1confidential | retiree choices. 2confidential | what is changing and why? how this affects you...
TRANSCRIPT
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1 CONFIDENTIAL |
Retiree Choices
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2 CONFIDENTIAL |
• What is changing and why?
• How this affects you
• Introducing Extend Health
• Medicare marketplace
• Going forward
• Questions & answers
What we’ll cover today
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3 CONFIDENTIAL |
• Retiree health care coverage options are changing
• Retirees & spouses age 65 and older are eligible
What’s changing?
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• Allows retirees to have more choice and the ability to customize their health care coverage.
• More than 75 leading insurance companies in the Medicare supplement market, including national carriers such as UnitedHealthcare®, AARP®, Aetna and Humana.
• Extend Health specializes in helping retirees across the U.S. choose the individual Medicare plan that meets their needs and budget.
Why This Approach?
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How This Affects You
• May change – depending on what coverage you choose.
• You will work with Extend Health to enroll in a plan that meets your medical and prescription needs. We will also help you establish your Health Reimbursement Account.
• Extend Health Advisors will help you understand the costs associated with your coverage – premiums, co-payments,
deductibles and all other costs.
What you pay
How you enroll
Your support
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6 CONFIDENTIAL |
Introducing Extend HealthThe Industry’s Largest Medicare Exchange
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• Independent company
• Partner with 75+ health plan carriers
• Objective and Trusted US based benefit
advisors
• Focused on helping each participant make an
informed and confident decision
Who is Extend Health?
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Why Extend Health
• We are experienced in helping people just like you
• Our services are at no cost to you
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9 CONFIDENTIAL |
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Plans & Partners
All Medicare Plan Types
• Medicare Advantage
• Medigap (supplement)
• Prescription Drug (Part D)
Select Carriers
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Educate
Evaluate/Enroll
Manage
The Process
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• Gather information – (e.g. prescriptions)– Pre-existing conditions will
not limit your plan selection*– Give us a call
855-663-4225– www.ExtendHealth.com/transamerica
EducationGetting Started Guide
* except end-stage renal disease
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• Prepare you for
enrollment discussion• Review Medicare basics• Appointment confirmation
letter
EducationEnrollment Guide
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Decision Support Tools
• Help Me Choose
• Prescription Profiler
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Licensed Benefit Advisor• 100% domestic workforce• Objective advocacy• Neutral compensation• Extend University• Licensed, certified, appointed• Average age 43
Hours of OperationMonday – Friday8 a.m. – 9 p.m. Eastern Time
Evaluate and Enroll
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Enrollment Process
• Benefit Advisors can discuss coverage options with anyone – need to speak to the participant to complete the enrollment.
• Once you have made a coverage selection, enrollment is conducted via telephone.
• 100% of calls are recorded.
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Medicare and You
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Your Future Coverage
Primary Coverage
Medicare A & B
Additional Coverage (Your Choice)
Medicare Advantage with Prescription Drug (MAPD)
Medigap + Prescription Drug
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Initial Coverage You pay
Deductible and co-pays for your plan
Coverage for the first $2,970 in actual cost of meds
Coverage Gap – Donut HoleYou pay
47.5% of brand drugs and 79% of generics
until out of pocket costs reach $4,750
Catastrophic CoverageYou pay
$2.65 for generics and $6.60 for brand
or 5% whichever is greater
Medicare Prescription Drug Coverage
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– $0 per month
– Network: PPO
– Deductible: $0
– Doctor co-pay: $15 Specialist co-pay: $25
– Hospital: $850 co-pay per hospital stay
– Emergency Room: $65 co-pay if not admitted
– Rx: $7/$43/$85/33%
– Mail order: (90 day)
Plan Example
Medicare Advantage Plan
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– Medical/Rx $215 ($175 - $40)
– Network: Any doctor that accepts Medicare
– Deductible: $0
– Doctor co-pay: $0 Specialist co-pay: $0
– Hospital: $0
– Emergency Room: $0 co-pay
– Rx: $0 deductible $7/$43/$85/33%
– Mail order: (90 day)
Plan Example
Medigap Plan F and PDP – 75 year old male
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Benefits Current Medicare Supplement Plan
Medigap Plan F plus Prescription Drug Plan
Deductible $250 $0Office Visits 20% coinsurance $0 co-payHospital 20% coinsurance $0 co-payOut of Pocket Maximum $1,250 per person N/ALifetime Maximum $3,000,000 None
Prescription (retail)
No deductible
Tier 1: $10 copay Tier 2: 20% ($30 min/$75 max) Tier 3: 40% ($50 min/$125 max) Coverage gap does not apply
No deductible
$7/$38/$74/33%No gap coverage
Your Medigap Plan F Costs (illustrative)
Your Monthly Plan F Premium
$183 ($140 medical + $43 Rx)* less any subsidy (if
applicable) equals your net
monthly Plan F cost
*2012 rate (2013 rates not available yet)
What are Popular Coverage Options and What Do They Cost
(costs assume a male, 75-year-old retiree)
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HRA Information
• You may meet the eligibility requirements to qualify for a Company subsidy
• The following information pertains to those who qualify for the subsidy amount
• Please call Extend Health at 855-633-4225 to find out if you quality for a Health Reimbursement Account subsidy
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Auto-Reimbursement
How the Process Works
Health Reimbursement Arrangement
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What Is An HRA?
• Tax-advantaged account used to reimburse you for eligible health care expenses
• You must meet the Plan’s eligibility requirements to qualify for HRA
• Your HRA funds will be available January 1, 2013
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Eligible participants
receive annual HRA subsidy
Participant HRA
Account
Administered by Extend Health
Participant works through Extend
Health to enroll in individual coverage
Participant is reimbursed for
healthcare expenses using
HRA benefit dollars
Health Reimbursement Arrangement: How It Works
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How to File a Paper Claim
Participant pays plan premium (Medical or
Rx) or Medical co-pays
Participant fills out claim form, attaches required information
Extend Health verifies receipt of
payment and eligibility
Extend Health reimburses customer
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Extend HealthHRA Claim Form
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How Auto-Reimbursement Works
Participant pays plan premium to
insurance company
Insurance company forwards receipt of payment to Extend
Health
Extend Health verifies receipt of
payment and eligibility
Extend Health reimburses participant
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• Auto-Reimbursement (AR) is a service offered by Extend
Health
• Auto-reimbursement applies only to premiums paid, not
expenses
• Auto-reimbursement is NOT available on all plans
• Due to the timing of Auto-Reimbursement, it is usually not the
fastest way to be reimbursed
• Forms and instructions provided in the HRA Welcome Kit
What is Auto-Reimbursement?
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Next Steps
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Next Steps
Review “Getting Started Guide”
Gather Medicare Prescriptions and Doctor information
Call Extend Health (855) 663-4225
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Post Enrollment Customer Service
Advocacy and support services• Toll-free number to contact Extend Health
representative• Direct support for claims issues, appeals and
network questions• Renewal process – ability to pick new coverage for
future years – not locked into this year’s choice• Ongoing enrollment services
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Questions
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Q: Do you offer plans that cover me in multiple states-I am a snowbird?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these plans may be right for you. Part D plans provide nationwide coverage from participating pharmacies. Medicare Advantage plans cover urgent and emergency services nationwide, but some may not provide nationwide coverage for non-emergency services. If you live part of the year out-of-state, these plans may not be right for you.
Q: How often will I be billed? By whom? Can I pay by check?
A: When you enroll in a new plan, you will need to begin making premium payments to the insurance company in order to maintain your coverage. Some insurance companies may require the first month’s premium payment during the application process. In this case, you should expect to make a payment within a few days of your enrollment. Please have your billing information ready when you make your enrollment call to Extend Health.
Most insurance companies give you several billing options for ongoing payments: direct billing, paid by check each month, Electronic Funds Transfer from your checking account, or automatic deduction from your social security check. You can choose to pay monthly, quarterly, or yearly.
Frequently Asked Questions
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Q: If I don’t like the plan that I enrolled in, when can I change?
A: Every year you will have an Annual Medicare Enrollment Period during which you can investigate other medical and drug plans and potentially enroll in a different plan. However, during future Medicare Annual Enrollment Period your current medical conditions may limit the plans available to you. You will receive notification from Extend Health of the Annual Medicare Enrollment Period (October 15-December 7), we encourage you to contact us should you have any questions.
Q: Will I be refused coverage due to a pre-existing condition? Will I pay more? Can my policy be cancelled once I am enrolled because of my condition? Can my rate be raised for that reason?
A: If you enroll in a Medigap plan when you first transition from group coverage, and you wish to change to another Medigap in the future, you will go through Medical underwriting. You will not necessarily be denied, but your monthly premiums could be higher. Your policy cannot be cancelled once you are enrolled unless you do not pay your premiums and your rate will not be raised for medical reasons. If you wish to enroll in a Medicare Advantage plan, they are always guaranteed issue.
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Frequently Asked Questions
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Q: What if I have the option for other coverage (spouse, military) – if I don’t enroll with Extend for 2013 can I enroll later?
A: No. You must enroll through Extend Health. You will need to enroll into Medical and Prescription coverage to be eligible for the HRA funding if applicable.
Q: Will my premium rates increase every year? If so, by how much?
A: In general, insurance premiums do increase every year. The increase in plan cost year-to-year can vary widely. We advise our enrollees to contact us and compare other plans if you experience rate increases in the 10-15% range. The national average is 3-4%.
Q: Are there plans that will cover me when I travel domestically or internationally?
A: Medigap plans are accepted by every Medicare-participating provider in the U.S., with some emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these plans may be right for you. A few Medicare Advantage plans also have world wide emergency coverage.
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Frequently Asked Questions
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Q: How does Extend Health make its money? Will our services be free next year?
A: On a high level, Extend Health, Inc. is paid just as any agent would be, by the carrier, not your company. Our services are always free to you.
Q: Can I obtain Medical and Rx from one carrier or will I need separate plans for each?
A: Some Medicare Advantage plans have limited provisions for all of these needs. If you enroll in a Medigap plan, you will need to enroll in each option separately. Your Benefit Advisor can help you find the best combination for you.
Frequently Asked Questions