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Office of Group Benefits Office of Group Benefits Medicare Advantage Fall Enrollment 2012 1 FOR RETIREES WITH MEDICARE PART A & PART B
Office of Group BenefitsOffice of Group BenefitsMedicare Advantage Fall Enrollment 2012
1FOR RETIREES WITH MEDICARE PART A & PART B
This presentation is a summary of information and does not purport to present complete details of all plan options not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan, read the plan documents carefully and consult other OGB and plan administrators’ publications.
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WELCOMEWELCOMEWELCOME....WELCOME....
This presentation will cover…
Enrollment information
Key facts
Overview of plans
3Life insurance
Medicare Advantage Enrollment TimelineMedicare Advantage Enrollment Timelinegg
Enrollmentends
Enrollmentstarts
October 1 December 2 January 1December 31 October 1 December 2 January 1December 31
Effective dateOGB must receive enrollment formto ensure correct deductions on of coverageto ensure correct deductions on
January retirement check
Enrollment RestrictionsEnrollment RestrictionsOGB Medicare Advantage Enrollment is the ONLY TIME li ibl OGB ti ll iONLY TIME eligible OGB retirees can enroll in OGB Medicare Advantage plans (also called Part C Medicare plans)Medicare plans)
OGB retirees can also enroll in OGB standard h lth l d i A l E ll t h f llhealth plans during Annual Enrollment each fall
Eligible retirees who enroll in an OGB Medicare gAdvantage plan must keep it through December 31, 2012
Key PointsKey PointsyyCan change health plans once each year during A l E ll t d M di Ad tAnnual Enrollment and Medicare Advantage Enrollment – both are now held in the fall
Compare costs, benefits and restrictions when choosing a plan
Retirees who choose to keep the same plan do not need to fill out an enrollment form
What happens if you drop coverage?What happens if you drop coverage?What happens if you drop coverage?What happens if you drop coverage?
If you drop OGB coverage without transferring to an
OGB standard plan or OGBMedicare Advantage Plan…
YOU LOSE O G BYOU LOSE O.G.B. COVERAGE FOREVER!!
You lose OGB coverage forever…You lose OGB coverage forever…EXCEPTEXCEPT ifif ……
Y j i d i di id l ( OGB) M diYou joined an individual (non-OGB) Medicare Advantage plan and it is no longer available or you withdrew, OR,
You joined TriCare for Life and it was discontinued f f O
You lost other creditable continuous coverage and
or had a significant reduction in benefits, OR
You lost other creditable continuous coverage and meet all requirements in PPO Plan Document
C ll OGB C t S iC ll OGB C t S iCall OGB Customer Service Call OGB Customer Service for more informationfor more information
Enrollment ProceduresEnrollment ProceduresIf you are not transferring from one plan to another, DO NOT send in a health plan enrollment form.11
22If your spouse is covered as a dependent on your OGB plan, both you and your spouse must have Medicare Part A and Part B to be eligible for a Medicare Advantage plan. You must both join the same plan.
If choosing an OGB Medicare Advantage plan…
Complete an OGB Medicare Advantage Plan enrollment form 33 p g(available at meetings, on OGB’s website or at any OGB office). Medicare requires a street address (not a post office box). Sign and date the form and mail it to:
OGB Eligibility DivisionP.O. Box 66678Baton Rouge, LA 70896
OGB must receive enrollment form by 12-2-11 to ensure accurate January premium deductions; final deadline for OGB to receive form is 12-30-11
Enrollment Form
Change NotificationChange NotificationIf the following information changesIf the following information changesat any time, report it immediately to OGB…at any time, report it immediately to OGB…
Mailing addressAddress
Working status
Mailing address
Working statusWorking status
Eligible dependentsEligible dependents
M di t tEligibility for MedicareMedicare status
Change NotificationChange NotificationTo report changes…To report changes…
Go to the Human ResourcesGo to the Human Resources office at the agency from which you retired orwhich you retired or
Send a letter to OGB or
Visit an OGB office
OGB Medicare Advantage Plans…OGB Medicare Advantage Plans…Key Facts & Decision Questions
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Key Fact # 1Key Fact # 1Key Fact # 1Key Fact # 1
You DO NOT have to join an OGB Medicare Advantage plan.
You can keep your OGB standard plan p y p(PPO, HMO, Regional HMO or Medical Home HMO).
Key Fact # 2Key Fact # 2Key Fact # 2Key Fact # 2
The Medicare program allows each person to enroll in only ONE medical or prescription drug Medicare-type plan.
Key Fact # 2 (continued)Key Fact # 2 (continued)
Once you enroll in an OGB Medicare Advantage Once you enroll in an OGB Medicare Advantage Once you enroll in an OGB Medicare Advantage
A Medicare supplemental plan;A Medicare supplemental plan;plan, DO NOT purchase or enroll in …plan, DO NOT purchase or enroll in …A Medicare supplemental plan;
plan, DO NOT purchase or enroll in …
A Medicare Advantage plan not sponsored by OGB that includes Medicare Part D prescription A Medicare Advantage plan not sponsored by OGB that includes Medicare Part D prescription A Medicare Advantage plan not sponsored by OGB that includes Medicare Part D prescription p pdrug coverage;
A group Medicare Advantage plan not
p pdrug coverage;
A group Medicare Advantage plan not
p pdrug coverage;
A group Medicare Advantage plan notA group Medicare Advantage plan not sponsored by OGB; or
A Medicare Part D plan for drug coverage only
A group Medicare Advantage plan not sponsored by OGB; or
A Medicare Part D plan for drug coverage only
A group Medicare Advantage plan not sponsored by OGB; or
A Medicare Part D plan for drug coverage onlyA Medicare Part D plan for drug coverage only.A Medicare Part D plan for drug coverage only.A Medicare Part D plan for drug coverage only.
Key Fact # 2 (continued)Key Fact # 2 (continued)
Signing up for a plan other than those offered by OGB cancels your previous choice and y y pcould leave you without OGB health and prescription drug coverage.
Key Fact # 3Key Fact # 3Key Fact # 3Key Fact # 3
If you DO join an OGB Medicare Advantage plan you will get ALL ofIf you DO join an OGB Medicare Advantage plan you will get ALL ofIf you DO join an OGB Medicare Advantage planAdvantage plan, you will get ALL of
your health benefits through that plan including your prescription
Advantage plan, you will get ALL of your health benefits through that plan including your prescription
Advantage plan…
You will get ALL of your healthb fit th h th t l i l diplan, including your prescription
drug coverage. You will continue to pay your Medicare Part B premium
plan, including your prescription drug coverage. You will continue to pay your Medicare Part B premium
benefits through that plan, including your prescription drug coverage; andY MUST ti tpay your Medicare Part B premium.pay your Medicare Part B premium.You MUST continue to pay your Medicare Part B premium.
Key Fact # 4Key Fact # 4Key Fact # 4Key Fact # 4
If your spouse is covered as a dependent…
Your covered spouse must also have both Medicare Part A and Part B to join an OGB M di Ad t lMedicare Advantage plan.
You and your covered spouse must join the same plansame plan.
Key Fact # 5Key Fact # 5Key Fact # 5Key Fact # 5
Medicare Advantage plans are NOTMedicare supplement plansMedicare supplement plans.
If you enroll in an OGB Medicare Ad l i ill l hAdvantage plan, it will replace whatever Medicare and OGB coverage you currently havecurrently have.
Key Fact # 6Key Fact # 6yy
Even though OGB Medicare Advantage plans replace traditional Medicare coverage, OGB M di Ad t l b till t iMedicare Advantage plan members still retain all rights and protections provided by traditional Medicare However benefits maytraditional Medicare. However, benefits may vary by plan.
ALL Medicare Advantage plan companies areALL Medicare Advantage plan companies are regulated by the federal Centers for Medicare and Medicaid Services (CMS).and Medicaid Services (CMS).
Key Fact # 7Key Fact # 7Key Fact # 7Key Fact # 7
If you enroll in an OGB Medicare If you enroll in an OGB Medicare If you enroll in an OGB Medicare yAdvantage plan, you must stay in that plan until December 31, 2012.
yAdvantage plan, you must stay in that plan until December 31, 2012.
yAdvantage plan, you must stay in that plan until December 31, 2012.
You can only change plans during OGB Annual Enrollment or Medicare You can only change plans during OGB Annual Enrollment or Medicare You can only change plans during OGB Annual Enrollment or Medicare Advantage Enrollment each fall.Advantage Enrollment each fall.Advantage Enrollment each fall.
Decision QuestionsDecision QuestionsDecision QuestionsDecision Questions1. Is the plan available in your area or parish?1. Is the plan available in your area or parish?2. Are your hospitals and doctors in the plan’s
provider network?2. Are your hospitals and doctors in the plan’s
provider network?3. Does the plan have out-of-state coverage if
you need it?3. Does the plan have out-of-state coverage if
you need it?4. What is the plan’s monthly premium cost? 5. How much will you pay in total yearly out-of-4. What is the plan’s monthly premium cost? 5. How much will you pay in total yearly out-of-
pocket costs?6. How does the plan compare to the costs and
b fit f t l ?
pocket costs?6. How does the plan compare to the costs and
b fit f t l ?benefits of your current plan?benefits of your current plan?
O i f PlOverview of Plans
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OGB Medicare Advantage Plans…OGB Medicare Advantage Plans…gg…offer premium savings…offer premium savings
3 HMO Plans 2 PPO Plans3 HMO Plans
H HMO
2 PPO Plans
H PPOHumana HMO
Peoples Health HMO-POS
Humana PPO
UnitedHealthcare PPO
Vantage HMO-POS
OGB Medicare Advantage PlansOGB Medicare Advantage PlansOGB Medicare Advantage PlansOGB Medicare Advantage Plans
PPO PlansHMO Plans
Usually have lower premiums
Offered in designated areas
Usually have lower premiums
Offered in designated areas
Usually have lower premiums
Offered in designated areasExpanded networks outside of LouisianaOffered in designated areas
Must utilize network providers
HMO-POS plans offer out-of-
Offered in designated areas
Must utilize network providers
HMO-POS plans offer out-of-
Offered in designated areas
Must utilize network providers
HMO-POS plans offer out-of-
Can use any provider that accepts Medicare assignment
network benefits
Encourage preventive care
network benefits
Encourage preventive care
network benefits
Encourage preventive care
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No referrals required
OGB Medicare Advantage PlansOGB Medicare Advantage PlansCoverage AreasCoverage Areas
Humana HMO
Peoples Health HMO-POS
Vantage HMO-POS
Humana PPO
UnitedHealthcarePPO
AlexandriaBaton RougeHammond
Baton RougeHammondNew Orleans
Statewide 23 states Nationwide
HammondHoumaLafayetteLake Charles
New OrleansNorth Shore
Lake CharlesNew OrleansNorth ShoreShreveportShreveportThibodaux
HMO Plan Overview …Plan Member Out-of-Pocket ExpensesHMO Plan Overview …Plan Member Out-of-Pocket ExpensesPlan Member Out of Pocket Expenses (Jan. 1 – Dec. 31, 2012)
Plan Member Out of Pocket Expenses (Jan. 1 – Dec. 31, 2012)
Humana HMO
Peoples Health HMO POS
Vantage HMO POSHMO HMO-POS HMO-POS
Lifetime Maximum Unlimited Unlimited Unlimited
Deductible(C l d Y ) $0 $0 $0(Calendar Year) $0 $0 $0
Out-of-Pocket Maximum $2500 $2500 $3250
in-networkInpatient $10 co pay $100 co payHospital Care
Per Day 1, 2
$10 co-payper day (days 1-10) $0 co-pay $100 co-pay
per day (days 1-5)
OutpatientHospital Care $100 maximum co-pay $0 co-pay $100 co-pay (facility) 2
Surgery/Anesthesia/X-ray
$0 co-pay $0 co-pay $0 co-pay (physician) 2
Ambulatory Surgical Facility $50 co-pay $0 co-pay $100 co-pay 2
Doctor VisitPrimary/Specialist $5/$15 co-pay $5/$10 co-pay $5/$30 co-pay
1 Semi-private room, ancillary services and doctor visits 2 Some services may require pre-certification
HMO Prescription Drug Coverage Plan Member Out-of-Pocket ExpensesHMO Prescription Drug Coverage Plan Member Out-of-Pocket ExpensesPlan Member Out of Pocket Expenses
(Jan. 1 – Dec. 31, 2012)Plan Member Out of Pocket Expenses
(Jan. 1 – Dec. 31, 2012)Humana
HMOPeoples Health
HMO POSVantage
HMO POSHMO HMO-POS HMO-POS
Formulary Open Open Closed with exceptions
Retail (30-day supply) 1
Level 1 - Generic Drugs $0 co-pay $0 co-pay $0 co-pay
Level 2 - Preferred Brands $20 co-pay $20 co-pay $20 co-pay
Level 3 - Non-Preferred Brands $40 co-pay $40 co-pay $40 co-payLevel 3 Non Preferred Brands $40 co pay $40 co pay $40 co pay
Level 4 - Specialty Drugs $60 co-pay 20% co-insurance 25% co-insurance
Mail Order (90-day supply)
G i D $0 $0 $0Level 1 - Generic Drugs $0 co-pay $0 co-pay $0 co-pay
Level 2 - Preferred Brands $40 co-pay $40 co-pay $60 co-pay
Level 3 - Non-Preferred Brands $80 co-pay $80 co-pay $120 co-pay
Level 4 - Specialty Drugs $60 co-pay 30-day limit 20% co-insurance 25% co-insurance
1 Vantage covers 31-day supply at retail
PPO Plan Overview … Plan Member Out-of-Pocket ExpensesPPO Plan Overview … Plan Member Out-of-Pocket ExpensesPlan Member Out of Pocket Expenses (Jan. 1 – Dec. 31, 2012)Plan Member Out of Pocket Expenses (Jan. 1 – Dec. 31, 2012)
Humana United HealthcareHumana PPO
United Healthcare PPO
Lifetime Maximum Unlimited UnlimitedDeductible (Calendar Year) $0 $0Deductible (Calendar Year) $0 $0Out-of-Pocket Maximum $3,400 $1,800Inpatient Hospital CareP D 1 2
$180 co-payd (d 1 5)
$180 co-payd (d 1 5)Per Day 1, 2 per day (days 1-5) per day (days 1-5)
Outpatient Hospital CareSurgery/Anesthesia/X-ray
20% co-insurance20% co-insurance
20% co-insurance$0 co-pay to 20% co-insurance
Ambulatory SurgicalFacility 20% co-insurance 20% co-insurance
Doctor Visits Primary Care/Specialist $15/$30 co-pay $15/$30 co-payPrimary Care/Specialist p y p y
1 Semi-private room, ancillary services & doctor visits 2 Some services may require pre-certification
PPO Prescription Drug Coverage Plan Member Out-of-Pocket ExpensesPPO Prescription Drug Coverage Plan Member Out-of-Pocket ExpensesPlan Member Out of Pocket Expenses(Jan. 1 – Dec. 31, 2012)Plan Member Out of Pocket Expenses(Jan. 1 – Dec. 31, 2012)
Humana PPO UnitedHealthcare PPOHumana PPO UnitedHealthcare PPO
Formulary Open 100% of all Medicare-approved drugs and bonus drug list
Retail (30-day supply)Retail (30 day supply)
Level 1 - Generic Drugs $5 co-pay $5 co-pay
Level 2 - Preferred Brands $35 co-pay $25 co-pay
N P f d B d $60 $50Level 3 - Non-Preferred Brands $60 co-pay $50 co-pay
Level 4 - Specialty Drugs $80 co-pay $50 co-pay
Mail Order (90-day supply)
Level 1 - Generic Drugs $0 co-pay $10 co-pay
Level 2 - Preferred Brands $70 co-pay $50 co-pay
Level 3 - Non-Preferred Brands $120 co-pay $100 co-payLevel 3 Non Preferred Brands $120 co pay $100 co pay
Level 4 - Specialty Drugs $80 co-pay30-day limit
$100 co-pay
OGB Medicare Advantage PlansOGB Medicare Advantage PlansPrescription Drug Coverage
All OGB Medicare Advantage plans provide coverage in the gap orAll OGB Medicare Advantage plans provide coverage in the gap or “donut hole”
Plan member pays applicable co-pays for prescription drugs (at all levels)
After $4,700 of eligible out-of-pocket prescription costs in a calendar year, co-pays are $2.60 for generic drugs and $6.50 for y , p y g gbrand name drugs or 5% co-insurance, whichever is greater
Plans vary, with open and closed formularies for prescription drugs
Humana HMOHumana HMOKey Features
Wide choice of doctors, specialists and hospitals in network
No referral needed to see a network specialistEmergency coverage anywhere in the worldEmergency coverage anywhere in the world
Silver Sneakers program
Full fitness club benefits at participating locationsSpecial exercise classes at no cost
Smart Summary
Personalized monthly summaryPersonalized monthly summaryDetailed claims and cost informationIncludes medical services and prescription drugs
Humana HMOHumana HMO
Advantages
Low monthly premium
Weigh costs and benefits
Humana’s stability
48-year company history48-year company history
Current financial position as Fortune 100 company
Peoples Health HMO-POSPeoples Health HMO-POSppKey Features
100% hospitalization coverage – 0% co-pay!
$0 f X MRI CT & l b$0 co-pay for X-rays, MRIs, CT scans & labs
Vision benefit – free glasses or contacts each year
Dental coverage – including dentures – up to g g p$1250 per year
Free health club membershipFree health club membership
Peoples Health HMO-POSPeoples Health HMO-POSAdvantages
Largest Louisiana-based Medicare Advantage company
Coverage for services from any provider you choose
Personalized service from representatives based in southeast Louisiana
Stability and experience – we have continuously served Louisiana Medicare beneficiaries since M di Ad t i t d dMedicare Advantage was introduced
Peoples Health was awarded the 2011 Senior Choice G ld A d f E ll i M di B fitGold Award for Excellence in Medicare Benefits Value in Baton Rouge and New Orleans markets
Vantage HMO-POSVantage HMO-POSVantage HMO POSVantage HMO POSKey Features
#1 OGB Medicare Advantage plan for Louisiana state retirees by enrollmentstate retirees by enrollment
Great customer service from a Louisiana-based b i llmember service call center
Plan offered statewide
Access to out-of-network providers through point-of-service (POS) optionpoint of service (POS) option
Vantage HMO-POSVantage HMO-POSAdvantages
Lo monthl premi m ith no ded ctibleLow monthly premium with no deductible
$0 generic drug co-pays
$5 primary care physician co-pays
Smoking cessation and wellness programsSmoking cessation and wellness programs available
N t bill f th l i t di l i tNo separate bills from pathologists, radiologists and anesthesiologists
Speak with a live person every time you call Vantage Member Services
Humana PPOHumana PPO
Key Features
Provider network spans 23 states Preventative office visits coveredPreventative office visits covered Prescription mail order program offers genericd t $0drugs at $0 co-paySmart Summary
P li d thlPersonalized monthly summaryDetailed claims and cost informationIncludes medical and prescription drugIncludes medical and prescription drug services
Humana PPOHumana PPOHumana PPOHumana PPOAdvantages
Available in 23 states
Low monthly premium
Weigh costs and benefitsg
Humana’s stability
48-year company history
Current financial position as Fortune 100 company
UnitedHealthcare PPOUnitedHealthcare PPOKey Features
A company you know and trust More affordable health careA company you know and trustNation’s largest Medicare insurer serving 1 out of every 5 people eligible for Medicare
More affordable health care$1,800 annual limit on out-of-pocket expenses, then covered at 100%
people eligible for Medicare
You don’t have to change providers – national network with no difference in cost to you
Lab, X-ray and preventive care covered at 100%
100% Medicare-covered with no difference in cost to you in or out of network
Dedicated Customer Service team
medications, with bonus medications covered
Access to 60,000 pharmacies team
No referrals or prior authorizations required
including CVS, Target, Walmart, Walgreens and other national chains with optional mail order serviceservice
Silver Sneakers fitness benefit included at no additional cost
AdvantagesUnitedHealthcare PPOUnitedHealthcare PPO
Advantages
Low monthly premiums
No deductible!
In-network and out-of-network costs are the sameIn network and out of network costs are the same
No difference in cost to you for in-network or out-of-network benefits
Broadest provider network in and out of Louisiana –continue to see any provider who accepts Medicare
Silver Sneakers fitness program at no additional cost
One ID cardO e ca d
Exceptional customer service
For More Information…For More Information…OGB Medicare Advantage HMO Plans
Humana HMO 1-866-396-8810Peoples Health HMO-POS 1-866-439-8318Vantage HMO-POS 1-888-823-1910
OGB Medicare Advantage PPO PlansHumana PPO 1-866-396-8810UnitedHealthcare PPO 1-800-610-2660
OGB Standard PlansOGB Standard PlansOGB Customer Service 1-800-272-8451
TDD (hearing impaired) 1-800-259-6771OGB Website www.groupbenefits.org
(OGB’s home page includes quick links to all OGB health plans)
Life InsuranceLife Insurance
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Life InsuranceLife InsurancePrudential Insurance Co. of America
Group term life insurance
State pays half of monthly premium for p y y pretiree life insurance coverageRetiree pays monthly premium forRetiree pays monthly premium for dependent life insurance coverage
25% d ti i ith i t25% reduction in coverage with appropriate reduction in premiums on July 1 after reaching age 65 and age 70age 65 and age 70
Life InsuranceLife InsuranceLife InsuranceLife Insurance
Accidental death and dismemberment (AD&D) benefits available to all active and retired employees covered by Basic or Basicretired employees covered by Basic or Basic Plus plan
R ti 70 t li ibl f AD&DRetirees over age 70 not eligible for AD&D
ALL life insurance changes and inquiriesALL life insurance changes and inquiries must be made through your former agency’s Human Resources office
Questions?Questions?
