Affordable Coverage for People Turning 65 and New Retirees Medicare Supplemental Products. An independent, local Vermont company

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1 Affordable Coverage for People Turning 65 and New Retirees 2015 Medicare Supplemental Products An independent, local Vermont company

2 Three smart steps to quality health care after retirement: peace of mind Vermont Medigap Blue SM offers Vermonters Attractive, competitive rates Personal attention from our Vermont-based sales and customer service staff Special invitations to funfilled activities and events throughout the state Coverage accepted throughout the U.S. and, with some plans, during foreign travel For more details about our Medigap products, see pages of this brochure. 2

3 Health care after retirement Know your retirement needs Determining your wants and needs while managing your resources wisely will make your transition into retirement a lot easier and more stress free. 3

4 4 STEP 1:

5 Enroll in Medicare Parts A & B What is Medicare? Medicare is a federal health insurance program for U.S. citizens and lawfully admitted aliens who have lived in the United States for at least five years. It covers: People age 65 and older People younger than age 65 with certain disabilities People of all ages with end stage renal disease or permanent kidney failures If neither you nor your spouse have paid Medicare taxes for at least 10 years, you will need to pay a monthly premium. If you are eligible for Part A hospital insurance, either for free or by paying for it, you can also enroll in Medicare medical insurance (Part B) by applying for it through Social Security and paying a monthly premium. Three smart steps to quality Medicare has three parts health care after retirement: 1. Part A Hospital Insurance helps you pay for your inpatient care in hospitals. For example, Part A will help cover the cost of a shared hospital room, meals and nursing. Some plans also assist with costs associated with nursing facility care if you meet certain requirements. 2. Part B Medical Insurance helps you pay for services that are considered important for the diagnosis or treatment of a medical condition. These include: Doctor visits Procedures that don t require an overnight hospital stay Some preventive care services, such as flu shots and a yearly wellness visit What is the cost? For most individuals, Medicare Part A (hospital insurance) is free. Part B (medical insurance), which you may decline, requires a monthly premium of $ How do you enroll? For Medicare Parts A and B, call Social Security toll-free at (800) (TTY: (800) ). You can also set up an appointment at your local Social Security office. You ll need to provide proof of age, such as a birth certificate. 3. Part D Prescription Drug Coverage helps you pay for commonly used brand name and generic drugs. It typically doesn t cover over-the-counter medications. Medicare Part D plans are run by private insurance companies approved by Medicare. You must enroll in Medicare Part D through a private carrier and pay a monthly premium. Each plan can vary in costs (premiums, deductibles, copayments and drugs covered). You will pay these in addition to your Part B premium. For more information on Part D, see page 9. peace of mind Recruit new brain cells Dr. Holly Atkinson, speaking at a BCBSVT health symposium, noted that when you try something new, your brain turns to the stem cells naturally found there, saying in essence, I m going to use these young cells to help me do this new activity you re actually engaging more brain power. Do something that you don t think you re going to be very good at, she says, Challenge your brain. Go back to dreams of your youth maybe painting, writing, foreign languages what have you always wanted to do? For Atkinson, it was learning French and playing her brand new Fender Stratocaster. Undertaking a new activity with somebody else yields fringe benefits, she says. It turns out that when couples do something new together, it can rekindle the feelings of being newly in love. 5

6 STEP 2: 6

7 Select a Medigap policy Choose a Medigap policy that works best for you Three smart steps to quality The next important component of the When you are eligible equation is Medigap, or a Medicare health care after retirement: You may apply for Vermont Medigap Blue coverage supplemental insurance policy. only during your initial Medicare open enrollment A Medigap policy is health coverage offered by period (or as otherwise required by law). The private companies and provides open enrollment period is the assistance with costs not paid six-month period that begins on by Medicare, like co-insurance, the first day of the month that co-payments and deductibles. you are both 65 years of age or You pay a monthly premium to older and enrolled for benefits the private company in addition under Medicare Part B. If you are to your Part B premium. eligible for Medicare because of a disability, you may only enroll Medigap policies in Vermont Medigap Blue during the six months differ based on their coverage. following the date you become eligible for Medicare. Your coverage takes effect on the first day of the month after we receive your application. Vermont Medigap Blue is our Medicare supplemental plan which may help you with a worry-free retirement. For more information about our different Medigap plans, see pages You may not cover dependents under your Vermont Medigap Blue supplemental plan. If you convert to Vermont Medigap Blue coverage from two-person or family coverage with Blue Cross and Blue Shield of Vermont or The Vermont Health Plan, you need to maintain separate coverage for your dependents. Please call (800) for more information. If you or your spouse are still employed, you may be eligible for group coverage. Contact your group benefits manager about your options. peace Please note that to be eligible for Vermont of Medigap mindblue, you must be enrolled under both Parts A and B of Medicare. Stay positive You ve worked hard, so enjoy! Keeping a healthy mental state will improve your overall wellness and retirement experience. Science now tells us that negative thoughts can cause chronic stress, which is damaging to the body. Make sure to do things that make you feel good about yourself and help others data shows that practicing random acts of kindness is actually good for you. 7

8 8 STEP 3:

9 Enroll in Part D drug coverage rt steps to quality e after retirement: Part D The third part of the equation The final component of the equation is Part D drug coverage. Part D drug coverage is Medicare s prescription drug program and is offered through private companies. Medicare prescription drug coverage (Part D) is available to anyone who is entitled to Medicare Part A and/or enrolled in Part B. Part D adds drug coverage to original Medicare. It may help to lower prescription drug costs and may protect you from higher costs in the future. It covers both brand-name and generic prescription drugs at participating pharmacies in your area. You should consider joining a plan unless you will already have drug coverage that is at least as good as Medicare Part D prescription drug coverage. Most people pay a monthly premium for this coverage. To get Medicare drug coverage, you must join a Medicare drug plan through a Prescription Drug Plan (PDP), or a Medicare Advantage Plan that offers Medicare peace prescription drug coverage of (MA-PD). mind Plans vary in cost and drugs covered. To compare plans go to It is important to investigate your options now. If you wait, you may have to pay more for your coverage later. Blue Cross and Blue Shield of Vermont, in a joint venture with three other New England Blue plans, contracts with the Federal Government to offer Medicare prescription drug coverage, called Blue MedicareRx S M (PDP). See our separate brochure, Blue MedicareRx, for more information on our product. Now let s review Three smart steps to quality health care after retirement: You can add the different elements to create one final equation. In other words, you can combine different types of Medicare coverage into one package that works best for you. peace of mind 9

10 Outline of coverage All standard Medigap products This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in Vermont. We offer Plans A, C, D, F and N as highlighted below. Monthly Costs $ $ $ Disabled under 65 $ $ $ A B C D Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Skilled Nursing Facility Co-insurance Skilled Nursing Facility Co-insurance Part A Part A Part A Part B Foreign Travel Emergency Foreign Travel Emergency * Plan F also has an option called a high-deductible Plan F. This high-deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan s separate foreign travel emergency deductible. 10

11 Basic benefits Hospitalization Part A co-insurance plus coverage for 365 additional days after Medicare benefits end. Blood First three pints of blood each year. Hospice Part A co-insurance. Medical Expenses Part B co-insurance (generally 20 percent of Medicare-approved expenses) or co payments for hospital outpatient services. Plans K, L, M and N require members to pay a portion of Part B co-insurance or co-payments. $ $ $ $ F F* G K L M N Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Basic Benefits, including 100% Part A Co insurance Part B Co-insurance Basic Benefits, including 100% Part A Coinsurance Part B Coinsurance Hospital and preventive care paid at 100%; other basic benefits paid at 50% Hospital and preventive care paid at 100%; other basic benefits paid at 75% Basic benefits, including 100% Part A Co insurance Part B Co insurance $20 co-payment for office visits, $50 co payment for ER; other basic benefits, including 100% Part A Co insurance Part B Co insurance Skilled Nursing Facility Co-insurance Skilled Nursing Facility Co-insurance Skilled Nursing Facility Coinsurance 50% Skilled Nursing Facility Co-insurance 75% Skilled Nursing Facility Co-insurance Skilled Nursing Facility Co insurance Skilled Nursing Facility Co insurance Part A Part A Part A 50% Part A 75% Part A 50% Part A Part A Part B Part B Part B Excess (100%) Part B Excess (100%) Part B Excess (100%) Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Foreign Travel Emergency Out-of-pocket limit $4,940; paid at 100% after limit reached Out-of-pocket limit $2,470; paid at 100% after limit reached 11

12 We offer Vermont Medigap Blue Plans A, C, D, F and N * Vermont Medigap Blue Plans A, C, D and N: save money by selecting the benefits important to you Plan F shown below has the richest benefits. Plan F covers Part B excess charges, or the difference when the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount. Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. SERVICES Example: Vermont Medigap Blue Plan F* Medicare (Part A) pays for hospital services MEDICARE PAYS (PER BENEFIT PERIOD) $ per month PLAN PAYS (PER BENEFIT PERIOD) YOU PAY (PER BENEFIT PERIOD) HOSPITALIZATION** *** Semiprivate room and board, general nursing and miscellaneous services and supplies First 60 days All but $1,260 $1,260 (Part A deductible) $0 61st through 90th day All but $315 a day $315 a day $0 91st day and after, while using 60 lifetime reserve days All but $630 a day $630 a day $0 Once lifetime reserve days are used: additional 365 days 100% of Medicare eligible $0 expenses $0 Beyond the additional 365 days $0 $0 All costs SKILLED NURSING FACILITY CARE ** You must meet Medicare s requirements, including having been in a hospital for at least three days and entered a Medicare approved facility within 30 days after leaving the hospital First 20 days All approved amounts $0 $0 21st through 100th day All but $ a day Up to $ a day $0 101st day and after $0 $0 All costs BLOOD First three pints $0 All costs $0 Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare s requirements, including a doctor s certification of terminal illness However, there are exceptions and this prohibition may not apply if services are received out of state. You can save money by selecting either Plans A, C, D or N, but Plan A ($ per month) does not cover Medicare deductibles, foreign travel, skilled nursing facility care or Part B Excess Charges. Plan C ($ per month) does not cover the Part B Excess Charges. Plan D ($ per month) does not cover All but very limited co payment/ co-insurance for outpatient drugs and inpatient respite care the Part B deductible or Part B Excess Charges. Plan N ($ per month) requires co-payments for some office visits as well as Emergency Room visits that don t result in an impatient admission, and does not cover the Part B deductible or Part B Excess Charges. The money you save monthly may be required later through cost sharing. Consider your health needs, travel habits and your cash flow when making your decision. Medicare co-payment/ co-insurance ** A benefit period begins on the first day you receive service as an *** Notice: When your Medicare Part A hospital benefits are exhausted, the insurer inpatient in a hospital and ends after you have been out of the hospital stands in the place of Medicare and will pay whatever amount Medicare would have and have not received skilled care in any other facility for 60 days in a row. paid up to an additional 365 days as provided in the policy s Core Benefits. During this time the hospital is prohibited from billing you for the balance based on any 12 difference between its billed charges and the amount Medicare would have paid. $0

13 SERVICES Example: Vermont Medigap Blue Plan F Medicare (Part B) pays for medical services MEDICARE PAYS (PER CALENDAR YEAR) PLAN PAYS (PER CALENDAR YEAR) YOU PAY (PER CALENDAR YEAR) MEDICAL EXPENSES in or out of the hospital and outpatient hospital treatment, such as physician s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment First $147 of Medicare-approved amounts $0 $147 (Part B deductible) Remainder of Medicare-approved amounts Generally 80% Generally 20% $0 Part B excess charges (above Medicare-approved amounts) $0 All costs $0 BLOOD First three pints $0 All costs $0 Next $147 of Medicare-approved amounts $0 $147 (Part B deductible) $0 Remainder of Medicare-approved amounts 80% 20% $0 CLINICAL LABORATORY SERVICES Blood tests for diagnostic services 100% $0 $0 Medicare Parts A & B HOME HEALTH CARE Medicare-approved services Medically necessary skilled care services and medical supplies 100% $0 $0 Durable medical equipment First $147 of Medicare-approved amounts $0 $147 (Part B deductible) Remainder of Medicare-approved amounts 80% 20% $0 Other Benefits Not Covered by Medicare FOREIGN TRAVEL (Not Covered By Medicare) Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA First $250 each calendar year $0 $0 $250 Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 $0 $0 20% and amounts over the $50,000 lifetime maximum 13

14 checklist ASK YOURSELF: YES NO IF NO, YOU CAN: Do I qualify for Medicare Part A? Most people ages 65 and older are eligible for Medicare hospital insurance without paying a monthly premium. Some exceptions apply. Contact Medicare for details at (800) MEDICARE (800) TTY: (877) ) Consider purchasing Part A coverage if you are age 65 or older or are disabled and have returned to work. To receive Part A benefits, you may have to enroll in Part B and pay its monthly premium. Should I sign up for Part B now? Sign up when you are eligible to avoid extra costs. If you wait, you will pay 10 percent more for each year that you qualified and didn t enroll. There are a few exceptions (for example, if you recently had group health insurance through a current or former employer). Enroll in Part B at a later time during the general enrollment period. If you had group health insurance, you can enroll during the special enrollment period. Do I want to pay the health care costs that Medicare doesn t cover out of pocket? Every year, you will likely pay: Part A and B deductibles before coverage begins A monthly premium for Part B 20 percent of the Medicare-allowed amount 100 percent of the cost for services not covered by Medicare Consider Vermont Medigap Blue, affordable supplemental coverage. For more information about this product, see page 7 and pages of this brochure. When am I eligible to enroll in Vermont Medigap Blue? You may apply for Vermont Medigap Blue coverage only during your initial Medicare open enrollment period (or as otherwise required by law). The open enrollment period is the six-month period that begins on the first day of the month that you are both 65 years of age or older and enrolled for benefits under Medicare Part B. If you are eligible for Medicare because of a disability, you may only enroll in Vermont Medigap Blue during the six months following the date you become eligible for Medicare. Your coverage takes effect on the first day of the month after we receive your application. Consider Vermont Blue 65, our program for Vermonters who aren t in their initial Medicare eligibility period. Call (802) or visit us on the web at Do I want prescription drug coverage? Add Medicare Part D coverage through Blue MedicareRx SM (PDP), which we offer through a contract with the Federal Government. Read the section on Medicare Part D prescription drug coverage on page 9 for more information. Even if you currently don t take medications or don t think you will need coverage, you may still want to consider enrolling in Part D through a private plan. It may protect you from unforeseen expenses. Also, you may have to pay a penalty if you join later. Do I need coverage for traveling abroad? Think about purchasing Vermont Medigap Blue plans C, D, F or N, which include foreign travel emergency benefits. Consider a less costly Medigap policy that covers only basic benefits, such as Vermont Medigap Blue Plan A. 14

15 disclosures Use the Outline of Coverage to compare benefits and costs among Plans. This Outline shows benefits and costs of Plans sold for effective dates on or after June 1, Plans sold for effective dates prior to June 1, 2010 have different benefits and premiums. Insured by the Vermont Health Plan Medicare supplemental policy series: Plan A ( ), Plan C ( ), Plan D ( ), Plan F ( ), Plan N ( ). The purpose of this material is a solicitation of insurance. An insurance agent may contact you. For costs and further details of the coverage, including exclusions, any reductions or limitations and terms under which the policy may be continued in force, contact your agent or the company. These Medicare supplement policies have exclusions and limitations. Please contact your insurance agent or the Vermont Health Plan for complete details concerning coverage, cost and eligibility requirements. In Vermont, plans are available to persons under the age of 65 who are eligible for Medicare by reason of disability. Subscription rate information The Vermont Health Plan can only raise your premium if we raise the premium for all policies like yours in this State. Read your certificate very carefully This is only an Outline describing your Certificate s most important features. The Certificate that you will receive after you enroll is your contract. You must read the Certificate itself to understand all of the rights and duties of both you and your health plan. Right to Return Policy If you find that you are not satisfied with your Plan, you may return it to us. If you send the policy back to us within 30 days after you receive it, we will treat the contract as if it had never been issued and return all of your payments. Policy replacement If you are replacing another health insurance Plan, do not cancel it until you have actually received your new policy and are sure you want to keep it. Notice This Plan may not fully cover all of your medical costs. The Vermont Health Plan is not connected with or endorsed by the U.S. government or the Federal Medicare Program. This Outline of Coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult the government publication Medicare and You for more details. Complete answers are very important Review the application carefully before you sign it. Be certain that all information has been properly recorded. 15

16 All Medicare supplemental policies are insured by The Vermont Health Plan, a subsidiary of Blue Cross and Blue Shield of Vermont. Blue Cross and Blue Shield of Vermont, in a joint venture with three other New England Blue plans, contracts with the Federal Government to provide Part D benefits. Blue Cross and Blue Shield of Vermont is an independent licensee of the Blue Cross and Blue Shield Association. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in BlueMedicareRx (PDP) depends on contract renewal. Registered marks of the Blue Cross and Blue Shield Association. P.O. Box 186 Montpelier, VT Phone: (802) (800) , option S2893_14110 Accepted (12/2014)

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