Molina Healthcare of Washington Molina Medicare Options Plus

  • Slides: 12
Download presentation
Molina Healthcare of Washington Molina Medicare Options Plus Molina Medicare Choice 2017 Benefits December

Molina Healthcare of Washington Molina Medicare Options Plus Molina Medicare Choice 2017 Benefits December 2, 2016 Linda Mc. Coy, Sales Manager

AGENDA 1. 2. 3. 4. 5. 6. 7. 8. 9. Introductions History of Molina

AGENDA 1. 2. 3. 4. 5. 6. 7. 8. 9. Introductions History of Molina Medicare Overview Washington Counties (Service Areas) for Medicare MMOP (Molina Medicare Options Plus) and MMC (Molina Medicare Choice) Eligibility 2017 Benefits Resources with Molina Q&A 2

History of Molina Medicare Molina Healthcare, Inc. entered the Medicare market effective January 1,

History of Molina Medicare Molina Healthcare, Inc. entered the Medicare market effective January 1, 2006 and operates as a multi-state managed care organization that arranges for the delivery of health care services. Services are offered to persons eligible to receive health care benefits through government-sponsored programs for low-income families and individuals, such as Medicaid and Medicare Advantage as well as other state-specific programs. Molina Healthcare is licensed by the Centers for Medicare & Medicaid Services (CMS) to serve the Medicare beneficiaries in the plan’s service areas of: • California • Florida • Illinois • Michigan • New Mexico • Ohio • Puerto Rico • Texas • Utah • Washington • Wisconsin 3

Medicare Overview Medicare is the nation’s largest health insurance program, covering approximately 42 million

Medicare Overview Medicare is the nation’s largest health insurance program, covering approximately 42 million Americans. Administered by Centers for Medicare and Medicaid Services (CMS) • The Medicare Program has four parts: • Part A Hospital Insurance o Medicare Part A helps cover inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also helps covers hospice care, some health care, and blood. • Part B is Voluntary Medical Insurance o Monthly premium is deducted from Social Security check or paid for by state if recipient is enrolled in full Medicaid benefits o Medicare Part B helps cover doctor’s services, outpatient hospital care, testing, labs certain preventative screenings and DME • Part C Medicare Advantage plans • Part D is Voluntary Prescription Drug Coverage o First comprehensive prescription drug benefit ever offered o Nearly 4 in 10 Medicare Part D plan enrollees are receiving low-income subsidies o Medicare prescription drug coverage helps the Medicare beneficiary pay for the prescriptions they currently need or may need in the future o There is also additional help for those who are low income o Medicare prescription drug coverage pays for brand name as well as generic drugs 4

Molina D-SNP Washington Service Area 5

Molina D-SNP Washington Service Area 5

Molina Medicare Options Plus (MMOP) and Molina Medicare Choice (MMC) The following are the

Molina Medicare Options Plus (MMOP) and Molina Medicare Choice (MMC) The following are the eligibility requirements to join the Molina Medicare Options Plus and/or Molina Medicare Choice • • • Have Medicare and Medicaid • Must be entitled and enrolled in Medicare Part A and Medicare Part B Plan Must live in the Plan’s service network area Must not have End Stage Renal Disease (ESRD) • ESRD is permanent kidney failure and requires regular kidney dialysis or a transplant to stay alive Must use Providers, Pharmacies and Services within the Molina network Must coordinate all care with Specialists through the Primary Care Physician + 6

Molina Medicare Options Plus Benefit for 2017 (Premium $0 -5. 20) Vendor Benefits for

Molina Medicare Options Plus Benefit for 2017 (Premium $0 -5. 20) Vendor Benefits for 2017 Dental Avesis (Dente. Max) • Annual Maximum - $1, 250 (for all supplemental dental services combined) • $0 copay per office visit • Preventative Services Oral Exams (up to 2 per CY) • Cleanings (2 per CY) • Fluoride Treatment (1 per CY) • Dental X-Rays (1 set of 2 or 4 bitewing films per year or 1 full set of x-rays per 3 years) • Comprehensive Services • Periodontics (deep cleanings) (4 quadrants every 24 months) • Restorative Services (fillings) (4 every CY) • Crowns and Crown Repairs • Endodontics / Root Canals • Extractions (simple) (5 every CY) • Denture Allowance ($500 maximum allowance every CY • Denture Adjustments (up to 2 any of the 4 covered denture adjustments per year) Vision March Vision $0 copay for: • Eyeglasses (frames and lenses) • Eyeglass frames • Eyeglass lenses • Eyeglasses or contact lenses after cataract surgery $200 allowance every 2 years Secure Transportation Avesis Hearing Routine Hearing Exam Hearing Aid Fitting/Evaluation Hearing Aid Allowance $0 copay for up to 60 one-way trips to plan-approved locations per CY $0 copay; 1 every year $0 Copay; 1 every 3 years $1000 allowance every 2 years 7

Molina Medicare Options Plus Benefit for 2017 Vendor CVS/Caremark Benefits for 2017 Over-the-Counter $25

Molina Medicare Options Plus Benefit for 2017 Vendor CVS/Caremark Benefits for 2017 Over-the-Counter $25 allowance every month GA Foods Meal Benefit Routine Podiatry $0 Copay for up to 56 home delivered meals delivered over 4 weeks, for qualifying members after transitioning from an in-patient hospital or skilled nursing facility. $0 Copay for up to 6 visits per CY 24 Hour Nurse Advice Line Health Education $0 Copay $0 copay Nutrition/Dietary Benefit $0 Copay for 12 individual telephonic counseling sessions Smoking Cessation Counseling $0 Copay Part D Cost-Sharing Tier 1 (Preferred Generic) Cost-Sharing Tier 2 (Generic) $0 Co. Pay 8

Molina Medicare Choice Benefits for 2017 (Premium $0 - $34. 40) Vendor Benefits for

Molina Medicare Choice Benefits for 2017 (Premium $0 - $34. 40) Vendor Benefits for 2017 Dental Avesis (Dente. Max) • Annual Maximum - $1, 250 (for all supplemental dental services combined) • $0 copay per office visit • Preventative Services Oral Exams (up to 2 per CY) • Cleanings (2 per CY) • Fluoride Treatment (1 per CY) • Dental X-Rays (1 set of 2 or 4 bitewing films per year or 1 full set of x-rays per 3 years) • Comprehensive Services • Periodontics (deep cleanings) (4 quadrants every 24 months) • Restorative Services (fillings) (4 every CY) • Crowns and Crown Repairs • Endodontics / Root Canals • Extractions (simple) (5 every CY) • Denture Allowance ($500 maximum allowance every CY • Denture Adjustments (up to 2 any of the 4 covered denture adjustments per year) Vision March Vision $0 copay for: • Eyeglasses (frames and lenses) • Eyeglass frames • Eyeglass lenses • Eyeglasses or contact lenses after cataract surgery $200 allowance every 2 years Secure Transportation Avesis Hearing Routine Hearing Exam Hearing Aid Fitting/Evaluation Hearing Aid Allowance $0 copay for up to 30 one-way trips every year and unlimited one-way trips for Primary Care Services $0 copay; 1 every year $0 Copay; 1 every 3 years $1000 allowance every 2 years 9

Molina Medicare Choice Benefits for 2017 Vendor CVS/Caremark Benefits for 2017 Over-the-Counter $25 allowance

Molina Medicare Choice Benefits for 2017 Vendor CVS/Caremark Benefits for 2017 Over-the-Counter $25 allowance every month GA Foods Meal Benefit Routine Podiatry $0 Copay for up to 56 home delivered meals delivered over 4 weeks, for qualifying members after transitioning from an in-patient hospital or skilled nursing facility. $0 Copay for up to 6 visits per CY 24 Hour Nurse Advice Line Health Education $0 Copay $0 copay Nutrition/Dietary Benefit $0 Copay for 12 individual telephonic counseling sessions Smoking Cessation Counseling $0 Copay Part D Cost-Sharing Tier 1 (Preferred Generic) Cost-Sharing Tier 2 (Generic) $0 Co. Pay 10

Eligibility with Molina Healthcare of WA Resources o Account Reps for Medicare: • Chris

Eligibility with Molina Healthcare of WA Resources o Account Reps for Medicare: • Chris Lee – (425 -492 -0244) • John Burke – (425 -219 -3634) • Steven Brigance – (425 -219 -0035) v Linda Mc. Coy – Sales Manager (425 -231 -5384) o Community Engagement: • Uriel Varela and Giselle Zapata Garcia o Community Connectors: – King County: • Ron Abram • Malcom Baber 11

12

12