WELCOME. 2018 H9808_18_20 - PowerPoint Presentation

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WELCOME.

2018

H9808_18_20

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TODAY’S DISCUSSION

You have questions…and we have answers.

We want to hear from you so don’t hesitate to ask questions throughout the presentation.

LET’S TALK MEDICARE

Medicare Questions? Answered.

Your

Needs. Your Decision.

Medicare Advantage –

HealthTeam

Advantage.

Enrollment.

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Who we are

The ABCs (and Ds)

of MedicareYour Medicare Options

Enrollment Eligibility

Medicare Advantage

HealthTeam Advantage Plans

Enrollment

Let’s

talk

Medicare!2

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Who we are

HealthTeam

Advantage

is an

affordable

alternative

to Medicare Supplement insurance that offers Medicare Advantage Plans starting at $0 monthly premium. Our goal is to

assist our members in living healthier and happier lives.HealthTeam Advantage (HTA) is a doctor-directed, local Medicare Advantage option for residents in the Piedmont Triad area. The Moses Cone System is the parent company of HealthTeam Advantage with the HTA office located in Greensboro, NC.

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Part

A of Medicare covers hospital stays

Part

B of Medicare covers doctor’s visits

i

n

most cases has a monthly premium

Part

D of Medicare covers prescription drugs

Part APart BP

art DThe ABCs of Medicare4

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Medi

ca

re Part C plans a

re commonly referred to as

Medi

care

Ad

v

antage (MA) plans.Private

insurance companies contracted with Medicar

e provide this coverage.Most plans offer health and drug coverage, as

well as ext

ra ben

efits.

Medi

ca

r

e

p

a

y

s

Medi

c

a

r

e

Ad

v

a

n

t

a

g

e

Plans

a

s

e

t

amou

n

t

every month for your health plan needs.MA plans must offer all of the current benefits offered through Medicare, and can include prescription drug coverage (Part D).Most Medicare Advantage plans have lower out-of-pocket costs than Original Medicare and Supplement plans.

Part C of Medicare is a Medicare Advantage Plan. It covers Parts A, B, and sometimes Part D of Medicare.

P

art

C

The ABCs of Medicare (cont.)

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Costs shown for 2017 Medicare Guidelines

Original Medicare

Part A - Inpatient Hospital

Part A Deductible (per benefit period) $1,316.00 (per event)

Days 1-60 $0

Days 61-90 $329.00 (per day)

Days 91-151 (lifetime reserve days) $658.00 (per day)

Days 151+ You pay 100% of cost

Part A - Skilled Nursing Facility

Days 1-20 $0 (per day)Days 21-100 $164.50 (per day) Days 100+ You pay 100% of costPart B - CoveragePart B Deductible $183.00 (annually)After Deductible Medicare Pays 80% - You pay 20%NO MAXIMUM OUT OF POCKET, NO DRUG COVERAGE 6

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MEDICARE OPTIONS

Original Medicare Only

Original Medicare + Part D Drug Plan

Original Medicare +

MedSupplement

Original Medicare +

MedSupplement

+ Part D Drug Plan

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Part D Important Reminders

Failure to Enroll in a Part D Plan or Maintaining credible coverage will result in a late enrollment penalty in the future.

Some drugs have special requirements such as Step Therapy, Quantity Limits, and Prior Authorization.

You may qualify for “Extra Help” in paying for Rx Drugs.

Part D Plans Include a Coverage Gap where you may be responsible for much of the cost of your Prescription Medications.

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Medicare Supplements (Medigap Plans)

This chart

shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the

Medigap plan covers that percentage of the benefit, and

you’re

responsible for the rest.

Designed by CMS to provide specific benefits to fill the “gaps” of Medicare.

Costs shown for 2017 Medicare Guidelines

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Initial Enrollment Period

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Eligibility Requirements

E

n

titled t

o P

art A.

Must

en

roll into Part B

and pay any required Part B Premiums.Original Medicare

No underwriting questions, if enrolled during initial enrollment period.Must pass underwriting

questions

a

fter

initial en

rollme

n

t

period.

No drug coverage included.

Must purchase a stand-alone Part D plan if you want Rx Coverage.

Medicare Supplement

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Medicare Advantage plans are contracted through the Centers for Medicare and Medicaid Services (CMS

).

Medicare Advantage plans are NOT Medicare Supplement Plans. Medicare Supplements are additional insurance products purchased to work with Original Medicare

.

You are still a part of Medicare.

You receive the same benefits offered under Original Medicare.

Private companies will pay for your health care services, not Medicare.

IMPORTANT POINTS & COMMON MISCONCEPTIONS

Medicare Advantage

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Medicare Advantage Plans

Plus Part D Medicare prescription drug coverage as part

of a Medicare Advantage Prescription Drug (MAPD) Plan

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HMO (Health Maintenance Organization)

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PPO (Preferred Provider Organization)

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PFFS (Private Fee-For-Service)

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Are you eligible for Medicare Advantage?

You must:

Be entitled to Medicare Part A

AND Be enrolled in Medicare Part B (premium may be required)

Must be a US Citizen or Lawful Resident

Be a permanent resident of the service area

Not have End-Stage Renal Disease (ESRD)

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Medicare Enrollment Periods

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Retire

Change where you live

Lose your current coverageChance to get other coverage

Speak to

your

licensed sales representative about other life

events

that

qualify for the Special Enrollment Period.Special Enrollment Period

You may be able to enroll in a Medicare plan outside of the Initial Enrollment Period or Open Enrollment. This depends on certain events happening in your life … 16

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Y0107_16_152 Approved

YOUR NEEDS.

YOUR DECISION.

2018

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Work with your licensed agent to make sure

We Care

for you!

– What type of coverage do you currently have?

– Evaluate the parts

you like about it.– Consider the areas that you would like changes.

– Assistance. Does anyone help you make healthcare decisions?

– Review your options that best fit your needs.

– Enroll into the best solution for you!

Choosing a Health Plan is a Big Decision18

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Y0107_16_152 Approved

CHOOSING THE

RIGHT PLAN

FOR YOU

2018

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HOW DOES A PPO WORK?

You have a network of doctors, specialist and facilities contracted with the plan to provide services.

You can see providers out-of-network. Reminder, providers that do not contract with us are not obligated to treat you, except in emergency situations.

Cost-sharing will be lower at in-network providers

.

You should expect to pay more if you choose to use out-of-network providers

.

Referrals

are not necessary, but some services may require plan authorization prior to receiving the service.

You have the ability to select a different Primary Care Physician as needed.

Healthteam Advantage PPO Plans20

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Your Local Healthcare Concierge

At

HealthTeam Advantage,

the HCC can

help:

Explain health plan benefits

Coordinate

healthcare

services with an In-Network doctorVerify health plan coverage with a participating

providerFind a healthcare facility nearest to the member. And much more!At Healthteam Advantage, we work hard to provide

our members excellent customer service. Whenever a member has a question, we are always just a phone call or email away.21

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Silver&Fit Fitness Program

Access to a fitness club or exercise center

Such as YMCA, Curves, 24 Fitness, Gold’s Gym and more!

Group classes made for older adults where offered

Web tools like a facility search, health articles, challenges, and more

Equipment to use at home

Healthy aging materials

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No annual deductible

Convenient pharmacy locations, local and nationwide,

offering $0 co-pay for many generics on some plans

Mail order program is available

3 Month Supply for 2 Month Copay

At Pharmacy OR Mail Order!

PART D

Prescription Drug Benefit

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Now your agent will take a few minutes to explain key benefits and features to you about our plan.

Your

licensed sales agent will review the Summary of Benefits and Formulary with you.

If you decide HealthTeam Advantage

is a good fit, your licensed sales agent can help you complete the enrollment form.

NEXT STEPS

Choosing the Right Plan for You

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Y0107_16_152 Approved

ENROLLMENT.

2018

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Review your enrollment kit with a licensed sales agent to learn more about plan benefits and decide on the

HealthTeam

Advantage

health plan that best fits your needs.

Complete the enrollment form.

Submit! Your licensed sales agent will submit your enrollment form to

HealthTeam

Advantage.

SIMPLE AS 1, 2, 3

Enrollment

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Once

HealthTeam Advantage

receives your enrollment form, we’ll confirm your

Medicare eligibility with CMS.After CMS approves your enrollment, we’ll send you a letter confirming your membership with

HealthTeam Advantage.

You will receive a welcome call from your Healthcare Concierge.

In the following few weeks, you’ll

receive

important plan material about your coverage.Member Identification CardsFormulary (if enrolled in a plan with prescription coverage)Evidence of Coverage

WHAT HAPPENS NEXT?

Enrollment27

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Thank you!

HealthTeam Advantage

is a Medicare Advantage Organization with a Medicare contract. Enrollment in HealthTeam Advantage

depends on contract renewal. The benefit information 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 co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B Premium.

Out-of-network/non-contracted providers are under no obligation to treat

HealthTeam Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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

.

HealthTeam Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call

1-877-905-9216 (TTY:711).HealthTeam Advantage cumple con las leyes federales de derechos civiles aplicables y no discrimina

por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos

de asistencia

lingüística. Llame

al 1-877-905-9216 (TTY: 711).

HealthTeam Advantage 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年齡、殘障或性別而歧視任何人

。

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電

1-877-905-9216 (

TTY: 711)。

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