Premera Blue Cross Medicare Advantage HMO Plans

Premera Blue Cross Medicare Advantage HMO Plans

© 2017 Premera Blue Cross

Presenter

Presentation Notes

Facilitator: Welcome and thank you for joining us! Introduce yourself. Provide attendees with your name, title and a little bit about your background to instill confidence: You are a licensed sales agent with Premera Blue Cross; you have xx years experience in the healthcare industry, etc. Keep it brief and relevant (30 seconds or less). Please also quickly refer to the sign-in sheet (if you are using one), and advise attendees that it is not mandatory to sign in.

Meeting agenda • Medicare basics

• Your Medicare options

• Premera Blue Cross Medicare Advantage Plans

• Enrolling is easy!

• The new customer experience — what to expect

Presenter

Presentation Notes

FACILITATOR: Today we are going to be together for about 45 minutes this morning/afternoon. During that time I’m going to give you information to help you make an informed decision about your Medicare coverage. We’ll begin by speaking briefly about Medicare and the basics of understanding how Medicare works. We’ll talk about the different coverage options you have as a Medicare beneficiary. And then we’ll spend a few minutes talking about Premera’s Medicare Advantage plans. We’ll go through the benefits and copays for each of our Medicare Advantage plans. The goal of this section of the presentation is to give you a clear understanding of what is covered in each of those plans and to help you decide which Premera Medicare Advantage plan might be the right fit for you. And for those that are interested, I’ll be available to help you chose the right plan for you and assist you in completing the enrollment application, so you can become a new Premera Blue Cross Medicare Advantage customer. Finally, we’ll end the presentation today by talking about what you can expect as a new plan customer.

Who qualifies for Medicare?

Age 65 or older

Under age 65 and disabled*

Living with end-stage renal disease (ESRD)

OR

To qualify for Medicare you need to be a U.S. citizen or resident and:

*Permanently disabled for 24 months or more.

OR

If you haven’t already, you can apply for Medicare at a Social Security office, by calling 1-800-772-1213 or www.ssa.gov.

Presenter

Presentation Notes

FACILITATOR: Medicare is a federal health insurance program that pays for hospital and medical care. To qualify for Medicare you need to be: A U.S. citizen or resident, and Age 65 or older, or Under 65 and permanently disabled for at least 24 months, or Be living with End-Stage Renal Disease For those of you who haven’t already done so — enrolling in Medicare is easy. If you’re already receiving Social Security benefits before you turn 65, you won’t need to file a Medicare application; you’ll automatically receive your Medicare card two months before your 65th birthday. If you don’t already receive Social Security, you may apply for Medicare at any Social Security office or by calling 1-800-772-1213 or visiting their website at www.ssa.gov.

When should you enroll?

What is your current situation? Are you covered by:

• Employer coverage • Union coverage • Coverage through spouse

Are you retired, planning to retire or retiring late?

Presenter

Presentation Notes

FACILITATOR: Things to consider. Look at your current situation Do you have coverage through your employer? Do you have coverage through a union? Do you have coverage through your spouse? If you fall within one of these categories, no need to enroll in Medicare Part B (medical insurance) until you or your spouse are ready to retire or lose coverage. Are you retired, planning to retire or retiring late?

Initial Enrollment Period: 3 months before, the month of, and 3 months after your 65th birth month

Annual Enrollment Period: October 15 – December 7

Medicare Advantage Disenrollment Period: January 1 – February 14

Special Enrollment Period: Example: Loss of employer coverage or moving to new service area

Enrollment periods

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Presentation Notes

FACILITATOR: There are several Medicare Enrollment Periods that you should know about: The first is your Initial Enrollment Period that begins 3 months prior to, the month of, and 3 months after your 65th birthday. This is when you are first eligible to enroll in Medicare. The Annual Enrollment Period takes place between October 15 and December 7 of each year. This is the only time you can sign up for a plan or change plans for the following year, unless you are eligible for one of these other enrollment periods. The Medicare Advantage Disenrollment Period takes place between January 1 and February 14 of the year of coverage. This is the only time you can disenroll from a Medicare Advantage Plan unless you have a special election period or qualifying event. The Medicare Advantage Disenrollment Period is an opportunity to disenroll from a Medicare Advantage plan and return to original Medicare, not to join or to switch Medicare Advantage plans. You may also qualify for a Special Enrollment Period. Some examples of a special enrollment period are when you move to a new service area or lose your employer group coverage.

Part B (medical insurance) penalty: An additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Part D (prescription drug) penalty: An additional 1% of the average monthly premium each month, for as long as you are enrolled in a Part D plan.

Late enrollment penalties

Presenter

Presentation Notes

FACILITATOR: If you don’t sign up for Medicare during your Initial Enrollment Period, you have a General Election Period which is a grace period between January 1 and March 31 where you can enroll for Medicare A & B and enroll in a Medicare Advantage Plan or Part D between April 1 and June 30. You will still get a penalty if you enroll during your General Election Period. Coverage will begin July 1st. There are some important late enrollment penalties you should know about. ��Two of the more common late enrollment penalties are the Part B and Part D penalty for late enrollment. Part B (medical insurance) penalty:�If you don’t enroll in Part B when you are first eligible, you may have to pay a penalty to get it later. The penalty is an additional 10% of the Part B premium for every 12-month period that you delay enrollment. In most cases, you will have to pay the penalty every month for as long as you have Part B. Part D (prescription drug) penalty:�If you sign up for Medicare Part D after your Initial Enrollment Period, you may be required to pay an additional 1% of the average monthly premium each month, for as long as you are enrolled in a Part D plan.

Original Medicare Part A and Part B

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Presentation Notes

FACILITATOR: The federal Medicare program is made up of four parts that help cover specific services. Let’s start with Parts A & B.

• Part A is free for most people

• There is a $1,340 Part A deductible per benefit period

• After 60 days in the hospital, you pay: – $335 per day copay for 61-90 days – $670 per day copay for 91-150 days – After day 150, you pay all hospital costs

Original Medicare: Part A

Part A Hospital Insurance

FIGURES ARE FOR 2018

Presenter

Presentation Notes

FACILITATOR: Medicare Part A is hospital insurance. It helps pay for inpatient care in hospitals and skilled nursing facilities, for hospice care and for home healthcare.��Part A does not cover physician services or diagnostic tests in the hospital, personal care items, private rooms, and custodial care. �Part A is free for most people because you have contributed to the cost of Part A during your working lifetime. � However, there is a $1,340 deductible per benefit period. So one stay in the hospital could cost you over $1,000. After a 60-day period stay in the hospital, you are responsible to pay a $335 copay per day for any stays between 61 and 90 days, a $670 copay per day for any stays between 91 and 150 days, and any hospital stays after 150 days will require you to pay all hospital costs.

• There is a $134 standard per monthly premium*

• There is a $183 annual deductible

• Original Medicare covers 80% of most Part B costs, leaving you to pay the other 20% for services like: – Most physician services – Outpatient therapies – Durable medical equipment – Home health care

Original Medicare: Part B

Part B Medical Insurance

*Higher incomes may pay a higher premium FIGURES ARE FOR 2018

Presenter

Presentation Notes

FACILITATOR: Medicare Part B is medical insurance. This is optional coverage that helps pay for doctors’ services and other medical services.� There is a premium for Part B. The Part B premium is $134; however, it does vary for higher-income consumers.��For most items, Medicare covers 80% of the cost. You pay the other 20%, after the $183 annual deductible is met.��Examples of Part B covered services include, home health care, most physician services, outpatient therapies, and durable medical equipment. ��For those that may be delaying retirement beyond age 65 years old, you can decline Part B. There is no penalty for postponing Part B enrollment if you enroll within 2 months of loss of active employee group coverage and have a drug coverage plan equivalent to a Part D prescription drug plan. NOTE: Point out that the figures are for 2017.

Prescription Coverage Part D

Presenter

Presentation Notes

FACILITATOR: Which brings us to Medicare Part D …Medicare Part D plans help cover the cost of prescription drugs. Let’s take a closer look…

• Voluntary program run by private companies

• You pay a monthly premium

• You pay a portion of the drug cost

• Plan designs must be equal to or better than standard Medicare benefit designed by CMS

• Coverage varies from plan to plan

• Some may pay penalty for late Part D enrollment

Prescription coverage: Part D

Part D Prescription Drug Plans

Presenter

Presentation Notes

FACILITATOR: �Part D is prescription drug coverage with a unique product design. The federal government designed Part D to serve as insurance to help Medicare participants with the cost of their prescription drugs. Part D enrollment is a voluntary benefit and is not required. It serves as catastrophic coverage for those who have high prescription costs and it helps to keep costs manageable for those with lower prescription expenses. Even more will be done between now and 2020 to provide opportunities to save by reducing the coverage gap. Before we get into too many details, let’s talk about how you can get Part D. All Part D plans are run by private insurance companies approved by Medicare. Like all insurance plans, you pay a monthly premium to participate, and for each prescription, you will pay a portion of the cost. If you do not sign up for Part D when you are first eligible you may owe a late enrollment penalty which will be added to your monthly premium, as we discussed previously. The government sets a standard benefit plan that has four steps or phases, which we will cover in a moment. Private insurance companies offer a variety of Part D plans. How much you pay and how much the plan pays varies — based on the plan you join and how many drugs you use during the year. Plans also vary based on monthly premiums and types of drugs that are covered.��Lastly, as a Medicare beneficiary, you have a number of ways to get your Part D coverage. Let’s take a look at the basic Part D model that Medicare designed and all health plans use as a base design.��Read Part D Coverage options on slide.

Prescription coverage: Part D phases

5% COPAY

$5,000

$3,750

$405 1 Deductible

YOU 5% PLAN 95%

2 Initial Coverage

3 Coverage Gap

4 Catastrophic

YOU 35% YOU 44%

YOU 25% PLAN 75%

YOU 100% PLAN 0%

BRAND GENERIC

This is an example of how Medicare Part D works and is not intended to portray a specific plan. In some instances, these costs will be approximate amounts.

FIGURES ARE FOR 2018

YOU pay $3.35/Generic and $8.35/Brand or 5%

Presenter

Presentation Notes

FACILITATOR: Deductible Phase: You’ll start the year in the Deductible phase. The deductible is the amount you pay before your insurance kicks in. The deductible is set by Medicare and can change from year to year. During this phase, you pay the full cost of your prescription drugs included in the formulary until your costs reach your yearly deductible amount. The 2018 deductible is $405. Step 1 ends when you reach your deductible. As a reminder, this is the basic model Medicare designed as a starting point; some plans don’t have deductibles.� Initial Coverage Phase: Once you’ve met your deductible, you move into the Initial Coverage Phase. During this phase, you and the Plan each pay a portion of the cost for each prescription included in the formulary(drug list). Keep in mind that some plans may have fixed copays for each prescription rather than a percentage. You’re in this phase until your year-to-date drug costs (paid by you, including your deductible from Step 1, and the Plan combined) reach the Initial Coverage Limit. For 2018, the Initial Coverage Limit is $3,750. Once you reach your Initial Coverage Limit, welcome to the gap!� Coverage Gap Phase: The coverage gap — or donut hole as some call it — is the next phase. In the past, you would have had to pay all costs at this phase out of your own pocket. For 2018, you pay 35% of brand-name drug costs and 44% of generic drug costs. If you reach your coverage gap limit of $5,000, Step 3 ends and you move into the final phase.� Catastrophic Phase: If your total out‐of‐pocket spending on prescriptions reaches a set amount — $5,000 for 2018 —and the year’s not over, you move into the catastrophic coverage phase for the rest of the year. You pay very little for your prescriptions —either 5% or $3.35 per generic and $8.35 per brand, whichever is higher. The plan pays the rest — unlimited — to the end of the calendar year.

• Formulary A list of drugs covered by the health plan.

• Prior Authorization (PA) For some covered drugs, you will need to get approval from the plan before you fill your prescriptions. Without approval, your drug may not be covered.

• Quantity Limits (QL) For some covered drugs, the plan may place limits on the amount of the drug provided for each prescription or for a defined period of time.

• Step Therapy (ST) For some covered drugs, the plan may require you to try certain drugs to treat your condition before the plan covers another drug for that condition.

• Transition Supply A temporary supply of your prescription drugs that allows you to transition to a new prescription covered by your plan drug list.

Common drug list terms

The drug list (formulary) may change at any time. You will receive notice when necessary.

Presenter

Presentation Notes

FACILITATOR: Here are some common terms associated with a health plan drug list. A drug list, also known as a formulary, is: Read the bullets listed on the slide. �

• Extra Help or Low Income Subsidy, is the name of the Part D drug program to help beneficiaries pay for drug costs.

• Extra Help is available from the government if you meet certain requirements.

• If you qualify, you may get help paying monthly premiums, copays, coinsurance, and deductibles.

• Do you qualify? You don’t know unless you apply.

Prescription coverage: Extra Help

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Presentation Notes

FACILITATOR: People with limited incomes may qualify for help to pay for their prescription drug costs through the federal and/or state government. If you qualify, you may receive help with drug costs including monthly prescription drug premiums, copays, coinsurance and deductibles. Keep in mind that any extra help you receive will only apply to the Part D prescription drug portion of your premium, and not the Part C medical portion. Those that receive Extra Help are also not subject to the Part D Coverage Gap. The income limits and the amount of help you receive may differ depending on your yearly income. So you may qualify, but you won’t know unless you apply. �You can complete an application for Extra Help by going to www.ssa.gov, calling or visiting your local Social Security office. I am also happy to help you apply if you think you may be eligible.

Your Medicare Coverage Options

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Presentation Notes

FACILITATOR: Now that we’ve given you a basic understanding and overview of the different parts of Medicare, let’s talk about the different coverage options you have as a Medicare beneficiary. The Medicare program is good and benefits lots of people, but it was never meant to cover 100% of your healthcare expenses. Deductibles, copayments and coinsurance are your responsibility. Many people want and need more coverage than Original Medicare provides. There are two main choices for getting your Medicare coverage.

Medicare coverage options

START with Original Medicare

DECIDE if you want more coverage

Option 1 Option 2

OR

Part A (hospital

insurance) +

Part B (medical

insurance)

Medicare Part D Prescription Drug

Plan and/or

Medicare Supplement

Insurance Plan

Medicare Advantage Plan • Combines Parts A & B • Many cover prescription

drugs and may include extra benefits

• Monthly payment as low as $0

Presenter

Presentation Notes

FACILITATOR: If you start with Medicare Parts A & B, you can then decide what option is best for you. In Option 1, you can add a Medicare Part D plan for prescription coverage…or a Medicare Supplement plan to help pay your share of hospital and medical costs... or both. Both types of plans are sold through private insurance companies, and you pay a monthly premium for each plan. In Option 2, you can join a Medicare Advantage plan and get hospital, medical and Part D drug coverage combined into a single plan. Some plans may have premiums as low as $0, and many Medicare Advantage plans include extra benefits you don’t get with Medicare — like a fitness membership. Medicare Advantage plans are offered through private health insurers like Premera Blue Cross.

Premera Blue Cross Medicare Advantage Plans

Presenter

Presentation Notes

FACILITATOR: Premera has stood for quality and reliability in Washington for more than 80 years! You can get all your Medicare hospital and doctor benefits we previously discussed — PLUS Part D prescription drug coverage — fitness and more — in one easy-to-use plan. Our plans are designed for who you are today — from a local company you’ve known your whole life.

• Medicare Advantage plans offered by private companies

• May cover some costs not covered by Medicare

• Often include extras like fitness and wellness

• Many also offer Part D drug coverage

Medicare Advantage (Part C)

Part C Medicare Advantage Plans

Presenter

Presentation Notes

FACILITATOR: You might be wondering why you would need insurance if you already have Medicare. Good question! Original Medicare was never meant to cover all your healthcare expenses, so many people enroll in a Part C or a Part D plan to help pay for some of the costs and benefits that aren’t paid by Original Medicare. � Medicare Advantage plans combine hospital care, doctor visits and outpatient care in a single plan. If you enroll in a Medicare Advantage Plan, your Medicare benefits are managed by the plan you join. These plans provide all Part A and Part B benefits. Members’ copays and coinsurances vary by plan.��Many Medicare Advantage plans also include prescription drug coverage. This means you have one plan and one card for your medical and prescription coverage. Our market is predominately HMO plans. With an HMO plan, you generally have to get your care and services from doctors and other healthcare providers in the Medicare Advantage network. There are exceptions, such as when you are traveling outside the service area or you need emergency care.

To qualify, you must:

• Have Medicare Parts A & B

• Continue to pay your Part B premium

• Not have end-stage renal disease (in most cases)

• Live in the plan service area

• Have a valid enrollment period

Medicare Advantage eligibility

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Presentation Notes

FACILITATOR: To qualify for a Medicare Advantage plan, you must meet the eligibility requirements: Have Medicare Parts A & B Continue to pay your Part B premium Not have end-stage renal disease (in most cases) Live in the plan service area Have a valid enrollment period

Plan service area

Snohomish

Thurston

King

Pierce

Spokane

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Presentation Notes

FACILITATOR: In order to enroll in a Premera Medicare Advantage plan, you must live in one of the five counties at least six months of the year. �

The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance.

The ratings help you know how good a job our plan is doing.

For 2018, Premera Blue Cross Medicare Advantage received an overall of 4 out of 5 Star Rating from Medicare.

2018 Medicare Star Rating

*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.

Presenter

Presentation Notes

FACILITATOR: The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. � The ratings help you know how good a job our plan is doing. � For 2018, Premera Blue Cross Medicare Advantage received an overall of 4 out of 5 Star Rating from Medicare. � 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.

Option 1 – HMO Premera Blue Cross Medicare Advantage (HMO)

Option 2 – Classic HMO Premera Blue Cross Medicare Advantage Classic (HMO)

Option 3 – Classic Plus HMO Premera Blue Cross Medicare Advantage Classic Plus (HMO)

2018 Premera Blue Cross Medicare Advantage plans King, Pierce, Snohomish and Thurston counties

Presenter

Presentation Notes

FACILITATOR: Each person has unique needs – and a personal budget – when it comes to Medicare Advantage coverage. That is why we offer three Health Maintenance Organization (HMO) plans. An HMO plan has a network of providers from which to choose. All HMO plans require you to select a primary care provider (PCP) who is in charge of your health. If you want to see a specialist for any reason, your primary care provider is responsible for providing you with a referral.

Let’s review Premera Blue Cross Medicare Advantage plans

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Presentation Notes

FACILITATOR: Now let’s review our Medicare Advantage HMO plans.

Our most POPULAR plan—no monthly premium

You must continue to pay your Medicare Part B premium.

Premera Blue Cross Medicare Advantage (HMO)

In-network only

Monthly plan premium $0

Medical deductible $0

Annual out-of-pocket maximum $6,200

Primary care provider visit $15 copay

Specialist visit $45 copay

Inpatient hospital care $450 copay (days 1–4) $0 copay (days 5+)

Outpatient hospital care Ambulatory surgical center Outpatient hospital center

15% coinsurance 20% coinsurance

Ambulance $300 copay/each one-way trip

Emergency care (worldwide coverage) $75 copay (waived if admitted)

Urgent care (worldwide coverage) $50 copay

X-rays and Lab services $20 copay

Preventive care $0 copay

Annual physical exam $0 copay

Annual routine eye exam Not covered

Eyewear allowance Not covered

Fitness benefit program Not covered

HMO Plan Benefits

Presenter

Presentation Notes

FACILITATOR: Let’s review our most popular plan. Using your copy of the Benefit Highlights, you can following along as I go through each of the benefits and copays. Coinsurance may apply on procedures done during either an office visit or a service performed in an ambulatory surgical center.

Prescription coverage

Search online at premera.com/ma

Premera Blue Cross Medicare Advantage (HMO) Drug Coverage

Prescription drugs (30-day supply from a preferred network pharmacy)

Drug deductible (applies to tiers 3-5) $340

Tier 1 – Preferred generic $5 copay ($0 deductible)

Tier 2 – Generic $15 copay ($0 deductible)

Tier 3 – Preferred brand $42 copay

Tier 4 – Non-preferred drug 35% coinsurance

Tier 5 – Specialty 26% coinsurance

HMO Plan Benefits

Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at 1-888-850-8526 (TTY: 711). You can call from Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, Oct. 1-Feb. 14).

Presenter

Presentation Notes

FACILITATOR: Read the prescription coverage limits and requirements on the slide. Premera Blue Cross Medicare Advantage Plans use both preferred network and standard network pharmacies. Preferred network pharmacies may offer lower cost sharing than other network pharmacies. Please see the provider and pharmacy directory for a complete listing of both preferred network and standard network pharmacies. Premera members can receive a long-term supply (up to 90 days) of maintenance medications in two ways. You can fill for up to 90 days at many of the retail pharmacies in our network or you can choose the convenience of home delivery via our mail order pharmacy. Usually a prescription placed through a mail-order pharmacy will get to you in no more than 10 business days after the pharmacy receives your order. If you do not receive medications within this timeframe, we recommend you call customer service at 1-888-850-8526 (TTY: 711). You can call from Monday-Friday, 8 a.m. to 8 p.m. (7 days a week, Oct. 1-Feb. 14).

Preventive dental coverage – optional rider


Add Dental Coverage — You may add the optional dental rider within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. Coverage starts the first of the month following the date we receive your completed enrollment form.

Premera Blue Cross Medicare Advantage (HMO) Preventive Dental Coverage

Preventive dental — optional rider ($0 copays from a preferred network dentist)

Monthly dental premium $26

Routine oral exams $0 copay (2 every year)

Routine cleanings / Periodontal maintenance $0 copay (2 every year)

Fluoride treatments $0 copay (1 every year)

Bitewing X-rays (set of 4) $0 copay (1 set every year)

Panoramic or complete series X-rays $0 copay (1 set every 60 months)

Emergency exam $0 copay (1 every year)

HMO Plan Benefits

Presenter

Presentation Notes

FACILITATOR: Read the dental coverage limits and requirements on the slide. You may add the optional dental rider within 60 days of enrolling in your Premera Blue Cross Medicare Advantage (HMO) plan. Coverage starts the first of the month following the date we receive your completed enrollment form. *Routine cleanings and Periodontal maintenance is a combined “either / or benefit” limited to 2 visits per year in any combination. Benefit definitions: Enhanced coverage for 2018! Periodontal maintenance: is the cleaning and maintenance of the teeth and gums following a diagnosis and treatment of periodontal disease Emergency exam: A dental condition requiring prompt or urgent attention due to trauma and/or pain caused by a sudden unexpected injury, acute infection or similar occurrence. X-ray definitions: Bitewing X-rays – Bitewing X-rays show the upper and lower back teeth and how the teeth touch each other in a single view. These X-rays are primarily used to check for decay (cavities) between the teeth and to show how well the upper and lower teeth line up. Bitewing X-rays can also show bone loss when severe gum disease or a dental infection is present. Bitewing X-rays are most often performed in conjunction with routine periodic oral examinations based on the persons age and oral health. Complete series (full-mouth series) X-rays — A full-mouth series of periapical and posterior bitewing X-rays (about 14 to 22 X-ray films) is most often done during a person's first visit to the dentist to determine the current status of oral health and help identify future changes in the growth and development of teeth.

Classic coverage and extra benefits

Premera Blue Cross Medicare Advantage Classic (HMO) In-network only

Monthly plan premium $75







15% coinsurance 20% coinsurance







Annual routine eye exam $50 copay

Eyewear allowance $150 reimbursement

Fitness benefit program $0

Classic HMO Plan Benefits


Presenter

Presentation Notes

FACILITATOR: Let’s review our plan that offers classic coverage and extra benefits. Using your copy of the Benefit Highlights, you can following along as I go through each of the benefits and copays.


Premera Blue Cross Medicare Advantage Classic (HMO) Drug Coverage











Presenter

Presentation Notes


Preventive dental coverage – included

Premera Blue Cross Medicare Advantage Classic (HMO) Preventive Dental Coverage

Preventive dental — included ($0 copays from a preferred network dentist)










Presenter

Presentation Notes

FACILITATOR: Read the dental coverage limits and requirements on the slide. *Routine cleanings and Periodontal maintenance is a combined “either / or benefit” limited to 2 visits per year in any combination. Benefit definitions: New in 2018! Periodontal maintenance: is the cleaning and maintenance of the teeth and gums following a diagnosis and treatment of periodontal disease Emergency exam: A dental condition requiring prompt or urgent attention due to trauma and/or pain caused by a sudden unexpected injury, acute infection or similar occurrence. X-ray definitions: Bitewing X-rays – Bitewing X-rays show the upper and lower back teeth and how the teeth touch each other in a single view. These X-rays are primarily used to check for decay (cavities) between the teeth and to show how well the upper and lower teeth line up. Bitewing X-rays can also show bone loss when severe gum disease or a dental infection is present. Bitewing X-rays are most often performed in conjunction with routine periodic oral examinations based on the persons age and oral health. Complete series (full-mouth series) X-rays — A full-mouth series of periapical and posterior bitewing X-rays (about 14 to 22 X-ray films) is most often done during a person's first visit to the dentist to determine the current status of oral health and help identify future changes in the growth and development of teeth.

Lower out-of-pocket costs PLUS extra benefits

Premera Blue Cross Medicare Advantage Classic Plus (HMO)

In-network only Monthly plan premium $166







$250 copay







Annual routine eye exam $40 copay

Eyewear allowance $150 reimbursement

Fitness benefit Program $0


Classic Plus HMO Plan Benefits

Presenter

Presentation Notes

FACILITATOR: Let’s look at our plan that provides lower out-of-pocket costs plus extra benefits. Using your copy of the Benefit Highlights, you can follow along as I go through each of the benefits and copays.


Premera Blue Cross Medicare Advantage Classic Plus (HMO) Drug Coverage











Presenter

Presentation Notes


Preventive dental coverage – included

Premera Blue Cross Medicare Advantage Classic Plus (HMO) Preventive Dental Coverage

Preventive dental — included ($0 copays from a preferred network dentist)










Presenter

Presentation Notes

FACILITATOR: Read the dental coverage limits and requirements on the slide. *Routine cleanings and Periodontal maintenance is a combined “either / or benefit” limited to 2 visits per year in any combination. Benefit definitions: New for 2018! Periodontal maintenance: is the cleaning and maintenance of the teeth and gums following a diagnosis and treatment of periodontal disease Emergency exam: A dental condition requiring prompt or urgent attention due to trauma and/or pain caused by a sudden unexpected injury, acute infection or similar occurrence. X-ray definitions: Bitewing X-rays – Bitewing X-rays show the upper and lower back teeth and how the teeth touch each other in a single view. These X-rays are primarily used to check for decay (cavities) between the teeth and to show how well the upper and lower teeth line up. Bitewing X-rays can also show bone loss when severe gum disease or a dental infection is present. Bitewing X-rays are most often performed in conjunction with routine periodic oral examinations based on the persons age and oral health. Complete series (full-mouth series) X-rays — A full-mouth series of periapical and posterior bitewing X-rays (about 14 to 22 X-ray films) is most often done during a person's first visit to the dentist to determine the current status of oral health and help identify future changes in the growth and development of teeth.

With thousands of local doctors in our Medicare Advantage network, you’ll be sure to find a provider that’s right for you and close to home.

The above list is not a complete list of participating and/or preferred providers.

Medical network


Western Washington Providers Eastern Washington Providers

EvergreenHealth The Everett Clinic Columbia Medical Associates

MultiCare Health System The Polyclinic MultiCare Health System

Northwest Physicians Network with hundreds of doctors in Pierce County

UW Medicine Providence Health and Services

Virginia Mason Medical Center Rockwood Clinic

Western Washington Medical Group with nearly one hundred doctors in Snohomish County

Spokane Internal Medicine Overlake Medical Center and Clinics

Pacific Medical Centers Providence Health & Services Swedish Health Services

Presenter

Presentation Notes

FACILITATOR: Medical Network: Premera contracts with thousands of doctors in our Medicare Advantage network. It’s likely your preferred provider is already part of our health plan. Ask us if you need help finding a provider that’s right for you close to home.

Premera contracts with national pharmacy chains and many independent and local pharmacies. Preferred pharmacies allow customers to pay the lowest cost for covered generic medications.

Pharmacy network

Preferred Pharmacies Standard Pharmacies

Albertsons QFC Pharmacy Bi-Mart Pharmacy

Bartell Drugs Rosauers Pharmacy Bob Johnson's United Drugs

Costco Pharmacy Safeway Pharmacy ReliantRx LLC

CVS (including inside Target stores) Sam's Club Pharmacy Rite Aid Pharmacy

Fred Meyer Pharmacy Sav-On Pharmacy Walgreens

Haggen Pharmacy Walmart Pharmacy

Pharmaca Yoke’s Pharmacy

The above list is not a complete list of standard and/or preferred pharmacies. Search online at premera.com/ma

Presenter

Presentation Notes

FACILITATOR: The provider and pharmacy directory lists all of the plan’s in-network providers and pharmacies, or visit our website for the most up to date listing. Premera Blue Cross Medicare Advantage Plans use both preferred network and network pharmacies. Preferred network pharmacies may offer lower cost-sharing than other network pharmacies. Please see the provider and pharmacy directory for a complete listing of both preferred network and network pharmacies. A list of covered medications can be found using our plans’ drug list or online at premera.com/ma. The drug list includes information on restrictions, limitations and transition coverage.

Enrolling is easy!

Five things to remember

1. Choose a plan that fits you and your budget – including the $0 premium plan

2. Receive care from a broad network of providers you know and trust

3. Choose from our plans with fitness benefits at a local gym near you

4. Travel with worldwide coverage for emergencies

5. Get your questions answered quickly and easily with support from a team focused on you

Presenter

Presentation Notes

FACILITATOR: Read the bullets listed on the slide. Our team includes me, our sales team and our customer service unit — dedicated to Medicare and you.

Enroll today

Enroll today in one of Premera Blue Cross’ Medicare Advantage Plans.

By mail using a paper

application

Over the phone by calling 888-868-7767

(TTY: 711)

Online at premera.com/ma

Presenter

Presentation Notes

FACILITATOR We can help you enroll today in one of Premera Blue Cross’ Medicare Advantage Plans. I also want to point out that there are other, convenient ways to enroll as well. You can enroll by mailing in a paper application, by going online at premera.com/ma or you can enroll over the phone by calling 888-868-7767 (TTY: 711), seven days a week from 8 a.m. to 8 p.m. You have an enrollment form in front of you. It only takes a few minutes to become a Premera Medicare Advantage customer today.

The new customer experience

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Presentation Notes

FACILITATOR: Let’s take a final few moments to talk about what you can expect as a new customer of Premera Blue Cross.

The new customer experience

Your membership generally starts on the first day of the following month. Plans start as of January 1 for enrollees in October, November and December (during the Annual Enrollment Period).

Welcome kit

Premera ID card

Fitness ID card

Welcome call

Outbound enrollment verification

Health Risk Assessment

Presenter

Presentation Notes

FACILITATOR Review the bullets listed on the slide: Welcome kit: Your new customer welcome kit with important plan information about covered benefits and services will be mailed to you. To learn more about the entire provider network, visit premera.com/ma. Membership ID card: Your plan membership ID card will be mailed separately in a Premera envelope. Your ID card must be used when accessing covered medical and plan services. Welcome call: Your welcome call will give you an opportunity to ask us questions. Outbound Enrollment Verification: You’ll receive an Outbound Enrollment Verification (OEV) communication confirming your intent in enrolling in the Medicare Advantage plan you selected. Fitness benefit provider ID card: Your fitness benefit provider will send you an ID card for use at participating gyms and fitness centers if you elect the Classic HMO or Classic Plus HMO plan. Health Risk Assessment (HRA) survey: A Health Risk Assessment (HRA) survey will also be mailed to you with basic questions about your overall health. A prepaid envelope will allow you to return the survey at no cost to you. Additional details to review: Membership start date: Your membership generally starts on the first day of the following month. Plans will start as of January 1 for enrollees in October, November and December (during the Annual Enrollment Period).

Premera Blue Cross is an HMO plan with a Medicare contract. This information is not a complete description of benefits. Contact the plan for more information. Enrollment in Premera Blue Cross depends on contract renewal. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The drug list (formulary), pharmacy network and provider network may change at any time. You will receive notice when necessary. You must continue to pay your Part B premium. For 2018, Premera Blue Cross Medicare Advantage plans received an overall 4 out of 5 Star Rating from Medicare. 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. Premera Blue Cross is an Independent Licensee of the Blue Cross and Blue Shield Association. 028403 (11-17-2017) H7245_PBC1458_Approved

Important plan information

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Presentation Notes

FACILITATOR: Display slide.

Thank you! Questions?

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Presentation Notes

FACILITATOR: Thank you for attending! Any additional questions?

Premera Blue Cross Medicare Advantage HMO Plans

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