Choosing a Medicare Advantage plan you ll be confident in.

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1 Choosing a Medicare Advantage plan you ll be confident in. Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Continued enrollment depends on the contract between CMS and the Plan/Part D Sponsor remaining in effect, i.e., being renewed and not terminated. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS. H7220_IUHMA14016 CMS Approved

2 Medicare coverage from one of the most respected names in Indiana. Trust one of the highest-rated Medicare Advantage plans in the state Indiana University Health Plans. Our Medicare Advantage program has received an overall rating of 4½ stars from the Centers for Medicare & Medicaid Services (CMS) for the last three years.* You ll find a wide range of valuable health benefits and improvement programs focused on keeping you healthy. We have been serving Hoosiers for 23 years, and more than 8,700 members trust our locally based plans because they are convenient, affordable and high quality, with resources and programs to help you live healthy and stay strong. You should never have to worry about your Medicare coverage. As a Medicare beneficiary, you have many options for health coverage. Selecting a plan to meet all of your healthcare and wellness needs means evaluating these important factors: Cost n What will you pay out-of-pocket? Include monthly premium, deductibles, copays and coinsurance. Benefits n What extras are covered? n Is there coverage for dental and vision services? n Are there other wellness benefits? Choice of doctors and hospitals n Can you visit doctors you prefer? n Are the hospitals you like part of the plan? Call us to find out more. Contact the IU Health Plans Customer Solutions Center at TTY users call Relay Indiana at Customer Solutions Center Hours: Oct. 1 to Feb am to 8 pm seven days a week. Feb. 15 to Sept am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 8 pm, on weekends, and holidays. Convenience n Are the doctors offices and hospitals close to your home? n What about the pharmacies are local and national pharmacies part of the plan? Prescription drugs n Are your drugs covered under the plan s formulary (list of covered drugs)? n What will your drugs cost under each plan? Also visit our website at IUHPlansforyou.org *Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. 1 2

3 Information to help you decide. As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (fee-for-service) Standard Medicare plan. Another option is a Medicare Advantage plan like the three plan choices offered by IU Health Plans. No matter what you decide, you are still in the Medicare program. You may join or leave a plan only at certain times. Please call us for more information. Medicare (Parts A & B) is provided by the government and government subcontractors. Medicare pays feed for your care directly to the doctors Medicare and hospitals (Parts you visit. A, Some B, people C & D) call this fee for service. STANDARD MEDICARE A B Part A helps with hospital costs. Part B helps with doctor and outpatient costs. ADDITIONAL POLICY D Part D assists with prescription drugs. OR MED SUPP Medicare Advantage (Part C) - ONE POLICY is provided by private companies approved by Medicare. Medicare pays a fixed fee to the plan for your care. Then the plan pays the doctors and hospitals. A+B=C D + Part C one plan that covers hospital costs, doctor and outpatient care. Part D offered in many Medicare Advantage plans, drug coverage that is either built-in or can be an optional add-on. ADDITIONAL POLICY Medicare supplement insurance plans cover some costs not covered in Parts A & B. Additional benefits may be included, such as vision, dental and hearing services. Mark your calendar with these important dates Oct. 15 Dec. 7, 2013 Annual Election Period Time to choose or change your Medicare Advantage health or prescription drug plan coverage for There may be other times when you can switch your coverage. These are called Special Enrollment Periods. With IU Health Plans, you re covered. IU Health Plans offers comprehensive health benefits, personalized service and a dedicated focus on wellness and prevention. Our Medicare Advantage program, which has received Medicare s 4½ star overall plan rating for quality and performance,* offers: Affordable, flexible plans n Premiums as low as $0, reducing Part B premium up to $25/mo. n Affordable hospitalization if needed n Plans with and without prescription drug coverage n Plan option that allows out-of-network care n Fitness center reimbursement, up to $150 per year Nationally recognized doctors and hospitals n Eleven clinical programs ranked among the top 50 national programs in U.S.News & World Report s Best Hospitals report n Strong network of doctors you trust with IU Health n A growing list of additional doctors and hospitals throughout the state Local company, personal service n Enrollment and customer service handled close to home n Knowledgeable, friendly customer service associates and enrollment specialists n Personalized help with care coordination (medication, specialists, etc.) Compare IU Health plans The charts on the following two pages will help you compare the three plans offered by IU Health Plans. Our members receive all the benefits of Original Medicare, plus some important extras. The charts list some, but not all available benefits. *Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. 3 4

4 Which Medicare Advantage Plan is right for me? Medicare-Covered Benefit Monthly Premium* Annual Deductible $0 $0 $0 $0 Inpatient Hospital/Mental Health Skilled Nursing (No hospital stay required) What iu health plans members pay Medicare Select Medicare Select Medicare Choice HMO-POS HMO Plus HMO In-Network Out-of-Network $0 Reduces your $36 $108 Part B premium up to $25 ea. month Inpatient/Home Health Care $225 days 1-7 IP Hosp. $225 days 1-6 IP Ment. Hlth. $225 days 1-7 IP Hosp. $225 days 1-6 IP Ment. Hlth. $195 days % $0 days 1-5 $20 days 6-20 $80 days $0 days 1-5 $20 days 6-20 $95 days $0 days 1-5 $20 days 6-20 $80 days % Home Health $0 $0 $0 50% Outpatient Care/Services/Supplies Primary Care $0 $15 $10 50% Physician Specialist $30 $45 $40 50% Chiropractor $20 $20 $20 50% Podiatry $15 $15 $10 50% Outpatient Surgery $265 $265 $195 50% Ambulance $150 $150 $150 50% Emergency $65 $65 $65 (worldwide) $65 (worldwide) Urgent Care $50 $50 $50 $50 Durable Medical 20% 20% 20% 50% Equipment Diabetic Supplies $0 $0 $0 50% Diagnostic Tests/ $10 $10 $0 50% Lab X-rays/Therapeutic $25 $25 $25 50% Radiology Diagnostic Radiology $75 $125 $125 50% Part B Covered Drugs 20% 20% 20% 50% The benefit information provided is a brief summary, not a comprehensive description of benefits. For more information contact the plan. *You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. What iu health plans members pay Medicare-Covered Medicare Select Medicare Select Medicare Choice HMO-POS Benefit HMO Plus HMO In-Network Out-of-Network Preventive Services for Bone Mass Measurement, Pap/Pelvic Screening, Colorectal Cancer Screening, Mammogram, Flu/Pneumonia Vaccines, Prostate Cancer Screening and More Preventive $0 $0 $0 Screenings Annual Physical Exam Fitness Center Membership Preventive Dental $10 $10 $10 Routine Vision Exam $0 $0 $0 Eyeglasses (lenses/frames) $40 $40 $40 Member Maximum Out-Of-Pocket Medical Cost Out-of-Pocket Cost Protection $4,500 $4,500 $4,500 Plan Limit No limit No limit No limit $10,000 Part D Prescription Drugs Annual Deductible $0 $0 $0 $0 Tier 1 (Generic) $6 31 day $18 90 day Tier 2 (Generic Non-Preferred) $15 31 day $44 90 day Tier 3 (Preferred) $45 31 day $ day Tier 4 (Non-Preferred) $0 $0 $0 Additional Benefits and Wellness Programs up to $150 reimbursement/yr. up to $150 reimbursement/yr. $95 31 day $ day up to $150 reimbursement/yr. $6 31 day $16 90 day $15 31 day $42 90 day $42 31 day $ day $95 31 day $ day Tier 5 (Specialty) 33% 31 day 33% 31 day Coverage Gap Tier 1 & 2 Gen. 72% Tier 1 Gen., lesser of after $2,850 until Tier 3 & 4 Brand $10 or 72% 31 day; out-of-pocket is 47.5% $30 90 day reached ($4,550) Tier 2 Gen. 72% Tier 3 & 4 Brand 47.5% Out-of-network options available Out-of-network reimbursement available 5 6

5 Eligibility who can join? Individuals must have both Part A and Part B to enroll with IU Health Plans Medicare Advantage program. You must live in the service area, which includes these counties: Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Clay, Clinton, Delaware, Fountain, Grant, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Jackson, Jay, Johnson, Lawrence, Marion, Monroe, Morgan, Orange, Owen, Parke, Putnam, Randolph, Shelby, Tippecanoe, Tipton, Vermillion, Vigo, Warren and White. Individuals with End Stage Renal Disease are generally not eligible to enroll unless they have had a successful kidney transplant. How can I get help with my prescription drug costs? People with limited incomes may qualify for Extra Help to pay for up to seventy-five (75) percent of your prescription drug costs. Many people are eligible for these savings. To see if you qualify for Extra Help, call 800.MEDICARE ( ). TTY users should call , 24 hours a day/7 days a week; the Social Security Office at between 7 am and 7 pm Monday through Friday. TTY users should call ; or Your Medicaid Office. Frequently asked questions Get to know more about IU Health Plans Medicare Advantage plans. If you have other questions, please contact our Customer Solutions Center. Can I choose my doctors? Answer: Yes. You have access to the largest, most comprehensive health system in Indiana, plus a growing list of doctors, specialists and hospitals throughout the state. You may use any doctor who is part of our network. In some cases, you may also go to a doctor outside of our network. A current provider directory with an up-to-date list of network doctors is available at IUHPlansforyou.org Will I still need to pay my Part B monthly premium? Answer: Yes. This is a Medicare requirement regardless of whether or not you enroll in a Medicare Advantage plan. However, IU Health Plans Select plan will reduce your Part B premium. If you have questions about your Part B premium, call Social Security at TTY users, call What are Part B drugs and how are they different from Part D drugs? Answer: Part B drugs are defined by Medicare and include certain chemotherapy drugs, some injections at your doctor s office and drugs you get at a dialysis facility. Part D drugs are ordered from a retail pharmacy or mail-order vendor and are listed on a formulary of covered drugs. Can I keep my current Part D plan? Answer: No. You can t have two Part D plans. Your premium with IU Health Plans includes Part D coverage with either the Choice or Select Plus options. (Note: You may have other prescription coverage (not Part D), like employer or union, military, or Veterans benefits.) 7 8

6 Frequently asked questions (continued) Notes What is the gap? Answer: The coverage gap (also called the donut hole ) refers to the difference between your initial coverage limit and your catastrophic coverage threshold. That means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Not everyone will reach the coverage gap. Once you reach your plan s out-of-pocket limit, you automatically get catastrophic coverage. At that point, you only pay a small coinsurance amount or copayment for the drugs for the rest of the year. IU Health Plans Medicare Choice will still cover generic drugs for a small copay during the gap. What happens if I get sick away from home or out of the coverage area? Answer: You are covered for urgent and emergency care for up to six months. Follow-up care must be authorized. IU Health Plans Medicare Choice offers coverage outside of the United States. Are hearing aids and dentures covered? Answer: These are not covered as a benefit. What is Member Maximum Out-of-Pocket Cost Protection? Answer: It is a protection against how much you pay for healthcare each year. After this level is reached, you will have 100% coverage for the remainder of the year. Part D prescription drugs do not count toward the limit. You continue to pay your monthly premium, if you have one. With the IU Health Plans Medicare Choice Point of Service (POS) plan, is there a maximum on how much the plan will pay for out-of-network care? Answer: Yes. Each year, your plan will pay up to $10,000 for Medicare-approved, out-ofnetwork services. After that limit is reached, you will be responsible for 100% of charges for out-of-network services. Medicare beneficiaries may enroll in a plan only during specific times of the year. Contact IU Health Plans for details. 9

7 950 N. Meridian St., Suite 200 Indianapolis, IN IUHPlansforyou.org If you have questions, we re here to help. Please call our Customer Solutions Center toll-free at TTY users call Relay Indiana at Customer Solutions Center Hours: Oct. 1 to Feb am to 8 pm seven days a week. Feb. 15 to Sept am to 8 pm Monday through Friday. You may receive assistance through alternate technology after 8 pm, on weekends and holidays IUHealth 9/13 IUH#15674

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