On your road to good health

Transcription

1 On your road to good health MyBlue SM Medicare Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent d licensees of the Blue Cross and Blue Shield Association. Medicare Plus Blue SM, BCN Advantage SM and Prescription Blue SM are PPO, HMO, HMO-POS and PDP plans with a Medicare contract. Enrollment in Medicare Plus Blue, BCN Advantage and Prescription Blue depends on contract renewal. Y0074_S_ 2015AEPpresentationR1 CMS Approved

2 The A, B, Cs and D of Medicare Each of these triangles represents a different part of Medicare. Part C is a full triangle because it covers A, B and usually D all on one card, with manyy extra benefits. Part A Original Medicare Hospital care Skilled nursing facility care Hospice Home health care Part B Original Medicare Part C Medicare Advantage Part D Prescription Doctor D t visits i it Everything Parts A Prescription Mental health care and B cover drugs Outpatient surgery Many plans cover Lab tests prescription drugs Durable medical Many plans cover fitness equipment membership, dental and vision Fills in the triangle with added benefits

3 Financial predictability and value built in Blues Medicare Advantage plans: Provide a range of predictable costs for hospital, medical, drugs and other services Cap out-of-pocket spending, unlike Medicare Generally include Part D prescription drug coverage so you ll know your cost share Include benefits and services beyond Original Medicare Are comprehensive, all-in-one plans, with a single card one card, one bill, one Explanation of Benefits and one customer service point of contact A Medicare Advantage plan may be simpler and more cost-effective than buying a la carte. 3

4 The Blues doctor and hospital network spans the country to help lower your costs Most providers accept your coverage 95 percent of all Michigan doctors participate with the Blues* Nearly every hospital in Michigan is in our network* Most doctors and hospitals outside the state that accept Medicare will accept your Blues ID card *Portico provider data system, August 2014; BCN Provider Count Report, August Providers may vary by plan. 95% of doctors Most hospitals 4

5 Impressive Star quality ratings 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. Our 2014 star ratings, out of a possible BCN Advantage HMO and HMO-POS Medicare Plus Blue PPO and Prescription Blue PDP There are no 5-star plans in Michigan* Medicare rates plans based on information gathered from members, health care providers and others. *U.S. News and World Report: Best Medicare Advantage Plans 2014, Oct. 31,

6 The Blues are all about choice yours Bundling services: It s a well-tested idea. Combine benefits and improve value while limiting cost cost. Medicare M di Part A Medicare M di Part B Part D P Prescription Drug Plan Supplement S l Plan Medicare M di Advantage Plans (Part C) Combines them all* all Plus additional benefits *Not all plans include Part D 6

7 PPO, HMO-POS and HMO defined What s the difference? PPO Preferred Provider Organization: You can go to any doctor and health care facility you choose, without a referral, though you pay less if you stay in the network. HMO-POS Health Maintenance Organization with Point of Service: You must select a primary care physician who oversees your care and will refer you to a specialist when the need arises. POS means you have coverage that travels with you when you leave the service area. HMO Health Maintenance Organization: HMOs require you to have a primary care physician and, in most instances, also require e that your doctors and health care facilities are within the plan-specific network. 7

8 The best plan for your wallet Considerations when choosing a plan: Deductible the amount you must pay before your plan begins to pay its share Coinsurance the percentage of the cost of the service that you pay Copay a fixed dollar amount you pay to health care providers each time you use their services, such as an office visit Out-of-pocket maximum the most you have to spend for copays, coinsurance and deductibles in any given year 8

9 Light, balanced and extended plans There are three bundle levels, each with varied plan options to fit your needs. Ask yourself: What works best for your physical and financial health status? Which includes your doctors and hospitals? Light: Lower monthly premiums and higher out-of-pocket costs Balanced: Ab balance between cost and coverage Extended: Higher monthly premiums and lower out-of-pocket costs 9

10 Light plans Lower monthly premium, higher out-of-pocket costs Features Basic HMO POS Elements HMO POS Essential PPO Part D prescription coverage Doctor visit copay: Primary/specialist Medically related transportation Nationwide travel coverage with BlueCard SilverSneakers fitness membership Statewide provider network $25/$45 $20/$40 $25/$50 = included in plan. = not included in plan. 10

11 Balanced plans Balancing cost and coverage Features ConnectedCare MChi MyChoice Vitality Classic Signature HMO Wellness HMO PPO HMO POS PPO Part D prescription coverage Doctor visit copay: Primary/specialist $0/$45 $0/$45 $20/$50 $15/$35 $15/$45 Medically related transportation Nationwide travel coverage with BlueCard SilverSneakers fitness membership Statewide provider network Oakwood Healthcare and Together Health Network* providers only Mercy Health Affiliated Providers only *An integrated network of doctors in partnership with Trinity Health and Ascension Health. 11

12 Extended plans Higher monthly premium, lower out-of-pocket Features Assure PPO Prestige HMO POS Part D prescription coverage Doctor visit copay: Primary/specialist Medically related transportation Nationwide travel coverage with BlueCard $10/$40 $10/$25 SilverSneakers fitness membership Statewide provider network 12

13 BCBSM Medicare Advantage PPO 2015 premium chart Counties by region Essential Vitality Signature Assure Light Balanced Balanced Extended Region 1 Allegan, Barry, Ionia, Kalamazoo, Mason, Muskegon, Newaygo, Oceana, Ottawa $15.50 $40 $110 $182 Region 2 Berrien, Branch, Calhoun, Eaton, Gratiot, Hillsdale, Ingham, Jackson, Monroe, Montcalm, St. Joseph, Van Buren Region 3 Alcona, Alger, Alpena, Arenac, Baraga, Bay, Charlevoix, Cheboygan, Chippewa, Clare, Crawford, Gladwin, Huron, Iosco, Kalkaska, Keweenaw, Luce, Mackinac, Montmorency, Ogemaw, Ontonagon, Oscoda, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, Tuscola Region 4 Antrim, Benzie, Cass, Clinton, Delta, Dickinson, Emmet, Genesee, Gogebic, Grand Traverse, Houghton, Iron, Isabella, Kent, Lake, Lapeer, Leelanau, Lenawee, Livingston, Manistee, Marquette, Mecosta, Menominee, Midland, Missaukee, Osceola, Otsego, Saint Clair, Wexford $ $75 $162 $238 $15.50 $95 $166 $283 $15.50 $75 $157 $232 Region 6 Macomb, Oakland, Washtenaw, Wayne $15.50 $100 $159 $283

14 BCN Advantage HMO-POS 2015 premium chart Counties by region Elements Basic Classic Prestige Light Light Balanced Extended Region 1 Allegan, Barry, Ionia, Kalamazoo, Kent, Mason, Muskegon, Newaygo, Oceana, Ottawa Region 2 Branch, Calhoun, Eaton, Gratiot, Hillsdale, Ingham, Jackson, Monroe, Montcalm, St. Joseph, Van Buren Region 3 Alcona, Alpena, Arenac, Bay, Charlevoix, Cheboygan, Clare, Crawford, Gladwin, Huron, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, Tuscola $0 $0 $91 $196 $38 $0 $113 $262 $43 $0 $121 $257 Region 4 Antrim, Benzie, Clinton, Emmet, Genesee, Grand Traverse, Isabella, Lake, Lapeer, Leelanau, Lenawee, Livingston, Manistee, Mecosta, Midland, Missaukee, Osceola, Otsego, St. Clair, Wexford $30 $0 $103 $244 Region 5 Macomb, Oakland, Washtenaw, Wayne $49 $0 $138 $262 14

15 BCN Advantage HMO BCN Advantage offers two balanced plans with providerspecific networks with $0 deductible and no primary care physician copay. ConnectedCare is available to residents of Genesee, Kalamazoo, Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne counties MyChoice Wellness plan is available to residents of Kent, Muskegon and Oceana counties Worldwide emergency and urgent care benefit Coverage for brand-name and generic drugs Free SilverSneakers fitness membership included Benefits beyond Original Medicare Monthly premium: ConnectedCare $41 MyChoice $29 15

16 Lower monthly premium, higher out-of-pocket costs Light Considerations Basic HMO POS Elements HMO POS Essential PPO Out-of-pocket maximum* $4,200 $3,600 $6,400 Medical deductible* $325 $160 Office visit*: primary/specialist $150 In- and out-of-network combined $25/$45 $20/$40 $25/$50 Hospital copay* daily for first 6 days Urgent care/emergency in U.S. Michigan comparative network size $225 $180 $250 $45/$65 $45/$65 $45/$65 *Out-of-network cost share is higher. 16

17 Balancing cost and coverage Balanced Considerations ConnectedCare HMO MyChoice Wellness HMO Vitality PPO Classic HMO POS Signature PPO Out-of-pocket maximum* $3,400 $3,400 $5,400 $3,400 $4,400 Medical deductible* $0 $0 $750 $750 $125 Out-of-network only Out-ofnetwork only Office visit*: primary/specialist Hospital copay* daily for first 6 days Urgent care/ emergency in U.S. $0/$45 $0/$45 $20/$50 $15/$35 $15/$45 $200 $200 $225 $130 $160 $45/$65 $45/$65 $45/$65 $40/$65 $35/$65 Michigan comparative network size *Out-of-network cost share is higher. 17

18 Higher monthly premium, lower out-of-pocket Extended Considerations Assure PPO Prestige HMO POS Out-of-pocket maximum* $3,400 $3,200 Medical deductible* $250 Out-of-network only $0 Office visit*: primary/specialist $10/$40 $10/$25 Hospital copay* daily for first 6 days $90 $90 Urgent care/emergency in U.S. $35/$65 $35/$65 Michigan comparative network size *Out-of-network cost share is higher. 18

19 BCN Advantage optional supplemental dental, vision and hearing benefit only $19.90 a month Enhanced dental benefits 2015 In-network only Annual maximum $1,000 Waiting periods No waiting period Additional Class I fluoride treatments 100% Class II services amalgam and resin fillings, root 50% canals, crown repairs, simple extractions Class II services crowns 50% Frequency rules Enhanced vision benefits fluoride treatment per year Amalgam or resin filling once per tooth every 48 months Root canal once per lifetime per tooth th Crowns once per tooth every 84 months In-network VSP Choice Network Additional services lens options Enhanced hearing benefits 2015 $200 additional allowance for glasses (lenses and frames) or contact t lenses every 24 months Discounts on antireflective coating, tints, polycarbonate lenses In-network only Annual routine hearing exam 50% Hearing aid exam every three years Hearing aids 50% of contracted audiologist fee 50% up to $500 ($250 per ear) Once every three years $500 maximum 19

20 Drug coverage included in most Blues plans 98 percent of Michigan pharmacies are in the Blues network* Home delivery (mail order) is free from Walgreens and Express Scripts Get a 90-day supply of most prescription drugs** through our retail network or mail-order pharmacies Some plan networks have preferred and nonpreferred pharmacies: Preferred pharmacies offer savings similar to mail order on up to a 90-day supply of drugs Nonpreferred pharmacies also offer savings on 90-day supplies, but less than a preferred pharmacy You also have access to an extensive retail pharmacy network outside of Michigan, including most retail chain pharmacies *January 2014 NCPDP/BCBSM BCN Pharmacy Network database **Formularies (drug lists) available at 20

21 Part D prescription drug coverage Three coverage stages: What the plan pays What you pay What you pay What the plan pays What you pay Initial coverage stage After your deductible, if you have one, you pay a portion of the cost and the plan pays the rest. Coverage gap stage Once you and the plan pay $2,960, you pay much of the cost, but, because we discount the cost of your drugs, you never pay full price. Catastrophic coverage stage Once you reach $4,700, your cost-sharing drops to its lowest and you stay in this stage until the end of the year. 21

22 Understanding your formulary All Medicare Part D plans are required to have a list of covered drugs known as a formulary The drugs are listed by drug category and class Blues Medicare Advantage plan formularies have five tiers Tier 1: Preferred generic drugs Tier 2: Nonpreferred generic drugs Tier 3: Preferred brands Tier 4: Nonpreferred brands Tier 5: Specialty Formularies (drug lists) are available at 22

23 Your formulary drug tiers Drug tier Includes Helpful tips Tier 1: Preferred generic drugs Many commonly prescribed generic drugs and other lowcost drugs Use Tier 1 drugs for the lowest copayments. Tier 2: Nonpreferred generic drugs Additional low-cost drugs Tier 2 drugs keep copayments in the lower range. Tier 3: Preferred brand drugs Preferred brand-name drugs The lowest copayments among brand-name drugs. Tier 4: Nonpreferred brand drugs Nonpreferred brand-name drugs Many nonpreferred brand drugs have lower-cost alternatives in Tiers 1, 2 and 3. Ask your doctor. Tier 5: Specialty drugs Very high-cost drugs To learn more about drugs in this tier, contact Customer Service at the number on the back of your card. 23

24 Built-in Part D protections Prior Authorization protects you against drug interactions or other potentially negative outcomes. Step Therapy has you try a proven drug, often at a lower cost, before covering a different drug. Quantity Limits are imposed per prescription p for some drugs or there may be limits on how often you can refill a drug. Medication Therapy Management Program offers a free medication review to help improve medication use and reduce the chance of adverse drug interactions. Extra Help in the form of a low-income subsidy may be available to you. Contact your Social Security office to see if you qualify. 24

25 Blues preventive services to stay healthy Welcome to Medicare visit setting your baseline Bone densityy test Colorectal screening Glaucoma screening Di b t screening Diabetes i Cardiovascular disease screenings Prostate cancer screening Pap smears, pelvic exams, mammogram Hepatitis C screening Immunizations Annual Medicare-covered wellness visit These preventive services must be performed by a participating provider. If non routine diagnostics or other types of services are provided during your visit, you may be responsible for a deductible, copay or coinsurance. 25

26 Dental, vision, hearing and more Choose from plans that have the extras you need, such as: Dental care Routine hearing and eye exams Eyeglasses Supplemental dental, vision and h i package hearing k Transportation to medical appointments Bathroom safety items 26

27 SilverSneakers Fitness membership A fun, energizing program that helps you take greater control of your health by encouraging physical activity and offering social events. Access to fitness classes, exercise equipment, pool, sauna and other available amenities Classes designed exclusively for you Health education seminars and other events Program Advisors to help you get started Access to online support to help you lose weight, quit smoking or reduce your stress Walking programs, home fitness programs and more, to meet every member s needs This benefit is not available with all plans. Visit for participating locations.* *Blue Cross Blue Shield of Michigan does not control this website or endorse its general content. 27

28 Personalized care management The Blues provide a wide range of care management support at no charge to help you stay healthy, support you in recovery or improve your quality of life. Many programs are based on medical conditions, and chronic conditions programs are designed to keep you informed with the latest information. Your own care management nurse develops a plan of care tailored just for you. 28

29 Behavioral health services Cheering you on the whole way Available for emotional or mental distress, including depression and drug or alcohol abuse Specialized case managers evaluate your needs and arrange for the right services Your behavioral health case manager will work with you and your doctor to get you the right care There is no added cost for you Sun City Poms 55+ cheerleading squad 29

30 BlueCard* covers you outside of Michigan Most plans have a point-of-service, or POS, travel benefit backed by Blue Cross Blue Shield Shield. Wherever you travel, medical emergencies and urgently needed care are always covered. Preauthorized routine and follow-up care are covered anywhere in the U.S. just use one of the manyy providers p who p participate p with Blues plans. 30 Emergency and urgent care is covered outside of the U U.S. S *A Blue Cross and Blue Shield Association program that allows members to receive care from providers who participate with Blues plans when traveling outside Michigan. Through the BlueCard Worldwide program, members have access to medical assistance services, doctors and hospitals in more than 200 countries and territories around the world. 30

31 Have fun, live healthy for less Member magazines keep you informed of healthy trends and lifestyle news, benefit and d plan l updates, d t and d so much h more Healthy Blue XtrasSM and Blue365 offer savings g on the p products and services yyou need for a healthy lifestyle Lots of member discounts, discounts such as: Weight Watchers Evola Music AAA auto and travel Great Wolf Lodge (Traverse City) Guardian Medical Monitoring and alarms Jitterbug cell phone with LiveNurse 31

32 Medigap plans If a Medicare Advantage plan doesn t work for you, the Blues can offer you a Medigap supplement plan. Supplement plans: Help pay for some health care costs that Original Medicare doesn't cover Do not offer additional benefits Do not include prescription drug coverage Are standardized by law Supplement You must still pay your Part B Medicare medical premium. 32

33 Prescription Blue a standalone Part D plan Remember, Original Medicare and Medicare supplement plans do not include prescription drug coverage. If you choose Original Medicare and a Medigap supplement plan, you ll still need to add a standalone Part D plan. Blue Cross Blue Shield of Michigan offers two Prescription Blue Part D plans. Plan Prescription Blue Option A Prescription Blue Option B Monthly premium $ Yearly deductible $210 for Tiers 3, 4, 5 only $0 33

34 What makes a plan a good fit for you? As you consider various plans, ask yourself: How often do I go to the doctor? Is my doctor in the network of the plan I m looking at? Am I in the hospital a lot? What prescription drugs do I take? Are they expensive? Do I travel much? In Michigan? Nationwide? Worldwide? Would I use a fitness membership if it came with my plan? Do I need preventive dental, vision and hearing benefits? 34

35 To get information, compare plans or enroll in a Medicare plan from the Blues: Call a sales representative at from 8 a.m. to 9 p.m. Eastern time Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Contact an independent agent licensed to sell MyBlue Medicare. Complete an application that we can give you here today and mail it to us. Visit one of our walk-in centers. Find locations on our website. Visit our website: to compare plans, get more information and to enroll directly. Medicare beneficiaries may also enroll in MyBlue Medicare through the CMS Medicare Online Enrollment Center located at 35

36 You re eligible to enroll in a MyBlue Medicare Advantage plan if You are entitled to Medicare Part A and are enrolled in Medicare Part B. You must continue to pay your Medicare Part B premium; it s a separate premium paid to Medicare. BCN Advantage HMO-POS: You reside in the 66-county plan service area for six consecutive months each year. BCN Advantage HMO ConnectedCare: You reside in Genesee, Kalamazoo, Livingston, Macomb, Oakland, St. Clair, Washtenaw or Wayne county for six consecutive months each year. BCN Advantage HMO MyChoice: You reside in Kent, Muskegon or Oceana County for six consecutive months each year. Medicare Plus Blue PPO: You are a resident of the state of Michigan. Prescription Blue PDP: You are entitled to Medicare Part A or you're enrolled in Part B or both and you are a Michigan resident. Medicare Advantage: You don t have end-stage renal disease (except under certain conditions, according to federal law). 36

37 Disenrollment and late enrollment Medicare Advantage disenrollment period Medicare Advantage plan members can switch to Original Medicare anytime between January 1 and February 14. If you switch to Original Medicare during this period, you ll have until February 14 to add a Medicare Part D prescription p drug plan. Your coverage will begin the first day of the month after the plan gets your enrollment request. Late enrollment penalty If you don t enroll in a Part D prescription drug plan when you first become eligible, or if you had a break in coverage of at least 63 consecutive days, a late enrollment penalty amount may be added to your Part D plan premium. 37

38 Other important information The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, provider network, premium and/or copayments and coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. For details, please call from 8 a.m. to 9 p.m. Eastern time Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under special circumstances, and quantity limitations and restrictions may apply. This presentation may be available in an alternate format. For more information, contact the plan at TTY users call 711. Hours are 8 a.m. to 9 p.m. Eastern time Monday through Friday, with weekend hours Oct. 1 through Feb. 14. The sales agent or other individuals employed by or contracted with Blue Cross Blue Shield of Michigan may be paid based on your enrollment. 38

39 Here s to the remarkable road ahead Questions? 39