Do more of what you love. HealthPartners Wisconsin Freedom (Cost) 2016 Plan Comparison Guide

Transcription

1 Do more of what you love. HealthPartners Wisconsin Freedom (Cost) 2016 Plan Comparison Guide H2462_ Accepted 9/14/2014 H2462_91699_01 Accepted 8/30/2015 WIPlanComp

2 Table of contents Introducing HealthPartners The Freedom network Words to know Perks to help you do what you love Your options at a glance A quick look at Medicare How to enroll Your resources

3 Enjoy your freedom Retirement is a time to do more of what you love. HealthPartners Wisconsin Freedom gives you the care and coverage you need to start your next adventure. We don t believe one size fits all. Together, we ll find a plan that fits your needs and budget. Choose from two medical plan options and optional prescription drug coverage with Wisconsin Freedom Balance. With Freedom, you re not locked into a primary care clinic or network. You can use your Original Medicare benefits outside of our network or service area at any time. Call HealthPartners Medicare Sales for more information. Know your network You can search for doctors, specialists and hospitals 24/7 at healthpartners.com/finddr. Or, if you prefer a printed version of the Freedom directory, you can call our Sales team at the numbers on page 10. Wondering where to get care? The Freedom service area includes eight Western Wisconsin counties and all of Minnesota. We have other clinic systems in our network, but here are the ones you re likely most familiar with: HealthPartners Medical Group Park Nicollet Health Services Fairview Health Services University of Minnesota Physicians North Memorial Health Care HealthEast Care System Stillwater Medical Group YOUR SERVICE AREA Barron, Burnett, Douglas, Dunn, Pierce, Polk, St. Croix and Washburn QUESTIONS TO ASK WHEN YOU RE SHOPPING Can I keep my doctor? Do I need referrals to see specialists? Are my medicines covered? Am I covered if I travel? What options do I have if I need to change my level of coverage in the future? This brochure talks about Wisconsin Freedom plan options. We also have a service area in Minnesota. If you re interested in Minnesota Freedom plan options, please contact us. 3

4 Words to know Benefit Period: Begins the day you re admitted as an inpatient in a hospital or skilled nursing facility (SNF) and ends when you haven t received inpatient hospital care (or care in a SNF) for 60 days in a row. Annual election period: When you can join or switch your Medicare plan. Coinsurance: The percentage of the total bill you pay when you use a medical service or drug. Copay or Copayment: What you pay when you use a medical service or drug; usually a flat dollar amount, like $15. Coverage gap ( donut hole ): Begins after you and your drug plan have spent a certain amount for covered drugs. When you reach the coverage gap, you ll receive some coverage for generic drugs and a discount on brand name drugs. Creditable Coverage: Prescription drug coverage that is equal to or better than standard Medicare Part D. Deductible: What you pay for a service item or drug before your insurance kicks in. Drug Tier: A system of copays or coinsurance for the different kinds of prescription drugs. Generally, a drug in a lower tier will cost less than a drug in a higher tier. Tier 1: Preferred Generic Drugs Tier 2: Generic Drugs Tier 3: Preferred Brand Drugs Tier 4: Non-preferred Brand Drugs Tier 5: Specialty Drugs Formulary: A list of medicines that are covered by your plan. Medicare Cost plan: A type of Medicare plan that lets you use benefits outside the plan s network or service area, and covered services within those benefits are paid for by Original Medicare. The Freedom plan is a Medicare Cost plan. Network: Doctors, hospitals, pharmacies and other health care providers who have contracted with your health plan. Typically, plan members get the lowest cost for services when using network providers. Premium: What you pay each month for your health or prescription drug plan. Preventive care: Tests and screenings that can help you avoid illness or improve your health. This includes blood pressure, diabetes and cancer screenings, some vaccines and more. Provider: Any organization, institution or individual that supplies health care services. Service area: The defined geographic region where a health plan accepts members and where the plan s services are provided. Specialty drugs: High-cost medicines used to treat rare conditions. ARE YOUR MEDS COVERED? Visit healthpartners.com/medicarerx to search the Freedom formulary or give us a call. 4

5 Perks to help you do what you love Your plan gives you more than just health care. You ll also get travel coverage, a large provider network, healthy discounts, online tools and more. Get care anywhere Sick. Click. Cured. From home: virtuwell is convenient online care that treats everyday medical conditions such as colds, coughs, ear pain or flu. All from the comfort of your home. Get 24/7 access to nurse practitioners who will give you personalized care and a treatment plan. And, if needed, a prescription sent right to your pharmacy. You ll get unlimited access at no cost. Visit virtuwell.com to learn more. Across the U.S.: Travel with peace of mind. You have in-network coverage nine months out of the year when you travel in the U.S. Plus, you get worldwide emergency and urgently needed care. To use your Extended Absence Benefit, just let Member Services know before you leave. Get quick advice from our trusted team Don t spend time searching the Web for answers. Call CareLine SM Service or Nurse Navigator SM Program to talk to a registered nurse. They ll be there when you need them. Need support for mental or chemical health? Call Behavioral Health Navigators to get support from one of our experts. Save time with pharmacy tools Get your meds your way with HealthPartners mymailrx. Your prescriptions are delivered right to your door. There s no additional cost and shipping is free. Typically, you can expect to receive your prescription drugs within five to eight business days from the time the mail order pharmacy receives your order. Log on to healthpartners.com/mymailrx to sign up. Or, call or You can also choose to get your medicines from one of our many in-network pharmacies. To see your options, visit healthpartners.com/partdpharmacy. If you prefer a printed copy of our pharmacy directory, call our Sales team at the numbers on page 10. Save money with healthy discounts Simply show your member ID card and save big at participating locations. Log on at healthpartners.com/ healthydiscounts for a full list of local and national retailers. Discounts include: Up to 35 percent off eyewear Up to 30 percent off hearing aids Savings on exercise equipment, fitness classes and more 5

6 You have options Monthly premium You must continue to pay your Medicare Part B premium. Out-of-pocket maximum Doctor offce visit (Including real-time audio and video technologies) Remote Access Technology WISCONSIN FREEDOM BASIC $65.60 You pay 20% of the cost. WISCONSIN FREEDOM BALANCE WITH RX Medical: $ Drug: $56.20 Total: $ No limit. $3,400 You pay $15 per visit. You get unlimited access to: virtuwell Electronic visits (e-visit) Scheduled Telephone Visits Diagnostic tests (X-Rays, Lab Services and Radiology Services) You pay $0 for lab services diagnostic procedures and tests You pay 20% of the cost for X-rays diagnostic radiology services (MRI, CT) therapeutic radiology services (cancer treatment) You pay $0 for lab services diagnostic procedures and tests X-rays therapeutic radiology services (cancer treatment) You pay 20% of the cost for diagnostic radiology services (MRI, CT) Preventive care 100% coverage. Inpatient hospital You pay $600 per benefit period. You pay $200 per benefit period. Ambulatory surgical centers You pay nothing. Durable medical equipment You pay 20% of the cost. Emergency care You pay $100 per visit. You pay $65 per visit. Ambulance Services You pay 20% of the cost. You pay 10% of the cost. Travel coverage In-network coverage for up to 9 months. PRESCRIPTION DRUG (PART D) coverage at in-network pharmacies Deductible Not offered. You pay $360 deductible on all drugs. Initial coverage (until costs reach $3,310) Coverage gap Catastrophic coverage (until costs reach $4,850) Not offered. Not offered. Not offered. You pay 25% of the cost. You pay 58% for generics and 45% for brand drugs. You pay 5% or $2.95 for generics and 5% or $7.40 for all brand drugs, whichever is greater. 6

7 A quick look at Medicare Medicare is a federal health insurance program for people who are 65 or older, younger people with disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). You cannot be denied coverage due to pre-existing conditions and your coverage cannot be cancelled if you get sick. Medicare is divided into parts: Part A is hospital insurance. It covers inpatient hospital care, including care in skilled nursing facilities, hospice and some home health care. Part B is medical insurance. It covers doctor s services and outpatient care. Part D is prescription drug insurance. It s only available from private health insurance companies, like HealthPartners. When and how do I get it? If you re already getting benefits from Social Security or the Railroad Retirement Board, you ll automatically get Original Medicare (Parts A and B) when you turn 65. If you re not getting those benefits, and have questions about how to enroll in Medicare or how to apply for extra help to pay for Medicare health and prescription drug premium and costs, contact the Social Security Office using the information listed on page 10. WHAT ISN T COVERED UNDER ORIGINAL MEDICARE? Many people decide to buy additional coverage because there are things Original Medicare does not cover: Deductibles, coinsurance and copays for covered services Most prescription drugs Health care services outside the U.S. Most dental care Routine hearing exams Routine eye care Acupuncture Certain private health plans may cover some or all of the services listed above. 7

8 When can I enroll? You can enroll in a Cost plan, like HealthPartners Freedom, at any time. However, there may be limitations if you re currently enrolled in another Medicare plan or Cost plan with prescription drug coverage. Visit medicare.gov for more information. Below are common Medicare enrollment periods. 1. The Annual Election Period (AEP) runs from October 15 to December 7. During the AEP: All Medicare-eligible individuals can make changes to medical and prescription drug coverage Changes are effective January 1 of the next year 2. The Part D Initial Enrollment Period (IEP) is the 7-month window beginning three months before to three months after your 65th birthday month. During IEP: You can enroll without penalty in a plan with Part D prescription drug coverage. 3. The Special Enrollment Period (SEP) is an enrollment period for special circumstances. Check with HealthPartners or medicare.gov for specific rules. 8

9 Signing up is easy Step 1: Pick your plan Choose the medical plan option that fits you best. Then decide if you want to add prescription drug coverage, available with Wisconsin Freedom Balance. Step 2: Enroll Visit healthpartners.com/medicare and choose Compare & enroll Call us at or Fill out and send in the paper application using the prepaid envelope in this folder. Or, you can fax it to us at Completed enrollment forms that we receive by the last day of the month are generally effective for the first day of the next calendar month. Have your info handy When filling out your application, you ll be asked to provide: Your contact information Your plan selection Your Medicare number and Part A and/or B effective dates Your payment/billing preference Answers to questions that help determine your eligibility and enrollment status Your signature or the signature of your authorized representative Step 3: Relax After you ve enrolled, a member from our Member Services team will call to confirm your enrollment. They ll also review the Freedom Plan rules to make sure you understand your new plan. In addition, you ll also receive a packet from us with your member ID card, Evidence of Coverage, drug formulary and other helpful materials. If you have questions before you receive your packet, just give us a call at the numbers on page 10. ELIGIBILITY To enroll in a Freedom plan, you must: Have Medicare Part B (or have both Part A and Part B) Live in these WI counties: Barron, Burnett, Douglas, Dunn, Pierce, Polk, St. Croix and Washburn Not have end-stage renal disease (ESRD). Some exceptions apply. Call HealthPartners Medicare Sales for more information or ; TTY or

10 Contact us We re here to support you every step of the way. If you have any questions during your research or enrollment, let us know. Medicare Sales: or TTY or From October 1 through February 14, we take calls from 8 a.m. to 8 p.m., seven days a week. You ll speak with a representative. From February 15 to September 30, call us 8 a.m. to 8 p.m. Monday through Friday to speak with a representative. On Saturdays, Sundays and Federal holidays, you can leave a message and we ll get back to you within one business day. medicaresales@healthpartners.com Online: healthpartners.com/medicare Come to an informational meeting: Call or visit healthpartners.com/meetings to find a meeting near you. Other helpful Medicare resources: Medicare medicare.gov 800-MEDICARE 24 hours a day, seven days a week Social Security Administration Call the Social Security Office at between 7 a.m. and 7 p.m. Monday through Friday. TTY users should call To learn if you qualify for extra help, call: MEDICARE ( ) TTY Users should call hours a day, 7 days a week. ssa.gov/pgm/medicare.htm Senior LinkAge Line mnaging.org/advisor/sll a.m. to 4:30 p.m. Monday through Friday Stop by and see us: HealthPartners Medicare Sales rd Ave S Bloomington, MN

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12 HealthPartners is a Cost plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal. If you attend a community meeting, a sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call HealthPartners Medicare Sales at the numbers on 10. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and 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 rd Ave S Bloomington MN, (10/15) 2015 HealthPartners