Coventry Advantra (HMO) offered by Coventry Health Care, part of the Aetna family, for State Employee Group Insurance Program members

Transcription

1 Cventry Advantra (HMO) ffered by Cventry Health Care, part f the Aetna family, fr State Emplyee Grup Insurance Prgram members Annual Ntice f Changes fr 2016 Yu are currently enrlled as a member f Cventry Advantra (HMO). Next year, there will be sme changes t the plan s csts and benefits. This bklet tells abut the changes. Yu may make a change during the annual enrllment perid ffered by yur Retirement System. Additinal Resurces Custmer Service has free language interpreter services available fr nn-english speakers (phne numbers are in Sectin 8.1). This dcument may be made available in ther frmats such as Braille, large print r ther alternate frmats Abut Cventry Advantra (HMO) Aetna Medicare is a PDP, HMO, PPO plan with a Medicare cntract. Our SNPs als have cntracts with State Medicaid prgrams. Enrllment in ur plans depends n cntract renewal. When this bklet says we, us, r ur, it means Cventry Health Care f Missuri, Inc. as administered by Cventry Health Care f Illinis, Inc. When it says plan r ur plan, it means Cventry Advantra (HMO). EG_ANOC_2016_IL10 Frm CMS ANOC/EOC (Apprved 03/2014) OMB Apprval

2 Think abut Yur Medicare Cverage fr Next Year Each fall, Medicare allws yu t change yur Medicare health and drug cverage during the Annual Enrllment Perid. It s imprtant t review yur cverage nw t make sure it will meet yur needs next year. Imprtant things t d: Check the changes t ur benefits and csts t see if they affect yu. D the changes affect the services yu use? It is imprtant t review benefit and cst changes t make sure they will wrk fr yu next year. Lk in Sectins 2.5 and 2.6 fr infrmatin abut benefit and cst changes fr ur plan. Check the changes t ur prescriptin drug cverage t see if they affect yu. Will yur drugs be cvered? Are they in a different tier? Can yu cntinue t use the same pharmacies? It is imprtant t review the changes t make sure ur drug cverage will wrk fr yu next year. Lk in Sectin 2.6 fr infrmatin abut changes t ur drug cverage. Check t see if yur dctrs and ther prviders will be in ur netwrk next year. Are yur dctrs in ur netwrk? What abut the hspitals r ther prviders yu use? Lk in Sectin 2.3 fr infrmatin abut ur Prvider & Pharmacy Directry. Think abut yur verall health care csts. Hw much will yu spend ut-f-pcket fr the services and prescriptin drugs yu use regularly? Hw much will yu spend n yur premium? Hw d the ttal csts cmpare t ther Medicare cverage ptins? Think abut whether yu are happy with ur plan. 1

3 If yu decide t stay with yur Retirement System s plan: If yu want t stay with us next year, it s easy - yu dn t need t d anything. If yu dn t make a change during the annual enrllment perid ffered by yur Retirement System, yu will autmatically stay enrlled in ur plan. If yu decide t change plans: If yu decide ther cverage will better meet yur needs, yu can switch during the annual enrllment perid ffered by yur Retirement System. If yu enrll in a new plan, yur new cverage will begin n the effective date established by yur Retirement System. Lk in Sectin 4.2 t learn mre abut yur chices. Summary f Imprtant Csts fr 2016 The table belw cmpares the 2015 csts and 2016 csts fr yur Retirement System s plan in several imprtant areas. Please nte this is nly a summary f changes. It is imprtant t read the rest f this Annual Ntice f Changes and review the enclsed Evidence f Cverage t see if ther benefit r cst changes affect yu. Cst 2015 (this year) 2016 (next year) Mnthly plan premium* * Yur premium may be higher r lwer than this amunt. See Sectin 2.1 fr details. Please cntact yur retirement system fr infrmatin n yur premium. In additin, yu must cntinue t pay yur mnthly Medicare Part B premium. Please cntact yur retirement system fr infrmatin n yur premium. In additin, yu must cntinue t pay yur mnthly Medicare Part B premium Maximum ut-f-pcket amunt This is the mst yu will pay ut-f-pcket fr yur cvered Part A and Part B services. (See Sectin 2.2 fr details.) $3,000 $3,000 Dctr ffice visits Primary care visits: $20 per visit Specialist visits: $30 per visit Primary care visits: $20 per visit Specialist visits: $30 per visit 2

4 Cst 2015 (this year) 2016 (next year) Inpatient hspital stays Includes inpatient acute, inpatient rehabilitatin, lng-term care hspitals and ther types f inpatient hspital services. Inpatient hspital care starts the day yu are frmally admitted t the hspital with a dctr s rder. The day befre yu are discharged is yur last inpatient day. $350 cpay per stay $350 cpay per stay Part D prescriptin drug cverage (See Sectin 2.6 fr details.) Standard Retail cst share during the Initial Cverage Stage: Drug Tier 1: $8 cpay Drug Tier 2: $26 cpay Drug Tier 3: $50 cpay Standard Retail cst share during the Initial Cverage Stage: Drug Tier 1: $8 cpay Drug Tier 2: $26 cpay Drug Tier 3: $50 cpay 3

5 Annual Ntice f Changes fr 2016 Table f Cntents Think abut Yur Medicare Cverage fr Next Year Unless Yu Chse Anther Plan, Yu Will Be Autmatically Enrlled in yur Retirement System's plan in Summary f Imprtant Csts fr SECTION 2 Changes t Benefits and Csts fr Next Year... 5 Sectin 2.1 Changes t the Mnthly Premium... 5 Sectin 2.2 Changes t Yur Maximum Out-f-Pcket Amunt... 5 Sectin 2.3 Changes t the Prvider Netwrk... 6 Sectin 2.4 Changes t the Pharmacy Netwrk... 6 Sectin 2.5 Changes t Benefits and Csts fr Medical Services... 7 Sectin 2.6 Changes t Part D Prescriptin Drug Cverage... 7 SECTION 3 Other Changes SECTION 4 Deciding Which Plan t Chse Sectin 4.1 If yu want t stay in yur Retirement System's plan Sectin 4.2 If yu want t change plans SECTION 5 Deadline fr Changing Plans SECTION 6 Prgrams That Offer Free Cunseling abut Medicare SECTION 7 Prgrams That Help Pay fr Prescriptin Drugs SECTION 8 Questins? Sectin 8.1 Getting Help frm Cventry Advantra (HMO) Sectin 8.2 Getting Help frm Medicare

6 SECTION 2 Changes t Benefits and Csts fr Next Year Sectin 2.1 Changes t the Mnthly Premium Cst 2015 (this year) 2016 (next year) Mnthly premium (Yu must als cntinue t pay yur Medicare Part B premium.) Please cntact yur Retirement System fr infrmatin n yur premium. In additin, yu must cntinue t pay yur mnthly Medicare Part B premium. Please cntact yur Retirement System fr infrmatin n yur premium. In additin, yu must cntinue t pay yur mnthly Medicare Part B premium. Yur mnthly plan premium will be mre if yu are required t pay a late enrllment penalty. If yu have a higher incme, yu may have t pay an additinal amunt each mnth directly t the gvernment fr yur Medicare prescriptin drug cverage. Yur mnthly premium will be subsidized if yu are receiving Extra Help with yur prescriptin drug csts. Sectin 2.2 Changes t Yur Maximum Out-f-Pcket Amunt T prtect yu, Medicare requires all health plans t limit hw much yu pay ut-f-pcket during the year. This limit is called the maximum ut-f-pcket amunt. Once yu reach this amunt, yu generally pay nthing fr cvered services fr the rest f the year. Cst 2015 (this year) 2016 (next year) Maximum ut-f-pcket amunt Yur csts fr cvered medical services (such as cpays r deductibles if applicable) cunt tward yur maximum ut-f-pcket amunt. Yur plan premium and yur csts fr prescriptin drugs d nt cunt tward yur maximum ut-f-pcket amunt. $3,000 $3,000 Once yu have paid $3,000 ut-f-pcket fr cvered services, yu will pay nthing fr yur cvered services fr the rest f the calendar year. 5

7 Sectin 2.3 Changes t the Prvider Netwrk There are changes t ur netwrk f prviders fr next year. An updated Prvider & Pharmacy Directry is lcated n ur website at Yu may als call Custmer Service fr updated prvider infrmatin r t ask us t mail yu a Prvider & Pharmacy Directry. It is imprtant that yu knw that we may make changes t the hspitals, dctrs and specialists (prviders) that are part f yur plan during the year. There are a number f reasns why yur prvider might leave yur plan but if yur dctr r specialist des leave yur plan yu have certain rights and prtectins summarized belw: Even thugh ur netwrk f prviders may change during the year, Medicare requires that we furnish yu with uninterrupted access t qualified dctrs and specialists. When pssible we will prvide yu with at least 30 days ntice that yur prvider is leaving ur plan s that yu have time t select a new prvider. We will assist yu in selecting a new qualified prvider t cntinue managing yur health care needs. If yu are underging medical treatment yu have the right t request, and we will wrk with yu t ensure, that the medically necessary treatment yu are receiving is nt interrupted. If yu believe we have nt furnished yu with a qualified prvider t replace yur previus prvider r that yur care is nt being apprpriately managed yu have the right t file an appeal f ur decisin. If yu find ut yur dctr r specialist is leaving yur plan please cntact us s we can assist yu in finding a new prvider and managing yur care. Sectin 2.4 Changes t the Pharmacy Netwrk Amunts yu pay fr yur prescriptin drugs may depend n which pharmacy yu use. Medicare drug plans have a netwrk f pharmacies. In mst cases, yur prescriptins are cvered nly if they are filled at ne f ur netwrk pharmacies. Our netwrk includes pharmacies with preferred cst-sharing, which may ffer yu lwer cst-sharing than the standard cst-sharing ffered by ther pharmacies within the netwrk. Our netwrk has changed mre than usual fr An updated Prvider & Pharmacy Directry is lcated n ur website at may als call Custmer Service fr updated prvider infrmatin r t ask us t mail yu a Prvider & Pharmacy Directry. We strngly suggest that yu review the 2016 Prvider & Pharmacy Directry t see if yur pharmacy is still in ur netwrk. 6

8 Sectin 2.5 Changes t Benefits and Csts fr Medical Services We are changing ur cverage fr certain medical services next year. The infrmatin belw describes these changes. Fr details abut the cverage and csts fr these services, see Chapter 4, Medical Benefits Chart (what is cvered and what yu pay), in yur 2016 Evidence f Cverage. Cst 2015 (this year) 2016 (next year) Emergency Care Skilled Nursing Facility (SNF) Yu pay a $65 cpay fr each emergency rm visit. Yu pay nthing fr skilled nursing facility sevices. Our plan cvers up t 120 days in a SNF per benefit perid. Yu pay a $75 cpay fr each emergency rm visit. Yu pay nthing fr skilled nursing facility services. Our plan cvers unlimited medically necessary skilled nursing facility days. Sectin 2.6 Changes t Part D Prescriptin Drug Cverage Changes t basic rules fr the plan s Part D drug cverage Effective June 1, 2016, befre yur drugs can be cvered under the Part D benefit, CMS will require yur dctrs and ther prescribers t either accept Medicare r t file dcumentatin with CMS shwing that they are qualified t write prescriptins. Changes t Our Drug List Our list f cvered drugs is called a Frmulary r Drug List. A cpy f ur Drug List is in this envelpe. We made changes t ur Drug List, including changes t the drugs we cver and changes t the restrictins that apply t ur cverage fr certain drugs. Review the Drug List t make sure yur drugs will be cvered next year and t see if there will be any restrictins. If yu are affected by a change in drug cverage, yu can: Wrk with yur dctr (r ther prescriber) and ask the plan t make an exceptin t cver the drug. We encurage current members t ask fr an exceptin befre next year. Current members can ask fr an exceptin befre next year and we will give yu an answer within 72 hurs after we receive yur request (r yur prescriber's supprting statement). If we apprve yur request, yu'll be able t get yur drug at the start f the new plan year. 7

9 T learn what yu must d t ask fr an exceptin, see Chapter 9 f yur Evidence f Cverage (What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints)) r call Custmer Service. Wrk with yur dctr (r ther prescriber) t find a different drug that we cver. Yu can call Custmer Service t ask fr a list f cvered drugs that treat the same medical cnditin. In sme situatins, we are required t cver a ne-time, temprary supply f a nn-frmulary in the first 90 days f cverage f the plan year r cverage. (T learn mre abut when yu can get a temprary supply and hw t ask fr ne, see Chapter 5, Sectin 5.2 f the Evidence f Cverage.) During the time when yu are getting a temprary supply f a drug, yu shuld talk with yur dctr t decide what t d when yur temprary supply runs ut. Yu can either switch t a different drug cvered by the plan r ask the plan t make an exceptin fr yu and cver yur current drug. Exceptin requests that were apprved in 2015 d nt carry ver int If yu were granted a frmulary exceptin in 2015, yu must request a new frmulary exceptin fr If yu d nt request a new frmulary exceptin prir t January 1, 2016, the fllwing transitin prcess will apply: Fr currently enrlled members wh d nt request an exceptin befre January 1, 2016, we will cver up t a 30-day temprary supply (unless yur prescriptin is written fr fewer days, in which case we will allw multiple fills t prvide up t a ttal f a 30-day supply) f the drug fr the first 90 days f the new plan year starting n January 1st. This will give yu time t discuss ptins with yur prescribing physician regarding alternative drugs r requesting an exceptin if yur current drug is nt n the frmulary next year r has new restrictins. Fr currently enrlled members wh are residents in a lng-term care facility and d nt request an exceptin befre January 1, 2016, we will cver up t a 31-day temprary supply (unless yur prescriptin is written fr fewer days, in which case we will allw multiple fills t prvide up t a ttal f a 31-day supply) f the drug fr the first 90 days f the new plan year starting n January 1st.This will give yu time t discuss ptins with yur prescribing physician regarding alternative drugs r requesting an exceptin. Currently enrlled members wh are changing frm ne treatment setting t anther such as: Members wh are discharged frm a hspital r skilled nursing facility t a hme setting. Members wh are admitted t a hspital r skilled nursing facility frm a hme setting. Members wh transfer frm ne skilled nursing facility t anther and are served by a different pharmacy. Members wh end their skilled nursing facility Medicare Part A stay (where payments include all pharmacy charges) and wh need t nw use their Part D plan benefit. Members wh give up hspice status and revert back t standard Medicare Part A and B cverage. Members discharged frm chrnic psychiatric hspitals with highly individualized drug regimens. 8

10 If yu experience a change in treatment setting as described abve and a drug therapy is nt n the frmulary r cvered with restrictins, we will cver a 31-day temprary supply if yu have nt already received a temprary supply in a lng term care setting and a 30-day temprary supply fr a retail setting. Regardless f why yu received a temprary supply, yu will need t utilize ur exceptin prcess, as defined in the Evidence f Cverage that was attached with this Annual Ntice f Changes, if yu need t cntinue n the current drug. Imprtant Nte: Please take actins n wrking with yur dctr t find apprpriate alternatives cvered in the next plan year befre the effective date f yur plan. It will make fr a very easy transitin int the next calendar year fr yu. T learn what yu must d t ask fr an exceptin, see the Evidence f Cverage that was attached t this Annual Ntice f Changes. Lk fr Chapter 9 f the Evidence f Cverage (What t d if yu have a prblem r cmplaint). Changes t Prescriptin Drug Csts Nte: If yu are in a prgram that helps pay fr yur drugs ( Extra Help ), the infrmatin abut csts fr Part D prescriptin drugs may nt apply t yu. We have sent yu a separate insert, called the Evidence f Cverage Rider fr Peple Wh Get Extra Help Paying fr Prescriptin Drugs (als called the Lw Incme Subsidy Rider r the LIS Rider ), which tells yu abut yur drug csts. If yu get Extra Help, and haven t received this insert by September 30th, please call Custmer Service and ask fr the LIS Rider. Phne numbers fr Custmer Service are in Sectin 8.1 f this bklet. There are fur drug payment stages. Hw much yu pay fr a Part D drug depends n which drug payment stage yu are in. (Yu can lk in Chapter 6, Sectin 2 f yur Evidence f Cverage fr mre infrmatin abut the stages.) The infrmatin belw shws the changes fr next year t the first tw stages the Yearly Deductible Stage and the Initial Cverage Stage. (Mst members d nt reach the ther tw stages the Cverage Gap Stage r the Catastrphic Cverage Stage. T get infrmatin abut yur csts in these stages, lk at Chapter 6, Sectins 6 and 7, in the attached Evidence f Cverage.) In additin t the changes in csts described belw, there is a change t daily cst sharing that might affect yur csts in the Initial Cverage Stage. Starting in 2016, when yur dctr first prescribes less than a full mnth s supply f certain drugs, yu may n lnger need t pay the cpay fr a full mnth. (Fr mre infrmatin abut daily cst sharing, lk at Chapter 6, Sectin 5.3, in the enclsed Evidence f Cverage.) 9

11 Changes t the Deductible Stage Stage 2015 (this year) 2016 (next year) Stage 1: Yearly Deductible Stage During this stage, yu pay the full cst f yur Part D drugs until yu have reached the yearly deductible. $100. $100 Changes t Yur Cst-sharing in the Initial Cverage Stage Stage 2015 (this year) 2016 (next year) Stage 2: Initial Cverage Stage During this stage, the plan pays its share f the cst f yur drugs and yu pay yur share f the cst. Yur cst fr a ne-mnth supply filled at a netwrk pharmacy: Tier 1Generic: Standard cst-sharing: Yu pay $8 per prescriptin Preferred cst-sharing: Nt available Yur cst fr a ne-mnth supply filled at a netwrk pharmacy: Tier 1 Generic: Standard cst-sharing: Yu pay $8 cpay per prescriptin Preferred cst-sharing: Yu pay $3 cpay per prescriptin. Tier 2 Preferred Brand Drugs: Standard cst-sharing: Yu pay $26 per prescriptin Preferred cst-sharing: Nt available. Tier 3 Nn-Preferred Brand Drugs: Standard cst-sharing: Yu pay $50 per prescriptin Preferred cst-sharing: Tier 2 Generic Drugs: Standard cst-sharing: Yu pay $26 per prescriptin Preferred cst-sharing: Yu pay $26 cpay per prescriptin Tier 3 Nn-Preferred Brand Drugs: Standard cst-sharing: Yu pay $50 cpay per prescriptin 10

12 The csts are fr a ne-mnth (30- day) supply when yu fill yur prescriptin at a netwrk pharmacy that prvides standard r preferred cst-sharing. Fr infrmatin abut the csts fr mail-rder prescriptins, lk in Chapter 6, Sectin 5 f yur Evidence f Cverage and yur Summary f Benefits. Nt available Once yur ttal drug csts have reached $2,850, yu will mve t the next stage (the Cverage Gap Stage). Preferred cst-sharing: Yu pay $50 cpay per prescriptin Once yur ttal drug csts have reached $3,310, yu will mve t the next stage (the Cverage Gap Stage). We changed the tier fr sme f the drugs n ur Drug List. T see if yur drugs will be in a different tier, lk them up n the Drug List. Changes t the Cverage Gap and Catastrphic Cverage Stages The ther tw drug cverage stages the Cverage Gap Stage and the Catastrphic Cverage Stage are fr peple with high drug csts. Mst members d nt reach the Cverage Gap Stage r the Catastrphic Cverage Stage. Fr infrmatin abut yur csts in these stages, lk at Chapter 6, Sectins 6 and 7, in yur Evidence f Cverage and Summary f Benefits. SECTION 3 Other Changes Prcess 2015 (this year) 2016 (next year) Prir Authrizatin Prir Authrizatin requirements are listed in yur 2015 Evidence f Cverage, Chapter 4 Medical Benefits chart. Yur prvider is respnsible fr any prir authrizatin submissins. Prir Authrizatin requirements may have changed fr Yur prvider is respnsible fr any prir authrizatin submissins. See the Medical Benefits chart in Chapter 4 fr benefits that require prir authrizatin. 11

13 Prcess 2015 (this year) 2016 (next year) Netwrk Pharmacies with Preferred Cst Sharing See yur 2015 Prvider & Pharmacy Directry fr a list f netwrk pharmacies. Yur preferred pharmacies may have changed fr Please refer t yur 2016 Prvider & Pharmacy Directry, visit ur website at r call Custmer Service t verify the netwrk pharmacies that have preferred cst sharing in yur area have nt changed. Out-f-Netwrk Pharmacy Temprary Supply Limited t a 30-day supply Limited t a 10-day supply Pharmacy Benefit Manager (PBM) Cventry Health Care is changing its name t Aetna. Preferred Pharmacy Netwrk Other pharmacies are als available in ur netwrk Express Scripts (ESI) was the administratr fr yur prescriptin drugs Yu received infrmatin frm nly Cventry Health Care. Nt Available CVS Health will be the administratr fr yur drugs. Yu will see r hear the CVS Health name. Yu may receive infrmatin frm either Cventry Health Care r Aetna. Available Preferred pharmacy cst-sharing may be lwer than the standard cst-sharing ffered by ther netwrk pharmacies. If yu stay with yur current plan during pen enrllment, we ll send yu an updated list f pharmacies that will ffer preferred cst-sharing in

14 SECTION 4 Deciding Which Plan t Chse Sectin 4.1 If yu want t stay in yur Retirement System s plan T stay in ur plan yu dn t need t d anything. If yu d nt sign up fr a different plan r change t Original Medicare by December 7, yu will autmatically stay enrlled as a member f ur plan fr Sectin 4.2 If yu want t change plans We hpe t keep yu as a member next year but if yu want t change fr 2016 fllw these steps: Step 1: Learn abut and cmpare yur chices Yu can jin a different Medicare health plan. Yu shuld cnsult yur retirement system befre yu enrll in a plan nt ffered by yur retirement system, r befre ending yur membership in ur plan utside f yur retirement system s pen enrllment perid. It is imprtant t understand yur retirement system s eligibility plicies, and the pssible impact t yur retiree health care. OR-- Yu can change t Original Medicare. If yu change t Original Medicare, yu will need t decide whether t jin a Medicare drug plan and whether t buy a Medicare supplement (Medigap) plicy. T learn mre abut Original Medicare and the different types f Medicare plans, read Medicare & Yu 2016, call yur State Health Insurance Assistance Prgram (SHIP), r call Medicare (see Sectin 8.2). Yu can als find infrmatin abut plans in yur area by using the Medicare Plan Finder n the Medicare website. G t and click Find health & drug plans. Here, yu can find infrmatin abut csts, cverage, and quality ratings fr Medicare plans. Step 2: Change yur cverage T change t a different Medicare health plan, enrll in the new plan thrugh yur Retirement System. Yu will autmatically be disenrlled frm Cventry Advantra (HMO). T change t Original Medicare with a prescriptin drug plan, enrll in the new drug plan. Yu will autmatically be disenrlled frm yur Retirement System s plan. T change t Original Medicare withut a prescriptin drug plan, yu must either: Send us a written request t disenrll. Cntact Custmer Service if yu need mre infrmatin n hw t d this (phne numbers are in Sectin 8.1 f this bklet). r Cntact Medicare, at MEDICARE ( ), 24 hurs a day, 7 days a week, and ask t be disenrlled. TTY users shuld call

15 SECTION 5 Deadline fr Changing Plans Because yu are enrlled in ur plan thrugh yur retirement system, yu are nly allwed t make plan changes at times designated by yur retirement system. Imprtant Nte: Yu may jin r leave a plan nly at certain times designated by yur retirement system. If yu chse t enrll in a Medicare health plan r Medicare prescriptin drug plan that is nt ffered by yur retirement system, yu may lse the ptin t enrll in a plan ffered by yur retirement system in the future. Yu culd als lse cverage fr ther emplyer-spnsred retirement benefits yu may currently have. Once enrlled in ur plan, if yu chse t end yur membership utside f yur retirement system s pen enrllment perid, re-enrllment in any plan yur retirement system ffers may nt be permitted, r yu may have t wait until their next pen enrllment perid. Yu shuld cnsult yur retirement system befre yu enrll in a plan nt ffered by yur retirement system, r befre ending yur membership in ur plan utside f yur retirement system s pen enrllment perid. It is imprtant t understand yur retirement system s eligibility plicies, and the pssible impact t yur retiree health care cverage ptins and ther retirement benefits befre submitting a request t enrll in a plan nt ffered by yur retirement system, r a request t end yur membership in ur plan. SECTION 6 Prgrams That Offer Free Cunseling abut Medicare The State Health Insurance Assistance Prgram (SHIP) is a gvernment prgram with trained cunselrs in every state. Fr yur state, the SHIP infrmatin is belw. State Health Insurance Assistance Prgrams (SHIPs) are independent (nt cnnected with any insurance cmpany r health plan). It is a state prgram that gets mney frm the Federal gvernment t give free lcal health insurance cunseling t peple with Medicare. SHIP cunselrs can help yu with yur Medicare questins r prblems. They can help yu understand yur Medicare plan chices and answer questins abut switching plans. Yu can call r learn mre abut by visiting their website. Senir Health Insurance Infrmatin Prgram (SHIP) CALL (800) WRITE WEBSITE Illinis Department n Aging One Natural Resurces Way, #100 Springfield, IL SECTION 7 Prgrams That Help Pay fr Prescriptin Drugs Yu may qualify fr help paying fr prescriptin drugs. Belw we list different kinds f help: 14

16 Extra Help frm Medicare. Peple with limited incmes may qualify fr Extra Help t pay fr their prescriptin drug csts. If yu qualify, Medicare culd pay up t 75% r mre f yur drug csts including mnthly prescriptin drug premiums, annual deductibles, and cinsurance. Additinally, thse wh qualify will nt have a cverage gap r late enrllment penalty. Many peple are eligible and dn t even knw it. T see if yu qualify, call: MEDICARE ( ). TTY users shuld call , 24 hurs a day/7 days a week; The Scial Security Office at between 7 a.m. and 7 p.m., Mnday thrugh Friday. TTY users shuld call, (applicatins); r Yur State Medicaid Office (applicatins); Prescriptin Cst-sharing Assistance fr Persns with HIV/AIDS. The AIDS Drug Assistance Prgram (ADAP) helps ensure that ADAP-eligible individuals living with HIV/AIDS have access t life-saving HIV medicatins. Individuals must meet certain criteria, including prf f State residence and HIV status, lw incme as defined by the State, and uninsured/under-insured status. Medicare Part D prescriptin drugs that are als cvered by ADAP qualify fr prescriptin cstsharing assistance thrugh the AIDS Drug Assistance Prgram (ADAP) fr yur. If yu are currently enrlled in an ADAP, it can cntinue t prvide yu with Medicare Part D prescriptin cst-sharing assistance fr drugs n the ADAP frmulary. In rder t be sure yu cntinue receiving this assistance, please ntify yur lcal ADAP enrllment wrker f any changes in yur Medicare Part D plan name r plicy number. Fr infrmatin n eligibility criteria, cvered drugs, r hw t enrll in the prgram, please call: AIDS Drug Assistance Prgram (ADAP)-Illinis Illinis Department f Public Health CALL Telephne: (217) WRITE WEBSITE AIDS Drug Assistance Prgram: ADAP Administratr 525 W. Jeffersn Street Springfield, IL SECTION 8 Questins? Sectin 8.1 Getting Help frm Cventry Medicare Advantage (HMO) Questins? We re here t help. Please call Custmer Service at (800) (TTY nly, call 711). We are available fr phne calls 8 am t 8 pm, lcal time seven (7) days a week, frm Octber 1 February 14, and 8 am t 8 pm, lcal time Mnday Friday, frm February 15 September 30. Calls t these numbers are free. 15

17 Read yur 2016 Evidence f Cverage (it has details abut next year's benefits and csts) This Annual Ntice f Changes gives yu a summary f changes in yur benefits and csts fr Fr details, lk in the 2016 Evidence f Cverage and Summary f Benefits fr ur plan. The Evidence f Cverage is the legal, detailed descriptin f yur plan benefits. It explains yur rights and the rules yu need t fllw t get cvered services and prescriptin drugs. A cpy f the Evidence f Cverage and Summary f Benefits is included in this envelpe. Visit ur Website Yu can als visit ur website at As a reminder, ur website has the mst up-t-date infrmatin abut ur prvider netwrk (Prvider & Pharmacy Directry. Sectin 8.2 Getting Help frm Medicare T get infrmatin directly frm Medicare: Call MEDICARE ( ) Yu can call MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users shuld call Visit the Medicare Website Yu can visit the Medicare website ( It has infrmatin abut cst, cverage, and quality ratings t help yu cmpare Medicare health plans. Yu can find infrmatin abut plans available in yur area by using the Medicare Plan Finder n the Medicare website. (T view the infrmatin abut plans, g t and click n Find health & drug plans ). Read Medicare & Yu 2016 Yu can read the Medicare & Yu 2016 Handbk. Every year in the fall, this bklet is mailed t peple with Medicare. It has a summary f Medicare benefits, rights and prtectins, and answers t the mst frequently asked questins abut Medicare. If yu dn t have a cpy f this bklet, yu can get it at the Medicare website ( r by calling MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users shuld call