Get more, save more. The 2015 Aetna Medicare Advantage Care 3 Medical plan. Participants becoming eligible for Medicare

Transcription

1 Get more, save more The 2015 Aetna Medicare Advantage Care 3 Medical plan Participants becoming eligible for Medicare B (12/14)

2 Table of contents Introduction Pg. 1 What is special about the Aetna Medicare Advantage Care 3 plan Pg. 2 Financial transition example Pg. 3 Plan descriptions Pg. 4 Original Medicare + Standard TRS-Care 3 / Aetna Medicare Advantage plan comparison Pg. 5 Claim examples Pg. 6 How the plan works for you and your doctor Pg. 11 The Aetna Medicare Advantage Care 3 plan features Pg. 12 Questions & answers Pg. 16 What materials I should expect Pg. 19 I would encourage everyone to take advantage of Medicare Advantage. F.P. a plan participant from Lago Vista, TX. Please be sure to read the Important Consumer Disclosure documents located on our website at TRS.aetnamedicare.com/docs_forms/index.html. To request a hard copy of these documents, please call us at (TTY: 711); Monday through Friday, 8 a.m. to 5 p.m. Central time. At the prompt, press 1 to speak to an Aetna Retiree Advocate. If you need this material translated into another language, please call Member Services at (TTY: 711). Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al (TTY: 711).

3 The Aetna Medicare Advantage Preferred Provider Organization (PPO) with Extended Service Area (ESA) Care 3 plan Welcome to the Aetna Medicare Advantage Care 3 plan. Read on! The Aetna Medicare Advantage Care 3 plan is designed to give you richer benefits and extra services at a lower cost than the combination of Original Medicare and the standard TRS-Care 3 plan. The Aetna Medicare Advantage plan includes coverage for Original Medicare Parts A and B (which include hospital services, doctor visits, routine preventive care and outpatient care) plus additional benefits to help you make the most of the years ahead, all in one plan! The Aetna Medicare Advantage plan has just one medical deductible to satisfy. If you decide to opt out of the Aetna Medicare Advantage coverage, the combination of Original Medicare and the standard TRS-Care plan would have two deductibles to satisfy. If you become eligible for Medicare while covered by TRS-Care 3, any deductible amount you have paid during the current plan year will be applied to offset the new deductible when you transition to the corresponding Aetna Medicare Advantage plan. The number of months used to accumulate this deductible credit will depend on the actual date you first become eligible for Medicare. You can call TRS-Care Customer Service at (TTY: 711) for details specific to your credit. The Aetna Medicare Advantage plan does not include prescription drug coverage as a part of the plan. Your prescription drug coverage is a separate plan and will be provided by the Express Scripts Medicare plan or the standard Express Scripts plan. For more information about your prescription drug coverage, refer to the Express Scripts plan documents. The Aetna Medicare Advantage plan is a Preferred Provider Organization (PPO) plan with an Extended Service Area (ESA). That means you can visit doctors and hospitals in or out of the plan s large network as long as they are willing to accept your PPO ESA plan and are eligible to receive Medicare payment. If you have any questions about obtaining medical services, please do not hesitate to call TRS-Care Customer Service at (TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. Central time. At the prompt, press 1 to speak to an Aetna Retiree Advocate. To be eligible, the Centers for Medicare and Medicaid Services (CMS) require that you must be enrolled in Original Medicare Parts A and B and continue to pay your Part B premium and Part A, if applicable. As you are new to Medicare, CMS has to accept your enrollment into Original Medicare before you will be enrolled into the Aetna Medicare Advantage plan or receive any Medicare benefits. To enroll in Medicare Parts A and B before your 65th birthday, call Medicare at Medicare ( ). TTY users should call or visit Your Aetna Medicare Advantage coverage will be effective the first day of the month in which you turn 65. If your birthday is on the first day of the month, your Aetna Medicare Advantage coverage will be effective the first day of the month prior to your 65th birthday. Two months before your 65th birthday, we ll call you to discuss the plan and answer any questions you may have. You do not need to take any action to enjoy the richer benefits and extra services at a lower cost with the Aetna Medicare Advantage plan. If you want to opt out of the Aetna Medicare Advantage plan and move into the combination of Original Medicare and the standard TRS-Care plan, please call TRS Health Benefits at (TTY: 711); Monday through Friday 8 a.m. to 5 p.m. Central time. For complete information, refer to your plan documents. The new Medicare Advantage program has been great N.P. a plan participant from Richardson, TX. TRSretireehealthplans.com 1

4 What is special about the Aetna Medicare Advantage Care 3 plan? The Aetna Medicare Advantage plan s premiums are $180 less per calendar year than the premiums you would pay with the combination of Original Medicare and the standard TRS-Care 3 plan. There is a lower deductible than there is with the combination of Original Medicare and the standard TRS-Care 3 plan. With the Aetna Medicare Advantage plan, you will not have two deductibles like you would with the combination of Original Medicare and the standard TRS-Care 3 plan. With the Aetna Medicare Advantage plan, your medical coverage will be coordinated so you will have less paperwork to deal with. That means one Explanation of Benefits (EOB). Access to Silver&Fit Exercise and Healthy Aging Program (Silver&Fit) which includes a standard health club membership where available, at no extra cost. Access2Care, a non-emergency medical transportation benefit that can provide you with up to 24 one-way trips per year to Medicare-covered services at no cost to you. Access to Aetna Retiree Advocates who are there to help you get the most out of your Aetna Medicare Advantage plan. There are no gatekeepers with the Aetna Medicare Advantage plan, so referrals are not needed. A routine vision exam benefit is included. A routine hearing exam benefit is included. The Aetna Medicare Advantage plan provides access to doctors across the country. Emergency care is provided when traveling outside the country. The Aetna Medicare Advantage plan provides access to dedicated nurse case managers who are available to help you navigate your health conditions and help prevent health problems. The Aetna Medicare Advantage plan includes programs to help you stay healthy and work through many health conditions you may have. The Aetna Medicare Advantage plan includes healthy lifestyle coaching to help you reduce stress, lose weight or quit smoking. We were happy to know that annual eye exams are completely paid. We are very pleased with the program. J.K. a plan participant from Commerce, TX. Have questions? We have answers Call us and ask about all of the resources available to you to help you understand the Aetna Medicare Advantage plan. Call us: (TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. Central time. At the prompt, press 1 to speak to an Aetna Retiree Advocate. You can also find information and other resources online at TRSretireehealthplans.com. To learn more about the federal Medicare program, you can visit or call MEDICARE ( ). TTY users should call

5 Financial transition example: Bob is turning 65 on February 11, He is currently on the standard TRS-Care 3 plan which began a new plan year on September 1, On February 1, 2015, Bob will be automatically enrolled into the Aetna Medicare Advantage Care 3 plan. Any money Bob paid toward his deductible and out-of-pocket maximum since September 1, 2014 will be carried over and applied to the 2015 deductible and out-of-pocket maximums of the Aetna Medicare Advantage plan. If Bob paid $100 toward his current TRS-Care plan deductible before his Aetna Medicare Advantage coverage began, that $100 would be applied to the Aetna Medicare Advantage plan deductible. He will not have to start over with a new deductible on the Aetna Medicare Advantage plan until January 1, TRSretireehealthplans.com 3

6 Plan descriptions How Original Medicare and the standard TRS-Care plan works: This plan is composed of separate pieces and parts: Medicare Part A and Part B along with standard TRS-Care. When a medical claim is filed, Medicare Part A and/or Part B pay their share of that medical claim. The standard TRS-Care plan is then applied to the remaining amount. Your cost share is a percentage (coinsurance) and it s not a predictable amount. This plan has separate ID cards and claim statements for medical coverage. Original Medicare Medicare Part A Medicare Part B + The standard TRS-Care medical plan This plan pays a portion of your cost share after Medicare Parts A & B pay their portions. How the Aetna Medicare Advantage plan works: With the Aetna Medicare Advantage plan, everything works together in a complete relationship. Medicare Part A and Part B are both integrated with supplemental insurance in one plan. For most services, you will have predictable, flat copayments instead of a coinsurance percentage to make things easier. And you will have a single ID card and claim statement for all your medical coverage. It is not just insurance. The Aetna Medicare Advantage plan is a fully integrated program that helps you manage your conditions and support your health and wellness. Aetna Medicare Advantage plan The Aetna Medicare Advantage plan All in one plan = Predictable cost Support for health/wellness as you age (not just insurance ) Extras at no extra cost One plan with all the benefits you need 4 TRSretireehealthplans.com

7 A brief comparison: Original Medicare + standard TRS-Care 3 plan versus the Aetna Medicare Advantage Care 3 plan Original Medicare and Standard TRS-Care 3 plan Annual premium savings (per person) n/a $180 Coverage* Your Cost Deductible $300 (per plan year) Primary Care Physician office visits Specialist office visits Annual maximum out-of-pocket limit Inpatient coverage Emergency room; worldwide (Copay waived if admitted) You pay 20% after your Medicare Part B payment AND you have met your TRS-Care deductible You pay 20% after your Medicare Part B payment AND you have met your TRS-Care deductible $3,700 includes deductible and coinsurance (per plan year) You pay 20% after your Medicare payment AND you have met your TRS-Care deductible You pay 20% after your Medicare payment AND you have met your TRS-Care deductible Aetna Medicare Advantage Care 3 plan $150** (per calendar year) You pay $5 after you have met the plan deductible (exam fee only, other charges are subject to plan benefits) You pay $10 after you have met the plan deductible (exam fee only, other charges are subject to plan benefits) $3,150** includes deductible, copays and coinsurance (per calendar year)** You pay $250 after you have met the plan deductible (includes hospital and related physician charges) You pay $50; deductible waived (includes all related physician charges) Transportation benefit Not covered $0 Copay; deductible waived Fitness benefit Discount to participating fitness centers Free membership to participating fitness centers in our expansive network * This is not a full list of covered benefits. See the benefit summary for additional details. ** Your deductible and out-of-pocket maximums accumulated from your standard plan will carry over and be applied to your Aetna Medicare Advantage plan. For additional details, refer to the example on page 3 of this booklet. TRSretireehealthplans.com 5

8 The following claim examples are for illustration purposes only. Twenty-five years of service was used to calculate the actual costs as most of the people eligible for the Medicare Advantage plan meet this criteria. Regardless of your years of service, the amount you pay TRS for your healthcare benefit program will be $180 less per year, per person if you enroll in the Medicare Advantage plan. TRS-Care 3 claim examples: Joan is a healthy 66 year-old retiree and only has to go to the doctor a few times a year. Amount Joan pays Services Medicare allowed amounts With Original Medicare and the Standard TRS-Care 3 plan (including deductible(s)) With Aetna Medicare Advantage Care 3 plan (including deductible) Office visits (3) $ 198 $ 157 $ 155 Routine GYN exam $ 66 $ 0 $ 0 Cervical cancer smear $ 27 $ 0 $ 0 Flu shot $ 22 $ 0 $ 0 Routine eye exam $ 0 $ 125 $ 0 Totals $ 313 $ 282 $ 155 Retiree only 25 service years yearly premium $ 1,200 $ 1,020 Total cost to Joan $ 1,482 $ 1,175 6 Joan saved $127 in claim costs, in addition to her $180 in yearly premium savings while covered by the Aetna Medicare Advantage plan. Savings for this occurrence, including the yearly premium savings, totaled $307!

9 On January 2nd, Robert slipped and fell while walking his dog. He was taken to the Emergency Room by ambulance. After several hours, he was released. This was his first claim of the year and his deductible had not yet been met. Amount Robert pays Services Medicare allowed amounts With Original Medicare and the Standard TRS-Care 3 plan (including deductible(s)) With Aetna Medicare Advantage Care 3 plan (including deductible) Hospital emergency room $ 3,000 $ 384 $ 50 Emergency room physician $ 225 $ 9 $ 0 Radiologist $ 120 $ 5 $ 0 Ambulance $ 400 $ 16 $ 20 Crutches $ 36 $ 1 $ 36 Totals $ 3,781 $ 415 $ 106 Retiree only 25 service years yearly premium $ 1,200 $ 1,020 Total cost to Robert $ 1,615 $ 1,126 Robert saved $309 in claim costs, in addition to $180 in his yearly premium savings, while covered by the Aetna Medicare Advantage plan. Savings for this occurrence, including the yearly premium savings, totaled $489! 7

10 Mary Jane is a 65 year-old retiree who was admitted to the hospital with stomach pains. She ended up having laparoscopic surgery during this four-day stay. This was her first claim of the year and her plan deductible had not yet been met. Amount Mary Jane pays Services Medicare allowed amounts With Original Medicare and the Standard TRS-Care 3 plan (including deductible(s)) With Aetna Medicare Advantage Care 3 plan (including deductible) Hospital $ 8,000 $ 483 $ 400 Surgeon $ 1,200 $ 72 $ 0 Anesthesia $ 500 $ 20 $ 0 Physician $ 300 $ 12 $ 0 Radiologist $ 95 $ 4 $ 0 Totals $ 10,095 $ 591 $ 400 Retiree only 25 service years yearly premium $ 1,200 $ 1,020 Total cost to Mary Jane $ 1,791 $ 1,420 Mary Jane saved $191 for this hospital stay in addition to her $180 in yearly premium savings, while covered by to the Aetna Medicare Advantage plan. Savings for this occurrence, including the yearly premium savings, totaled $371! 8

11 Sam is a 68 year-old retiree. He was being treated by his cardiologist for angina. He was admitted to the hospital for stent implants. After the surgeon went in, it was determined Sam needed quadruple bypass surgery. He had already satisfied his deductible(s) prior to this occurrence. Amount Sam pays Services Medicare allowed amounts With Original Medicare and the Standard TRS-Care 3 plan (deductible(s) already met) With Aetna Medicare Advantage Care 3 plan (including deductible) Hospital $ 18,000 $ 243 $ 250 Surgeon $ 3,000 $ 120 $ 0 Anesthesia $ 1,600 $ 64 $ 0 Physician $ 700 $ 28 $ 0 Radiologist $ 950 $ 38 $ 0 Totals $ 24,250 $ 493 $ 250 Retiree only 25 service years yearly premium $ 1,200 $ 1,020 Total cost to Sam $ 1,693 $ 1,270 Sam saved $243 in claim costs in addition to his $180 in yearly premiums under the Aetna Medicare Advantage plan. Savings for this occurrence, including the yearly premium savings, totaled $423! 9

12 Sharon, a 67 year-old, was diagnosed with cancer. After all the pre-testing was done, she ended up in the hospital for a total of 114 days. This exceeded her Original Medicare Part A 90-day benefit period. Amount Sharon pays Services Medicare allowed amounts With Original Medicare and the Standard TRS-Care 3 plan (including deductible(s)) With Aetna Medicare Advantage Care 3 plan (including deductible) Office visits (4) $ 264 $ 165 $ 160 X-Ray $ 207 $ 41 $ 10 MRI $ 905 $ 111 $ 45 Hospital (114 days) $ 78,505 $ 2,956 $ 250 Surgeon $ 4,772 $ 191 $ 0 Assistant Surgeon $ 492 $ 20 $ 0 Anesthesia $ 800 $ 32 $ 0 Radiologist $ 400 $ 16 $ 0 In-patient physician services $ 10,200 $ 168 $ 0 Totals $ 96,545 $ 3,700 $ 465 Retiree only 25 service years yearly premium $ 1,200 $ 1,020 Total cost to Sharon $ 4,900 $ 1, Sharon saved 3,235 in addition to her $180 in yearly premium savings by moving to the Aetna Medicare Advantage plan. Savings for this occurrence, including the yearly premium savings, totaled $3,415!

13 How our plan works for you and your doctor. It s easy to receive covered care from your doctor with the Aetna Medicare Advantage Care 3 plan. Just show your Aetna Medicare ID card. You can see any doctor that participates with Original Medicare, even if that doctor is not in our network. Your benefits remain the same and you will pay the same amount for covered services, in or out of network. Selecting a primary care physician (PCP) is not required with the Aetna Medicare Advantage plan, but we encourage you to select one. A PCP is often the only doctor to have a complete picture of your health. If you do not have a PCP, you may find one within our network. How will I know if my doctor accepts the Medicare Advantage plan? Call us at (TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. Central time. Press 1 at the prompt and we ll help you find out. Visit us online at If you use a doctor or hospital that does not participate in the plan s network, they must be licensed, eligible to receive Medicare payment and be willing to accept the plan. You can locate a Medicare provider at Check with your doctor. If your doctor tells you that he/she does not accept the Aetna Medicare Advantage plan, we have included a flyer within this packet of information that you can share. It outlines the steps your doctor can take in order to start accepting the plan. I have had an annual checkup, three diagnostic procedures and a biopsy each with a different doctor and/or hospital. Each one has accepted my insurance without any question. M.F. a plan participant from Midland, TX. TRSretireehealthplans.com 11

14 Aetna Medicare Advantage Care 3 Aetna Medicare SM Plan (PPO) Medicare ESA PPO plan Benefits and Value-Added Services are effective January 1, 2015 through December 31, 2015 Plan features In or out-of-network providers Combined in and out of network deductible $150 (Plan Level/includes Network Deductible) Unless otherwise indicated, the deductible must be met prior to benefits being payable. Plan Level Deductible does not apply to: annual wellness exams, routine physical exam, routine mammograms, routine hearing exam, routine colorectal screening, routine prostate screening, bone mass measurement, immunization, routine GYN, routine eye care, additional Medicare preventive care services, emergency room, emergency ambulance services, urgently needed care, non-emergency transportation (up to 24 one-way trips), fitness membership. Member coinsurance 5% applies to all expenses unless otherwise stated. Annual maximum out-of-pocket amount $3,150 (Includes deductible, copays and coinsurance) Primary care physician selection Recommended Certification requirements There is not a requirement for member pre-certification. If a member fails to obtain pre-certification he/she will not be denied services or will any penalty amount be applied. However, pre-certification is requested on certain services including inpatient hospital care, inpatient mental health and substance abuse, skilled nursing facility, home health care and some durable medical equipment. Referral requirement None Physician services Primary care physician visits (including after hours) Includes services of an internist, general physician, family practitioner for routine care as well as diagnosis and treatment of an illness or injury. $5 copay after deductible Service charges billed with the office visit/consult are subject to deductible and coinsurance (e.g. injections, x-rays) Physician specialist visits Allergy testing/treatment visits Diagnostic procedures Outpatient diagnostic laboratory Outpatient diagnostic X-ray, testing and complex imaging $10 copay after deductible Service charges billed with the office visit/ consult are subject to deductible and coinsurance (e.g. injections, x-rays) $10 copay after deductible $0 copay after deductible X-ray: 5% after deductible Testing: $10 copay after deductible Complex Imaging: 5% after deductible 12 TRSretireehealthplans.com

15 Emergency medical care Urgently needed care Emergency care; worldwide (waived if admitted) Ambulance services $35 copay; deductible waived $50 copay; deductible waived 5% after deductible; deductible waived for emergency transport Hospital care Inpatient hospital care the member cost sharing applies to covered benefits incurred during a member s inpatient confinement. Outpatient surgery the member cost sharing applies to covered benefits incurred during a member s outpatient visit. $250 copay after deductible Includes all related physician charges. Copay does not apply if re-admitted with the same diagnosis within 30 days. No maximum day limit. $75 copay after deductible Includes all related physician charges. Mental health services Inpatient mental health care the member cost sharing applies to covered benefits incurred during a member s inpatient stay. Outpatient mental health care the member cost sharing applies to covered benefits incurred during a member s outpatient visit. $250 copay after deductible Includes all related physician charges. Copay does not apply if re-admitted with the same diagnosis within 30 days. No maximum day limit. $10 copay after deductible Service charges billed with the office visit/consult are subject to deductible and coinsurance. Alcohol/drug abuse services Inpatient substance abuse (detox and rehab) the member cost sharing applies to covered benefits incurred during a member s inpatient stay. Outpatient substance abuse (detox and rehab) the member cost sharing applies to covered benefits incurred during a member s outpatient visit. $250 copay after deductible Includes all related physician charges. Copay does not apply if re-admitted with the same diagnosis within 30 days. No maximum day limit. $10 copay after deductible Service charges billed with the office visit/consult are subject to deductible and coinsurance. Preventive care Annual wellness exams (one exam every 12 months) Covered 100% Routine physical exams (one exam every 12 months) Covered 100% Medicare Covered Immunizations Pneumococcal, Flu, Hepatitis B Routine GYN care (cervical and vaginal cancer screenings) One routine GYN visit and pap smear every 24 months Routine mammograms (breast cancer screening) One baseline mammogram for members 35 39; and one annual mammogram for members age 40 and over Covered 100% Covered 100% Covered 100% TRSretireehealthplans.com 13

16 Routine prostate cancer screening exam for covered males age 50 and over every 12 months Routine colorectal cancer screening for all members age 50 and over Routine bone mass measurement (one exam every 24 months) Covered 100% Covered 100% Covered 100% Additional Medicare preventive services* Covered 100% Routine eye exams (one exam every 12 months) Routine hearing screening (one exam every 12 months) Other services Skilled nursing facility (SNF) care Plan deductible applies. The member cost sharing applies to covered benefits incurred during a member s inpatient stay. Home health agency care Hospice care Private duty nursing visits subject to medical necessity review by Aetna. Outpatient rehabilitation services Includes speech, physical, pulmonary and occupational therapy. Cardiac rehabilitation services Chiropractic services For manipulation of the spine to the extent covered by Medicare. Plus, up to 20 additional visits for modalities, X-ray and exam. Durable medical equipment/prosthetic devices Podiatry services limited to Medicare covered benefits only Diabetic supplies Outpatient dialysis treatments Covered 100% Covered 100% $0 days 1 20 $25 a day for days % days 101+ Covered 100% after deductible Covered by Medicare at a Medicare certified hospice 20% after deductible 5% after deductible $10 copay after deductible 5% after deductible 5% after deductible $10 copay after deductible Service charges billed with the office visit/ consult are subject to the deductible and coinsurance. Covered 100% after deductible $10 copay after deductible Service charges billed with the office visit/ consult are subject to the deductible and coinsurance. The same cost share applies regardless of setting (office, home, outpatient). * Additional Medicare Preventive Services include ultrasound screening for abdominal aortic aneurysm (AAA), cardiovascular disease screening, diabetes screening tests and diabetes self-management training (DSMT), medical nutrition therapy, glaucoma screening, smoking and tobacco use cessation counseling, screening and behavioral counseling for alcohol misuse, adult depression screening, behavioral counseling for and screening to prevent sexually transmitted infections, behavioral therapy for obesity, behavioral therapy for cardiovascular disease, and HIV screening. 14 TRSretireehealthplans.com

17 Home infusion services Administration of the drug covered under the Medicare Advantage plan. Chemotherapy Medicare Part B prescription drugs Wigs Additional non-medicare covered services Healthy lifestyle coaching one phone call per week Fitness membership Transportation (non-emergency) 20% after deductible $10 copay for office visit after deductible; 5% for drugs after deductible 5% after deductible 5% after deductible Included Included through Silver&Fit Access2Care: up to 24 one-way trips for Medicare covered services Aetna Medicare is a Medicare Advantage organization with a Medicare contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium, and/or copayments/coinsurance may change on January 1 of each year. Plans are offered by Aetna Health Inc. Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. Members must be entitled to Medicare Part A and continue to pay the Part B premium and Part A, if applicable. This document is for your information only. The plan documents describe what is covered, what isn t covered and any limits to coverage under the plan. What the plan covers and how may vary by location and may change. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. In case of emergency, members should call 911 or the local emergency hotline, or go directly to an emergency care facility. The following is a partial list of what isn t covered or limits to coverage under this plan: Services that are not medically necessary unless the service is covered by Original Medicare Custodial care Experimental procedures or treatments that Original Medicare doesn t cover Outpatient prescription drugs unless covered under Original Medicare Part B Providers must be licensed and eligible to receive payment under the federal Medicare program. Health information programs provide general information and do not replace diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change. If there is a difference between this document and the Evidence of Coverage, the Evidence of Coverage is considered correct. Discount offers provide access to discounted services and are not part of an insured plan or policy. Discount offers are rate-access offers and may be in addition to any plan benefits. Check any insurance benefits you have before using these discount offers, as those benefits may result in lower costs to you than using these discounts. Aetna makes no payment to the discount vendor. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee paid to a discount vendor. This information is available for free in other languages. Please contact our customer service number at (TTY: 711) for additional information. Monday through Friday, 8 a.m. to 5 p.m. CT. Esta información está disponible en otros idiomas de manera gratuita. Si desea más información, comuníquese con Servicios al Cliente al (TTY: 711). Horario de atención: Lunes al Viernes, de 8 a.m. a 5 p.m CT. For more information about Aetna plans, refer to Aetna Medicare 15

18 Questions & answers Q When does my Aetna Medicare Advantage plan become effective? Your coverage will become effective the first day of the month in which you turn 65. If you turn 65 on the first day of the month, your coverage starts on the first day of the month before your birthday. Q What if I have other health insurance coverage? You can have other health insurance coverage in addition to the Aetna Medicare Advantage plan. However, you cannot be a member of two Medicare Advantage medical plans at the same time. Q What happens to the money I have already spent toward my deductible and out-of-pocket maximum on my current TRS-Care plan? Q What does it mean to have a PPO Extended Service Area (ESA) plan? It means you will not pay a higher cost share if you use an out-of-network provider. With the Aetna Medicare Advantage PPO ESA plan, you can see any licensed provider who is eligible to receive payment from Medicare and is willing to accept the plan, even if that provider is not contracted with Aetna. Q What happens to family members who are not eligible for Medicare but currently have TRS coverage? They will stay on the standard TRS-Care plan. When you transition to the Aetna Medicare Advantage plan from your TRS-Care plan, your deductible and out-of-pocket accumulations will carry over and be applied to the Aetna Medicare Advantage plan for the remainder of TRSretireehealthplans.com

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20 Q Will I be able to enroll into the Aetna Medicare Advantage plan at a later date if I decide to opt out? Future opportunities to enroll are not guaranteed. Q What if I want to enroll in a different Medicare Advantage plan? Since you will be automatically enrolled into the Aetna Medicare Advantage Plan offered by TRS-Care, you will need to call TRS Health Benefits at prior to turning 65 to opt out of this plan. Please make sure you do this before enrolling in a different Medicare Advantage plan. You cannot be enrolled in two Medicare Advantage plans at the same time. Q Can I try the Aetna Medicare Advantage plan and drop it if it does not meet my needs? Yes, you can. Just contact TRS Health Benefits at You will be moved to the combination of Original Medicare and the standard TRS-Care plan. Your coverage in the combination of Original Medicare and the standard TRS-Care plan will start over on the first of the month following your notification to TRS of your change. Your plan deductible and benefits will start over. Any out-of-pocket costs or money paid toward your deductible will not transfer. Q What should I do if I am not interested in this plan? If you want to opt out of the Aetna Medicare Advantage plan and be moved to the combination of Original Medicare and the standard TRS-Care plan, please call the TRS Health Benefits at (TTY: 711); Monday through Friday 8 a.m. to 5 p.m. Central time. And remember, if you decide to opt out, you will not get the extra features and benefits of the Aetna Medicare Advantage plan, such as: A lower deductible A lower out-of-pocket maximum The transportation benefit The fitness benefit 18 TRSretireehealthplans.com

21 What materials should I expect to receive? What is it? Plan confirmation letter A letter informing you that Aetna has confirmed with the Centers for Medicare and Medicaid Services (CMS) that you are approved to become a member of the Aetna Medicare Advantage plan. Aetna Medicare identification (ID) card This is the card you show to providers prior to receiving services. If you need to obtain services before you receive your ID card, present the Plan Confirmation Letter to your provider as documentation that you are in the plan. Plan documents You will also receive several plan documents to help you understand and use your plan. They include the Evidence of Coverage, a Schedule of Copayments and a directory (if you live within our PPO network service area). Health risk survey We will call to ask general questions regarding your health. You can also complete the survey on paper and mail it back. How will I receive it? U.S. Mail U.S. Mail U.S. Mail Several attempts by phone, then U.S. Mail When should I expect it? After you are covered by Medicare Part A and Part B Within two weeks of CMS approval After your Aetna Medicare Advantage plan effective date After your Aetna Medicare Advantage plan effective date TRSretireehealthplans.com 19

22 Aetna Medicare Advantage Care 3 Medical plan Participants becoming eligible for Medicare TRSretireehealthplans.com 2015 Aetna Inc B (12/14)