4800 Linglestown RoadSuite 300Harrisburg, PA 17112

www.RitterIM.com / 800-769-1847

CaremoreSpecial Needs PlansPresenters: David Dietz & April Ford

About Ritter Insurance Marketing

• Ritter Insurance Marketing– Medicare Supplement, Medicare Advantage,

Medicare Part D, Final Expense & Individual Health.

– Online Services: • Medicare Quote Engine• Ritter CRM• Online Licensing• Events Calendar• Medicareful.com

– 27 Staff members in house• 800-769-1847

Special Needs Plan Basics

• Special Needs Plans (SNP’s) – Dual Eligible- Medicare and Medicaid – Chronic- Specific chronic diseases and conditions.– Institutionalized

• Who is Eligible to join a Chronic or Dual SNP? – Medicare A & B– Live in the plan’s service area– Meet one of the following

• Have one or more specific chronic conditions that are included in the plan• Have both Medicare and Medicaid

• When can a Beneficiary enroll into a SNP? – Dual Eligible

• You can enroll or change at any time– Chronic

• Newly Eligible to Medicare (IEP)• Annual Enrollment period (AEP)• Have or develop a chronic condition (SEP)

– Change at any time but once you enroll in a plan, this SEP ends.

Caremore Online

• www.caremore.com– Summary of Benefits– Pharmacy search– Evidence of coverage– 2011 Drug Formulary– Training Schedule

Caremore SNP Prescription Benefit

• Included in all Caremore SNP plans– Prescription Drug Coverage

• Tier One - $0 co-pay with coverage through the gap• Tier Two - $5 co-pay with coverage through the gap• Tier Three - $0 co-pay with coverage through the Gap

– Many types of Insulin included at this tier

• Tiers 4, 5 and 6 – No coverage through the Gap – LA and Orange Counties Full coverage through Gap

Plan Details –Arizona

• Maricopa County– Plan Availability

• Heart, Diabetes and ESRD– Plan Details

• Premium- $0• Inpatient Hospital $100 days 1-5 (Diab/Heart) $175 days 1-5 (ESRD)• Doctor Co-pays: $0 PCP and $25 Specialist

– $0 Co-pay Podiatry • $100 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $80 every two years• Dental (Package 1 $14.80 month) • OTC Benefit • Transportation $0 Co-pay to Caremore Care Centers *Dialysis • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details –Arizona

• Pima County– Plan Availability

• Heart, Diabetes and Breathe– Plan Details

• Premium- $0• Inpatient Hospital $100 days 1-5 • Doctor Co-pays: $0 PCP and $25 Specialist

– $0 Co-pay Podiatry • $75 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $80 every two years• Dental (Package 1 $14.80 month) • OTC Benefit • Transportation $0 Co-pay for up to 24 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details - Nevada

• Clark County– Plans Available

• Diabetes and Breathe– Plan Details

• Premium- $0• Inpatient Hospital $100 days 1-5• Doctor Co-pays: $0 PCP and $20 Specialist

– $0 Co-pay Podiatry • $25 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $80 every two years• Dental (Package 1 $7.30 month) • OTC Benefit • Transportation $0 Co-pay for up to 24 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details – California

• Santa Clara and Stanislaus County– Plans Available

• Diabetes and Breathe– Plan Details

• Premium- $59 monthly• Inpatient Hospital $100 days 1-5• Doctor Co-pays: $0 PCP and $15 Specialist

– $0 Co-pay Podiatry • $100 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $100 every two years• Dental (Package 1 $12.90 month) • OTC Benefit • Transportation $0 Co-pay for Caremore Care Center visits • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details – California

• Riverside County– Plans Available

• Diabetes– Plan Details

• Premium- $0• Inpatient Hospital $45 days 1-5• Doctor Co-pays: $0 PCP and $0 Specialist

– $0 Co-pay Podiatry • $45 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $100 every two years• Dental (Package 1 $9.50 month) • OTC Benefit • Transportation $0 Co-pay for up to 24 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details – California

• San Bernardino– Plans Available

• Reliance (Diabetes), Breathe, ESRD and Connect– Plan Details

• Premium- $0• Inpatient Hospital $75 days 1-4• Doctor Co-pays: $0 PCP and $0 Specialist• $0 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $100 every two years• Dental (Package 1 $9.50 month) • OTC Benefit • Transportation $0 Co-pay for up to 24 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details – California

• Los Angeles and Orange Counties– Plans Available

• Reliance (Diabetes), Breathe, ESRD, Heart and Connect– Plan Details

• Premium- $0• Inpatient Hospital $0 Co-pay• Doctor Co-pays: $0 PCP and $0 Specialist• $0 Co-pay Outpatient Surgery (Hospital Facility)• $0 Co-pay for Diabetic Supplies• Vision- $100 every two years• Dental (Package 1 $9.50 month) • OTC Benefit • Transportation $0 Co-pay for up to 50 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Plan Details – California

• Los Angeles & Orange Counties– Caremore Connect (Dual Eligible)– Plan Details

• Premium- $0• Vision- $150 every two years • Dental • OTC Benefit • Transportation $0 Co-pay for up to 50 one-way trips • Fitness – Shape Up, Levels Down• Healthy Start program

Marketing Special Needs Plans

• Marketing to Dual Eligibles– 21% of Medicare Beneficiaries are dual eligible

• Varies widely by state 12% in Utah 41% in Maine– www.statehealthfacts.org

– 36% of dual eligible are under 65, where as with all Medicare Beneficiaries only 16% are under 65

– Traditional Marketing does not work• Successful marketing requires more of a “grass roots”

approach. Building relationships with centers of influence such as low income housing will be more successful.

Marketing Special Needs Plans

• Marketing to Chronic SNP’s– Chronic SNP's require similar specialized

marketing. Since the qualification to enroll in these plans requires a particular medical condition, keep this in mind as you develop your marketing plan. In some cases you may find events sponsored for those with Diabetes or similar diseases which would be a good place to market your services.

Question and Answer

Contact Ritter Insurance MarketingPhone: 800-769-1847

Dave Dietz – 213April Ford – 212Carl Conrad – 223Amy Shuman - 224

Email: Daved@ritterim.com Post a comment on the blog

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