Medicare coverage options

MULTIPLAN_19_598A_M Approved 09302019

Effective as of July 1, 2020

What is Medicare? Your Medicare coverage choices at a glance

Medicare prescription drug coverage (Part D) What it is and how it works

Blue Shield Medicare Advantage HMO and PPO plans Blue Shield 65 PlusSM (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield Inspire (HMO), Blue Shield Vital (HMO), Blue Shield Trio Medicare (HMO) and Blue Shield Medicare (PPO)

Medicare Supplement plans (Medigap) What they are, buying plans, switching plans, and what’s not covered

Blue Shield Medicare Supplement plans What sets us apart

Blue Shield Medicare Prescription Drug Plans What Blue Shield offers

Agenda

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What is Original Medicare?• Health insurance for people age 65 or

older; people under age 65 with certain disabilities; people of any age with end-stage renal disease (ESRD)

• Helps cover out-of-pocket expenses on certain services

• You can go to any doctor or hospital that accepts Medicare

Medicare

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The different parts of MedicareMedicare Part A (hospital insurance) – automatic

• Helps cover inpatient care in hospitals

• Helps cover skilled nursing facility, hospice, and home health care

Medicare Part B (medical insurance) – requires a premium

• Helps cover physician services, hospital outpatient care, and home health care

• Helps cover many preventive services to help maintain your health and to keep certain illnesses from getting worse

Medicare Part C (also known as Medicare Advantage)

• Offers health plan options run by Medicare-approved private insurance companies like Blue Shield of California

• Combines benefits and services covered under Part A and Part B, and often Part D; some also include extra benefits

Medicare Part D (Medicare prescription drug coverage)

• A prescription drug option run by Medicare-approved private insurance companies like Blue Shield of California

• Helps cover the cost of prescription drugs

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Original Medicare Part A & Part B does not cover(not a complete list)

Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless:

• You have other insurance that covers them

• You have a Medicare health plan that covers them

Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.

Some of the items and services that Medicare doesn’t cover include:

• Long-term care (also called custodial care)

• Most dental care

• Eye exams related to prescribing glasses

• Dentures

• Cosmetic surgery

• Acupuncture

• Hearing aids and exams for fitting them

• Routine foot care

For more informationTo learn more about Medicare, the different parts of Medicare, and Medicare enrollment periods, visit https://www.medicare.gov/what-medicare-covers/whats-not-covered-by- part-a-part-b, and read the Medicare & You handbook. You can also call (800) MEDICARE [(800) 633-4227], 24 hours a day/seven days a week. TTY users should call (877) 486-2048.

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Your Medicare coveragechoices at a glanceThere are two main ways to get your Medicare coverage: Original Medicare, which can be supplemented by a Medicare Supplement plan, or a Medicare Advantage Plan.

Original Medicare• Original Medicare includes Medicare Part A (hospital

insurance) and Part B (medical insurance).

• If you want drug coverage, you can join a separate Part D plan.

• To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage.

Part A

Part B

You can add:

Part D

You can also add:

Supplemental coverage (Some examples include coverage from a Medicare Supplement Insurance [Medigap] policy, or coverage from a former employer or union.)

Medicare Advantage (also known as Part C)• Medicare Advantage is an “all in one” alternative to

Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

• Some plans may have lower out-of-pocket costs than Original Medicare.

• Some plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.

Part A

Part B

Most plans include:

Part D

Some plans also include:

Lower out-of-pocket costs

Extra benefits

Source: 2020 Medicare & You handbook, www.medicare.gov.

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1 Basic gym access is not included as part of the Blue Shield Vital (HMO) plan benefits in Los Angeles, Orange, San Bernardino and Riverside counties.

2 Every year, Medicare evaluates plans based on a 5-star rating system.

Blue Shield Medicare Advantage HMOs and PPOPart CEffective January 1, 2020

Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield Inspire (HMO), Blue Shield Vital (HMO),1 Blue Shield Trio Medicare (HMO), and Blue Shield Medicare (PPO)• Plans include Part A (hospital insurance),

Part B (medical insurance), and Part D prescription drug coverage (a separate Medicare Prescription Drug Plan is not necessary).

• You must use plan doctors, hospitals, and other providers except in certain situations. We have a large network of primary care physicians and specialists, so chances are you can keep seeing your doctor.

• Plan premiums vary by county (you must continue to pay Medicare Part B premium).

• There is a yearly cap on how much you will spend on Part A and Part B services (amount varies by plan and service area).

• Includes extra benefits like vision coverage and basic gym access1 at no additional cost.

Blue Shield has a 4-Star CMS rating for our Medicare Advantage plans in 2020.2

Let’s go through the Summary of Benefits to learn about the benefits for the plan(s) available in this area.

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Medicare Supplement plans(also known as Medigap)

• You must have both Medicare Parts A and B.

• Standardized plans with varying benefits.

• Designed to cover the gaps of Original Medicare, including some deductibles and coinsurance of Medicare-allowed amounts for covered healthcare expenses.

• Offered by private health plans like Blue Shield of California.

• Freedom to choose any medical doctor or hospital that accepts Medicare anywhere you travel in the United States.

• You must pay monthly plan premiums in addition to Medicare Part B premium.

• Regular Medicare Supplement plan designs do NOT include: Part D prescription drug coverage, routine vision care, routine dental care, and hearing aids.

PPO

Medicare Supplement

Plan FPart B Deductible Y

MemberJohn DoeID#XEAJ12345678

Group# X0001002Effective 09/01/2016

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Medicare Supplement plan enrollment tips• A great time to enroll in a Medicare

Supplement plan is when you are new to Medicare. You have six months to enroll when you are new to Medicare Part B and will qualify for “guaranteed acceptance” – meaning you don’t need to answer health questions or go through medical underwriting.

• You may enroll in a Medicare Supplement plan if you are 65 or older and leaving an employer-sponsored health plan with guaranteed acceptance.

• If you joined a Medicare Advantage Plan when you first became eligible for Medicare and disenrolled within 12 months, you have guaranteed acceptance.

• Other guaranteed acceptance scenarios include moving to a different state, losing employer coverage, and losing your Medicare Advantage Plan, among others. Refer to the Blue Shield Guaranteed Acceptance Guide, blueshieldca.com/medicare. Click Medicare Supplement plans and scroll to the bottom of the Overview page.

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1 Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. The Welcome to Medicare Rate Savings do not apply to Plan N.

2 Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).

Why choose a Blue Shield Medicare Supplement plan?We are a California-based, nonprofit plan with 80 years of experience providing Californians like you with access to high-quality health care at an affordable price.

• A diverse range of Medicare Supplement plans to choose from

• SilverSneakers fitness membership nationwide included

• NurseHelp 24/7SM advice phone line and online instant messaging service available

• Outstanding customer service

• Many ways to save, including the Welcome to Medicare Rate Savings1

• Convenience of adding other types of coverage:

– Medicare Part D Prescription Drug Plans

– Two dental PPO plans and one combination PPO dental + vision care package2 to choose from that are specifically designed for Blue Shield Medicare Supplement plan members

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1 Vision benefits have limited access outside of California.

2 One-time use per quarter allowance.

Blue Shield of CaliforniaMedicare Supplement Plan G ExtraEffective January 1, 2020

Our newest Medicare Supplement Plan G Extra offers everything our standard Plan G covers, plus some additional benefits, and includes:

• Vision benefits including coverage for the cost of eye exams, frames, eyeglass lenses, or contact lenses that are not traditionally covered by Original Medicare1

• Hearing aid benefits including annual hearing test and coverage for Vista brand mid-level and premium-level hearing aids

• Physician consultation benefits available by phone or video via computer or mobile app

• Over-the-counter (OTC) items benefits that provide a one-time per use quarterly allowance for eligible OTC products such as cold and allergy medicines, first-aid supplies, pain relievers, and more2

• SilverSneakers fitness membership nationwide

• Coverage for Medicare Part A deductible

• Skilled nursing facility care

• Foreign travel emergencies

• 100% coverage of Medicare Part B excess charges

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Blue Shield of CaliforniaMedicare Supplement plans Effective January 1, 2020

If a check mark appears in a plan’s column below, that plan covers 100% of the described benefit. If a column lists a number, the plan covers that percentage of the benefit. If a column is blank, the plan doesn’t cover that benefit.

Medicare Supplement benefits Plan A Plan N Plan G Plan G Extra Plan F Extra1

Medicare Part A coinsurance hospital cost up to an additional 365 days after Medicare benefits are used up

Medicare Part B coinsurance or copayment 2

Blood (first 3 pints)

Part A hospice care coinsurance or copayment

Skilled nursing facility care coinsurance

Medicare Part A deductible

Medicare Part B deductible

Medicare Part B excess charges

Foreign travel emergency (up to plan limits)

NurseHelp 24/7SM

Basic gym access through SilverSneakers

Vision benefits3

Hearing aid services

Personal Emergency Response System (PERS)

Physician consultation benefits

Over-the-counter (OTC) items benefits4

1 Plan F Extra is only available to applicants who attained age 65 before January 1, 2020 or first became eligible for Medicare benefits due to disability before January 1, 2020.

2 Except up to $20 per office visit and up to $50 per emergency room visit.

3 Vision benefits have limited access outside of California.

4 One-time use per quarter allowance for eligible items.

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1 Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber. The Welcome to Medicare Rate Savings do not apply to Plan N.

2 The Household Savings Program does not apply to tobacco users and is not available to those age 64 or younger.

More reasons to selectBlue Shield of California $25 Welcome to Medicare Rate Savings

You can save $25 each month for the first 12 months of coverage in a Blue Shield Medicare Supplement plan if you’re 65 or older and we receive your application within six months of the date you first enrolled in Part B.1

New member dental or dental + vision plan savings

You can save $3 each month for the first six months on your dental or dental + vision plan rates if you enroll in a dental or dental + vision plan at the same time you enroll in any Blue Shield Medicare Supplement plan.1

Household Savings

If you and another member of your household are both interested in enrolling in the same plan type, you could save 7% off the combined individual plan rates for both members of your party through our Household Savings Program.1,2

Easy$PaySM

Save $3 per month by paying your monthly dues through automatic checking or savings account debits.1

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1 Participating locations (“PL”) are not owned or operated by Tivity Health, Inc. or its affiliates. Use of PL facilities and amenities is limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL.

2 Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes vary by location.

* At-home kits are offered for members who want to start working out at home or for those who can’t get to a fitness location due to injury, illness, or being home-bound.

SilverSneakers FitnessSilverSneakers is a fitness and lifestyle benefit included with your Blue Shield of California health plan at no additional cost.

What does SilverSneakers include?

• Memberships to thousands of participating locations nationwide1 – visit as many as you wish!

• Group exercise classes2 designed for all abilities. Fun activities held outside the gym.*

• SilverSneakers On-DemandTM online workout videos that feature tips on fitness and nutrition

• SilverSneakers GOTM mobile app with workout programs, location finder, and more

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Blue Shield’s Medicare Supplement plan rates for ages 65 to 66 Effective July 1, 2020

Single-party, non-tobacco monthly rates.1 For rates for other age bands and other regions, see the rate tables in your presale kit.

Plans: A N G Plan G Extra F Extra2

Region 1 – Los Angeles County except ZIP Codes 91711, 91759, 91765, 91766, 91767, 93535, 93544, 93563, and 93591 – Ages 65-66

$97 $133 $110 $124 $146

Region 2 – Orange County – Ages 65-66 $97 $133 $113 $127 $150

Region 3 – San Diego, Sonoma, San Bernardino, Kern counties, and LA ZIP Codes 91711, 91759, 91765, 91766, 91767, 93535, 93544, 93563, and 93591 – Ages 65-66

$91 $123 $100 $114 $134

Region 4 – Riverside and Ventura counties – Ages 65-66 $102 $137 $117 $131 $156

Region 5 – San Joaquin, Santa Barbara, and Stanislaus counties – Ages 65-66 $83 $114 $90 $104 $122

Region 8 – Includes San Francisco, San Mateo, Fresno, and Santa Clara counties – Ages 65-66 $82 $114 $90 $104 $122

Region 9 – Sacramento, Amador, Calaveras, Colusa, El Dorado, Tehama, and Marin counties – Ages 65-66 $80 $119 $95 $109 $128

1 These rates include the $25 Welcome to Medicare Rate Savings that would apply to the first 12 months of your enrollment and the $3 Easy$Pay monthly savings. The $25 Welcome to Medicare Rate Savings do not apply to Plan N. These rates do not include the new member dental or dental + vision plan savings of $3 each month for the first six months of enrollment.

2 Plan F Extra is only available to applicants who attained age 65 before January 1, 2020 or first became eligible for Medicare benefits due to disability before January 1, 2020.

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1 Does not apply to Blue Shield Rx Plus (PDP) Tier 1 Preferred Generic Drugs

2 Does not apply to all tiers.

Blue Shield of California Medicare Part D Prescription Drug Plans Effective January 1, 2020 through December 31, 2020

Complement your Blue Shield Medicare Supplement coverage with a Part D Prescription Drug Plan by adding one of three PDP plans.

Blue Shield Rx Plus (PDP)

• Reduced rate! $40.70 monthly premium

• $435 annual deductible1

• Lower cost-sharing than our Blue Shield Rx Enhanced (PDP) plan2

Blue Shield Rx Enhanced (PDP)

• $118.40 monthly premium

• $0 annual deductible

• Blue Shield Rx Enhanced (PDP) includes some drugs not on the Blue Shield Rx Plus (PDP) formulary

• You may want to consider this option if you take drugs on the Blue Shield Rx Enhanced (PDP) formulary and don’t want an annual deductible

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Blue Shield of California Medicare Part D Prescription Drug Plans (continued)

Effective January 1, 2020 through December 31, 2020

SilverScript Choice (PDP)

• $30.50 monthly premium (must continue to pay Part B premium)

• $230 annual deductible1

• Some coverage through the coverage gap

• SilverScript® is one of America’s largest2 standalone Medicare Part D prescription drug plan sponsors

• More than 28,000 preferred cost-sharing pharmacies including CVS Pharmacy® and Walmart, and 37,000 standard cost-sharing pharmacies including Walgreens, and Costco3

• You can join the 6 million beneficiaries nationwide who have chosen SilverScript to help protect their savings against the high cost of prescriptions2

1 Tier 1 and Tier 2 are excluded.

2 CMS, Monthly Enrollment by Plan report as of February 2020. http://go.cms.gov/mapddata.

3 According to CVS Health, http://www.silverscript.com/pharmacy-locator.aspx

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Other pharmacies are available in our network.

1 As of August 2018.

Blue Shield of California Medicare Part D Prescription Drug Plans (continued)

All Blue Shield Medicare Prescription Drug Plans

• You can choose to get your prescriptions filled at more than 6,000 network pharmacies contracted with Blue Shield.1

• You pay less at network pharmacies that offer preferred cost-sharing than you do at network pharmacies that offer standard cost-sharing.

• Receive a 90-day supply of covered drugs for the cost of two 30-day supplies for Tiers 1 to 3 when filled at a network pharmacy that offers preferred cost-sharing or through our mail service pharmacy. (Note: For Tiers 4 and 5, members are responsible for the applicable coinsurance. Tier 5 Drugs are available only at a 30-day supply.)

Pharmacies that offer preferred cost-sharing include: Costco

CVS Pharmacy (including CVS Pharmacy at Target)

Safeway and Vons

Albertsons/Sav-on/ Osco

Ralphs, Walmart

And many more

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Dental plans at a glance for Medicare Supplement plan subscribers* Effective April 1, 2020

This chart is only an at-a-glance summary. For a complete list of the benefits, exclusions, and limitations, please refer to the Evidence of Coverage and Health Service Agreement.

Plan type Dental PPO 1000 Dental PPO 1500Specialty DuoSM dental PPO + vision package1,2

Monthly plan premium $32.10 $49.80 $55.40

Calendar-year deductible $75 $50 $50

Calendar-year maximum $1,000 $1,500 $1,500

Dental benefits using network dentists

Diagnostic and preventive care for annual exam and six-month checkup3 Plan covers 100% Plan covers 100% Plan covers 100%

Basic services4 Plan covers 50% Plan covers 80% Plan covers 80%

Major services5 Plan covers 50% Plan covers 50% Plan covers 50%

1 The Specialty Duo package includes a vision benefit that covers certain costs Original Medicare does not cover. Plan includes $0 copayment annual eye exam, $25 copayment for lenses and low-vision aids, and $100 frame allowance. Please note that Plan F Extra and Plan G Extra already include vision benefits.

2 The Specialty Duo package is underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life). Specialty Duo vision plan is administered by MESVision, Inc.

3 Deductible does not apply to diagnostic and preventive services including oral exam, X-rays, and cleanings.

4 Deductible applies to basic services including anesthesia, palliative treatment, and minor restorative dentistry.

5 Six-month waiting period for major dental services applies to Dental PPO 1000; twelve-month waiting period for major dental services applies to Dental PPO 1500 and Specialty Duo dental + vision. Deductible applies to major services including endodontics, periodontics, oral surgery, crowns, bridges, and dentures.

* Dental benefits have limited access outside of California.

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Three sample monthly cost summariesMedicare Supplement Plan G Extra $__________________

Blue Shield Rx Plus (PDP) $40.70

Dental PPO 10001 $32.10

TOTAL monthly cost2 $__________________

Medicare Supplement Plan N $__________________

Blue Shield Rx Plus (PDP) $40.70

Dental PPO 10001 $32.10

TOTAL monthly cost2 $__________________

Blue Shield Medicare Advantage Plan (Medicare Advantage HMO) $__________________

TOTAL monthly cost2 $__________________

1 These rates do not include the new member dental or dental + vision plan savings of $3 each month for the first six months of enrollment.

2 Costs reflect monthly plan dues and premiums only. Does not include monthly Part B premium. Does not include any deductibles that you may need to meet before coverage begins.

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Q & A

Blue Shield of California is an HMO, PPO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Not all plan types are available in all areas.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/seven days a week;

• The Social Security office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or

• Your Medicaid office.

SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. SilverSneakers On-Demand and SilverSneakers GO are trademarks of Tivity Health, Inc. © 2020 Tivity Health, Inc. All rights reserved.

NurseHelp 24/7 and Specialty Duo are service marks of Blue Shield of California.

Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad.

Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性 別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。SilverScript Choice is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. SilverScript Insurance Company is an independent company whose products and services are not Blue Shield of California products and services. SilverScript Insurance Company is solely responsible for this prescription drug coverage.

SilverScript Insurance Company complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

SilverScript Insurance Company cumple con las leyes federales sobre derechos civiles y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

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Contact us

Call 8 a.m. to 8 p.m., seven days a week from October 1 through March 31, and 8 a.m. to 8 p.m., weekdays from April 1 through September 30.