priorityhealth.com priority health medicare the choice is easy. ncms_6000_6014_a 05092013
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Priority Health Medicare
The choice is easy.
NCMS_6000_6014_A 05092013
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• 25+ years of health care experience in Michigan
• Priority Health is a nationally recognized health benefits company. We consistently rank among the nation's top health plans for quality and service
• #1 Medicare plan in the state
• 19,000+ providers– including the University of Michigan Health System
• 57,000 pharmacies nationwide. 98% of pharmacies in the U.S. are in our national network
Priority Health is health plan with a Medicare contract.
Great reasons to choose us
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High
•Employer involvement low – simply wants to assist Medicare-eligibles with transition into individual coverage
Mid
•Employer contributes money/stipend and Medicare-eligibles choose desired individual coverage (MAPD or Medigap plan)
Low
•Employer sponsors coverage for Medicare-eligibles via an MAPD plan – technically known as Employer Group Waiver Plan (EGWP)
Employer-sponsored options:
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Why choose a Priority Health Medicare plan?
• Control rising health care costs with our growing portfolio of high quality, affordable Medicare plans.
• Offer competitive benefits to both retired employees and those looking forward to retirement.
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Three great reasons to choose Priority Health Medicare
#1 Improve your bottom line
• Save 10 – 15% by moving people 65 and older away from your
group plan without sacrificing the quality of their benefits.
• Drug plan administration handled by Priority Health now that
Affordable Care Act removed your Retiree Drug Subsidy (RDS).
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Three great reasons to choose Priority Health Medicare
#2 Enhance your benefits
Retain the best employees by adding an employer-sponsored
Priority Health Medicare plan to your overall benefits package.
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Three great reasons to choose Priority Health Medicare
#3 Plans for employers of all sizes
• Choose from two standard Medicare Advantage plans with enhanced hospitalization benefits, prescription drug coverage in the “donut hole” and worldwide coverage for urgent and emergency care.
• No minimum employer contribution necessary for companies of 20 or more employees.
• We can create custom plans for (companies with 100 or more employees).
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Our members love us!
• More individuals choose Priority Health Medicare Advantage plans over any other plan in Michigan*
• Our individual PriorityMedicare ValueSM (HMO-POS) and PriorityMedicareSM (HMO-POS) plans were awarded 4.5 stars (out of 5) by the Centers for Medicare and Medicaid Services**
• Our plans received the highest accreditation status of "Excellent" from the National Committee for Quality Assurance (NCQA).
*According to January 2012 - April 2013 monthly enrollment reports from the Centers for Medicare
and Medicaid Services.
**Plan performance star ratings are assessed each year and may change from one year to the next.
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Our group Medicare Advantage plans
• Offer additional benefits beyond what you get with Original Medicare
• Include prescription drug coverage with no “donut hole” and a home delivery option
• Coverage in the United States and around the world
• Have predictable out-of-pocket expenses
• Include doctor visits and hospital coverage
• Don’t require a referral to see a specialist
• Local, exceptional customer service
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Standard plan benefits
Benefits in-network PriorityMedicare (HMO-POS) Basic PriorityMedicare (HMO-POS) Enhanced
Annual deductible $250 $0
Doctor/specialist office visit
$15/$30 copayment $10/$25 copayment
Inpatient medical hospital care
$0 copayment $0 copayment
Emergency/urgent care
$65/$45 copayment $65/$40 copayment
Diagnostic tests and lab services
$0/$150 copayment $0/$100 copayment
Preventive care $0 copayment for all preventive services covered by Original Medicare$0 copayment for an annual physical exam
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Standard plan benefits
Benefits in-network PriorityMedicare (HMO-POS) (basic) PriorityMedicare (HMO-POS) (enhanced)
Part D prescription drug coverage (31-day retail copay/ coinsurance)
$15 for generics$50 for preferred brand$80 for non-preferred brand20% specialty up to $150 maximum
$10 for generics$40 for preferred brand$70 for non-preferred brand20% specialty up to $100 maximum
Includes coverage through the coverage gap
Hearing $0 copayment for routine hearing tests, including Medicare-covered diagnostic hearing exams.An office visit copayment may apply.$300 allowance for hearing aids every three years
$0 copayment for routine hearing tests, including Medicare-covered diagnostic hearing exams.An office visit copayment may apply.$200 allowance for hearing aids every three years
Vision $30 copayment for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.$60 allowance for eye wear every two years.
$25 copayment for Medicare-covered exams to diagnose and treat diseases and conditions of the eye.$0 allowance for eye wear every two years.
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Medicare Advantage eligibility
• Individuals must have both Medicare Part A and
Part B to enroll
• Must be a permanent Michigan resident and reside in our service area for at least six months of the year. May temporarily be outside the service area for 6 months or less
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Enrollment periods & eligibility
• Mid-year enrollment may lower your group’s average age and positively impact your renewal premium.
• Enrollment changes (elections) made on the group’s renewal date thereafter.
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Simple 4 step process
• MAPD Group Agreement
• MAPD Eligibility Verification Form
• 30-day Notification Letter
• PriorityMedicare MAPD Group Enrollment Form
Get started:
*Contact your account manager for MAPD quotes for Mid- and Large-size groups.
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Mid• Employer contributes money/stipend and
Medicare-eligibles choose desired individual coverage (MAPD or Medigap plan)
Employer-sponsored options:
Low
•Employer involvement low – simply wants to assist Medicare-eligibles with transition into individual coverage
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Our Individual Medicare Advantage plans
• PriorityMedicare ValueSM (HMO-POS)
• PriorityMedicareSM (HMO-POS)
• PriorityMedicare MeritSM (PPO)
• PriorityMedicare SelectSM (PPO)
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2013 Individual Priority Health Medicare Advantage premiums
• Premiums range from $0 to $154*
• Vary by county and plan
• Refer to the Summary of Benefits in your
individual packet for premium information
*You must continue to pay your Medicare Part B premium
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Individual MAPD benefits
Benefits In-network
PriorityMedicare Value (HMO-POS)
PriorityMedicare (HMO-POS)
PriorityMedicare Merit (PPO)
PriorityMedicare Select (PPO)
Annual deductible $0 $0 $325 combined in and out of network
$0
PCP/specialist office visit
$20/$45 copayment $15/$40 copayment $30/$45 copayment $20/$40 copayment
Inpatient medical hospital care
$800 copayment per hospital stay
$130 copayment per day (days 1-5)$0 copayment per day (days 6+)
$250 copayment per day (days 1-5)$0 copayment per day (days 6+)
$125 copayment per day (days 1-5)$0 copayment per day (days 6+)
Emergency/urgent care
$65/$50 copayment
Lab services and diagnostic tests
$0-$175 copayment $0-$100 copayment $0-$150 copayment $0-$100 copayment
Preventive care $0 copayment for all preventive services covered by Original Medicare$0 copayment for an annual physical exam
The benefits information provided is a brief summary, not a complete description of benefits. For more information contact Priority Health Medicare.
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Individual MAPD benefits
BenefitsIn-network
PriorityMedicare Value (HMO-POS)
PriorityMedicare (HMO-POS)
PriorityMedicare Merit (PPO)
PriorityMedicare Select (PPO)
Part D prescription drug coverage (31-day retail copay/ coinsurance)
$9 for generics$40 for preferred brand$90 for non-preferred brand33% specialty
$8 for generics$35 for preferred brand$80 for non-preferred brand33% specialty
$10 for generics$45 for preferred brand$90 for non-preferred brand 33% specialty
$8 for generics$40 for preferred brand$85 for non-preferred brand33% specialty
Dental coverage Includes 1 annual preventive oral exam and 1 annual dental cleaning. 50% coverage for one set of dental x-rays annually. $45 copay for Medicare covered dental benefits.
Includes 1 annual preventive oral exam and 1 annual dental cleaning. 50% coverage for one set of dental x-rays annually. $40 copay for Medicare covered dental benefits.
Not applicable
Includes 1 annual preventive oral exam and 1 annual dental cleaning. 50% coverage for one set of dental x-rays annually. $40 copay for Medicare covered dental benefits.
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Individual MAPD benefits
BenefitsIn-network
PriorityMedicare Value (HMO-POS)
PriorityMedicare (HMO-POS)
PriorityMedicare Merit (PPO)
PriorityMedicare Select (PPO)
Enhanced Dental coverage for $17 a month in addition to your monthly plan premium
100% coverage for 2 annual preventive oral exams and 2 annual dental cleanings. 100% coverage for one set of dental x-rays annually. 50% coverage for endodontic services. 50% coverage for minor restorative fillings.
100% coverage for 2 annual preventive oral exams and 2 annual dental cleanings. 100% coverage for one set of dental x-rays annually. 50% coverage for endodontic services. 50% coverage for minor restorative fillings.
Not applicable 100% coverage for 2 annual preventive oral exams and 2 annual dental cleanings. 100% coverage for one set of dental x-rays annually. 50% coverage for endodontic services. 50% coverage for minor restorative fillings.
Silver&Fit Free fitness club membership or at-home fitness kits
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• Affordable - plans as low as $100 a month
• Give you access to any Medicare provider in the U.S.
• Generally have no copays at the time of service
• Help pay some of the health care costs that Original Medicare doesn’t cover
• Have low out-of-pocket expenses
• Automatically process and pay claims to providers
2 Preferred rates apply for beneficiaries who are in their Open Enrollment Period or who have Guaranteed Issue Rights, or who may qualify if they meet certain medical criteria.
Non-Standard rates apply for those not in their Open Enrollment Period or don’t have Guaranteed Issue Rights; also based on health status and tobacco use.
Why choose a Priority Health Medigap plan?
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Plan A Plan D Plan F Plan N
Hospitalization (Medicare Part A copays plus coverage for 365 additional days after Medicare benefits end)
Covered Covered Covered Covered
Skilled nursing facility care (Part A daily copays)
Covered Covered Covered
Medicare Part A deductible: $1,156
Covered Covered Covered
Medicare Part B deductible: $140
Covered
Medigap benefits
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Plan A Plan D Plan F Plan N
Outpatient hospital services (Part B coinsurance)
Covered Covered Covered
100% after copay/coinsurance of up to $20 office visit & up to a $50 ER visit
Medicare Part B excess charges
Covered
Hospice care (Part A coinsurance & copays)
Covered Covered Covered Covered
Blood (First 3 pints under Parts A & B)
Covered Covered Covered Covered
Foreign travel emergency services4
Covered Covered Covered
Medigap benefits
4Lifetime maximum of $50,000 on care received outside the U.S.
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Plan F: 65 year old Female, Guaranteed Issue
Kent, Ottawa $120
Grand Traverse, Livingston, Monroe $129
Genesee, Ingham, Macomb, Oakland, Saginaw, Washtenaw, Wayne $132
Kalamazoo, Muskegon, St. Clair $136
Medigap Premium Example
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Eligibility requirements
• Beneficiaries must be eligible for Medicare Part A and enrolled in Medicare Part B
• Must be a permanent resident of Michigan and physically reside in the state for six months of the year
• Can’t have more than one Medigap plan
• Can’t have a Medigap and an MAPD plan at the same time
Neither Priority Health Medigap plans nor agents authorized to sell Priority Health Medigap plans are connected with or endorsed by the United States government or the federal Medicare program.
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Questions?