Lesson 5: 2011 Lovelace Medicare Products

1. Lesson 5:2011 Lovelace Medicare Products

2. In 2011 LSP will offer the Standard Plan HMO, the Enhanced Plan which will be an HMO with a new Point-of-Service feature and the Medical-only HMO plan.

3. 2011 Plan Premiums • LSP Standard Plan HMO $0 • LSP Enhanced Plan HMO-POS $57 • LSP medical-only Plan HMO $0

4. LSP Enhanced HMO-POS New Feature for 2011 • This product will give the flexibility to obtain services in-network for lower cost-sharing or out-of-network (or at point-of-service) at a higher cost-sharing. • All POS services must be received from Medicare providers or at Medicare facilities and benefits only apply to Medicare-covered services. • Claims for POS services must be sent to the claims address on the back of the member ID card. The provider should not send claims to Medicare.

5. LSP Standard Plan HMO Any benefit not mentioned here will remain the same for 2011.

6. LSP Enhanced Plan HMO-POS

7. Enhanced Plan Benefits cont’d

8. LSP Enhanced Plan HMO-POS Comparison

9. LSP Enhanced Plan HMO-POS cont’d • Benefits that are the same cost-sharing in and out of network: • Ambulance $75 • Emergency room $50 • Prescription drug coverage $10/32/62/33% • Routine annual physical exam $0 • Home health care $0 • Immunizations $0 • Benefits not offered out-of-network: • Chiropractic • Routine hearing • Routine Vision • Acupuncture • Safety devices

10. LSP Medical Only

11. Comparison

12. LSP Standard Plan HMO Prescription Drug Benefit LSP Enhanced Plan HMO-POS Prescription Drug Benefit The prescription benefit is the same in or out of network.

13. Beginning January 1, 2011, Medicare beneficiaries will receive a 50% discount on brand drugs in the coverage gap • Beneficiaries with Limited Income Subsidy or Medicaid will not be eligible for the discount • 50% discount applies to ingredient costs only • If there is a dispensing fee on the prescription that will not be subject to the 50% discount

14. Generic Discount Program Lovelace Health System Pharmacies offer a Discount Generic Program • Over 350 generic medications are offered • List is available online at Lovelace.com or at Lovelace pharmacies • The generics on the list will be $4.99 or $12.00 for a 90-day supply

15. Additional Services • Silver Sneakers – provides complimentary fitness club membership • Assist America – provides all of the services involved with getting a person to appropriate medical care while traveling away from home (more than 100 miles for less than 90 days) • Social Services Coordinators (SSC) – our partner who works with members to determine if they are eligible for extra help with drug costs and Medicare savings programs, such as QMB and SLMB

16. In 2011 we will offer two Medicare Advantage plans in San Juan County. • San Juan County Medicare Plus Standard HMO - $0 premium • San Juan County Medicare Plus Enhanced HMO-POS - $51.50 premium They will mirror the plans offered in the current LSP service area of Bernalillo, Sandoval, Valencia, Torrance and Santa Fe counties except without the acupuncture benefit.

17. Savings Programs! Available help with Medicare out-of-pocket prescription expenses, Medicare premiums, and more. • Limited Income Subsidy (LIS) Part D Extra Help Medicare provides “extra help” to pay prescription drug costs for people who meet specific income and resource limits • Medicare Savings Programs New Mexico offers programs that could pay Medicare Part B You could qualify for prescription copays as low as: • $1.10 for generic and $3.30 for brand • $2.50 generic and $6.30 for brand • 15% coinsurance • Full coverage in the coverage gap CALL – SOCIAL SERVICES COORDINATORS 1-866-706-6874

18. Important Information Election/Enrollment Period Changes • Annual Election Period (AEP) November 15, 2010 through December 31, 2010 for an effective date of January 1, 2011. • In 2011 there will NOT be an opportunity to change between LSP Standard and LSP Enhanced plans (no Open Enrollment Period). • January 1 through February 14, 2011 plan members can only disenroll and return to Original Medicare with a stand alone PDP. This election period is called Medicare Advantage Disenrollment Period (MADP). • Annual Election Period (AEP) for January 1, 2012 effective date will be October 15 through December 7, 2011.