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Education, Sales and Enrollment
Presentation 2008PowerPoint Presentation
M0018_TO_PPT_0907 CMS (Pending CMS Approval)
H5421 Today’s Options
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Understanding Medicare Advantage Plans
• A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare Supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies.
• If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at www.todaysoptions.com.
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What is a PrivateFee-for-Service Plan?
• It is a type of Medicare Advantage plan offered by a private insurance company like Pyramid Life
• It is not the same as the Original Medicare plan that is offered by the federal government
• It is not a Medicare Supplement, Medigap, Medicare Select, or Prescription Drug Plan
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Today’s Options Can Help You Get:
• One low monthly premium• Choice of prescription drug and medical coverage through
Today’s Options “plus” plan*• Receive covered services from any provider who accepts
Medicare, and agrees to accept Today’s Options terms and conditions of payment.
• Annual out-of-pocket limit on healthcare expenses• The benefits of Original Medicare plus services beyond what
Original Medicare offers
*Plus plans available only during certain enrollment periods. Please ask your sales agent for further guidance.
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How Does a Today’s Options PFFS Plan Work?
• The Today’s Options plan pays instead of Medicare.
– You will pay amounts that the plan does not pay, which are called copayments and coinsurance.
– Medicare Advantage plans, like Today’s Options are not secondary to Medicare, it’s the only plan.
• Original Medicare will not pay for your healthcare while you are
enrolled in a Today’s Options PFFS plan.
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Eligibility
• You can join Today’s Options if you:– Have both Medicare Part A and Part B– Pay the Today’s Options premium– Live in a state where the plan is available– Do not have End-Stage Renal Disease
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How Do You Obtain Services as a Member of Today’s Options?
• You may receive healthcare services from any provider allowed to bill Medicare who agrees to accept the Today’s Options payment terms and conditions.
• For Today’s Options “Plus” (MAPD) plans, you must use network pharmacies to obtain prescription drugs, except in emergencies or urgent situations.
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Before Seeing a Provider You Should …
• Verify that your provider will accept the Today’s Options plan. Your healthcare providers have the right to choose whether to accept a Private Fee-for-Service plan’s payment terms and conditions every time you see your providers.
• If your provider decides not to accept the Today’s Options plan, you will need to find another provider who will.
• They should not provide services to you, except in an emergency.
• If they choose to provide services, they may not bill you. They must bill the Today’s Options plan for your covered healthcare services. You must pay the appropriate copayments and coinsurance.
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Get the Best of Both Worlds
• Get comprehensive healthcare and prescription drug coverage all in one plan.Choose one of our new Plus plans: – Today’s Options Basic Plus Plan– Today’s Options Value Plus Plan– Today’s Options Premier Plus Plan
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Get Prescription Drug Benefits with Today’s Options
• Covered prescription drugs– Almost all medications are covered with few prior authorizations.
• Access– Or fill your prescriptions at more than 63,000 network pharmacies nationwide (applies to Today’s Options Premier
Plus,Value Plus and Basic Plus plans only).
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When You Go to the Doctor or Hospital…
• Show your Today’s Options ID card and tell them that you have chosen Today’s Options for your Medicare health plan.
• Do not show your red, white and blue Medicare card.
• Pay any Today’s Options copayments or coinsurance at the time of service.
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When You Go to the Doctor or Hospital (cont’d)
• The doctor or hospital will bill Today’s Options for the rest.
• Healthcare providers must bill the Private Fee-for-Service plan once the provider has agreed to accept Today’s Options.
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Today’s Options BasicMonthly Plan Premium
• ($20)-$35* each month• Medicare Part B premium of $93.50** each month
* ($10)-($20) Part B premium reduction in some areas** This is the 2007 amount and may change January 1, 2008.
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Today’s Options Basic Plan Benefits
Hospital Inpatient Care• $250 copayment each day/day(s) 1- 6 per admission• $1,700 maximum out-of-pocket every year
Skilled Nursing Facility• $0 each day/days 1–20• $125 each day/days 21–100
Doctor/Specialist Office Visits• $20 for each doctor visit• $35 for each specialist visit
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Today’s Options BasicPlan Benefits
Emergency Care• $50 for each emergency room visit• Worldwide coverage
Preventive Care• $0 co-pay for preventive exams
Today’s Options Health & Wellness Services• A health assessment• Complex case management• In-house pharmacy support• 24/7 Health Hotline & Eldercare services
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Today’s Options Basic PlusMonthly Plan Premium
• $20.20-55.20 each month• Medicare Part B premium of $93.50* each month
– Most people will pay the standard Part B premium. Starting January 1, 2008, some people will have to pay a higher premium because of their yearly income. For more information, call Social Security at 1-800-772-1213; TTY 1-800-325-0778.
• Includes all the benefits of the Basic plan plus prescription drugs.
* This is the plan for 2007 and may change January 1, 2008.
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Today’s Options Basic Plus Prescription Drug Benefits
Prescription Drugs
• First dollar coverage with no deductible and $2,510 combined initial limit on drugs
• $5 co-pay for generic drugs• $31 co-pay for formulary preferred drugs• $61 co-pay for formulary non-preferred drugs• 30% coinsurance for specialty drugs
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Today’s Options ValueMonthly Plan Premium
• ($10)-$65 each month*• Medicare Part B premium of $93.50** each month
* ($10) Part B premium reduction in some areas** This is the 2007 amount and may change January 1, 2008.
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Today’s Options Value Plan Benefits
Hospital Inpatient Care• $195 copayment each day/day(s) 1- 5 per admission• $1,700 maximum out-of-pocket every year
Skilled Nursing Facility• $0 each day/days 1–20• $100 each day/days 21–100
Doctor/Specialist Office Visits• $20 for each doctor visit• $30 for each specialist visit
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Today’s Options Value Plan Benefits
Emergency Care• $50 for each emergency room visit• Worldwide coverage
Preventive Care• $0 co-pay for preventive exams
Today’s Options Health & Wellness Services• A health assessment• Complex case management• In-house pharmacy support• 24/7 Health Hotline & Eldercare services
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Today’s Options Value PlusMonthly Plan Premium
• $20.20-$85.20 each month• Medicare Part B premium of $93.50* each month
– Most people will pay the standard Part B premium. Starting January 1, 2008, some people will have to pay a higher premium because of their yearly income. For more information, call Social Security at 1-800-772-1213; TTY 1-800-325-0778.
• Includes all the benefits of the Value plan plus prescription drugs.
* This is the 2007 amount and may change January 1, 2008.
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Today’s Options Value Plus Prescription Drug Benefits
Prescription Drugs
• First dollar coverage with no deductible and $2,510 combined initial limit on drugs
• $5 co-pay for generic drugs• $31 co-pay for formulary preferred drugs• $61 co-pay for formulary non-preferred drugs• 30% coinsurance for specialty drugs
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Today’s Options PremierMonthly Plan Premium
• $0-$90 each month• Medicare Part B premium of $93.50* each month
– Most people will pay the standard Part B premium. Starting January 1, 2008, some people will have to pay a higher premium because of their yearly income. For more information, call Social Security at 1-800-772-1213; TTY 1-800-325-0778.
* This is the 2007 amount and may change January 1, 2008.
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Today’s Options Premier Plan Benefits
Hospital Inpatient Care• $195 copayment per admission• $600 maximum out-of-pocket every year
Skilled Nursing Facility• $0 each day/days 1–20• $100 each day/days 21–100
Doctor/Specialist Office Visits• $10 for each doctor visit• $25 for each specialist visit
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Today’s Options Premier Plan Benefits
Emergency Care• $35 for each emergency room visit• Worldwide coverage
Preventive Care• $0 co-pay for preventive exams
Today’s Options Health & Wellness Services• A health assessment• Complex case management• In-house pharmacy support• 24/7 Health Hotline & Eldercare services
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Today’s Options Premier PlusMonthly Plan Premium
• $32-$122 each month• Medicare Part B premium of $93.50* each month
– Most people will pay the standard Part B premium. Starting January 1, 2008, some people will have to pay a higher premium because of their yearly income. For more information, call Social Security at 1-800-772-1213; TTY 1-800-325-0778.
• All the benefits of the Premier Plan plus prescription drug benefits
* This is the 2007 amount and may change January 1, 2008.
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Today’s Options Premier Plus Prescription Drug Benefits
Prescription Drugs
• First dollar coverage with no deductible and $2,510 combined initial limit on drugs
• $5 co-pay for generic drugs(co-pay continues after the initial $2,510 limit)
• $31 co-pay for formulary preferred drugs• $61 co-pay for formulary non-preferred drugs• 30% coinsurance for specialty drugs• Generic Drug Coverage in the “Coverage Gap”
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Preventive Care Benefits for $0 Co-pay
$0 co-pay for the following services– Bone mass measurement– Colorectal screenings– Immunizations– Mammograms– Pap smears and pelvic exams– Prostate cancer screenings
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How Are Medicare Advantage Plans Possible?
Federal Government(CMS)
Today's Options
Pharmacy Network(Premier Plus,
Value Plusand Basic Plus)
Hospitals DoctorsAncillaryServices
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We Have MedicareExperience You Can Trust
• Pyramid Life Insurance Company• Founded in 1913• One of the country’s leading providers of senior insurance
products.
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Questions?
?
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Would You Like to GetMore from Medicare?
• Let’s talk about it. Even our enrollment process is easy.• Contact Information
– Pyramid Life Insurance Company
1-800-913-9990; TTY 1-800-777-9083 – Centers for Medicare & Medicaid Services 1-800-MEDICARE
[Agent Name][Agent Company][Agent Contact Information]
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Pyramid Life
Pyramid Life is an insurance company with a Medicare Advantage contract to offer a Private Fee-for-Service plan, available to anyone enrolled in Part B and entitled to Part A of Medicare through age or disability who continues to pay any applicable Medicare premiums and lives in the service area. You must continue to pay your Medicare Part B premium. Pyramid Life and its agents are not connected in any way with the federal or state government or Medicare.
