Sales Presentation The Michigan Medicare Plans Designed Around YOU

Transcription

1 Sales Presentation The Michigan Medicare Plans Designed Around YOU HARBOR MEDICARE (HMO) HARBOR MEDICARE SELECT (HMO) H7960_ Approved

2 WHAT YOU CAN EXPECT FROM THIS PRESENTATION PART 1 Introduction Medicare Advantage Plans to Be Discussed PART 2 Understanding Medicare Basics: Parts A, B, C and D Introducing Harbor Health Plan (HHP) PART 3 HHP Benefits at a Glance Prescriptions Diabetes Benefits PART 4 How & When to Enroll in HHP Low Income Subsidy (LIS) When You Choose Us Now That I m a Member Grievance and Appeals How to Disenroll Disclaimers 2

3 PART 1 A FEW WORDS ABOUT ME I m an authorized representative of Harbor Health Plan, a local Michigan health plan. I m licensed to sell insurance in Michigan, have completed the annual agent Medicare training and I am certified as a Harbor Health Plan Agent. I may be compensated based on your enrollment. A FEW WORDS ABOUT THIS APPOINTMENT Prospective enrollees for these plans must be entitled to Medicare Part A, enrolled in Medicare Part B and NOT have ESRD. I will only be providing information about the Medicare Advantage Plan specified in the Scope of Appointment discussed over the phone or signed prior to this appointment. Materials You May Receive During this Appointment: Enrollment Kit Harbor Medicare Brochures My Business Card 3

4 PART 2 UNDERSTANDING MEDICARE THE BASICS MEDICARE is the United States national health insurance program administered by the federal government. WHO QUALIFIES? People age 65 or older Some people under the age of 65 with certain disabilities (restrictions may apply) YOUR CHOICES: Original Medicare plus a Prescription Drug Plan (PDP) Medicare Advantage Plan Medicare Advantage Plan with Prescription Drug Coverage Former Employer or Union Group 4

5 PART 2 UNDERSTANDING MEDICARE (CONTINUED) PART A Hospital insurance with basic coverage for hospital stays, skilled nursing facilities, home health and hospice care PART B Medical insurance to cover many of the fees associated with doctor visits, laboratory testing, and outpatient services and supplies PART C A Medicare Advantage Plan that includes Medicare Parts A and B PART D Medicare Prescription Drug Coverage (PDP) is insurance to help pay for outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Part B 5

6 INTRODUCING HARBOR HEALTH PLAN PART 2 Serving Medicare eligible Michigan individuals in the following counties: Macomb, Oakland and Wayne History Local, personalized service Well-founded and continually expanding provider network No referral required for in-network physicians/providers More than 2,500 network doctors and specialists and 12 hospitals Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with our plan to deliver covered services to our members. WHAT OUR HEALTH PLANS ARE NOT: Harbor Medicare (HMO) and Harbor Medicare Select (HMO) are not Medicare Supplement plans. A Medicare Supplement plan (Medigap) is health insurance sold by private insurance companies to fill the gaps in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that Original Medicare does not cover. 6

7 BENEFITS AT A GLANCE PART 3 BENEFITS Harbor Medicare (HMO) Harbor Medicare Select (HMO) Maximum Out-of-Pocket (MOOP) $3,400 $3,400 Premium $0 $47 Primary Care Visit $10 $0 Specialist $45 $35 Inpatient Hospitalization $245 for days 1 7 $200 for days 1 6 Urgent Care Visit $60 copay $50 copay Vision Dental $100/year allowance for Contacts; Glasses (lenses and frames); $15 routine vision exam Preventive services: (2) exams, (2) cleanings, and (1) x-ray per year $100/year allowance for Contacts; $100/year allowance for Glasses (lenses and frames); $10 routine vision exam Preventive services: (2) exams, (2) cleanings, and (1) x-ray per year Over-the-Counter (OTC) N/A $25 per quarter Prescription Coverage Yes Yes Transportation Services 10 trips annually to plan approved locations. 0 trips annually to plan approved locations. Fitness Coverage $50 deductible $25 deductible Our plans offer more benefits than Original Medicare alone such as: Dental, Vision, OTC Allowance, Fitness and Nurse Advice Line. 7

8 PART 3 HARBOR MEDICARE ($0) PREMIUM PRESCRIPTION DRUG COSTS Tier Levels Copay for 30-day supply Copay for 60-day supply Copay for 90-day supply Mail order for 90-day supply Preferred Generic $10.00 $20.00 $30.00 $20.00 Generic $20.00 $40.00 $60.00 $40.00 Preferred Brand $45.00 $90.00 $ $90.00 Non-Preferred Brand $95.00 $ $ $ Specialty Tier 27% cost sharing Not Offered Not Offered Not Offered 8

9 PART 3 HARBOR MEDICARE SELECT ($47) PREMIUM PRESCRIPTION DRUG COSTS Tier Levels Copay for 30-day supply Copay for 60-day supply Copay for 90-day supply Mail order for 90-day supply Preferred Generic $4.00 $8.00 $12.00 $8.00 Generic $10.00 $20.00 $30.00 $20.00 Preferred Brand $45.00 $90.00 $ $90.00 Non-Preferred Brand $95.00 $ $ $ Specialty Tier 33% cost sharing Not Offered Not Offered Not Offered 9

10 PART 3 OUR PRESCRIPTION DRUG BENEFITS OFFER FLEXIBILITY AT THE PHARMACY $4/$8/$12 copay for a 30/60/90-day supply of Preferred Generic Drugs SAVE YOU TIME AND MONEY VIA MAIL Prescriptions mailed to your door Savings on 90-day supplies when ordered by mail YOUR PROVIDERS & PRESCRIPTIONS AT YOUR FINGERTIPS Refer to the Provider/Pharmacy Directory, which can be found at: HarborMedicarePlans.com Refer to the Comprehensive Formulary (list of drugs) Call Member Services at (855) , TTY should call

11 PART 3 HARBOR HEALTH PLAN OFFERS DIABETIC PROGRAMS AND SUPPLIES AT NO EXTRA COST TO YOU ORIGINAL MEDICARE HARBOR MEDICARE (HMO) HARBOR MEDICARE SELECT (HMO) 20% coinsurance $0 copay for diabetes self-management training 20% coinsurance $0 copay for diabetes monitoring supplies 20% coinsurance $0 copay for therapeutic shoes and inserts 11

12 PART 4 ENROLLMENT IN HARBOR MEDICARE (HMO) OR HARBOR MEDICARE SELECT (HMO) WHEN CAN YOU ENROLL? You can enroll in Harbor Medicare (HMO) or Harbor Medicare Select (HMO) during the Annual Enrollment Period (AEP) between October 15 and December 7. During the AEP, Medicare Advantage (MA) eligible individuals may enroll in or disenroll from an MA plan. The last enrollment request made, determined by the application date, will be the enrollment request that takes effect. There are special circumstances that allow you to enroll in a Medicare Advantage Plan outside of this period. These are called Special Enrollment Periods (SEP). Special Enrollment Periods constitute periods outside of the usual Initial Enrollment (IE), Annual Enrollment Period (AEP) or Medicare Advantage Disenrollment Period (MADP) when an individual may elect a plan or change his or her current plan election. There are various types of SEPs, including SEPs for dual eligibles, and for individuals whose current plan terminates, who change residence and who meet exceptional conditions as CMS may provide. Source: Medicare Managed Care Manual 12

13 PART 4 ENROLLMENT IN HARBOR MEDICARE (HMO) OR HARBOR MEDICARE SELECT (HMO) CONTINUED Examples of Special Circumstances (not a complete list) Change in residence Employer/Union Group Health Plan (EGHP) Disenroll from Part D to enroll in Creditable Coverage Full and partial dual eligible Other Low Income Subsidy Retroactive notice of Medicare entitlement Program of All-inclusive Care for the Elderly (PACE) Source: Medicare Managed Care Manual 13

14 ENROLLING IS SIMPLE! WE WILL WALK YOU THROUGH THE PROCESS. PART 4 Via this appointment today With a licensed agent/broker. By paper application I can give you an application form. You can fill it out and return it to the plan. Visit the plan s website Visit: HarborMedicarePlans.com and begin the enrollment process online. Medicare s website Visit: Medicare.gov and begin the enrollment process online. By phone Contact Harbor Health Plan (855) , TTY: 711 or call MEDICARE ( ) TTY users should call At a seminar or group meeting 14

15 PART 4 LOW INCOME SUBSIDY (LIS) YOU MAY QUALIFY FOR EXTRA HELP Need help paying for prescription drugs or Medicare Part A and Part B premiums? Medicare provides Extra Help for people who have limited income and resources. If you qualify, you get help paying for any Medicare drug plan s monthly premium, yearly deductible, and prescription copayments. This Extra Help also counts toward your out-of-pocket costs. Find out if you qualify for assistance by calling: MEDICARE ( ). TTY users should call , 24 hours a day/7 days a week and visit Medicare.gov to review Programs for People with Limited Income and Resources in the publication Medicare & You. The Social Security Administration at between 7 a.m. and 7 p.m., Monday through Friday. TTY:

16 PART 4 WHEN YOU CHOOSE HARBOR HEALTH PLAN, WE PROMISE TO: Provide you with information in a way that works for you (in languages other than English, in Braille, in large print, or other alternative formats, etc.) Treat you with fairness and respect at all times Ensure that you get timely access to your covered services and drugs Protect the privacy of your personal health information Give you information about the plan, its network of providers, and your covered services Support your right to make decisions about your health care 16

17 PART 4 AS A MEMBER OF HARBOR HEALTH PLAN, YOU WILL RECEIVE SUPPORT FROM CARING PROFESSIONALS WE HELP YOU: Change your Primary Care Provider, if required Ensure that you have continuous prescription drug coverage Manage the prior authorization process for previously scheduled doctor visits, post-operative care and surgery Coordinate your health care if you have a complex or chronic condition Navigate through the health care system and address any heath-related questions you may have 17

18 PART 4 WHAT CAN I EXPECT NOW THAT I AM A MEMBER? WHAT YOU GET HOW YOU GET IT DESCRIPTION Copy of Enrollment Form Agent Confirms you submitted an enrollment form. Enrollment Verification Letter Enrollment Confirmation and Acknowledgement Letter Member ID Card and Your Welcome Kit Welcome Call Over-the-Counter (OTC) Card Mail Mail Mail Phone Mail Verifies that the selected benefit plan is fully understood and directs you where to call should you have any questions. A notice from Medicare approving your enrollment form and acknowledging that your enrollment is complete. Membership Identification Card: be sure to have this with you when you visit your doctor, hospital or pharmacy. Kit includes your Evidence of Coverage, Formulary (list of drugs), Health Risk Assessment (HRA) and important plan benefit information. A Member Services representative will call you to ensure you have received your member materials, answer any questions you may have and discuss PCP assignment. Your OTC card will be sent in a separate mailing; you will need to activate your card prior to use. 18

19 PART 4 GRIEVANCE AND APPEALS As a member of Harbor Medicare (HMO) or Harbor Medicare Select (HMO), you have the right to: Request an organization determination if you want us to provide or pay for an item or service that you believe should be covered Request a coverage determination, which is a coverage decision about your prescription drugs File an appeal if we deny coverage or payment for an item or service File a grievance if you are unhappy about any other aspect of the health plan, our providers or pharmacies 19

20 PART 4 HOW CAN I DISENROLL? IF YOU WOULD LIKE TO SWITCH FROM OUR PLAN TO: Another Medicare Health Plan Original Medicare with a separate Medicare prescription drug plan Original Medicare without a separate Medicare prescription drug plan. Note: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. YOU SHOULD: Enroll in the new Medicare Health Plan. You will automatically be disenrolled from our plan when your new plan s coverage begins. Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our plan when your new plan s coverage begins. Send us a written request to disenroll. Contact Member Services if you need more information on how to do this. You can also contact MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call You will be disenrolled from our plan when your coverage in Original Medicare begins. 20

21 PART 4 DISCLAIMERS Harbor Health Plan is an HMO plan with a Medicare contract. Enrollment in Harbor Health Plan 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/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B Premium. This information is available for free in other languages. Please contact our Member Services number at (855) for additional information. (TTY users should call 711). Hours are October 1, 2015-February 14, 2016: 8 a.m. to 8 p.m. seven days a week, and February 15, 2016-September 30, 2016: 8 a.m. to 8 p.m., Monday through Friday. Esta información está disponible gratuitamente en otros lenguajes. Por favor llame a servicio al miembro al (855) para información adicional. (Usuarios de TTY llamar al 711). Horario es 1 octubre, febrero, 2016: 8 a.m. a 8 p.m., los siete días a la semana, y 15 febrero 30 septiembre, 2016: 8 a.m. a 8 p.m., de lunes a viernes. 21