.-registered trademark of Aetna Inc. Aetna SM is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties. Informed Health nurses do not diagnose, prescribe or give members medical advice. GRP_TBD 2014 Aetna Inc. Part # TBD Thank you Aetna Marketplace