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Care Improvement Plus-
Making the Right Choice for You
2012 Plan Options
Y0072_OE12_6211_A _GA SC_CMS Approved 09262011
Making the Right Choice for You
• Medicare and You
• Welcome to Care Improvement Plus– Selecting the Plan That’s Right for You– Prescription Drug Overview– Additional Services
• How to Enroll
2
Medicare and You
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Who Qualifies for Medicare?
• You or your spouse worked for at least 10 years (40 quarters)
• Citizen or permanent resident of the U.S.
• Age 65
• Under age 65 and disabled
• Living with ESRD (end stage renal disease)
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Original Medicare
• Part A – hospital insurance
• Part B – doctor and medical insurance
• Part D – prescription drug coverage
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Medicare Advantage Plans• Health plan options that are part of the
Medicare program– Also known as “Part C”
• Must offer all benefits of Original Medicare and most include Part D prescription drug coverage
• In most plans – including Care Improvement Plus– there are generally extra benefits and lower out-of-pocket costs than with Original Medicare
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Medicare Advantage Plans• It is important to note
– If you join a Medicare Advantage plan, you are still in the Medicare program.
– These plans are part of the Medicare program.
– Medicare approves health plans such as Care Improvement Plus and pays them to provide your benefits.
– Your Medicare coverage does not go away!
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Welcome to Care Improvement Plus
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Care Improvement Plus• Is dedicated to caring for the health and
well-being of chronically ill and other underserved Medicare beneficiaries
• Provides a variety of plan options to fit the health and financial needs of Medicare beneficiaries
• Offers comprehensive medical and prescription drug benefits
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Complete Health Coverage
• Hospital (Medicare Part A)
• Medical (Medicare Part B)
• Prescription Drugs (Medicare Part D)– Most Medicare-approved generic drugs
included– Full or partial coverage through the gap
• Depending on your level of subsidy
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An Open Access Provider Network
• No referrals required for Medicare-covered services
• Go to any Medicare-approved provider who accepts payment from our plan– Check to make sure your provider accepts the
plan
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Benefits Beyond Original Medicare
• Offering you additional benefits and services – Vision benefits for eyewear and eye exams– Preventive dental coverage– Transportation– Routine Podiatry
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Unique Programs Exclusive to Members
• HouseCalls
• PharmAssist
• Social Service Coordinators
• Comprehensive Care Management and more...
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Selecting the Plan That’s Right for You
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Available Where You Live
• The Care Improvement Plus service area includes the entire states of Georgia and South Carolina.
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“Best Fit Plan Options”
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If You Are: Then You Should Consider:
Diabetes &/or Heart Failure + Full Dual (Medicare & Full Medicaid) Silver Rx (CSNP)
Diabetes &/or Heart Failure + Not Full Dual Gold Rx (CSNP)
No Chronic Condition Required + Medicare & Full Medicaid Dual Advantage (DSNP) *
No Chronic Condition Required + Medicare Only Medicare Advantage
*where available
Silver Rx
• If you have diabetes and/or heart failure and full Medicaid, consider Silver Rx (Regional PPO SNP) or (PPO SNP).
• To be eligible for this plan, you must:– Live in the service area– Have both Medicare Part A and Part B; and– Have been diagnosed with diabetes and/or
heart failure
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Silver Rx Highlights • $33.60 monthly plan premium and cost
sharing that is similar to Original Medicare• For those with full Medicaid, monthly plan
premium and cost sharing as low as $0• Vision and transportation benefits• Dental benefits (including dentures; referral
required)• Over-the-Counter benefit – monthly
allowance for drugs and other health purchases via mail order
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Silver Rx – Georgia & South Carolina (RPPO)
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Benefits What You Pay With Silver Rx What You Pay if You Are Medicare & Full Medicaid
Monthly Plan Premium $33.60 $0
Maximum Out-of-Pocket $6,700 $6,700
Primary Care Physician VisitSpecialist Visit
20% coinsurance
20% coinsurance
$0 copay
$0 copay
Inpatient HospitalDeductible:
Days 1-60Days 61-90
Days 91-150
In 2011 the rates are:$1,132
$0 $283 per day
$566 per lifetime reserve day
$0
Retail Pharmacy (30 day supply)
$10 generic; $45 preferred brand;
$95 non-preferred brand; 29% specialty
$0/$1.10/$2.60 – generic $0/$3.30/$6.50 for all other drugs
Preventive DentalRoutine office visit includes: annual exam, cleaning, x-rays
$15 routine office visit that includes denture adjustments
$0 in-network/20% out-of-network for dentures
$0 routine office visit that includes denture adjustments
$0 in-network/20% out-of-network for dentures
Transportation $0 copay for 24 one way trips $0 copay for 24 one way trips
Vision
$0 in-network/20% out-of network for routine eye exam every year
$200 yearly toward eyewear
$0 in-network/20% out-of network for routine eye exam every year
$200 yearly toward eyewear
Over-The-Counter $6 monthly allowance, accumulates throughout the year $6 monthly allowance, accumulates throughout the year
Gold Rx
• If you are a Medicare beneficiary with diabetes and/or heart failure, and do NOT receive full Medicaid, consider Gold Rx (Regional PPO SNP) or (PPO SNP).
• To be eligible for this plan, you must:– Live in the service area.– Have both Medicare Part A and Part B; and– Have been diagnosed with diabetes and/or
heart failure
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Gold Rx Highlights
• $0 monthly plan premium and low, predictable cost sharing
• Vision and transportation benefits
• Dental benefits (including denture adjustments)
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Gold Rx – Georgia & South Carolina (RPPO)
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Benefits What You Pay with Gold Rx Plan
Monthly Plan Premium $0
Maximum Out-of-Pocket $6,700
Primary Care Physician Copay
Specialist Copay
$30
$50
Inpatient Hospital
Days 1-15/ 16-90:
Days 91-150:
No deductible
$165 /$0 per day
$0 per lifetime reserve day
Retail Pharmacy
(30-day supply)
$8 generic; $45 preferred brand;
$95 non-preferred brand; 33% specialty
Preventive Dental
Routine office visit includes: annual exam, cleaning, x-rays
$10 routine office visit that includes denture adjustments
Transportation $0 copayment for 10 one way trips
Vision $25 for routine exam every year
$150 yearly toward eyewear
Dual Advantage
• Dual Advantage (PPO SNP) is a Special Needs Plan designed specifically for those who have both Medicare and full Medicaid.
• To be eligible for this plan, you must:– Live in the service area– Have both Medicare Part A and Part B; and– Have your Medicare Parts A and B cost
sharing covered by the State
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Dual Advantage Highlights
• $0 monthly plan premium and $0 cost sharing options for Medicare-covered services
• Vision and transportation benefits
• Dental benefits (including dentures; referral required)
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Dual Advantage – select counties
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Benefits What You Pay With Dual Advantage if You Are Medicare & Full Medicaid
Monthly Plan Premium $0
Maximum Out-of-Pocket $6,700
Physician Copay
Specialist Copay
$0
$0
Inpatient Hospital $0
Retail Pharmacy
(30-day supply)
$0 deductible
$0/$1.10/$2.60 – for generic
$0/$3.30/$6.50 for all other drugs
Preventive Dental
Routine office visit includes: annual exam, cleaning, x-rays
$0 routine office visit that includes denture adjustments
$0 in-network/20% out-of-network for dentures
Transportation $0 copayment for 20-22 one way trips
Vision $0 in-network/20% out-of-network for routine exam
$200 yearly toward eyewear
Medicare Advantage
• Medicare Advantage (Regional PPO) or (PPO) was specifically designed for beneficiaries with Medicare only– Such as caregivers and spouses of our
Special Needs Plan members
• To be eligible for this plan, you must:– Live in the service area– Have both Medicare Part A and Part B
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Medicare Advantage Highlights
• Affordable monthly plan premium and predictable cost sharing
• Vision and transportation benefits
• Dental benefits (including denture adjustments)
• Convenience of one health plan for everyone in your household
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Medicare Advantage – Georgia & South Carolina (RPPO)
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Basic and Additional Benefits What You Pay With the Medicare Advantage Plan
Monthly Plan Premium $70
Maximum Out-of-Pocket $6,700
Physician Copay
Specialist Copay
$35
$50
Inpatient Hospital
Days 1-15 /16-90:
Days 91-150:
No deductible
$175 /$0 per day
$0 per lifetime reserve day
Retail Pharmacy
(30-day supply)
$10 generic; $45 preferred brand;
$95 non-preferred brand; 27% specialty
Preventive Dental
Routine office visit includes: annual exam, cleaning, x-rays
$10 routine office visit that includes denture adjustments
Transportation $0 copayment for 12 one way trips
Vision $25 routine exam every year
$150 yearly toward eyewear
Prescription Drug Overview
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Part D Benefit• Comprehensive, low-cost Part D coverage
• Covers most generics and the common branded medications that are not excluded by Medicare
• Accepted at nearly 60,000 network pharmacies nationwide, including many national and local chains
• Mail-order pharmacy service is available for added convenience and savings
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Part D Benefit• A formulary (list of covered drugs) chosen
by our pharmacy experts to meet our member’s healthcare needs– Mailed to all members and available online
• www.careimprovementplus.com
– Use the formulary to:• See if your medications are covered• Determine the copayment for your medications
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“Extra Help”• People with limited incomes may qualify for
Extra Help to pay for their prescription drug costs.
• If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance.
• Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.
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“Extra Help” cont...
• Many people are eligible for these savings and don’t even know it. To see if you qualify for Extra Help, contact:– 1-800-MEDICARE (1-800-633-4227), (TTY: 1-
877-486-2048), 24 hours per day, 7 days per week.
– Social Security: 1-800-772-1213, 7 a.m. – 7 p.m., Monday-Friday. (TTY: 1-800-325-0778)
– Your State Medicaid Office
33
Low Income Subsidy• Beneficiaries with Low Income Subsidy
(LIS) receive help paying their drug costs– Various levels depending on individual factors– $0-$2.60 or 15% for generics or $0 - $6.50 or
15% for others– Coverage through the gap (“donut hole”)
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Coverage Gap
• Most Medicare drug plans have a coverage gap (“donut hole”).
• This means there’s a temporary limit on what the drug plan will cover for drugs.
• Not everyone will enter the coverage gap.
• The coverage gap begins after you and the plan have spent a certain amount for covered drugs.
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Coverage Gap cont…• The member reaches the coverage gap once
they have spent $2,930 in drug spend – what the members plus (+) what the plan pays
• Once a member enters the coverage gap, they pay 50% of the cost of brands and 86% for generics until the total amount paid reaches the out-of-pocket limit.
• Members who receive LIS still have coverage during the coverage gap.
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Additional Services
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Our Commitment• Care Improvement Plus remains
committed to our members and to the Medicare Community at-large.
• Care Improvement Plus members receive the extra help they need through valuable programs such as:– Comprehensive Care Management– 24/7 Nurse Hotline – HouseCalls– PharmAssist
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Care Management
• Supports, helps, and assists people living with long-term chronic illnesses
• Provides personalized care to meet individual needs of members– Nursing support – Medication monitoring/counseling– Health education– Tools to help manage your health
• in-home monitoring equipment (if needed)
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Care Coordination
• The management of healthcare between doctor visits coordinated among multiple providers.
• Making sure you are getting the right care at the right time.
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24/7 Nurse Hotline
• Information and support when you need it– Nurses are available 24 hours a day to
answer health-related questions
• Communicate better with your provider– Call before or after you see your doctor to
make the most of your appointment.
• Guidance for difficult decisions– The more you know, the better decision you
can make.
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Social Service Coordinators
• Available to help determine your eligibility for state, local and federal programs that can assist with expenses such as– Medical costs– Prescription drugs– Heating and electric bills– Housing/rent– Meals– Legal
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HouseCalls• In-person visit with a physician or nurse
practitioner who performs a health assessment to: – Gather information to help Care Improvement
Plus provide additional health education and care coordination
– Identify urgent health problems or health risks– Provide advice on health-related topics to discuss
at the next appointment with provider
• No additional cost to members• All members are eligible for this program
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PharmAssist
• Specialist Pharmacists are available for personalized, private counseling– Review of medications to avoid duplication– Educate members about their medications– Ensure medications are being taken as
prescribed– Assess needs for any new drugs– Discuss any issues with physician
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How to Enroll
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So...How Do You Choose?Factors to consider when choosing your plan:
– Health needs- How often and for what services will you use the plan most often?
– Cost- Compare your current out of pocket costs including monthly premium, copayment and coinsurance amounts.
– Providers- Are your providers (doctors and hospitals) Medicare-approved? And are they willing to accept payment from the plan?
– Benefits- Does the plan offer you the coverage and benefits you need including valuable extras at no additional cost?
46
Keep in Mind
• No matter which Care Improvement Plus plan you choose to join, you are still part of the Medicare program and you must continue to pay your applicable Medicare premiums.
• Care Improvement Plus is not a “stand-alone” Part D plan (PDP)
• Care Improvement Plus is not a Medicare Supplement plan (Medigap)
47
Keep in Mind
• If you currently have a Medicare Supplement or Medigap plan, you should not cancel or stop paying your premiums until your enrollment in Care Improvement Plus has been confirmed by Medicare.
• If you currently have Medicare Advantage (MA), Medicare Advantage Part D (MAPD) or Part D coverage you will be automatically disenrolled from your plan by Medicare upon your effective date with Care Improvement Plus.
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Important Dates
49
In 2011 Description In 2012
October 15 – December 7 Annual Enrollment Period (AEP) begins.
You can enroll or dis-enroll in a Medicare Advantage health plan.
Annual Disenrollment Period (ADP) begins.
January 1 – February 14
Special Election Period• If you have diabetes, heart failure or
Medicaid/Low Income Subsidy (LIS), you may enroll in a Care Improvement Plus Special Needs Plan ANYTIME during the year by exercising a “Special Election Period”.
• There are other times you are eligible for a special election period; for example:– If you permanently move to another service
area– Other Medicare-approved circumstances
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How to Enroll
Four Easy Steps
1. Decide which plan is best for you.
2. Complete the enrollment application and other applicable paperwork.
3. Receive an education call.
4. Become a Care Improvement Plus member!
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What Happens Next?
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Temporary Proof of Coverage
• Once you complete the enrollment application, you will have a Temporary Proof of Coverage document in the Enrollment Guide.– This provides you with proof of your
application for enrollment and important contact information until your Care Improvement Plus ID card and Welcome Kit arrives.
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Temporary Proof of Coverage
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Enrollment Verification Call
• You will receive a phone call from Member Services within 15 days of Care Improvement Plus receiving your completed enrollment application verifying your choice to participate in our plan.
• We will also discuss our unique programs that are available to you as a member of our plan.
55
Member ID & Welcome Kit
• Within 10 days of Care Improvement Plus receiving your completed enrollment application, you will receive:– A copy of your completed enrollment
application– Your new Member ID Card
• Upon Medicare confirming your enrollment in Care Improvement Plus, you will receive your new Member Welcome Kit
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Member ID Card
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Front Back
Benefit Notes• You must continue to pay your Medicare
Part B premium. If the State pays your Part B premium, you will not be responsible for paying your Part B premium.
• In 2011, the annual Part B deductible was $162 and may change for 2012.
• Cost sharing may vary based on the level of help that beneficiaries may receive.
58
Benefit Notes cont...• Care Improvement Plus is a Medicare Advantage
organization with a Medicare contract. • The Care Improvement Plus contract with CMS is
renewed annually and coverage availability beyond the end of the current contract year is not guaranteed.
• The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information, contact the plan.
• Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change on January 1, 2013.
• Benefit limitations, copayments and restrictions may apply.
59
Benefit Notes cont...• Members must use network pharmacies to access
their prescription drug benefit, except under non-routine circumstances. Quantity limitations and restrictions may apply.
• If there is no network provider available for you to see, you may visit an out-of-network provider that is contracted with Medicare and willing to accept payment from Care Improvement Plus.
• Except for emergency or urgent care situations, it may cost more to get care from out-of-network providers.
• Contact the plan for details.
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Plan Eligibility Status Change• Care Improvement Plus may end your
membership in the plan if you do not meet the plan’s eligibility requirements:– CSNP: If we are unable to confirm with your doctor
that you have diabetes or heart failure, you will have 60 days to confirm your eligibility before we end your membership.
– DSNP: If you no longer have full Medicaid (your A/B cost sharing is no longer covered by the State), you will have 6 months to regain eligibility before we end your membership.
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Thank You!
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For more information:• “Medicare and You 2012” handbook
• www.medicare.gov
• Your local State Health Insurance Program (SHIP)
• Visit us at:
www.careimprovementplus.com
• Contact us at: [email protected]
Prospective Members:1-800-711-1656 (TTY: 711)
Member Services:1-800-204-1002 (TTY: 711)
8:00 am – 8:00 pm, 7 days a week
Send completed applications to:Care Improvement PlusP.O. Box 691350San Antonio, TX 78269-1350Attn: Enrollment Department
For overnight applications: Care Improvement Plus 4350 Lockhill-Selma RoadSan Antonio, TX 78249Attn: Enrollment Department(210) 587-2111
Care Improvement Plus
Specialized Care for Medicare Beneficiaries
63
Y0072_OE12_6211_A_GA SC_CMS Approved 09262011
