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如何隨時都能參加紅藍卡(共付額 配方藥 公開期 四部分)

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演講題目

How Immigrants can be qualified for Medicare.(as early as 55)
新/老移民如何獲取紅藍卡資格?(最早是55)

4 Parts of Medicare A/B/C/D
– 紅藍卡的A/B/C/D四部分

Medicare AEO/IEP/OEP
– 紅藍卡的公開期/ 特殊公開期

———————–
– 新移民如何獲取紅藍卡資格?
如:需交10年稅
– 紅藍卡的A/B/C/D四部分
https://212-484-9888.com/medicare-a-b-c-d/
– 紅藍卡的公開期/參加期
AEP/IEP/OEP(本次主要講述OEP 1/1-3/31)
如有時間會介紹(SEP 特殊公開期)

立即對比紅藍卡報價

高達$750元的視力補助
每月$145元OTC補助
免費看診交通接送
除了長照,還有750元眼睛補助或145元每月藥房報銷。還曾經高達180元呢

 

1. 紅藍卡投保公開期 3月31日
https://www.medicare.gov/blog/medicare-advantage-open-enrollment-2020

2. 新冠疫情期間如何申請紅藍卡

3. 新移民如何申請紅藍卡?
例如:居住在國外的美國公民如何獲得紅藍卡的福利?
a. B部分 報銷項目
b. 哪個計劃覆蓋
https://www.medicare.gov/coverage/travel

EPIC (Humana 計劃詳情)

HumanaChoice H5970-024 (PPO)

Plan type: Medicare Advantage with drug coverage
Plan ID:H5970-024-1

Overview

PREMIUM

Total monthly premium
$0.00
Health plan premium
$0.00
Drug plan premium
$0.00
Standard Part B premium
$148.50
Part B premium reduction
No

 

Health deductible
$0
Drug plan deductible
$350.00

ESTIMATED YEARLY COSTS

$3,630.00

MAXIMUM YOU PAY FOR HEALTH SERVICES

$11,000 In and Out-of-network
$7,200 In-network

Benefits & costs

DOCTOR SERVICESView Provider Network Directory

Primary doctor visit
In-network: $0 copay
Out-of-network: $15 copay per visit
Specialist visit
In-network: $40 copay per visit
Out-of-network: $50 copay per visit

TESTS, LABS, & IMAGING

In-network: $0-90 copay
Out-of-network: $0-50 copay or 30% coinsurance

Lab services
In-network: $0-40 copay
Out-of-network: $15-50 copay or 30% coinsurance

Diagnostic radiology services (like MRI)
In-network: $0-350 copay
Out-of-network: $15-50 copay or 30% coinsurance

Outpatient x-rays
In-network: $0-90 copay
Out-of-network: $15-50 copay or 30% coinsurance

Emergency care
$90 copay per visit (always covered)
Urgent care
$0-50 copay or 30% coinsurance per visit (always covered)

HOSPITAL SERVICES

Inpatient hospital coverage
In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $500 per day for days 1 through 7
$0 per day for days 8 through 90

Outpatient hospital coverage
In-network: $40-350 copay per visit
Out-of-network: $50 copay or 30% coinsurance per visit

SKILLED NURSING FACILITY

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: 30% per stay

 

 

Preventive services
In-network: $0 copay
Out-of-network: $0-50 copay or 30% coinsurance

AMBULANCE

Ground ambulance
In-network: $290 copay
Out-of-network: $290 copay

THERAPY SERVICES

Occupational therapy visit
In-network: $40 copay
Out-of-network: $50 copay or 30% coinsurance

Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $50 copay or 30% coinsurance

MENTAL HEALTH SERVICES

Outpatient group therapy with a psychiatrist
In-network: $40 copay
Out-of-network: $50 copay

Outpatient individual therapy with a psychiatrist
In-network: $40 copay
Out-of-network: $50 copay

Outpatient group therapy visit
In-network: $40 copay
Out-of-network: $50 copay

Outpatient individual therapy visit
In-network: $40 copay
Out-of-network: $50 copay

OPIOID TREATMENT PROGRAM SERVICES

Opioid treatment program services
  • In-network:

    • $40-$100 copay
  • Out-of-network:

    • $50 copay
    • 30% coinsurance

OTHER SERVICES

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item

Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item

Dialysis
  • In-network:

    • 20% coinsurance
  • Out-of-network:

    • 20% coinsurance

Diabetes supplies
In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 30% coinsurance per item

Extra benefits & costs

HEARING

Hearing exam
In-network: $40 copay
Out-of-network: $50 copay

Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay

Hearing aids – All types
In-network: $699-999 copay
Out-of-network: $699-999 copay

Care to prevent or find problems with your teeth and gums.

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Care to maintain or treat problems with your teeth and gums.

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Extractions
Not covered
Prosthodontics, other oral/maxillofacial surgery, other services
Not covered

VISION

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay

Advanced Plan Approval Required – A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.
Plan limits – There may be limits on how much the plan will provide.
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay

Advanced Plan Approval Required – A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.
Plan limits – There may be limits on how much the plan will provide.
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay

Advanced Plan Approval Required – A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.
Plan limits – There may be limits on how much the plan will provide.
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

MEDICALLY-APPROVED NON-OPIOID PAIN MANAGEMENT SERVICES

Chiropractic services
Not covered
Acupuncture
Not covered
Massage therapy
Not covered
Alternative therapies
Not covered

MORE BENEFITS

Fitness benefit
Some coverage
Transportation services for non-emergency care: Any health-related locations
Not covered
Transportation services for non-emergency care: Plan-approved locations
Not covered
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Some coverage
Annual physical exams
Some coverage
Telehealth
Some coverage
Worldwide emergency
Some coverage

Optional packages

This plan includes optional benefits you can add to your coverage at an additional cost.
Package #1 Includes preventive dental services, and comprehensive dental services
Monthly premium: $23.20
Deductible: N/A
Package #2 Includes preventive dental services, and comprehensive dental services
Monthly premium: $30.50
Deductible: N/A

Drug coverage & costs

Plans group their drug lists into tiers. The table below shows your portion of the drug cost in certain tiers based on which coverage phase you’re in for this plan

Tiers Initial coverage phase Gap coverage phase Catastrophic coverage phase
Preferred Generic $2.00 copay
Generic drugs:25%Brand-name drugs:25%
Generic drugs:$3.70 copay or 5% (whichever costs more)Brand-name drugs:$9.20 copay or 5% (whichever costs more)
Generic $9.00 copay
Preferred Brand $47.00 copay
Non-Preferred Drug $100.00 copay
Specialty Tier 26%

Pharmacies

See the cost level to fill your drugs at the pharmacies you chose. You can also change pharmacies to see the cost level of other pharmacies in your area to find the lowest cost pharmacy.

Mail Order Pharmacy Costs vary based on the specific mail-order pharmacy

ESTIMATED DRUG COSTS DURING COVERAGE PHASES

The drug prices shown may vary based on the plan and pharmacy you’ve selected. Contact the plan if you have specific questions about drug costs.

Mail order pharmacy – Drug costs during coverage phases

Selected drugs Retail cost Cost before deductible Cost after deductible Cost in coverage gap Cost after coverage gap
Atorvastatin 10mg tablet $0.00 $0.00 $0.00 $0.00 $0.00
Glimepiride 2mg tablet $0.00 $0.00 $0.00 $0.00 $0.00
Invokana 300mg tablet $1,633.87 $131.00 $131.00 $408.47 $81.69
Metformin hydrochloride 850mg tablet $0.00 $0.00 $0.00 $0.00 $0.00
Olmesartan medoxomil 20mg tablet $0.00 $0.00 $0.00 $0.00 $0.00
Monthly totals $1,633.87 $131.00 $131.00 $408.47 $81.69

Estimated total drug + premium cost

You will pay $994.37 per year on drug + premium costs.

Based on current drug costs, it’s estimated that:

  • You won’t meet your $350.00 deductible this year

Estimated monthly drug costs

This doesn’t include your monthly plan premium of $0.00.

Time period Estimated monthly drug costs
marzo $131.00
junio $131.00
septiembre $323.90
diciembre $408.47

OTHER DRUG INFORMATION

Selected drugs Tier Prior authorization Quantity limits Step therapy
Atorvastatin 10mg tablet Tier 1
Glimepiride 2mg tablet Tier 1
Invokana 300mg tablet Tier 3
Metformin hydrochloride 850mg tablet Tier 1
Olmesartan medoxomil 20mg tablet Tier 2

藥物費用

Formulary

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

HealthFirst Formulary Example

https://healthfirst.org/formularies

HealthFirst Medicare Insurance 2021 Formularies

2021 Chinese Formularies List

https://assets.healthfirst.org/pdf_2d1357acc64ca13b1d3f0bda7f855a53?v=1006203326

HealthFirst Formularies

什麼是共付額(Copayment)

共付額(Copayment) 是承保服務的固定金額,由患者在接受服務之前支付給服務提供者。可以在保險單中對其進行定義,並在每次獲得醫療服務時由被保險人支付。從技術上講,它是共同保險的一種形式,但在健康保險中有不同的定義,在健康保險中,共同保險是自付額達到一定限額後的百分比支付額。必須在保險公司支付任何保單利益之前支付。

根據藥物使用,成本和臨床有效性,將藥物劃分為四個,五個或六個類別之一,稱為共付額或共同保險等級。 我們的處方藥搜索可以根據您的福利計劃向您顯示適用於特定藥物的那一級別。

“四層配方”的共付額定義

第1層處方藥:包括成本最低的處方藥,大多數是仿製藥

第2層處方藥:包括中等成本的處方藥,大多數是仿製藥,還有一些品牌原廠處方藥;

第3層處方藥:包括成本較高的處方藥,大多數是品牌原廠處方藥,還有些是特殊專業藥物;

第4層處方藥:包括成本最高的處方藥,大多數是特殊專業藥物。

 

Comparing Formulary Aetna vs HealthFirst

 

 

https://www.aetnamedicare.com/en/prescription-drugs/check-medicare-drug-list.html

 

「原文出處」