MULTI-PLAN_18_317B Approved 08062018

Medicare coverage options

Contact us:

(888) 228-6113 [TTY: 711]

Call 8 a.m. to 8 p.m., Monday through Friday. Or contact your authorized Blue Shield agent.

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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 HMOsBlue Shield 65 PlusSM (HMO), Blue Shield 65 Plus Choice Plan (HMO), and Blue Shield Trio Medicare (HMO)

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

Blue Shield Medicare Supplement plansWhat sets us apart

Blue Shield Medicare Prescription Drug PlansWhat 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

• Helps cover the cost of prescription drugs

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Medicare

1 Medicare covers medically necessary foot care, including care for medical conditions affecting the lower limbs.

Original Medicare does not cover (not a complete list)• Routine vision or foot care1

• Routine dental care

• Routine hearing exams and hearing aids

• Custodial care at home or in a nursing home

• Health care outside of the United States except in very rare situations

• Copayments, coinsurance, and deductibles

• There is no maximum out-of-pocket amount

Because Medicare has limited hospital coverage, and because copayments, coinsurance, and deductibles can be expensive, some Medicare beneficiaries choose Medicare Supplement plans to help fill in the “gaps” that Original Medicare doesn’t cover, or a Medicare Advantage HMO Plan.

For more informationTo learn more about Medicare, the different parts of Medicare and Medicare enrollment periods, visit https://www.medicare.gov 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 coverage choices 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.

Source: 2018 Medicare & You handbook, www.medicare.gov.

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Blue Shield Medicare Advantage HMOsBlue Shield 65 Plus, Blue Shield 65 Plus Choice Plan, and Blue Shield Trio Medicare (Part C)

• Includes 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 coverage1 and basic gym access2 at no additional cost.

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

1 Vision coverage is not included as part of the Blue Shield 65 Plus plan benefits in San Luis Obispo (partial) and Santa Barbara (partial) counties.

2 Basic gym access is not included as part of the Blue Shield 65 Plus plan benefits in Kern (partial), San Luis Obispo (partial), and Santa Barbara (partial) counties.

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Medicare Supplement plans(also known as Medigap)

• You must have both Medicare Parts A and B.

• Ten standardized plans with varying benefits, plus a high-deductible option for Plan F.

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

• Freedom to choose any doctor, specialist, and hospital that accepts Medicare anywhere you travel in the United States.

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

• You must pay monthly plan dues in addition to your 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.

• If you already have a Medicare Supplement plan, Blue Shield’s special enrollment period allows you to switch to any Blue Shield Medicare Supplement plan that offers benefits that are equal to or lesser in value than your current plan any time of the year – without going through underwriting. This Special Enrollment Period is available until December 31, 2018.

• 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 for all the details.

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Why choose a Blue Shield Medicare Supplement plan?

We are a California-based, nonprofit plan with over 75 years of experience providing Californians like you with access to quality 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 Savings

• Convenience of adding other types of coverage:

– Medicare Part D Prescription Drug Plans

– Two dental PPO plans and one combination PPO dental + vision care package1 to choose from that are specifically designed for Blue Shield Medicare Supplement plan members

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

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1 Rates vary by plan, age, and by geographic area. $135/month for Blue Shield’s Medicare Supplement Plan F Extra versus $156/month for Blue Shield’s Medicare Supplement Plan F effective October 1, 2018 for non-tobacco users age 65 in Blue Shield’s Medicare Supplement rating region 1. These rates include Welcome to Medicare Rate Savings and Easy$Pay savings. Your rates may be different.

NEW! Blue Shield of California Medicare Supplement Plan F Extra

Our newest Medicare Supplement Plan F Extra offers everything our regular plan F covers plus some additional benefits at a lower1 cost, including:

• Comprehensive vision benefits including routine eye exam, frames, eyeglass lenses or contact lenses.

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

• Personal Emergency Response System (PERS) – an emergency alert device that provides access to help 24/7, at the push of a button.

• SilverSneakers fitness membership nationwide

• Coverage for Medicare Parts A and B deductibles

• Skilled nursing facility care

• Foreign travel emergencies

• 100% coverage of Medicare Part B excess charges

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1 Blue Shield also offers High Deductible Plan F that offers the same benefits as Plan F after you have paid a calendar-year $2,240 deductible in 2018. This amount may change for 2019.

2 After you meet your out-of-pocket yearly limit ($5,240 in 2018) and your yearly Part B deductible ($183 in 2018), the plan pays 100% of covered services for the rest of the calendar year. These amounts may change for 2019.

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

Blue Shield of California Medicare Supplement plansIf 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 C

Plan D

Plan F1

New! Plan F Extra

Plan G

Plan K2

Plan N

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

Medicare Part B coinsurance or copayment 50%

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Blood (first 3 pints) 50% Part A hospice care coinsurance or copayment 50% Skilled nursing facility care coinsurance 50% Medicare Part A deductible 50% Medicare Part B deductible Medicare Part B excess charges Foreign travel emergency (up to plan limits) NurseHelp 24/7 Basic gym access through SilverSneakers Comprehensive vision Hearing aid services Personal Emergency Response System (PERS)

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More reasons to select Blue 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

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 does not apply to High Deductible Plan F, Plan K, or Plan N.

2 The Household Savings Program does not apply to High Deductible Plan F or Plan K. The Household Savings Program does not apply to tobacco users and is not available to those 64 or younger.

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SilverSneakers

Love Life LongerTM with SilverSneakers

SilverSneakers fitness program, your fitness benefit at no extra cost, can help you improve your life so you can continue to do the things you love.

SilverSneakers gives you access to:

• SilverSneakers – access to 14,000+ fitness locations1 nationwide

• Trained instructors for support

• Classes for all levels, designed to improve energy levels, strength, balance, flexibility and endurance

• Participating locations nationwide

• Online fitness and nutrition tips plus daily workout videos

1 As of January 2018.Tivity Health, SilverSneakers and Love Life Longer are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2018 Tivity Health, Inc. All rights reserved.

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Blue Shield’s Medicare Supplement plan rates for ages 65 to 66(effective October 1, 2018)

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 C D F F-Extra Hi-F G K NRegion 1 – Los Angeles Countyexcept ZIP codes 91711, 91759, 91765, 91766, 91767, 93535, 93544, 93563, and 93591

Ages 65-66

$97 $143 $118 $156 $135 $58 $140 $75 $117

Region 2 – Orange CountyAges 65-66 $97 $143 $118 $162 $139 $58 $145 $75 $117

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

$91 $132 $108 $145 $124 $45 $118 $63 $109

Region 4 – Riverside and Ventura countiesAges 65-66

$102 $150 $124 $164 $144 $56 $134 $70 $121

Region 5 – San Joaquin, Santa Barbara, and Stanislaus countiesAges 65-66

$83 $121 $100 $134 $112 $47 $109 $62 $101

Region 8 – Includes San Francisco, San Mateo, Fresno, and Santa Clara countiesAges 65-66

$82 $122 $99 $134 $112 $42 $109 $60 $101

Region 9 – Sacramento, Amador, Calaveras, Colusa, El Dorado, Tehama, and Marin countiesAges 65-66

$80 $124 $97 $136 $118 $43 $111 $57 $105

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 High Deductible Plan F, Plan K and Plan N. These rates do not include the new member dental or dental + vision plan savings of $3 each month for the first 6 months of enrollment.

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Blue Shield of California Medicare Part D Prescription Drug PlansComplement your Blue Shield Medicare Supplement coverage with a Part D prescription drug plan by adding one of three PDP plans:

SilverScript Choice (PDP)

• $28.50 monthly premium (must continue to pay Part B premium)

• $0 annual deductible

• Some coverage through the coverage gap

• SilverScript is one of America’s largest stand-alone Medicare Part D prescription drug plan sponsors with a 4-star rating1

• More than 26,000 preferred cost-sharing pharmacies including CVS Pharmacy and Longs, and 41,000 standard cost-sharing pharmacies including Walgreens, Walmart, and Costco2

• You can join the 6.1 million beneficiaries nationwide who have chosen SilverScript to help protect their savings against the high cost of prescriptions3

1 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.

2 According to CVS Health, https://www.silverscript.com/pharmacy-locator.aspx.3 CMS, Monthly Enrollment by Plan report as of March 2018. http://go.cms.gov/mapddata.

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

• $82.50 monthly premium (must continue to pay Part B premium)

• $405 annual deductible – does not apply to Tier 1: Preferred Generic Drugs

• Some coverage through the coverage gap

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

Blue Shield Rx Enhanced (PDP)

• $111.30 monthly premium (you must continue to pay your Medicare Part B premium)

• $0 annual deductible

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

• Some coverage through the coverage gap

• 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)All Blue Shield Medicare Prescription Drug Plans• You can choose to get your prescriptions filled at any of the nearly

6,000 network pharmacies contracted with Blue Shield.

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

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

• Receive a 90-day supply of covered drugs for the cost of two 30-day supplies from a network pharmacy that offers preferred cost-sharing or through our mail service pharmacy. (Note: Tier 6: Specialty Tier Drugs are available only at a 30-day supply.)

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1 The Specialty Duo package includes a comprehensive vision plan. 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 already includes 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 Twelve-month waiting period. Deductible applies to major services including endodontics, periodontics, oral surgery, crowns, bridges, and dentures.

Dental plans at a glance For Medicare Supplement plan subscribers (effective April 1, 2018)

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 1500

Specialty DuoSM dental PPO + vision package1,2

Monthly plan premium $40.70 $49.80 $61.90

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 services4Plan covers 50% Plan covers 80% Plan covers 80%

Major services5Plan covers 50% Plan covers 50% Plan covers 50%

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Three sample monthly cost summariesPlan F Extra1 Total Medicare Supplement plan cost $

SilverScript Choice (PDP) (Part D plan) $28.50

Dental PPO 10002 $40.70

TOTAL monthly cost3 $

Plan N1 Total Medicare Supplement plan cost $

SilverScript Choice (PDP) (Part D plan) $28.50

Dental PPO 10002 $40.70

TOTAL monthly cost3 $

Blue Shield Medicare Advantage Plan (Medicare Advantage HMO) $

TOTAL monthly cost3 $

1 Plan F Extra and Plan N rates above include the $25 Welcome to Medicare Rate Savings and $3 Easy$Pay Savings. The Welcome to Medicare Rate Savings does not apply to High Deductible Plan F, Plan K or Plan N. Savings due to increased efficiencies from administering Medicare Supplement plans under this program/service are passed on to the subscriber.

2 $3 Dental or Dental + Vision Plan Savings 6 months period.3 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.

Thank you for attending today.

Talk directly with one of our dedicated Blue Shield Medicare authorized

Blue Shield agents.

Blue Shield of California is an HMO and PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal.

This information is not a complete description of benefits. Call (888) 228-6113 [TTY: 711] for more information.

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.

Tivity Health, SilverSneakers, and Love Life Longer are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2018 Tivity Health, Inc. All rights reserved.

NurseHelp 24/7 is a service mark of Blue Shield of California. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans.

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 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.

English:

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.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-235-5660 (TTY: 711), 24 hours a day, 7 days a week. ATENCIÓN: Si usted habla español, tenemos servicios de asistencia lingüística disponibles para usted sin costo alguno. Llame al 1-866-235-5660 (TTY: 711), las 24 horas del día, los 7 días de la semana. 小贴士: 如果您说中文，欢迎使用免费语言协助服务。请拨 1-866-235-5660 (TTY: 711) 。一周7天，每天24小时随时受理。

Spanish:

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

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-235-5660 (TTY: 711), 24 hours a day, 7 days a week. ATENCIÓN: Si usted habla español, tenemos servicios de asistencia lingüística disponibles para usted sin costo alguno. Llame al 1-866-235-5660 (TTY: 711), las 24 horas del día, los 7 días de la semana. 小贴士: 如果您说中文，欢迎使用免费语言协助服务。请拨 1-866-235-5660 (TTY: 711) 。一周7天，每天24小时随时受理。 Bl

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