Kansas Medicare Advantage Plan Updates 2023-2024

Blue Cross Blue Shield of Kansas
Medicare Advantage Sales Team Training
August 23, 2023
Introductions
2023 MA Benefit Changes
The Medicare Advantage Product Team researched and analyzed the Medicare
Advantage product offerings in our service area for 2023.
The team determined there was a need for some benefit changes in 2024 to stay
competitive and continual growth of our Medicare Advantage membership. 
Leavenworth county has been added to the Topeka region.
Some plans encompass all regions now.
2024 Blue Medicare Advantage Comprehensive (007) Changes
Regions have combined under 1 comprehensive plan (Topeka & Wichita $40 premium)
Primary Care physician copay- 
$0
Specialist copay- 
$35
Dental Allowance increased to 
$3,000
Eyewear allowance increased to 
$200
OTC increased to 
$350
Dental Buy up will be allowed in both regions and for 
$25 
premium
Insulin drugs are 
$10 
copay/all coverage phases
2024 Blue Medicare Advantage Choice Changes
In Network Out-of-pocket max 
$3,500
Specialist copay-
$30
Inpatient Hospital copay-
$295 
per day for days 1 to 5
Dental allowance increased to 
$1,750
Eyewear allowance increased to 
$200
Added OTC of 
$50 
quarterly
2024 Blue Medicare Advantage Freedom
Premium- $0
Part B credit- $75
Out-of-pocket max- $5,400
PCP copay-$0
Specialist copay-$45
Inpatient Hospital- $400 copay per day for days 1-5
Dental allowance- $1,000
No Part D coverage
 
Service Area
What are the two 
distinct 
service areas for
Kansas’s Medicare Advantage products?
Name the counties within each.
17 counties for Topeka area, and 10 for the Wichita area
.
 
Topeka Service Area Counties:
Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, Wabaunsee, 
Chase,
Coffey, Franklin, Geary, Linn, Lyon, Miami, Morris,
 Riley, Leavenworth.
Wichita Service Area Counties:
Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, Sumner, Dickinson,
 Marion,
McPherson.
2023 Medicare Advantage Regions
Wichita Region
$0 Blue Medicare Advantage
10 Counties
Topeka Region
$0 Blue Medicare Advantage
17 Counties
All Regions
$0 Blue Medicare Advantage Choice and Blue
Medicare Advantage Freedom
$40 Blue Medicare Advantage Comprehensive
27 Counties
Medicare Advantage:
Eligibility and Enrollment
OCTOBER 1
Overview of CMS Selling Periods
CMS only allows Medicare beneficiaries to enroll in Medicare Advantage during certain times of the year.  Review the eligibility qualifications for each selling period carefully, as adhering to these regulations is critical.
JANUARY 1
January 1 – March 31
During the OEP, consumers
with a MA plan can:
Switch to another MA Plan
Disenroll from a MA Plan and
return to Original Medicare
April 1 – October 14
During Pre-AEP, new MA plans can:
Perform Educational Events and communicate
Educational content about general Medicare
Announce new MA Provider Partnerships
Call existing BCBSKS members or prospective enrollees
who have requested to be contacted
October 15 – December 7
During the AEP, consumers can:
Sign up for Medicare health or
prescription drug coverage
Change their Medicare health
or prescription drug coverage
APRIL 1
DECEMBER 7
DECEMBER 31
We are
currently in
Pre-AEP!
During this period, MA
plans:
Can 
begin Marketing
MA product benefits
Cannot 
enroll members
until October 15
Communications Pre and During AEP
During the Pre-Annual Enrollment Period, all communications must remain strictly educational and simply provide information without influencing potential enrollees decisions. During the Annual
Enrollment Period, communications may be used to inform a potential enrollee about plan specifics and benefits as well as attempt to influence the enrollee’s decision-making process when choosing a
plan.
During Pre-AEP, all communications must be used 
to
provide information 
to current and prospective
enrollees. This means that no activities or materials
during Pre-AEP may mention specific products and
their benefits or have the intent of drawing the
attention of a current or prospective enrollee to
influence the enrollee’s decision-making process
about joining a plan.
Pre-AEP: Educational Communication
Source: 
Medicare Communications and Marketing Guidelines, 2019
AEP: Marketing Communication
During the AEP, activities and the use of materials by the Plan/Part
D sponsor may have
 the intent to draw a beneficiary's attention to
a plan or plans and to influence a beneficiary's decision-making
process
 when selecting a plan for enrollment or deciding to stay
enrolled in a plan (that is, retention-based marketing). Additionally,
marketing materials may contain information about the 
plan’s
benefit structure, cost sharing, measuring, or ranking standards
.
Communications Pre and During AEP
OCTOBER 1
JANUARY 1
APRIL 1
DECEMBER 7
DECEMBER 31
Medicare Advantage Eligibility Criteria
Use the criteria in the table below to determine if a candidate is eligible for Medicare Advantage.
Source
: MA Enrollment and Disenrollment Guidance, 2019
 
Marketing Periods
What 
is the period for 
marketing of Medicare Advantage
products called?  When does this period begin and end?
 
Answer:
Marketing can begin on 
October 1
, but sales for MA products may not
begin until the 
Annual Enrollment Period (AEP)
 
on 
October 15
.
The end of AEP is 
December 7
.
CMS Requirements for
Sales Call Centers
Call Center CMS Regulations
Due to the overarching increase in expected call volumes and narrow Annual Enrollment Period selling window (October 15 – December 7), BCBSKS has contracted with Faneuil to assist with Medicare Advantage
telephonic sales.
Please Note:
  Customer Service calls post-sale will be supported by 
Advantasure
,
Prime Therapeutics, and our respective Supplemental Benefit Vendors.
Brief Review of CY2020 Lax in Regulations
In 2019, CMS provided MA plans more flexibility in the types of communications they can leverage prior to AEP.  The revised marketing guidelines allow for some new and unique best practices while also maintaining
strict rules that MA plans must adhere to on an ongoing basis.
Distribute 
plan-specific materials 
or
enrollment packets
Conduct 
sales presentations or attempt
to enroll
 prospective members
Never
Distribute your 
business card and contact info 
for
beneficiaries to use to initiate contact
Collect 
Scope of Appointment (SOA) 
forms
Schedule sales / marketing appointments
Best Practices
Use contact information for anything
other than the purpose for which it was
collected
Offer meals
Market in restricted areas of a healthcare
setting
Submit talking points and presentations to CMS
prior to use, including those to be used by agents
Clearly label sign in sheets as optional
Collect Enrollment Forms
Adhere to 
SOA parameters and documentation
Pre-AEP
Educational
Communication
AEP
Marketing
Communication
Source
: Medicare Marketing and Communications Guidelines, 2019
CMS Required Marketing Materials
The resources listed below provide information on BCBSKS benefits, MA Plan operations, and CMS regulatory guidance.
Medicare Advantage
Buyer Behaviors
National Senior Market Buyer Behaviors
Medicare beneficiaries have the option to stay in Original Medicare or supplement their coverage with a MA plan or Med Supp policy. MA plans are attractive to seniors due to lower premiums and the inclusion of
Part D coverage and supplemental benefits.
 
 
Network
Product
Design
Price
Original Medicare
Parts A + B
Medicare Advantage
Part C
Medicare Supplement
Parts A + B
+
Budget conscious individuals typically 
do not
want to pay the additional premium
 over
and above that paid for Medicare Part B.
+
Original Medicare beneficiaries must pay
their
 Part A deductible and Part B premiums
+
Broadest possible choice in doctors and
medical providers
 (more doctors accept
Medicare than MA)
+
Maximum flexibility 
when seeking medical
specialties (no prior authorizations to see
specialists)
+
Original Medicare then covers most services
at 
20% coinsurance 
to the beneficiary
+
Original Medicare has 
no drug coverage
(unless member adds Part D)
+
Some MA plans 
cost no more per month
than Original Medicare 
($0 premium plans)
+
Some plans 
may offer lower coinsurance
than that charged by Original Medicare (20%)
+
Cap on out-of-pocket health spending
(Original Medicare has no out-of-pocket max)
+
Broadest possible choice in doctors and
medical providers
 (more doctors accept
Medicare than MA)
+
Maximum flexibility 
when seeking medical
specialties (no prior authorizations to see
specialists)
+
Alternative to 
enhance Original Medicare
coverage
 (e.g. lower copays / coinsurance
on Medicare-covered services)
+
Medicare Supplement has 
no drug
coverage 
(unless member adds Part D)
+
Beneficiaries 
must pay a monthly
premium
, dependent on the level of
supplemental coverage obtained
+
Typically 
attracts more affluent consumers
that do not mind paying higher premiums
(average of $183/month)
+
Designated HMOs 
require patients to see a
PCP for a referral
 to visit a specialist
+
PPO plans 
allow members to see a specialist
without a referral 
(out-of-network could cost
more, however)
+
Alternative to 
enhance Original Medicare
coverage
 (e.g. lower copays / coinsurance on
Medicare-covered services)
+
Can 
include value-added benefits not
covered by Original Medicare  
(e.g. vision,
dental, hearing)
+
MA plans can 
include Part D prescription
drug coverage
 (MAPD vs. MA)
Source
: US Health News, Medicare vs. Medicare Advantage: How to Choose, 2018
 
 
MA Enrollment by Monthly Premium Price Points:
National MA Selection Criteria: Price
Medicare Advantage offers consumers product features that are not covered by traditional Medicare. Additionally, many plans are available at a $0 premium and/or include Part D drug coverage.
Blue 
Medicare
Advantage 
(PPO) has
a $0 premium in
both the Topeka and
Wichita regions!
Blue Medicare
Advantage
Comprehensive (PPO)
has a $40 premium in
ALL 
regions!
Network
Product
Design
Price
Market research suggests that
97% of MA plans provided
coverage for a minimum of one
extra ancillary benefit — vision,
dental, or hearing.
1
Over 94% of Medicare
beneficiaries have access to a $0
premium Medicare Advantage
plan.
1
Critical Product Features
While HMO products cover 2/3
of MA members, access to
preferred PCP remains a key
decision point.
1,3
of Age-ins selected products on
the basis of premium
affordability
3
41%
is the average premium for products
outside of $0 plans, thus creating
two distinct pricing markets
1
$70
Sources
: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study
National MA Selection Criteria: Network
Nationally, most Medicare Advantage products are HMO’s with more narrow networks. However, PPO Medicare Advantage products continue to grow in popularity and currently dominate the Kansas Medicare Advantage market.
 
of MA enrollees considered access to their
preferred PCP a primary consideration
33%
annual growth in PPO product enrollment
between 2009-2019
24.3%
7.0
9.0
11.3
12.7
14.9
16.4
17.5
18.4
19.8
21.4
22.3
All BCBSKS Medicare Advantage
products are PPOs, thus
meeting the increasing market
demand!
Network
Product
Design
Price
Market research suggests that
97% of MA plans provided
coverage for a minimum of one
extra ancillary benefit — vision,
dental, or hearing.
1
Over 94% of Medicare
beneficiaries have access to a $0
premium Medicare Advantage
plan.
1
Critical Product Features
While HMO products cover 2/3
of MA members, access to
preferred PCP remains a key
decision point.
1,3
MA Enrollment by Network Type:
Sources
: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study
 
Network
Product
Design
Price
Market research suggests that
97% of MA plans provided
coverage for a minimum of one
extra Ancillary benefit — vision,
dental, or hearing.
1
Over 94% of Medicare
beneficiaries have access to a $0
premium Medicare Advantage
plan.
1
Critical Product Features
+
Most MA plans embed Dental, Fitness
or Vision within their product benefits
+
Since 2010, the share of enrollees in
plans that provide fitness or dental
care has increased (from 52% and 48%
of enrollees, respectively).
Supplemental benefits are defined as
extra benefits not covered under
traditional Medicare.  CMS continues to
relax rules around the definition of
supplemental including Over the Counter
(OTC), Transportation, and Meal Delivery.
Regulatory hurdles decreased
Supplements are becoming
market standard
While HMO products cover 2/3
of MA members, access to
preferred PCP remains a key
decision point.
1,3
4 of the 5
 BCBSKS Medicare Advantage plans offer Dental, Fitness (BMA Choice does not
offer the fitness benefit), and Vision!
Plans Offering the following Ancillary Benefits
1
:
National MA Selection Criteria: Product Design
MA offers consumers product features that are not covered by traditional Medicare. These supplemental benefits can range from Dental and Vision to Meal Delivery, OTC allowances and transportation services.
Sources
: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study
Blue Cross Blue Shield of Kansas:
Medicare Advantage Product Overview
Types of Medicare Plans
There are a number of Medicare Advantage plan options available to consumers. BCBSKS has a Preferred Provider Organization (PPO) product.
Source: 
CMS Managed Care Manual, 2019
Blue Medicare Advantage: 
Service Area & Network
Note: 
Wesley Medical Center and Hutchinson
Clinic are not currently contracted
Preventive
Blue Medicare Advantage: 
Value-Added Benefits
Medicare Advantage plans can embed supplemental benefits that provide additional coverage above what Original Medicare covers.
Supplemental benefits are allowed as long as they are “health-related;” therefore, there are quite a few variations in the national MA market.
 
Product Specifics
Who are the key in-network medical systems present in
BCBSKS Kansas’s Topeka and Wichita regions?
 
Answer:
Topeka: 
Stormont Vail, Lawrence Memorial, and St. Francis / KU Hospital
Wichita: 
Via Christi, Kansas Medical Center, and Kansas Heart Hospital
Blue Cross Blue Shield of Kansas
Supplemental Benefits Deep Dive
Vision 101
COMMON VISION TERMS
COMMON VISION TERMS 
Network: 
a group of providers that a plan has contracted with to offer services to its
members. These providers are considered in-network and may be independent or part of
a national or regional retail chain
.
 
Here is a look at your network,
Allowances
:
 
the dollar amount a member has to spend on frames and contacts before
incurring any out-of-pocket costs. Allowances typically range from $100-$200 
.
Here is a look at your plan allowances,
Copay
: 
a small dollar amount the member pays with the rest of the cost covered by the
insurer. Copays range from $0-$45.
 
Your plans offer,
Frequency
: 
the time period a member can use their benefit for different services and
material benefits (exam/lens/frame).  
 
Your plans have the following frequencies,
COMMON VISION TERMS
VISION DISCOUNTS
Standard vision plan discounts:
20% off balance over frame allowance
15% off balance over conventional contact
15% off retail or 5% off promotional price LASIK
40% off additional pairs of prescription glasses
20% off a pair of non-prescription glasses
TOP 3
Vision care is important because its impact reaches over 190 million U.S. adults
and 
affects all age groups 
from babies to seniors
The components of a vision plan are: 
exam, materials (frames, lenses, lens
options, contact lenses) , and discounts
On average, a vision plan will 
save a member 71% compared to paying retail
1
2
3
If you remember anything today, remember this; 
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BCBS KS Sales and Agent Training
September 2024
The Member Experience
 
Member Calls TruHearing at
1-833-734-4426
 
Member Visits a Provider
for a Hearing Exam
 
Member is Fitted and
Trained on Hearing Aids
 
 
 
 
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SilverSneakers
InComm Over-The-Counter Benefits
USING THE CARD AT PARTICPATING RETIAILERS
InComm Over-The-Counter Benefits
Above list of participating retailers subject to change at
any time.
For details on approved items, check the website at
myotccard.com and/or download the 
OTC Network
mobile app 
to scan items at retail locations.
List of example covered items provided right.
COVERED OTC ITEMS
 
Product Specifics
What are the premiums of each of BCBS Kansas’s
Medicare Advantage offerings?
 
Answer:
Both Blue Medicare Advantage (PPO) plans and
 the Blue
 Medicare Advantage Choice
 have $0 premiums.
Blue Medicare Advantage Comprehensive (PPO) plan has
 a
$40 premium. Blue Medicare Advantage Freedom (PPO) has a $0 premium.
Helping members thrive at home
March 2021
 
Care Guides Provide Full Continuum of Support
52
52
Early Planning                  Congenital Disorder                  Debilitating Disease                   Catastrophic Event                   Aging Decline
1: 1 Hands on Help Through the Entire Caregiving Continuum
Personalized Concierge Support Plan
Legal
Financial
Insurance
Safety
Housing
Medical
Social
Transportation
Deliveries
Care Plan Assessment
Physical, Social, & Cognitive
Review
Home Safety Analysis &
Recommendations
Building a Trusting
Relationship
Research, Coaching,
Advocacy
Time Saving Research
Health Behavior Coaching
Medication & Appointment
Reminders
Regular Communication
Concierge Supportive
Services
Recommend and Arrange
Services with Certified
Partners
Deliveries, Medication,
Home Care & More
Nationwide Coverage
Social Interaction
Regular Care Guide
Engagement
Virtual Resources (concerts,
museum tours, etc.)
Mailed Activities
Homethrive Meets Members Where They Are
53
Program participants will receive coaching from assigned Care Guide and coordination of third-party
products and services while, importantly, engaging family and community resources.
Members can engage with Care Guides however they are comfortable:
Phone Calls
Video Calls
Text
Email
Homethrive Offers Tablet-Based Engagement Platform to All
Members
Fully Connected Care Plan
Care Guide communication
Appointment reminders
Service coordination
Medication reminders
Social Connections
Family communication – call and video
Photo sharing
Homethrive virtual programing
Truly Smart Technology
Easy & intuitive for all age/tech levels
No set up, no maintenance
In-home sensor monitoring
Bluetooth device data integration
54
Homethrive Can Provide Comprehensive Service Anywhere in
Kansas
55
 
Social Engagement
Community: 
Local Senior Centers
Private Pay: 
Element3 Health
 
Grocery Delivery
Community: 
Roving Pantry
Private Pay: 
Instacart
 
Transportation
Community: 
Sedgwick County
Transportation
Private Pay: 
MedicaRide
 
PERS
Private Pay: 
VRI
 
Home Care
Community: 
Mental Health
Assn. of South-Central Kansas
Private Pay: 
Comfort Keepers
 
DME & Health Products
Community: 
Wichita Medical Loan
Closet
Private Pay: 
Medline
 
Meal Delivery
Community: 
Meals on Wheels
Private Pay: 
Magic Kitchen
 
Home Modification
Community: 
Wichita Habitat for
Humanity
Private Pay: 
Heartland Home
Social Engagement
Community: 
Local Senior Centers
Private Pay: 
Element3 Health
Grocery Delivery
Community: 
Harvesters 
Community Food 
Network
Private Pay: 
Instacart
 
Transportation
Community: 
Catholic Charities
Private Pay: 
First Class Transport
PERS
Community: 
Jayhawk Area 
Agency on Aging
Private Pay: 
VRI
Home Care
Community: 
Jayhawk Area
Agency on Aging
Private Pay: 
Home Instead
DME & Health Products
Community: 
Capper Foundation 
Equipment 
Loan Bank
Private Pay: 
Medline
Meal Delivery
Community: 
Meals on Wheels
Private Pay: 
Magic Kitchen
Home Modification
Community: 
Topeka Habitat for
Humanity
Private Pay: 
Passow Remodeling
Wichita Service Partners
Topeka Service Partners
All Homethrive Members Also Have Access to Curated Social
Activities
56
Homethrive recognizes the critical importance
of preventing social isolation and offers a
variety of activities and services to mitigate it.
All members would have access to:
Virtual Homethrive-hosted events such as:
Bingo
Concerts
Art classes
And much more
Homethrive-facilitated interactions such as a
pen pal program as well as virtual or in-
person clubs based on interests (e.g.,
gardening, chess, etc.)
 
57
57
It feels as if an angel has come down to help me figure out
and handle things. I’ve been so overwhelmed and felt very
alone.
I can’t tell you how helpful Monique has been and what a
relief it is to have her in my life.
- Deborah
Homethrive Member & Medicare Advantage Beneficiary
Homethrive Can Provide Comprehensive Service Even in Very Rural
Areas
58
Population:
3,803
Economy:
Manufacturing and
industrial
Notable Employers:
AGCO and Excel Industries
Location:
Central Kansas, 40 miles north of Wichita and 130 miles
southwest of Topeka
Homethrive Service Partners
Social Engagement
Community: 
Hesston Area Senior Center
Private Pay: 
Element3 Health
Grocery Delivery
Community: 
Store-to-Door
Private Pay: 
Instacart
 
Transportation
Community: 
Harvey Interurban
Private Pay: 
OT Cab Company
PERS
Private Pay: 
VRI
Home Care
Community: 
Central Plains Area
Agency on Aging
Private Pay: 
Home Instead
DME & Health Products
Community: 
Prairie Loan Closet
Private Pay: 
Medline
Meal Delivery
Community: 
Meals on Wheels
Private Pay: 
Magic Kitchen
Home Modification
Community: 
Central Plains Area
Agency on Aging
Private Pay: 
Heritage Home Works
 
Product Specifics
What are the 
standard out-of-network coinsurance 
amounts
for 
each BCBSKS Medicare Advantage
 product?
 
Answer:
Blue Medicare
 Advantage
 
Plans:
 
40%
Blue Medicare Advantage Choice 40%
Blue Medicare Advantage Freedom
 40%
Blue Medicare Advantage Comprehensive Plans: 
30%
Blue Cross Blue Shield of Kansas:
Medicare Advantage Pharmacy
Benefits
Overview: Part D Drug Phases
The Medicare Part D coverage phases are designed to help beneficiaries control their out-of-pocket costs.
Stage 3:
Coverage Gap
Stage 1:
Deductible
Stage 2:
Initial Coverage
Stage 4:
Catastrophic
Coverage
Otherwise referred to as
the 
“donut hole.”
Deductible
:
You pay the full cost
of your drugs until
you meet the
deductible.
Initial Coverage
:
Your plan gives you coverage
for your drugs, up to the
coverage gap.
Coverage Gap
:
Begins after the total yearly drug cost
(including what your plan has paid and
what you have paid) reaches 
$5,030.
Catastrophic Coverage
:
Once yearly True Out-Of-
Pocket (TrOOP) costs reach
$8,000
 you will be close to fully
covered again.
Source: 
2019 CMS Managed Care Manual
Blue Medicare Advantage: 
High-Level Offering
Each BCBSKS product contains different Part C copays and coinsurance to meet Topeka and Wichita market norms for pricing. All products also provide additional gap coverage for Tier 1 and Tier 2 drugs to
help lower beneficiaries out-of-pocket costs.
**See the changes in red**
Blue Medicare Advantage: 
Part D Initial Coverage
During the Initial Coverage phase, the beneficiary is responsible for paying a co-pay or coinsurance for their covered drugs, until the Initial Coverage Limit (ICL) of $4,020 is reached.
Note
: The above cost-shares represent preferred retail and preferred mail-order cost-shares for a 30-day supply.  Cost-shares may vary depending on the pharmacy members
choose or the Rx day supply. For more information, access the Evidence of Coverage.
 
Product Specifics
In which Part D drug phase(s) does BCBSKS offer supplemental
coverage above what is required by CMS?
 
Answer:
Phase 1 (Deductible)
Phase
 3 
(
Coverage Gap Phase)
Closing 
Remarks
Appendix
Regulatory Guidelines
This table defines the communication guidelines and requirements and their applicability to BCBSKS MA Plans.
Source: 
Medicare Marketing and Communications Guidelines, 2019
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Explore the latest updates for Blue Cross Blue Shield of Kansas Medicare Advantage plans for 2023-2024, including benefit changes, new plan details, and distinct service areas in Topeka and Wichita. Learn about enhancements such as increased allowances for dental and eyewear, copay adjustments, and the introduction of new plan offerings. Stay informed about the evolving options available to members in Kansas. Strictly confidential information presented by HealthScape Advisors.


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  1. Blue Cross Blue Shield of Kansas Medicare Advantage Sales Team Training August 23, 2023 Property of HealthScape Advisors Strictly Confidential

  2. Introductions Property of HealthScape Advisors Strictly Confidential

  3. 2023 MA Benefit Changes The Medicare Advantage Product Team researched and analyzed the Medicare Advantage product offerings in our service area for 2023. The team determined there was a need for some benefit changes in 2024 to stay competitive and continual growth of our Medicare Advantage membership. Leavenworth county has been added to the Topeka region. Some plans encompass all regions now. 3

  4. 2024 Blue Medicare Advantage Comprehensive (007) Changes Regions have combined under 1 comprehensive plan (Topeka & Wichita $40 premium) Primary Care physician copay- $0 Specialist copay- $35 Dental Allowance increased to $3,000 Eyewear allowance increased to $200 OTC increased to $350 Dental Buy up will be allowed in both regions and for $25 premium Insulin drugs are $10 copay/all coverage phases 4

  5. 2024 Blue Medicare Advantage Choice Changes In Network Out-of-pocket max $3,500 Specialist copay-$30 Inpatient Hospital copay-$295 per day for days 1 to 5 Dental allowance increased to $1,750 Eyewear allowance increased to $200 Added OTC of $50 quarterly 5

  6. New Plan!!! 2024 Blue Medicare Advantage Freedom Premium- $0 Part B credit- $75 Out-of-pocket max- $5,400 PCP copay-$0 Specialist copay-$45 Inpatient Hospital- $400 copay per day for days 1-5 Dental allowance- $1,000 No Part D coverage 6

  7. Service Area What are the two distinct service areas for Kansas s Medicare Advantage products? Name the counties within each. 17 counties for Topeka area, and 10 for the Wichita area. Topeka Service Area Counties: Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, Wabaunsee, Chase, Coffey, Franklin, Geary, Linn, Lyon, Miami, Morris, Riley, Leavenworth. Wichita Service Area Counties: Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, Sumner, Dickinson, Marion, McPherson. Property of HealthScape Advisors Strictly Confidential 7

  8. 2023 Medicare Advantage Regions Wichita Region $0 Blue Medicare Advantage 10 Counties Topeka Region $0 Blue Medicare Advantage 17 Counties All Regions $0 Blue Medicare Advantage Choice and Blue Medicare Advantage Freedom $40 Blue Medicare Advantage Comprehensive 27 Counties 8

  9. Medicare Advantage: Eligibility and Enrollment Property of HealthScape Advisors Strictly Confidential

  10. C Overview of CMS Selling Periods CMS only allows Medicare beneficiaries to enroll in Medicare Advantage during certain times of the year. Review the eligibility qualifications for each selling period carefully, as adhering to these regulations is critical. January 1 March 31 During the OEP, consumers with a MA plan can: Switch to another MA Plan Disenroll from a MA Plan and return to Original Medicare April 1 October 14 During Pre-AEP, new MA plans can: Perform Educational Events and communicate Educational content about general Medicare Announce new MA Provider Partnerships Call existing BCBSKS members or prospective enrollees who have requested to be contacted October 15 December 7 During the AEP, consumers can: Sign up for Medicare health or prescription drug coverage Change their Medicare health or prescription drug coverage JANUARY 1 APRIL 1 DECEMBER 7 OCTOBER 1 Annual Enrollment Period (AEP) Open Enrollment Period (OEP) Pre-Annual Enrollment Period (Pre-AEP) Market Open Special Enrollment Period (SEP) We are currently in Pre-AEP! DECEMBER 31 Year-round Examples qualifying a consumer for SEP: The consumer has just become eligible for Medicare (Age-In) The consumer moves out of the current plan s service area The consumer has or loses Medicaid The consumer qualifies or loses Extra Help During this period, MA plans: Can begin Marketing MA product benefits Cannot enroll members until October 15 Property of HealthScape Advisors Strictly Confidential The consumer lives in an institution (e.g. nursing home) 10

  11. C Communications Pre and During AEP During the Pre-Annual Enrollment Period, all communications must remain strictly educational and simply provide information without influencing potential enrollees decisions. During the Annual Enrollment Period, communications may be used to inform a potential enrollee about plan specifics and benefits as well as attempt to influence the enrollee s decision-making process when choosing a plan. Communications Pre and During AEP JANUARY 1 APRIL 1 DECEMBER 7 OCTOBER 1 Market Open OEP Pre-AEP AEP SEP DECEMBER 31 AEP: Marketing Communication Pre-AEP: Educational Communication During Pre-AEP, all communications must be used to provide information to current and prospective enrollees. This means that no activities or materials during Pre-AEP may mention specific products and their benefits or have the intent of drawing the attention of a current or prospective enrollee to influence the enrollee s decision-making process about joining a plan. During the AEP, activities and the use of materials by the Plan/Part D sponsor may have the intent to draw a beneficiary's attention to a plan or plans and to influence a beneficiary's decision-making process when selecting a plan for enrollment or deciding to stay enrolled in a plan (that is, retention-based marketing). Additionally, marketing materials may contain information about the plan s benefit structure, cost sharing, measuring, or ranking standards. Property of HealthScape Advisors Strictly Confidential Source: Medicare Communications and Marketing Guidelines, 2019 11

  12. C Medicare Advantage Eligibility Criteria Use the criteria in the table below to determine if a candidate is eligible for Medicare Advantage. In general, an individual is eligible to elect an MA plan when each of the following requirements is met: As of 2021 individuals that have been determined to have ERSD are eligible to apply for coverage. The individual or his/her legal representative completes an enrollment request and includes all the information required to process the enrollment or meets alternative conditions for enrollment specified by CMS. The individual permanently resides in the service area of the MA plan. The individual is fully informed of and agrees to abide by the rules of the MA organization that were provided during the enrollment request. The individual is a U.S. citizen or lawfully present in the United States. The individual is entitled to Medicare Part A and enrolled in Part B, provided that he or she will be entitled to receive services under Medicare Part A and Part B as of the effective date of coverage under the plan. The individual makes a valid enrollment request that is received by the plan during an election period (see Overview of CMS Selling Periods slide). Property of HealthScape Advisors Strictly Confidential Source: MA Enrollment and Disenrollment Guidance, 2019 12

  13. Marketing Periods What is the period for marketing of Medicare Advantage products called? When does this period begin and end? Answer: Marketing can begin on October 1, but sales for MA products may not begin until the Annual Enrollment Period (AEP) on October 15. The end of AEP is December 7. Property of HealthScape Advisors Strictly Confidential 13

  14. CMS Requirements for Sales Call Centers Property of HealthScape Advisors Strictly Confidential

  15. C Call Center CMS Regulations Due to the overarching increase in expected call volumes and narrow Annual Enrollment Period selling window (October 15 December 7), BCBSKS has contracted with Faneuil to assist with Medicare Advantage telephonic sales. Category CMS Regulations October 1 March 31: 8:00 AM to 8:00 PM CST, 7 days per week + Hours: 8:00 AM to 8:00 PM CST, 7 days per week during AEP and OEP (October 1 to March 31) Hours of Operation April 1 September 30: 8:00 AM to 8:00 PM CST, Monday to Friday Answer Rate 80% of incoming calls within 30 seconds Disconnect Rate 5% or below All prospective enrollee voicemails must be returned within 1 business day. Returning Calls Please Note: Customer Service calls post-sale will be supported by Advantasure, Prime Therapeutics, and our respective Supplemental Benefit Vendors. Property of HealthScape Advisors Strictly Confidential 15

  16. C Brief Review of CY2020 Lax in Regulations In 2019, CMS provided MA plans more flexibility in the types of communications they can leverage prior to AEP. The revised marketing guidelines allow for some new and unique best practices while also maintaining strict rules that MA plans must adhere to on an ongoing basis. Best Practices Never Distribute your business card and contact info for beneficiaries to use to initiate contact Pre-AEP Educational Communication Distribute plan-specific materials or enrollment packets Collect Scope of Appointment (SOA) forms Conduct sales presentations or attempt to enroll prospective members Schedule sales / marketing appointments Submit talking points and presentations to CMS prior to use, including those to be used by agents Use contact information for anything other than the purpose for which it was collected AEP Clearly label sign in sheets as optional Marketing Communication Collect Enrollment Forms Offer meals Adhere to SOA parameters and documentation Market in restricted areas of a healthcare setting Property of HealthScape Advisors Strictly Confidential Source: Medicare Marketing and Communications Guidelines, 2019 16

  17. C CMS Required Marketing Materials The resources listed below provide information on BCBSKS benefits, MA Plan operations, and CMS regulatory guidance. Reference Contents Location BCBSKS References Evidence of Coverage (EOC) A comprehensive explanation of the coverage offered by a MA plan https://www.bcbsks.com/medicare/ forms A list of key benefits offered by a MA plan; a shortened version of Chapter 4 of the Evidence of Coverage https://www.bcbsks.com/medicare/ forms Summary of Benefits (SB) Provider Directory A list of all the providers contracted by a MA plan https://www.bcbsks.com/medicare/ forms Pharmacy Directory A list of all the pharmacies contracted by a MA plan https://www.bcbsks.com/medicare/ forms Formulary A list of the drugs covered by a MA plan https://www.bcbsks.com/medicare/ forms CMS References Communications & Marketing Guidelines CMS regulations for Marketing and Selling Medicare Advantage products Medicare Communications & Marketing Guidelines Medicare Advantage Enrollment & Disenrollment Guidance Chapter 2 of the Medicare Managed Care Manual details CMS regulations for enrollment and disenrollment of MA Members Enrollment & Disenrollment Guidance Managed Care Manual contains all applicable regulatory requirements for operation / administration of Medicare Advantage plans Medicare Managed Care Manual Medicare Managed Care Manual Property of HealthScape Advisors Strictly Confidential 17

  18. Medicare Advantage Buyer Behaviors Property of HealthScape Advisors Strictly Confidential

  19. C National Senior Market Buyer Behaviors Medicare beneficiaries have the option to stay in Original Medicare or supplement their coverage with a MA plan or Med Supp policy. MA plans are attractive to seniors due to lower premiums and the inclusion of Part D coverage and supplemental benefits. Original Medicare Parts A + B Medicare Supplement Parts A + B Medicare Advantage Part C + Budget conscious individuals typically do not want to pay the additional premium over and above that paid for Medicare Part B. + Original Medicare beneficiaries must pay their Part A deductible and Part B premiums + Beneficiaries must pay a monthly premium, dependent on the level of supplemental coverage obtained + Typically attracts more affluent consumers that do not mind paying higher premiums (average of $183/month) + Some MA plans cost no more per month than Original Medicare ($0 premium plans) + Some plans may offer lower coinsurance than that charged by Original Medicare (20%) + Cap on out-of-pocket health spending (Original Medicare has no out-of-pocket max) Price + Broadest possible choice in doctors and medical providers (more doctors accept Medicare than MA) + Maximum flexibility when seeking medical specialties (no prior authorizations to see specialists) + Broadest possible choice in doctors and medical providers (more doctors accept Medicare than MA) + Maximum flexibility when seeking medical specialties (no prior authorizations to see specialists) + Designated HMOs require patients to see a PCP for a referral to visit a specialist + PPO plans allow members to see a specialist without a referral (out-of-network could cost more, however) Network + Original Medicare then covers most services at 20% coinsurance to the beneficiary + Original Medicare has no drug coverage (unless member adds Part D) + Alternative to enhance Original Medicare coverage (e.g. lower copays / coinsurance on Medicare-covered services) + Medicare Supplement has no drug coverage (unless member adds Part D) + Alternative to enhance Original Medicare coverage (e.g. lower copays / coinsurance on Medicare-covered services) + Can include value-added benefits not covered by Original Medicare (e.g. vision, dental, hearing) + MA plans can include Part D prescription drug coverage (MAPD vs. MA) Product Design Property of HealthScape Advisors Strictly Confidential Source: US Health News, Medicare vs. Medicare Advantage: How to Choose, 2018 19

  20. C National MA Selection Criteria: Price Medicare Advantage offers consumers product features that are not covered by traditional Medicare. Additionally, many plans are available at a $0 premium and/or include Part D drug coverage. MA Enrollment by Monthly Premium Price Points: Critical Product Features $1-$19 4% Over 94% of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.1 Blue Medicare Advantage Comprehensive (PPO) has a $40 premium in ALL regions! Price $20-$49 20% $0 Premium 51% While HMO products cover 2/3 of MA members, access to preferred PCP remains a key decision point.1,3 $50-$99 15% Network Blue Medicare Advantage (PPO) has a $0 premium in both the Topeka and Wichita regions! $100+ 10% Market research suggests that 97% of MA plans provided coverage for a minimum of one extra ancillary benefit vision, dental, or hearing.1 41% $70 Product Design of Age-ins selected products on the basis of premium affordability3 is the average premium for products outside of $0 plans, thus creating two distinct pricing markets1 Property of HealthScape Advisors Strictly Confidential Sources: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study 20

  21. C National MA Selection Criteria: Network Nationally, most Medicare Advantage products are HMO s with more narrow networks. However, PPO Medicare Advantage products continue to grow in popularity and currently dominate the Kansas Medicare Advantage market. MA Enrollment by Network Type: Critical Product Features 25.0 HMO PPO Other 22.3 21.4 0.4 Over 94% of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.1 19.8 0.8 20.0 18.4 MA Enrollment (in millions) 0.8 Price 17.5 0.9 8.0 16.4 0.9 7.1 14.9 0.8 6.4 15.0 5.5 0.8 12.7 5.3 All BCBSKS Medicare Advantage products are PPOs, thus meeting the increasing market demand! 5.0 11.3 0.8 4.4 0.8 While HMO products cover 2/3 of MA members, access to preferred PCP remains a key decision point.1,3 9.0 3.4 10.0 3.0 0.7 7.0 Network 1.8 13.9 0.5 13.4 12.6 0.9 12.0 11.3 10.6 5.0 9.7 8.5 7.5 6.5 5.6 - Market research suggests that 97% of MA plans provided coverage for a minimum of one extra ancillary benefit vision, dental, or hearing.1 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Product Design 33% 24.3% annual growth in PPO product enrollment between 2009-2019 of MA enrollees considered access to their preferred PCP a primary consideration Property of HealthScape Advisors Strictly Confidential Sources: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study 21

  22. C National MA Selection Criteria: Product Design MA offers consumers product features that are not covered by traditional Medicare. These supplemental benefits can range from Dental and Vision to Meal Delivery, OTC allowances and transportation services. Plans Offering the following Ancillary Benefits1: Critical Product Features 4 of the 5 BCBSKS Medicare Advantage plans offer Dental, Fitness (BMA Choice does not offer the fitness benefit), and Vision! Over 94% of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.1 Price 77% 69% 62% While HMO products cover 2/3 of MA members, access to preferred PCP remains a key decision point.1,3 Network Fitness Benefit Vision Benefit Dental Benefit Regulatory hurdles decreased Supplements are becoming market standard Supplemental benefits are defined as extra benefits not covered under traditional Medicare. CMS continues to relax rules around the definition of supplemental including Over the Counter (OTC), Transportation, and Meal Delivery. Market research suggests that 97% of MA plans provided coverage for a minimum of one extra Ancillary benefit vision, dental, or hearing.1 + Most MA plans embed Dental, Fitness or Vision within their product benefits + Since 2010, the share of enrollees in plans that provide fitness or dental care has increased (from 52% and 48% of enrollees, respectively). Product Design Property of HealthScape Advisors Strictly Confidential Sources: 1- Kaiser Family Foundation; 2- Pareto Spotlight Tool, 2018 CMS Enrollment Data; 3- Deft 2018 Medicare Age-In Study 22

  23. Blue Cross Blue Shield of Kansas: Medicare Advantage Product Overview Property of HealthScape Advisors Strictly Confidential

  24. C Types of Medicare Plans There are a number of Medicare Advantage plan options available to consumers. BCBSKS has a Preferred Provider Organization (PPO) product. Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Special Needs Plan (SNP) Private Fee-For-Service (PFFS) Original Medicare No. Enrollee must get their care and services from doctors, other health care providers, or hospitals in the plan s network. In most cases, yes. PPO plans have network doctors, other health care providers, and hospitals, but enrollees can also use out-of-network providers for covered services, usually for a higher cost. Enrollees generally must get their care and services from doctors, other health care providers, or hospitals in the plan s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). Enrollees can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan s payment terms and agrees to treat you. Yes, if they accept Medicare Can I get a my health care from any doctor, other health care provider, or provider? If enrollees join a PFFS plan that has a network, enrollees can see any of the network providers who have agreed to always treat plan members In most cases, yes. If you want Medicare drug coverage, you must join a HMO plan that offers a prescription drug coverage. In most cases, yes. If you want Medicare drug coverage, you must join a PPO plan that offers a prescription drug coverage. Yes. Sometimes. If enrollees PFFS plan does not offer drug coverage, enrollee can join a Medicare Prescription Drug Plan to get coverage. No Are prescription drugs covered? Yes, all Medicare Advantage plans must have limits on out-of-pocket spending Yes, all Medicare Advantage plans must have limits on out-of-pocket spending Yes, all Medicare Advantage plans must have limits on out-of-pocket spending Yes, all Medicare Advantage plans must have limits on out-of-pocket spending No Is there a limit to my out- of-pocket spending? In most cases, yes. Certain services, like yearly screening mammograms, do not require a referral. In most cases, no. In most cases, yes. Certain services, like yearly screening mammograms, do not require a referral. No No Do I have to get a referral to see a specialist? Property of HealthScape Advisors Strictly Confidential Source: CMS Managed Care Manual, 2019 24

  25. C Blue Medicare Advantage: Service Area & Network Topeka Topeka Topeka Wichita Blue Medicare Advantage Comprehensive (PPO) Wichita Blue Medicare Advantage Choice (PPO) Wichita Blue Medicare Advantage Freedom (PPO) Blue Medicare Advantage Comprehensive (PPO) Topeka Wichita Blue Medicare Advantage (PPO) Blue Medicare Advantage Choice (PPO) Blue Medicare Advantage Freedom (PPO) Blue Medicare Advantage (PPO) Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, Wabaunsee, Chase, Coffey, Franklin, Geary, Linn, Lyon, Miami, Morris, Leavenworth, and Riley Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, Sumner, Dickinson, Marion, and McPherson Counties Serviced Network: Part C Medical Note: Member may see providers in Wichita or Topeka regardless of their product Note: Wesley Medical Center and Hutchinson Clinic are not currently contracted . **No preferred pharmacies** Network: Preferred Retail Pharmacy Other Independent Pharmacies required to meet adequacy requirements. Reference the online Pharmacy Directory for additional detail. Network: Standard Retail Pharmacy Property of HealthScape Advisors Strictly Confidential 25

  26. Preventive

  27. 28

  28. Property of HealthScape Advisors Strictly Confidential 29

  29. C Blue Medicare Advantage: Value-Added Benefits Medicare Advantage plans can embed supplemental benefits that provide additional coverage above what Original Medicare covers. Supplemental benefits are allowed as long as they are health-related; therefore, there are quite a few variations in the national MA market. Common Medicare Advantage Supplemental Benefits BCBSKS Benefit Covered OON Services Available? Vendor Acupuncture In-Home Safety Assessment Readmission Prevention Alternative Therapies Meals Benefit Remote Access Technologies Dental Services Yes Bathroom Safety Devices Medical Nutrition Therapy (MNT) Repairs Fitness Benefit No Routine Chiropractic Services Nutritional / Dietary Benefit Telemonitoring Services Hearing Services Exam Yes Aids - No Counseling Services Over-the-Counter (OTC) Benefit Transportation Services Meals Benefit No Personal Emergency Response System (PERS) Dental Services Vision Services Over-the- Counter (OTC) Benefit No Fitness Benefit Physical Exam Visitor / Travel Benefit Enhanced Disease Management (EDM) Point of Service (POS) Weight Management Programs Vision Services Yes Post-discharge in-home Medication Reconciliation Wigs for Hair Loss Related to Chemotherapy Worldwide Emergency / Urgent Coverage Health Education Covered by BCBSKS Network Telehealth Yes Hearing Services Preventive Benefits Covered by BCBSKS Network or BlueCard Other Services Yes Property of HealthScape Advisors Strictly Confidential 30

  30. Product Specifics Who are the key in-network medical systems present in BCBSKS Kansas s Topeka and Wichita regions? Answer: Topeka: Stormont Vail, Lawrence Memorial, and St. Francis / KU Hospital Wichita: Via Christi, Kansas Medical Center, and Kansas Heart Hospital Property of HealthScape Advisors Strictly Confidential 31

  31. Blue Cross Blue Shield of Kansas Supplemental Benefits Deep Dive Property of HealthScape Advisors Strictly Confidential

  32. Vision 101

  33. COMMON VISION TERMS Network: a group of providers that a plan has contracted with to offer services to its COMMON VISION TERMS members. These providers are considered in-network and may be independent or part of a national or regional retail chain. Here is a look at your network, Network name Providers Locations Insight 103,400 26,000 Allowances:the dollar amount a member has to spend on frames and contacts before incurring any out-of-pocket costs. Allowances typically range from $100-$200 . Here is a look at your plan allowances, Package allowance(s) Depends on plan- See plan details

  34. COMMON VISION TERMS Copay: a small dollar amount the member pays with the rest of the cost covered by the insurer. Copays range from $0-$45. Your plans offer, Benefit Copay Eye Exam $0 copay Frequency: the time period a member can use their benefit for different services and material benefits (exam/lens/frame). Your plans have the following frequencies, Plan Frequency 12 months / 12 months

  35. VISION DISCOUNTS Standard vision plan discounts: 20% off balance over frame allowance 15% off balance over conventional contact 15% off retail or 5% off promotional price LASIK 40% off additional pairs of prescription glasses 20% off a pair of non-prescription glasses

  36. TOP 3 If you remember anything today, remember this; Vision care is important because its impact reaches over 190 million U.S. adults and affects all age groups from babies to seniors 1 The components of a vision plan are: exam, materials (frames, lenses, lens options, contact lenses) , and discounts 2 3 On average, a vision plan will save a member 71% compared to paying retail

  37. BCBS KS Sales and Agent Training September 2024

  38. The Member Experience Member Calls TruHearing at 1-833-734-4426 Member Visits a Provider for a Hearing Exam Member is Fitted and Trained on Hearing Aids 39 CONFIDENTIAL. FOR DISCUSSION ONLY.

  39. 40

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  41. 42

  42. 43

  43. Property of HealthScape Advisors Strictly Confidential

  44. SilverSneakers Property of HealthScape Advisors Strictly Confidential 45

  45. Property of HealthScape Advisors Strictly Confidential 46

  46. Property of HealthScape Advisors Strictly Confidential 47

  47. InComm Over-The-Counter Benefits Property of HealthScape Advisors Strictly Confidential 48

  48. InComm Over-The-Counter Benefits USING THE CARD AT PARTICPATING RETIAILERS COVERED OTC ITEMS Above list of participating retailers subject to change at any time. For details on approved items, check the website at myotccard.com and/or download the OTC Network mobile app to scan items at retail locations. List of example covered items provided right. Property of HealthScape Advisors Strictly Confidential 49

  49. Product Specifics What are the premiums of each of BCBS Kansas s Medicare Advantage offerings? Answer: Both Blue Medicare Advantage (PPO) plans and the Blue Medicare Advantage Choice have $0 premiums. Blue Medicare Advantage Comprehensive (PPO) plan has a $40 premium. Blue Medicare Advantage Freedom (PPO) has a $0 premium. Property of HealthScape Advisors Strictly Confidential 50

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