Thank you for joining us for this special presentation on Freedom Health s Medicare Advantage Plans. Today we will explain the tremendous value of a Freedom Health plan which offers benefits and savings you can use every day! At the end of this presentation one of our skilled Benefit Consultants will be available to answer any questions you may have or sign you up for a Freedom Health plan today. During this presentation you will learn about the variety of Freedom Health s benefit plan options to determine what best fits YOU and your lifestyle. And if you like what you hear today one of our benefit consultants can help you enroll in a Freedom Health Medicare Advantage H-M-O Plan or H-M-O Special Needs Plan. Freedom Health is an H-M-O Plan with a Medicare contract and a contract with the Florida Medicaid Program. Your enrollment in Freedom Health depends on contract renewal. The benefit information you hear today is just a brief summary, not a complete description of benefits but you can always contact the Plan for more information. Benefits may vary by Plan and County and limitations, copayments and restrictions may apply. As with all Medicare Advantage Plans benefits formulary pharmacy network premium and-or co-payments/co-insurance may change on January 1st of each year. Please hold any questions you may have for the end of this presentation when one of our benefit consultants will be happy to assist you. We ll begin by explaining Medicare. As you probably already know Medicare is federal health insurance for people 65 and older younger people with certain disabilities and people with end stage renal disease with limited exceptions. Medicare is divided into several parts. Part A is hospital insurance. It helps cover the care of patients in hospitals skilled nursing facilities hospice or even home health care.part B is medical insurance which helps cover doctor s services outpatient care or some preventive services. Part C is Medicare Advantage which is a health coverage option that is run by a private insurance company and may offer extra coverage. Medicare Advantage Plans are approved and under contract with Medicare. They include Parts A, B and usually prescription drug coverage which is known as Part D. Part D is also an option run by private companies approved by and under contract with Medicare to help cover the cost of prescription drugs. To be eligible for Medicare Advantage you must have both Medicare Parts A and B. You must be a permanent resident in the area where the plan is offered. People with End Stage Renal Disease are not eligible for Medicare Advantage with limited exceptions. If you are eligible you may enroll in an H-M-O plan only during specific times of the year. If you are eligible for an H-M-O Special Needs Plan or S-N- P you can enroll at any time of the year. You can always contact the Plan for more information but here is a brief description of the different Medicare Enrollment Periods. From October 15th through December 7th each year All Medicare beneficiaries may enroll or disenroll in a Plan. Coverage begins January 1st of each year. January 1st through February 14th of each year you may switch back to Original Medicare and choose a Part D Plan.
The Initial Coverage Enrollment Period is when newly eligible beneficiaries can enroll in a Medicare Advantage Plan. The time frame is based on their individual circumstances and allows for a 7 month period of eligibility. An agent is available to assist you with any questions on your eligibility. The Special Enrollment Period is when you may enroll or disenroll in a plan due to a qualifying condition. Qualifying conditions are listed on the last page of our enrollment application. There are many reasons to choose Freedom Health. It is owned and operated by doctors who are focused on preventive care they don t just see you when you are sick or have a health problem. Freedom Health has its headquarters in Tampa Florida with convenient concierge centers across the entire state. Freedom Health is accredited by The National Committee for Quality Assurance N-C-Q-A and received a Commendable rating and was re-awarded a three year accreditation from December 26th 20-12 to December 26th 20-15.Freedom Health has also been approved by N-C-Q-A to operate a Special Needs Plan or S-N-P until December 2014 based on a review of Freedom Health s Model of Care. N-C-Q-A accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS the performance measurement tool used by more than 90% of the nation s health plans. Freedom Health passed these rigorous standards and reported their performance in dozens of clinical areas to earn the N-C-Q-A seal of approval. You will also find a Medicare Plan Ratings sheet in the Plan enrollment kit. The Plan rating is given by Medicare and shows how well a plan is performing in different categories. Medicare evaluates Plans based on a 5 star rating system. For 2013 Freedom Health was awarded a 5 star rating in Customer Service and 5 stars in Member Overall Rating of Drug Coverage. Freedom s Overall Star Plan Rating was an above average 3 point 5 stars. Star Ratings are calculated each year and may change from one year to the next. For more information on Plan Star Ratings go to w-w-w dot Medicare dot gov. It is really easy to find a Freedom Health plan to fit your needs and lifestyle. There are Medicare Advantage H-M-O Plans with and without prescription drug coverage including the Freedom Savings Plan (H-M-O) Freedom Savings Plan R-X (H-M-O) and Freedom Medicare Plan R-X (H-M-O).Freedom Health also offers dual eligible Special Needs Plans with drug coverage including Freedom Medi-Medi Full and Freedom Medi-Medi Partial (H-M-O S-N-P) Plans. H-M-O Dual Eligible Special Needs Plans are available to anyone who has both Medical Assistance from the state and Medicare. There are also Chronic Condition Special Needs Plans with drug coverage. These include Freedom V-I-P Savings and Freedom V-I-P Care (H-M-O S-N-P) Plans for people with Cardiovascular Disorders Chronic
Heart Failure or Diabetes Mellitus. And for people with Chronic Lung Disorders there is the Freedom V-I- P Savings C-O-P-D and Freedom V-I-P Care C-O-P-D (H-M-O S-N-P) Plans.Premiums co-pays coinsurance and deductibles for dual eligibles may vary based on the level of Extra Help you receive. Here are what just some of the satisfied members have to say about Freedom Health (Member Testimony) This is one you don t have to worry about. You really don t have to worry about it. It s just a great program and the whole thing is being healthy and if they can catch it before it comes then you are that much ahead not only financially but health wise. You have a better life. It s great. It s great. Freedom is the best. Really, I m enjoying it a lot. We have everything we need. Earlier in this presentation we mentioned Medicare Special Needs Plans or S-N-Ps which are a type of Medicare Advantage plan that is focused on individuals with special needs. Freedom Health S-N-Ps are limited to people with specific chronic conditions or people eligible for both Medicare and Medicaid. If you qualify to join a Medicare S-N-P you get all of your Medicare hospital and medical health care services through that plan including Medicare prescription drug coverage. Freedom Health offers two types of S-N-Ps. Chronic Care Special Needs Plans or C-S-N-Ps are for people with one or more of the following chronic or disabling conditions: Cardiovascular Disorders Chronic Heart Failure Diabetes Mellitus and Chronic Lung Disorders. To join a Freedom Health C-S-N-P the plan will need to obtain verification of the chronic condition from your doctor. A response from your doctor s office is required within 30 days of enrollment. The second type of S-N-P offered by Freedom health is a Dual Eligible Special Needs Plan or D-S-N-P. These plans are for people who are eligible for both Medicare and Medicaid. You can contact the Plan to confirm your eligibility or get your questions answered. If you lose eligibility or there are changes to your eligibility or qualifying condition you will be disenrolled from your Special Needs Plan but you will be eligible for a Special Election Period that will allow you to enroll in another plan. The bottom line is Freedom Health offers benefits and savings you can use every day and that is a true value for its members! For instance, there are $0 cost Primary Care Visits $0 cost Preventive Services and even $0 cost Plan Premiums on most plans! You can also save with the Medicare Advantage Savings Plan. Members can receive up to $50 of their Part B Premium back each month on the Freedom Savings Plans that s up to $600 each year! Freedom Chronic Condition Special Needs Savings Plans offer savings too. Members can receive up to $72.00 of their Part B Premium back each month on the VIP Care Savings Plans that s up to $864 each year! All these savings vary by Plan and County and are based on a 12 month enrollment. You must
continue to pay your Medicare Part B Premium. The Part B Premium is covered for full benefit dual members of Special Needs Plans. Another exciting Freedom Health benefit is the O-T-C Allowance. This covers over the counter health related items and supplies that most people buy regularly and Freedom Health Members love it! (Member Testimony) Once a month you can call and get up to, depending on your plan, a number of over the counter items. Bandages, anything, you know, dental floss. Whatever you need to keep your preventive maintenance going there. And it s shipped to you in three to four days and at no cost to you. Everything from band-aids to anti-biotic ointment to vitamins. It s an array of many things. If you just think of what s in a drug store you pretty much have it with Freedom. (HOST) Plan participants can receive between $18 and $50 each month depending on Plan selection and where you live. Over the course of a year this could mean between $216 and $600 in savings! Plus members can order these supplies on-line or over the phone and have them delivered directly to their homes at no cost! It s easy and hassle-free. Specifics vary by plan and county and limitations and restrictions may apply. When it comes to prescription drugs there are four cost sharing tiers. Every drug on the plan s list can be found in one of these tiers. Cost sharing tier one covers preferred generic prescription drugs. Cost sharing tier two covers preferred brand prescription drugs. Cost sharing tier three is for nonpreferred brand prescription drugs. And cost sharing tier four is dedicated to specialty prescription drugs. In general, cost sharing Tier 1 drugs are the lowest tier and includes some Generic Drugs and some Brand Drugs. Tier 2 Drugs include Preferred Brand Drugs and some Non-Preferred Generic Drugs. Tier 3 Drugs include Non-Preferred Brand Drugs and Non-Preferred Generic Drugs and Tier 4 Drugs are the highest tier and include Specialty Tier Drugs. To find out which cost sharing tier your drug is in look it up in the Plan s Formulary and then refer to the benefits section for specific cost sharing. Eligible beneficiaries must use network pharmacies to take advantage of their prescription drug benefit except in non-routine circumstances. Quantity limits and restrictions may apply. You may also receive a Late Enrollment Penalty or L-E-P which is an amount that Medicare adds to your Part D Premium. You may owe the L-E-P if after your initial enrollment period is over there is a period of more than 63 days in a row when you don t have Part D or other creditable prescription drug coverage. There are exceptions. If you get Extra Help then you will not owe
a L-E-P. Beneficiaries can find out at enrollment if they owe a L-E-P and if so how much. If you are presented with a L-E-P but disagree you may request a reconsideration request form from the Plan. There are two ways to find a drug within the Formulary. You can look it up depending on the type of medical conditions it is used to treat. For example drugs used to treat a heart condition can be found under the category Cardiovascular Agents. The index of the Formulary also provides an alphabetical listing of all the drugs along with the page number where you can find coverage information. Any drug restrictions will also be noted in the formulary. Some drugs require Prior Authorization P-A. Quantity limits Q-L and or step therapy S-T requirements. If your drug is indicated as P-A your doctor will need to contact the plan to request authorization. If your drug is indicated as Q-L your doctor will need to prescribe the Plan approved amount or contact the Plan for an exception. If your drug indicates S-T the Plan will want you to try certain drugs to treat your medical condition before covering another drug. If you doctor already has you on a step drug they may ask the Plan for an exception. If you are newly eligible switching Plans or have a change in your level of healthcare you can receive a one-time 31 day supply of your current medications within the first 90 days of membership. This is called the Formulary Transition Process. You can ask the Plan to make an exception to the coverage rules by asking for a Formulary Exception. How much you pay for your prescription drugs depends on your coverage stage. Stage 1 is the initial coverage stage and the Plan will pay its share of the cost of your drugs and you are responsible for your share. You remain in Stage 1 until your payments for the year PLUS the Plan s payments equal two thousand-850 dollars. Stage 2 is the Coverage Gap stage many of you may know it as the Donut Hole. In Stage 2 you pay 25 percent of generic drug costs as well as discounted costs for brand drugs until your yearly out of pocket drug costs reach four thousand-550 dollars. This total may be different if you are already getting Medicare Extra Help. For certain plans, you may pay zero or ten dollars for drugs in Tier 1 during the Coverage Gap or Donut Hole. You can contact the Plan for more information. The third stage is the Catastrophic Coverage Stage. Once you have paid enough for your drugs to move into this last payment stage the Plan will pay most of the cost of your drugs for the rest of the year. You will pay the greater of five percent or two dollars 55 cents for generic or preferred multi-source drugs and the greater of five percent or six dollars 35 cents for all other drugs. Another great feature of Freedom Health Plans is the Medical Home. Here your Primary Care Provider or P-C-P acts as your personal physician and coordinates all your health care needs. Your P-C-P focuses on prevention and your overall wellness not just treating you when you are sick and this allows for a higher quality of overall service. (Provider Testimony) That s preventive maintenance. They re interested in your health. // And to me that s a good thing. If I don t look out for it properly they ll catch something perhaps that I wouldn t. I
think the accessibility is the key. We can get access to the specialty right way. They can see the patient right away. They communicate the urgency or the intensity of the care to us right away and we can coordinate those cares. So coordination of care is excellent. (HOST) You must use Freedom Health providers except in emergent or urgent care situations out of area renal dialysis or other services. If you choose to get routine care from an out of network provider neither Medicare nor Freedom Health will be responsible for the cost. The bottom line is Freedom Health offers its members more benefits for less money than Original Medicare. For example there are no plan premiums on most plans. Some Freedom Health plans even provide a Part B Premium refund. In fact the Freedom Savings Plan H-M-O plan provides a refund of up to $50 dollars each month. And the Freedom V-I-P Savings Plan H-M-O S-N-P provides a refund of up to $72 dollars each month. Plus there s an O-T-C benefit! Freedom members can receive from $18 to $50 dollars each month to purchase Over The Counter health related items. That s between $216 and $600 in savings each year! There s also brand and generic prescription drug coverage available on plans that offer Part D coverage. And all Freedom Health plans offer supplemental benefits like dental vision hearing and health club or fitness memberships. But probably most importantly for people on a budget Freedom Health members can expect predictable costs and low out of pocket maximums. (Member Testimony) It s the best insurance that we ve ever had for the least amount of money and we are just grateful that we have found this because we have saved money off of it. We re just delighted that our monthly rates we can afford it easily. It s great. I hope they never change because it s perfect the way it is. It s just what the word says. Freedom. Gives you Freedom (laughs). It does. But we re really thrilled to death and like I said, it was beyond what we were looking for. (HOST) There are more than a dozen preventive services available to Freedom Health members at zero cost.
These include bone mass measurements cardiovascular colorectal and diabetes screenings flu shots glaucoma tests mammograms and more. Benefit limitations may apply so be sure to review your Evidence of Coverage or ask your benefit consultant for complete details of your coverage.so you may be asking when you can enroll in a Freedom Health plan it s called the Annual Enrollment Period or A-E-P. During the A-E-P people eligible for Medicare Advantage may enroll or end their enrollment in a Medicare Advantage Plan. The 20-13 A-E-P starts October 15th and goes through December 7th. Most enrollments submitted during this time will have an effective date of January 1st, 20-14. If you have a special enrollment period or initial coverage election period you may be able to enroll with an earlier effective date. If you have questions please call our Member Services department for more information or refer to the Medicare and You handbook for more information on enrollment periods.after you enroll you will receive some important items from Freedom Health including your I-D card and evidence of coverage a provider directory and if your plan offers Part D coverage a pharmacy directory and the formulary which is the list of covered drugs as well as other member materials. This is what the Freedom Health I-D card looks like and the information it provides. On the front you ll find your plan benefits for your pharmacist if you have Part D coverage your Freedom Health identification number the year you joined Freedom Health the name of your Freedom Medicare Advantage Plan and your plan number. On the back are the up-front payments or co-pays for your plan benefits Member Services contact information and information for your doctor pharmacist or hospital. If you ever have a question that you would like answered face to face you can always stop by one of our seven concierge centers conveniently located around the state. These centers are open Monday through Friday from eight in the morning until five in the evening. You ll find concierge centers in Casselberry Bradenton Spring Hill Ft. Myers Tampa Vero Beach and Ocala. Each location has helpful staff licensed agents and a one hour resolution time. To find a concierge center close to you go to our website at w-w-w dot freedom health dot com. Freedom Health believes your health is important and it changes on a daily basis. Freedom can help you stay on top of these changes with their Health Assessment Tool or HAT. Once you submit a HAT Freedom Health uses it to coordinate any care that you may need or to qualify you for any specialized health wellness program or education available. The HAT will not be used to disqualify you and will not impact your enrollment with Freedom Health. You may have questions about what you have learned here today. Freedom Health wants to make finding those answers as easy as possible. To start you can meet with the benefit consultant who is with you now. Or you can always go to our website w-w-w dot freedom health dot com. You can also call Member Services at 1-800-401-2740. T-T-Y T-D-D users should call 1-800-955-8771. These numbers are available seven days a week from eight in the morning until
eight at night October 1st 20-13 through February 14th 20-14. From February 15th 20-14 through September 30th 20-14 the lines are open Monday through Friday from eight in the morning until eight in the evening. And from October 1st 20-14 through December 31st 20-14 you can reach someone seven days a week from eight in the morning until eight in the evening. Thank you for your time today. Remember Freedom Health is Focused on You.