Comprehensive Overview of CompanionCare Medicare Supplement Plan
Explore the benefits and coverage provided by the CompanionCare Medicare Supplement Plan effective January 1, 2021. Learn about the plan's offerings, enrollment criteria, and details on Medicare co-pays, coinsurance, and out-of-pocket expenses. Gain insights into who is eligible, moving to CompanionCare, and how it compares with other available plans based on Medicare enrollment. Delve into the plan's benefits overview, focusing on services, inpatient hospital coverage, skilled nursing facilities, deductibles, and payment structures under Medicare Part A and Part B.
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RANCHO SANTIAGO CCD MEDICARE SUPPLEMENT PLAN CompanionCare Medicare Supplement Plan Effective January 1, 2021
Cheryl Jackson Benefit Services Consultant ASCIP Lauri Phillips Account Manager SISC Dan Sanger Executive Director of Health Benefits ASCIP
WHAT IS A MEDICARE SUPPLEMENT PLAN? Medicare Supplement plans pays the copays / coinsurance for care covered by Medicare. Plan is claim free when provider accepts Medicare assignment. If the provider does not then the member may be subject to out-of-pocket expenses due to balance billing. Always confirm. Members do not assign their Medicare to a carrier. Providers that accept Medicare will accept CompanionCare nationwide. 3
WHO IS MOVING TO COMPANIONCARE? RSCCD retirees and spouses/domestic partners with both Medicare Part A (hospital / inpatient) and Part B (physician / outpatient) will be covered by CompanionCare effective 1/1/2021. Retirees will be automatically enrolled in Medicare Part D (Drug) and be provided coverage under a CMS approved formulary through Navitus. All non-Medicare enrolled retirees and dependents will remain on one of the active employee medical plan options. 4
AVAILABLE PLANS VS. MEDICARE ENROLLMENT Medicare Enrollment Covered Children*? Retiree Spouse Available Plans A&B A&B No Companion Care for both retiree and spouse A&B Non-A&B No Retiree on CC, spouse on active plan Non-A&B A&B No Retiree on active plan, spouse on CC A&B A&B Yes One parent on CC and one on the active plan w/ the ch(ren) A&B Non-A&B Yes Retiree on CC and spouse on the active plan w/ the ch(ren) Non-A&B A&B Yes Spouse on CC and Retiree on the active plan w/ the ch(ren) *Non-disabled 5
BENEFITS OVERVIEW Services Medicare 2020 Benefits CompanionCare Based on 2020 Medicare Benefits Pays $1,408 Pays $352 a day Inpatient Hospital (Part A) Pays all but first $1,408 for 1st 60 days Pays all but $352 a day for the 61st 90th day Pays all but $704 a day Lifetime Reserve for 91st to 150th day Pays nothing after Lifetime Reserve is used (refer to Evidence of Coverage) Pays $704 a day Pays 100% after Medicare and Lifetime Reserve are exhausted, up to 365 days per lifetime Skilled Nursing Facilities (must be approved by Medicare) Pays 100% for 1st 20 days Pays nothing th Pays all but $176 a day for 21st to 100th day Pays $176 a day for 21st to 100 day Pays nothing after 100th day Pays nothing after 100th day Deductible (Part B) $198 Part B deductible per year Pays $198 Basis of Payment (Part B) 80% Medicare-approved (MA) charges after Part B deductible Pays 20% MA charges Including 100% of Medicare Part B deductible 6
BENEFITS OVERVIEW Services Medicare 2020 Benefits CompanionCare Based on 2020 Medicare Benefits Medical Services (Part B) Doctor, x-ray 80% MA charges Pays 20% MA charges Appliances and ambulance lab 100% MA charges Pays nothing Physical/Speech Therapy (Part B) 80% MA charges up to the Medicare annual benefit amount Pays 20% MA charges up to the Medicare annual benefit amount (PT and ST combined) Blood (Part B) 80% MA charges after 3 pints Pays 1st 3 pints unreplaced blood and 20% MA charges Travel Coverage (when outside the US for less than 6 consecutive months) Not covered Pays 80% inpatient hospital, surgery, anesthetist and in-hospital visits for medically necessary services for 90 days of treatment per hospital stay. For details call Anthem customer service at 1-800- 825-5541. 7
BENEFITS OVERVIEW Outpatient Prescription Drugs Medicare Part D Prescription Drug Plan Through Navitus Health Solutions Retail Pharmacy Mail Order 30-day supply $9 Generic co-pay, $35 Brand co-pay 90-day supply $18 Generic co-pay, $90 Brand co-pay Due to Medicare restrictions the following programs are not available with CompanionCare: Pharmacy benefits are administered through Navitus Health Solutions Medicare Rx using a Medicare CMS- approved Part D formulary. Some exclusions and prior authorizations may apply. $0 generic co-pay at Costco % diabetic supplies for generic co-pay Members that have questions regarding their medication coverage can call Navitus Health Solutions Medicare Rx at 1- 866-270-3877 or TYY users please call 711. - compound medication coverage 8
ENROLLMENT PROCESS CompanionCare enrollment form must be completed and submitted to RSCCD along with a copy of each CC enrollee s Medicare card. Each enrollee will complete a separate enrollment form SISC must receive completed application no less than 45 days prior to coverage effective date. Retiring employees or retirees becoming Medicare eligible will enroll mid-year and there is no need to wait till open enrollment. 9
ELIGIBILITY REQUIREMENTS New retirees enrolled in Medicare Parts A & B are eligible for CompanionCare. Retirees will be automatically enrolled in Medicare Part D (Drug) Note: Medicare may apply a fee based on income, known as an Income-Related Monthly Adjustment Amount (IRMAA) based on federal tax return data from two years prior. 10
SUPPORT Medicare coverage issues: Medicare www.medicare.gov 1- 800-633-4227 CompanionCare Medicare Supplement coverage issues: SISC Customer Service 800-825-5541 Drug Coverage Issues: Navitus Health Solutions 1-866-270- 3877 11
