Medicare Plans. Plan Options

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1 Medicare Plans 2015 Medicare Plans IMPORTANT: Your current Medicare Plan will no longer be available after December 31, 2014 and you will need to make a Medicare Plan selection for the 2015 plan year. There are a variety of options available to you, depending on your county of residence, and you can enroll in one of the following Medicare Plan Options, including: AARP Medicare Supplement Plans in addition to Original Medicare, Medicare Part D Prescription Drug Plans, and Medicare Advantage Plans. Please note that you will automatically receive an AARP Medicare Supplement kit at your home address, and for those living in the Cigna or Health First coverage areas, you will receive Medicare Advantage kits from those providers. Be sure to contact the appropriate provider for plan details, and remember that plan design and/or rates vary by county of residence. The following charts are intended to provide a summary of plan availability and benefits. The plan options available to you are based upon where you live in Florida or in another state. See the charts below to learn more about the coverage options available to you for the 2015 plan year. Plan Options Medicare Supplement Plans Medicare Supplement Plans, sold by private companies, can help pay some of the health care costs that Original Medicare doesn t cover, like copayments, coinsurance and deductibles. Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your benefits. Plans A, F and N are endorsed by the FSRBC; see your packet for options to continue other plans. These plans are available statewide and also out of state. Medicare Part D Prescription Drug Plans Medicare Part D Prescription Drug Plans (sometimes called PDPs ) add drug coverage to Original Medicare and some other types of Medicare plans. These plans are available statewide and also out of state. A brief summary of the Comprehensive Pharmacy Plan and Premier Pharmacy Plan can be found on page 9. AARP Medicare Supplement Plans Plan A Plan F Plan N Medicare Part D Perscription Drug Plan UnitedHealthcare Packet will be mailed to you Comprehensive Pharmacy Plan Premier Pharmacy Plan UnitedHealthcare Call UHC for additional information or to request a complete packet. FLORIDA SCHOOL RETIREE BENEFIT CONSORTIUM REFERENCE GUIDE 7

2 FSRBC Medicare Supplement, Advantage and Prescription Drug Plans Medicare Plans Medicare Advantage Plans A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. If you re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. These plans are available in specific areas. See the chart beginning on page 12 for any Medicare Advantage Plans available in your county of residence. A high-level summary of the benefits available under these plans can be found on page 10. Medicare Advantage Plans County Specific Zero Premium HMO Plan HMO Zero Premium Plan Group Plus A HMO Group HMO POS Zero Premium National PPO Plan Comprehensive Plan 3 National PPO Low Premium National PPO Cigna Leon Cares UnitedHealthcare Packet will be mailed to you if you live in the service area, as shown beginning on Page 12. Packet will be mailed to you if you live in the service area, as shown beginning on Page 12. Call UHC for additional information or to request a complete packet. 8 FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM REFERENCE GUIDE

3 Medicare Supplement, Advantage and Prescription Drug Plans 2015 AARP Medicare Supplement Plan Benefits Medicare Supplement Plans Supplement Benefits Plan A Plan F Plan N Part A Coinsurance and Hospital Costs Medicare Part B Coinsurance or Copayment Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission. Blood (First 3 Pints) Part A Hospice Care Coinsurance or Copayment Skilled Nursing Facility Care Coinsurance Medicare Part A Deductible ($1,216) Medicare Part B Annual Deductible ($147) Medicare Part B Excess Charges (15%) Foreign Travel Emergency (To Limits*) *Care needed immediately because of an injury or an illness of sudden and unexpected onset. Benefit covers 80% and beneficiaries are responsible for 20%. UnitedHealthcare Medicare Plan Benefit Comprehensive Premier Drug Coverage Drug List 100% + Bonus 100% + Bonus Initial Coverage Period Deductible $0 $0 Generic $2 to $10 $2 to $7 Brand Preferred/Non-Preferred $45/$75 $30/$60 Specialty 33% $75 Gap Generic Preferred $2 to $10 $2 to $7 Brand Preferred/Non-Preferred 55% Discount $30/$60 Specialty 55% Discount $75 Catastrophic Generic $2.55 or 5% $2.55 or 5% Brand $6.35 or 5% $6.35 or 5% Monthly Premium $84.18 $ FLORIDA SCHOOL RETIREE BENEFIT CONSORTIUM REFERENCE GUIDE 9

4 FSRBC Medicare Supplement, Advantage and Prescription Drug Plans Medicare Advantage Plans Medicare Advantage Brevard County (See chart for available Medicare Advantage Plans by county of residence.) Benefit HMO Zero Premium Plan Group Plus A HMO Group HMO POS Medical HMO HMO In-Network Out-of-Network Annual Deductible $0 $0 $0 $0 Annual Out-of-Pocket $6,650 $2,000 $3,000 $6,000 Hospital Admit $260/Day to 7 Days $250 $150/Day to 5 Days 20% Office Visit $10/$35 $10/$20 $15/$25 20% Emergency Care $65 $50 $50 $50 Outpatient Surgery $300 $125 $150 20% Generic $0 to $10 $0 to $10 $0 to $10 N/A Brand $45/$95 $25/$45 $45/$90 N/A Specialty 33% $90 33% N/A Coverage Gap Applies No Gap Applies Applies If you would like more information about the Plans or have questions, please call Member Services, at , from 8:00 a.m. to 8:00 p.m., seven days a week. UnitedHealthcare Medicare Advantage Brevard County & Duval County (See chart for available Medicare Advantage Plans by county of residence.) Benefit Zero Premium National PPO Plan Comprehensive Plan 3 National PPO Medical In-Network Out-of-Network In-Network Out-of-Network Annual Deductible $0 $0 $0 Annual Out-of-Pocket $4,500 $10,000 $2,500 combined Hospital Admit $275/Day to 40% $175 $175 6 Days Office Visit $10/$40 $35/$60 $5/$15 $5/$15 Emergency Care $65 $65 $65 $65 Outpatient Surgery 20% 40% $15 $15 Generic $7 N/A $5 N/A Brand $40/$90 N/A $30/$60 N/A Specialty $90 N/A $80 N/A Coverage Gap Applies N/A No Gap N/A If you would like more information about the UnitedHealthcare Group Medicare Advantage plan or to receive a complete pre-enrollment plan guide, call UnitedHealthcare at , TTY 711, 8 a.m. 8 p.m. local time, seven days a week. 10 FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM REFERENCE GUIDE

5 Medicare Supplement, Advantage and Prescription Drug Plans 2015 Medicare Advantage Plans UnitedHealthcare Medicare Advantage Escambia County & Miami-Dade County (See chart for available Medicare Advantage Plans by county of residence.) Benefit Low Premium National PPO Comprehensive Plan 3 National PPO Medical In-Network Out-of-Network In-Network Out-of-Network Annual Deductible $400 Med & $320 $0 Annual Out-of-Pocket $6,700 $2,500 Hospital Admit $230/Day to 7 Days $230/Day to 7 Days $175 $175 Office Visit $25/$50 $25/$50 $5/$15 $5/$15 Emergency Care $65 $65 $65 $65 Outpatient Surgery 20% 20% $15 $15 Generic 25% N/A $5 N/A Brand 25% N/A $30/$60 N/A Specialty 25% N/A $80 N/A Coverage Gap Applies N/A No Gap N/A If you would like more information about the UnitedHealthcare Group Medicare Advantage plan or to receive a complete pre-enrollment plan guide, call UnitedHealthcare at , TTY 711, 8 a.m. 8 p.m. local time, seven days a week. Cigna Leon Medical Center Health Plans - Leon Cares (HMO) Miami-Dade County (See chart for available Medicare Advantage Plan by county of residence.) Benefit Zero Premium Medical HMO Annual Deductible $0 Annual Out-of-Pocket $3,400 Hospital Admit $0 Office Visit $0 Emergency Care $0 Outpatient Surgery $0 Generic $0 Brand $0 Specialty 33% Coverage Gap Applies If you would like more information about the Cigna Leon Medical Center Health Plans or have questions, please call Cigna Leon Medical Center Health Plans Member Services, at or toll-free or, for TTY users, 711, from 8:00 a.m. to 8:00 p.m., seven days a week. FLORIDA SCHOOL RETIREE BENEFIT CONSORTIUM REFERENCE GUIDE 11

6 FSRBC Medicare Supplement, Advantage and Prescription Drug Plans Medicare Advantage Plan Enrollment Options By County of Residence The table below details the Medicare Advantage Plans available by county. Plan options may vary by county and state. If you would like to enroll in one of the Medicare Advantage Plans or receive more information, please contact the appropriate provider. Contact information is available on page 8 of this guide. County/ Metro Area Zero / Low Premium Plan Plan 1 Plan 2 UHC Plan 3 Alachua $301 Baker $301 Bay $301 Bradford $301 Brevard / UHC $ $ $301 Broward $328 Calhoun $301 Charlotte $301 Citrus UHC $301 Clay UHC - $45 $312 Collier UHC $301 Columbia $301 DeSoto $312 Dixie UHC $301 Duval UHC $312 Escambia UHC-$25 $232 Flagler UHC $232 Franklin $232 Gadsden $328 Gilchrist $312 Glades $301 Gulf $312 Hamilton $312 Hardee $312 Hendry $328 Hernando UHC $312 Highlands $312 Hillsborough UHC $301 Holmes $301 Indian River UHC / $ $ $312 Jackson $312 Jefferson $328 Lafayette $ FLORIDA SCHOOL RETIREE BENEFITS CONSORTIUM REFERENCE GUIDE

7 Medicare Supplement, Advantage and Prescription Drug Plans 2015 Medicare Advantage Plan Enrollment Options By County of Residence The table below details the Medicare Advantage Plans available by county. Plan options may vary by county and state. If you would like to enroll in one of the Medicare Advantage Plans or recieve more information, please contact the appropriate provider. Contact information is available on page 8 of this guide. County/ Metro Area Zero / Low Premium Plan Plan 1 Plan 2 UHC Plan 3 Lake UHC $312 Lee UHC $301 Leon $328 Levy $301 Liberty $312 Madison UHC $312 Manatee UHC $301 Marion UHC $312 Martin UHC $328 Miami-Dade UHC-$45 / Cigna $328 Monroe $328 Nassau $301 Okaloosa $301 Okeechobee $312 Orange UHC $301 Osceola UHC $232 Palm Beach $328 Pasco UHC $312 Pinellas UHC $301 Polk UHC- $55 $301 Putnam $301 Santa Rosa $312 Sarasota UHC $301 Seminole UHC $301 St. Johns UHC $312 St. Lucie $312 Sumter UHC $312 Suwannee UHC $312 Taylor $232 Union $312 Volusia $232 Wakulla $312 Walton $301 Washington $312 FLORIDA SCHOOL RETIREE BENEFIT CONSORTIUM REFERENCE GUIDE 13

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