Slide 1 (Welcome slide)
We’re pleased you’ve tuned 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”).
Slide 2 (Agenda)
In this video, we’ll start with a short testimonial video from your fellow UAW Trust members. Then we’ll cover:
· Information about Aetna
· Access to doctors and hospitals
· How Aetna Medicare Advantage works
· Extras you get with our plan
· How you can get answers to any questions you have
Slide 3 (video)
In this brief video, you’ll meet Mr. and Mrs. Hodge, UAW Trust members who are both Aetna Medicare Advantage members living in Ohio.
(Video plays)
I hope you enjoyed the video. What we heard:
· All their doctors were covered by the Aetna plan. Switching to Aetna’s Medicare Advantage plan meant the Hodges didn’t have to switch their doctors. We can help you find out if your doctors accept the Aetna plan, too.
· Mr. Hodge had a good experience when he needed care away from home. The Aetna plan travels with you if you need to seek care when you’re traveling.
The Aetna member services team was able to resolve an issue for Mrs. Hodge quickly, which made it a great experience for her.
Slide 4 (Journey)
At Aetna, we recognize each of you is on a unique health journey. Aetna is here to help support you on that journey by:
· Making health care simpler for you
· Helping you save money
· Supporting you with programs tailored to your health needs
Slide 5 (We’ve got you)
I’m sure all of you have heard about Aetna before watching this video today, but what you may not know is Aetna:
· Has been in business for over 165 years
· Has been working with Medicare since it started more than 50 years ago
· Currently has more than 1.7 million Americans enrolled in Medicare Advantage plans across the country
· Has more than 130,000 Trust members enrolled in the exact plan we are talking about today
Suffice to say, Aetna has a long history of delivering health care coverage for people on Medicare.
I’m confident you’ll find many reasons to consider Aetna as your medical plan for next year, including these three key reasons:
1. We expect you’ll find switching your health plan to Aetna means many of you won’t have to switch doctors.
2. Aetna is dedicated to delivering best-in-class member services right here in the U.S.
3. Aetna Medicare Advantage is the least costly medical plan option the Trust offers you and covers you when you travel in the U.S.
Slide 6 (First Medicare check)
Aetna is proud we paid the very first Medicare claim back in 1966. Here’s a picture of the check.
Slide 7 (Fellow Trust members)
Aetna is also proud to be serving Trust members since 2012. Now over 130,000 Trust members are enrolled in the Aetna Medicare Advantage plan.
Overall, Trust members give Aetna a high satisfaction score. In fact, 98 percent are satisfied. (This is based on 2017 Aetna Medicare Advantage Trust group plan member satisfaction survey.)
Trust members save $204 in contributions per person with Aetna. If you are a couple, it’s $408 of savings.
Slide 8 (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.
I’m going to talk about two different plans.
First, we’ll talk about the Aetna Medicare Advantage PPO plan, or Preferred Provider Organization plan. Second, we’ll talk about the Aetna Medicare Advantage ESA plan, or Extended Service Area plan.
Slide 9 (Brochure)
You can refer to your “You lead, we’ll follow” brochure if you aren’t sure if you’re eligible for the PPO or Extended Service Area plan. Page 5 of the brochure will tell you which plan is available in your area. On page 5 you’ll see if you’re eligible for either the PPO plan or the PPO with Extended Service Area 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), Monday through Friday, 8 a.m. to 6 p.m. in all time zones. Our member service representatives will be able to tell you which plan is available in your area.
Slide 10 (PPO)
Let’s spend some time talking about the PPO Plan.
Slide 11 (Are my doctors in network – PPO)
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. If you want to know if your doctors or hospitals are in our network, you can call us at 1-855-406-4062 (Deaf or hard of hearing beneficiaries can dial 711), Monday through Friday, 8 a.m. to 6 p.m. all time zones.
Slide 12 (Out-of-network providers - PPO)
The PPO plan has been specifically designed for Trust members, which gives you the flexibility to see any provider, in network or out of network. But, if you see an out-of-network doctor, you’re going to pay more out of your pocket.
If the doctor is out of network, you’ll be covered as long as the provider is:
· Eligible to receive Medicare payment
· Willing to accept Aetna Medicare Advantage
You should know many doctors do in fact accept Medicare and accept Aetna Medicare Advantage, but there may be some that don’t. If you’re not sure if your doctor accepts the plan, give us a call. Our representatives will be happy to verify that information for you.
Aetna has done a careful review of the doctors Trust members and dependents utilize, and I can tell you nationally 95 percent* of the doctors do accept the Aetna Medicare Advantage plan. (This is based on analysis of the Trust’s provider utilization data for year ended December 31, 2015 compared to providers known to accept Aetna Medicare Advantage plans.)
Slide 13 (ESA plan)
Now, let’s spend some time talking about the Extended Service Area plan, or ESA for short.
Earlier, we reviewed the Aetna Medicare Advantage PPO plan. Now let’s talk about two key differences with the ESA plan.
1. Your doctor does not have to be in our network.
2. You get the same benefits in or out of network. This means if you see an out-of-network doctor, you’ll pay the in-network copay, coinsurance and deductible.
Slide 14 (Will my doctors accept the ESA plan?)
The ESA plan has been 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
· Willing to accept Aetna Medicare Advantage
You should know many doctors do in fact accept Medicare and accept Aetna Medicare Advantage, but there may be some that don’t. If you’re not sure if your doctor accepts the plan, give us a call. Our representatives will be happy to verify that information for you.
Aetna has done a careful review of the doctors Trust members and dependents utilize, and I can tell you nationally 95 percent of the doctors do accept the Aetna Medicare Advantage plan. (This is based on analysis of the Trust’s provider utilization data for year ended December 31, 2015 compared to providers known to accept Aetna Medicare Advantage plans.) It’s important to know the customized Aetna Medicare Advantage plan in your area doesn’t cost you more if your provider isn’t in our network.
Slide 15 (Call us - ESA)
Will my doctor accept the plan?
We’re here to help you find that out. You can call us if you have questions about certain doctors and/or need help finding a new provider. Our representatives are available Monday – Friday, 8 a.m. to 6 p.m. all time zones. We have a member services team dedicated to Trust members. They will be happy to help you and even call your doctor’s office on your behalf to confirm they will accept our plan.
Slide 16 (Nationwide)
No matter which plan area you’re in, PPO or ESA, Aetna Medicare Advantage provides coverage nationwide. Your Aetna plan travels with you wherever you go in the U.S. If you need help finding a doctor when you’re away from home, just call us. We can help!
It also covers you when you are traveling outside the country in case you have an urgent need for medical care.
Slide 17 (A plan with you in mind)
Now that we’ve covered how to access health care providers, let’s talk about how this plan option works.
Slide 18 (Current plan)
To better understand the Medicare Advantage plan, first let’s give you a brief overview of how the other national Medicare plan option for the Trust works.
In addition to the Aetna Medicare Advantage plan, the Trust offers another Medicare plan option for members age 65 and over. The other Medicare plan option involves two ID cards, a complicated payment process with many steps and paperwork from your doctor and Medicare. This can be a long and time-consuming process. That is shown on the left side of this slide.
The Aetna Medicare Advantage plan is on the right part of this slide. 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.
It’s simple.
Slide 19 (MA, all-in-one plan)
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 physician or $25 for a specialist.
A Medicare Advantage plan must cover all Medicare-approved services, so it includes comprehensive coverage similar to the other plan. Plus, the Aetna Medicare Advantage plan offers extra benefits such as SilverSneakers® and wellness programs that we’ll talk about in a few minutes.
Slide 20 (Your cost share - PPO)
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 PPO plan.
First, 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, 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.
Chiropractic care on Aetna Medicare Advantage plan has a $20 copay. Under the other Medicare plan option, you’ll pay 20 percent after meeting your $185 Part B deductible.
Last, you have coverage for other services paid at the coinsurance rate of ten percent, after you satisfy 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.
Let’s talk through an example of when the deductible, coinsurance and primary out-of-pocket (OOP) maximum might apply.
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. Also, keep in mind, this plan has an annual primary out-of-pocket maximum. This means, for the year, you’re only going to pay 10 percent until you reach a $630 out-of-pocket maximum. So, the most you’d pay for the hospital stay in this example is $630.
After you meet the $630 for the year, the plan will pay 100 percent for any services where deductible and coinsurance (of 10 percent) would otherwise apply.
Keep in mind you’ll continue to pay any copays for office visits, emergency room or urgent care visits.
Slide 21 (Your cost share - ESA)
Now we’ll talk about the Extended Service Area (ESA) plan. As I previously mentioned, 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.
First, 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, 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.
Chiropractic care on Aetna Medicare Advantage plan has a $20 copay. Under the other Medicare plan option, you’ll pay 20 percent after meeting your $185 Part B deductible.
Lastly, you have coverage for other services paid at the coinsurance rate of ten percent, after you satisfy 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.
Let’s talk through an example of when the deductible, coinsurance and primary out-of-pocket (OOP) maximum might apply.
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. Also, keep in mind, this plan has an annual primary out-of-pocket maximum. This means, for the year, you’re only going to pay 10 percent until you reach a $630 out-of-pocket maximum. So, the most you’d pay for the hospital stay in this example is $630.
After you meet the $630 for the year, the plan will pay 100 percent for any services where deductible and coinsurance (of 10 percent) would otherwise apply.
Keep in mind you’ll continue to pay any copays for office visits, emergency room or urgent care visits.
Slide 22 (Comparison)
Let’s look closer at the costs with this plan and how it compares to your other plan option. This isn’t a complete list of your benefits, but just a comparison.
Here, we highlight some services that are important to you, such as office visits, emergency room and urgent care. This is a comparison of the other Medicare plan and the Aetna Medicare Advantage plan, along with your savings.
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 per person for your health care plan. Once you turn 65, you’ll continue to pay $17 a month unless you choose the Aetna Medicare Advantage plan. So, here is 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. This compares to a $400 deductible on the other Medicare plan. Your deductible is $155 lower on the Aetna Medicare Advantage plan. You can see that the annual primary out-of-pocket maximum is $630 as compared to $800 on the other Medicare plan. You’ll reach your maximum out of pocket sooner on the Aetna Medicare Advantage plan while saving $170.
When you visit your primary care physician, there is a $20 office visit copay and a $25 specialist copay. But how does it 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. The Part B deductible is waived on the Aetna Medicare Advantage plan saving you $185.
Many members like the Aetna Medicare Advantage plan because of the 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’ll see a savings of $75 for emergency room services and a $25 savings for urgent care services.
Lastly, chiropractic care on Aetna Medicare Advantage plan has a $20 copay. Under the other Medicare plan, you’ll pay 20 percent after meeting your $185 Part B deductible.
Slide 23 (How the plan works)
Now, let’s spend some time understanding how the benefits work. We will cover your deductible, your member coinsurance and your out-of-pocket expenses.
Suppose you see your primary care physician 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’re responsible for a $20 copay. Aetna will pay the remaining amount and you’re 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 you pay out of pocket before Aetna pays. After you pay your deductible, you’ll then pay your 10 percent coinsurance which is the amount you pay for covered health services after you pay the deductible. Aetna is paying 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 out-of-pocket maximum. Here’s the good news! This means you won’t pay any more coinsurance (10 percent) for the rest of the year.
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 office visit copayments until you reach your combined out-of-pocket maximum of $1,500.
Slide 24 (What you’ll get with this plan)
We talked about how the Aetna Medicare Advantage plan is simpler – you only have one ID card, you receive one explanation of benefits and you may be able to keep your doctors. We also talked about savings.
Now, I’d like to share with you some of the support programs you’ll get with this plan.
Slide 25 (Support)
At Aetna, we aim to support you on your health journey.
• For those who want to focus on wellness, we have programs such as SilverSneakers. You get access to more than 14,000 gyms nationwide at no extra cost to you.
• We also offer Healthy Home Visits. With these, a medical professional comes to your house and you can ask questions, review medications and discuss any concerns. More than 25,000 Trust members already completed a visit in 2018.
• For those who have complex medical conditions, we offer nurse support. Get help with managing chronic conditions, help preventing you from being readmitted. You can also get a nurse case manager if you need one and compassionate care for advanced illnesses.
All of these are at no extra cost to you and are intended to complement your current health care; they’re not meant to replace it.
Slide 26 (Rewards)
We have a new program for 2019 called Aetna Healthy Rewards. This member rewards program encourages you to get healthy and stay healthy. You’ll be rewarded with a gift card for completing certain important health care activities such as breast cancer screenings, flu shots, colon cancer screenings and more.
Slide 27 (Help)
Changing to the Aetna plan doesn’t mean changing your medical care. We can help if you have a planned hospital admission for surgery or a procedure scheduled in late 2018 or early 2019. We call this continuity of care support. We’ll walk you through every step if you need treatment or therapy for certain conditions that goes beyond 2018.
Slide 28 (What’s next)
What’s next?
Let’s talk about the next steps.
Slide 29 (To enroll)
In most cases, if you turned 65 this year or will be turning 65 between now and January 31, 2019, you will be automatically enrolled in Aetna Medicare Advantage.
Most members impacted by a plan change will also be automatically enrolled in the Aetna Medicare Advantage plan.
Otherwise, if you would like to enroll in the Aetna Medicare Advantage plan, you must call Retiree Health Care Connect between September 4 and November 30.
If you are automatically enrolled in the Aetna Medicare Advantage plan and you wish to opt out or choose another plan option, you can call Retiree Health Care Connect at 1-866-637-7555 Monday – Friday, 8:30 a.m. to 4:30 p.m. ET, between September 4 and November 30.
Slide 30 (After enrollment)
If you enroll in our plan for 2019, you’ll receive:
· Plan confirmation letter (from the Trust), which confirms your enrollment in the Aetna Medicare Advantage plan
· New ID card from Aetna
· Aetna’s welcome kit
− Helpful kit to get the most from your new plan
− Includes evidence of coverage and plan coverage details
− Explains how to get a provider directory
· Welcome call
− To see if you have any questions about the transition
− To check if you may qualify for benefits that can help you manage a medical condition or situation
Slide 31 (Journey)
At Aetna, we recognize each of you is on a unique health journey. Aetna is here to help support you on that journey.
Simplicity, savings and support – just what you heard from the Hodges video.
We provided you a lot of information, not only in the mail, but also in this video. We know you have choices when it comes to your health care coverage, and we hope Aetna’s experience in taking care of retirees has come through in this video. It would be an honor and a privilege to serve you next year.
Slide 32 (Questions)
Thank you so much for your time today. We hope you choose the Aetna Medicare Advantage plan. You can always call us with questions at 1-855-406-4062 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. all time zones. We look forward to joining you on your health journey.
Slide 33 – Thank you
Slide 34
©2018 Aetna Inc.
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