2014 Medicare Advantage Plans

Introduction Eligibility Basics of Medicare: 4 Parts: Original Medicare basics (Parts A and B) and limitations Medicare Advantage – Part C Medicare prescription drug – Part D Enrollment periods Plan specific information

Today’s Topics

You are eligible to join if one of these three items applies to you:• You are 65 or older, or• You are under 65 with certain

disabilities, or• You are any age with end-stage renal

disease – permanent kidney failure requiring dialysis or kidney transplant

• Must be entitled to Part A and enrolled in Part B, and permanently reside in the plan’s service area.

Original Medicare:

Eligibility

And, both of these items describe you:

1. You or your spouse worked and paid Social Security taxes for at least 10 years.

2. You are a permanent resident of the U.S. or a legal citizen who has lived in the U.S. for five years in a row.

Original Medicare: (Continued)

Eligibility

Medicare has 4 parts:

Original Medicare: Part A & Part B

Part C

Part D – prescription drug coverage

TheBasics

• Inpatient care in hospitals and skilled nursing facilities (not custodial or long-term care).

• Hospice and some health care services.

Medicare Part A is hospital coverage that helps cover the costs for:

*Late enrollment penalty may apply.

• Doctors’ services, hospital outpatient care and home health care services, as well as lab tests and durable medical equipment.

• Most preventive services, including a yearly wellness exam.

Medicare Part B is medical care coverage that helps cover the

costs for:

*Late enrollment penalty may apply.

* Some of these additional benefits may require an additional fee.

• Is offered by private insurers that have been approved by Medicare.

• Offers similar coverage to Part A (hospital) and Part B (medical), and typically offers additional benefits.*

• Some plans may include prescription drug coverage, vision, dental, and fitness and wellness programs.

Replace Medicare Parts A and B with Medicare Part C, also called Medicare Advantage. Medicare Part C:

• Most of these plans can be purchased

either as an HMO, PPO or stand-alone

plan, with an option to add supplemental

benefits for an additional monthly fee.*

You must continue to pay your Medicare

Part B premium.

HMO PPO

LPPO RPPO

Part C (Medicare Advantage)Plan Options

HMO vs.

PPOHMO vs.

PPO

Health Maintenance Organization (HMO)• Must receive all routine care

from network providers (except for emergency and urgent care)

• Monthly premiums generally lower than other plan types

• Set copays for most covered services

• Most plans include Part D prescription drug coverage

Preferred Provider Organization (PPO)• Local Preferred Provider

Organization (LPPO)Use network providers for

savingsFreedom to see out-of-network

providers (may cost more unless it’s an emergency)

• Regional Preferred Provider Organization (RPPO)See network and out-of-

network providersLarger service area than

an LPPO

(continued)

HMO vs.

PPOHMO vs.

PPO

Medicare

Part C:

Annual Deductible1

• For plans offering deductibles, the deductible will only need to be met once during the year.

• The deductible may be met through any qualifying expenses.

• The plan deductible does not apply to the following services:– Doctor office visits (PCP and Specialist)– Basic lab services– Basic X-rays– Preventive services2 (e.g., mammogram

screening, Pap/pelvic exam, prostate cancer screening, colorectal screening, immunization, etc.)

1 Not all Medicare Advantage

Plans include a deductible.

2 These services are $0 cost to a member and will not apply to the deductible.

Medicare Part D is only offered by private insurers approved by Medicare. These plans:•Help pay for many brand-name and generic prescribed drugs.

•Give you access to retail drugstores across the country and mail-order options.

Medicare Part D is prescription drug coverage

*Late enrollment penalty may apply.

2014 Medicare Standard Part D Coverage1

1Base coverage on a Part D plan; minimum set by Medicare

2Includes total cost of insured’s prescription drugs in the calendar year

3Includes insured’s out-of-pocket cost for prescription drugs in the calendar year

Deductible: $310

May vary by plan

Initial

Up to $2,8502

Plan pays: 75%

Gap

$2,8502 – $4,5503

During this stage, you pay 47.5% of the price

(plus the dispensing fee) for brand-name drugs

and 72% of the price for generic drugs.

Catastrophic

More than $4,5503

You pay greater of:

• $2.55 copay generic and $6.35 other

• 5% coinsurance

Medicare Basics

OROR

Piecing the “Parts” together:

Medicare Advantage Plans

Part DPrescription Drug: can be

combined with Part C; can be stand-alone if combined with

PFFS or MSA*

Part CCombines Parts A and B, and sometimes Part D

Requires only one ID card

* Stand-alone Part D with Private Fee For Service (PFFS) or Medicare Medical Savings Account (MSA) requires separate ID cards.

Original Medicare Plan

Part BMedical

+Part D

Stand-alone Prescription Drug+

Medicare Supplement(Medigap)

Requires three ID Cards

Part AInpatient Hospital

– When can I enroll?

– Timing matters!Enrollm

ent

Initial enrollment period:*

7 months surrounding your Medicare eligibility: This is the 3 months before you turn 65, the month when you turn 65, and the 3 months after.

* Must be entitled to Part A and

enrolled in Part B, and permanently

reside in the plan’s service area

Election

PeriodsElection

Periods

* Must be entitled to Part A and

enrolled in Part B, and permanently

reside in the plan’s service area

Annual election period:*

•October 15 to December 7, 2013. The period you can enroll in or change your MA or MAPD plan.

•This is also the period you can enroll in, change or disenroll from a Part D plan. •You may also switch to Original Medicare. New coverage will begin January 1, 2014.

Election

PeriodsElection

Periods

(continued)

Special enrollment period:*

•A common SEP is for those covered under their employer’s health plans who retire after 65. •In this case, you can enroll with no penalty during the three months before your Part B takes effect.

(continued)

Election

PeriodsElection

Periods

* Must be entitled to Part A and enrolled in

Part B, and permanently reside in the

plan’s service area

You may only be enrolled in one prescription drug plan at a time. If enrolled in a Medicare Advantage coordinated care (HMO or PPO) plan or an MA PFFS plan that includes Medicare prescription drugs, you may not enroll in a stand-alone prescription drug plan unless you disenroll from the HMO, PPO or Medicare Advantage PFFS plan.

Additional Information

• Limitations, copayments, and restrictions may apply.

• Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year.

Additional Informati

on

Additional

Information

We renew our contract with Medicare annually.Anthem Blue Cross renews its contract with Medicare (the federal government) each year on January 1. Premiums and benefits may change at that time, but not during the year, unless the change is to your advantage. In addition, the plan may reduce its service area and no longer offer services in the area where the beneficiary resides. If we do not renew our contract, we’ll tell you at least 90 days in advance. You may then switch to a standard Medigap plan (A, B, C, F, K or L) that won’t deny coverage because of a pre-existing condition. It will normally go into effect the day after your Medicare Advantage membership ends.

Medicare Advantage 2014

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.

Let’s examine

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benefits

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out the out the

enrollment enrollment

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Let’s fill Let’s fill

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SAMPLE

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.

Anthem Blue Cross is a PPO plan, an HMO plan and a PDP with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

Additional Information

Y0071_14_18365_R_001 CMS Approved 9/30/2013 41241WPSENMUB_001 BROKER