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Premium member Presentation Transcript Choosing betweenBlue Cross plans…: Choosing between Blue Cross plans… …when you have Medicare Presented by Guerren Solbach UCD/UCDHS Health Care Facilitator Program September 19, 2007 Agenda: Agenda Medicare and UC Medicare and Blue Cross Plan Comparisons Pros/Cons Medical coverage Coordination with Medicare Mental health coverage Rx coverage Cost vs. Benefit Medicare and UC: Medicare and UC Medicare and UC: Medicare and UC Medicare is the federal health insurance program for those over 65 and some disabled Part A (premium-free for most) Part B ($93.50/month in 2007) Costs more if you make more than $80K/year ($160K for couples) UC relies on Medicare to offset the cost of retiree medical insurance Retirees without Medicare cost 3 times more to insure UC’s Medicare Requirements: UC’s Medicare Requirements UC requires retirees and their family members to enroll in Medicare Part B: If enrolled in medical insurance If eligible for Part A free of charge Failure to comply may result in the loss of UC-sponsored medical coverage Exceptions: Retirees who reside outside of the U.S. Those who retired prior to July 1, 1991 Medicare Part D: Medicare Part D New drug benefit as of 2006 Subsidizes medical plan premiums The Rx coverage of most UC medical plans is equivalent to or better than Part D Considered creditable coverage Medicare Part D (cont.): Medicare Part D (cont.) Retirees will automatically be enrolled in Part D by their medical plan No additional Part D premium Retirees do not need to do anything to enroll Exception: double coverage Enrollment in a non-UC Part D plan will result in loss of coverage Medicare and Blue Cross: Medicare and Blue Cross Blue Cross Plans: Blue Cross Plans UC offers 4 Blue Cross of CA medical plans: Core Medical Blue Cross PLUS Blue Cross PPO High Option Rely upon 'Evidence of Coverage' booklets for detailed plan information: http://www.bluecrossca.com/uc Call Blue Cross at 1-888-209-7975 Blue Cross Plans w/ Medicare: Blue Cross Plans w/ Medicare Assumption: eligible for Parts A andamp; B Medicare pays primary, Blue Cross secondary Use Medicare providers Providers must be certified with Medicare No 'private contracts' If Medicare will not pay a claim because the provider is not part of Medicare, then Blue Cross will not pay About Medicare Providers…: About Medicare Providers… 91% of U.S. physicians participate in Medicare as of 2001 If seeing a new doctor, be sure to ask if accepting new Medicare patients Providers that do not accept Medicare 'assignment' can charge up to 15% more Find doctors online: http://www.medicare.gov Blue Cross Plans w/ Medicare: Blue Cross Plans w/ Medicare Medicare Crossover program To activate, call Blue Cross with your Medicare number and Part A/B effective dates Blue Cross will be able to access your Medicare EOBs (Explanation of Benefits) No need to resubmit claims after filing with Medicare Plan Comparisons: Plan Comparisons Wellness/DM Programs: Wellness/DM Programs Wellness programs: Discounted fitness, massage therapy, yoga, weight loss, etc. Educational classes through local medical groups Today’s Health andamp; Wellness magazine Disease management programs: Asthma/diabetes/congestive heart failure/cancer (chemotherapy)/musculoskeletal disorders Tobacco cessation Core Medical w/ Medicare: Core Medical w/ Medicare Fee-for-Service plan No net premium (full Medicare Part B reimbursement) Core Medical w/ Medicare: Core Medical w/ Medicare Pros Access any Medicare provider Deductible: $100 Chiropractic/acupuncture coverage Out-of-Pocket maximum: $1,260 Separate Rx Out-of-Pocket Maximum: $1,000 Lifetime maximum benefit: $2,000,000/person Core Medical w/ Medicare: Core Medical w/ Medicare Cons $2,260 out-of-pocket maximum Hearing aids/exams not covered Behavioral health not covered Skilled nursing facility limit: 120 days per calendar year Core Medical w/ Medicare: Core Medical w/ Medicare Medicare coordination: Blue Cross will pay 80% of their allowable charges If this is less than Medicare’s payment, Blue Cross pays nothing, member pays 20% If more than Medicare’s payment, Blue Cross pays difference up to 80% of allowable charges Core Medical w/ Medicare: Core Medical w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Core Medical w/ Medicare: Core Medical w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Core Medical w/ Medicare: Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) not covered 90-day supplies from UC pharmacies 2 copayments $1,000 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Core Medical w/ Medicare Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Point-of-Service plan In-Network Benefits Primary Care Physician (PCP) and medical group coordinate care Out-of-Network Benefits Self-refer to Medicare providers Higher premium than Core and PPO Behavioral health benefits Administered through United Behavioral Health In- and Out-of-Network benefits Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits Pros No deductible/claim forms $20 physician office visit copay $75 ER copay (waived if admitted) $250 inpatient hospitalization copay $20 hearing exam 50% coinsurance on hearing aids (max benefit of $2,000) Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Pros (cont.) Skilled nursing facility limit: 240 days/calendar year $20 Chiropractic/acupuncture copay American Specialty Health Plans providers only Maximum copayment liability: $1,500 per person Lifetime maximum benefit: unlimited Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Cons Sutter medical groups not available Sutter West, Sutter Medical Group, Sutter Independent Physicians Must go through PCP to get to specialists PCP will usually refer you only to doctors/hospitals in the same medical group Routine vision exams not covered Chiropractic/acupuncture: American Specialty Health Plan providers only Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Medicare coordination You pay copayment Medicare and Blue Cross pay the rest Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits Pros Can see any Medicare doctor without going through PCP Includes Sutter doctors 50% coinsurance on hearing aids (max benefit of $2,000) Skilled nursing facility limit: 240 days/calendar year Lifetime maximum benefit: $2,000,000/member Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits (cont.) Cons $500 per person, calendar year deductible Not waived for preventive exam 30% coinsurance Chiropractic/acupuncture not covered Out-of-Pocket Maximum = $5,000 per person, per calendar year Separate $500 deductible for non-UBH behavioral health Outpatient mental health coverage limited to 20 visits/year Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits (cont.) Medicare Coordination: Blue Cross will pay 70% of their allowable charges If this is less than Medicare’s payment, Blue Cross pays nothing, member pays 30% If more than Medicare’s payment, Blue Cross pays difference up to 70% of allowable charges Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Blue Cross PLUS w/ Medicare: Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) 6 tablets or units per 30-day period Retail pharmacies only 90-day supplies from UC pharmacies 2 copayments $3,850 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Blue Cross PLUS w/ Medicare Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Preferred Provider Organization plan Use any Medicare provider Lower premium than PLUS More flexible than PLUS (no PCP) Behavioral health benefits Administered through United Behavioral Health In- and Out-of-Network benefits Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Pros Access any Medicare provider Deductible: $100 per person, per calendar year Waived for preventive physical exam Coinsurance: 20% of balance after Medicare Hearing exam/hearing aids (up to $2,000): 20% Chiropractic/acupuncture: 20% Skilled nursing facility limit: 240 days Out-of-pocket maximum: $1,500 Lifetime maximum benefit: $5,000,000/member Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Cons 20-visit limit on outpatient, out-of-network behavioral health ($500 deductible) Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Medicare coordination: Blue Cross pays 80% of balance after Medicare pays Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) 6 tablets or units per 30-day period Retail pharmacies only 90-day supplies from UC pharmacies 2 copayments $3,850 Rx out-of-pocket maximum Excludes copays for non-formulary drugs High Option w/ Medicare: High Option w/ Medicare Medicare supplement plan Highest monthly premium among plans that UC offers Behavioral health benefits: Use any Medicare provider High Option w/ Medicare: High Option w/ Medicare Pros Access any Medicare provider Deductible: $50 per person, per calendar year Coinsurance: none for many services Chiropractic: no copay if covered by Medicare Acupuncture: 20% after deductible Skilled nursing facility limit: 130 days Out-of-pocket maximum: $1,050 Rx out-of-pocket maximum: $1,000 $2,000,000 lifetime maximum benefit High Option w/ Medicare: High Option w/ Medicare Cons Hearing aids/exam not covered Sexual dysfunction drugs not covered No behavioral health out-of-pocket maximum High Option w/ Medicare: High Option w/ Medicare Medicare coordination: 'coordination of benefits' Plan pays balance after Medicare High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) not covered 90-day supplies from UC pharmacies 2 copayments $1,000 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Compare the various plans’ total costs Monthly premium Copays/deductibles/coinsurance Out-of-pocket maximums Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2007 Part B premium: ≥$93.50 per month Part B deductible: $131 per year Part A deductible: $992 per benefit period Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2007 (cont.) Part A For each benefit period you pay: A total of $992 for a hospital stay of 1-60 days $248 per day for days 61-90 of a hospital stay $496 per day for days 91-150 of a hospital stay (Lifetime Reserve Days) All costs for each day beyond 150 days Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2006 (cont.) Part A Skilled nursing facility coinsurance: $124 per day for days 21 through 100 each benefit period Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Which plans give you access to the doctors you want to see? Cost vs. Benefit: Cost vs. Benefit Which plans cover benefits you are most likely to need? Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Remember, you can always change plans during a future Open Enrollment… Choosing betweenBlue Cross plans…: Choosing between Blue Cross plans… …when you have Medicare Presented by Guerren Solbach UCD/UCDHS Health Care Facilitator Program September 19, 2007 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
plan 06 Haggrid Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 38 Category: News & Reports.. License: All Rights Reserved Like it (0) Dislike it (0) Added: September 19, 2007 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Choosing betweenBlue Cross plans…: Choosing between Blue Cross plans… …when you have Medicare Presented by Guerren Solbach UCD/UCDHS Health Care Facilitator Program September 19, 2007 Agenda: Agenda Medicare and UC Medicare and Blue Cross Plan Comparisons Pros/Cons Medical coverage Coordination with Medicare Mental health coverage Rx coverage Cost vs. Benefit Medicare and UC: Medicare and UC Medicare and UC: Medicare and UC Medicare is the federal health insurance program for those over 65 and some disabled Part A (premium-free for most) Part B ($93.50/month in 2007) Costs more if you make more than $80K/year ($160K for couples) UC relies on Medicare to offset the cost of retiree medical insurance Retirees without Medicare cost 3 times more to insure UC’s Medicare Requirements: UC’s Medicare Requirements UC requires retirees and their family members to enroll in Medicare Part B: If enrolled in medical insurance If eligible for Part A free of charge Failure to comply may result in the loss of UC-sponsored medical coverage Exceptions: Retirees who reside outside of the U.S. Those who retired prior to July 1, 1991 Medicare Part D: Medicare Part D New drug benefit as of 2006 Subsidizes medical plan premiums The Rx coverage of most UC medical plans is equivalent to or better than Part D Considered creditable coverage Medicare Part D (cont.): Medicare Part D (cont.) Retirees will automatically be enrolled in Part D by their medical plan No additional Part D premium Retirees do not need to do anything to enroll Exception: double coverage Enrollment in a non-UC Part D plan will result in loss of coverage Medicare and Blue Cross: Medicare and Blue Cross Blue Cross Plans: Blue Cross Plans UC offers 4 Blue Cross of CA medical plans: Core Medical Blue Cross PLUS Blue Cross PPO High Option Rely upon 'Evidence of Coverage' booklets for detailed plan information: http://www.bluecrossca.com/uc Call Blue Cross at 1-888-209-7975 Blue Cross Plans w/ Medicare: Blue Cross Plans w/ Medicare Assumption: eligible for Parts A andamp; B Medicare pays primary, Blue Cross secondary Use Medicare providers Providers must be certified with Medicare No 'private contracts' If Medicare will not pay a claim because the provider is not part of Medicare, then Blue Cross will not pay About Medicare Providers…: About Medicare Providers… 91% of U.S. physicians participate in Medicare as of 2001 If seeing a new doctor, be sure to ask if accepting new Medicare patients Providers that do not accept Medicare 'assignment' can charge up to 15% more Find doctors online: http://www.medicare.gov Blue Cross Plans w/ Medicare: Blue Cross Plans w/ Medicare Medicare Crossover program To activate, call Blue Cross with your Medicare number and Part A/B effective dates Blue Cross will be able to access your Medicare EOBs (Explanation of Benefits) No need to resubmit claims after filing with Medicare Plan Comparisons: Plan Comparisons Wellness/DM Programs: Wellness/DM Programs Wellness programs: Discounted fitness, massage therapy, yoga, weight loss, etc. Educational classes through local medical groups Today’s Health andamp; Wellness magazine Disease management programs: Asthma/diabetes/congestive heart failure/cancer (chemotherapy)/musculoskeletal disorders Tobacco cessation Core Medical w/ Medicare: Core Medical w/ Medicare Fee-for-Service plan No net premium (full Medicare Part B reimbursement) Core Medical w/ Medicare: Core Medical w/ Medicare Pros Access any Medicare provider Deductible: $100 Chiropractic/acupuncture coverage Out-of-Pocket maximum: $1,260 Separate Rx Out-of-Pocket Maximum: $1,000 Lifetime maximum benefit: $2,000,000/person Core Medical w/ Medicare: Core Medical w/ Medicare Cons $2,260 out-of-pocket maximum Hearing aids/exams not covered Behavioral health not covered Skilled nursing facility limit: 120 days per calendar year Core Medical w/ Medicare: Core Medical w/ Medicare Medicare coordination: Blue Cross will pay 80% of their allowable charges If this is less than Medicare’s payment, Blue Cross pays nothing, member pays 20% If more than Medicare’s payment, Blue Cross pays difference up to 80% of allowable charges Core Medical w/ Medicare: Core Medical w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Core Medical w/ Medicare: Core Medical w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Core Medical w/ Medicare: Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) not covered 90-day supplies from UC pharmacies 2 copayments $1,000 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Core Medical w/ Medicare Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Point-of-Service plan In-Network Benefits Primary Care Physician (PCP) and medical group coordinate care Out-of-Network Benefits Self-refer to Medicare providers Higher premium than Core and PPO Behavioral health benefits Administered through United Behavioral Health In- and Out-of-Network benefits Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits Pros No deductible/claim forms $20 physician office visit copay $75 ER copay (waived if admitted) $250 inpatient hospitalization copay $20 hearing exam 50% coinsurance on hearing aids (max benefit of $2,000) Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Pros (cont.) Skilled nursing facility limit: 240 days/calendar year $20 Chiropractic/acupuncture copay American Specialty Health Plans providers only Maximum copayment liability: $1,500 per person Lifetime maximum benefit: unlimited Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Cons Sutter medical groups not available Sutter West, Sutter Medical Group, Sutter Independent Physicians Must go through PCP to get to specialists PCP will usually refer you only to doctors/hospitals in the same medical group Routine vision exams not covered Chiropractic/acupuncture: American Specialty Health Plan providers only Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare In-Network Benefits (cont.) Medicare coordination You pay copayment Medicare and Blue Cross pay the rest Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits Pros Can see any Medicare doctor without going through PCP Includes Sutter doctors 50% coinsurance on hearing aids (max benefit of $2,000) Skilled nursing facility limit: 240 days/calendar year Lifetime maximum benefit: $2,000,000/member Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits (cont.) Cons $500 per person, calendar year deductible Not waived for preventive exam 30% coinsurance Chiropractic/acupuncture not covered Out-of-Pocket Maximum = $5,000 per person, per calendar year Separate $500 deductible for non-UBH behavioral health Outpatient mental health coverage limited to 20 visits/year Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Out-of-Network Benefits (cont.) Medicare Coordination: Blue Cross will pay 70% of their allowable charges If this is less than Medicare’s payment, Blue Cross pays nothing, member pays 30% If more than Medicare’s payment, Blue Cross pays difference up to 70% of allowable charges Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Blue Cross PLUS w/ Medicare: Blue Cross PLUS w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Blue Cross PLUS w/ Medicare: Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) 6 tablets or units per 30-day period Retail pharmacies only 90-day supplies from UC pharmacies 2 copayments $3,850 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Blue Cross PLUS w/ Medicare Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Preferred Provider Organization plan Use any Medicare provider Lower premium than PLUS More flexible than PLUS (no PCP) Behavioral health benefits Administered through United Behavioral Health In- and Out-of-Network benefits Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Pros Access any Medicare provider Deductible: $100 per person, per calendar year Waived for preventive physical exam Coinsurance: 20% of balance after Medicare Hearing exam/hearing aids (up to $2,000): 20% Chiropractic/acupuncture: 20% Skilled nursing facility limit: 240 days Out-of-pocket maximum: $1,500 Lifetime maximum benefit: $5,000,000/member Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Cons 20-visit limit on outpatient, out-of-network behavioral health ($500 deductible) Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Medicare coordination: Blue Cross pays 80% of balance after Medicare pays Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies Blue Cross PPO w/ Medicare: Blue Cross PPO w/ Medicare Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) 6 tablets or units per 30-day period Retail pharmacies only 90-day supplies from UC pharmacies 2 copayments $3,850 Rx out-of-pocket maximum Excludes copays for non-formulary drugs High Option w/ Medicare: High Option w/ Medicare Medicare supplement plan Highest monthly premium among plans that UC offers Behavioral health benefits: Use any Medicare provider High Option w/ Medicare: High Option w/ Medicare Pros Access any Medicare provider Deductible: $50 per person, per calendar year Coinsurance: none for many services Chiropractic: no copay if covered by Medicare Acupuncture: 20% after deductible Skilled nursing facility limit: 130 days Out-of-pocket maximum: $1,050 Rx out-of-pocket maximum: $1,000 $2,000,000 lifetime maximum benefit High Option w/ Medicare: High Option w/ Medicare Cons Hearing aids/exam not covered Sexual dysfunction drugs not covered No behavioral health out-of-pocket maximum High Option w/ Medicare: High Option w/ Medicare Medicare coordination: 'coordination of benefits' Plan pays balance after Medicare High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit Generic drugs on Blue Cross formulary $15 for a 30-day supply $30 for a 90-day supply (mail order) Brand name drugs on formulary $25 for a 30-day supply $50 for a 90-day supply (mail order) High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit (cont.) Non-formulary drugs Certain drugs may require prior authorization $40 for a 30-day supply $80 for a 90-day supply (mail order) If doctor writes 'dispense as written' (DAW) or 'do not substitute' (DNS) on prescription, brand copay applies High Option w/ Medicare: High Option w/ Medicare Prescription drug benefit (cont.) Impotence/sexual dysfunction drugs (e.g. Viagra) not covered 90-day supplies from UC pharmacies 2 copayments $1,000 Rx out-of-pocket maximum Excludes copays for non-formulary drugs Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Compare the various plans’ total costs Monthly premium Copays/deductibles/coinsurance Out-of-pocket maximums Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2007 Part B premium: ≥$93.50 per month Part B deductible: $131 per year Part A deductible: $992 per benefit period Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2007 (cont.) Part A For each benefit period you pay: A total of $992 for a hospital stay of 1-60 days $248 per day for days 61-90 of a hospital stay $496 per day for days 91-150 of a hospital stay (Lifetime Reserve Days) All costs for each day beyond 150 days Cost vs. Benefit: Cost vs. Benefit Medicare rates for 2006 (cont.) Part A Skilled nursing facility coinsurance: $124 per day for days 21 through 100 each benefit period Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Which plans give you access to the doctors you want to see? Cost vs. Benefit: Cost vs. Benefit Which plans cover benefits you are most likely to need? Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Cost vs. Benefit: Cost vs. Benefit Remember, you can always change plans during a future Open Enrollment… Choosing betweenBlue Cross plans…: Choosing between Blue Cross plans… …when you have Medicare Presented by Guerren Solbach UCD/UCDHS Health Care Facilitator Program September 19, 2007