2020 minneapolis public schools · mail service pharmacy for 3-month supplies through preferred...
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Minneapolis Public Schools
2020
MEDICA MEDICARE PLAN OPTIONS
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MEDICA ADVANTAGE SOLUTION ELIGIBILITY
Enrolled in Medicare Parts A & B
Pay your Medicare Part B premium
Must not have end-stage renal disease (ESRD)*
Unless coming off a Medica plan
Permanently reside in Medica’s 66 county Medicare Advantage service area or most counties through the United States and it’s territories
– MINNESOTA: Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Grant, Hennepin, Houston, Hubbard, Isanti, Jackson, Kandiyohi, Kittson, Lac qui Parle, Lake of the Woods, Lincoln, Lyon, Mahnomen, Marshall, Martin, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Roseau, Scott, Sherburne, Stearns, Steele, Swift, Todd, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright
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MEDICA PRIME SOLUTION COST PLAN ELIGIBILITY
Enrolled in Medicare Parts A and B, or only Part B
Pay your Medicare Part B premium
Must not have end-stage renal disease (ESRD)*
unless coming off a Medica plan
Permanently reside in a Medica Cost plan service area
MINNESOTA: Aitkin, Carlton, Cook, Goodhue, Itasca, Kanabec,
Koochiching, Lake, Le Sueur, McLeod, Meeker, Mille Lacs, Pine, Pipestone, Rice, Rock, Sibley, St. Louis, Stevens, Traverse, Yellow Medicine
All Counties in South Dakota, most counties in North Dakota, 13 counties in western Wisconsin, and 15 counties in Iowa
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MINNEAPOLIS PUBLIC SCHOOLS PLAN OPTIONSPlan 2 Plan 6
Monthly Premium $299.00 $148.00
Medical Benefit
Primary Care Office Visit $15 copay $0 copay
Specialist Office Visit $15 copay $10 copay
Urgent Care $15 copay $0-10 copay
Inpatient Hospital $100 copay $100 copay
Outpatient Hospital $0 copay $50 copay
Ambulance $0 ground/20% air $25 copay
Worldwide Emergency Room $50 copay $50 copay
Preventive Care $0 copay $0 copay
Hearing Aids $500 $400
Eyewear Reimbursement $150 $75
Dental Reimbursement $500 $500
Durable Medical Equipment 10% coinsurance 20% coinsurance
Part B Drugs 20% coinsurance 20% coinsurance
Part D Prescription Drug Coverage Preferred Standard Preferred Standard
Tier 1 $5 copay $10 copay $2 copay $6 copay
Tier 2 $15 copay $25 copay $5 copay $12 copay
Tier 3 $30 copay $35 copay $30 copay $35 copay
Tier 4 $60 copay $65 copay 50% coinsurance
Tier 5 25% coinsurance 33% coinsurance
Gap Coverage Yes No
Deductibles & Max. Out-of-Pocket Limits
Medical Deductible $0 $0
Pharmacy Deductible $0 $0
Medical Out-of-Pocket Max. $1,500 $3,000
Rx Out-of-Pocket Maximum Medicare limits Medicare Limits
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MINNEAPOLIS PUBLIC SCHOOLS | PART D COVERAGE
Highlights of Benefit Structure
No Part D Deductible
5-Tier formulary with more than 3,600 prescription drugs
Large Nationwide Pharmacy Network
65,000+ pharmacies nationwide, including all major chains and thousands of independent pharmacies
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MINNEAPOLIS PUBLIC SCHOOLS | PART D COVERAGE
Option to Save When Using Preferred Pharmacies
Advantages to you
Copay savings when using preferred pharmacies
Includes Walgreens, Hy-Vee Pharmacy, Walmart, Sam’s Club and Costco, and other independent pharmacies (25,000 nationwide)
Save when using
preferred retail
pharmacies
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MINNEAPOLIS PUBLIC SCHOOLS | PART D COVERAGE
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Mail Service Pharmacy
For 3-month supplies through preferred mail order vendor: 3 month supply for 2 preferred copayments
Order refills online anytime, anywhere
Set up handy automatic refills for most maintenance medications
Real-time order tracking and typically receive in 3-5 days
Save when
using convenient mail service.
Great for maintenance
drugs.
EXTRA BENEFITS & SERVICES
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SILVERSNEAKERS® FITNESS & LIFESTYLE BENEFIT PROGRAM
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Membership toFitness Locations
SilverSneakersOn-DemandTM
SilverSneakers GoTM
Mobile App
Unlimited access to more than 16,000 locations nationwide. Visit as many as you wish!
Online workout videos that feature tips on fitnessand nutrition
Workout programs, location finder and more
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PERSONAL SUPPORT PROGRAMS | Available 365 days a year 24/7
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24/7 NurseLineHighly-trained nurses answer questions about symptoms, medications, health conditions and offer self-care tips for non-urgent medical issues.
Personal Advocacy Support
Personal Health Advocates help in a variety of ways from finding the right doctor to resolving claims questions to answering questions about coverage, find network providers, schedule appointments, and more.
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ACCESS PLAN INFORMATION 24/7
mymedica.com
Secure personal account information
Mobile app
Check prescription drug coverage info on the go
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Acknowledgement Letter
Member ID Card
Member Packet
Verification Information
Confirmation Letter
WHAT TO EXPECT NEXT
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COMMITMENT TO MEMBERS
Caring, personal service you deserve from local Medicare experts.
Toll free 1-800-575-2330 8 a.m.– 8 p.m. Central, 7 days a weekAccess to representatives may be limited at times
medica.com/Medicare
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