University of Michigan Medicare Advantage Plans

Hello, my name is Dan D'Amico. I'm a Medicare Advantage consultant.

Today, I'll be going through your University of Michigan Medicare Advantage Benefits.

Today's agenda will be understanding Medicare Basics, getting started with your plan group Plan benefits, how to find providers and health and wellbeing programs.

Let's start off with understanding Medicare basics.

On this slide, you're going to see part A, part B, D, and C.

Let's just do a quick overview to make sure we're all on the same page.

Your Part A includes hospital care, skilled nursing, facility care, hospice, home healthcare.

The important thing to point out here is there's no charge for people who have worked at least 40 or credits or 40 quarters, so there's no premium for part A.

Part B includes your PCP or what we call primary care provider mental healthcare, outpatient surgery lab tests, durable medical equipment.

Part B does include a premium, so you need to make sure that you are paying that on a monthly basis and your premium does depend on when you signed up and your total income.

Part D'S prescription drugs, which the University of Michigan has with Magellan. As of right now, you do have the equivalent of A part D.

Now part C is part A and B, so if you have A in place and B in place, then you can qualify for Medicare Advantage.

Medicare Advantage does include original Medicare covered services, also original Medicare rights and protections, and your plan does also include other benefits such as Silver Sneakers, care Management services and we'll get to that later in the presentation.

Just as a reminder, part B premiums do need to be paid on a monthly basis getting you started with your Medicare plan.

In this slide, I'm gonna help you understand your enrollment materials.

You have some materials that are sent to your home.

Most of you, if not all of you have already received your University of Michigan enrollment book.

Later on, you'll also receive an online material notice and an annual notice of change the annual notice of change.

What that does is it describes what has changed from one year to the next in your benefits.

There are other documents that are available as well, but they're available online for you such as benefits at a glance, evidence of coverage, and your resource guide.

If at any time when you speak to customer service should you get a call from them or call them and you cannot receive these online or you do not have an internet access, they can send these documents to you in hard copy.

Speaking of communications that you can expect with Medicare Advantage, it's very different than a medical supplemental plan in regards to how we communicate. You will receive a welcome call, which again, I would highly recommend any questions that you may have during that welcome call.

Ask the customer representative any of those questions that you may have.

You'll also receive a new ID card, health assessment. Health assessment. They help connect you to member programs for your healthcare needs.

Again, it's completely voluntary coordination of benefit survey.

Wanna make sure that we have everything correct in the system, and then there's a Medicare Blue and You magazine which gives you plan related information that can improve your health and wellbeing.

Finally, as I stated before, an annual notice of change, which is just simply a summary of benefit updates to your plan from one year to the next.

Membership confirmation and ID card, you can now take your red, white, and blue card and you can put it in a safe place 'cause you will not need that when you go to the doctor.

This is just an example of the cards that you will have one if you decide to pick the MA PPO plan.

The one on the left, the one on the right is if you take the HMO plan, which we refer to as Premier Care Advantage.

Another difference that you will experience is what we call explanation of benefits from your MedSup to a Medicare Advantage plan.

Now, many of you have been in the Medicare Advantage plan already, so you're very familiar with this.

Simply this is the information that you're going to get that shows any types of services you may have had the month prior, so it explains your benefits and how they've been used.

Next we're gonna look into the University of Michigan Medicare Advantage Plan benefits. But before we do that, I wanna look at some key terms deductible, which is simply the amount you pay before the plan begins to pay its share.

Co-insurance is the percentage of cost of the service that you pay. Co-payments, that's a fixed dollar amount that you pay each time you use provider services like an office visit and then your out-of-Pocket maximum, which is the most you can spend in any calendar year.

This is just a quick overview of your plan, your annual deductible, you don't have one, so there's no deductible as part of this plan.

Co-Insurance, also no co-insurance as well.

Now the out-of-Pocket maximum is $3,000 for this plan.

You notice on the next slide, office visits, specialist visits, chiropractic urgent care, all are a $10 copay.

Emergency care is $65, but it will be waived if you're admitted to the hospital after three business days.

And one other. Just quick note, ambulatory services when medically necessary are also covered at a hundred percent.

Now again, this is just a brief overview. If you want more information, again, you can go online and download a bag or evidence of coverage, which we refer to as an EOC.

Durable medical equipment is also covered as part of this plan. One thing I wanna point out is that Northwood, they help coordinate your supplies and help find you in-network providers for both medical and diabetic testing supplies.

Their phone number is +1 800-667-8496.

Moving forward, as of ten one twenty twenty four, your continuous glucose monitors CGMs, they will now not go through Northwood.

You must obtain these from a Medicare Advantage pharmacy network. Again, I want to repeat that to you. CGMs will now be point of sale from a Medicare Advantage pharmacy network.

A prescription is required and if you need more information, just call the number on the back of your card and they will assist you. Prior authorizations for medical services is one way. Health plans make sure that you receive high quality care as you and your provider develop a personalized treatment plan.

Now, I will say over the last year, I've noticed that prior authorizations continue to be approved more likely than not, and what I mean by that, over 95% of prior authorizations have been approved over the past year.

Now, it may be necessary for your provider to have certain services in your treatment plan approved by Blue Cross, and this is just really for the safety of the member to make sure that you're getting the proper services.

Now, services that require a prior authorization include acute inpatient hospitalization, post-acute care, skilled nursing facilities, long-term, acute care, high tech radiology services.

Those are just a few examples of prior authorization.

Most common denials, even though I said 95% have been approved, are due to the fact that there's been insufficient provider information or does not meet medical necessity.

Can we? Here at Blue Cross Blue Shield will assist you and try to move along your prior authorization.

How do you find a provider?

Medicare Advantage, PPO providers?

The PPO means preferred provider organization within and Outta Network benefits.

The University of Michigan has what we call a passive plan where you do receive both in and outta network benefits all the same.

You have the freedom to choose any provider you'd like, any specialist or hospital that accepts Medicare as long as the provider agrees to bill the plan directly for your services.

Again, you may continue to use your provider.

Just confirm that they take Medicare and will bill our plan directly before receiving services. During the welcome call, the representative can check to see if your current provider accepts your plan.

Your provider doesn't accept the plan. The representative will help you select one who does accept it.

In the PPO network, we have thousands of pound thousands of providers, so there's a really good chance that your provider is within our network.

Now, if you decide later after the welcome call that you wanna call customer service and you chose the M-A-P-P-O plan, you can call them the number on the back of your card, which is 8 5 5 6 6 9 8 0 4 0, and that's 8:00 AM to 5:30 PM Eastern Time, Monday through Friday.

We also have extended hours October 1st through March 31st, 8:00 AM to 8:00 PM seven days a week. Finally, you can always visit bcbs.com/medicare and click Find a Doctor How to choose your University of Michigan Premier Care Advantage primary care provider operates the exact same way as the M-A-P-P-O. During that welcome call, ask them any questions, make sure that your provider is in network.

Now, unlike the M-A-P-P-O, everything is in network. There's not an in and outta network because it's an HMO system. So one thing to keep in mind, if you receive a letter and you've already had a primary care provider when you came into the plan and you're not seeing the name there, please call customer service to make sure that there wasn't a mistake made.

'cause we wanna make sure that you've had the same experience and the same provider that you came from and check to see that they are in network.

That is first and foremost. Again, your customer service number is 806 5 8 8 8 7 8. Same hours Monday through Friday, 8:00 AM to 5:30 PM Eastern Standard, and then extended hours October 1st through March 31st, 8:00 AM to 8:00 PM as well. One key fact, with the Premier Care Plan, you may change your PCP for any reason at any time as well, so you don't feel that you have to stay with the provider if you're not having a good relationship with them. Again, customer service is there to help you in any of these circumstances.

We do get a lot of questions with Premier Care, since it's an HMO, do I need a referral In the Premier Care Advantage, you do not need a referral. It's not necessary. However, we do recommend that you let your primary care provider know what you're looking to do, just so that you get the best quality of care throughout the entire process.

Your PCP will help coordinate services and get some member of U of M Premier Care advantage to the right spots at the right time. So again, I still think it's a really good idea to keep them involved, but it is not necessary to have a referral.

Traveling with this plan couldn't be easier. We have both domestic travel and international travel when it comes to domestic travel.

Urgent and emergent care is covered when traveling outside of your service area. Whether you're in the M-A-P-P-O plan or the Premier Care Advantage plan, extra services such as dialysis infusions or labs, we wanna make sure that you contact customer service before you travel just so that that's coordinated in case you should need any of those.

And again, normal cost share will apply. When it comes to international travel, I again, highly recommend calling what we call Global Care Global Care.

The numbers on your screen, it's 808 1 0 blue. They'll help you find doctors, hospitals, resources outside the us.

I think it's just a good idea to make sure that you're forecasting that you're leaving and that they can kind of help coordinate that just in case you have any kind of an emergency. The URL is on the slide as well if you'd prefer to go in that direction.

One of my favorite benefits is virtual care. Virtual care is simply this. It's like doing FaceTime with a doctor now. It wouldn't be your doctor instead, it would be through Teladoc Health.

They have 24 7 access to US board certified medical providers that are trained telemedicine to treat non-emergency illnesses.

So for me personally, I use Teladoc 'cause I have four kids.

Makes it a little bit more convenient, a little easier to go in and out of the doctor's office for me personally, plus since they're 24 7, something could happen after hours and you can't get ahold of your doctor.

So this is also an available benefit to you.

The URL is also on the slide as well as the phone number. I mentioned this a little prior, the Blue Cross mobile app. I highly recommend that you download it.

If you have any kind of smartphone promise, it's going to make the experience easier. I personally use it myself just because I don't like carrying extra cards with me. That's one of the features and benefits that you can always pull up your card if you have the app to show your doctor as well.

Plus, you can go into your member account, you can see how you're utilizing your benefits, pull up all sorts of information that you may need.

Throughout this presentation. I've given you a lot of information. This slide is your customer service slide from Medicare Advantage PPO.

The phone number is displayed (855) 669-8040, and if you choose the University of Michigan Premier Care Advantage 806 5 8 8 8 7 8.

Again, the hours of operation, normal business hours are 8:00 AM to 5:30 PM Monday through Friday with extended hours from October 1st through the 31st, seven days a week, eight to eight.

Do not hesitate to call customer service if you have any questions.

Our next section, I'm gonna go through the Blue Cross Health and Wellbeing programs.

On this slide, you see a lot of information, care management, chronic conditions, wellbeing, preventative care.

Now what I wanna point out is all of these services are part of your plan.

However, you do have to have the criteria in order to take advantage of some of these.

As an example, palliative care. You need to make sure that you have the criteria in place in order to be able to use these types of benefits.

Now, that's obviously up to you and your doctor. The doctor will diagnose and do what they need to do in order to get you the care that you need.

Another example may be meal delivery. It's not just using GrubHub.

There's an actual service that you would use based on your conditions.

Great slide. Highly recommend revisiting this so that you know all the different benefits that you do have based on the care that you may need.

If you have questions about any of those programs, we do have an engagement center.

It's open 8:00 AM to 6:00 PM Eastern Time.

That's Monday through Friday. Phone number is displayed here.

You can talk to a nurse care manager.

They can let you know about the programs, see if you qualify for any of the programs, should you need those. I wanna point out that we have other Blue Cross Blue Shield affiliate partners.

Just to give you a few examples, Carefor, Caron, Everwell, these are just a few of the different affiliate partners that we have.

The reason I wanna point this out is because you may receive some phone calls throughout the year and you may think they're spam if they don't introduce themselves as saying, as an example, I'm carefor on behalf of Blue Cross Blue Shield of Michigan.

Then yes, it could be. But if you hear Blue Cross Blue Shield of Michigan, these are some different programs that we do offer.

Again, depending on if you qualify for the program, so we don't just do outreaches to everybody in Medicare Advantage, you actually have to qualify in order or have certain conditions that may require additional support for these programs or these vendors to reach out to.

I wanna look specifically at Signify Health.

This is our in-Home assessment.

This is a CMS approved Comprehensive Health Assessment in home or in a virtual setting. Some of you may have already received calls from this prior in the year or you may later on.

Again, this is extremely voluntary. However, you may require the additional support.

So if you do get a phone call and they do address, Hey, this is Signify Health on behalf of Blue Cross Blue Shield, we do want you to know that this is a program that we do offer as part of Medicare Advantage.

Again, this is gonna support members diverse needs does not replace your primary care physician by any means, and again, I can't stress enough.

It's a voluntary program that helps support member outcomes.

Another program that you get, the most popular program probably is Silver Sneakers.

I know a lot of you guys may enjoy working out in the gym.

This is a fitness program, thousands of different gyms

that do participate in the program.

If you wanna know if your gym does participate, just reach out to 'em.

8 8 8 4 2 3 4 6 3 2.

Again, the hours of operations are on here, or you can visit 'em on the web silversneakers.com and you can even find out about the tuition rewards program.

Lots of great things, lots of great programs, and I, I find more and more seniors building a strong community within their gyms.

That does conclude our presentation for the day. I wanna just kind of sum it up with five steps that'll help you find answers, should you still have a lot of questions.

Number one, use your University of Michigan handbook for more details and answers.

It's gonna be your best guide to get all the information possible.

If after going through that you need more information, you can also visit the University of Michigan's personalized micro site. The URL is right on there.

It's gonna have all your plan documents you can download.

You can look over to make sure that you have everything that you need.

If you need even more information, you can also visit University of Michigan's HR site where they're gonna have lots of FAQ questions.

They're gonna also have the documents posted As well.

Number four, call customer service. The number on the back of your card is quintessential to getting you the answers that you need.

And finally, if all four of those are not working, you can always call shared services seven three four six one five 2000 and I'm sure they'd be more than happy to help you as well.

Again, I want to thank you for looking at this presentation and I hope you found it very helpful.

Thank you.