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W H AT Y O U N E E D T O K N O WMedicare 101Your Guide to MedicareY0013 22M101Guide C

Watch tolearn more.YO U R G U I D E TO M E D I C A R EUnderstandingMedicareMedicare can be confusing. But you’ve got this.And we’re here to help. Whether you’re new toMedicare or just want a refresher, use this guideto help you understand what’s best for you.12345page 3page 7page 8page 10page 14ORIGINALSUPPLEMENTINGM E D I C A R E PA R T DALL-IN-ONEMAKINGMEDICARE FROMORIGINALPRESCRIPTIONMEDICAREYO U RTHE GOVE RN MENTMEDICAREDRUG COVE R AGEOPTIONSDECISION1

OVE RV IE WMedicare ata GlancePA R T A PA R T BW H AT ’ S C O V E R E DPA R T DSUPPLEMENTPA R T COriginal MedicarePrescriptionDrug PlansMedicareSupplement PlansMedicare AdvantagePlansFederal program that generallycovers 80% of the cost ofmedical expenses.Can be added to OriginalMedicare to help pay foryour drug coverage.Most plans limit out-of-pocketcosts for care and offermore coverage than OriginalMedicare.Combines Part A, Part B andusually Part D coverage.Often offers extra benefitsas well.Hospital Insurance ( P A R T A )Medical Insurance ( P A R T B )Prescription Drugs ( P A R T D )Limited Annual Out-Of-Pocket ExpensesDentalVisionFitness BenefitHearing Aid2

ORIGINAL MEDICAREParts A & BF HEALTH ANDTOENDEPARTMWhen you turn 65, have a qualifying disability or end stage renaldisease (ESRD), you're eligible for PA R T A a n d PA R T B —that’s Original Medicare.SAN SERIVCEMAS-UHUMEDICARE HEALTH INSURANCEName/NombreJAMES R. SMITHMedicare Number/Númerode Medicare1EG3-TE4-AM79Entitled to/Con derechoaHOSPITAL (PART A)MEDICAL (PART B)Coverage starts/Coberturaempieza03-01-201603-01-2016H O S P I TA L I N S U R A N C E ( PA R T A )M E D I C A L I N S U R A N C E ( PA R T B ) In-patient care in a hospital Doctor's services Limited stays in a skilled nursing Outpatient carefacility Some home health care Hospice careMost people don’t pay a Part Apremium because they paid Medicaretaxes while working. Durable medical equipment Some preventive services Some prescription drugsPart B is optional and has a monthly premium. There is apenalty if you don’t enroll when first eligible. In most cases,you can delay enrollment in Part B without penalty if you areactively at work and enrolled in an employer group health plan.3

ORIGINAL MEDICAREOut-of-Pocket CostsThere are some out-of-pocket costs you’ll pay with Parts A and B. Out-of-Pocket CostsDeductibles and copays for hospital staysPart B annual deductible20% of the Medicare-approved amount for most care you getfrom doctors or other health care providers, outpatient therapy,Medicare Part B drugs and durable medical equipmentRoutine dental careRoutine vision care and eyewearRoutine hearing exam and hearing aids4

ORIGINAL MEDICAREEligibilityYou can sign up during these 7 months. If you plan towork past age 65, these times can differ for you:3 monthsBefore YourBirthday65THbirthdayDuring YourBirthday Month3 monthsAfter YourBirthday5

COVE R AGE OP T IONSWhen You NeedMore CoverageYou may want more than OriginalMedicare gives you. That’s whereyour plan options come in.12MEDICARESUPPLEMENT3M E D I C A R E PA R T DPRESCRIPTION DRUGSMEDICAREA D VA N TA G EPA R T C6

MEDICARE SUPPLEMENTWatch tolearn more.Covering Medicare GapsMedicare Supplement plans help limit out-of-pocket costsand offer more coverage than Original Medicare. Privateinsurance companies sell them. Monthly premiums areusually based on age. You can go to any doctor or hospital that acceptsMedicare. Options with low — or no — copays or coinsurancefor a visit to the doctor or a stay in the hospitalYou can sign up for a Medicare Supplement plan withoutanswering health questions during your Medigap OpenEnrollment Period. This six-month period begins on the firstday of the month in which you’re 65 or older and enrolledin Part B. If you sign up after this period, you might have toanswer health questions.7

M E D I C A R E PA R T DPrescription Drug CoverageOriginal Medicare ( PA R T A o r B )doesn’t cover most prescriptions. Youcan get Medicare Part D plans from aprivate insurance company.Part D plans addextra coverage.Part B CoveragePart D Additional CoverageInjections you get in a doctor’s officePrescription drugsCertain oral anti-cancer drugsBiological productsImmunosuppressant drugsVaccines licensed under Public Health Service ActUnder limited circumstances, certain drugs you getduring hospital outpatient treatmentMedical supplies associated with insulin injections,including syringes, needles, alcohol swabs and gauzeDrugs used with some durable medical equipment(like a nebulizer or external infusion pump)A copay of 35 or less for select insulin drugs throughthe Senior Savings Model with some plansYou pay 20% of the Medicare-approvedamount for these covered drugs. And the Part Bdeductible applies.You pay a copay or coinsurance for these covereddrugs. The amount you pay is based on the planyou choose.8

M E D I C A R E PA R T DInfo on Costs These plans vary in costs from company tocompany and year to year. You might encounter: Copays and coinsurance Monthly premiums Annual deductiblesExtra HelpLate Enrollment PenaltyYou may be able to get Extra Help to payfor your prescription drug premiums andcosts. To see if you qualify, you can callyour local Social Security office or go towww.socialsecurity.gov/prescription help.You may have to pay a late-enrollment penaltyif you don’t join a Medicare Part D drug planwhen you are first eligible for Medicare andyou go without creditable prescription drugcoverage for 63 continuous days or more.9

M E D I C A R E PA R T CMedicare Advantage PlansSome plans combine medical, hospital, andmay also include prescription drug coverage,with extra benefits. That means you get all yourMedicare benefits in a single, all-in-one plan.Private insurance companies offer these plans.You’ll still pay your Medicare Part B premiumevery month.ABDExtra sMedicareAdvantage Options with 0 monthly premium Out-of-pocket maximums Extra benefits like vision, dentaland hearing10

OTHER PL ANSSpecial Plans forSpecific NeedsMedicare MedicaidIf you get TennCare, you might be eligiblefor a Medicare Advantage Dual EligibleSpecial Needs Plan (D-SNP).11

M E D I C A R E PA R T CSigning UpYou can sign up for a Medicare Advantage plan when yousign up for Original Medicare and during other periods.Initial Coverage Election Period (ICEP)A 7-month opportunity surrounding your initial Medicare eligibility.Annual Enrollment Period (AEP)Oct. 15 – Dec. 7Medicare Advantage Open Enrollment Period (MA OEP)*Jan. 1 – Mar. 31Special Enrollment Period (SEP)Based on a qualifying event, such as loss of coverage, moving to a new area, etc.* This enrollment period is only available to individuals already enrolled in a Medicare Advantage plan.12

SUPPLEMENT OR ALL IN ONEA Closer LookEveryone’s needs are different. Let’s lookat Medicare Supplement and MedicareAdvantage plans side-by-side so you cansee what might work best for you.Medicare SupplementMedicare AdvantageAge-based premiumsFlat premium, regardless of ageDeductibles, copayments and coinsuranceDeductibles, copayments and coinsuranceNo Part D prescription drug coverageMay include Part D prescription drug coverageStandardized benefitsBenefits varyAccepted by any Medicare providerUses a provider networkCan change at any time during the yearLimited enrollment periodsMay have to answer health questions and mayhave a pre-existing waiting periodNo health questions and no pre-existingwaiting periodMay require additional priorauthorizations for servicesMay offer additional services,including personalized supportMay offer reminders to keep youon track to complete preventive services13

Watch tolearn more.M A K I N G YO U R D E C I S I O NWhat’s Right for YouIt’s important to pick coverage that works for you.Here are important things to consider whenresearching your options:Costs. It’s a good ideato keep the followingexpenses in mind:Monthly premiumCopays, coinsurance,deductibles and maximumout-of-pocketYour prescription drugsNetwork. Check to see if theplan includes:Extras. Does the plangive you any extras?The hospital and health carefacilities you useDentalYour Primary Care ProviderHearingAny specialists you seeFitness membershipVisionYour pharmacy14

Nondiscrimination NoticeBlueCross BlueShield of Tennessee (BlueCross), includingits subsidiaries SecurityCare of Tennessee, Inc. andVolunteer State Health Plan, Inc. also doing business asBlueCare Tennessee, complies with applicable Federal civilrights laws and does not discriminate on the basis of race,color, national origin, age, disability or sex. BlueCross doesnot exclude people or treat them differently because of race,color, national origin, age, disability or sex.BlueCross: Provides free aids and services to people withdisabilities to communicate effectively with us, such as:(1) qualified interpreters and (2) written information inother formats, such as large print, audio and accessibleelectronic formats. Provides free language services to people whose primarylanguage is not English, such as: (1) qualified interpretersand (2) written information in other languages.If you need these services, contact Member Service atthe number on the back of your Member ID card or call1-800-831-2583, TTY 711. From Oct. 1 to March 31, youcan call us 7 days a week from 8 a.m. to 9 p.m. ET. FromApril 1 to Sept. 30, you can call us Monday throughFriday from 8 a.m. to 9 p.m. ET. Our automated phonesystem may answer your call outside of these hours andduring holidays.Y0013 21NDMLI C (08/20)If you believe that BlueCross has failed to provide theseservices or discriminated in another way on the basis ofrace, color, national origin, age, disability or sex, you canfile a grievance (“Nondiscrimination Grievance”). For helpwith preparing and submitting your NondiscriminationGrievance, contact Member Service at the number onthe back of your Member ID card or call 1-800-831-2583,TTY 711. They can provide you with the appropriate formto use in submitting a Nondiscrimination Grievance.You can file a Nondiscrimination Grievance in person orby mail, fax or email. Address your NondiscriminationGrievance to: Nondiscrimination ComplianceCoordinator; c/o Manager, Operations, MemberBenefits Administration; 1 Cameron Hill Circle, Suite0019, Chattanooga, TN 37402-0019; 423-591-9208 (fax);Nondiscrimination OfficeGM@bcbst.com (email).You can also file a civil rights complaint with the U.S.Department of Health and Human Services, Office forCivil Rights, electronically through the Office for CivilRights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:U.S. Department of Health and Human Services, 200Independence Avenue SW., Room 509F, HHH Building,Washington, DC 20201, 1-800-368-1019, 1-800-537-7697(TDD), 8:30 a.m. to 8 p.m. ET. Complaint forms areavailable at http://www.hhs.gov/ocr/office/file/index.html.15