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Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutionsMedicare 101Understanding your Medicare optionsBrought to you by Aetna

1. Medicare Parts A - DToday’sagenda2. Government andprivate plans3. Your options4. Prescription drugs5. Medical SupplementalInsurance6. Next stepsAetna Inc.

1CHAPTERLet’s start atthe beginning.Medicare partsA DAetna Inc.

Medicare has four parts:A, B, C and D.Aetna Inc.4

ABPARTCovers hospital insurance.HOSPITAL CAREPARTCovers medical insurance.Like doctor visits.MEDICAL CAREAetna Inc.5

ABPARTHOSPITAL CAREPARTThese are called“Original Medicare.”They are administeredand provided by thefederal government.MEDICAL CAREAetna Inc.6

ABPARTMedicare is healthinsurance for: People 65 or olderHOSPITAL CARE People under 65 withcertain disabilitiesPART People of any age with EndStage Renal Disease (ESRD)(permanent kidney failurerequiring dialysis or akidney transplant)MEDICAL CAREAetna Inc.7

CPARTThen there’s Part C.This is called MedicareAdvantage.MEDICARE ADVANTAGEAetna Inc.8

CPARTYou can buy Part C(Medicare Advantage) fromprivate insurance companies.MEDICARE ADVANTAGEAetna Inc.9

CPARTMEDICARE ADVANTAGEMedicare Advantagecombines Parts A and B andmay even offer prescriptiondrug coverage.It can include additional benefits like eye care,hearing, wellness services, or anurse phone line.Aetna Inc.10

CPARTMEDICARE ADVANTAGEYou can buy a MedicareAdvantage Plan (Part C) if you: Are enrolled in Parts A and B.Live in the plan’s service area.Do not have end-stage renal disease(some exceptions apply)Aetna Inc.11

DPARTPRESCRIPTION DRUGSThen there’s Part D.It helps pay for prescription drugs.It is only offered through privateinsurance companies.We’ll talk more about Part D later.Aetna Inc.12

The four parts of Medicare.A CB DPARTGovernmentprogramsPARTHOSPITAL CAREMEDICARE ADVANTAGEPARTPARTMEDICAL CAREPrivatemedicalplansPrivate drugplansPRESCRIPTION DRUGSAetna Inc.13

2CHAPTERGovernmentand private plansWhy can’t I justrely on Parts A and B –what the governmentpays for?Aetna Inc.

You can rely on Parts A and B, butit only pays about 80 percent ofyour health care costs.It covers hospital and doctor visits, along withsome drugs. Aetna Inc.15

Part C, a MedicareAdvantage plan,will help youcover costs like: DeductiblesCopays and coinsuranceMost drugsPreventive servicesDental and vision(sometimes)Aetna Inc.16

So what’s thebottom line? Part C, or MedicareAdvantage -helps you payfor what OriginalMedicare and Part Ddon’t. There are many choicesin the marketplace. We can help youweigh your options.Aetna Inc.

3CHAPTERYour optionsHow to decide whichMedicare optionis right for youAetna Inc.

Questions to considerwhen choosing yourMedicare options1. Do I have a chroniccondition?2. What monthlypremium can I afford?3. Can I see the doctors Iwant?Aetna Inc.19

And what about yourprescription drugs?4. Will my prescription drugsbe covered?5. What will my out-of-pocketcosts be?6. Can I use the pharmaciesI want?Aetna Inc.20

You have 2 paths to choose from.MedicarePart A: HospitalPart B: MedicalPart D: A separatedrug plan – if you buy it.Supplemental insurance –if you buy it.MedicareAdvantageCombines Part A: Hospitaland Part B: MedicalIt usually includes adrug plan.Medicare Part D:You can buy it if it is notincluded in the MedicareAdvantage plan.Aetna Inc.21

You have 2 paths to choose from.MedicarePart A: HospitalPart B: MedicalPart D: A separatedrug plan – if you buy it.Supplemental insurance –if you buy it.MedicareAdvantageCombines Part A: Hospitaland Part B: Medical.It usually includes adrug plan.Medicare Part D:You can buy it if it is notincluded in the MedicareAdvantage plan.Aetna Inc.22

If you choose Medicare Advantage.Here are two options:A HealthMaintenanceOrganization(an HMO)A PreferredProviderOrganization(a PPO)Aetna Inc.23

If you choose Medicare Advantage.Here are two options:A HealthMaintenanceOrganization(an HMO)A PreferredLet’s take anProviderHMO first.Organization You’ll use(adoctorsinPPO)the network. You might need areferral to see a specialist.Aetna Inc.24

If you choose Medicare Advantage.Here are two options:A HealthNow let’sMaintenancelook at a PPO.OrganizationYou canuse doctors(anHMO)and hospitals outsideof the network, butoften for a higher copay.A PreferredProviderOrganization(a PPO)Aetna Inc.25

Let’s look atwhat a MedicareAdvantageplan can helpyou pay forand what OriginalMedicaredoes not pay for.Aetna Inc.

What Medicare Advantage can helpyou pay for 1,316 164.50 183Per dayPart AdeductibleSkilled nursingfacility copayfor days 21through 100AnnualPart Bdeductible20%Coinsurancefor covereddoctorservicesAetna Inc.27

Depending on the plan, MedicareAdvantage can help you pay for otherthings. Emergencymedicalcare outsidethe U.S.AnnualhearingexamsEyewear andhearing aidsPart DprescriptiondrugsOut-of-pocketmedical costsannual limitAetna Inc.28

4CHAPTERPrescription drugsNow let’s look atPart D – the drug plan.Aetna Inc.

Here’s how Part D works.You buy this in addition to Parts A and/or B.You have 2 choices.Stand-aloneMedicarePrescriptionDrug Plan (PDP)A Medicare AdvantagePlan that comeswith prescription drug(Part D) coverageAetna Inc.30

Have youheard aboutthe “donuthole”?Aetna Inc.31

Here’s how it works.You have four coverage levels.Phase 1Phase 2Phase 3Phase 4You payuntil youreach yourdeductible.Your Part Dinsurance paysuntil 3,700 inTotal Part Ddrug spendingis reached.Once 3,700 isreached, you arein the coveragegap until yourexpenses reach 4,950. This isthe “donut hole.”After 4,950 you pay thegreater of 5%or 3.30 forgenerics and 8.25 for allothers drugs.Aetna Inc.32

5CHAPTEROk, just one more typeof insurance to go.MedicareSupplementalInsuranceAetna Inc.

You have 2 paths to choose from.OriginalMedicarePart A: HospitalPart B: MedicalPart D: A separatedrug plan – if you buy it.Supplemental insurance –if you buy it.Sometimesit’sMedicarecalledAdvantageMed Supp orMedigap.Combines Part A: HospitalPartB: Medical.Youandmaywantto considerthisItifusuallyyou chooseOriginalincludesaMedicare.drug plan.It helpscoverPartthe gapsMedicareD: of whatOriginaldoesn’tif it isMedicarenot included.cover — such as portions ofcoinsurance, copayments anddeductibles.Aetna Inc.34

You have 2 paths to choose from.OriginalMedicarePart A: HospitalPart B: MedicalPart D: A separatedrug plan – if you buy it.Supplemental insurance –if you buy it.MedigapplansMedicareare healthinsuranceAdvantagepolicies sold by privateCombinesPart A: Hospitalinsurancecompanies.and Part B: Medical.They help cover medical benefitIt usually includes a“gaps,” such as Parts A and Bdrug plan.deductibles and coinsurance.MedicarePart D:Part DTheydo not includeif itis not includedinthatthedrugcoverage– you buyMedicare Advantage plan.separately.They cover visits to anydoctor who accepts Medicare.Aetna Inc.35

6CHAPTERNext stepsBringing it all togetherAetna Inc.

Step 1Enroll in Medicare Part A and Part Bwhen you are first eligible.Aetna Inc.37

Step 2Now you have two ways to proceed.Option 1Option 2Keep OriginalMedicare and add:Buy a MedicareAdvantage Plan Medicaresupplementinsurance Medicare Part DThis combines MedicareParts A & B andoften Part Dand additional benefits.Aetna Inc.38

Now that Iunderstand myMedicareoptions, whencan I enroll?Aetna Inc.

ABPARTHOSPITAL CAREPARTHow do I enroll in Part Aand Part B?If you are getting Social Securitywhen you turn 65, you willautomatically be enrolled.If you’re not getting Social Securitywhen you turn 65, you’ll need to signup. Contact Social Security threemonths before you turn 65. If youworked for a railroad, contact theRailroad Retirement Board.Note: People on social securitydisability will automatically be enrolledin their 25th month of disability.MEDICAL CAREAetna Inc.40

ABPARTHOSPITAL CAREPARTWhen can I enroll inPart A & Part B?It’s a seven-month window.It includes the three months beforeyou turn 65, your birthday monthand the three months after your65th birthday.What if I don’t enrollwhen I am first eligible?You may have to pay a penaltyin the form of a higher premium.MEDICAL CAREAetna Inc.41

CDPARTMEDICARE ADVANTAGEPARTWhen can I first enroll inParts C and D?It’s the same “seven-month window”as Part B:It includes the three monthsbefore you turn 65, your birthdaymonth and the three months afteryour 65th birthday.PRESCRIPTION DRUGSAetna Inc.42

CDPARTMEDICARE ADVANTAGEPARTAre there other times I canenroll in Parts C and D?From October 15 to December 7,all people with Medicare can changetheir health care plans.You can switch to Medicare Advantageduring this Open Enrollment period, joina Medicare Prescription Drug Plan orchange plans.PRESCRIPTION DRUGSAetna Inc.43

CDPARTMEDICARE ADVANTAGEPARTYou can also enroll inParts C and D during a “specialenrollment period” forspecial circumstances such as:Losing your employer coverageMoving to a new service areaBeing assigned to a MedicarePrescription Drug plan by thegovernmentPRESCRIPTION DRUGSAetna Inc.44

CDPARTMEDICARE ADVANTAGEPARTWhat if I am latein signing up for Part D?You may face a lateenrollment penalty.It increases based on eachmonth that you delay.This can get costly.PRESCRIPTION DRUGSAetna Inc.45

When can I enroll in a Medicaresupplement plan?In most states, it’s a six-month window thatstarts when you turn 65 and enroll in Part B.What if I delay enrollment?You may join any plan. You can’t bedenied coverage due to a pre-existingcondition if you enroll during openenrollment. You may be deniedcoverage for a pre-existing condition, ifyou miss the enrollment period and tryto apply later.Aetna Inc.46

Important datesand instructions.Enroll in a Medicare planduring open enrollmentOctober 15 – December 7Here’s how:www.medicare.govor call 1-800-MEDICARETTY 1-877-486-2048,24 hours a day, 7 days a weekAetna Inc.

Thank youAetna Inc.