Northern CA, LA & Orange County, Southern CA

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Presentation transcript:

Northern CA, LA & Orange County, Southern CA California Northern CA, LA & Orange County, Southern CA Amerilife Agent Value Prop Overview 9/9/13 AGENT TRAINING ONLY

2014 Anticipated MA Plan Footprint 2014 MA Territory County Medicare Eligible Existing HMO Fresno 101,125 Kings 12,887 Madera 18,350   Alameda 181,414 Contra Costa 151,655 San Joaquin 76,591 San Francisco 117,309 Tulare 46,775  Existing MA Counties Total Total 740,435 2014 Expansion HMO Counties Santa Barbara 66,854 Santa Clara 223,786 Santa Cruz 33,728 Stanislaus 63,215 Ventura 116,618 504,201 All MA Counties Total 1,244,636

Bay Area HMO Counties

2014 MA Plan Summaries Current HMOs Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $10 Hospital: $250 per days 1-5 PDP Benefit: $3/$10/$45/$95/25% Plan Type: HMO Premium: $19 MOOP: $5,000 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $5/$10/$45/$95/33% Premium: $ 49 MOOP: $3,400 PCP: $0 Specialist: $0 Hospital: $0 per days 1-3, $300 per days 4-7 PDP Benefit: $0/$10/$45/$95/33%; Full Tier Gap Cvg: Tier 1 - $0, Tier 2: $10 Alameda I

2014 MA Plan Summaries Current HMOs Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $10 Hospital: $395 per days 1-4 PDP Benefit: $3/$10/$45/$95/25% Plan Type: HMO Premium: $19 MOOP: $5,000 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $5/$10/$45/$95/33% Premium: $ 49 MOOP: $3,400 PCP: $0 Specialist: $5 Hospital: $0 per days 1-3, $300 per days 4-7 PDP Benefit: $0/$10/$45/$95/33%; Full Tier Gap Cvg: Tier 1 - $0, Tier 2: $10 Contra Costa

2014 MA Plan Summaries Current HMOs Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $10 Hospital: $395 per days 1-4 PDP Benefit: $4/$9/$45/$95/25% Plan Type: HMO Premium: $19 MOOP: $5,000 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $5/$10/$45/$95/33% Premium: $ 49 MOOP: $3,400 PCP: $0 Specialist: $5 Hospital: $0 per days 1-3, $300 per days 4-7 PDP Benefit: $0/$10/$45/$95/33%; Full Tier Gap Cvg: Tier 1 - $0, Tier 2: $10 San Francisco

2014 MA Plan Summaries Current HMOs Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $10 Hospital: $395 per days 1-4 PDP Benefit: $3/$8/$45/$95/25% Plan Type: HMO Premium: $19 MOOP: $5,000 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $5/$10/$45/$95/33% Premium: $ 39 MOOP: $3,400 PCP: $0 Specialist: $0 Hospital: $0 per days 1-3, $300 per days 4-7 PDP Benefit: $0/$10/$45/$95/33%; Full Tier Gap Cvg: Tier 1 - $0, Tier 2: $10 San Joaquin I

2014 MA Plan Summaries Current HMOs Santa Clara Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $10 Hospital: $395 per days 1-4 PDP Benefit: $5/$10/$40/$95/25% Plan Type: HMO Premium: $19 MOOP: $5,000 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $5/$10/$45/$95/33% Premium: $ 49 MOOP: $3,400 PCP: $0 Specialist: $5 Hospital: $0 per days 1-3, $300 per days 4-7 PDP Benefit: $0/$10/$45/$95/33%; Full Tier Gap Cvg: Tier 1 - $0, Tier 2: $10 I

2014 MA Plan Summaries Expansion HMOs Stanislaus Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $0 Specialist: $10 Hospital: $0 per days 1-2, $325 per days 3-7 PDP Benefit: $3/$10/$45/$95/26% Premium: $39 MOOP: $3,400 PCP: $0 Specialist: $5 Hospital: $0 per days 1-3, $300 per days 4-7 PDP: $0/$10/$45/$95/33% I

Central HMO Counties

2014 MA Plan Summaries Current HMOs Fresno, Kings, & Madera Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $0 Specialist: $5 Hospital: $335 per days 1-5 PDP Benefit: $5/$10/$45/$95/33% Premium: $42 MOOP: $5,900 PCP: $0 Specialist: $5 Hospital: $335 per day 1-5(in) PDP Benefit: $0/$10/$45/$95/33% ; Full Tier Gap Covg: Tier 1 - $0, Tier 2 - $10

2014 MA Plan Summaries Current HMOs Tulare Plan Type: HMO Premium: $0 MOOP: $6,700 PCP: $5 Specialist: $35 Hospital: $295 per days 1-5 PDP Benefit: $5/$10/$45/$95/33%

Coastal HMO Counties

2014 MA Plan Summaries Expansion HMOs Santa Barbara & Ventura Plan Type: HMO Premium: $0 MOOP: $5,900 PCP: $0 Specialist: $5 Hospital: $335 per days 1-5 PDP Benefit: $5/$10/$45/$95/33%

2014 MA Plan Summaries Expansion HMOs Santa Cruz Plan Type: HMO Premium: $52 MOOP: $6,700 PCP: $5 Specialist: $5 Hospital: $419 per days 1-4 PDP: $5/$10/$45/$95/33% AGENT TRAINING ONLY

2014 Los Angeles & Orange County Market

2014 MA Plan Summaries Orange County Los Angeles County H0108-011 Plan Type: HMO Premium: $0 MOOP: $3,400 PCP: $0 Specialist: $0 Hospital: $0 per days PDP Benefit: $0/$10/$45/$95/33% Orange County H0108-013 Premium: $0 PCP: $0 Specialist: $0 Hospital: $0 PDP: $0/$10/$45/$95/33%

2014 San Diego/Riverside/ San Bernardino Market Russ Barbour Director of Sales August 2013

2014 MA Plan Summaries $0 HMO $32 HMO enhanced benefits $0 HMO $0 HMO-MA only $42 HMO-POS PDP only

2014 MA Plan Summaries San Diego County Plan Type: HMO Premium: $0 MOOP: $3,400 PCP: $10 Specialist: $25 Hospital: $150 per days 1-8 PDP Benefit: $0/$10/$45/$95/33% Plan Type: HMO-POS Premium: $42 MOOP: $5,000 (in)/$5,000 (out) combined PCP: $10 (in)/$35 (out) Specialist: $25 (in)/$50 (out) Hospital: $150 per days 1-8(in)/$300 per days 1-8(out) PDP: Same as HMO $0 prem.

2014 MA Plan Summaries San Diego County $30 Part B giveback Plan Type: HMO-MA only Premium: $0 MOOP: $6,700 PCP: $0 Specialist: $0 Hospital: $250 per days 1-5 PDP Benefit: not included $30 Part B giveback Silver Sneakers Gym Membership Vision and dental benefits OTC Drug benefit Transportation benefit Well-Dine benefit

San Diego County IPA’s Greater Tri-Cities IPA Mercy Physicians Medical Group Primary Care Associates Medical Group Vantage Medical Group San Diego Physician’s Medical Group

2014 MA Plan Summaries Riverside/San Bernardino Counties Plan Type: HMO Premium: $0 MOOP: $3,400 PCP: $0 Specialist: $0 Hospital: $0/admit PDP Benefit: $0/$10/$41/$92/33% Plan Type: HMO enhanced benefits Premium: $ 32 PCP: $0 Specialist: $0 PDP: $0/$5/$24/$68/33%

Riverside/San Bernardino IPA’s Empire Physician’s Medical Group (Coachella Valley) Prime Care Medical Group Anchor Medical Group Choice Medical Group Employee Health Systems Hemet Community Medical Group Riverside Medical Clinic Riverside Physician’s Network Vantage Medical Group San Bernardino Medical Group Prime Care Associates of California Epic (including Beaver Medical Group, Redlands Yucaipa Medical Group, Pinnacle Medical Group and Alliance Desert Physicians Group) Alpha Care