1. WELCOME.
2018
H9808_18_20

2. You have questions…and we have answers.
TODAY’S DISCUSSION
LET’S TALK MEDICARE
Medicare Questions? Answered.
Your Needs. Your Decision.
Medicare Advantage – HealthTeam Advantage.
Enrollment.
You have questions…and we have answers.
We want to hear from you so don’t hesitate to ask questions throughout the presentation. 1

3. Let’s talk Medicare! Who we are Enrollment Eligibility
The ABCs (and Ds) of Medicare
Medicare Advantage
HealthTeam Advantage Plans
Your Medicare Options
Enrollment 2

4. Who we are
HealthTeam Advantage is an affordable alternative to Medicare Supplement insurance that offers Medicare Advantage Plans starting at $0 monthly premium. Our goal is to assist our members in living healthier and happier lives.
HealthTeam Advantage (HTA) is a doctor-directed, local Medicare Advantage option for residents in the Piedmont Triad area. The Moses Cone System is the parent company of HealthTeam Advantage with the HTA office located in Greensboro, NC. 3

5. The ABCs of Medicare Part A Part A of Medicare covers hospital stays
Part B of Medicare covers doctor’s visits
in most cases has a monthly premium
Part B
Part D
Part D of Medicare covers prescription drugs 4

6. The ABCs of Medicare (cont.)
Part C
Part C of Medicare is a Medicare Advantage Plan. It covers Parts A, B, and sometimes Part D of Medicare.
Medicare Part C plans are commonly referred to as Medicare Advantage (MA) plans.
Private insurance companies contracted with Medicare provide this coverage.
Most plans offer health and drug coverage, as well as extra benefits.
Medicare pays Medicare Advantage Plans a set amount every month for your health plan needs.
MA plans must offer all of the current benefits offered through Medicare, and can include prescription drug coverage (Part D).
Most Medicare Advantage plans have lower out-of-pocket costs than Original Medicare and Supplement plans. 5

7. NO MAXIMUM OUT OF POCKET, NO DRUG COVERAGE
Original Medicare
Part A - Inpatient Hospital
Part A Deductible (per benefit period) $1, (per event)
Days $0
Days $ (per day)
Days (lifetime reserve days) $ (per day)
Days You pay 100% of cost
Part A - Skilled Nursing Facility
Days $0 (per day)
Days $ (per day)
Days You pay 100% of cost
Part B - Coverage
Part B Deductible $ (annually)
After Deductible Medicare Pays 80% - You pay 20%
NO MAXIMUM OUT OF POCKET, NO DRUG COVERAGE 6
Costs shown for 2017 Medicare Guidelines

8. MEDICARE OPTIONS Original Medicare Only
Original Medicare + Part D Drug Plan
Original Medicare + MedSupplement
Original Medicare + MedSupplement + Part D Drug Plan 7

9. Part D Important Reminders
Failure to Enroll in a Part D Plan or Maintaining credible coverage will result in a late enrollment penalty in the future.
Some drugs have special requirements such as Step Therapy, Quantity Limits, and Prior Authorization.
You may qualify for “Extra Help” in paying for Rx Drugs.
Part D Plans Include a Coverage Gap where you may be responsible for much of the cost of your Prescription Medications. 8

10. Costs shown for 2017 Medicare Guidelines
Medicare Supplements (Medigap Plans)
Designed by CMS to provide specific benefits to fill the “gaps” of Medicare.
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you’re responsible for the rest. 9
Costs shown for 2017 Medicare Guidelines

11. Initial Enrollment Period10

12. Eligibility Requirements
Original Medicare
Medicare Supplement
Entitled to Part A.
Must enroll into Part B and pay any required Part B Premiums.
No underwriting questions, if enrolled during initial enrollment period.
Must pass underwriting questions after initial enrollment period.
No drug coverage included.
Must purchase a stand-alone Part D plan if you want Rx Coverage. 11

13. Medicare Advantage
IMPORTANT POINTS & COMMON MISCONCEPTIONS
Medicare Advantage plans are contracted through the Centers for Medicare and Medicaid Services (CMS).
You are still a part of Medicare.
You receive the same benefits offered under Original Medicare.
Medicare Advantage plans are NOT Medicare Supplement Plans. Medicare Supplements are additional insurance products purchased to work with Original Medicare.
Private companies will pay for your health care services, not Medicare. 12

14. 1 2 3 Medicare Advantage Plans HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization) 3
PFFS (Private Fee-For-Service)
Plus Part D Medicare prescription drug coverage as part
of a Medicare Advantage Prescription Drug (MAPD) Plan 13

15. Are you eligible for Medicare Advantage?
You must:
Be entitled to Medicare Part A
AND Be enrolled in Medicare Part B (premium may be required)
Must be a US Citizen or Lawful Resident
Be a permanent resident of the service area
Not have End-Stage Renal Disease (ESRD) 14

16. Medicare Enrollment Periods15

17. Special Enrollment Period
You may be able to enroll in a Medicare plan outside of the Initial Enrollment Period or Open Enrollment. This depends on certain events happening in your life …
Retire
Change where you live
Lose your current coverage
Chance to get other coverage
Speak to your licensed sales representative about other life events that qualify for the Special Enrollment Period. 16

18. YOUR NEEDS.
YOUR DECISION.
2018 17
Y0107_16_152 Approved

19. Work with your licensed agent to make sure We Care for you!
Choosing a Health Plan is a Big Decision
– What type of coverage do you currently have?
– Evaluate the parts you like about it.
– Consider the areas that you would like changes.
– Assistance. Does anyone help you make healthcare decisions?
– Review your options that best fit your needs.
– Enroll into the best solution for you!
Work with your licensed agent to make sure We Care for you! 18

20. CHOOSING THE RIGHT PLAN FOR YOU
2018 19
Y0107_16_152 Approved

21. Healthteam Advantage PPO Plans
HOW DOES A PPO WORK?
You have a network of doctors, specialist and facilities contracted with the plan to provide services.
You should expect to pay more if you choose to use out-of-network providers.
Referrals are not necessary, but some services may require plan authorization prior to receiving the service.
You can see providers out-of-network. Reminder, providers that do not contract with us are not obligated to treat you, except in emergency situations.
You have the ability to select a different Primary Care Physician as needed.
Cost-sharing will be lower at in-network providers. 20

22. Your Local Healthcare Concierge
At Healthteam Advantage, we work hard to provide our members excellent customer service. Whenever a member has a question, we are always just a phone call or away.
At HealthTeam Advantage, the HCC can help:
Explain health plan benefits
Coordinate healthcare services with an In-Network doctor
Verify health plan coverage with a participating provider
Find a healthcare facility nearest to the member. And much more! 21

23. Silver&Fit Fitness Program
Access to a fitness club or exercise center
Such as YMCA, Curves, 24 Fitness, Gold’s Gym and more!
Group classes made for older adults where offered
Web tools like a facility search, health articles, challenges, and more
Equipment to use at home
Healthy aging materials 22

24. Prescription Drug Benefit
PART D
No annual deductible
Convenient pharmacy locations, local and nationwide, offering $0 co-pay for many generics on some plans
Mail order program is available
3 Month Supply for 2 Month Copay
At Pharmacy OR Mail Order! 23

25. Choosing the Right Plan for You
NEXT STEPS
Now your agent will take a few minutes to explain key benefits and features to you about our plan.
Your licensed sales agent will review the Summary of Benefits and Formulary with you.
If you decide HealthTeam Advantage is a good fit, your licensed sales agent can help you complete the enrollment form. 24

26. ENROLLMENT.
2018 25
Y0107_16_152 Approved

27. Enrollment
SIMPLE AS 1, 2, 3
Review your enrollment kit with a licensed sales agent to learn more about plan benefits and decide on the HealthTeam Advantage health plan that best fits your needs.
Complete the enrollment form.
Submit! Your licensed sales agent will submit your enrollment form to HealthTeam Advantage. 26

28. Enrollment
WHAT HAPPENS NEXT?
Once HealthTeam Advantage receives your enrollment form, we’ll confirm your Medicare eligibility with CMS.
In the following few weeks, you’ll receive important plan material about your coverage.
After CMS approves your enrollment, we’ll send you a letter confirming your membership with HealthTeam Advantage.
Member Identification Cards
Formulary (if enrolled in a plan with prescription coverage)
You will receive a welcome call from your Healthcare Concierge.
Evidence of Coverage 27

29. Thank you!
HealthTeam Advantage is a Medicare Advantage Organization with a Medicare contract. Enrollment in HealthTeam Advantage depends on contract renewal. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B Premium.
Out-of-network/non-contracted providers are under no obligation to treat HealthTeam Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
HealthTeam Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call (TTY:711).
HealthTeam Advantage cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711).
HealthTeam Advantage 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年齡、殘障或性別而歧視任何人。
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 (TTY: 711)。 28