Vermont Blue 65 SM Coverage for Vermonters with Medicare 2016 Medicare Supplemental Products Group Brochure An independent, local Vermont company
Three smart steps to quality health care after retirement: peace of mind The following equation shows how Medicare supplemental coverage will work for you: Vermont Blue 65 SM offers Vermonters Attractive rates Discounts on health, travel and other supplies Special invitations to fun filled activities and events throughout the state Coverage accepted throughout the U.S. and, with some plans, during foreign travel Personal attention from our Vermont based sales and customer service staff The peace of mind that comes with membership in Blue Cross and Blue Shield, the most trusted name in health coverage What is Medicare? Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). If neither you nor your spouse have paid Medicare taxes for at least 10 years, you will need to pay a monthly premium. If you are eligible for hospital insurance, either for free or by paying for it, you can also enroll in Medicare medical insurance () by applying for it through Social Security and paying a monthly premium. Medicare has three parts hospital insurance helps you pay for your inpatient care in hospitals. For example, will help cover the cost of a shared hospital room, meals and nursing. Some plans also assist with costs associated with nursing facility care if you meet certain requirements. medical insurance helps you pay for services that are considered important for the diagnosis or treatment of a medical condition. These include: Doctor visits Procedures that don t require an overnight hospital stay Some preventive care services, such as flu shots 2
Part D prescription drug coverage helps you pay for commonly used brand-name and generic drugs. It typically doesn t cover over-the-counter medications. Medicare Part D plans are run by private insurance companies approved by Medicare. You must enroll in Medicare Part D through a private carrier and pay a monthly premium. Each plan can vary in costs (premiums, deductibles, co-payments and drugs covered). You will pay these in addition to your premium. What is the cost? For most individuals, Medicare (hospital insurance) is free. (medical insurance), which you may decline, requires a monthly premium. In 2016, most people who get Social Security benefits will continue to pay a premium of $104.90 each month. You ll pay a different premium amount of $121.80 (or higher depending on your income), if: You enroll in for the first time in 2016. You don t get Social Security benefits. You have Medicare and Medicaid, and Medicaid pays your premiums. Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount. The premium can come right out of your Social Security check. You should plan to sign up for right away, too. If you don t sign up for Part B when you re first eligible, penalties could apply when you do sign up. How do you enroll? For Medicare Parts A and B, call Social Security toll-free at (800) 772-1213 (TTY: (800) 325-0778). You can also set up an appointment at your local Social Security office. You ll need to provide proof of age, such as a birth certificate. Supplemental policies Medicare supplemental policies differ based on their coverage. Vermont Blue 65 is our Medicare supplemental plan which can help you with a worry-free retirement. Please turn the page to look at a chart of the supplemental plans we offer and what s covered in those plans. Call (802) 371-3299 or visit our website at www.bcbsvt.com/vtblue65. Part D drug coverage The final component of the equation is Part D drug coverage. Part D drug coverage is Medicare s prescription drug program and is offered through private companies. Medicare prescription drug coverage (Part D) is available to anyone who is entitled to Medicare and/or enrolled in. Part D adds drug coverage to original Medicare. It helps to lower prescription drug costs and protect you from higher costs in the future. It covers both brand-name and generic prescription drugs at participating pharmacies in your area. You should consider joining a plan unless you will already have drug coverage that is at least as good as Medicare Part D prescription drug coverage. Most people pay a monthly premium for this coverage. To get Medicare drug coverage, you must join a Medicare drug plan through a Prescription Drug Plan (PDP), or a Medicare Advantage Plan that offers Medicare prescription drug coverage (MA-PD). Plans vary in cost and drugs covered. To compare plans go to www.medicare.gov. It is important to investigate your options now. If you wait, you may have to pay more for your coverage later. Blue Cross and Blue Shield of Vermont, in a joint venture with several other New England Blue plans, partners with the Federal Government to offer Medicare prescription drug coverage, called Blue MedicareRx SM (PDP). See our separate brochure, Blue MedicareRx, for more information on our product, or visit our website. You can learn more about our plans and eligibility requirements at www.rxmedicareplans. com. You may also call the Blue MedicareRx (PDP) team at (888) 496-4178, TTY: 711 or (800) 253-0191 (24 hours a day, 7 days a week). The next important component of the equation is a Medicare supplemental policy. A Medicare supplemental policy is health coverage offered by private companies to fill the gaps in Medicare coverage. A Medicare supplemental policy provides assistance with costs not paid by Medicare, like co-insurance, co payments and deductibles. You pay a monthly premium to the private company in addition to your premium, which is usually deducted from your Social Security payment. 3
Outline of coverage All standard Medicare supplemental products This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in Vermont. Blue Cross and Blue Shield of Vermont offers Plans A, C and F. Monthly Costs $151.32 $155.31 A B C D 100% 100% 100% 100% Skilled Nursing Facility Skilled Nursing Facility 1 Plan F also has an option called a high-deductible Plan F. This high-deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for and, but do not include the plan s separate foreign travel emergency deductible. 4
benefits Hospitalization co-insurance plus coverage for 365 additional days after Medicare benefits end. Blood First three pints of blood each year. Hospice co-insurance. Medical Expenses co-insurance (generally 20 percent of Medicare-approved expenses) or co payments for hospital outpatient services. Plans K, L and N require members to pay a portion of co-insurance or co-payments. $156.08 F F* 1 G K L M N 100% Coinsurance Skilled Nursing Facility Benefits, including 100% Skilled Nursing Facility Hospital and preventive care paid at 100%; other basic benefits paid at 50% 50% Skilled Nursing Facility 50% Hospital and preventive care paid at 100%; other basic benefits paid at 75% 75% Skilled Nursing Facility 75% benefits, including 100% Skilled Nursing Facility 50% $20 co-payment for office visits, $50 co payment for ER; other basic benefits, including 100% Skilled Nursing Facility Excess (100%) Excess (100%) Out-of-pocket limit $4,960; paid at 100% after limit reached Out-of-pocket limit $2,480; paid at 100% after limit reached You may not cover dependents under your Vermont Blue 65 supplemental plan. If you convert to Vermont Blue 65 coverage from two-person or family coverage with Blue Cross and Blue Shield of Vermont, you need to maintain separate coverage for your dependents. Please call (800) 255-4550 for more information. Contact your group benefits manager about your options. Please note that to be eligible for Vermont Blue 65, you must be enrolled under both Parts A and B of Medicare. 5
We offer Vermont Blue 65 Plans A, C and F Example: Vermont Blue 65 Plan F* $156.08 per month Medicare () pays for hospital services SERVICES MEDICARE PAYS (PER BENEFIT PERIOD) PLAN PAYS (PER BENEFIT PERIOD) YOU PAY (PER BENEFIT PERIOD) HOSPITALIZATION 2, 3 Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,288 $1,288 ( deductible) 61st through 90th day All but $322 a day $322 a day 91st day and after, while using 60 lifetime reserve days All but $644 a day $644 a day Once lifetime reserve days are used: additional 365 days 100% of Medicare eligible expenses Beyond the additional 365 days All costs SKILLED NURSING FACILITY CARE 2 You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital First 20 days All approved amounts 21st through 100th day All but $161 a day Up to $161 a day 101st day and after All costs BLOOD First three pints All costs Additional amounts 100% HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness All but very limited co payment/co-insurance for outpatient drugs and inpatient respite care Medicare co-payment/ co-insurance * Vermont Blue 65 Plan A and C: Save money by selecting the benefits important to you Plan F shown above has the richest benefits. Plan F covers excess charges, or the difference when the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount. Vermont law prohibits a physician from charging more than the Medicare-approved amount. However, this prohibition may not apply if services are received out of state. You can save money by selecting Plan A, but Plan A ($151.32 per month) does not cover Medicare deductibles, foreign travel, skilled nursing facility care or excess charges. Plan C ($155.31 per month) does not cover the excess charges. The money you save monthly may be required later through cost-sharing. Consider your health needs and your cash flow when making your decision. 6
Example: Vermont Blue 65 Plan C Medicare () pays for medical services SERVICES MEDICARE PAYS (PER CALENDAR YEAR) PLAN PAYS (PER CALENDAR YEAR) YOU PAY (PER CALENDAR YEAR) MEDICAL EXPENSES in or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment First $166 of Medicare-approved amounts 4 $166 ( deductible) Remainder of Medicare-approved amounts Generally 80% Generally 20% excess charges (above Medicare-approved amounts) 5 All costs BLOOD First three pints All costs Next $166 of Medicare-approved amounts 4 $166 ( deductible) Remainder of Medicare-approved amounts 80% 20% CLINICAL LABORATORY SERVICES Tests for diagnostic services 100% HOME HEALTH CARE Medicare-approved services Medicare Parts A & B Medically necessary skilled care services and medical supplies 100% Durable medical equipment First $166 of Medicare-approved amounts 4 $166 ( deductible) Remainder of Medicare-approved amounts 80% 20% Other Benefits Not Covered by Medicare FOREIGN TRAVEL (Not Covered By Medicare) Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2 A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. 3 Notice: When your Medicare hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. 4 Once you have been billed $166 of Medicare-approved amounts for covered services (which are noted with an asterisk), your deductible will have been met for the calendar year. 5 Plan F covers excess charges, or the difference when the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount. Vermont law prohibits a physician from charging more than the Medicare-approved amount. 7
disclosures Use the Outline of Coverage inside to compare benefits and costs among Plans. This Outline shows benefits and costs of Plans sold for effective dates on or after June 1, 2010. Plans sold for effective dates prior to June 1, 2010 have different benefits and premiums. Subscription rate information Blue Cross and Blue Shield of Vermont can only raise your premium if we raise the premium for all policies like yours in this State. Read your certificate very carefully This is only an Outline describing your Certificate s most important features. The Certificate that you will receive after you enroll is your contract. You must read the Certificate itself to understand all of the rights and duties of both you and your health plan. Policy replacement If you are replacing another health insurance Plan, do not cancel it until you have actually received your new policy and are sure you want to keep it. Notice This Plan may not fully cover all of your medical costs. This Outline of Coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult the government publication Medicare and You for more details. Complete answers are very important Review the application carefully before you sign it. Be certain that all information has been properly recorded. Blue Cross and Blue Shield of Vermont is an independent licensee of the Blue Cross and Blue Shield Association. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk bearing entities for Blue MedicareRx PDP plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in BlueMedicareRx (PDP) depends on contract renewal. Registered marks of the Blue Cross and Blue Shield Association. Right to Return Policy If you find that you are not satisfied with your Plan, you may return it to us. If you send the policy back to us within 30 days after you receive it, we will treat the contract as if it had never been issued and return all of your payments. Medicare Secondary Payer According to Medicare secondary payer rules, group size and retiree status determine who is primary. In order to purchase this coverage, you should be retired or working for a small employer (less than 20 employees). Please contact us with questions. P.O. Box 186 Montpelier, VT 05601-0186 Phone: (800) 255-4550 (802) 371-3299 salesandretention@bcbsvt.com www.bcbsvt.com/vtblue65 S2893_15182 Approved 01112016 284.317 (12/2015)