Transcript Aetna Open Enrollment Presentation

Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
Finding the path to a
healthier plan choice
Aetna Medicare Advantage Plans
City of Marietta
Transition to the Aetna Medicare Advantage Plan
Scott Weber
October 2015
18.25.350.1 (09/14)
Some common Medicare Advantage myths
Healthcare reform is eliminating Medicare Advantage
plans.
FA L S E
Medicare Advantage is just another supplemental plan
like the one you already have.
FA L S E
If you enroll in Medicare Advantage, you lose your
Original Medicare coverage.
FA L S E
You can’t get more coverage for less money. It’s too
good to be true.
FA L S E
None of these statements are true
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Is Medicare Advantage a smart choice?
More than
17.3
million retirees
have chosen
Medicare Advantage
Plans1
Patients enrolled in a
Medicare Advantage plan had
better health
outcomes
than retirees enrolled in
traditional Medicare2
Millions of retirees think so.
1CMS
February 2015 Medicare Advantage enrollment data.
Consulting Group, “Alternative Payer Models Show Improved Health-Care Value.” BCG.Perspectives by the Boston Consulting Group. May 14, 2013. Available at
https://www.bcgperspectives.com/content/articles/health_care_payers_providers_alternative_payer_models_show_improved_health_care_value/
2Boston
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The “parts” of Medicare and types of coverage
OR
Original Medicare
Part A
Hospital
insurance
Medicare Advantage plan
(HMO or PPO)
PartBB
Part
Medical
Medical
insurance
Insurance
Separate plan that supplements
or coordinates with Original
Medicare
Employer’s Traditional
Drug Plan
Part C
Combines Part A, Part B
and often includes Part D
Part D
Prescription drug plan (PDP)
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Traditional vs Medicare Advantage Model
Traditional group retiree plan
An uncoordinated, siloed approach
Medicare Parts
A and B that
pay primary
Separate,
traditional
prescription
drug plan
Separate Medicare
“wraparound”
indemnity plan that
pays secondary
Aetna Medicare Advantage plan
Bringing care management and cost control
together
INCLUDES
Medicare
Parts A and B
benefits
INTEGRATES
Medicare
prescription
drug
coverage
INCLUDES
important benefits
beyond Medicare
Parts A and B
Includes care management
4Enhanced preventive benefits beyond original
Medicare
4Coordinated, integrated approach to care and
benefits
4Care management that improves care and lowers
costs
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Traditional Medicare
Part A Deductible
$1,260 per benefit period
Days 1 – 60: $0 copayment after deductible
Days 61-90: $315 per day after deductible
Days 91 and beyond: $630 per day after deductible
Part B Deductible
$147 per year
After deductible – 20% of Medicare Costs
* Supplemental plans help cover these costs. Medicare Advantage plans also
cover these costs.
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Examples of Supplemental plans vs. MAPD
Total Expense $1,100
100% Coordination
Medicare Pays $600
Exclusion
Medicare Pays $600
Balance
$500
Plan Pays $500
Medicare Advantage
Balance
$500
Retiree pays
$100 Deductible
Balance
$1,090
Plan Pays $1,090
Balance
$400
Plan Design:
$100 Deductible
80% Coinsurance
Retiree Pays $10 Specialist Copay
Balance
800
Retiree pays
$80 Coinsurance
Balance
$200
Balance
$320
Plan pays $320
Medicare
$600
Plan
$500
Medicare
$600
Retiree
$180
Plan
$320
Plan
$1,090
Retiree
$10
Aetna Medicare plan
(PPO — extended service area)
Highlights
Allows access to providers
nationally that accept Medicare
Value
• Use in-network or out-of-network
providers but only pay lower in-network
cost sharing
Simplicity
•
•
•
•
No referrals
No need to choose primary doctor
One single ID card
Faster payments for the providers
Freedom
• See any doctor (eligible for
Medicare payment)
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Medicare plan comparisons
Current Plan
Aetna Medicare
Advantage PPO
 You pay 
 You pay 
$0
$0
$2,400
$2,400
Lifetime Max Plan Coverage
Unlimited
Unlimited
Primary Care Doctor Visit
$10 copay
$5 copay
Specialist Care Doctor Visit
$20 copay
$10 copay
Inpatient Hospital
$500 copay
$250 copay
Emergency Room Visit
$65 copay
$65 copay
Urgent Care Visit
$35 copay
$35 copay
Outpatient Surgery
$250 copay
$100 copay
Part B Drugs
20% Coinsurance
$0 copay
Durable Medical Equipment
20% Coinsurance
$0 copay
Plan deductible
Annual Max OOP Limit
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Your Aetna Part D (PDP) phases and cost level comparison
Prescription Drug Cost
Phases
Current Plan
Aetna Prescription Drug Plan
 You pay 
 You pay 
$0
$0
Phase II: Initial Coverage
Limit (ICL)
Generic - $10 copay
Preferred Brand - $25 copay
Non-Preferred Brand - $40 copay
Specialty - $40 copay
Generic - $10 copay
Preferred Brand - $25 copay
Non-Preferred Brand - $40 copay
Specialty - $40 copay
Phase III: Medicare
Coverage Gap (Donut
Hole)
Generic - $10 copay
Preferred Brand - $25 copay
Non-Preferred Brand - $40 copay
Specialty - $40 copay
Generic - $10 copay
Preferred Brand - $25 copay
Non-Preferred Brand - $40 copay
Specialty - $40 copay
Greater of $2.65 or 5% for
covered generic drugs
Greater of $2.95 or 5% for
covered generic drugs
Greater of $6.60 or 5% for all
other covered drugs
Greater of $7.40 or 5% for all
other covered drugs
Phase I: Deductible
Phase IV: Catastrophic
Coverage
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So what is different about this plan?
Medical
• You have access to providers across the nation that accepts Medicare. In
the Atlanta Metro Area, you have access Emory, Piedmont, Grady, Wellstar
and those facilities not in the Aetna network.
• Veteran Affairs Medical and Medicare Advantage – The government does
not allow for two Federal programs to bill each other. You might be
responsible for copays while you are on the Medicare Advantage plan.
• Tricare for Life and Medicare Advantage – You can continue to use Tricare
for Life and will continue to be your secondary coverage after the Aetna
Medicare Advantage Plan.
• You will not need to use your Medicare card after 1/1/2016. The Aetna
Medicare Advantage card is the only card you will need for medical and
pharmacy services.
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So what is different about this plan?
Pharmacy
•
On the Aetna plan, you can get a 90 day supply of generic drugs for $20 at your
local retail pharmacy or through mail order.
•
You will receive an Explanation of Benefits for Pharmacy that will show the
different levels. Your copays will be the same through all the Part D Phases
except when you reach the Catastrophic phase.
Extras
•
The plan includes a no cost fitness membership with SilverSneakers. For gyms in
your location, call member services at 1-888-423-4632 (TTY: 711), Monday
through Friday, 8 a.m. to 8 p.m. EST.
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Here’s what to expect
You’ll get everything you
need to use to your plan:
During Enrollment Period
• Plan Acknowledgement Letter
Aetna ID Card
• Aetna ID card
• Owner’s Manual
Owner’s Manual
• Evidence of Coverage
• RX Abridged Formulary Guide
After Enrollment Period
• Health Risk Assessment
• Telephonic Outreach
Evidence of Coverage
Abridged Formulary
We’ll be here for you every step of the way.
If you have any questions about your coverage during this
transition period, you can contact Aetna representatives
at:
(800) 307-4830
Monday through Friday
8:00 a.m. to 6:00 p.m.
Thank you
This is an advertisement. Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna
Medicare depends on contract renewal. 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. Benefits, formulary,
pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each
year. Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company
(Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions,
limitations and conditions of coverage. Plan features and availability may vary by location. Participating physicians,
hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna.
The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
You must continue to pay your Medicare Part B premium. Health® is a U.S.-registered trademark of Aetna Inc. AetnaSM is
a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties. Informed Health
nurses do not diagnose, prescribe or give members medical advice.
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©2014 Aetna Inc.
18.25.350.1(09/14)
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