Download presentation
Presentation is loading. Please wait.
1
2017 Individual CareSource Competitive Analysis - Cathy
2
Bronze HMO Benefit Comparison
Sales Talking Points: Anthem has lower deductible and lower ER Copay. Bronze Benefit Comparison CareSource Anthem Metal Level/Plan Type Bronze HMO New Bronze Standardized HMO Deductible (Single/Family) $6,650/$13,300 $5,000/$10,000 OOP $6,850/$13,700 $7,150/$14,300 Coinsurance (Network/Non-Network) 40%/NA 50%/NA PCP Office Visits $35 Copay $45 Copay $50 Copay for first 2, then Ded /Coins Specialist Office Visits $75 Copay Ded/Coins Urgent Care $100 Copay Ded + $50 Copay + Coins ER Ded + $500 Copay + 40% Ded + $300 Copay + Coins IP Hospital Facility $250 per day for days 1-5, $0 per day for days Ded + $500 Copay + 50% Coins Rx Tier 1 Generic: $25 Tier 2 Preferred: $100 Tier 3 Non-Preferred: $250 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Tier 1 Generic: $35 Tier 2 Preferred: Ded + 35% Tier 3 Non-Preferred: Ded + 40% Tier 4 Specialty: 45% Level 1 40% Coins Level 2 50% Coins Louisville Rate (non-Smoker) Single Age 25 $159.97 $150.04 $204.48 Single Age 45 $230.08 $215.79 $294.09 Couple Age 55 $710.64 $666.50 $908.33 Lexington Rate (non-Smoker) $174.60 $163.75 $214.72 $251.11 $235.51 $308.83 $775.59 $727.42 $953.85
3
Silver HMO Benefit Comparison
Sales Talking Points: - Anthem’s New Tiered Pharmacy network offers $5 copay for Tier 1 generics. - Anthem’s new Silver plan provides lower Tier 2 copay and lower deductible/OOP than CareSource’s New Low premium plan. Silver Benefit Comparison CareSource Anthem Metal Level/Plan Type New Silver Standardized HMO Silver HMO New Silver HMO New Silver Low Prem HMO Deductible (Single/Family) $3,500/$7,000 $3,300/$6,600 $5,300/$10,600 $6,150/$12,300 OOP $7,150/$14,300 $6,400/$12,800 $5,850/$11,700 $6,750/$13,500 $7,000/$14,000 Coinsurance (Network/Non-Network) 20%/NA 30%/NA 25%/NA 15%/NA PCP Office Visits $30 Copay No Copay $35 Copay Specialist Office Visits $65 Copay $50 Copay Ded/Coins Urgent Care $75 Copay $90 Copay Ded + $50 Copay + Coins $100 Copay ER Ded + $400 Copay + Coins Ded + $500 Copay + Coins IP Hospital Facility $250 per day for days 1-5, $0 per day for days Ded + $500 Copay + 50% Coins Rx Tier 1 Generic: $15 Tier 2 Preferred: $50 Tier 3 Non-Preferred: $100 Tier 4 Specialty: 40% coins Tier 1 Generic: $0 Tier 2 Preferred: $60 Tier 3 Non-Preferred: $130 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Level 1 Tier 1: $5 Tier 2: $1000 Ded + $40 Tier 3: $1000 Ded + 40% Tier 4: $1000 Ded + 40% Level 2 Tier 1: $15 Tier 2: $1000 Ded + $50 Tier 3: $1000 Ded + 50% Tier 4: $1000 Ded + 50% Level 1 Tier 1: $10 Tier 2: $40 Tier 3: Ded + 40% Tier 4: Ded + 40% Level 2 Tier 1: $20 Tier 2: $50 Tier 3: Ded + 50% Tier 4: Ded + 50% Tier 1 Generic: $10 Tier 2 Preferred: $50 Tier 3 Non-Preferred: Ded + 15% Tier 4 Specialty: Ded + 15% Tier 5 Specialty Non-Pref: Ded + 15% Louisville Rate (non-Smoker) Single Age 25 $170.50 $188.61 $245.27 $231.81 $161.17 Single Age 45 $245.22 $271.27 $352.76 $333.41 Couple Age 55 $757.41 $837.86 $1,089.55 $1,029.77 $715.97 Lexington Rate (non-Smoker) $186.09 $205.85 $257.56 $243.43 $175.90 $267.64 $296.07 $370.44 $350.12 $252.99 $826.64 $914.45 $1,144.16 $1,081.39 $781.41
4
Gold HMO Benefit Comparison
Sales Talking Points: Anthem’s New Tiered Pharmacy network offers $5 copay for Tier 1 generics. Anthem has all inclusive $90 Urgent Care copay (not subject to deductible). Gold Benefit Comparison CareSource Anthem Metal Level/Plan Type Gold HMO New Gold Standardized HMO Deductible (Single/Family) $1,000/$2,000 $1,250/$2,500 $1,450/$4,350 OOP $2500/$5000 $4,750/$9,500 $4,100/$8,200 Coinsurance (Network/Non-Network) 20%/NA PCP Office Visits No Copay $20 Copay $30 Copay Specialist Office Visits $40 Copay $50 Copay Urgent Care Ded + $75 Copay $65 Copay $90 Copay ER Ded + $250 Copay Ded + $250 Copay + Coins Ded/Coins IP Hospital Facility $150 per day for days 1-5, $0 per day for days Ded + $500 Copay + 50% Coins Rx Tier 1 Generic: $0 Tier 2 Preferred: $120 Tier 3 Non-Preferred: $160 Tier 4 Specialty: 40% up to $300 Tier 5 Specialty Non-Pref: 50% up to $300 Tier 1 Generic: $10 Tier 2 Preferred: $30 Tier 3 Non-Preferred: $75 Tier 4 Specialty: 30% coins Level 1 Tier 1: $5 Tier 2: $600 Ded + $35 Tier 3: $600 Ded + 40% Tier 4: $600 Ded + 40% Level 2 Tier 1: $15 Tier 2: $600 Ded + $45 Tier 3: $600 Ded + 50% Tier 4: $600 Ded + 50% Louisville Rate (non-Smoker) Single Age 25 $226.60 $206.62 $329.58 Single Age 45 $325.91 $297.18 $474.02 Couple Age 55 $1,006.61 $917.87 $1,464.08 Lexington Rate (non-Smoker) $247.31 $225.51 $346.10 $355.70 $324.34 $497.78 $1,098.62 $1,001.77 $1,537.46
5
2017 Anthem/CareSource Network Comparison – Regions 1 & 2
Individual Anthem RA Areaname Hospital Blue Access Pathway PPO Pathway HMO CareSource 1 Paducah Baptist Health Paducah X Caldwell Medical Center Crittenden Co Hospital Jackson Purchase Medical Center Livingston Hospital and Healthcare Services Lourdes Inc Marshall County Hospital Murray-Calloway County Hospital Total Hospital Count 8 7 *Note: CareSource not offering plans in Region 1 Total PCP Count 136 131 37 12 Total SPC Count 189 180 118 18 2 Owensboro Baptist Health Madisonville Jennie Stuart Medical Ctr Methodist Hospital Methodist Hospital Union County Ohio County Hospital Owensboro Health Muhlenberg Community Hospital Owensboro Health Regional Hospital Trigg County Hospital 5 *Note: CareSource not offering plans in Region 2 261 246 123 19 377 327 210 25
6
Bowling Green-Campbellsville-Somerset
2017 Anthem/CareSource Network Comparison – Regions 3 & 4 Individual 3 Louisville Baptist Health Lagrange X Baptist Health Louisville Breckinridge Memorial Hospital Carroll County Memorial Hospital Flaget Memorial Hospital Hardin Memorial Hospital Jewish Hospital Jewish Hospital Shelbyville Kosair Children's Hospital Norton Audubon Hospital Norton Brownsboro Hospital Norton Hospital Norton Suburban Hospital Saints Mary and Elizabeth Hospital Spring View Hospital Twin Lakes Reg Medical Ctr University of Louisville Hospital Total Hospital Count 17 15 12 Total PCP Count 959 934 657 498 Total SPC Count 1,212 1,156 1,107 515 4 Bowling Green-Campbellsville-Somerset Casey County Hospital Caverna Memorial Hospital Clinton County Hospital Cumberland Co Hospital Greenview Regional Hospital Jane Todd Crawford Memorial Hospital Lake Cumberland Regional Hospital Logan Memorial Hospital Monroe County Medical Center Russell County Hospital T J Samson Community Hospital Taylor Regional Hospital The Medical Center at Bowling Green The Medical Center At Franklin The Medical Center at Scottsville Wayne County Hospital Westlake Regional Hospital 16 5 2 309 308 101 59 394 375 280 74
7
2017 Anthem/CareSource Network Comparison – Regions 5 & 6
Individual 5 Frankfort-Lexington Baptist Health Lexington X Baptist Health Richmond Bluegrass Community Hospital Bourbon Community Hospital Clark Regional Medical Center Ephraim McDowell Regional Medical Center Fort Logan Hospital Frankfort Regional Medical Center Georgetown Community Hospital Harrison Memorial Hospital James B Haggin Memorial Hospital Marcum and Wallace Memorial Hospital New Horizons Medical Center Rockcastle Regional Saint Joseph Berea Saint Joseph East Saint Joseph Hospital Saint Joseph Mount Sterling Uk Healthcare Hospitals Total Hospital Count 18 19 8 9 Total PCP Count 635 573 354 196 Total SPC Count 820 787 734 226 6 Cincinnati KY-OH St Elizabeth Healthcare Christ Hospital 2 1 289 261 50 250 420 266 141 154
8
2017 Anthem/CareSource Network Comparison – Regions 7 & 8
Individual 7 Northeast KY Fleming Medical Center X Kings Daughters Medical Center Meadowview Regional Medical Center Morgan County ARH Our Lady of Bellefonte St Claire Regional Medical Center Three Rivers Medical Center Total Hospital Count 6 2 1 Total PCP Count 199 193 84 26 Total SPC Count 275 253 130 46 8 Corbin-London ARH Regional Medical Center Hazard Baptist Health Corbin Harlan ARH Highlands Regional Medical Center Kentucky River Medical Center Mary Breckinridge ARH Hospital McDowell ARH Memorial Hospital Middlesboro ARH Paul B Hall Regional Medical Center Pikeville Medical Center Pineville Community Hospital Saint Joseph London Saint Joseph Martin Tug Valley Arh Regional Medical Center Whitesburg ARH 16 15 10 400 385 169 132 369 379 225 75
9
Individual Competitive Landscape - Harry
10
Anthem HMO/PPO 2017 Coverage Area Map
PPO no longer offered in the 74 counties where HMO is available. PPO will remain in 46 counties where HMO is not available. Individual PPO plans change to limited Blue Card urgent/emergency care coverage only out-of-state
11
Region 1 Counties Counties Product offered Ballard Caldwell Calloway
HMO Caldwell PPO Calloway Carlisle Crittenden PPO Fulton Graves Hickman Livingston Lyon McCracken Marshall
12
Region 2 Counties Counties Product offered HMO Christian Daviess PPO
Hancock PPO Henderson Hopkins McLean Muhlenberg Ohio Todd Trigg Union Webster
13
Region 4 Counties Counties Product offered PPO Adair HMO Allen Barren
Butler Casey Clinton Cumberland Edmonson Green Hart Logan McCreary Metcalfe Monroe Pulaski Russell Simpson Taylor Warren Wayne
14
Region 3 Counties Counties Product offered HMO Bullitt PPO
Breckinridge PPO Carroll Grayson Hardin Henry Jefferson Larue Marion Meade Nelson Oldham Shelby Spencer Trimble Washington
15
Region 6 Counties Counties Product offered HMO Campbell Gallatin Grant
Kenton Pendleton Boone
16
Region 5 Counties Counties Product offered HMO Anderson Bourbon PPO
Boyle PPO Clark Estill Fayette Franklin Garrard Harrison Jackson Jessamine Lincoln Madison Mercer Montgomery Nicholas Owen Powell Rockcastle Scott Woodford
17
Region 7 Counties Counties Product offered PPO Bath HMO Boyd Bracken
Carter Elliott Fleming Greenup Lawrence Lewis Mason Menifee Morgan Robertson Rowan
18
Region 8 Counties Counties Product offered HMO Bell PPO Breathitt Clay
Floyd Harlan Johnson Knott Knox Laurel Lee Leslie Letcher Magoffin Martin Owsley Perry Pike Whitley Wolfe
Similar presentations
