Embed Size (px)
Citation preview
one oneTO
NEWSLETTER FOR MEDICARE ADVANTAGE MEMBERS
Y0010_MK13119 Accepted 10152012
FALL 2012
You’re in Control When it comes to your insurance needs, you’re the expert
-How to comparison shop
- The facts on fl u
IS-15631_MIS1204NBCI_SR.indd 1 10/11/12 10:22 AM
bcidaho.com/medicare blue cross of idaho 2
one to one
with summer behind us and the holiday season just ahead, many people are taking a well-deserved deep breath. Fall is a good time to pause and refl ect. Gather your thoughts and focus your goals for the remainder of the year.
If better health and smarter spending are among your goals, here are a few reminders to help you. Check out the discounted services and products available to our Medicare members at bcidaho.com/Health_Wellness/discount_services.asp. If you haven’t had your annual health check up yet, call your doctor today. These appointments let your doctor assess your overall health and look out for serious (and costly!) problems.
Lastly, we hope you’ll take time to review the valuable information about our plans in this issue of One to One. This newsletter is just one of the many ways we try to help you achieve your health goals.
if you have friends who might be interested in health coverage offered
by Blue cross of idaho, pass on this issue of One to One. or have them
call us at 1-888-494-2583 for more information. the hearing-impaired
can call ttY 1-800-377-1363. We are available from 8 a.m. to 8 p.m.,
seven days a week.
PASS IT ON
IS-25631_MIS1204NBCI_SR.indd 2 10/10/12 4:38 PM
blue cross of idaho 3 bcidaho.com/medicare
medication updateThe brand-name drugs below have recently been released in a generic form. Generics are a safe and effective way to lower the cost of your medications. For a complete listing of medications on our formulary, visit bcidaho.com/ma_formulary.
Brand name Generic name medication UseZiagen abacavir Infectious Disease
Detrol tolterodine Bladder/ Kidney (Urinary Agents)
Duac Gel clindamycin/benzoyl peroxide gel
Dermatologic
Clarinex 5mg desloratadine Respiratory
Plan B One Step levonorgestrel Women's Health
Singulair montelukast Respiratory
Actos pioglitazone Diabetes
Actosplus Met pioglitazone/metformin Diabetes
Getting your flu vaccine can help prevent the spread of the virus in your community throughout the flu season. The flu shot also helps protect you from getting seriously ill, especially if you have existing chronic medical conditions like asthma or COPD.
Even better? It’s free! Blue Cross of Idaho Medicare Advantage members have a $0 cost share on flu shots.
You can get your flu shot at your doctor’s office. Or, remember that many pharmacies provide flu shots. Get your flu shot and pick up your prescriptions at the same time!
Learn more flu facts at cdc.gov/flu.
Flu Facts
the clock is ticking:
december 7th is the
last day to select or
change your plan
for 2013 coverage.
still have questions?
call customer
service for help at
1-888-494-2583,
ttY users can call
1-800-377-1363.
We are available from
8 a.m. to 8 p.m.,
seven days a week.
Last Chance!
IS-35631_MIS1204NBCI_SR.indd 3 10/10/12 4:38 PM
Secure Blue PPO
True Blue HMO
Prime 65 A, F, K, M and N
Are prescribed drugs covered?
Yes. Yes, true Blue Hmo Rx Option I covers generics in the gap and has no drug deductible
no.
Can I get healthcare from any doctor or hospital?
Yes, in- and out-of-network providers are covered.
You must select from plan’s participating providers, except when urgent or emergency care is needed.
Yes.
Do I need a referral to see a specialist?
no. no, but prior authorization is required for some services.
no.
Where is the plan available? In other words, what is the service area?
available in the following counties: ada, adams, Bannock, Benewah, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, canyon, caribou, cassia, clark, elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, madison, minidoka, nez Perce, oneida, owyhee, Payette, Power, shoshone, twin Falls, Valley, and Washington
available statewide.
What are the eligibility requirements for this plan?
You must be:- entitled to medicare benefi ts
under Part a.- enrolled in Part B and continue to
pay your Part B premium.- reside in the plan service area.
You must be:- enrolled in medicare Part a and Part B.
YOU KNOW BESTWhen it comes to considering your insurance coverage, you’re the expert. determine your priorities, educate yourself on your options, and then make your choice!
start HereIt’s important to choose a plan that’s affordable for you, but it’s also essential to fi nd coverage that suits your lifestyle. To assess your needs, fi rst ask yourself if you:
- Have any health issues?
- Have any fi nancial concerns?
- Have an active lifestyle?
- Travel frequently?
- Want to choose your doctors and hospitals, even if it costs more?
- Take several prescription drugs?
- Do you wear glasses and want help paying for eyewear?
- Want a plan that covers both routine and preventive care?
- Want freedom from claims forms?
- Are you are enrolled in Medicare Part A and Part B?
KeY QUestionsonce you know your priorities, you can better review your choices. to get you star ted, here’s an overview of the plans Blue cross of idaho offers:
IS-4
blue cross of idaho bcidaho.com/medicare 4
You wouldn’t purchase a car or buy an appliance without weighing your options, would you? Well, the same applies to selecting the right healthcare coverage. It’s a big decision that deserves careful consideration. Choose the best coverage plan for your needs, by doing your homework and being an informed consumer. Think about your needs, your budget and your health.
And let’s be honest: When Medicare is part of the mix, things can get a bit more complicated. Fortunately, Blue Cross of Idaho offers Medicare Advantage plans, which are an alternative to Original Medicare and provide comprehensive coverage and affordable pricing.
Let’s take a closer look at the process of assessing your options—plus the Medicare Advantage plans Blue Cross of Idaho offers.
5631_MIS1204NBCI_SR.indd 4 10/10/12 4:38 PM
Secure Blue PPO
True Blue HMO
Prime 65 A, F, K, M and N
Are prescribed drugs covered?
Yes. Yes, true Blue Hmo Rx Option I covers generics in the gap and has no drug deductible
no.
Can I get healthcare from any doctor or hospital?
Yes, in- and out-of-network providers are covered.
You must select from plan’s participating providers, except when urgent or emergency care is needed.
Yes.
Do I need a referral to see a specialist?
no. no, but prior authorization is required for some services.
no.
Where is the plan available? In other words, what is the service area?
available in the following counties: ada, adams, Bannock, Benewah, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, canyon, caribou, cassia, clark, elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, madison, minidoka, nez Perce, oneida, owyhee, Payette, Power, shoshone, twin Falls, Valley, and Washington
available statewide.
What are the eligibility requirements for this plan?
You must be:- entitled to medicare benefi ts
under Part a.- enrolled in Part B and continue to
pay your Part B premium.- reside in the plan service area.
You must be:- enrolled in medicare Part a and Part B.
When it comes to considering your insurance coverage, you’re the expert. determine your priorities, educate yourself on your options, and then make your choice!
start HereIt’s important to choose a plan that’s affordable for you, but it’s also essential to fi nd coverage that suits your lifestyle. To assess your needs, fi rst ask yourself if you:
- Have any health issues?
- Have any fi nancial concerns?
- Have an active lifestyle?
- Travel frequently?
- Want to choose your doctors and hospitals, even if it costs more?
- Take several prescription drugs?
- Do you wear glasses and want help paying for eyewear?
- Want a plan that covers both routine and preventive care?
- Want freedom from claims forms?
- Are you are enrolled in Medicare Part A and Part B?
KeY QUestionsonce you know your priorities, you can better review your choices. to get you star ted, here’s an overview of the plans Blue cross of idaho offers:
IS-5
blue cross of idaho bcidaho.com/medicare 5
5631_MIS1204NBCI_SR.indd 5 10/10/12 4:38 PM
tHe detaiLsnow that you have a feel for your needs and priorities, take time to learn the details about each plan.
IS-6
blue cross of idaho bcidaho.com/medicare 6
comparison shoppingare you thinking of changing your coverage?
We can help you fi nd the right Blue cross
of idaho plan for your needs. after
all, changing your coverage
doesn’t have to mean sacrificing
the service you’re accustomed to.
Visit bcidaho.com/medicare and
select compare Plans to learn more.
You can call us at 1-888-494-2583.
if you’re hearing-impaired, call ttY
1-800-377-1363.
Secure Blue PPO
A preferred provider organization (PPO) plan, Secure Blue PPO gives you fl exibility in controlling out-of-pocket costs, along with the freedom to visit the provider of your choice.
- No specialist referrals required.
- The Visitor/Travel program provides access to in- and out-of-network providers in Idaho plus 30 states and one U.S. territory with Blue Cross and Blue Shield Medicare Advantage PPO plans.
- Protection from unexpected healthcare costs.
- Low out-of-pocket limits.
- Extended formulary with more than 4,500 drugs.
- Benefi ts beyond Original Medicare including vision and eyewear, health and wellness education, and emergency care services available worldwide.
- Available with and without Part D drug coverage.
- $93 for Secure Blue PPO with Part D drug coverage.
- $63 for Secure Blue PPO with Part D drug coverage in Ada, Boise, Canyon, Gem, and Owyhee counties.
- $40 for Secure Blue PPO without drug coverage.
True Blue HMO
This health maintenance organization (HMO) plan offers coverage with affordable premiums and predictable costs.
- With three variations; you choose the level of coverage that fi ts you best.
- True Blue HMO Rx Option I: Security with the coverage you’ve come to know, no deductible and coverage for generics in the gap.
- True Blue HMO Rx Option II:No need to pay for drug coverage you don’t use. With a lower premium, you pay a deductible and a lower percentage for your medications in the gap.
- True Blue Freedom HMO: For those who want the security of a lower cost Blue Cross of Idaho plan with Part D drug coverage and are willing to pay a bit more out-of-pocket.
- Local providers you know and trust; more than 2,200 participating network providers.
- No specialist referrals required.
- Out-of-Idaho travel benefi ts.
- Benefi ts beyond Original Medicare including vision and eyewear, health and wellness education, and
emergency care services available worldwide.
- $142 for True Blue HMO Rx Option I with Part D prescription drug coverage.
- $121 for True Blue HMO Rx Option II with Part D prescription drug coverage.
- $24 for True Blue Freedom HMO with Part D prescription drug coverage.
- $30 for True Blue HMO without drug coverage.
5631_MIS1204NBCI_SR.indd 6 10/10/12 4:38 PM
tHe detaiLsnow that you have a feel for your needs and priorities, take time to learn the details about each plan.
IS-7
blue cross of idaho bcidaho.com/medicare 7
comparison shoppingare you thinking of changing your coverage?
We can help you fi nd the right Blue cross
of idaho plan for your needs. after
all, changing your coverage
doesn’t have to mean sacrificing
the service you’re accustomed to.
Visit bcidaho.com/medicare and
select compare Plans to learn more.
You can call us at 1-888-494-2583.
if you’re hearing-impaired, call ttY
1-800-377-1363.
True Blue HMO
This health maintenance organization (HMO) plan offers coverage with affordable premiums and predictable costs.
- With three variations; you choose the level of coverage that fi ts you best.
- True Blue HMO Rx Option I: Security with the coverage you’ve come to know, no deductible and coverage for generics in the gap.
- True Blue HMO Rx Option II:No need to pay for drug coverage you don’t use. With a lower premium, you pay a deductible and a lower percentage for your medications in the gap.
- True Blue Freedom HMO: For those who want the security of a lower cost Blue Cross of Idaho plan with Part D drug coverage and are willing to pay a bit more out-of-pocket.
- Local providers you know and trust; more than 2,200 participating network providers.
- No specialist referrals required.
- Out-of-Idaho travel benefi ts.
- Benefi ts beyond Original Medicare including vision and eyewear, health and wellness education, and
emergency care services available worldwide.
- $142 for True Blue HMO Rx Option I with Part D prescription drug coverage.
- $121 for True Blue HMO Rx Option II with Part D prescription drug coverage.
- $24 for True Blue Freedom HMO with Part D prescription drug coverage.
- $30 for True Blue HMO without drug coverage.
Other Options
Prime 65 medicare supplement:
In addition to Medicare Advantage plans, we offer fi ve different Prime 65SM Medicare Supplement insurance plans: A, F, K, M and N. We don’t require a health questionnaire for members who move from our Medicare Advantage plans to our Medicare Supplement plans, and we won’t turn you down for health reasons. There are several options with no waiting periods for preexisting conditions. If you’d like to know more about Prime 65, call us or visit our website at bcidaho.com/medicare.
5631_MIS1204NBCI_SR.indd 7 10/10/12 4:38 PM
Impo
rtan
t pla
n in
form
atio
n.
Keep your smile healthy by visiting your dentist regularly. Blue Cross of Idaho offers Healthy Smiles. These standalone dental plans use our PPO network of more than 900 contracting PPO dentists.
Healthy Smiles Preventive: No maximum limits, no in-network deductibles and no waiting periods. You get 100 percent coverage for in-network preventive services after a $20 copayment.- Regular and emergency
oral exams, cleanings or periodontal maintenance
- Bitewing, periapical and full mouth X-rays
- $20.03 per month for those over 64
Healthy Smiles Plus: The same coverage as Healthy Smiles Preventive, plus additional basic services after six months and a $50 deductible
(in-network preventive services don’t apply to deductible).- All Healthy Smiles Preventive
benefits plus fillings and extractions- $1,000 benefit period coverage limit- $30.95 per month for those over 64
Healthy Smiles Preferred: Offers comprehensive coverage for preventive, basic and major services. You can carry over unused benefit dollars from year to year.- All Healthy Smiles Plus benefits
as well as crowns, bridges, dentures, implants, root canals and periodontics
- $1,000 benefit period coverage limit- $48.07 per month for those over 64
Want to enroll or learn more? Give us a call at 1-888-494-2583. We can answer your questions or send you more information.
Say Cheese!30
00 E
. Pin
e A
ve.
Mer
idia
n, ID
836
42bc
idah
o.co
m/m
edic
are
1-88
8-49
4-25
83 Pu
blis
hed
by M
cMur
ry. ©
201
2. A
ll ri
ghts
res
erve
d. N
o m
ater
ial
may
be
repr
oduc
ed i
n w
hole
or
in
part
fro
m t
his
publ
icat
ion
wit
hout
the
exp
ress
wri
tten
per
mis
sion
of
the
publ
ishe
r. T
he
info
rmat
ion
in t
his
publ
icat
ion
is i
nten
ded
to c
ompl
emen
t—no
t ta
ke t
he p
lace
of—
the
reco
mm
enda
tion
s of
you
r he
alth
care
pro
vide
r. C
onsu
lt y
our
phys
icia
n be
fore
mak
ing
maj
or
chan
ges
in y
our
lifes
tyle
or
heal
thca
re r
egim
en. M
cMur
ry m
akes
no
endo
rsem
ents
or
war
rant
ies
rega
rdin
g an
y of
the
prod
ucts
and
serv
ices
incl
uded
in th
is p
ublic
atio
n or
its a
rtic
les.
PR
SR
T S
TD
U
.S. P
OS
TAG
E
PA
IDO
ne
to O
ne
IS-8
IS
5631_MIS1204NBCI_SR.indd 8 10/10/12 4:38 PM
