Federal Programs Business Unit

1
Presentation for

• Presented by
• Federal Programs Business Unit Blue Care
  Network of Michigan
• (Date )

Blue Cross Blue Shield of Michigan and Blue Care
Network are nonprofit corporationsand
independent licensees of the Blue Cross and Blue
Shield Association.
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Information to share with you today

• Original Medicare
• New Medicare Environment
• Blue Cross Blue Shield of Michigan (BCBSM) Blue
  Care Network (BCN)
• Individual Products
• Medicare Plus Blue 2007
• BCN Advantage 2007
• Prescription Blue 2007 (Part D)
• Eligibility
• Cost
• Benefits of Blue
• Questions and Answers

3
Original Medicare
4
New Medicare Environment

• Part A
• Hospital
• Institutional

• Part B
• Doctors
• Supplies
• Outpatient
• Professional

Medicare Advantage (MA)

• Part D
• Drugs

MA-PD

• Part D
• Drugs
• Stand
• Alone

HMO
PFFS
Original Medicare

• Medigap Supplemental
• Offered by private insurance
• companies
• Fills in Medicare payment gaps

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5
Medicare Part DDrug Coverage Model
Member Pays
Medicare Pays
Greater 2.15 generic 5.35 brand or 5
95 Medicare Coverage
Catastrophic Coverage
True Out-of-Pocket (TrOOP)
Member Pays 100 of Total Drug Costs a.k.a.
Coverage Gap
Total Drug Cost
3,850
No Coverage

25 Member Coverage
Health Plan Drug Coverage
2,400
798.75
Initial Coverage
75 Medicare Coverage
265 Annual Deductible
265
265
Premium
0
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BCBSM and BCN Individual Products

• 4 Medicare Plus Blue Options (PFFS)
• Medical and Prescription Drugs
• 3 BCN Advantage Options (HMO)
• Medical and Prescription Drugs
• 2 Prescription Blue Options (Part D)
• Stand alone Prescription Drug Plans

7
Medicare Plus Blueand BCN Advantage

• Combines
• Medicare Part A (Hospital)
• Medicare Part B (Physician)
• Supplemental (Medigap)
• Drugs (Optional)

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What is Medicare Plus Blue?

• A Medicare Advantage Private-Fee-for-Service Plan
  offered by Blue Cross Blue Shield of Michigan
• Private Fee-for-Service means
• Members can receive care from any Medicare doctor
  or hospital as long the provider accepts the
  terms and conditions of Plans payment rate.

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What is BCN Advantage?

• A Medicare Advantage Health Maintenance
  Organization (HMO) Plan offered by Blue Care
  Network of Michigan

• BCN Advantage is offered in 28 counties Barry,
  Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot,
  Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer,
  Livingston, Macomb, Midland, Monroe, Montcalm,
  Muskegon, Newaygo, Oakland, Ottawa, Saginaw,
  Shiawassee,St. Clair, Tuscola, Washtenaw, Wayne.

10
What is BCN Advantage? (Continued)

• BCNA Provider Network
• Contracts with a network of providers to deliver
  medical care to members and assures the quality
  of care provided.
• Members choose their own primary care physician
  from our network directory.
• Network continues to grow
• Primary Care Physicians 1,934
• Specialists 6,128
• Hospitals 55

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Who is eligible for Medicare Advantage?

• You are guaranteed acceptance into Medicare Plus
  Blue or BCN Advantage, regardless of age or
  health status, as long as you meet the following
  requirements
• You must be enrolled in Medicare Part A and Part
  B benefits
• You are a resident of Michigan for six months
• You do not have end stage renal disease (federal
  law) except under certain conditions

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How does the 2007 Medicare Plus Blue work?
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How does the 2007 Medicare Plus Blue work?
14
How does the 2007 BCN Advantage plan work?
(waived if admitted within 1 day)
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How does the 2007 BCN Advantage plan work?
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What are some additions to original Medicare
coverage?

• These preventive services are covered in full
• Bone mass measurement
• Colorectal screening exams
• Immunizations
• Pap smears pelvic exams
• Prostate cancer screenings
• Disease and case management programs (BCN
  Advantage only)
• Cardiovascular program
• Congestive heart failure program
• Diabetes management program
• Depression management program

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What are some additions to original Medicare
coverage?

• Other preventive services require a small copay
• Annual physical exams
• Medicare-covered diagnostic hearing exams
• Medicare-covered eye exams for diagnosis and
  treatment of diseases and conditions of the eye

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Advantages of Medicare Plus Blue

• Virtually no paperwork to complete
• One identification card
• One bill or no bill (i.e., premium payment
  options EFT or deduction from Social Security
  check)
• One monthly explanation of benefits
• No network of doctors or hospitals no need for
  referrals
• Use of medical and drug coverage outside of
  Michigan (i.e., coverage for other than emergency
  services while traveling)
• Worldwide emergency and urgent care
• Security of knowing the Blues have more than 65
  years of healthcare experience

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Advantages of BCN Advantage

• Low monthly premiums
• One identification card
• One bill or no bill (i.e., premium payment
  options EFT or deduction from Social Security
  check)
• One monthly explanation of benefits
• Growing network of physicians, specialists and
  hospitals
• Preventive dental and hearing aid coverage
• Worldwide emergency and urgent care
• Only HMO backed by the experience of Blue Cross
  Blue Shield of Michigan

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How does this work for me?

• Medicare eligible's can pick the Medicare Plus
  Blue or BCN Advantage option that works best for
  them.
• You continue to pay your Part B premium to
  Medicare (deduction from your monthly Social
  Security check)
• A monthly premium to the Blues for the plan that
  you choose

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Additional features as a Blues member

• Naturally Blue 20 savings
• Acupuncture
• Massage therapy
• Nutrition counseling
• Vitamins at participating locations
• The products and services described in slides
  21-23 are neither offered nor guaranteed under
  our contract with the Medicare program. In
  addition, they are not subject to the Medicare
  appeals process. Any disputes regarding these
  products and services may be subject to the Blue
  Cross Blue Shield of Michigan grievance process.

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Additional features as a Blues member

• Blue Health Connection
• Registered nurses available 24/7
• Help managing chronic illness get better and
  stay healthy
• Weight Watchers Discounts on regular priced
  membership

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Additional features as a Blues member

• BlueSafe
• Discounts on safety items at participating stores
• Discounts on non-covered durable medical
  equipment at a participating provider

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PrescriptionBlue (Part D)
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Prescription Drug Plans

• BCBSM offers Two Stand Alone Prescription Drug
  Plans
• Prescription Blue - Option 1
• 265 deductible
• Prescription Blue - Option 2
• 0 deductible

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How do the 2007 Prescription Blue drug plans work?
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How do the Prescription Blue drug plans work?
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How do the Prescription Blue drug plans work?
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Pharmacy Network

• BCBSM contracts with approximately 95 percent of
  pharmacies located in Michigan, including major
  retail pharmacy chains
• Mail order is a value added benefit
• Outside of Michigan, Prescription Blue, Medicare
  Plus Blue and BCN Advantage enrollees have access
  to an extensive network of retail pharmacies
  across the country
• NOTE BCBSM and BCNA formularies are
  comprehensive but not identical, important to
  review to ensure that your coverage needs are met

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When Can I Join

• Annual election period is Nov. 15 through Dec.
  31, 2006, effective Jan 1st
• New Medicare beneficiaries coverage begins the
  first day of the month after the month they have
  enrolled, without penalty

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How to Enroll in Medicare Plus Blue, BCN
Advantage or Prescription Blue

• By paper enrollment application (i.e., enrollment
  kit)
• BCBSMs and BCNs corporate website (i.e.,
  capability to download enrollment application)
• Medicares website (www.medicare.gov) - by using
  Medicares online enrollment center
• By calling 1-800-MEDICARE (i.e., telephone
  enrollment)

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For more information contact ourPre-Enrollment
Call Center

• 1-800-485-4415 (BCBSM)
• 1-866-966-2583 (BCN)
• 8 a.m.- 8 p.m., seven days a week
• (TTY users 1-800-481-8704)
• www.bcbsm.com/medicarewww.mibcn.com/medicarewww.
  medicare.gov

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Questions