Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Other pharmacies/physicians/providers are available in our network. Other plans may be available in the service area.
H7220_CHP11214 CMS Approved 8.10.2011
Notes
Choose coverage that’s right for you
Cost
n What will you pay out-of-pocket? Include monthly premium, deductibles, copays and coinsurance.
Benefits
n What “extras” are covered? Is there coverage for dental and vision services? Are there other wellness benefits?
Choice of doctors and hospitals
n Can you visit doctors you prefer? Are the hospitals you like part of the plan?
Convenience
n Are the doctors’ offices and hospitals close to your home?
n What about the pharmacies—are local and national pharmacies part of the plan?
Prescription drugs
n Are your drugs covered under the plan’s formulary (list of covered drugs)?
n What will your drugs cost under each plan?
As a Medicare beneficiary, you have many options for health coverage. Selecting a plan to meet all of your healthcare and wellness needs means evaluating these important factors:
As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (fee-for-service) Medicare plan. Another option is a Medicare Advantage plan like the three plan choices offered by IU Health Plans. No matter what you decide, you are still in the Medicare program. You may join or leave a plan only at certain times. Please call us for more information.
Start
Step 1: Decide how you want to get your coverage
Step 2
Step 3: Decide if you need to add supplemental coverage
Original Medicare
Steps to help you decide
Mark your calendar with these important dates
Oct. 15 – Dec. 7, 2011 Annual Election Period begins—Time to choose or change your Medicare health or prescription drug plan for 2012.
There may be other times when you can switch your coverage. These are called Special Enrollment Periods.
Part A Hospital Insurance
Part B Medical Insurance
All-In-One Policy
Combines Part A, Part B, and in most plan options, Part D prescription drug coverage
Part D
Prescription Drug Coverage
End
Medigap (Medicare Supplement Insurance) policy
If you join a Medicare Advantage plan, you don’t need and can’t be sold a Medigap policy.
or Medicare Advantage Plan (like IU Health Plans)
Why IU Health Plans?
Affordable, flexible plans
n Premiums as low as $0
n Plans with prescription drug coverage, including some over-the- counter medications
n Affordable hospitalization if you need it
n Wellness-focused plans with fitness center membership options
n Plan option that allows out-of-network care Nationally recognized doctors and hospitals
n Access to Indiana University Health—the only health system in Indiana to be consistently ranked among America’s best hospitals by U.S.News & World Report
n Strong network of doctors you trust with IU Health and Community Health Network
Local company, personal service
n Enrollment and customer service handled close to home
n Knowledgeable, friendly customer service associates and enrollment specialists
n Personalized help with care coordination (medication, specialists, etc.)
Compare IU Health Plans
The charts on the following two pages will help you compare the three plans offered by IU Health Plans. Members of IU Health Plans receive all the benefits of Original Medicare, plus some important extras. The charts list some of these benefits, but not all available benefits.
If you value comprehensive health benefits, personalized service and a dedicated focus on wellness and prevention, consider IU Health Plans. Our Medicare Advantage program, which has received Medicare’s highest (5 star) member satisfaction rating, offers:
Which Medicare Advantage plan is right for me?
Inpatient – Hospital/Mental Health
$210 days 1-5
$0 days 6-90 $265 days 1-5
$0 days 6-90 $195 per admission 30% Skilled Nursing
(No hospital stay required)
$0 days 1-20
$75 days 21-100 $0 days 1-20
$75 days 21-100 $0 days 1-20
$75 days 21-100 30%
Home Health $0 $0 $0 30%
Primary Care
Physician $25 $25 $15 30%
Specialist $40 $50 $35 30%
Chiropractor $20 $20 $20 30%
Podiatry $15 $15 $10 30%
Outpatient Surgery $210 $265 $195 30%
Ambulance $65 $65 $65 30%
Emergency $65 $65 $65 (worldwide) $65 (worldwide)
Urgent Care $50 $50 $50 $50
Durable Medical
Equipment 10% 10% 10% 30%
Diagnostic Tests/
Lab $10 $10 $0 30%
X-rays/ Therapeutic
Radiology $25 $25 $25 30%
Diagnostic Radiology $35 $35 $35 30%
Part B Covered Drugs 20% 20% 20% 30%
Diabetic Supplies $0 $0 $0 $0
Annual Deductible $0 $0 $0 $0
Monthly Premium*
$0 – Reduces your Part B premium up to $20 ea. month
$63.90 $122.70
WhAt Iu hEALth PLANS MEMBErS PAy Medicare-Covered
Benefit Medicare Select
hMO Medicare Select
Plus hMO In-NetworkMedicare Choice hMO-POSOut-of-Network
Inpatient/home health Care
Outpatient Care/Services/Supplies
WhAt Iu hEALth PLANS MEMBErS PAy Medicare-Covered
Benefit Medicare Select
hMO Medicare Select
Plus hMO In-Network Out-of-Network
Routine Vision Exam $15 $15 $0 Not covered
Eyeglasses
(lenses/frames) $40 $40 $40 Not covered
Out-of-Pocket Cost
Protection $4,500 $5,000
Tier 1 (Generic) Not covered $5.50 31 day
$13.75 90 day $5 $10 31 day90 day Not covered Tier 2 (Preferred) Not covered $35 31 day
$87.50 90 day $35 $70 31 day 90 day Not covered Tier 3 (Non
Preferred) Not covered $85 31 day
$212.50 90 day $85 $170 31 day 90 day Not covered Tier 4 (Specialty) Not covered 30% 31 day 30% 31 day Not covered Coverage Gap after
$2,930 until out-of-pocket is
$4,700
Not covered 50% Discount Brand
86% Generic 50% Discount Brand
$10 Generic 31 day
$20 Generic 90 day
Not covered
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. *You must continue to pay your Medicare Part B premium.
Medicare Choice hMO-POS
Annual Deductible $0 $0 $0 $0
Preventive
Screenings $0 $0 $0 Not covered
Annual Physical
Exam $0 $0 $0 Not covered
Health Club
Membership $25 $25 $25 Not covered
Preventive Dental $10 $10 $10 Not covered
Plan Limit No limit No limit No limit $10,000
Preventive Services for Bone Mass Measurement, Pap/Pelvic Screening, Colorectal Cancer Screening, Mammogram, Flu/Pneumonia Vaccines, Prostate Cancer Screening and More
Additional Benefits and Wellness Programs
Member Maximum Out-Of-Pocket Medical Cost
$4,500
Part D Prescription Drugs
Eligibility—who can join?
Individuals must have both Part A and Part B to enroll with IU Health Plans Medicare Advantage program. You must live in the service area, which includes these counties: Benton, Blackford, Boone, Brown, Carroll, Clay, Clinton, Delaware, Grant, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Jay, Johnson,
Lawrence, Marion, Monroe, Morgan, Orange, Owen, Parke, Putnam, Randolph, Shelby, Tippecanoe, Tipton, Vermillion, Vigo and White. Individuals with End Stage Renal Disease are generally not eligible to enroll unless they have had a successful kidney transplant. how can I get help with my prescription drug costs?
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call 800.MEDICARE (800.633.4227). TTY users should call 877.486.2048, 24 hours a day/7days a week; the Social Security Office at
800.772.1213 between 7 am and 7 pm Monday through Friday. TTY users should call 800.325.0778; or Your Medicaid Office. People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it.
Frequently asked questions
Prospective members often ask these questions about IU Health Plans Medicare Advantage plans. If you have others, please contact our Customer Solutions Center.
Can I choose my doctors?
Answer: Enrolling with IU Health Plans means you have access to the largest, most comprehensive health system in the state. Doctors, specialists and hospitals affiliated with IU Health and Community Health Network are part of our network. You may use any doctor who is part of our network. In some cases, you may also go to a doctor outside of our network. Please keep in mind that the health providers in our network can change at any time. A current provider directory with an up-to-date list of network doctors is available at iuhealthplansmedicare.org or call us to help you find a doctor. You must use plan providers except in emergency or urgent care situations. If you obtain routine care from out-of-network providers neither Medicare nor IU Health Plans will be responsible for the costs in all IU Health Plans options except IU Health Plans Medicare Choice.
Will I still need to pay my Part B monthly premium?
Answer: Yes. You must continue to pay your Part B premium. This is a Medicare requirement regardless of whether or not you enroll in a Medicare Advantage plan.
Note: IU Health Plans Select plan reduces your Part B premium. If you have questions about your Part B premium, call Social Security at 800.772.1213. TTY users should call 800.325.0778. What are Part B drugs and how are they different from Part D drugs? Answer: Part B drugs are defined by Medicare and includes a limited number of drugs such as injections you get in a doctor’s office, certain oral cancer drugs, drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump) and under very limited circumstances, certain drugs you get in a hospital outpatient setting. Part D drugs are ordered from a retail pharmacy or mail-order vendor and are listed on a formulary of covered drugs.
Can I keep my current Part D plan?
Answer: No. You can’t have two Part D plans. Your premium with IU Health Plans includes Part D coverage with either the Choice or Select Plus options. (Note: You may have other prescription coverage (not Part D), like employer or union, military, or Veterans’ benefits.)
What is “the gap?”
Answer: The coverage gap (also called the “donut hole”) means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Not everyone will reach the coverage gap. Your yearly deductible, your coinsurance or copayments, and what you pay in the coverage gap all count toward this out-of-pocket limit. The limit doesn’t include the drug plan premium you pay or what you pay for drugs that aren’t covered. If you reach the coverage gap, you will get a 50% discount on covered brand-name prescription drugs at the time you buy them. Once you reach your plan’s out-of-pocket limit, you automatically get “catastrophic coverage.” Catastrophic coverage assures that once you have spent up to your plan’s out-of-pocket limit for covered drugs, you only pay a small coinsurance amount or copayment for the drug for the rest of the year.
(IU Health Plans Medicare Choice will still cover generic drugs during the gap.)
What happens if I get sick away from home or out of the coverage area?
Answer: You are covered for urgent and emergency care for up to six months. Follow-up care must be authorized. (IU Health Plans Medicare Choice will cover you for urgent and emergency care outside of the United States.)
Are hearing aids and dentures covered? Answer: These are not covered as a benefit.
Frequently asked questions (continued)
What is Member Maximum Out-of-Pocket Medical Expense (or cost)?
Answer: There is catastrophic protection against how much you pay out of your pocket for certain covered healthcare services each year. After this level is reached, you will have 100% coverage and not have to pay any out-of-pocket costs for the remainder of the year for your covered medical services. Part D prescription drugs do not count toward the limit. You will have to continue to pay your monthly premium, if your plan has a premium.
With the Iu health Plans Medicare Choice Point of Service (POS) plan, is there a maximum on how much the plan will pay for out-of-network care?
Answer: Yes. Each year, your plan will pay up to $10,000 for Medicare-approved, out-of-network services. After the $10,000 limit is reached, you will be responsible for 100% of charges for out-of-network services.
Call us for more information
Contact the IU Health Plans Customer Solutions Center at 800.455.9776. TTY users call Relay Indiana at 800.743.3333. Customer Solutions Center hours:
Oct. 15 to Feb. 14 – 8 am to 8 pm seven days a week. Feb. 15 to Oct. 14 – 8 am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 5:00 p.m., on weekends, and holidays.
Also visit our website at iuhealthplansmedicare.org.
Medicare beneficiaries may enroll in a plan only during specific times of the year. Contact IU Health Plans for details. This document is available in alternative formats upon request by calling our Customer Solutions Center.
Customer Solutions Center hours:
Oct. 15 to Feb. 14 – 8 am to 8 pm seven days a week. Feb. 15 to Oct. 14 – 8 am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 5:00 pm, on weekends, and holidays.
