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  1. MedicareAdvantage Plans2015 Y0096_MRK_IL_MAEDPPT15

  2. Today’s Topics • Medicare Basics • Medicare Advantage (MA) Plans • Eligibility and Enrollment periods

  3. What is Medicare? Medicare is a Health Insurance Program for those: • Age 65 or better • Under age 65 with certain disabilities • Any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

  4. Two Paths to Medicare Coverage 1You are free to use any hospital or physician that is a Medicare contracted provider. 2 You must use network hospitals and doctors for maximum coverage and in non-emergency situations.

  5. Two Paths to Medicare Coverage

  6. Medicare Advantage Plans

  7. A Medicare Advantage Plan (Part C or MA Plan) is a private health insurance plan that replaces Original Medicare (Parts A & B) Some MA plans include prescription drug coverage (Part D) and are referred to as Medicare Advantage Prescription Drug plans (MAPD) Think of MAPD as your all-in-one plan, covering all of your hospital and medical insurance and prescription drugs Medicare Advantage Plans are notMedicare Supplement insurance plans; they are differentfrom Medicare Supplement insurance What is a Medicare Advantage Plan? D C D MAPD A B + + + = = Hospital Medical Rx Drug Hospital &Medical Rx Drug All-In-One Coverage

  8. Original Medicare andMedicare Advantage MAPD (Part C) Includes Both Parts A & B Note: If you have a MA or MAPD Plan, you do not need and cannot be sold a Medicare Supplement Insurance (Medigap) Plan • Original Medicare • Part A & Part B

  9. How is Medicare Advantage different from Medicare Supplement? MAPD • Medigap If you have an MA or MAPD Plan, you do not need and cannot purchase a Medicare Supplement Plan

  10. Types of MAPD Plans The most popular options include: • Health Maintenance Organization (HMO) plans • Preferred Provider Organization (PPO) plans • Private Fee-for-Service (PFFS) plans Less common options include: • HMO Point-of-Service plans • Special Needs plans

  11. Medicare Advantage Plans May include Extra Coverage: • Vision • Hearing • Dental • Health and Wellness • Prescription Drug Coverage

  12. How Much Does a Medicare Advantage Plan Cost? Each Medicare Advantage Plan determines the out-of-pocket costs you will pay. Out-of-pocket expenses in a Medicare Advantage Plan can depend on: • Whether the plan charges a monthly premium • Whether the plan pays any of your monthly Part B premium • Whether the plan has a yearly deductible or any additional deductibles • Note: You must continue to pay your Part B premium

  13. How Much Does a Medicare Advantage Plan Cost? Out-of-pocket expenses in a Medicare Advantage Plan can depend on: • How much you pay for each visit or service (copays or coinsurance) • The type of health care services you need and how often you use them • Whether you follow the plan’s rules, like using network providers • Whether you need extra benefits and if the plan charges for them • The plan’s yearly limit on your out-of-pocket expensesfor all medical services

  14. Medicare Advantage Facts • You are still in the Medicare program • You still have Medicare rights and protections • Plans cannot charge more than Original Medicare for certain services (e.g., chemotherapy and dialysis) • Medicare Advantage Plans must cover all of the services covered by Original Medicare except hospice care • You pay as you go • Your Medicare services are NOT paid for by Original Medicare, but by the Medicare Advantage plan you choose

  15. How Medicare Advantage Plans Work • When you go to the doctor, show your Medicare Advantage card from the plan you select – NOT your Medicare card • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan! • All MA Plans must have an Annual Out-of-Pocket Expense (OPX) Limit

  16. What is an Annual Out-of-Pocket Expense (OPX) Limit? • Medicare Advantage Plans have a cap on how much you pay for Part A and Part B services during the year • This yearly maximum out‑of-pocket amount can be different between Medicare Advantage Plans • For MAPD plans, there is a separate out-of-pocket expense for prescription drug coverage • You should consider this when you choose a plan

  17. Eligibility & Enrollment Periods

  18. Who is eligible to enroll in a Medicare Advantage Plan? If you answer “yes” to both of the following questions, you are eligible to enroll in a Medicare Advantage plan: • Are you enrolled in Part A and Part B? • Is your primary residence in the plan’s service area? Note: You cannot enroll if you have End-Stage Renal Disease (ESRD) unless you have been a member of that plan while receiving treatment

  19. When can you enroll in a Medicare Advantage Plan? • Initial Enrollment Period (IEP) • Sign up when you first become eligible • The7-month period starts 3 months before the month you turn 65, includesthe month you turn 65, and ends 3 months after the month you turn 65 • Annual Enrollment Period (AEP) • October 15 to December 7 • Enroll for the first time or switch plans • Note: If you like what you have, there is no need to switch • Special Enrollment Period (SEP) • Enroll or switch plans due to special circumstances

  20. Disenrollment Period January 1 to February 14: During this period, you cannotdo the following: • Switch from Original Medicare to a Medicare Advantage Plan • Switch from one Medicare Advantage Plan to another • Switch from one Medicare Prescription Drug Plan to another • **SEP Trial Rights

  21. Resources Medicare • Visit for online tool • 1-800-MEDICARE (633-4227), 24 hours a day, 7 days a week • TTY/TDD 1-877-486-2048, 24 hours a day, 7 days a week Social Security • Visit www.ssa.govfor online tool • 1-800-772-1213, Monday-Friday, 7 a.m. - 7 p.m. • TTY/TDD 1-800-325-0778, Monday-Friday, 7 a.m. - 7 p.m.

  22. Questions & Discussion Call1-877-592-3874 Sign up for future Medicare events:

  23. Thank You! Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.