Choosing a Medicare Advantage
plan you’ll be
confident
in.
Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Continued enrollment depends on the contract between CMS and the Plan/Part D Sponsor remaining in effect, i.e., being renewed and not terminated. Other pharmacies/physicians/providers
You should never have to worry
about your
Medicare coverage.
Medicare coverage from
one of the
most respected
names in Indiana.
Cost
n What will you pay out-of-pocket? Include monthly premium, deductibles, copays and coinsurance. Benefits
n What “extras” are covered?
n Is there coverage for dental and vision services? n Are there other wellness benefits?
Choice of doctors and hospitals n Can you visit doctors you prefer?
n 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:
Trust one of the highest-rated Medicare Advantage plans in the state —
Indiana University Health Plans. Our Medicare Advantage program has
received an overall rating of 4½ stars from the Centers for Medicare &
Medicaid Services (CMS) for the last three years.*
You’ll find a wide range of valuable health benefits and improvement
programs focused on keeping you healthy. We have been serving Hoosiers
for 23 years, and more than 8,700 members trust our locally based plans
because they are convenient, affordable and high quality, with resources and
programs to help you live healthy and stay strong.
Call us to find out more.
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. 1 to Feb. 14 – 8 am to 8 pm seven days a week. Feb. 15 to Sept. 30 – 8 am to 8 pm Monday through Friday.
You may receive assistance through alternate technology after 8 pm, on weekends, and holidays.
Also visit our website at IUHPlansforyou.org
*Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A
B
A+B=
C
D
+
D
MED SUPP
ADDITIONAL POLICY
OR
STANDARD MEDICARE
Part Ahelps with hospital costs. Part B
helps with doctor and outpatient costs.
Part D
assists with prescription drugs.
Part D
offered in many Medicare Advantage plans, drug coverage that is either built-in or can be an optional add-on.
Additional benefits may be included, such as vision, dental
and hearing services.
Medicare supplement insurance plans
cover some costs not covered in Parts A & B.
Part C one plan that covers hospital costs, doctor
and outpatient care.
Medicare Advantage (Part C) - ONE POLICY is provided by private companies approved by Medicare.
Medicare pays a fixed fee to the plan for your care. Then the plan pays the doctors and hospitals.
Medicare (Parts A & B)
is provided by the government and government subcontractors. Medicare pays feed for your care directly to the doctors and hospitals you visit. Some people call this “fee for service.”
ADDITIONAL POLICY
Information to help
you decide.
With IU Health Plans,
you’re covered.
As a Medicare beneficiary, you can choose from different Medicare options.
One option is the Original (
fee-for-service
) Standard 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.
IU Health Plans offers comprehensive health benefits, personalized service
and a dedicated focus on wellness and prevention.
Our Medicare Advantage program, which has received Medicare’s 4½ star
overall plan rating for quality and performance,* offers:
Mark your calendar with these important dates
Oct. 15 – Dec. 7, 2013 Annual Election Period—Time to choose or change your Medicare Advantage health or prescription drug plan coverage for 2014.
There may be other times when you can switch your coverage. These are called Special Enrollment Periods.
Medicare
(Parts A, B, C & D)
Compare
IU Health plans
The charts on the following two pages will help you compare the three plans offered by IU Health Plans. Our members receive all the benefits of Original Medicare, plus some important extras. The charts list some, but not all available benefits.
*Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
Affordable, flexible plans
n Premiums as low as $0, reducing Part B premium up to $25/mo.
n Affordable hospitalization if needed
n Plans with and without prescription drug coverage n Plan option that allows out-of-network care
n Fitness center reimbursement, up to $150 per year Nationally recognized doctors and hospitals
n Eleven clinical programs ranked among the top 50 national programs in U.S.News & World Report’s 2013-14 Best Hospitals report
n Strong network of doctors you trust with IU Health
n A growing list of additional doctors and hospitals throughout the state 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.)
Which Medicare Advantage Plan
is right for me?
Inpatient – Hospital/Mental Health
$225 days 1-7 IP Hosp. $225 days 1-6 IP Ment. Hlth.
$225 days 1-7 IP Hosp. $225 days 1-6 IP Ment. Hlth.
$195 days 1-7 50%
Skilled Nursing (No hospital stay required)
$0 days 1-5 $20 days 6-20
$80 days 21-100
$0 days 1-5 $20 days 6-20 $95 days 21-100
$0 days 1-5 $20 days 6-20
$80 days 21-100 50%
Home Health $0 $0 $0 50%
Primary Care
Physician $0 $15 $10 50%
Specialist $30 $45 $40 50%
Chiropractor $20 $20 $20 50%
Podiatry $15 $15 $10 50%
Outpatient Surgery $265 $265 $195 50%
Ambulance $150 $150 $150 50%
Emergency $65 $65 $65 (worldwide) $65 (worldwide)
Urgent Care $50 $50 $50 $50
Durable Medical
Equipment 20% 20% 20% 50%
Diagnostic Tests/
Lab $10 $10 $0 50%
X-rays/Therapeutic
Radiology $25 $25 $25 50%
Diagnostic Radiology $75 $125 $125 50%
Part B Covered Drugs 20% 20% 20% 50%
Diabetic Supplies $0 $0 $0 50%
Annual Deductible $0 $0 $0 $0
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 $0 † † $0 † † $0 † †
Eyeglasses
(lenses/frames) $40
† † $40 † † $40 † †
Out-of-Pocket Cost
Protection $4,500 $4,500
TIER 1 (Generic) Not covered $6 31 day
$18 90 day $6 $16 31 day90 day Not covered
TIER 3 (Preferred) Not covered $45 31 day
$126 90 day $42$118 90 day 31 day Not covered TIER 2 (Generic
Non-Preferred) Not covered $15 $44 31 day90 day $15 $42 31 day 90 day Not covered
TIER 4
(Non-Preferred) Not covered $95 $266 31 day90 day $95 $266 31 day 90 day Not covered TIER 5 (Specialty) Not covered 33% 31 day 33% 31 day Not covered
Coverage Gap after $2,850 until out-of-pocket is reached ($4,550)
Not covered Tier 1 & 2 Gen. 72% Tier 3 & 4 Brand 47.5%
TIER 1 Gen., lesser of $10 or 72% 31 day; $30 90 day
TIER 2 Gen. 72% TIER 3 & 4 Brand 47.5%
Not covered
For more information contact the plan. *You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a comprehensive description of benefits.
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
Fitness Center
Membership up to $150reimbursement/yr. up to $150reimbursement/yr. up to $150reimbursement/yr. Not covered
Preventive Dental $10 † $10 † $10 †
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
Monthly
Premium* $0 – Reduces your Part B premium up to $25 ea. month
Eligibility
— who can join?
Frequently asked
questions
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: Bartholomew, Benton, Blackford, Boone,
Brown, Carroll, Clay, Clinton, Delaware, Fountain, Grant, Greene, Hamilton,
Hancock, Hendricks, Henry, Howard, Jackson, Jay, Johnson, Lawrence,
Marion, Monroe, Morgan, Orange, Owen, Parke, Putnam, Randolph, Shelby,
Tippecanoe, Tipton, Vermillion, Vigo, Warren and White.
Individuals with End Stage Renal Disease are generally not eligible to enroll unless they have had a successful kidney transplant.
Get to know more about IU Health Plans Medicare Advantage plans.
If you have other questions, please contact our Customer Solutions Center.
How can I get help with my prescription drug costs?
People with limited incomes may qualify for Extra Help to pay for up to seventy-five (75) percent of your prescription drug costs. Many people are eligible for these savings. 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/7 days 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.
Can I choose my doctors?
Answer: Yes. You have access to the largest, most comprehensive health system in Indiana, plus a growing list of doctors, specialists and hospitals throughout the state. 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. A current provider directory with an up-to-date list of network doctors is available at IUHPlansforyou.org
Will I still need to pay my Part B monthly premium?
Answer: Yes. This is a Medicare requirement regardless of whether or not you enroll in a Medicare Advantage plan. However, IU Health Plans Select plan will reduce your Part B premium.
If you have questions about your Part B premium, call Social Security at 800.772.1213. TTY users, 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 include certain chemotherapy drugs, some injections at your doctor’s office and drugs you get at a dialysis facility. 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.)
Frequently asked
questions
(continued)
What is “the gap?”Answer: The coverage gap (also called the “donut hole”) refers to the difference between your initial coverage limit and your catastrophic coverage threshold.
That 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.
Once you reach your plan’s out-of-pocket limit, you automatically get “catastrophic coverage.” At that point, you only pay a small coinsurance amount or copayment for the drugs for the rest of the year.
IU Health Plans Medicare Choice will still cover generic drugs for a small copay 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 offers coverage outside of the United States.
Are hearing aids and dentures covered? Answer: These are not covered as a benefit.
What is Member Maximum Out-of-Pocket Cost Protection?
Answer: It is a protection against how much you pay for healthcare each year.
After this level is reached, you will have 100% coverage for the remainder of the year. Part D prescription drugs do not count toward the limit. You continue to pay your monthly premium, if you have one.
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 that limit is reached, you will be responsible for 100% of charges for out-of-network services.
Medicare beneficiaries may enroll in a plan only during specific times of the year. Contact IU Health Plans for details.
950 N. Meridian St., Suite 200 Indianapolis, IN 46204-1202 IUHPlansforyou.org
If you have questions, we’re here to help. Please call our Customer Solutions Center toll-free at 800.455.9776. TTY users call Relay Indiana at 800.743.3333.
Customer Solutions Center Hours:
Oct. 1 to Feb. 14 – 8 am to 8 pm seven days a week. Feb. 15 to Sept. 30 – 8 am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 8 pm, on weekends and holidays.
