University of Michigan Medicare Advantage Plans

Mark Elzy: Hello, I'm Mark Elzy, key account manager at Blue Cross Blue Shield of Michigan and I have here with me today Dan D’Amico who's also with Blue Cross Blue Shield of Michigan as a Medicare Advantage consultant. And we're going to introduce you to the University of Michigan's retiree options. But before we do, I'd also like to introduce you to a friend and colleague your account manager, Jennifer Landon. Hey, Jennifer how's it going today?

 

Jennifer Landon: Hey guys, great to see you both!

 

Mark Elzy: Jennifer, before we get rolling with the presentation, we wanted to give you a chance to say hi and just do a quick introduction.

 

Jennifer Landon: Appreciate that. Well, as Mark said, I'm Jennifer Landon. I'm your account manager at Blue Cross Blue Shield of Michigan, and I handle the business on the non-Medicare side of the house. I've been with Blue Cross about 12 years now and actually have had the great opportunity to work on the U of M account for about three years. But with that said, I've got to be running to another meeting really quick. I really thank you for this opportunity to say hi. I just want to let you know you are in great hands with Dan and Mark.

 

Dan D’Amico: Hey, thanks Jennifer! So, Mark for about the next 25 minutes you wanted to go through Medicare Advantage, what it is and ask me some questions about the plans being offered is that correct?

 

Mark Elzy: That's right, why don't you give us an overview and what we'll be covering today.

 

Dan D’Amico: Sounds good. All right, I want to start with the agenda.

 

So, today's agenda we're going to go through the Medicare basics, getting started with your Medicare plan, we’ll then go through the group plan benefits and finally the health and well-being programs.

 

Why don’t we start with the Medicare basics.

 

So, on this slide there's a lot going on. We're covering Part A, B, D and C. I want to start with Part A.

 

Your Part A includes hospital care, skilled nursing, hospice, and home health care. And what's unique about part A is there's no premium, as long as you've had at least 40 work credits or 40 quarters working.

 

Now your Part B is a little different. That's what people are accustomed to those flat dollar copays, seeing a PCP, going to a mental health care facility, outpatient surgery, lab test or DME — which we refer to as durable medical equipment. Now the unique part about Part B is you have to pay that premium every month and it may not be the same for you as it is for me because it's based on when you signed up and on your income. 

 

Now Part D. I always say “D” stands for drugs — prescription drugs. Now Part D is a government-sponsored program that helps cover prescription drug costs. Now the University of Michigan's prescription drug coverage is equivalent to a Part D plan. Your plan benefit will continue to be administered by Magellan RX.

 

Finally, Part C. You have got to have Parts A and B to have Part C — so that's the original Medicare covered services, original Medicare rights and protections. And it does include, it says may, but yours does include some extra benefits such as SilverSneakers and some care management services. I want to point out again that Part B you've got to pay that premium.

 

Mark Elzy: So, I understand that there are two plan choices for the University of Michigan.

 

Dan D’Amico: That’s right Mark. U of M is offering both a Medicare Advantage PPO plan and a BCNA plan which we're going to call through the remainder of the presentation U of M Premier Care Advantage.

 

Mark Elzy: Are you ready to get started?

 

Dan D’Amico: I am. So let's get you started with your Medicare Plan.

 

First, we're going to look at the Medicare Advantage PPO enrollment materials. Now I want you to understand the different documents that you'll receive and will also be posted online.

 

We'll first start on the left side of the page what we call a Benefits-at-a-Glance - we call a BAAG - it's a high level of the benefits. Also, an open enrollment book which the University of Michigan will be sending out to all of its participants will be mailed to each and every member. Now all of these two documents will be also posted online as well.

 

Now once they make a decision, it's what we call post-enrollment documents. Those will be mailed to the home, and you'll get a welcome letter, an EOC, otherwise known as evidence of coverage, and a resource guide.

 

Much like the PPO, the Premier Advantage enrollment materials are going to look and feel almost the same — maybe just a couple of different pictures. But they will also see a Benefits-at-a-Glance, they'll receive the University of Michigan open enrollment book, and those will also be posted online.

 

Once they choose this plan, if they decide to, they'll get a welcome letter, evidence of coverage, as well as a resource guide. Now once they've chosen the plan of course they need a card.

 

Now I always like to look at this information and say “Hey, the red, white and blue card — keep safe, nut you're not going to need it." Because you're going to either receive a Blue Cross Blue Shield MA-PPO card — which at the top of the card you'll see Medicare Plus Blue Group PPO. It's the same exact plan. Or you'll get your Premier Care Advantage card which is the BCNA or HMO.

 

Now what's unique about Medicare Advantage? A lot of people ask that question. It's a little more concierge. So, you do get contacted from us, we contact you as you can see on this slide four different times.

 

So of course, you'll have a welcome call, and you'll get your ID card. When you get that welcome call, I would always recommend maybe you have a couple of questions, maybe the presentation, or you're still not quite sure on how this works out, have those questions on the side so you can talk to the customer service representative and get those questions answered right there on that call.

 

Also, a health assessment — we want to make sure we're healthy — so we will send out the proper documentation on a health assessment.

 

Another one is your coordination of benefits. Some of our members have different plans and we want to make sure those coordinate appropriately.

 

And then finally your Medicare Blue and You magazine which gives you plan related information that can improve your health and well-being.

 

On a monthly basis, should you use your benefits, you'll get something called an EOB, or explanation of benefits, this summarizes the total cost of the medical services you received. It shows you what your health care provider billed us what we paid the provider and your share of the cost.

 

You won't get this on a monthly basis if you don't use your benefits. But it always has a one-month lag, so if something happened in May that you went and saw services, in June you would get your EOB explanation of benefits.

 

Mark Elzy: So, Dan, we just went over the what the members should expect in terms of the materials. Can you explain some of the key terms and the plan benefits.

 

Dan D’Amico: Absolutely! The next few slides describe some of the everyday terms a member may hear or use. So, these are some of the terms that a member may come across. I know you and I were pretty proficient in that it's what we do every day, but I want to make sure we break it down for them. We'll also dive right into the plan benefits as well.

 

So, these are some of the terms that a member may come across. You and I, of course, are familiar with these terms but I want to break them down.

 

So, deductible that is the amount you pay before a plan begins to pay its share. I always give an example of a windshield because I break a few of those. And I have 100 deductible, so I have to satisfy that deductible of a hundred dollars and then the plan will pay. Same thing with medical as well.

 

Your coinsurance is simply the percentage of the cost the service that you would pay, and your co-payment is a flat dollar amount. So typically, when you see the doctor, you may pay twenty-five dollars or whatever it may be to go see your primary care physician. That would be your copayment.

 

And then finally your out-of-pocket max. That is the absolute most a member would pay in any one calendar year.

 

So, let's take a look at the plan. So, we're going to look first at your Medicare Advantage PPO plan. As you can see this is very high level — we're not going to dig too deep. But your annual deductible per member per year is zero — there is no deductible. I know it's a great plan. That’s what they currently have today so we kept that the same. Coinsurance zero as well, and your out-of-pocket maximum is three thousand dollars. Your office visits are 25, specialists 30, chiropractic would be 20.

 

All of this is congruent with what they have today. And your emergency care is $65 but will be waived if you're admitted. Urgent Care is 25 and your ambulatory care will be covered at 100 percent.

 

Next, we're going to look at the U-M Premier Care Advantage.

 

Your annual deductible is zero there's no deductible as well as zero coinsurance and a three-thousand dollar maximum out of pocket. The office visits are 25, specialists are 30. Now they have a chiropractic benefit they did not have that prior, so this is an enhancement, it is a $20 copay. Emergency care 65 but that will be waived if admitted, urgent care is 25 and ambulatory is again covered.

 

Now that we've done an overview of the  plan designs being offered let's now look at your durable medical equipment, otherwise known as DME. You do have durable medical equipment benefits. The  coverage for this such as prosthetics, orthotics and supplies are going to be provided regardless of which plan you do decide to take.

 

DME such as canes, walkers, wheelchairs, braces and artificial limbs, as well as diabetic therapeutic shoes or inserts. Our preferred provider for you to go to is Northwood Network, the numbers listed right below it's 800-667-8496. Feel free to call them. That's your customer service number for any DME questions that you may have. Again, prior authorization rules may apply.

 

To keep it simple for you, the diabetic monitoring supplies such as your insulin pumps, blood glucose monitors, test strips and lancets again your preferred provider is Northwood Network so I'd write that number down in case you have any questions at all in regards to your DME benefit from medical and diabetic.

 

This brings me to prior authorization programs I want to make sure that you understand as a member that this is between the doctor and Blue Cross Blue Shield. You’re prior to authorization for medical services is just one way health plans make sure you receive high quality care. As you and your provider develop a personalized treatment plan it may be necessary for your provider to have certain services in your treatment plan approved by Blue Cross.

 

If a request for some reason is not approved you and your provider will both receive a letter detailing the rationale and the process to request reconsideration, which we refer to as an appeal, if needed.

 

Mark Elzy: So, you've given us a great overview of the benefits can you tell us about how to find a provider what happens when you travel and then a little bit about Teladoc and BCBSM.com.

 

Dan D’Amico: I feel like you're leading me here Mark. The good news is the members shouldn't experience any issues using their current providers at all. And it seems like you, since you brought up the traveling, the Teladoc app, sounds like you have some experience with these topics. Why don't you walk us through these slides?

 

Mark Elzy: I think you're doing a great job. Take it from here.

 

Mark D’Amico: All right, I'll do that. So why don't we start things with finding a provider. So, Medicare Advantage PPO providers, we’ll start there. First PPO means preferred provider organization within network or out of network benefits. So, you have the freedom in the MA-PPO to choose any provider you would like — that accepts Medicare. Referrals are not required in and out of network number. Out of pocket costs are the same with a passive plan. I don't know if you caught that they do have a passive plan, so they're not going to see any kind of member abrasion going in and out of network. You also may continue to use your provider, just confirm please that they will bill our plan.

 

Now, how do you find a Medicare Advantage PPO provider? Well, during the welcome call which I mentioned a few slides prior, the representative can check to see if your current provider accepts your plan. If your provider does not accept the plan, the representative will help you select one who does accept it. So, I always say if you don't mind the telephone, call customer service as well if you do not tackle that with them on that first call at 855-669-8040. And that's from 8am to 5:30pm Eastern Time Monday through Friday. We do have extended hours as well, Mark. October 1st through March 31st we'll be open 8am to 8pm Eastern Time and that's seven days a week so that's really going to help some of those people maybe on the west coast they can they can talk to a customer service rep. Want to also always mention our URL BCBSM.com Medicare and you can click find a doctor if you are internet savvy, too.

 

Finally, you can ask the billing department of your provider's office if they participate with Medicare Advantage offered by Blue Cross and hey download the mobile app. I can't stress that enough. If you have a smartphone, and if you're like me and it's smarter than you, find the app, download that app because you'd be surprised how amazing that app is. And for me personally even I use it for everything.

 

I want to take a look at the U-M Premier Care Advantage primary care providers. So, your primary care providers they coordinate your care, that's a main difference. They help you navigate sometimes through complex health care waters. When you become a member of U-M Premier Care Advantage, you must choose a plan provider.

 

Before selecting a PCP verify that they are accepting new patients, if there is a specific U-M Premier Care Advantage Specialist or hospital that you would like, verify he or she uses that hospital as well let us know that you've selected a participating U of M care provider or PCP. We're going to complete and return a physician selection form.

 

First and foremost, call customer service they can always walk you through this if there's any kind of confusion as well. I'm a huge fan always call customer service. The number is right there, 800-658-8878. Again, the hours of operation are going to be the exact same as the MA-PPO the 8am to 5:30pm Monday through Friday and we do have the extended hours, October 1st through March 31st, 8am to 8pm as well, seven days a week. Again visit BCBSM.com/Medicare and click login — once you've registered and logged in select view or change your PCP to make any changes as well.

 

Again, the app, download the app, it works also on the BCN as well, or the U-M Premier Care as we referred to it. U-M Premier Care Advantage, PCP referrals aren't needed, but are still a really good idea. U of M Premier Care Advantage allows its members the opportunity to make specialist appointments within their plans network without a PCP referral. Your PCP coordinates services you get as a member of U-M Premier Care Advantage. Although U-M Premier Care Advantage doesn't require a referral prior to seeking care with an in-network specialist, some specialists may require a referral prior to providing care unless authorized by your PCP. Care provided by a non-participating provider won't be paid, so again I want to emphasize that that you need to have the authorization of your primary care physician.

 

Now traveling, I know you mentioned that you must do a little bit of traveling. I just want everybody to make sure that they know that they are covered. That's right, so there are two ways to find a provider when you're traveling. You can use the Find a doctor feature, you can always call the number on the back of your card, my recommendation, if you know you're going to be traveling and going out of the country — call customer service. Let them set that up let them do the footwork for you. Because who wants to be in Paris, and they can't find a doctor if something should happen. So always use that customer service number just in case there's any questions whatsoever.

 

Now have you ever heard of Teladoc? Yes, you have, okay. So, Teladoc is — I call it it’s just my friend — so we do a lot of Zoom calls today and a lot of members are used to doing Zoom calls. It's really no different. The only difference between you going on an online visit or a virtual visit with your doctor and Teladoc is that Teladoc will not be your doctor. It is available 24/7 anywhere in the US using an internet connection.

 

Doctors are virtual visit experts, US board certified, licensed and credentialed to provide non-emergency medical visits on demand and at in network costs. So, as I told you before, their PCP copay is do you remember 25. So, when they use this, it'll still be 25 dollars.

 

Tell you a quick story about that — my wife and I were shopping one time and uh she just was not feeling well. So, I said pull up the app so we were at a Starbucks wouldn't you know it she was able to talk to a doctor not only talk to a doctor, get a medication and we were able to pick up her script without ever going into a doctor's office. 24-hour access to plan information. Again, I can't stress enough, download that app.

 

Corny joke it's the best app-ortunity we have. That's right. So, you can use it to find a participating primary care provider and preferred pharmacies track your costs check claims and the most important thing for me is the virtual card. So, I can always seem to forget my card when I go to the doctor when I do go in person, but I just pull it up on my phone and I can show them my card.

So again, download that app. Go to BCBSM.com/index/members/online-account or just take a look at that take a screenshot and go ahead and put that in the URL so you can visit that later.

 

Mark Elzy: So, I gotta tell you, I love the mobile app, too. I use it in place of the actual physical ID card. I know it's a lot of information, so if you need a refresher, you can visit BCBSM.com/UMichMAplans that's BCBSM.com/UMichMAplans.

 

Dan D’Amico: That's right and they'll see that URL also in their handbook when we mail that out. So, we'll make sure that they get that information as well.

So, we only have about five more minutes, Mark are you ready to learn about our Blue Cross health and well-being programs?

 

Mark Elzy: Sounds great!

 

Dan D’Amico: All right! Well, let's roll. SilverSneakers one of my absolute favorite things. We're going to be offering you great enhancement. If you enjoy going to the gym, you're going to really like this. We're in over 16,000 gyms coast to coast, exercise at your own pace with people your own age group.

 

Now when the pandemic hit, Mark, you couldn't go to the gym, so they kind of had to pivot and because of that they got they got smart. So, now people that still aren't necessarily comfortable going to the gym, you have online support they'll help you lose weight, reduce your stress, online classes and even if you don't have weights at home they'll send you armbands and so on and so forth to help you exercise and work out. I'm telling you there are hundreds of classes. I've gone out there myself just to kind of see what they're about and they're quite phenomenal. Now it's maybe not P90X, but they'll get you moving, they'll get the blood flowing.

 

Also, the tuition rewards program is excellent. Members can earn a college tuition discount for loved ones simply by exercising. I know it's great. And loved one doesn't necessarily mean a family member. So, it can be somebody that you just want to help out for college.

 

There are age restrictions, so I would recommend going to silversneakers.com or calling the 888-423-4632 and again as you can see that's Monday through Friday 8am to 8pm and they'll answer any questions that a member would have in regard to the program as well.

 

Blue365 is another huge benefit. Now I talked about SilverSneakers, what Blue365 can do is it complements by giving even more discounts. So, when you go to blue365deals.com — those are refreshed sometimes on a monthly or even weekly basis, and some of the vendors that we work with as you can see below.

 

Beltone HandsFree Health, TruHearing, Nutrisystem they give great discounts. And one thing I want to point out is, since the members at University of Michigan have a hearing benefit, I'd recommend reaching out to TruHearing because not only do you have a great hearing benefit, they can give you even steeper discounts on your hearing aids themselves.

 

And of course, HandsFree Health — so if somebody does fall, they can help you. It'll contact an emergency, an ambulance, and they can be right there on the spot a lot sooner than if, you know, you didn't use them. So, these are just some of the vendors that we work with.

 

Our Medicare Advantage rewards, it just doesn't stop. We want to make sure that we're incentivizing our members to stay healthy and if you just take some healthy actions such as getting your annual physical which some of you guys out there I know you don't like to do it, but when you do it we do get you rewards. Your flu shots, monitoring your physical health, breast cancer screening, diabetes these are all just examples and how you can earn points and get more rewards. I was actually at a meeting last year and one of the retirees came up to me and said, “Man, I got a $25 gift card just for getting my flu shot and annual physical!” I was like, all right! So we do incentivize because we want to make sure that our members stay healthy.

 

Our Coordinated Care — this is another huge benefit so when you're coming from a med sup and you're getting to a Medicare Advantage plan again that's more concierge, so this is truly the backbone. This is a nurse-led care team, it's the backbone for care in our integrated care program. A registered nurse will reach out to you if you're identified for any kind of Coordinated Care program. A customer care program will set up to improve your health and well-being and this is just an example of some of our care teams: medical directors, pharmacists, dietitians, social workers, behavioral health specialists. They're all here to help our members stay healthy.

 

Just a couple additional well-being programs. Again, just so you know this presentation will be posted online at the URL that you gave earlier. So, if you want to do a refresh check this out but just real quick. Advanced care planning, collaborative care, meals delivery, diabetes management just a couple of things on the slide to point out.

 

A lot of information so I wanted to make sure that we gave them our Engagement Center, which is specific to a lot of those programs we went through. We can help coordinate program referrals, talk with a nurse care manager, whatever you may need. The number is right below, it's the 800-775-BLUE. Hours of operation 8 am-6 pm Eastern time and that's Monday through Friday. So as a member, if you would like to call them and ask them about the Coordinated Care, they'll be there to help you as well.

 

This next slide is one of my favorites. So, I need you all to look at the slide write these numbers down, they will also be on the back of your card, but this is our customer service. They are here to help with anything that you may have questions on. They'll discuss your claims assist with benefit questions, help you locate that provider, answer all personal account questions, even order a card, and confirm out-of-pocket costs. The reason I want to make sure that you see this slide. The numbers are right there for both the Medicare Advantage PPO and the U-M Premier Care Advantage. Hours are identical — call them first. I know some of you are used to calling the University of Michigan, call them first. The reason why is we record all of our calls, we are here to help, we're your first line of defense. If it's not resolved, for whatever reason, then maybe tag in the University of Michigan and they can assist, and we'll make sure that we help you along the way. But again, here's your phone numbers — great slide to keep in your back pocket and we're here to help.

 

Thank you guys for paying such close attention. We really look forward to serving you. We want to give you a smarter better health care and just be there when you need us.

 

Mark Elzy: And thank you for taking the time to walk us through the University of Michigan benefit offerings for the upcoming year.

 

Dan D’Amico: Oh, you bet. Hey, let's see what questions some of our members may have. Mark, what do you say?

 

Mark Elzy: I think that's a great idea.

 

Dan D’Amico: All right!