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2014 Medicare Advantage Plans


Basics of Medicare: 4 Parts: Original Medicare ... permanent kidney failure requiring dialysis or kidney transplant Must be entitled to Part A and enrolled in ... – PowerPoint PPT presentation

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Title: 2014 Medicare Advantage Plans

2014 Medicare Advantage Plans
  • Introduction
  • Eligibility
  • Basics of Medicare 4 Parts
  • Original Medicare basics (Parts A and B) and
  • Medicare Advantage Part C
  • Medicare prescription drug Part D
  • Enrollment periods
  • Plan specific information

Todays Topics
Original Medicare
  • 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 plans service

Original Medicare (Continued)
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
The Basics
  • Medicare has 4 parts
  • Original Medicare Part A Part B
  • Part C
  • Part D prescription drug coverage

Medicare Part A is hospital coverage that helps
cover the costs for
  • Inpatient care in hospitals and skilled nursing
    facilities (not custodial or long-term care).
  • Hospice and some health care services.

Late enrollment penalty may apply.
Medicare Part B is medical care coverage that
helps cover the costs for
  • 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.

Late enrollment penalty may apply.
Replace Medicare Parts A and B with Medicare Part
C, also called Medicare Advantage. Medicare
Part C
  • 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
  • Some plans may include prescription drug
    coverage, vision, dental, and fitness and
    wellness programs.

Some of these additional benefits may require
an additional fee.
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.
Part C (Medicare Advantage)Plan Options
  • 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
  • Set copays for most covered services
  • Most plans include Part D prescription drug

  • Preferred Provider Organization (PPO)
  • Local Preferred Provider Organization (LPPO)
  • Use network providers for savings
  • Freedom to see out-of-network providers (may cost
    more unless its an emergency)
  • Regional Preferred Provider Organization (RPPO)
  • See network and out-of-network providers
  • Larger service area than an LPPO

  • For plans offering deductibles, the deductible
    will only need to be met once during the year.
  • The deductible may be met through any qualifying
  • 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,

Medicare Part C Annual Deductible1
1 Not all Medicare Advantage Plans include a
2 These services are 0 cost to a member and will
not apply to the deductible.
Medicare Part D is prescription drug coverage
  • 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.

Late enrollment penalty may apply.
2014 Medicare Standard Part D Coverage1
Deductible 310 May vary by plan
Initial Up to 2,8502 Plan pays 75
  1. Base coverage on a Part D plan minimum set by
  2. Includes total cost of insureds prescription
    drugs in the calendar year
  3. Includes insureds out-of-pocket cost for
    prescription drugs in the calendar year

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
Catastrophic More than 4,5503 You pay greater
of 2.55 copay generic and 6.35 other 5
Medicare Basics
Piecing the Parts together
Medicare Advantage Plans
Original Medicare Plan
Part C Combines Parts A and B, and sometimes Part
Part A Inpatient Hospital
Part B Medical
Part D Stand-alone Prescription Drug Medicare
Supplement (Medigap)
Part D Prescription Drug can be combined with
Part C can be stand-alone if combined with PFFS
or MSA
Requires only one ID card
Requires three ID Cards
Stand-alone Part D with Private Fee For Service
(PFFS) or Medicare Medical Savings Account (MSA)
requires separate ID cards.
When can I enroll? Timing matters!
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.
Election Periods
  • 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.

Must be entitled to Part A and enrolled in Part
B, and permanently reside in the plans service
  • Special enrollment period
  • A common SEP is for those covered under their
    employers health plans who retire after 65.
  • In this case, you can enroll with no penalty
    during the three months before your Part B takes

Election Periods
Must be entitled to Part A and enrolled in Part
B, and permanently reside in the plans service
Additional Information
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
  • Benefits, formulary, pharmacy network, premium
    and/or copayments/coinsurance may change on
    January 1 of each year.

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, well
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 wont deny coverage because of a
pre-existing condition. It will normally go into
effect the day after your Medicare Advantage
membership ends.
Additional Information
Medicare Advantage 2014
Lets examine some benefits
The benefit information provided is a brief
summary, not a complete description of benefits.
For more information contact the plan.
Lets fill out the enrollment form
Additional Information
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
Y0071_14_18365_R_001 CMS Approved
9/30/2013 41241WPSENMUB_001 BROKER
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