Slide 1
Thanks for viewing this short video to learn about the Aetna MedicareSM Plan (PPO) for UAW Retiree Medical Benefits Trust members with General status.
Slide 2
If the Trust determined that you have Protected status, call us for information on your Aetna Medicare Advantage plan.
If you don’t know if you are a General or Protected status Trust member, call Retiree Health Care Connect. They’re available at 1-866-637-7555.
Slide 3 - Agenda
During this video, I’ll cover:
• Your other benefits provided by the Trust
• How Medicare Advantage plans work
• What you pay with Aetna
• Keeping the doctors you know and trust
• Extra support programs
And
• Enrolling in Aetna
Slide 4 - Your other benefits provided by the Trust
The Trust offers you benefits in addition to the Aetna medical plan option I’ll go over on this video. These include coverage for prescription drugs, dental, hearing and vision. Enrolling in Aetna for your medical coverage does not impact any of these other benefits provided by the Trust.
Slide 5 - How Medicare Advantage plans work
Let’s start by going over what Medicare Advantage plans are and how they work.
Slide 6 - What is Medicare Advantage?
Medicare Advantage plans are approved by Medicare and offered by private insurance companies, such as Aetna.
Medicare Advantage, or Medicare Part C, plans provide all the benefits you get with Original Medicare Part A (hospital) and Part B (medical). Similar to Original Medicare, Medicare Advantage doesn’t pay for everything. You may have to pay a share of your health care costs through deductibles, flat 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 Advantage plans also often include helpful care support programs, such as fitness programs, personalized nurse support and more, at no extra cost
Slide 7 – Am I eligible?
To be eligible for a Medicare Advantage plan, you must be enrolled in Medicare
Parts A and B. You must also continue to pay your monthly Medicare Part B premium when enrolled in a Medicare Advantage plan. And you cannot be enrolled in more than one Medicare Advantage plan.
Slide 8 - Easy to use
Medicare Advantage plans are also easy to use. When you go to the doctor for an office visit, you’ll only need to show your Medicare Advantage ID card and pay any applicable copay. Your provider will submit the claim directly to the plan. 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 a Medicare Advantage plan. Since your doctor will only need to bill Aetna, that is less paperwork for both them and you. This means you’ll receive one medical Explanation of Benefits.
Slide 9 – Two types of Aetna plans
There are two Aetna plan types. The type that’s available to you is based on your residential zip code.
The first plan type is the Preferred Provider Organization or PPO plan.
The second plan type is the Extended Service Area or ESA plan.
If you’re in the PPO plan, you may pay less if you use Aetna Medicare network providers.
If you’re in the ESA plan, you can see any provider that accepts Medicare and is willing to bill Aetna. You won’t pay more if the provider is not in the Aetna Medicare network.
Slide 10 - Which plan applies to you?
At this point you might not be sure whether you live in an area that has a PPO plan or an ESA plan. Just give us a call at 1-855-406-4062. Deaf or hard of hearing beneficiaries can dial 711. One of our representatives will look that up for you.
Slide 11 – Key terms
Before I go into more detail on Aetna Medicare Advantage itself, let’s go over some key terms that apply to many medical plans.
I’ll start with one you’ll likely be familiar with – copay. A copay is a fixed amount you pay for covered health services. For example, you go to see your doctor and you pay an office visit copay and your plan covers the rest.
The next term is deductible. This is the amount of money you pay out of pocket annually before the plan pays.
Another important term is coinsurance. This is the percentage you pay for covered health services after you meet your deductible.
The last term I want to cover is out-of-pocket maximum. The out-of-pocket maximum is the most you have to pay for covered health services in a plan year. After you spend this amount on deductibles, copays and coinsurance, your health plan pays 100 percent of the costs of covered benefits.
Slide 12 - Here’s what you pay
Now let’s look at an overview of what you’ll pay with the Aetna Medicare Advantage plan.
Keep in mind, if you’re in the Preferred Provider Organization plan, this information applies to Aetna Medicare in-network providers. If you’re in the Extended Service Area plan, this information applies to any provider that accepts Medicare and is willing to bill Aetna.
With the Aetna plan, you don’t have to pay a monthly contribution just to have the plan.
You have coverage for certain health services where you first must pay a $245 deductible. Once you meet that deductible, and then pay your share, or coinsurance, of ten percent. Aetna pays the other 90 percent. You pay this 10 percent share up to your primary out-of-pocket maximum of $630. The primary out-of-pocket maximum is the deductible plus coinsurance.
Once you meet your primary out-of-pocket maximum of $630, you won’t pay any more coinsurance for the rest of the year. The Aetna plan will pay 100 percent for any services where the deductible and coinsurance would otherwise apply.
For office visits, emergency room visits and urgent care visits, you’ll pay a copay at the time of the visit.
• If the doctor is a primary care physician or family doctor, you pay $20.
• If the doctor is a specialist, such as a cardiologist or orthopedist, you pay $25.
• If you see a chiropractor, you pay $20.
• If you go to urgent care, you pay $25.
• If you go the emergency room, you pay $50. This copay is waived if you’re admitted to the hospital.
Slide 13 - Keeping your doctors
You’ve learned what you’ll pay with the Aetna Medicare Advantage plan. Now let’s talk about keeping the providers you know and trust.
Slide 14 - Preferred Provider Organization
If you’re in the Preferred Provider Organization plan, this information applies to you.
Our PPO plan features a network of over 800,000 providers and over 3,500 hospitals.
If you visit PPO in-network providers, your out-of-pocket expenses may be lower.
You can also use out-of-network providers as long as they accept Medicare and are willing to bill Aetna.
To find out if your doctors are in our network, you can call our Member Services team.
Slide 15 - Extended Service Area
If you’re in the Extended Service Area plan, this information applies to you.
The ESA plan is designed to give you the flexibility to see any provider that accepts Medicare and is willing to bill Aetna.
This means that with this plan, it doesn’t matter whether they are in or out of the Aetna Medicare network. You will pay the same amount, according to the costs listed on your plan benefits summary.
You can find out if your doctor accepts the Aetna Medicare Advantage ESA plan by calling our Member Services team.
Slide 16 - Whether you’re in the PPO or ESA plan
No matter which plan you’re in, with Aetna Medicare Advantage you:
• Have access to doctors and hospitals nationwide
• Don’t need referrals
And
• Get national coverage when traveling
Slide 17 - The Aetna plan comes with extras
I mentioned at the beginning of this video that Medicare Advantage plans often come with extra programs. And Aetna Medicare Advantage is no exception. Let’s go over a few of those programs.
Slide 18 - Bonus programs, at no extra cost
To help you focus on your physical health, we offer the popular SilverSneakers® fitness benefit. This program allows you to access any of the over 16,000 gyms and fitness centers. And if you’re not near a participating location, you can get a home fitness kit.
We also offer the Healthy Home Visit program. If you choose to take part in this voluntary program, 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.
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.
Remember, these are just a few of the programs you get at no extra cost with Aetna Medicare Advantage.
Slide 19 - Bonus programs, at no extra cost
For more information on other programs that come with the Aetna plan, click on the Live Well menu on the top of this page. There you can explore other programs such as the Teladoc® telemedicine program and ways an Aetna nurse can help you manage your health.
Slide 20 - Ready to enroll?
If you’re not already an Aetna member, let’s go over how you can enroll.
Slide 21 - Just call …
All you have to do is call Retiree Health Care Connect at 1-866-637-7555 and tell them you want to join the Aetna plan. They’re available Monday through Friday, 8:30 AM to 4:30 PM ET.
If you switch to Aetna during the plan year, you won’t lose the amount you already paid towards your annual in-network deductible and coinsurance from your previous plan. We’ll automatically apply it to the Aetna Medicare Advantage plan shortly after your effective date with Aetna.
Slide 22 - Questions?
If you have questions, call our helpful Member Services team at 1-855-406-4062. Deaf or hard of hearing beneficiaries can dial 711.
They’re available Monday through Friday, 8 AM to 6 PM all time zones.
Slide 23 - Thank you
Thank you for your time today. We look forward to joining you on your health journey.
GRP_4004_2644_C 12/2019
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