Guiding you on the new road aheadYour 2015 retiree plan options
Caltech Retiree Information Sessions
Aetna Marketplace
Today’s focus:
Your 2015 plan options
Understanding the plans
How to enroll in 2015
Aetna Marketplace
What’s the Aetna Marketplace?
• New shopping experience for selecting your retiree coverage in 2015
• Online marketplace that will empower you to compare and shop for plans based on your unique needs
• A variety of plan options available between Aetna and Kaiser
• Though you’ll have more plan choices, live licensed plan specialists and Aetna Marketplace Service Advisors will be there to guide you every step of the way. You’ll get one‐on‐one support both online through live chat or by phone.
• In the Aetna Marketplace, you will be able to view your Defined Dollar Credit provided by Caltech
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Aetna Marketplace
Take note of your health informationBefore you visit the Aetna Marketplace, take a few minutes to take note of important health information. This information will help you when it comes time to compare plans, enroll or when you’re talking to a plan specialist.
1. Are you eligible for Medicare and enrolled in both Medicare Part A and Part B? If not, you can enroll in Medicare Part A and Part B, go to www.cms.gov. If you don’t know, call us at 1‐844‐210‐8389, beginning November 3, 2014, so we can help determine if you are enrolled in both Medicare Part A and Part B.
2. Have your Medicare Health Insurance Claim Number for you and any eligible dependents on Medicare available.
3. What is the name of the pharmacy where you usually fill your prescriptions?4. Do you primarily take brand name or generic prescription medications? 5. For what reasons do you see your current doctors? For example, basic preventive exams or an
occasional health problem, or for chronic conditions.6. Who are the doctors you see most often?7. Think about what is most important to you when selecting health coverage?
• Low monthly premium• Physician choice• Low payment when admitted to the hospital• Low payment for doctor office visit
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Aetna Marketplace
ORIGINAL MEDICARE
How the “Parts” of Medicare work with your Current Anthem PPO plan
Part DPrescription Drug Coverage (PDP)
Anthem plan supplements or coordinates with Original
Medicare
Part BMedical Insurance
Part AHospital Insurance
Anthem PPO Coordinates with Original Medicare
Deductible / Out‐of‐Pocket Maximum
$0 / $2,000
Physician Coinsurance 20%
Specialty Coinsurance 20%
Inpatient Cost Share $250
Part D Deductible N/A
Part D 30 Day Retail Scripts $15/$35
• Access to any Medicare Certified provider for medical care• You access care with two ID Cards : Your Medicare Card + Anthem ID Card• Medicare pays medical claims first and Anthem pays secondary
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Aetna Marketplace
Medicare Advantage (MA)Referred to a Part C Plan Details
Anthem Senior Secure
MA‐HMO
Kaiser MA‐HMO
Deductible / Out‐of‐Pocket Maximum
Physician Copay/Coinsurance
Specialty Copay
Inpatient Cost Share
Part D Deductible
Part D 30 day Retail Scripts
$0 / $3,400
$15
$15
$250
N/A
$15/$35
$0 / $1,500
$15
$15
$0
N/A
$10/$20
How the “Parts” of Medicare work with your Current Anthem and Kaiser HMO plans
Part CCombines Part A, Part B
and often Part D
• Access providers within the Anthem or Kaiser network only• Must select a primary care provider• Referrals required for most specialist (exception OB/GYN)• One ID card
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Aetna Marketplace
In 2015 all plans offered to Medicare Eligible will be Medicare Advantage Plans
HMO and PPO Options
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It’s a complete relationship.
One plan, one ID card
More than just “insurance”
Management of Parts A & B
Ongoing support for health and wellness
Extra benefits and value
Integrated Part D prescription drugsMedicarePart D
Medicare Part C
Medicare Part B
Medicare Part A
Aetna Marketplace
Who is Eligible for Medicare Advantage…
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Age 65 or older retired, and enrolled in Medicare Part A and Part B: Must continue to be enrolled in Medicare after enrolling in Medicare Advantage
• Age under 65 years, retired, and enrolled in Medicare Part A and Part B due to Medicare qualified disability: Must continue to be enrolled in Medicare after enrolling in Medicare Advantage
• Medicare Eligible due to End Stage Renal Disease: some limitations may apply for enrollment into Aetna and Kaiser Medicare Advantage plans
Aetna Marketplace
A Little More on the new Aetna Medicare Advantage Offerings…
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of more than and you must use, except for emergencies or out‐of‐area kidney dialysis.
For the you have the to use providers in or
out of network.2
in and out of network;
used by people over age 65
, including convenient Aetna RX Home Delivery (mail order services)
1Based on an Aetna survey conducted with 2,776 Medicare Advantage plan members from 8 employer group plan sponsor organizations, January 2012‐January 2013 .2 Non‐network doctors or hospitals must be licensed, agree to accept your PPO plan before treating you, and be eligible to receive Medicare payment.
Aetna Marketplace
MedicarePart D
Medicare Part C
Medicare Part B
Medicare Part A
Medicare prescription drug coverage (Part D)
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Aetna Marketplace 14
Standard Medicare Part D plan phases (cost levels)This is a guide only and not the Caltech PlanPhase 1 – Deductible Standard Part D –Medicare eligible pays all costs until they meet the 2015 Medicare Defined $320 deductible
Phase 2 – Initial Coverage Limit “ICL”Standard Part D – Medicare eligible plan cost share plus the Part D plan drug payment (total cost of drugs) = $2,960
Phase 3 – Medicare Coverage Gap “Donut Hole”Standard Part D –Medicare eligible pays all costs (except for brand drug assistance) until your total (or combined total with brand drug assistance) = $4,700
Phase 4 – Catastrophic Coverage Standard Part D –Medicare eligible pays the greater of: $2.65 or 5% for generic drugs and $6.60 or 5% for brand drugs
Aetna Marketplace 15
Aetna PPO plans – no referrals and no member pre‐certification required
Aetna Premier
Medicare S02 ESA PPO with Part D RX 1337
AetnaMedium
Medicare C01 PPO with Part D RX 1337
Aetna Low
Medicare V02 PPO with Part D RX 1201
Unlimited Lifetime plan coverage
You pay same cost share for In Networkand Out of Network
Providers
You pay for In
Network
You pay for Out of Network
You pay for In Network
You pay for Out of Network
Plan deductible $0 $0 $0 $0 $0
Annual Out of Pocket Max $6700 $6700 $10,000 $3400 $10,000
Primary Care Doctor Visit $25 15% 25% $15 30%
Specialist Care Doctor Visit $25 15% 25% $40 30%
In Patient Hospital $250/stay $500/stay 25% $200 d/1‐7 30%
Medicare Advantage PPO Plan Comparison
Aetna Marketplace 16
Prescription Drug CostPhases
Aetna Premier and Aetna Medium
Medicare S02 and C01 PPO with Part D RX 1337
Aetna Low
Medicare V02 PPO with RX 1201Note: Brand Tiers include some
High cost Generics
Phase I: Deductible $0 $260
Phase II: Initial Coverage Limit (ICL)
$0 Select Care Generics$5 Generics$30 Preferred Brand$60 Non‐Preferred Brand
$1 Select Care Generics20% Generics25% Preferred Brand45% Non‐Preferred Brand
Phase III: Medicare Coverage Gap (Donut Hole)
$0 Select Care Generics$5 Generics$30 Preferred Brand$60 Non‐Preferred Brand
65% Generics45% Brand
Phase IV: Catastrophic Coverage
Greater of 5% or $2.65 GenericsGreater of 5% or $6.60 for all other drugs
Greater of 5% or $2.65 GenericsGreater of 5% or $6.60 for all other drugs
Medicare Advantage PPO Plan Comparison Continued
Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes
Aetna Marketplace 17
Aetna PPO plans – no referrals and no member pre‐certification required
Examples Of Out of Area: if you live in Kern, Santa Clara, and Sacramento Counties
Aetna Premier
Medicare S02 ESA PPO with Part D RX 1337
AetnaMedium
Medicare C01 ESA PPO with Part D RX 1337
Aetna Low
Medicare V02 PPO with RX 1201
Unlimited Lifetime plan coverage
You pay same cost share for In Network and Out of Network
Providers
You pay same cost share for In Network and Out of Network
Providers
You pay same cost share for In Network and Out of Network
Providers
Plan deductible $0 $0 $0
Annual Out of Pocket Max $6700 $6700 $3400
Primary Care Doctor Visit $25 15% $15
Specialist Care Doctor Visit
$25 15% $40
In Patient Hospital $250/stay $500/stay $200 d/1‐7
Medicare Advantage ESA PPO Plan Comparisonfor Out of Area Retirees – Extended Service Area (ESA)
Aetna Marketplace 18
Prescription Drug Cost Phases
Aetna Premier & Medium
Medicare S02 ESA and C01 ESA PPO with Part D RX 1337
Aetna Low
Medicare V02 ESA PPO with RX 1201Note: Brand Tiers include some High
cost Generics
Phase I: Deductible $0 $260
Phase II: Initial Coverage Limit (ICL)
$0 Select Care Generics$5 Generics$30 Preferred Brand$60 Non‐Preferred Brand
$1 Select Care Generics20% Generics25% Preferred Brand45% Non‐Preferred Brand
Phase III: Medicare Coverage Gap (Donut Hole)
$0 Select Care Generics$5 Generics$30 Preferred Brand$60 Non‐Preferred Brand
65% Generics45% Brand
Phase IV: Catastrophic Coverage
Greater of 5% or $2.65 GenericsGreater of 5% or $6.60 for all other drugs
Greater of 5% or $2.65 GenericsGreater of 5% or $6.60 for all other drugs
Medicare Advantage ESA PPO Plan Comparison for Out of Area Retirees – Extended Service Area (ESA) Continued
Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes
Aetna Marketplace 19
Medicare Advantage HMO plans require utilization of plan network providers and selection of Primary Care Physician
Kaiser MA HMOSenior Advantage
Aetna MA HMOMedicare P02 HMO
Unlimited Lifetime plan coverage You Pay You Pay
Plan deductible $0 $0
Annual Out of Pocket Max $1500 $3400
Primary Care Doctor Visit $15 $10
Specialist Care Doctor Visit $15 $15
In Patient Hospital $0 $0
Medicare Advantage HMO plan comparison
Aetna Marketplace 20
Prescription Drug CostPhases
Kaiser MA HMO
Senior Advantage with Part D RX
Aetna MA HMO
Medicare P02 HMO with Part D RX 1505
Phase I: Deductible $0 $0
Phase II: Initial Coverage Limit (ICL)
Most Generics $10/100daysMost Brand $20/100days
$0 Select Care Generics$5 Generics$25 Preferred Brand$45 Non‐Preferred Brand
Phase III: Medicare Coverage Gap (Donut Hole)
Most Generics $10/100daysMost Brand $20/100days
$0 Select Care Generics$5 Generics$25 Preferred Brand$45 Non‐Preferred Brand
Phase IV: Catastrophic Coverage
Most Generics $10/100daysMost Brand $20/100days
Greater of 5% or $2.65 GenericsGreater of 5% or $6.60 for all other drugs
Medicare Advantage HMO plan comparison continued
Select Care Generics are specific generics in your formulary that are used for the treatment of Hypertension, High Cholesterol, and Diabetes
Aetna Marketplace
Sample Network Pharmacies
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Just a Few Pasadena Area Pharmacies
Brown Welin United Drugs
Good Drugs Ralphs
Berry & Sweeney Michaels Rite Aide
Buy Well Nova Target
Cal Oaks Pasadena City Vons
CVS Phoenix Plaza Washington
Fair Oaks Pavilions Walgreens
Aetna Marketplace
Ready to get started? Create an account and log in
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User Name: Your first initial + last name + birthdate (YYYYMMDD) + RExample: John Smith, born October 13, 1948, has a user name of JSmith19481013R
Password: Your last name + the last four digits of your Social Security Number
Remember, Medicare coverage is individual. If both you and your spouse are Medicare eligible, or you are not but your spouse is, each of you will need to create your own account to select your medical plan.
Aetna Marketplace
Review your health plan options and see how your Defined Dollar Credit impacts the total cost
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Aetna Marketplace
What You Need to Do
Caltech 2014 Enrolled Plan Caltech Auto Enrolled 2015 Plan
Kaiser Pre‐65/Non‐Medicare Kaiser Pre‐65/Non‐Medicare
Kaiser Post‐65/Medicare Kaiser Post‐65/Medicare
Anthem Pre‐65/Non‐Medicare ‐ PPO Aetna Open Choice® PPO ‐High Option Network Plan
Anthem Pre‐65/Non‐Medicare ‐ HMO Aetna HMO
Anthem Post‐65/Medicare ‐ PPO Aetna MedicareSM Plan (PPO) – PremierPlanMedicare S02 ESA PPO Plan with Rx 1337
Anthem Post‐65/Medicare ‐ HMO Aetna MedicareSM Plan (HMO) Medicare P02 HMO Plan with Rx 1505
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If you do not contact Aetna Marketplace with your health benefit decisions by December 7th you will be automatically be enrolled in a 2015 Caltech Health Plan based on your 2014 plan enrollment
Aetna Marketplace
Recap of important detailsBeginning November 3rd• Plan information will be available on www.caltechretiree.hrintouch.com to
compare plans. Refer to your printed materials along with the Aetna Marketplace tools when shopping for your plan
• You can also call to speak to a licensed Aetna Marketplace Service Advisor.
1‐844‐210‐83897 days a week ‐ 5 a.m. – 8 p.m. (PT)
November 10th to December 7th
• Online and phone enrollment will be open
• Visit www.caltechretiree.hrintouch.com or call 1‐844‐210‐8389, toll‐free, 5 a.m. – 8 p.m. (PT) to speak to a licensed Aetna Marketplace Service Advisor.
November 10th to 21st
• You can schedule an individual consultation session on the Caltech campus (visit hr.caltech.edu/retirees)
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Aetna Marketplace 32
2014 Anthem PPO
Unlimited Lifetime plan coverageYou Pay
In Network After DeductibleYou Pay
Out of Network AfterDeductible
Plan deductible $750/$2250 $750/$2250
Out of Pocket Maximum $2000/$8,000 $4000/$16,000
Primary Care Doctor Visit $25 50%
Specialist Care Doctor Visit $25 50%
Inpatient Hospital $250, 20% $250, 50%
Pharmacy
Deductible N/A
Generic $15
Brand $35
Current Pre‐65 plan comparison
Aetna Marketplace 33
HMO plans require utilization of plan network providers and selection of Primary Care Physician
Kaiser HMOTraditional
Anthem HMO
Unlimited Lifetime Plan Coverage You pay You pay
Plan deductible $0 $0
Annual Out of Pocket Maximum $1500 $1500
Primary Care Doctor Visit Most $15 $10
Specialist Care Doctor Visit Most $15 $10
Inpatient Hospital $250/stay $100/stay
Pharmacy
Generics Most at $10/100 days $15 Formulary / $40 Non Formulary30 day supply
Brands Most $20/100 days $25 Formulary / $40 Non Formulary30 day Supply
Current Pre‐65 Anthem and Kaiser HMO
Aetna Marketplace
If you or your spouse is under 65, your new Aetna plan options will offer:
• Your preventive care is paid in full
• No deductible for preventive care if certain in‐network providers are used
• Out‐of‐network cap on expenses, then plan pays 100%
• Provider networks focused on quality care, efficiency and, where possible, improving health outcomes
• “Medicare”‐style case management
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Aetna Marketplace 35
High OptionAetna Open Choice PPO
Mid OptionAetna Open Choice PPO
Low OptionAetna Aexcel Open Access Managed Choice POS
Unlimited Lifetime Plan Coverage
You pay InNetwork AfterDeductible
You pay Out of Network AfterDeductible
You pay In Network After Deductible
You pay Out of Network After Deductible
You pay In Network After Deductible
You pay Out of Network After Deductible
Plan deductibleSingle /Family
$1200/$2400 $4000/$8000 $3500/$7000 $5500/$11000 $3950/$79000 $3950/$79000
Annual Max Out of Pocket MaximumSingle/Family
$2800/$5600 $7000/$14000 $6000/$12000 $10000/$20000 $6250/$12500 $10000/$30000
Primary Care 20% 40% 30% 50% 20% 40%
Specialist Care 20% 40% 30% 50% 20% for designated specialist /30% for non‐designated
40%
Inpatient Hospital 20% 40% 30% 50% 20% 40%
Pre‐65 Aetna PPO Plan comparison
Aetna Marketplace
Pre‐65 Aetna PPO Plan comparison continued
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Pharmacy
PharmacyDeductible
$0 $0 Integrated Medical/PharmacyDeductible applies
Preferred Generic $10 $10 $0
Non Preferred Generics 40% 50% $0
Preferred Brand $40 $75 25%
Non‐Preferred Brand
40% 50% 50%
Specialty $70 Preferred Generic & Brand 40% Non Preferred Generic and
Brand
50% Generics50% Brands
0% Generics50% Brands
High OptionAetna Open Choice PPO
Mid OptionAetna Open Choice PPO
Low OptionAetna Aexcel Open Access Managed Choice POS
Unlimited Lifetime Plan Coverage
You pay InNetwork AfterDeductible
You pay Out of Network AfterDeductible
You pay In Network After Deductible
You pay Out of Network After Deductible
You pay In Network After Deductible
You pay Out of Network After Deductible
Aetna Marketplace 37
HMO plans require utilization of plan network providers and selection of Primary Care Physician
Aetna HMO Kaiser HMO
Unlimited Lifetime Plan Coverage You pay You pay
Plan deductible $0 $0
Annual Out of Pocket Maximum $1500/$3000 $1500/$3000
Primary Care Doctor Visit $10 $15
Specialist Care Doctor Visit $10 $15
Inpatient Hospital $100/stay $250/stay
Pharmacy
Generics $15 / 30 day supply $10 / 100 days
Brands $25 Preferred $40 Non Preferred30 day supply
$35 / 100 days
Pre‐65 Aetna and Kaiser HMO Comparison
Aetna Marketplace
Thank you
This is an advertisement. Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. You must continue to pay your Medicare Part B premium. Health® is a U.S.-registered trademark of Aetna Inc. AetnaSM is a trademark of Aetna Inc. and is protected throughout the world by trademark registrations and treaties. Informed Health nurses do not diagnose, prescribe or give members medical advice.
GRP_TBD
©2014 Aetna Inc. Part # TBD
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