Turning 65?

Watch these informational videos:

Medicare 101

ABCs of Medicare Advantage

Medicare is the federal insurance program for people age 65 or older and for some people with certain illnesses.

Here are the different types of Medicare and what they cover:

• Part A covers hospital stays.
• Part B covers doctor visits. All Medicare enrollees pay a Part B premium each month.
• Part C (or Medicare Advantage) combines Part A and Part B coverage. It also offers additional benefits that Original Medicare doesn’t cover, such as care advocacy and wellness programs.
• Part D covers prescription drugs.

You can apply for Medicare online at socialsecurity.gov, or enroll at your local Social Security office.¹

¹State of New Jersey recommends enrolling in Medicare as early as possible to avoid a delay in the start of your Medicare coverage, which could result in out-of-pocket expenses.

For most people, the Medicare enrollment period opens three months before they turn 65 and ends three months after their birthday.

You deserve a health plan that helps you make the most of retirement. That’s why State of New Jersey and Aetna have teamed up to design a health plan just for you.

You can attend a conference call to learn more about Aetna Medicare Advantage.

To register, call 1-866-795-2091 (TTY: 711),  Monday through Friday,
8 AM to 9 PM ET.

Welcome and thank you for joining this Aetna Medicare Advantage presentation.

My name is Jason and I’m here from Aetna. I’m here today to talk about your health benefits through the New Jersey State Health Benefits Program, which from now on we’ll call the SHBP and the New Jersey School Employees’ State Health Benefits Program which from now on we’ll call SEHBP.

Because you are close to turning 65, we have some important information we’d like to share with you. This information is for SHBP and SEHBP members who will be eligible for Medicare soon.

During this presentation we’ll explain:

• What Medicare is
• Why turning 65 is important
• Your options as an SHBP or SEHBP member
• The Aetna Medicare Advantage plan
• Extras you get with Aetna Medicare Advantage

Whether you’re new to Medicare or getting ready to turn 65, you’ll need to make several important decisions about your health coverage. On behalf of Aetna, I want to welcome you to Medicare! We understand access to affordable, quality health insurance in retirement is important to you. We’d like to help make some of these decisions easier by sharing what your plan options are so you can make an informed decision when you turn 65.

The first thing you'll need to do is enroll in Medicare. To be eligible for Medicare starting the month of your 65^th birthday, you must sign up for Medicare between one and three months before your birthday.

You can apply online at SocialSecurity.gov or enroll at your local Social Security office.

Before we get into what your plan options are, let’s spend a few moments reviewing Medicare and what it means to you. So, what is Medicare, and how do you know you’re eligible? Medicare is a federal health insurance program for:

• People who are 65 and older
• People with disabilities who are younger than 65
• People with End Stage Renal Disease (ESRD)

If any of these apply to you, then you should be eligible for Medicare. Medicare coverage is broken into different parts which help cover the costs of specific services. They are Part A, Part B, Part C and Part D.

First let’s discuss Parts A and B, which is also known as Original Medicare. Parts A and B cover the costs of different services. Part A is hospital coverage and Part B is medical coverage.

(Medicare Part A)

Medicare Part A covers:

• Inpatient hospital stays
• Care in a Skilled Nursing Facility
• Some home health care

Most people age 65 or older qualify for Medicare Part A (hospital insurance) based on their employment history.

(Medicare Part B)

Medicare Part B covers:

• Medically necessary doctor services
• Outpatient care
• Medical supplies
• Preventive services

Almost everyone who is eligible for Medicare Part A can enroll in Medicare Part B. A monthly premium is required and will be deducted from your Social Security check. It is possible for some of you that the State will reimburse you for your Part B premium, but this will not apply to everyone. For most people, the monthly amount is about $144, but it may be higher. The information you have or will receive from Social Security will indicate your monthly contribution for Parts A and B.

One important thing to remember is that Original Medicare doesn’t cover the costs of all of your health expenses. You still may have to pay monthly premiums and will have to pay a share of your health care costs through deductibles, copays and coinsurance.

(Medicare Part C)

You can instead get your benefits through a Medicare Part C plan. This is also referred to as a Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies, such as Aetna, that are approved by Medicare. To be eligible for a Medicare Advantage plan, you must be enrolled in Medicare Parts A and B. You also must continue to pay your monthly Part B premium when enrolled in a Medicare Advantage plan.

Medicare Advantage plans combine Part A and Part B coverage in one plan and may include extra benefits not offered by Original Medicare, such as preventive, vision and hearing services. Some of the extra benefits you get with the Aetna Medicare Advantage plan will be discussed later in this presentation.

Just like Original Medicare, Medicare Part C doesn’t pay for everything. You may have to pay a share of your health care costs through deductibles, copays and coinsurance. However, Medicare Advantage plans place a limit on your out-of-pocket costs. This provides you with financial protection in case of a major illness. There is no out-of-pocket limit with Original Medicare (Parts A and B).

(Medicare Part D)

Medicare Part D is prescription drug coverage. Part D plans are also offered by private insurance companies that are approved by Medicare. Your plan with the SHBP or SEHBP provides prescription drug coverage, so no need to worry. You’ll continue to use Optum for your prescription drugs, just like you do today, and you will be enrolled in a Part D plan. The Part D information provided here is strictly for educational purposes.

As a member of the SHBP or SEHBP, you will have two PPO ESA plan options. You will be automatically enrolled into the plan most closely matching your current plan, but if you want to make a change you can do that. More information will be provided to you later in this presentation. For a complete list of your options based on your eligibility, just contact the Division of Pensions and Benefits and they will be able to confirm which plans you are eligible for.

During this time, you’ll receive a lot of mailings about Medicare from many different companies. Although this may seem overwhelming, Aetna is here to help. When looking through all of the Medicare information that comes to your mailbox, be sure to look for the State of New Jersey logo. All mailings with the State of New Jersey logo will detail information about the plans that are specifically designed for you as an SHBP or SEHBP member. Other mailings may have great plan options, but these plans may not be offered through the State of New Jersey.

Aetna has sent you an information packet.

If you didn’t receive a copy and would like one, let us know. You can call us  Monday through Friday, 8 AM to 6 PM ET.

• SHBP call 1-866-234-3129 (TTY: 711)
• SEHBP call 1-866-816-3662 (TTY: 711)

One of the medical plans available to you is the Aetna Medicare Advantage plan. We will be discussing the Aetna medical plan options and the many support programs that are provided at no additional cost. The SHBP and SEHBP offers the Aetna Medicare Advantage PPO ESA plan across the country in all 50 states, making it the primary plan for most Medicare members.

I won’t be covering your other SHBP or SEHBP insurance coverages offered through Horizon or your prescription drug coverage through Optum. If you have questions on these plans, you can contact them directly.

So why should you choose Aetna? We are one of the country’s largest health insurers, and we have over 166 years of insurance experience.

I’m pleased to tell you that Aetna has been providing Medicare Advantage coverage to State of New Jersey members for over 11 years. Almost 190,000 State of New Jersey members are enrolled with Aetna Medicare Advantage today. In total Aetna serves over 2.1 million Medicare Advantage members.

And we do that from right here in the United States. Your dedicated Member Services team is based in Ohio. That team got a 98 percent satisfaction rating from State of New Jersey members last year, based on the 2018 State of NJ member satisfaction survey. This team has been created to serve you specifically and the Member Services representatives only take calls from members in the State of New Jersey sponsored plans. As an Aetna member, if I were to call Member Services, I would speak to someone completely different than you. Your representatives know Medicare and know your plans.

Our mission is to build a healthier world for everyone. To us, that means simplifying your health care experience. We want to help you reach your full potential in life. We want you to be happy and healthy and to have the support you deserve during your retirement.

Here’s a real-life example of how an Aetna nurse helped a State of New Jersey member achieve better health. The nurse taught retired educator Gerry how to better manage his diabetes and lose weight, so he could get back to doing the things he loves: spending time with his grandkids, swimming, walking and staying active in his community.

We already over the basics of Medicare Advantage or Medicare Part C plans, but let’s recap. Aetna Medicare Advantage is approved by Medicare and administered by Aetna.

It provides your Original Medicare Part A (hospital) and Part B (medical) benefits.

And the Aetna Medicare Advantage plan includes additional benefits, such as the preventive health reminders, healthy lifestyle coaching and more at no extra cost to you.

Now let’s talk about getting care. We know the most important question for SHBP and SEHBP members when reviewing health plan options is, “Will my doctor take this plan?” So we want to make sure we spend plenty of time covering this topic.

Aetna offers what’s called a Preferred Provider Organization Extended Service Area (or PPO ESA) plan. The PPO ESA plan is designed to give you the flexibility to see any provider that is eligible to receive Medicare payment and accepts the Aetna Medicare Advantage plan.

With this PPO ESA plan, it doesn’t matter whether they are in or out of the Aetna Medicare network. If you see an out-of-network provider, you will pay the in-network cost.

You should know that many doctors do in fact accept Medicare and accept Aetna Medicare Advantage. In fact, over 819,000 providers accept the Aetna plan nationwide.

You can find out if your doctor will accept the Aetna Medicare Advantage PPO ESA plan by calling our helpful Member Services team. Our representatives are available Monday through Friday, 8 AM to 6 PM, all time zones. You also have a custom website available to you which will allow you to look up your provider on your own if you’d prefer. You can visit SONJ.AetnaMedicare.com. If for some reason you do not find your doctor, I always recommend calling Aetna so we can confirm if in fact they will accept the plan.

With the Aetna Medicare Advantage PPO ESA plan, you get coverage nationwide and you don’t need referrals. It also covers you when you are traveling outside the country in case you have an emergency or urgent need for medical care. When traveling away from home, Aetna will help you find a doctor that accepts the Aetna Medicare Advantage plan.

Now that we’ve covered how to access health care providers, let’s talk about how this plan works. In order to better understand the Aetna Medicare Advantage plan, first let’s give you a brief overview of how the other Medicare plan options for the State of New Jersey work.

In addition to the Aetna Medicare Advantage plan, the State offers other Medicare plan options for members age 65 and over. The other Medicare plan option involves two medical  cards, a complicated payment process with many steps, and requires paperwork from your doctor and Medicare. This can be a long and time-consuming process.

Now let’s talk about the Aetna Medicare Advantage plan and the simplicity in how it works. When you go to the doctor, you’ll only need to show your Aetna Medicare Advantage card, and your provider will submit the claim directly to Aetna. You can put your red, white and blue Medicare ID card away in a safe place, because you won’t need to present that card while you’re enrolled in this plan. For you, that means one ID card, one Explanation of Benefits and less paperwork. For your doctor it also means less paperwork, and timely payment of claims.

Aetna Medicare Advantage is simple because it’s an all-in-one plan. That means it’s easy to use. When you go to your doctor for an office visit, you’ll need two things: your Aetna ID card and your office visit copay. That’s either $10 or $15 for both the primary care physician as well as specialist, depending on which plan option you are enrolled in. I will get into additional details on your specific cost share with each plan in a minute.

The Aetna Medicare Advantage plan must cover all Medicare-approved services, so it includes comprehensive coverage and coverage for all benefits covered under Original Medicare. Plus, the Aetna Medicare Advantage plan offers extra benefits such as the nurse support and wellness programs that we’ll talk about in a few minutes.

Now let’s spend some time reviewing benefits. You can find this information in your information packet. What’s unique about your PPO ESA plan is you will pay the same amount out of pocket for both in- and out-of-network benefits. If you recall from our earlier discussion, I mentioned that with the PPO ESA plan you would have the same cost share for doctors — regardless if they are in or out of network.

I will now review some of the specific benefits which apply to the PPO plans available to you:

Aetna Medicare Advantage PPO ESA $10 Plan

• Referral requirement: None, Deductible $0, Out-of-Pocket Maximum $400, Preventive Care 100% covered, Primary Care Physician $10, Specialist $10, In-Patient Hospital $0, Outpatient Surgery $0, Foreign Travel Included

Aetna Medicare Advantage PPO ESA $15 Plan

• Referral requirement: None, Deductible $0, Out-of-Pocket Maximum $1,000, Preventive Care 100% covered, Primary Care Physician $15, Specialist $15, In-Patient Hospital $0, Outpatient Surgery $0, Foreign Travel Included

Once you have met your out-of-pocket maximum you will not pay any more for Medicare covered benefits for the remainder of the calendar year. Aetna will be responsible for all costs at that point.

Again, for these two PPO ESA plans, the cost share I mentioned would apply for providers both in and out of Aetna’s Medicare Advantage PPO network!

We talked about how to access health care providers and how simple the Aetna Medicare Advantage plan is. Now, we’d like to share some of the support programs that are included with your new plan. We value your total health — physical, emotional and social. We want to help you reach your full health potential in life. We can help support you wherever you may be on your health journey.

We value your total health — physical, emotional and social well-being. We want to help you reach your health goals and your full potential in life, however you define it. We want to support you wherever you are on your health journey, and we do so by providing additional programs and support:

We will send you reminders for preventive services, and we have a 24-hour nurse line for those times where you just need a bit of extra advice or aren’t quite sure if you need to make that appointment or go to urgent care.

We support you with programs to help manage conditions such as diabetes and heart disease.

For those with complex medical conditions, we offer nurse case management, assistance to prevent you from being readmitted to the hospital, and our Compassionate Care program for advanced illnesses.

All of these are included at no additional cost to you and are intended to complement your current health care; they aren’t meant to replace it.

As a member of one of the Aetna Medicare Advantage plans, you have access to our Healthy Lifestyle Coaching program. This program allows you weekly access to one of the Aetna nurses. They’ll work with you to develop a strategy for you to accomplish a personal health goal you may have. Maybe you want to quit smoking or lose weight. The nurse will work with you to develop a program that fits your lifestyle to ensure you are able to meet the goal you set. For example, let’s say someone is looking to lose weight but has never been a runner before in their life. Our nurse will not suggest going out and running as a means to lose weight. Working with you they will develop a plan that allows you to accomplish your goals in a reasonable manner resulting in the highest rate of success.

We also offer the Healthy Home Visit. This visit is totally voluntary and is available at no cost to you. If you choose to take part, a health care professional will come to your home to review your health needs. They will make sure your home is safe and doesn’t have any tripping hazards. They also do a medication review and discuss your medical and family history with you. The visit does not replace care from your primary care physician, so we’ll share the results of your visit with them. The provider that comes to your home may also recommend one of our support programs that may be helpful for you. 

Because many of us would like to prevent health challenges from getting worse, we also have programs to help with complex conditions such as diabetes and heart disease. For those who have complex medical conditions, we offer nurses who can help guide you through the health care system. Maybe you’ve been in the hospital for five days after a surgery and your doctor recommends in-home health care. The Aetna nurse can help you find a home health care provider and help you coordinate that process, so you can simply focus on your recovery.

If you have questions about any of the programs I talked about, you can call us at the number listed on the back of your information packet. I will also provide the number again at the end of this presentation.

Now, let’s talk about the next steps.

If you like what you heard today, once you’ve enrolled in Medicare Parts A and B you will automatically be enrolled in the Medicare Advantage plan that most closely matches the plan you have today. For example, if you are currently in the NJ Direct $10 plan you will automatically be enrolled in the PPO ESA $10 plan. If you are currently enrolled in the NJ Direct $15 plan, you will automatically be enrolled in the PPO ESA $15 plan.

If you want to opt out of the Aetna Medicare Advantage plan, or you would like to enroll in a different plan you are eligible for, you must complete the required Retiree Health Benefit Enrollment and/or Change form on the Pensions and Benefits website at NJ.gov/Treasury/Pensions. If you opt out, you will have to wait a full 12-months before you can enroll again in the Aetna Medicare Advantage plan. Keep in mind, if you are currently in the NJ Direct $15 plan and want to change to the Aetna Medicare PPO ESA $10 plan, it may result in higher premiums for you. You can contact the State for specific premium questions.

We know that when you become Medicare eligible you will get a lot of information delivered to you. So be on the lookout for Medicare information from the State and Aetna which will include the State’s logo.

And be sure to sign up for Medicare before your 65^th birthday or before you become eligible. You’ll need to be enrolled in Medicare Parts A and B to be eligible for this plan.

Thank you so much for your time today. We hope enjoy the Aetna Medicare Advantage plan. You can always call us with other questions at  Monday through Friday, 8 AM to 6 PM ET.

• SHBP call 1-866-234-3129 (TTY: 711)
• SEHBP call 1-866-816-3662 (TTY: 711)

Or you can go online to SONJ.AetnaMedicare.com to learn more. We look forward to joining you on your health journey.

©2020 Aetna Inc.
GRP_6013_2478_M  10/2019