Your Medicare Advantage Solutions © 2011 Coventry Health Care, Inc.Y0022_2011_6002_092a_FINAL9 CMS Approval Date: 04/14/2011.

Your Medicare Advantage Solutions

© 2011 Coventry Health Care, Inc.Y0022_2011_6002_092a_FINAL9 CMS Approval Date: 04/14/2011

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Agenda

• Do You Qualify?• Understanding Your Needs• Who We Are• How Medicare Works• Plan Benefits• Network• Member Rights/Responsibilities• Plan Value• Enrollment• What Happens Next (if you enroll)

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Do You Qualify - Eligibility

Three Eligibility Requirements:

• Must have both Medicare Parts A & B

• Must live in the plan’s service area

• Not have End Stage Renal Disease (ESRD) – some exceptions

Also Important to Know: • Part D Eligibility – Must have Part

A and/or B

• Must still pay Medicare Part B premium (if not paid for by Medicaid or another third party)

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Do You Qualify - Plan Service Area

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Understanding Your Needs

• Why did you decide to look into PersonalCare plans?

• What other coverage do you have now?

• What types of coverage have you had in the past?

• What health care access considerations are important to you?

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Who We Are – Coventry Health Care

More than 20 years1 of experience administering health plans

Experience

Financial Stability

Presence

Fortune 500 Company

Serve more than 1.3 million2 Medicare beneficiaries

Sources: 1. Public website www.coventryhealthcare.com. 2. Publicly published CMS report “Monthly Enrollment by Contract – July 2011.” Can be accessed from www.cms.hhs.gov.

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Who We Are - Your Neighborhood Health Plan

• Location: 2110 Fox Drive Suite A Champaign, IL 61820-

7592• Plan Rating: 4 Stars!• Plan ratings: www.medicare.gov

or call the plan

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How Medicare Works

• PersonalCare sells Medicare Advantage plans through its contract with the Centers for Medicare and Medicaid Services (CMS)

• Benefit information presented is not comprehensive – contact the plan for complete details

• Plan benefits are subject to change annually• You are still a part of Medicare• You receive the same benefits offered under

Original Medicare• PersonalCare will pay for your health care

services, not Medicare• My compensation

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Part C – Medicare Advantage

Part A - Hospital

How Medicare Works – The 4 Parts

Part B – Doctor’s Services

Part D – Prescription Drug

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How Medicare Works - Enrollment Periods

Annual Enrollment

Period (AEP)

Medicare Advantage Disenrollme

nt Period (MADP)

Initial Coverage Election Period (ICEP)

Initial Enrollment

Period – Part D (IEP)

Special Election Period (SEP)

Oct. 15 to Dec. 7

Jan. 1 to Feb. 14

3 months before and 3 months after eligible for Part B

Entitled to Part A OR enrolled in Part B

Varies based on circumstance

All people with Medicare may enroll or disenroll from a plan (coverage will start 1/1/12)

May switch back to Original Medicare and elect a Part D plan

Newly eligible may enroll in a Medicare Advantage plan

Newly eligible may enroll in a Part D plan

May enroll or disenroll in a plan because of a special circumstance

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How Medicare Works – Part D Late Enrollment Penalty

What is it?

The amount added to your premium if you did not join a Medicare drug plan when you were first eligible AND you did not have creditable drug coverage OR you had a break in your drug coverage for 63 days in a row.

Are there exceptions?

Yes, if you have credible drug coverage or get Extra Help, you don’t pay a penalty.

Q.

A.

Q.

A.

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Extra Help (Low Income Subsidy [LIS]) – You may qualify

Program Help Paying For…

Extra Help Prescription drug premium and costs

QMB (Qualified Medicare

Individual)

Part A and B premiums, and other cost-sharing (like deductibles, coinsurance and copays)

SLMB(Special Low-income

Medicare Beneficiary)

Part B premium

• 1-800-Medicare (1-800-633-4227), 24 hours a day/7 days a week

(TTY 1-877-486-2048)

• Social Security Office 1-800-772-1213, 7 a.m. to 7 p.m. (TTY 1-800-325-0778)

• State Medicaid Office

• www.Medicare.gov

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Extra Help – Find Out More

www.BenefitsCheckUp.org/Coventry

One-stop resource for determining eligibility for programs that can help with all types of expenses, including health care,

prescriptions, taxes, utilities and more!

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Plan Benefits - Kit Contents

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Plan Benefits

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2012 Standard Part D Benefit Design

Deductible

Initial Coverage Limit (ICL)

Coverage Gap Catastrophic Coverage

Beneficiary pays first

$320 worth of

prescription costs

before the plan starts to pay its

share.

Beneficiary pays a copayment/coinsurance and their plan pays its share for each covered

drug until their combined amount (including the deductible) reaches

$2,930.

Once the beneficiary and their plan have

spent $2,930 for covered drugs, the beneficiary is in the

coverage gap.

In 2012, the beneficiary gets a 50%

discount on covered brand-name

prescription drugs and 14% discount on covered generic

prescription drugs that counts as

out‑of‑pocket spending, and helps them get out of the

coverage gap.

Once the beneficiary has spent $4,700

out‑of‑pocket for the year, their coverage gap ends. Now they

only pay a small copayment or

coinsurance for each drug until the end of

the year.

$2.60 for generic$6.50 for brand or a

5% coinsurance, which ever is

greater.

You pay NO prescription drug deductible with PersonalCare

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Reaching the Coverage Gap

Example*:30-day supply of a prescription = $100 (total

drug cost)

You Pay Plan Pays

Amount that counts toward the Initial Coverage Limit of

$2,930

$10 $90 $100*This is only an example and does not represent the actual cost

you will pay for your specific prescription medication(s)If you are receiving Extra Help, the coverage gap does not apply to you

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Closing the Coverage Gap

Example*: 30-day supply of a brand-name drug

Contracted Cost

Dispensing Fee Contracted Cost After 50%

Discount

Total Member Cost

(Discounted Cost +

Dispensing Fee)

$100 $2 $50 $52**With Health Care Reform, beneficiaries will now receive discounts on their generic and brand-name drugs once they enter the gap

**2012 True Out of Pocket (TrOOP) is $4,700. It includes any applicable deductible, copayments, coinsurance and out of pocket costs for covered drugs in the coverage gap.

*This is only an example and does not represent the actual cost you will pay for your specific prescription medication(s)

If you are receiving Extra Help, the coverage gap does not apply to you

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Prescription Plan Benefits

• Formulary Exception – You can ask the plan to make an exception to the coverage rules

• Cost Tiers – Each drug is categorized by Tier, which determines how much you will pay for that drug

• Restrictions – Some drugs have Prior Authorization, Quantity Limits and/or Step Therapy requirements

• Transition Process – If you are entering or leaving a long-term facility, you can receive a one-time emergency 31-day supply of your medication(s)

• Network – Extensive network of participating pharmacies, as well as mail order option for long term medications

Important: Review the plan’s Formulary and Summary of Benefits for details on the pharmacy benefit. Online

searchable formulary: www.pcadvantra.com

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Network Overview

Extensive network of physicians, hospitals and facilities to provide you with convenient access to quality care

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Member Rights – Appeals/Grievances and More

As a member, you can:• File a grievance if you have a specific concern/complaint or

file an appeal if you disagree with a coverage of care decision

• Access medical treatment regardless of race, national origin,

religion, physical handicap or source of payment

• Receive treatment for any emergency medical condition

• Refuse treatment, unless otherwise provided by law

• Be treated with dignity, respect, and right to privacy

• Receive information about the plan, its services and providers

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Member Responsibilities

As a member, your responsibilities include:

• Member pays plan premium and cost sharing

• Notify PersonalCare if you receive care from a non-network provider, inside or outside service area

• Out-of-Network services may incur a higher level of cost sharing

• Notify PersonalCare and Social Security Administration if you move, even if only a temporary move

• Submit your change of address, new telephone number in writing to PersonalCare

• If you move, but do not move out of the current service area, you may not have to disenroll (call the plan to confirm)

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Plan Value Summary

• Comprehensive and flexible coverage to meet your medical and prescription drug needs

• $0 or low monthly plan premium options and predictable expenses

• Benefits to help you live life your way at a price you want

Take charge of your Medicare. The choice is yours.

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Enrollment – What You Need to Know

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Enrollment - What Happens Next

Once we receive your application, we’ll confirm your Medicare eligibility with CMS.

A plan representative will make three (3) attempts to call you within 15 days of receiving your application to: Confirm that you have enrolled in our plan. Review some important information about the plan and answer any questions you

may have.

If we are unable to reach you after the first attempt, you will receive a letter outlining the plan rules. Both the telephone calls and letters will cover the same information.

You will receive a letter that your application was received and is being processed

If your application was incomplete, you will receive a letter explaining what information is missing. You must reply by calling the telephone number listed on the letter within 21 days of the date on the letter to avoid cancellation of your application.

Once your application is approved, you will receive another letter confirming your membership with our plan (Use this letter as proof of insurance until you receive your member ID card.)

In the next few weeks, you will receive important materials regarding your coverage

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Enrollment – Your New Card

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Closing

Thank You!