Welcome

2010Excellus BlueCross

BlueShield Medicare Plans Workshop

A nonprofit independent licensee of the Blue Cross Blue Shield Association

(Sales Rep’s Name)

Medicare Sales Consultant

Excellus BlueCross BlueShield contracts with the Federal government and is a Medicare Advantage Organization with a Medicare contract.

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Our Vision

“…to be a best in class Medicare Program, providing Medicare

beneficiaries with a range of products and services that meet their needs for

health coverage at an affordable price.”

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Agenda

Medicare Basics

Plan Options & Benefits

Valuable Extras

Enhanced Web Tools

Questions

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Medicare Basics

There are two parts to Original Medicare: Part A and Part B

Part A

Helps cover inpatient care in hospitals. Helps cover skilled nursing facility, hospice and home

health care.

You pay deductibles, coinsurance and copays.

You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working.

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Medicare Basics

Part B

Helps cover doctor’s services and outpatient care. Helps cover some preventive care.

With Part B you pay premium, deductible, coinsurance and copays. $96.40 monthly standard Medicare Part B premium generally

deducted from Social Security check $135 Part B annual deductible 20% coinsurance on most services

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Medicare Basics

Part C: Medicare Advantage Plans

Part D: Prescription Drug Plans

Medicare Supplement: Medigap Plans

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Your Plan Options

Medicare Supplement Plans (Medigap) Secondary payer to Original Medicare Do not include Part D Drug Coverage

• Can purchase Part D separately

Medicare Advantage Plans Medical Coverage with Part D Drug Coverage

(MA-PD) Medical Coverage without Part D Drug Coverage

(MA)

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What is a Medicare Supplement Plan? (Medigap)

A Medicare Supplement (Medigap) policy is designed to supplement the Original Medicare Plan

Fills gaps in Original Medicare

Medicare Part D drug coverage not included

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Medicare Supplement Plans (Medigap)

Plan A Basic benefits only

Plan B

Basic benefits

Part A deductible under Original Medicare Plan

Plan C

Basic benefits

Parts A & B deductibles under Original Medicare Plan

Foreign travel emergency

Skilled Nursing Facility (SNF) coinsurance

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Medicare Supplement Plans (Medigap)

Plan F / High Deductible F+

Basic benefits

Parts A & B deductibles under the Original Medicare Plan

Foreign travel emergency

Part B excess charges

Skilled Nursing Facility (SNF) coinsurance

F+ has $2,000 deductible (deductible subject to change annually)

Plan H

Basic benefits

Part A deductible under Original Medicare Plan

Skilled Nursing Facility (SNF) coinsurance

Foreign travel emergency

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How Do Medicare Advantage Plans Work?

Provides Part A (Hospital) and Part B (Medical) Benefits

You pay affordable copays/coinsurance

Offers extra benefits such as:• Vision Exam• Hearing Exam• Health and Wellness• Preventive Services

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Eligibility and Service Area

You are eligible to join one of our Medicare Advantage

HMO or PPO Plans if:

You have Medicare Part A (Hospital) and are enrolled in Medicare Part B (Medical)

You are a legal resident in the service area of the plan (includes: Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties, NY)

You do not have End-Stage Renal Disease (ESRD)

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Medicare Advantage Plan Enrollment Periods

Annual Enrollment Period (AEP) Runs from November 15 – December 31, each year Can change Medicare Advantage or stand-alone Prescription Drug

Plans Can add or drop prescription drug coverage Can return to Original Medicare Enrollment changes take effect on January 1

Open Enrollment Period (OEP) Runs from January 1 – March 31, each year Can change Medicare Advantage Plans Cannot add or drop prescription drug coverage One opportunity to change to a similar plan

(No-drug plan to no-drug plan – OR – drug plan to drug plan) Enrollment or disenrollment becomes effective the month after the

application is received

There are only certain times during the year when you may change or voluntarily end your membership in a Medicare Advantage or stand-alone Prescription Drug Plan.

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Initial Enrollment Period (IEP)3 months before you turn age 65 to 3 months after the month you turn age 65 If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability Can join a Medicare Advantage or stand-alone Prescription Drug PlanEnrollment changes take effect on the first day of your birth month

Special Enrollment Period (SEP)Change of residence into or out of the service areaLoss of employer coverageQualify for Low Income Subsidy

To obtain more information regarding Medicare Advantage Enrollment Periods you can contact our Customer Service Department at 1-877-883-9577. TTY/TDD 1-800-421-1220. Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are available weekends from 8:00 a.m. – 8:00 p.m.

Medicare Advantage Plan Enrollment Periods

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HMO vs. PPO

HMOHealth Maintenance Organization

PPOPreferred Provider Organization

Primary Care Physician (PCP) is required

Primary Care Physician (PCP) not required

Referral required to see a specialist No referral required to see a specialist

Must use In-Network providers(You must use plan providers except in cases such as emergency care, urgently needed care, or out-

of-area renal dialysis.)

Can use In-Network & Out-of-Network providers*

(Out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-

area renal dialysis)

*Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.

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Medicare Advantage Plan Options

HMO Plans Medicare Blue Choice ValueSM (HMO) Medicare Blue Choice Value PlusSM (HMO) Medicare Blue Choice OptimumSM (HMO) Medicare Blue Choice PlatinumSM (HMO)

PPO Plan Medicare Blue PPOSM Plan 201 (PPO)

For full information on our Medicare Blue Choice and/or our Medicare Blue PPO Plan benefits, call our Customer Service Department at 1-877-883-9577 or TTY/TDD 1-800-421-1220 Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

Our contract with CMS is renewed annually and the availability of coverage beyond the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2011. Please contact Excellus BlueCross BlueShield for details.

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Medicare Blue Choice ValueSM (HMO) $5.501

Benefit Medicare Blue Choice Value (HM0)

Inpatient Hospital Care(unlimited days each benefit period)

$500 copay for each Medicare-covered stay at a network hospital;

Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full

Primary Care Physician $20 copay per visit

Specialist $40 copay per visit

Outpatient Hospital Services 2 $0 - $125 copay per visit

Radiology 20% coinsurance

Outpatient Prescription Drugs3

(Part D)

Part D with $150 annual deductible; Before total annual drug costs reach $2,830, for each 30 day

supplyyou pay:$5 for Tier 1 generic drugs$30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred drugs25% coinsurance for Tier 4 specialty drugs

1 You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

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Medicare Blue Choice Value PlusSM (HMO)

$411

Benefit Medicare Blue Choice Value Plus (HM0)

Inpatient Hospital Care(unlimited days each benefit period)

$350 copay for each Medicare-covered stay at a network hospital;

Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full

Primary Care Physician $20 copay per visit

Specialist $35 copay per visit

Outpatient Hospital Services2 $0 - $100 copay per visit

Radiology 10% coinsurance

Outpatient Prescription Drugs3

(Part D)

Part D with $150 annual deductible; Before total annual drug costs reach $2,830, for each 30 day

supplyyou pay:$5 for Tier 1 generic drugs$30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs25% coinsurance for Tier 4 specialty drugs

1You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

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Medicare Blue Choice OptimumSM (HMO) $1011

Benefit Medicare Blue Choice Optimum (HM0)

Inpatient Hospital Care(unlimited days each benefit period)

$250 copay for each Medicare-covered stay at a network hospital;

Maximum 3 copays per year;4th and subsequent hospitalizations are covered in full

Primary Care Physician $15 copay per visit

Specialist $30 copay per visit

Outpatient Hospital Services2 $0 - $50 copay per visit

Radiology $30 copay

Outpatient Prescription Drugs3

(Part D)

Part D with $0 annual deductible; Before total annual drug costs reach $2,830, for each 30 day

supplyyou pay: $5 for Tier 1 generic drugs$30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs33% coinsurance for Tier 4 specialty drugs

1You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2 Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

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Medicare Blue Choice PlatinumSM (HMO) $611

1You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. See Summary of Benefits for more details.

Benefit Medicare Blue Choice Platinum (HM0)

Inpatient Hospital Care(unlimited days each benefit period)

$100 copay for each Medicare-covered stay at a network hospital;

Maximum 3 copays per year; 4th and subsequent hospitalizations are covered in full

Primary Care Physician $10 copay per visit

Specialist $25 copay per visit

Outpatient Hospital Services2 $0 - $35 copay per visit

Radiology $25 copay

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Medicare Blue PPOSM Plan 201 (PPO)

$361

Benefit In Network Out of Network

Inpatient Hospital Care

(unlimited days eachbenefit period)

$500 copay for each Medicare-covered stay at a network

hospital; Maximum 3 copays per year;4th and subsequent hospitalizations are covered in full

30% coinsuranceper visit

Primary Care Physician

$20 copay per visit $25 copay per visit

Specialist $40 copay per visit $45 copay per visit

Outpatient Hospital Services2 $0 - $125 copay per visit

30% coinsuranceper visit

Radiology 20% coinsurance 30% coinsurance

Outpatient Prescription

Drugs3

(Part D)

Part D with $150 annual deductible;Before total annual drug costs reach $2,830, for each

30 daysupply you pay:$5 for Tier 1 generic drugs$30 for Tier 2 preferred brand drugs $75 for Tier 3 non-preferred brand drugs25% coinsurance for Tier 4 specialty drugs

Emergency Benefit Only

1You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another 3rd party. 2Your cost share will be higher when the service performed is of a surgical nature or observation and the lower cost share is applicable when the service is non-surgical. 3 See Summary of Benefits for more details. When your total Part D drug costs reach $2,830, you pay 100% of the cost of your drugs. Once you or others on your behalf spend $4,550 in out-of-pocket costs, you then pay $2.50 for generics, and $6.30 for brand drugs or 5% of the price (whichever is greater). Copays based on getting 30-day supply; call us about reduced copays for mail order or a 90-day supply.

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Medicare Prescription Drug Plan (Part D)

2 ways to get Medicare Prescription Drug Coverage:

Join a stand-alone Medicare Prescription Drug Plan (PDP)

Join a Medicare Advantage Prescription Drug Plan (MA-PD)

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Medicare Prescription Drug Plan (Part D)Formulary List of drugs that are covered under your Part D drug plan To obtain a copy of our formulary go to our

Web site at www.excellusbcbs.com/medicare

Network About 60,000 pharmacies nationwide Retail, mail order, long term care, home infusion, Indian/Tribal/Urban

pharmacies included For additional information regarding our pharmacy network, quantity

limits or mail order prescription drug service call 1-800-659-1986. TTY/TDD 1-800-421-1220 Monday – Friday 8:00 a.m. – 8:00 p.m. From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

You may write to us at: Excellus BlueCross BlueShieldPO Box 546Buffalo, NY 14201

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use network pharmacies.

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Medicare Prescription Drug Plan (Part D)

You pay $2.50 for generics and $6.30 for brand name drugs, or 5% of the price (whichever is

greater)

Catastrophic Coverage

Excellus BlueCross BlueShield pays the balance

Coverage GapAll costs are out-of-pocket

You PayYour

copays/coinsurance

Initial Coverage PeriodExcellus BlueCross BlueShield pays the

balanceDeductible is out-of-pocket

$0 or $1502

Medicare Drug BenefitOut Of Pocket

4 Coverage PhasesCatastrophic Coverage begins when you or others on your behalf have spent $4,5501.

No coverage when total drug spend exceeds $2,8301 until your true out of pocket spending reaches $4,5501.

Initial Coverage starts after you have met your deductible, if applicable, and continues until your total drug costs reach $2,8301.

You must pay your deductible, if applicable, before you start getting your prescription drug coverage.

1 Coverage limits for all phases of the Part D benefit change annually.

2 Benefits, formulary, pharmacy network, premium, copayment/coinsurance may change on January 1, 2011. Contact Excellus BlueCross BlueShield for details.

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Prior Authorization In some cases, we require you to obtain prior

approval from us before you fill your prescription.

Step Therapy In some cases, we require you to first try certain

drugs to treat your medical condition before we will cover another drug for that condition.

Quantity Limits For certain drugs, we limit the amount of the drug

that we will cover per prescription.

Medicare Prescription Drug Plan (Part D)

Some prescription drugs may have additional requirements or limits.

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Medicare Prescription Drug Plan (Part D)

You may be able to get Extra Help to pay for your prescription drug premiums and costs.

To see if you qualify for getting Extra Help, call:1. 1-800-MEDICARE (1-800-633-4227), TTY/TDD users

should call 1-877-486-2048, 24 hours a day/7 days a week

2. The Social Security Office at 1-800-772-1213 between 7:00 a.m. – 7:00 p.m., Monday through Friday, TTY/TDD users should call 1-800-325-0778

3. Your State Medicaid office

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People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for:

seventy-five percent of drug costs including monthly prescription drug premiums,

annual deductibles, and co-insurance.

Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social

Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Medicare Prescription Drug Plan (Part D)

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Other Government Insurance

EPIC - Elderly Pharmaceutical Insurance Coverage

• New York State residents that are 65 or older, and have an annual income of $35,000 or less if single, or $50,000 or less if married

• New York State Department of Health:• www.health.state.ny.us/health_care/epic• 1-800-332-3742

Department of Veterans Affairs• Provides coverage to veterans• Call the VA in your area if you believe that you

may be eligible

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Medicare Blue Choice: Emergency: Nationwide and Worldwide Urgent Care: Nationwide Routine Care: Covered under the Travel Benefit

on Medicare Blue Choice Optimum (HMO) andPlatinum (HMO) plans.

Medicare Blue PPO: Emergency: Nationwide and Worldwide Urgent Care: Nationwide

Coverage While Traveling

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GoGetters® Flexible Fitness Benefit• Up to $650 per calendar year* • Qualified fitness facility membership fees • Qualified weight management program

membership fees• Included in Medicare Blue Choice (HMO) and Medicare Blue PPO plans

* This benefit does not cover any ancillary services or items that are not part of a membership fee.

Health and Wellness

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Blue365 offers access to savings and discounts on items that members may purchase directly from independent vendors. Blue365 may also be used in conjunction with the GoGetters® Benefit.

Fitness- save on membership, monthly fees and other services at Gold’s Gym®, Curves®, Snap FitnessTM and Global FitTM

Nutrition- Save on programs, products and consultations at eDiets®, Kronos Optimal Health® and Jenny Craig®

Elective procedures- Save on vision products and services at Davis Vision®, QualSight LASIK ®, LasikPlus® and TruVisionTM

Hearing aids- Save on products from BeltoneTM and TruHearingThe products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Excellus BlueCross BlueShield grievance process.Note: Not all vendors that have provided discounts for Blue365 are

qualified fitness facilities or weight management programs for purposes of our GoGetters®benefit.

Valuable Extras

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24-hour Personal Health Coaching Line Provides education and programs on

nutrition, weight management and much more.

Disease & Case Management Clinical staff work with you to make informed

choices on your health care and prescriptions.

Valuable Extras

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Our Enhanced Web site

Allows members and prospective members to:

Estimate annual costs Compare our plans Learn more about cost-cutting options Enroll online*

Enhanced Web Tools

www.excellusbcbs.com/www.excellusbcbs.com/medicaremedicare

…and more!

*Medicare beneficiaries may enroll in Excellus BlueCross BlueShield Medicare Advantage Plans through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov. For more information, contact Excellus BlueCross BlueShield at 1-800-659-1986, TTY/TDD 1-800-421-1220, 8:00 a.m. – 8:00 p.m., Monday – Friday. From November 15 – March 1, 8:00 a.m. – 8:00 p.m., 7 days a week.

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How to Enroll

Complete application form One application per person You must continue to pay your Medicare

Part B premium You may need to cancel your other

insurance carrier Effective date of coverage is determined

by enrollment period and when application is signed and received

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Why Excellus BlueCross BlueShield?

Power of Blue- One of the most recognized healthcare insurers

More than 3,000 Participating Providers

In business for over 70 years

Offering plans that fit your needs and budget

Commitment to our local community

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How to Contact us

Call us:Medicare Sales Representative:

• 1-800-659-1986 TTY/TDD 1-800-421-1220• Monday – Friday 8:00 a.m. – 8:00 p.m.

From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

For full information on our Medicare benefits call a Medicare Customer

Service Representative:• 1-877-883-9577 TTY/TDD 1-800-421-1220• Monday – Friday 8:00 a.m. – 8:00 p.m.

From November 15 – March 1, representatives are also available weekends from 8:00 a.m. – 8:00 p.m.

Write us:• Excellus BlueCross BlueShield P.O. Box 546

Buffalo, NY 14201

Visit us on the Web at www.excellusbcbs.com/medicare

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Important Numbers

Centers for Medicare & Medicaid Services (CMS)• 1-800-633-4227 • TTY/TDD 1-877-486-2048• 24 hours a day, 7 days a week• www.medicare.gov

To apply for Low Income Subsidy• Social Security Administration:1-800-772-1213 • TTY/TDD 1-800-325-0778• Monday – Friday 7:00 am – 7:00 pm• www.ssa.gov

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Questions ?

Thank You!

H3351, H3335 1774_0 (10/2009)