welcome to the aetna answer sm presentation discussion topics what is medicare? what choices do i...
TRANSCRIPT
Welcome to the Aetna AnswerSM Presentation
Discussion Topics
What is Medicare?
What choices do I have?
Why Aetna Medicare?
How do I enroll?
M0001_7A_80822 (01/2009)
The Aetna AnswerSM
A federal health insurance program Available to those age 65 and older:
who are entitled to monthly Social Security benefits Widows or widowers who are entitled to monthly Social Security benefits
Available to those under age 65: who have been entitled to Social Security disability benefits for at least 24
months with ALS (Amyotrophic Lateral Sclerosis), known as Lou Gehrig’s disease, the
first month they are entitled to Social Security benefits who are entitled to Social Security benefits and need maintenance kidney
dialysis or a kidney transplant
What is Medicare?
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Part A – is primarily for hospitalization. Part B – pays doctor bills as well as outpatient costs, including preventive services. Part C – is also known as the Medicare Advantage program. Medicare Advantage
plans are offered by private insurance companies that have a contract with the federal government.
Part D – the Medicare prescription drug benefit, which provides coverage for prescription drugs. This benefit is only available through private insurance companies.
Which “Parts” of Medicare are you interested in?
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What choices do I have? Both medical and prescription drug coverage are available.
We’ll explain your choices.
Overview of Options
Medical Plan and Pharmacy Plan Choices
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1. Original Medicare 2. Original Medicare & Supplement
3. Medicare Advantage Plan (MA)
Covers part of hospital care (Part A) and other care the doctor provides (Part B)
No prescription drug coverage
Original Medicare covers basic hospital and doctor care
The supplement provides coverage for expenses Original Medicare does not cover (MediGap Plans)
Different benefits and premiums are available
If you enrolled in a Medicare supplement plan prior to December 31, 2005, your plan may have some prescription drug coverage.
Otherwise, you must choose and pay an additional premium for a free-standing Prescription Drug Plan
Typically offers more benefits than Original Medicare and a supplement
May have lower monthly plan premiums than a supplement
Includes Original Medicare benefits typically with lower predictable copays
Plus coverage for: Routine physicals Eye exams Preventive care
Options that combine prescription drug and medical coverage
One plan, one card, one company
Benefits provided with Aetna Medicare Advantage plans: Comprehensive medical coverage that includes Original Medicare benefits plus
additional benefits, such as: Routine yearly physicals, yearly eye exams and preventive care at no
additional cost Specialist and hospital coverage Emergency medical coverage worldwide Plans that include Medicare prescription drug coverage (MA-PD) Optional dental plans and other Aetna ExtrasSM Aetna Golden
Medicare Plan® Aetna Golden Choice Plan
Aetna Medicare OpenSM Plan
Health Maintenance Organization (HMO) plan
Monthly plan premiums starting at $0 in many markets
Access to a network of nearly 100,000 doctors nationwide
Preferred Provider Organization (PPO) plan
Access to in-network or out-of-network doctors
Stay in-network to reduce your out-of-pocket expenses
No referrals required
Private Fee-For-Service (PFFS) plan
These are non-network plans
Access services from any doctor or hospital that is eligible to receive payment from Medicare and accepts Aetna Medicare terms and conditions
Aetna Medicare Advantage Plans (MA)
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All Medicare prescription drug plans must be at least as good as or better than the federal base benefit.
2009 Federal Medicare Prescription Drug Base Benefit
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95% Medicare / Plan Contribution
5% Enrollee
Co-insurance
100% Enrollee Payment at Aetna Discounted Rate
Coverage Gap
75% Plan Contribution25% Enrollee Co-insurance
$295 Enrollee Deductible$0
$2,700
$6,153.75
$295
Total Drug
Expenditures
$0
$896.25
$4,350+
$295
EnrolleeOut-of-Pocket Expenditures
Aetna also offers stand-alone Medicare prescription drug plans. Aetna Medicare prescription drug plans are open formulary, meaning they cover all
Medicare Part D prescription drugs* All plans have $0 deductibles for preferred generic prescription drugs The variety of prescription drug features included in our plans may include:
No deductible Aetna Rx Home Delivery®* Specialty Pharmacy Coverage gap protection*
* Subject to precertification, step therapy and quantity limits.
Aetna Medicare Prescription Drug Plans (PDP)
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Aetna Medicare Advantage Prescription Drug Plans (MA-PD)
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Aetna Medicare Advantage plans offer medical and prescription drug coverage in one plan
One company, one number to call, one premium (in addition to your Part B premium)
Our Medicare Advantage plans may cost less than Medicare supplements
Our Medicare Advantage medical plans with prescription drug benefits may be cost effective compared to paying for separate Medicare supplement and prescription drug plans
Medicare Advantage Plans (MA)
MedicarePrescription
Drug Plans(PDP)
Medicare Advantage Prescriptio
n Drug Plans (MA-
PD)
Aetna Medicare Advantage plans that combine medical and prescription drug coverage offer comprehensive benefits for one monthly Medicare Advantage plan premium
Aetna Medicare Advantage plans with prescription benefits are open formulary, meaning they cover all Medicare Part D prescription drugs*
There are a variety of features included in our Medicare Advantage plans with prescription drug coverage, such as: Over 59,000 pharmacies throughout the U.S. Aetna Rx Home Delivery®, which mails prescription drugs to your door
Pay a 2-month copay for a 3-month supply of covered prescription drugs Our Specialty Pharmacy provides access to highly specialized drugs and clinical
advice from pharmacists No generic prescription drug deductible Plans with $0 copays for preferred generic prescription drugs Plans with varying types of coverage gap protection
* Subject to precertification, step therapy and quantity limits.
Aetna Medicare Advantage Prescription Drug Plans (MA-PD)
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Why Aetna Medicare Advantage?
The Aetna AnswerSM
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Over 150 years of health insurance experience and service, including 40 years of Medicare experience
All-in-one plans that incorporate Medicare benefits and more: Routine and preventive services covered at a $0 copay Predictable copays Emergency coverage worldwide Medicare prescription drug coverage available with features such as gap
coverage to suit your needs Additional Benefits:
Lifestyle Coaching. Helps you develop a specific health improvement program based on your needs. To qualify for the smoking cessation, weight management or healthy living package, you must complete three phone call sessions with a coach.
Healthy Fitness. Free membership at a participating fitness center nationwide.*
Hearing-aid allowance Eyewear allowance* Cancer screening reminders. For breast, colorectal and cervical cancers. Annual preventive reminders. Regular mailers that help you to remember to
get your flu shots and other vaccinations. Optional dental benefits through an Aetna dental supplemental plan.*
Why Aetna Medicare Advantage?
* Available with most plans.
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Aetna ExtrasSM at no extra cost: Vision discounts. Up to 40% off the retail prices of eyeglass
frames, savings on all types of lenses and up to 15% off Lasik procedures. Discounts on dental services.* Discounts on exams, x-rays, cleaning and
polishing, fillings, crowns, root canals, minor denture adjustments and more. Aetna Weight ManagementSM Program. Discounts on weight-loss programs
and products from Jenny Craig®, one of the largest weight management firms worldwide.
Aetna Natural Products and ServicesSM Program. Discounts on over-the-counter vitamins, herbal and nutritional supplements and natural products, plus reduced rates* from chiropractors, acupuncturists, massage therapists and nutritional consultants.
Aetna ExtrasSM
* Available with most plans.
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Aetna Medicare Advantage plans include tools to help you manage your health. Online tools:
Aetna NavigatorTM helps you understand how your coverage is working for you.
Personal Health Record allows you to securely manage your personal health information online and access the information you and your doctor need to make informed decisions about your health.
Aetna InteliHealth® provides helpful wellness and healthy lifestyle information.
Phone tools: Informed Health® Line is a toll-free 24-hour telephone service that puts
you in touch with experienced registered nurses.
Managing your health
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The Aetna AnswerSM is an integrated Medicare Advantage plan with prescription drug coverage. With this plan you will receive medical and prescription drug coverage, plus more benefits than you typically get with the Original Medicare Plan alone.
2009 Medical & Prescription Drug Coverage Choices
What do you want in a health plan?
Original Medicar
e
Med Supp*
PDP MA MA-PD
Medical Coverage X X X X
Extra Medical Coverage
X X X
Prescription Drug Coverage*
X X
Optional Dental Coverage
X X
Aetna ExtrasSM X X X
Total Integrated Solution X
* Prescription drug coverage available only to H, I, or J Medicare • supplement policy holders who enrolled prior to December 31, 2005.
The Aetna AnswerSM
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Optional Supplemental Dental Benefit
Large Selection of
Doctors
Leading Customer Service
Emergency Coverage Anywhere
Over 150 Years of
Experience
Simple Plan Designs
Low or No Monthly Plan
Premium
Medicare Prescription
Drug Coverage
Aetna ExtrasSM
Predictable Copayments
Get all the coverage you need with an Aetna Medicare Advantage plan.
Why Aetna Medicare Advantage?
How do I enroll?
Enrolling is as simple
as 1 – 2 – 3.
Enrollment Process
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Complete the enrollment form.
Step 1
Mail your completed form to Aetna.
Hand in your application, or…
Review your enrollment kit and select a plan.
Enrollment 1 - 2 - 3
Step 3Step 2
Enrolling is as simple as 1–2–3. Once you know that you are eligible for the plan, follow the steps below. You can also enroll online at www.aetnamedicare.com.
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Initial Enrollment Period (IEP) – the 7-month period surrounding your Medicare eligibility, including the three months prior to your 65th birthday, the month of your 65th birthday and the 3 months after your 65th birthday.
Annual Election Period (AEP) – Nov. 15 through Dec. 31
Enroll in the 2009 plan of your choice for a Jan. 1 effective date
Open Enrollment Period (OEP) – Jan. 1 through March 31
Allows one limited plan change to the same type of plan
* You may qualify for a Special Election Period (SEP) – ask your Aetna Representative.
Important dates to remember
Annual Election Period Open Enrollment Period
1/1/09OEP begins
12/31/08AEP ends*
11/15/08AEP begins
3/31/09OEP ends*
November 2008 January – March 2009 December 2008
Do you have any questions?
Thank you, we look forward to serving you. For additional information, you can also contact Medicare at 1-800-MEDICARE or Medicare.gov.
Welcome to Aetna
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Benefits coverage is provided by Aetna Health Inc., Aetna Health of California Inc., Aetna Health of Illinois Inc. and/or Aetna Life Insurance Company, which are Medicare Advantage organizations with a Medicare contract, and benefits, limitations, service areas and premiums are subject to change on January 1 of each year.
This material is for informational purposes only. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as pre-certification, step therapy and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount programs provide access to discounted prices and are not insured benefits.
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable .
©2008 Aetna Inc. 18.25.303.1 (10/08)