New Plans And New Benefits For 2022
New plans and new benefits for 2022
2021 STAR RATING MEDICARE 5 STAR RATING KCA HISTORIC STAR RATING. 5 Star Rated for 5 years in a row (2017, 2018, 2019, 2020, 2021) Only one in 20 plans in 2020 rated 5 Stars The ONLY plan in Houston in rated 5 Stars for 5 CONSECATIVE Voted Best MA Plan in Texas by US News (2017, 2018, 2019, 2020, 2021)
KELSEYCARE ADVANTAGE SERVICE AREA Austin Brazoria Chambers Fort Bend Galveston Grimes Harris Liberty Montgomery San Jacinto Waller Walker Wharton
New clinic locations
Number of Clinics: 22 Number of Providers: 540 Number of Clinics: 29 Number of Providers: 598 Number of Clinics: 38 Number of Providers: 701 Number of Clinics: 43 Number of Providers: 847
New Plans New Names 2021 Plan Names 2022 Plan Name MA Type Plan Type Service Area - Platinum – NEW! MA-PD HMO 5 Counties Rx Gold MA-PD HMO 5 Counties Rx Choice Gold Freedom MA-PD HMO-POS 5 Counties Essential Silver MA Only HMO 5 Counties Essential Choice Silver Freedom MA Only HMO-POS 5 Counties Essential Select Silver Community MA Only HMO-POS Surrounding Counties Rx Select Gold Community MA-PD HMO-POS Surrounding Counties 5 Counties Harris, Brazoria, Fort Bend, Galveston, Montgomery Surrounding Counties Austin, Chambers, Grimes, Liberty, San Jacinto, Walker, Waller, Wharton
Quick Comparison New Plan Name Monthly Premium Drug Coverage Provider Network Comprehensive Dental Platinum – NEW! 0 X Kelsey-Seybold Clinic: Referrals needed for outside of KSC X Gold Freedom 0 X In-Network Cost-Share: KSC Affiliates (no referral) Out-of-Network Cost-Share: All other providers (no referral) X X Kelsey-Seybold Clinic: Referrals needed for outside of KSC Only w/ add-on (down from 77) Gold 0 Silver 0 Kelsey-Seybold Clinic: Referrals needed for outside of KSC X 0 In-Network Cost-Share: KSC Affiliates (no referral) Out-of-Network Cost-Share: All other providers (no referral) X 0 In-Network Cost-Share: KSC Affiliates (no referral) Out-of-Network Cost-Share: All other providers (no referral) Only w/ add-on 15 In-Network Cost-Share: KSC Affiliates (no referral) Out-of-Network Cost-Share: All other providers (no referral) Only w/ add-on Silver Freedom Silver Community Gold Community X
New Freedom Plans Gold Freedom Silver Freedom
You can keep your current doctor In addition to Kelsey-Seybold physicians, Freedom Plans allow members to keep their out-of-network doctor with a low copay & 0 monthly premium. Talk about a game-changer!
Freedom in action Taking Advantage on In-Network Cost-Share Member sees a Kelsey-Seybold Clinic PCP Member sees a Kelsey-Seybold Clinic specialist Member sees an affiliate provider contracted with Kelsey No referrals needed! Accessing Out-of-Network Cost-Share 0 25 25 Member sees an out-of-network PCP Member sees an out-of-network specialist Member sees an MD Anderson provider No referrals needed! 10 35 40%
MEDICAL DRUG COVERAGE Gold (HMO) 5 core counties Gold Freedom (POS) 5 core counties Gold Community (POS) 8 outlier counties Platinum (HMO) NEW! 5 core counties 11
MAPD w/Drug Coverage / Value-Added Benefits Platinum Gold Gold Freedom Gold Community IP Hospital 350/stay 375/stay 375/stay 375/stay T2 Drug 0/ 15 0/ 15 0/ 15 0/ 15 (outlier counties) Dental Comprehensive with 1,500 limit Preventive option to purchase supplemental ( 32.80) Comprehensive with 1,500 limit Preventive option to purchase supplemental ( 32.80) COVID-19 Benefit Yes Yes Yes Yes OTC 25 monthly 25 quarterly 25 monthly 25 quarterly Wellness Benefit Yes No Yes No
MEDICAL COVERAGE ONLY Silver (HMO) 5 core counties Silver Freedom (POS) 5 core counties Silver Community (POS) 8 outlier counties 1313
MA Only Value-Added Benefits Silver Silver Freedom Silver Community IP Hospital 325/stay 325/stay 325/stay Dental Comprehensive with 1,500 limit Comprehensive with 1,500 limit Preventive option to purchase supplemental ( 32.80) COVID-19 Benefit Yes Yes Yes OTC 50 quarterly 50 quarterly 25 quarterly Vision Allowance 125 125 75 Wellness Benefit Yes Yes No (outlier counties)
More changes for 2022
Comprehensive dental* With 1,500 allowance Plus 0 copay for Tier 1 & 2 drugs* Increased vision allowance* Wellness benefit* – up to 100 a year in gift card rewards COVID-19-related care and waiver of IP copay Simplified in-hospital stay copays Monthly and/or quarterly OTC allowances* * Available in specific plans
2022 PART D SUMMARY MAPD w/ DRUG COVERAGE Part D Deductible T1 Drug T2 Drug T3 Drug T4 Drug T5 Drug EXCLUDED drugs covered OUTLIER COUNTIES MA ONLY (MA/MAPD-POS) Gold Community Silver HMO Silver Freedom Silver Community POS (008) (001) POS (003) POS (007) 15 premium Gold HMO (002) Platinum HMO NEW (009) Gold Freedom POS (004) 100 (T3, T4, T5) 100 (T3, T4, T5) 100 (T3, T4, T5) 100 (T3, T4, T5) 0/ 3 0/ 15 40/ 45 80/ 90 31% 0/ 3 0/ 15 40/ 45 80/ 90 31% 0/ 3 0/ 15 40/ 45 80/ 90 31% 0/ 3 0/ 15 40/ 45 80/ 90 31% Generic Viagra Generic Viagra Generic Viagra with QL 6/30days with QL 6/30days with QL 6/30days No Drug Coverage No Drug Coverage Generic Viagra with QL 6/30days 17
VALUE ADDED BENEFITS: DENTAL BENEFITS Platinum HMO Gold HMO (002) NEW (009) Embedded Prev Included Preventive Option to Dental (mandatory) Purchase Supp No Optional Buy( 32.80 Up premium) (Supplemental) Comprehensive 1,500 Comp included in plan No Included (mandatory) Gold Freedom Silver Freedom Silver Community Gold Community Silver HMO (001) POS (004) POS (003) POS (007) POS (008) No No No 1,500 Comp Included 1,500 Comp Included 1,500 Comp Included Prev Included Prev Included Option to Option to Purchase Supp Purchase Supp ( 32.80 ( 32.80 premium) premium) No No Once the member reaches the 1,500 threshold everything else is their responsibility, which is 0%/0% for the preventive and diagnostic services 25 per visit 25 per visit 25 per visit and 50% coinsurance for each of those comprehensive procedures listed copay* copay* copay* in the Dental EOC. Product doesn’t have a per visit copay it has per procedure coinsurance. *Covers certain preventative services: Oral exam, Comprehensive oral exam, Adult Cleaning – prophylaxis, Intraoral-Complete Series of Radiographic Images, Bitewings (2 or 4) 18
VALUE ADDED BENEFITS CONTINUED Platinum HMO Gold HMO (002) NEW (009) Vision Allowance contacts/glasses OTC Monthly Benefit OTC Quarterly Benefit Gold Freedom Silver Freedom Silver Community Gold Community Silver HMO (001) POS (004) POS (003) POS (007) POS (008) 75 125 125 125 125 75 75 -- 25 25 -- -- -- -- 25 -- -- 50 50 25 25 Yes Yes Yes Yes Not Offered Not Offered Up to 100/yr Wellness Benefit Not Offered (based on health actions) 19
VALUE ADDED BENEFITS CONTINUED Platinum HMO Gold HMO (002) NEW (009) Hearing Aid Allowance Inpatient Cost Share waived with COVID19 diagnosis, all testing and related visits as well as Meal Delivery post discharge (w/ covid diagnosis) 2 meals per day for 7 days* Gold Freedom Silver Freedom Silver Community Gold Community Silver HMO (001) POS (004) POS (003) POS (007) POS (008) 750 per ear every 3 years 750 per ear every 3 years 750 per ear every 3 years 750 per ear every 3 years 750 per ear every 3 years 750 per ear every 3 years 750 per ear every 3 years Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Not Covered Not Covered 20 one-way trips to medical Yes appointments *EGWPs not covered 20
Thank you!
Taking Advantage on In-Network Cost-Share Accessing Out-of-Network Cost-Share Member sees a Kelsey-Seybold Clinic PCP 0 Member sees an out-of-network PCP 10 Member sees a Kelsey-Seybold Clinic specialist 25 Member sees an out-of-network specialist 35 Member sees an affiliate provider contracted with Kelsey 25 Member sees an MD Anderson .
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