Welcome UAW Trust members
Thank you for tuning in to view this informational video that explains the Aetna Medicare Advantage plan offered by the UAW Retiree Medical Benefits Trust (which from now on we’ll call “the Trust”).
Agenda
We created this video for you because you are close to turning 65, and we have some important information we’d like to share with you. We’ll cover:
- What Medicare is
- Why turning 65 is important
- Your options as a Trust member
- The Aetna Medicare Advantage plan and
- Extras you get with Aetna Medicare Advantage
You’ll also see a short testimonial video from one of your fellow UAW Trust members.
Welcome to Medicare
On behalf of Aetna, I want to welcome you to Medicare! Whether you’re new to Medicare or getting ready to turn 65, you’ll need to make several important decisions about your health coverage.
We understand access to affordable, quality health insurance in retirement is important to you. We’d like to provide information on 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 65th 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.
What is Medicare?
Before we get into your plan options, let’s spend a few moments reviewing Medicare and what it means to you. 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 are 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 and
- Some home health care
Most people age 65 or older qualify for Medicare Part A based on their employment history. As a member of the Trust, you qualify for Medicare Part A.
Medicare Part B
Medicare Part B covers:
- Medically necessary doctor services
- Outpatient care
- Medical supplies and
- 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. For most people, the monthly amount is about $134.00. The information you have or will receive from Social Security shows 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’ll still have to pay monthly premiums and a share of your health care costs through deductibles, copays and coinsurance.
Medicare Part C
You can also choose to get your benefits through a Medicare Part C plan. This is 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 Medicare 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 video.
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 protection 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 Trust already provides prescription drug coverage, so no need to worry. You’ll continue to use Express Scripts© for your prescription drugs, just like you do today.
Which Aetna plan applies to me?
Before we start talking in detail about the Aetna Medicare Advantage plan, it’s important to know that there are two plans. They are called the Extended Service Area (ESA) plan and the Preferred Provider Organization (PPO) plan. The plan available to you depends on your residential zip code.
If you received a brochure called “Find out more” from Aetna in the mail, you can refer to the cover of this brochure to find out if you’re eligible for the ESA or PPO plan.
And if you don’t have a brochure, you can call us at 1-855-406-4062. Deaf or hard of hearing beneficiaries can dial 711. We’re available Monday through Friday, 8 AM to 6 PM in all time zones. Our Member Services team will be able to tell you which plan is available in your area.
Aetna Medicare Advantage
One of the medical plan options available to you is the Aetna Medicare Advantage plan. We will be discussing the Aetna medical plan and the many support programs that are provided at no additional cost. The Trust offers the Aetna Medicare Advantage plan in 49 states, making it the primary plan for most Trust Medicare members.
We will not be discussing your other Trust insurance coverages. Those coverages are your prescription drug, your dental, your vision or your hearing aid coverage. Be sure to call Retiree Health Care Connect (RHCC) at 1-866-637-7555, Monday – Friday,
8:30 AM to 4:30 PM, to understand all the choices you have.
What is Aetna Medicare Advantage?
We already went 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 SilverSneakers® fitness program, personalized nurse support and more, at no extra cost to you.
To better understand the Aetna Medicare Advantage plan, first let’s give you a brief overview of how the other Medicare plan option available through the Trust works.
In addition to the Aetna Medicare Advantage plan, the Trust offers another type of Medicare plan option for members age 65 and over. With that plan, you have two ID cards, so when you visit your doctor, you show both ID cards. After your visit, your doctor submits your claim to Medicare and Medicare Part A or Part B pays. Then, the plan pays and lets your doctor know about any balance left over. Your doctor will then bill you for the balance.
Aetna Medicare Advantage is an all-in-one plan
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. 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 than the other plan option, and direct 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 $20 for your primary care doctor or $25 when you visit a specialist.
The Aetna Medicare Advantage plan must cover all Medicare-approved services, so it includes comprehensive coverage similar to the other plan option. 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.
Comparing costs
Now let’s look at how the costs of the Aetna Medicare Advantage plan compares to the other Medicare plan option. Keep in mind this isn’t a complete list of your benefits, but just a comparison. We will discuss benefits in more detail in a moment.
Here, we highlight some services that are important to many of you, such as office visits, emergency room and urgent care.
The Aetna Medicare Advantage plan column shows your costs for in-network care if you are in our PPO plan. If you are in our ESA plan, it shows your costs for any provider that is eligible to receive Medicare payment and willing to accept Aetna Medicare Advantage.
Let’s start with your monthly contribution. You are currently paying $17 a month for your health care plan and once you turn 65 you will continue to pay $17 a month unless you choose the Aetna Medicare Advantage plan. So, here’s the good news! There is a $0 contribution with the Aetna Medicare Advantage plan, saving you $204 per person a year.
The next line shows your deductible of $245 per person. This compares to a $400 total deductible on the other Medicare plan. The total deductible is a combined amount of $215 for the other plan plus $185 for the Medicare Part B deductible. Your deductible is $155 lower per person on the Aetna Medicare Advantage plan.
You can see that the annual primary out-of-pocket maximum is $630 per person with Aetna, compared to $800 on the other Medicare plan. You will reach your out-of-pocket maximum sooner on the Aetna Medicare Advantage plan while saving $170 per person.
When you go to see your primary care doctor, you will pay a $20 office visit copay at the time of your visit. And when you see a specialist, you’ll pay a $25 copay at the time of your visit. How does that compare to the other Medicare plan? With the other Medicare plan, you are paying 20 percent of the office visit charges after the Part B deductible of $185. This means you get a bill in the mail after your appointment. The Part B deductible doesn’t apply to the Aetna Medicare Advantage plan.
Many Trust members like the Aetna Medicare Advantage plan because there are predictable copays. This is especially helpful for specialist office visits. With this plan, you know exactly what you’re going to pay for office visits: a $20 or $25 copay.
The emergency room and urgent care services offer significant savings as well. You will see a savings of $75 for emergency room services and a $25 savings for urgent care services.
Your cost share - ESA
Now, I want to spend a few minutes talking about the features of the Aetna Medicare Advantage plan, so you can better understand how your out-of-pocket costs are determined. We’ll start with the ESA plan.
Trust members in the ESA plan pay the same out-of-pocket amounts whether or not you use Aetna’s network of doctors and hospitals.
When you see a doctor, you’ll be responsible for paying a copay at the time of the visit.
- If the doctor is a primary care doctor or family doctor, you pay $20.
- If the doctor is a specialist, such as a cardiologist or orthopedist, you pay $25.
Next on the chart, you’ll see the emergency and urgent care benefits. An emergency room visit has a $50 copay, and an urgent care facility has a copay of $25.
For other covered services, you pay a coinsurance rate of ten percent, after you meet your $245 deductible. A hospital stay is a good example of a service in which your deductible and coinsurance apply. The words coinsurance and deductible may seem confusing, so let’s clarify:
- The deductible is the amount of money you pay out of pocket annually before Aetna pays.
- The coinsurance is the percentage you pay for a covered health service after you meet your deductible.
Lastly, you’ll see that you have a primary out-of-pocket maximum of $630. The primary out-of-pocket maximum includes your deductible and coinsurance. Once you meet your $245 deductible, you’re only responsible for $385 in coinsurance before you meet this out-of-pocket maximum. Then you won’t pay any more coinsurance for the rest of the year.
You’ll continue to pay your office visit copays until you meet your combined out-of-pocket maximum of $1,500.
Your cost share - PPO
Now we’ll talk about the PPO plan. These costs apply to network doctors and hospitals.
When you see a doctor, you’ll be responsible for paying a copay at the time of the visit.
- If the doctor is a primary care doctor or family doctor, you pay $20.
- If the doctor is a specialist, such as a cardiologist or orthopedist, you pay $25.
Next on the chart, you’ll see the emergency and urgent care benefits. An emergency room visit has a $50 copay, and an urgent care facility has a copay of $25.
For other covered services, you pay a coinsurance rate of ten percent, after you meet your $245 deductible. A hospital stay is a good example of a service in which your deductible and coinsurance apply. The words coinsurance and deductible may seem confusing, so let’s clarify:
- The deductible is the amount of money you pay out of pocket annually before Aetna pays.
- The coinsurance is the percentage you pay for a covered health service after you meet your deductible.
Lastly, you’ll see that you have a primary out-of-pocket maximum of $630. The primary out-of-pocket maximum includes your deductible and coinsurance. Once you meet your $245 deductible, you’re only responsible for $385 in coinsurance before you meet this out-of-pocket maximum. Then you won’t pay any more coinsurance for the rest of the year.
You’ll continue to pay your office visit copays until you meet your combined out-of-pocket maximum of $1,500.
Your cost share example
Let’s talk through an example of when the deductible, coinsurance and primary out-of-pocket maximum might apply. This example explains your costs when you use network providers with either the ESA or PPO plan. If you have the ESA plan, it also applies to out-of-network providers as long as they are eligible to receive Medicare payment and willing to accept Aetna Medicare Advantage.
Let’s say you’re in the hospital for an extended inpatient stay. You would expect to pay your $245 deductible. Once you have paid the deductible, you would be responsible for paying 10 percent of the remaining hospital bill, up to $385, and Aetna would pay the other 90 percent.
After you meet the $630 out-of-pocket maximum for the year, the plan will pay 100 percent for any services where the deductible and coinsurance (of 10 percent) would otherwise apply.
You’ll continue to pay any copays for office visits, emergency room or urgent care visits. Remember, on your other plan option, you pay a monthly contribution of $17. That adds up to $204 per year — or the equivalent of 10 primary care office visit copays.
Understanding how your benefits work
Now, let’s spend some time understanding how the benefits work. We will cover your deductible, your member coinsurance and your out-of-pocket maximums.
Suppose you see your primary care doctor for an office visit in January. Your copay is $20, and there is no deductible and no coinsurance for this visit. You simply show your Aetna Medicare Advantage card and you are responsible for a $20 copay at the visit. Aetna will pay the remaining amount and you are finished.
A month later, you visit your cardiologist. Since a cardiologist is considered a specialist, your copay would be $25. Again, there is no deductible and no coinsurance for an office visit. In this example, the doctor recommends a surgical procedure to be performed at a hospital. You’re admitted to the hospital and the procedure expense is a total of $20,245. For this hospital stay, you only need to pay your deductible and your 10 percent coinsurance.
Your annual deductible is $245. Remember, your deductible is the amount of money that you pay out of pocket before Aetna pays. After you pay your deductible, you will then pay your 10 percent coinsurance, which is the amount you pay for covered health services after you pay the deductible. Aetna pays 90 percent of the bill and your responsibility is 10 percent of the bill. When your deductible and your 10 percent coinsurance combined reach a total of $630, you have then reached your primary out-of-pocket maximum.
Here’s the good news! This means you won’t pay any more coinsurance for the rest of the year. All you’ll continue to pay are your copays for doctor office visits until you reach your annual combined out-of-pocket maximum of $1,500.
Two months later, after you recover from surgery, you begin physical therapy. Since you’ve already met your $245 deductible and reached your primary out-of-pocket maximum for the year, your total cost for physical therapy is covered at 100 percent. You will however, continue to pay your doctor office visit copays until you reach your combined out-of-pocket maximum of $1,500.
What happens to your current annual out-of-pocket spending?
You may be wondering about the money you’ve already spent toward your deductible and out-of-pocket maximum this year. There’s good news. When you join the Aetna Medicare Advantage plan, you won’t lose the amount you already paid toward your annual
in-network deductible and coinsurance from your current plan. We’ll automatically apply it to the Aetna Medicare Advantage plan shortly after your effective date with Aetna.
Keep your doctors
Now let’s talk about your doctors. We know the most important question for our 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.
First, we’ll talk about the Extended Service Area or ESA plan.
The Extended Service Area plan
The ESA plan was specifically designed for Trust members and gives you the flexibility to see any provider, as long as the provider is:
- Eligible to receive Medicare payment and
- Willing to accept Aetna Medicare Advantage
This means that with this 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. Just remember, the provider must be eligible to receive Medicare payment and willing to accept Aetna Medicare Advantage.
You should know that many doctors do in fact accept Medicare and accept Aetna Medicare Advantage. In fact, over 700,000 providers accept the Aetna plan nationwide.
You can find out if your doctor will accept the Aetna Medicare Advantage ESA plan by calling our helpful Member Services team. Our representatives are available Monday – Friday, 8 AM to 6 PM in all time zones.
The Preferred Provider Organization plan
Now let’s talk about the Preferred Provider Organization or PPO plan.
If you’re in our PPO plan, your out-of-pocket expenses will be lower if you visit network providers. The Aetna Medicare network includes over 700,000 network doctors and specialists and 3,100 hospitals.
To find out if your doctors are in our network, just call our Member Services team. Our representatives are available Monday – Friday, 8 AM to 6 PM in all time zones.
You can still see out-of-network providers with the PPO plan; however, you may pay more out of pocket. If the doctor is out of network, you’ll be covered as long as the provider is:
- Eligible to receive Medicare payment and
- Willing to accept Aetna Medicare Advantage
Get care no matter where you are
With the Aetna Medicare Advantage 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 an urgent need for medical care. When traveling away from home, Aetna will help you find a doctor that you can see.
Plan extras
We talked about how to access health care providers and how simple it is to use the Aetna Medicare Advantage plan. We’ve also talked about savings. But now, we’d like to share some of the support programs that are included with this 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.
Helping you reach your goals
Because many of us want to focus on our health and wellness, we offer many helpful programs such as the popular SilverSneakers fitness benefit. The program allows you to access any of the over 16,000 gyms and fitness centers, at no additional cost.
We also offer our Healthy Lifestyle Coaching program. You can talk to a health coach who can help you create a realistic plan to improve your health. This program may help you in many areas of wellness, such as quitting smoking, losing weight or eating better. Your coach will set up regular calls with you and you’ll work together to reach your health goals.
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 after a surgery and your doctor recommends in-home health care. The Aetna nurse advocate can help you find a home health care provider and help you coordinate that process, so you can simply focus on your recovery.
Helping you get and stay healthy
We also offer our Aetna Healthy Rewards program. This member rewards program encourages you to get healthy and stay healthy. You’ll get rewarded with a gift card for completing important health care activities such as getting your annual exam, screenings and more.
Helping you where you are
Sometimes you need support at home too. We’ve got programs for that.
The Resources For Living® referral program is offered at no extra cost to you. A Resources For Living life consultant can refer you to services in your area that make life easier and more enjoyable. You can get referrals for things such as help at home, social activities, transportation, caregiver support and more. Keep in mind, you’ll have to pay for any services you decide to use.
We also offer the Healthy Home Visit program. 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 doctor and 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.
With Aetna Medicare Advantage, you also get access to the Teladoc® telemedicine service. Teladoc is a 24/7 service that allows you to speak to a licensed doctor by web, phone or mobile app — usually within 15 minutes. To use the service for the first time, you just need to register and provide your medical history. After you’ve registered, you can schedule a session with a doctor. All you have to do is request a visit and pay the regular $20 office visit copay. You can use Teladoc for non-emergency conditions such as allergies, sinus infection, rash, cold or flu.
If you have questions about any of the programs we talked about, just call us.
The Aetna advantage
I’ve told you a lot about the Aetna Medicare Advantage plan and the additional programs that come with it. Now let’s talk about the benefits of choosing Aetna for your medical plan.
Why choose Aetna?
So why should you choose Aetna? First and most important, when you switch to Aetna, you’ll get credit for what you already paid toward your annual in-network deductible and coinsurance from your current plan.
We’re also 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 coverage to a subset of Trust members since 2012. More than 135,000 Trust members are with Aetna today. We also serve over 2.1 million Medicare Advantage members.
And we do that from right here in the United States. Our Member Services team is based in Ohio.
Value of Aetna Medicare Advantage
As noted before, the Trust offers another Medicare plan option for members age 65 and over. Unlike this other plan option available through the Trust, with Aetna Medicare Advantage, you won’t have to pay a monthly contribution just for having the plan. This saves you $17 per month.
With Aetna, you’ll also have a lower annual deductible — in fact, you’ll pay $155 less each year. Remember, the deductible is the amount of money you pay before the plan pays.
Aetna Medicare Advantage also has a lower primary out-of-pocket maximum, saving you $170 each year.
And you get extra programs that you don’t get with the other plan option. These include SilverSneakers, Healthy Home Visits, Aetna Healthy Rewards and more to support you on your health and wellness journey.
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.
Play video
Don’t just take my word for it. Let’s hear why one of your fellow UAW Trust members chose Aetna, in his own words.
“My name is Philip Manes. I’m retired and came here three years ago and I’m just living the dream now. I’m originally from Chicago and a friend of mine worked for Ford Motor Company. Went for an interview and I was 18 years old when I walked in there and I just left three years ago.
I got married pretty late in life. Getting married and have a baby and my age is the best. My daughter is 15, I like to see her grow up. Working out in the gym and playing golf, and just try to do as much as I can outdoors. I got to keep myself active in order to spend that time with my daughter because I wanna do it for as long as I possibly can.
Well I had received a letter to change my insurance, it was a hard decision but it was probably, looking back now and where I’m at right now, it was the best decision. And they had my doctors. Which was very important. Because I’ve had my doctors for 10 years.
Aetna called me. They said they’d like to have a couple of nurses come in and speak with me. So they came in and gave me a physical. And when that was done we had some conversations. They were excellent they wrote everything down that I talked about. I feel Aetna is very caring to the people that are on Social Security. They follow up all the time to see if I’m okay. I even got phone calls to see how I was feeling. That’s big.
The other benefit was the SilverSneakers. You can go to any place that’s covered through Aetna. So now I go there and I work out. Try to keep myself healthy and proactive. They pay for everything. Nobody likes change. Then after you get into it and you see how much Aetna cares, I wouldn’t of had it any other way. I’m very happy with Aetna.”
I hope you enjoyed the video. We heard from Phillip that he was able to keep his doctors and he appreciates the extras he gets with his Aetna plan, such as SilverSneakers and Healthy Home Visits.
Next steps
Now, let’s talk about the next steps.
How to enroll
If you like what you heard today, you can enroll in the plan by calling Retiree Health Care Connect (RHCC) at 1-866-637-7555 and telling them that you want the Aetna Medicare Advantage plan. They’re available Monday – Friday, 8:30 AM to 4:30 PM ET.
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 Trust and Aetna, which will include the Trust logo.
And be sure to sign up for Medicare before your 65th birthday or before you become eligible. You’ll need to be enrolled in Medicare Parts A and B to be eligible for this plan. Regardless of which plan you choose, it is important to call RHCC and inform them of your Medicare eligibility.
Learn about your other benefits
You also have dental, hearing and vision benefits available to you through the Trust. Your coverage will be unchanged for these benefits if you enroll with Aetna.
To learn more about these benefits, you can contact Retiree Health Care Connect (RHCC).
Questions?
Thank you for your time today. We hope you decide to enroll in the Aetna Medicare Advantage plan. You can always call us with other questions at 1-855-406-4062. Deaf or hard of hearing beneficiaries can dial 711. We’re available Monday through Friday, 8 AM to 6 PM in all time zones.
We look forward to joining you on your health journey.
GRP_6013_2124_M 05/2019
