Fall 2015 For Tufts Medicare Preferred HMO Plan Members ... · Get $150 back for acupuncture...

well!Fall 2015

Your HMO plan received Medicare’s highest rating— 5 stars!…More to smile about— add dental coverage to your plan! …Pay your premium online…Easy-to-use benefits chart…New discounts & savings

Everything

for 2016!You Need to Know

For Tufts Medicare Preferred HMO Plan Members

2 tuftsmedicarepreferred.org well! Fall 2015

Benefit information described in this issue is for Tufts Medicare Preferred HMO plan members.

Please note: Not all plan benefit information in this booklet is the same for Employer Group plans. If you receive your

benefits from a current or former employer, please contact your benefits administrator or Customer Relations with

any questions regarding plan benefits.

Tufts Health Plan is an HMO plan with a Medicare contract. Enrollment in Tufts Health Plan depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. 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.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

well!Fall 2015

5 Star Customer Relations—ready to help!We go the extra mile for our members. When you call us you can

expect service that is professional, knowledgeable, courteous,

and respectful. In fact, Tufts Medicare Preferred HMO plans

received 5 out of 5 stars (the highest possible rating) for

2016 including 5 stars for Customer Service! We’re here to

help answer any questions you have about your current plan or

switching to a new plan. We can help make sure you are in the

plan that is right for you!

H2256_2016_228 Accepted

Need a new plan? We have a range of plans to choose from. For details on our different plan options see page 8!

Have questions? Call us!

1-800-701-9000

(TTY 1-800-208-9562)

Mon. – Fri.

8:00 a.m. – 8:00 p.m.

(From Oct. 1 – Feb. 14,

representatives are

available 7 days a week,

8:00 a.m. – 8:00 p.m.)

After hours and on holidays,

please leave a message

and a representative

will return your call

on the next business day.

tuftsmedicarepreferred.orgFall 2015 well!

Tufts Medicare Preferred HMO plans received 5 out of 5 stars for 2016 from Medicare*. This is Medicare’s highest rating and makes your plan one of the best in the country!

Your HMO plan is one of the best in the country!

Anytime I call Tufts Health Plan Medicare Preferred,

they talk to you, they help you, they get results…”— Willard, Tufts Health Plan Medicare Preferred member since 2009“

Overall Rating of Plan

(Members’ overall rating of our health plan)★ ★ ★ ★ ★

Overall Rating Of Health Care Quality

(Members’ rating of the overall quality of health care they received)★ ★ ★ ★ ★

Getting Appointments and Care Quickly

★ ★ ★ ★ ★

Customer Service

★ ★ ★ ★ ★

Rating of Drug Plan

★ ★ ★ ★ ★

5 STARS FROM MEDICARE!

Where do the ratings come from?

The Medicare Program rates all health and prescription drug plans each year. The ratings are based on a plan’s quality and performance in a number of categories including: • Member satisfaction • Customer service • Staying healthy with screenings and check-ups • Managing chronic conditions • Number of member complaints

We are honored to be a 5 star plan and receive such high ratings for quality, satisfaction, and service. For more information on plan ratings, go to www.medicare.gov.

* Medicare evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next.

3

tuftsmedicarepreferred.org well! Fall 2015

I enjoy that Tufts Health Plan Medicare Preferred keeps things simple.

I pay my monthly premium, my copayments, and my plan takes care of the rest.

I like knowing that I don’t have to worry about anything.” — Elaine, Tufts Health Plan Medicare Preferred Member since 2007

“

Need dental coverage? Add Delta Dental® Option to your plan! As a Tufts Medicare Preferred HMO member, you can enroll in the Tufts Health Plan Delta Dental Option for just $53 a month! Get excellent dental coverage including:• Reduced prices that can save you hundreds off dental costs • $0 cost share for cleanings and X-rays • Access to more than 143,000 dentists across the nation• Comprehensive coverage for dental services such as fillings, crowns, and implants

The Delta Dental Option is in addition to your medical coverage with Tufts Health Plan Medicare Preferred. If you want the Delta Dental Option, you need to add it to your plan. It is not automatically included. The cost for the Delta Dental Option is just $53 a month. This cost is in addition to your Tufts Health Plan Medicare Preferred monthly premium. To sign up, or for more information, call Customer Relations. You have until January 31, 2016 to add the Delta Dental Option to your 2016 plan.

Please note: The Delta Dental Option may not be available to members who receive their benefits from a current or former employer.

Delta Dental of Massachusetts is an Independent Licensee of the Delta Dental Plans Association. ®Registered Marks of the Delta Dental Plans Association. This plan is administered by Delta Dental® of Massachusetts.

1

NEW WAYSTO USE YOUR PLAN!G

REAT5

4

5tuftsmedicarepreferred.orgFall 2015 well!

Get $150 back for acupuncture treatment!Your Wellness Allowance benefit can be used for great programs that help you stay healthy. You can get $150 back each year for joining a gym or taking a fitness class like Tai Chi, yoga, or aerobics, and much more!1 Beginning January 1, 2016 you can apply your $150 Wellness Allowance to acupuncture treatment as well! For more information, see your Evidence of Coverage booklet.

1$150 is the total reimbursement amount each year for this benefit (Jan. 1 – Dec. 31).

Pay your premium online and more! Now you can access your personal plan information by signing up for a secure online account! It’s easy to create your account and: • Pay your monthly premium • View your claims history• View your current and past referrals• View your monthly Explanation of Benefits (EOB) documents• Choose to get your plan documents electronically instead of by mail—and view them in your account • And much more!

Sign up today! thpmp.org/registration

Signing up only takes a few minutes. If you have any questions, just call Customer Relations.

Please note: The monthly premium online payment feature may not apply if you receive your benefits from a current or former employer.

2

3


New discounts help you save!Your Preferred Extras offer great discounts on hearing aids, Nutrisystem, certain CVS products, and much more.1 Beginning January 1, 2016 new discounts will be added to your Preferred Extras including iDiet and a new way to save with Jenny Craig:

Jenny Craig—Beginning January 1, 2016, get 50% off Jenny Craig All Access Enrollment plus 5% off All Jenny Craig Food2. When you’re ready to lose weight, Jenny Craig makes it simple. With Jenny Craig, you don’t have to count, track or worry over every meal. Jenny Craig gives you everything you need to succeed. A day on Jenny Craig includes highly personal one-on-one support plus breakfast, lunch, dinner, snacks and desserts.

iDiet—This easy-to-follow program helps retrain your brain to crave healthy foods that support weight loss while keeping you full and satisfied. Save 15% on the iDiet program ($45 savings) for enrolling in the Engage (entry level) or Advance (experienced dieter) programs. Plus, save even more on iDiet when you use the benefit described below.

For more information on Preferred Extras discounts, go to thpmp.org/preferred-extras

4

Get $150 back for joining iDiet! Your $150 Weight Management benefit is a great way to stay fit. Use it toward joining Weight Watchers, Jenny Craig, hospital-based weight loss programs, and beginning January 1, 2016 the iDiet program!3 This easy-to-follow program helps retrain your brain to crave healthy foods that support weight loss while keeping you full and satisfied. Plus, through our Preferred Extras program you can save even more on iDiet (details above).

5

1 Discounts and services included in the Preferred Extras program are not plan benefits and are not subject to the Medicare appeals process.

2 50% discount on $99 enrollment fee. Enrollment and monthly fees of $19 required. Plus the cost of food. Plus the cost of shipping if applicable. Member is responsible for all payments for the Jenny Craig Program. Active program enrollment and program eligibility status required. Upon request, must provide proof of eligibility for participation in organization’s wellness program that is registered with Jenny Craig. Food Discount not applicable to shipping cost and only valid for personal consumption. Non-transferable. No cash value. Not valid with any other offer or discounts. Only available at participating locations and Jenny Craig Anywhere. Not valid at jennycraig.com. Restrictions apply. Offer expires 12/31/2016.

3$150 is the total reimbursement amount each year for this benefit (Jan. 1 – Dec. 31).


Do you take a specialty medication?If you take a specialty medication, you might be interested in knowing about Accredo Specialty Pharmacy. One of the largest specialty pharmacies in our network, Accredo Specialty Pharmacy can make filling your specialty prescription easier. Accredo Specialty Pharmacy is just one of the pharmacies in our network of over 60,000 pharmacies that you can use to fill your prescriptions. You are not required to use Accredo Specialty Pharmacy.

What is a specialty medication?

Specialty pharmacy medications are medications that require special handling, storage, and delivery. They include drugs used to treat a number of complex conditions including cancer, multiple sclerosis, pulmonary hypertension, and rheumatoid arthritis.

Accredo Specialty Pharmacy offers:

1 | Home delivery of specialty medications (not always available at local retail pharmacies)

2 | A team of care coordinators, registered nurses, and pharmacists available around the clock to help you and your physician manage your medications and your health

3 | Help finding programs that offer financial assistance, if available

4 | Regular reminders to schedule your next refill

5 | Online refills for certain specialty medications at Accredo.com

For more information

To learn more about Accredo Specialty Pharmacy, visit www.accredo.com. If you have any questions, call Customer Relations.

Note: Accredo is not a mail order pharmacy. Accredo is a retail pharmacy and medications obtained from Accredo are subject to retail copays.

New logo and new look

We updated our logo

for a fresh new look.

(You may have noticed

it on the cover.) We are

the same company and

nothing has changed.

Look for our new logo on

all the communications

you receive from us

going forward!


Plan Medical Costs HMO Saver Rx2 HMO Basic No Rx2 HMO Basic Rx

Medical Deductibles No medical deductible

Annual Out-of-Pocket Maximum3 $3,400 $3,400 $3,400

Monthly Plan Premium1 by County HMO Saver Rx2 HMO Basic No Rx2 HMO Basic Rx

Barnstable & Bristol $0 Not Offered $35.90

Essex & Suffolk $0 $34.00 $55.90

Hampden & Hampshire Not Offered Not Offered $0

Middlesex, Norfolk & Plymouth $0 Not Offered $35.90

Worcester $0 $33.00 $65.60

1 You must continue to pay your Medicare Part B premium.2Not available in all counties.3 Comprised of all your medical co-pays/co-insurance—your out-of-pocket costs will never exceed this amount.

Co-Pays HMO Saver Rx2 HMO Basic No Rx2 HMO Basic Rx

Doctor Office Visits

Primary Care Physician (PCP) $20 per visit $10 per visit

Specialist $40 per visit $30 per visit

Preventive Care

Annual Physical $0 per visit $0 per visit

Cancer Screening (Colorectal, Prostate, Breast)

$0 per visit $0 per visit

Vision and Hearing

Annual Routine Vision Exam $40 per visit $30 per visit

Annual Eyewear Benefit $150 per year toward eyewear at an EyeMed Vision Care participating provider or $90 per year at non-participating providers.

Annual Routine Hearing Exam $40 per visit $30 per visit

Outpatient and Lab Services

Outpatient Services / Surgery $250 per day $200 per day $225 per day

Physical Therapy4 $40 per visit $30 per visit

Occupational Therapy4 $40 per visit $30 per visit

Speech Therapy $40 per visit $30 per visit

Laboratory Services, X-rays, Diagnostic Procedures


Diagnostic Radiology Services $200 per day $150 per day $185 per day

Emergency Services

Emergency Room $75 per visit $75 per visit

Urgently Needed Care $20-$40 per visit $10-$30 per visit

Ambulance Services $225 per day $200 per day

Medical Coverage

YOUR 2016 BENEFITS At a glance


The charts on pages 8-11 are a quick reference guide to services and costs for our plans beginning January 1, 2016. Use this chart to compare plans. For comprehensive benefit information, see your Evidence of Coverage (EOC) booklet.

HMO Value No Rx HMO Value Rx HMO Prime No Rx HMO Prime Rx HMO Prime Rx Plus2

$96.00 $120.30 $130.00 $154.40 $188.20

$117.00 $141.30 $154.00 $178.40 $212.20

$22.00 $46.30 $52.00 $76.40 $110.20

$96.00 $120.30 $130.00 $154.40 $188.20

$109.00 $144.60 $148.00 $183.50 Not Offered


No medical deductible

$3,400 $3,400 $3,400 $3,400 $3,400

4 You pay $0 for a post-outpatient surgical procedure physical therapy or occupational therapy consultation of up to 15 minutes, prior to discharge.

Please note: costs may differ if you receive your benefits from a current or former employer.







$150 per year toward eyewear at an EyeMed Vision Care participating provider or $90 per year at non-participating providers.


$125 per day $75 per day





$75 per day 20% up to $75 per day


$10-$20 per visit $10-$15 per visit

$100 per day $150 per day $50 per day $75 per day $75 per day


Copays HMO Saver Rx2 HMO Basic No Rx2 HMO Basic Rx

Inpatient Care

Inpatient Hospital Coverage Days 1-5: $350 per day, $0 per day

after day 5

Days 1-5: $225 per day, $0 per day

after day 5

Additional Benefits

Wellness Allowance $150 per year toward fitness club membership, instructional fitness classes, nutritional counseling, acupuncture, or wellness programs such

as memory fitness activities

Weight Management Programs $150 annual reimbursement toward program fees for weight loss programs such as Weight Watchers, Jenny Craig, iDiet,

or hospital-based weight loss programs

Plan Drug (Rx) Costs HMO Saver Rx2 HMO Basic Rx (all counties except Worcester)

HMO Basic Rx (Worcester county)

Deductible $0 for Tiers 1-2; $300 for Tiers 3-5

$0 for Tiers 1-2; $250 for Tiers 3-5

Copays

Retail 30-day supply

Mail Order 90-day supply





Tier 1: Preferred Generic $6 $15 $4 $10 $4 $10

Tier 2: Non-Preferred Generic $12 $30 $8 $21 $6 $15

Tier 3: Preferred Brand $47 $141 $47 $141 $47 $141

Tier 4: Non-Preferred Brand $100 $300 $100 $300 $75 $225

Tier 5: Specialty Tier 26% 26% 27% 27% 27% 27%

Coverage Gap Stage: After your total prescription drug

costs reach $3,310, and until your payments reach $4,850, you pay:

• 58% for Part D generic drugs • 45% of costs for Part D brand drugs

plus a portion of the dispensing fee5

Catastrophic Coverage Stage: After the coverage gap, when your

payments for the year are greater than $4,850, you pay the greater of:

• 5% per prescription or • $2.95 per prescription for Part D generic drugs • $7.40 per prescription for Part D brand drugs

Prescription Drug (Rx) Coverage

Medical Coverage cont.

2Not available in all counties.



Days 1-5: $165 per day, $0 per day

after day 5

$200 per stay; you will not pay more than

$400 per year

$150 per year toward fitness club membership, instructional fitness classes, nutritional counseling, acupuncture, or wellness programs such

as memory fitness activities

$150 annual reimbursement toward program fees for weight loss programs such as Weight Watchers, Jenny Craig, iDiet,

or hospital-based weight loss programs

HMO Value Rx (all counties except Worcester)

HMO Value Rx (Worcester county)

HMO Prime Rx (all counties except Worcester)

HMO Prime Rx (Worcester county)

HMO Prime Rx Plus2

$0 for Tiers 1-2; $200 for Tiers 3-5

No deductible No deductible











$4 $10 $4 $10 $4 $10 $4 $10 $2 $5

$8 $21 $6 $15 $8 $21 $6 $15 $4 $10

$47 $141 $47 $141 $47 $141 $47 $141 $30 $90

$100 $300 $75 $225 $100 $300 $75 $225 $80 $240

28% 28% 28% 28% 33% 33% 33% 33% 33% 33%

• 58% for Part D generic drugs• 45% of costs for Part D brand drugs

plus a portion of the dispensing fee5

• Tier 1 copayments for generic drugs on Tier 1

• Tier 2 copayments for generic drugs on Tier 2

• 58% for all other generic drugs

• 45% of costs for Part D brand drugs plus a portion of the dispensing fee5

• 5% per prescription or • $2.95 per prescription for Part D generic drugs• $7.40 per prescription for Part D brand drugs

5 The amount discounted by the manufacturer in the Coverage Gap counts toward your out-of-pocket costs as if you had paid the total amount of the drug yourself. This helps you move through the gap.

Please note: costs may differ if you receive your benefits from a current or former employer.


If you need a new plan, we have options

We strive to provide excellent benefits and services that help you stay healthy. We hope you are happy with your current plan, but if you think you might need a different plan we can help.

Now is the time you can change your plan

Every year from October 15th to December 7th, Medicare Advantage members can change their plan. This time period is known as the Annual Election Period, and you can switch to a new plan, add or remove prescription drug coverage, or stay in the plan you are in now and not make any changes. If you think you might need to switch your plan give us a call. We have many plan options to choose from and can help you find the one that fits you best. Of course, you don’t have to make a change to your plan or take any action during the Annual Election Period if you are happy with your plan.

When I was about to retire, I didn’t know which way to turn, so I looked into several

insurance companies. I picked Tufts Health Plan Medicare Preferred, and I’ve been VERY happy.

I tell everybody I know how great I think Tufts Health Plan Medicare Preferred is.” — Paulette, Tufts Health Plan Medicare Preferred Member since 2008

“

make sure

your planis right

for you!We’re proud to be able to say our HMO plan is one of the highest rated plans in the country (see page 3 for details.)

tuftsmedicarepreferred.org well! Fall 2015

If you need a new plan, we have options

We strive to provide excellent benefits and services that help you stay healthy. We hope you are happy with your current plan but if you think you might need a different plan, we can help.

Now is the time you can change your plan

Every year from October 15th to December 7th, Medicare Advantage members can change their plan. This time period is known as the Annual Election Period, and you can switch to a new plan, add or remove prescription drug coverage, or stay in the plan you are in now and not make any changes. If you think you might need to switch your plan, give us a call. We have many plan options to choose from and can help you find the one that fits you best. Of course, you don’t have to make a change to your plan or take any action during the Annual Election Period if you are happy with your plan.

When I turned 65, I signed up for Tufts Health Plan Medicare Preferred, and I’ve been happy

ever since. Tufts Health Plan Medicare Preferred is ‘top of the line’ as far as I’m concerned!” — Bruce, Tufts Health Plan Medicare Preferred Member since 2008“

make sure

your planis right

for you!We’re proud to be able to say our HMO plan is a 5-star plan (see page 3 for details)!

12

tuftsmedicarepreferred.orgFall 2015 well!

Looking for an easy way to compare our HMO plans?Use the chart on page 8! KNOW SOMEONE WHO

MIGHT WANT TO join A TUFTS HEALTH PLAN MEDICARE PREFERRED PLAN?

* Enrollment in Medicare Parts A and B is required. Other restrictions may apply.

Now is the time they can join!* If you know someone

who is looking for a top rated plan with excellent

benefits, great services, extra discounts, and customer

service they can trust, have them give us a call. Our

plans include a range of HMO plans and Medicare

Supplement plans as well. We have plans for different

needs and budgets. See page 8 for details!

Friendly service

Our Medicare Specialists can go over all our plan

options, explain how to enroll, and even send out a

free information packet. If you know someone who

would like to join, ask them to call 1-877-409-3496

(TTY 888-899-8977)! Representatives are available

Mon – Fri, 8 a.m. – 8 p.m. (From Oct 1 – Feb 14,

representatives are available 7 days a week, 8 a.m. –

8 p.m.) After hours and on holidays, please leave

a message and a representative will return your call

on the next business day.

Our HMO plans received 5 stars from Medicare! See page 3 for details.

We have several HMO plans to choose from

If your health care needs have changed over the past year, we have different plans for you to choose from. We offer a range of HMO plans at different costs, and can help you find the one that fits you best. To compare the cost of services for our HMO plans, see pages 8–11. You can also use the plan finder tool on our website to help you match your needs to the right plan. If you need to switch your plan, give us a call today!

Medicare Supplement plans too

A Medicare Supplement plan works differently than an HMO plan. Medicare Supplement plans cover “gaps” in Original Medicare coverage such as deductibles and coinsurance. For details on how our Medicare Supplement plans work, call Customer Relations or visit our website at tuftsmedicarepreferred.org.

Have Questions? Call us!

We’re here to help answer any questions you have about your current plan or switching to a new plan. We can help make sure you are in the plan that is right for you!

1-800-701-9000 // (TTY 1-800-208-9562)

Mon. – Fri. 8:00 a.m. – 8:00 p.m. (From Oct. 1 – Feb. 14, representatives are available 7 days a week, 8:00 a.m. – 8:00 p.m.) After hours and on holidays, please leave a message and a representative will return your call on the next business day.

13


Remember to get your flu shotFlu shots are key to reducing your risk of illness and stopping the spread of the flu virus. The best way to prevent the flu? Get the flu shot each season, preferably early in the flu season. Experts recommend that everyone age six months and older get a flu shot. The Centers for Disease Control and Prevention (CDC) states that those with the highest risk and in greatest need of a flu shot include adults 65 years of age and older and people of any age with underlying medical conditions (e.g., asthma, diabetes).

It’s covered

The flu vaccine is available at no charge to you. As a Tufts Medicare Preferred HMO member, you are covered for a flu shot each year with no out-of-pocket cost.

Where can you get a flu shot?

You can get a flu shot at your doctor’s office. If your doctor is unable to schedule you for a flu shot before the end of the year, we cover flu vaccines given at any pharmacy in the Tufts Health Plan Medicare Preferred national network that administers it. Look in your Provider Directory for location information. Vaccines are also covered at MinuteClinics within CVS pharmacy locations in Massachusetts. There is no charge at these locations when you show your member ID card, and you don’t need an appointment. For location information go to CVS.com. If you get a flu shot from a clinic, make sure you let your doctor’s office know so it can be noted in your medical record.

3WINTER HEALTH TIPS

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5 Ways to prevent winter fallsWinter is just around the corner and with winter comes the danger of slipping on patches of snow or ice. These hazards are especially dangerous for older adults. Falls are the leading cause of both fatal and nonfatal injuries among older adults. The Centers for Disease Control reported that falls were the number one reason adults over the age of 45 visit the emergency room. Fractured ankles and broken hips are some of the most common injuries caused by slipping on snow or ice.

To avoid winter falls:

1 | Wear the right footwear. Shoes with rubber soles and good tread provide better traction than leather or plastic soles.

2 | When walking on slippery surfaces bend your body slightly forward and take shorter strides.

3 | Allow extra time to get to your destination. Avoid rushing or taking shortcuts across slippery areas.

4 | Use cleared pathways that have been treated with sand or salt.

5 | Make sure your footing is solid when getting into or out of a car.

Concerned about falling in your home?

If you’re concerned about falling in your home, remember your plan has a $0 copay for an in-home safety assessment. If your doctor or Care Manager recommends it, a nurse employed by Lifeplans will come to your home to assess your risk of falling*.

Should you have a Bone Mineral Density (BMD) test?

If you recently had a fracture, you may need a BMD test to determine your future risk for fractures and osteoporosis. Talk to your doctor. A BMD test is offered at no charge to you.

* This assessment evaluates your risk of falling. It is not a safety inspection of your home.

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03

Printed on Recyclable

Paper 543M

This newsletter is not

intended to replace the

advice of health care

professionals. Please

consult your physician for

your health care needs.

Services and medical

technologies may not be

covered, or may be subject

to preauthorization.

© 2015. Printed in U.S.A.

705 Mount Auburn Street,

Watertown, MA 02472

well!

Everything

for2

01

6!

You Need to K

now

Your HM

O plan received

Medicare’s highest

rating—5

stars!…M

ore to smile about—

add dental coverage to your plan! …E

asy-to-use benefi

ts chart…N

ew discounts &

more!

Health and w

ellness or prevention information

Fall 20

15

For Tufts M

edicare Preferred H

MO

Plan M

embers

Fall 2015 For Tufts Medicare Preferred HMO Plan Members ... · Get $150 back for acupuncture...

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