Health Care Choices For Minnesotans On Medicare - Metropolitan ...

A publication of the Minnesota Board on Aging Senior LinkAge Line ®• Travel. Do you go south during Minnesota winters? Isit important to you to have coverage when you travel?Medicare does not cover foreign travel care, but mostMedicare supplemental and Medicare health planscover emergency care abroad. If you travel or live outof Minnesota for part of the year, check the plan’s travelbenefits.• Extras. Does the plan offer optional dental or hearing aidcoverage? Is there a fitness benefit that you might want touse? Does the plan include some non-Medicare coveredpreventive services, like routine physicals beyond theWelcome to Medicare physical?• Health screening. Can the company or plan ask youhealth questions and deny coverage based on how youanswer? Some plans health screen unless you enrollwithin six months of your Medicare Part B enrollment(or leave active employee health coverage if later).• Special chronic disease plans. Some plans provide caremanagers and other valuable services for people withcertain chronic diseases.• Prescription drug coverage. Medicare Part B coversa limited set of outpatient drugs, including somemedications that are injected and also some oral anticancer,oral anti-emetic and oral immunosuppressivedrugs. Most people will want to sign up for a MedicarePart D plan or Medicare health plan with Part D to getprescription drug coverage. Check each Medicare healthcare plan to see if Medicare Part D drug coverage isincluded, either in the monthly premium or as an addon.If not, consider a Medicare Part D prescription drugstand-alone plan (provides Medicare prescription drugcoverage only).nPlease be aware that some types of Medicare healthplans require you to receive your Medicare prescriptiondrug coverage (Part D) from the Medicare healthplan and not through a separate Medicare Part Dprescription drug stand alone plan. Enrolling in aseparate Medicare Part D prescription drug stand aloneplan could dis-enroll you from your Medicare healthplan. Please review the plan information contained inHealth Care Choices or call the Senior LinkAge Line ®at 1-800-333-2433 for assistance.Coverage still too expensive?If you find that you cannot afford coverage other thanOriginal Medicare, or you cannot afford to pay theMedicare Part B premium or the Part D premium andco-pays, you may want to find out if you qualify for otherassistance or programs. See the Medicare Savings Programsand Extra Financial Help for Part D information in HealthCare Choices.Questions?Contact the Senior LinkAge Line ® at 1-800-333-2433if you have questions or would like free, objective,comprehensive assistance to help understand your options.The Minnesota Board on Aging Senior LinkAge Line ®is designated by the Centers for Medicare & MedicaidServices (CMS) to be the State Health InsuranceAssistance Program (SHIP) for Minnesota. Every state inthe U.S. has a SHIP. Go to www.medicare.gov/contacts.Quick Tip 1You can download and print a copy of Health Care Choices 2010 at www.mnaging.org and www.MinnesotaHelp.info ® .Quick Tip 2Live chat with a Senior LinkAge Line ®specialist is available at www.MinnesotaHelp.info ® ,Monday through Friday from 8:00 a.m.– 4 :30 p.m.7

Health Care Choices for Minnesotans on MedicareMedicare Basics and Beyond in 2010What is Medicare?Medicare is a federal health insurance program thatbegan in 1965. States are not involved in the program’sadministration. In general, the rules governing Medicare’soperation are the same nationwide, though payment ratesoften vary from one region to another.CMS, SSA, RRBThe Centers for Medicare & Medicaid Services (CMS) isthe federal agency that administers Medicare and Medicaid(known as Medical Assistance in Minnesota). CMSheadquarters are in Baltimore, with ten Regional Offices.The Regional Office for Minnesota is located in Chicago.CMS manages Medicare’s program operations includingclaims processing, monitoring the quality of care forpatients, handling complaints and reviewing appeals.The Social Security Administration (SSA) handles Medicareeligibility and enrollment for Social Security recipients.SSA sends enrollment packets and Medicare cards to newMedicare beneficiaries. It also processes applications forMedicare Part D Extra Help (also known as Low IncomeSubsidy–LIS) program.The Railroad Retirement Board (RRB) handles Medicareeligibility and enrollment for Railroad Retirees.Medicare is a national health insurance program for:• People age 65 or older• People under age 65 with certain disabilities• People of any age with End-Stage Renal Disease (ESRD)–permanent kidney failure requiring dialysis or a kidneytransplantImportant! Medicare age is not based onSocial Security benefits age. Even though the retirementage for full Social Security benefits is increasing until itreaches 67, you will still get Medicare at age 65, eventhough you may not yet be eligible for Social Securityretirement benefits. The age eligibility date for Medicareremains age 65.The Basics: A, B, C, and D of MedicareOriginal Medicare: Medicare Part A and Medicare Part BMedicare Part A is hospital insurance.• Most people do not pay a premium for Part A. Theyreceive it premium-free because they have worked andhave more than 40 credits in Social Security-coveredemployment or they can receive Social Security benefitsbased on a spouse’s earnings.• You can get Medicare Part A at 65 without having to paypremiums if:nYou already get retirement benefits from Social Securityor the Railroad Retirement Board.nYou are eligible to get Social Security or Railroadbenefits but haven’t yet filed for them.nYou or your spouse had Medicare-covered governmentemployment.• If you are under 65, you can get Part A without havingto pay premiums if you have:nReceived Social Security or Railroad Retirement Boarddisability benefits for 24 months.nEnd-stage renal disease (ESRD) and meet certainrequirements.• In 2010, those with fewer than 40 credits, can buy PartA coverage for $461 per month (with 29 or less credits)or $254 per month (with 30 to 39 credits).• Who can purchase Medicare Part A?nU.S. citizens age 65 and older who do not have enoughwork credits.nPermanent resident aliens aged 65 and older whohave lived in the U.S. for 5 years before applying forMedicare.• A late enrollment penalty of 10% of the current monthlypremium must be paid if enrollment is a year or moreafter your 65 th birthday.Medicare Part A includes:• Inpatient hospital, including critical access hospitals,inpatient rehabilitation facilities, long-term care hospitalsand psychiatric hospitals• Skilled nursing facility• Home health care• Hospice care8

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Part A Late Enrollment Penalty:If you are not automatically enrolled into Medicare Part A and do not sign up for it when first eligible, you may have topay a penalty unless you are eligible for a Special Enrollment Period (SEP). Individuals who enroll in Medicare Part A12 or more months after they are initially able to enroll, will be charged a 10% higher premium. This increased premiumwill be charged to the Medicare beneficiary for two times the number of years that the beneficiary was late in enrolling.Example: Mr. Lowry was one year late in enrolling in Medicare Part A, so he will pay increased premiums for two years.Medicare Part B is medical insurance.• In 2010, most people will pay a Part B monthly premium of $110.50. Part B premiums may be higher depending onyour income.• Current Medicare beneficiaries (enrolled as of 12/31/09) will continue to pay the 2009 monthly premium amount of$96.40 in 2010 if they had their Medicare Part B premiums withheld from their Social Security payment AND haveincomes of $85,000 or less (single filers) or $170,000 (joint filers) in 2009. Refer to chart below.• If you are eligible for Part A, you are also eligible for Part B.• People age 65 and older who are U.S citizens or permanent resident aliens for 5 years, who are not entitled toPart A can enroll in Part B without enrolling in Part A.Will you pay a higher Medicare Part B monthly premium in 2010?Income ThresholdLess than or equal to $85,000 ($170,000 couples)and did have Social Security withhold MedicarePart B premiums in 2009Less than or equal to $85,000 ($170,000 couples)and did not have Social Security withhold MedicarePart B premiums in 2009Greater than $85,000 and less than or equal to$107,000 ($170,000 to $214,000 couples)Greater than $107,000 and less than or equal to$160,000 ($214,000 to $320,000 couples)Greater than $160,000 and less than or equal to$214,000 ($320,000 to $428,000 couples)Part B Individual Monthly Premium$96.40$110.50$154.70$221$287.30Greater than $214,000 ($428,000 couples) $353.609

A publication of the Minnesota Board on Aging Senior LinkAge Line ®2010 Medicare Part AHospitalization (Inpatient)Semi-private room and board, general nursingand other hospital services and supplies, for eachbenefit period. *Please note: these 60 days maybe used only once in a person’s lifetime. These areknown as lifetime reserve days.Benefit Medicare Pays You PayDay 1 – 6061st - 90th day91st - 150th day*Beyond 150 daysAll but $1,100All but $275 per dayAll but $550 per dayNothing$1,100$275 per day$550 per dayAll costsSkilled Nursing Facility CareSemi-private room and board, skilled nursingand rehabilitation services and other servicesand supplies, for each benefit period, after athree-day minimum inpatient hospital stay fora related medical condition. Medicare does notcover long-term custodial care.Days 1 – 2021st - 100th dayBeyond 100 days100% of approved amountAll but $137.50 per dayNothingNothingUp to $137.50 per dayAll costsHome Health CarePart-time or intermittent skilled care, therapy,home health aide services and other supplies andservices. You must be homebound.Unlimited as long as you meetMedicare’s strict requirements forhome health care benefits.100% of approved amountfor services.80% of approved amount fordurable medical equipment.Nothing for services.20% of approved amount for durablemedical equipment.Hospice CarePain relief, symptom management and supportservices, for a person with a terminal illness.Medicare also covers inpatient respite care whichis care you get in a Medicare‐approved facility sothat your usual caregiver can rest. You can stayup to 5 days each time you get respite care.Your doctor must certify (or recertify)that you are expected to live 6months or less.A Medicare-approved hospice usuallygives hospice care in your home (orother facility like a nursing home).All but limited costs foroutpatient drugs andinpatient respite care.Limited cost sharing for outpatient drugsand inpatient respite care.• $5 co-pay for prescriptions used tomanage pain and symptoms• 5% co-insurance for Medicare-approvedinpatient respite careRoom and board is not coveredBloodWhen furnished by a hospital or skilled nursingfacility during a covered stay.Unlimited during a benefit period ifmedically necessary.All but first 3 pints percalendar year.For the first 3 pints.Medicare Part A Benefit Period• A benefit period begins the day you go into a hospital or skilled nursingfacility. The benefit period ends when you haven’t received any inpatienthospital care (or skilled care in a SNF) for 60 days in a row.• If you go into a hospital or a skilled nursing facility after one benefitperiod has ended, a new benefit period begins.• You must pay the inpatient hospital deductible for each benefit period.• There is no limit to the number of benefit periods.11

Health Care Choices for Minnesotans on MedicareMedicare Part C: Medicare AdvantageMedicare Advantage• Is a series of private health insurance plan options thatmust cover the same services and benefits availablethrough Original Medicare.• People who enroll in a Part C (Medicare Advantage) planreceive all of their Medicare Part A, B and sometimesPart D benefits through the plan.• In most cases, the Part C (Medicare Advantage) planis the only payer for most if not all of your Medicarebenefits.• If the Medicare Advantage plan includes Medicare PartD, it may be referred to as a MA-PD plan.The Five Types of Medicare Advantage PlansType 1: Health Maintenance Organizations(Local) Plans• What you need to knownYou must use the plan’s network of providers, except inan emergency or urgently needed care, to get coverage,or you may have to pay the charges in full on your own.nLocal HMO plans may require referrals to see aspecialist, but some Local HMO Medicare Advantageplans include a point-of-service self-referral option,which gives you some flexibility with going to out-ofnetworkproviders.nPoint-of-Service plans have an option that allows visits to“out of network” providers at an additional cost.nIf the POS plan offers Medicare Part D coverage,enrollees must get it from the POS plan.nIf you enroll in a stand-alone plan, you will be disenrolledfrom the Local HMO Medicare Advantage plan.• What you need to know about Local HMO Plansand Medicare Part DnWhether or not the Local HMO Medicare Advantageplan includes Part D coverage, you CANNOTENROLL IN A SEPARATE STAND-ALONE PARTD or you will be dis-enrolled from your Local HMOMedicare Advantage plan.nEvery company offering Local HMO MedicareAdvantage plans in Minnesota, must offer at least oneplan option that includes standard Medicare Part Dcoverage.nIf you enroll in a Local HMO Medicare Advantageplan and want Part D coverage included, you wouldwant to enroll in a Local HMO Medicare Advantageplan option that includes Part D coverage.14nIf Part D is not included in the plan option you choose,you will not have Medicare Part D drug coverage.nThis may work fine for you if you have Medicare PartD creditable coverage (refer to Part D information)such as Veterans Administration prescription drugcoverage, employer group health, union or retireeplan coverage for prescription drugs that providescoverage that is at least as good as the standardMedicare Part D coverage.nIf you do not have creditable prescription drug coverageand decide to enroll in Medicare Part D at a later date,you will most likely be required to pay a premiumpenalty. Refer to Medicare Part D for additionalinformation.Type 2: Regional Preferred Provider Organizations(RPPO) Plans• What you need to knownWith the Regional Preferred Provider OrganizationMedicare Advantage plan, you can see any doctor orprovider that accepts Medicare.nYou don’t need a referral to see a specialist but you maypay more if you go outside the network.• What you need to know about Regional PreferredProvider Plans and Medicare Part DnWhether or not the RPPO Medicare Advantage planincludes Part D coverage, you CANNOT ENROLL INA SEPARATE STAND-ALONE PART D or you will bedisenrolled from your RPPO Medicare Advantage plan.nEvery company offering RPPO Medicare Advantageplans in Minnesota, must offer at least one plan optionthat includes standard Medicare Part D coverage. If youenroll in a RPPO Medicare Advantage plan and wantPart D coverage included, you would want to enroll ina RPPO Medicare Advantage plan option that includesPart D coverage.

Health Care Choices for Minnesotans on MedicarenSNBC plan coverage includes most Medical Assistance(Medicaid) services and Medicare Part A, B and D if applicable.nYour home and community based waiver services,personal care attendants (PCA) and private duty nursesare paid for by Medical Assistance (Medicaid) fee-forserviceand not the SNBC plan.nThere are 6 SNBC plans available in 2010 (refer toSNBC plan grids within this publication).nEffective 1/1/10, SNBC plans are available in all 87counties of MN.Type 5: Medicare Savings Accounts(not available in MN in 2010)Other Medicare Health PlansMedicare Cost PlansThese are plans that provide Medicare A, B and D coverageand have some important differences when compared toMedicare Advantage plan options.• Cost Plans have networks of providers to use in order toreceive the maximum amount of coverage with the lowestout-of-pocket cost.• Cost Plan enrollees may obtain Medicare-covered servicesoutside of the Cost Plan network. Providers will be paidby Original Medicare for the services and you will beresponsible for Medicare deductibles and co-insurance.• Cost Plan enrollment periods are not bound to MedicareAdvantage enrollment periods so enrollment is possible ifthe plan is open to new enrollees. You can also dis-enrollfrom the plan at any time and return to Original Medicare.• Cost Plans are allowed to include Medicare Part Dcoverage, but they are not required to offer it.• When a Cost Plan offers Part D, the Part D coverage ismuch like a local HMO Medicare Advantage plan Part Dcoverage.• Cost Plan enrollees in plans that do not offer Part Dcoverage are allowed to enroll in a stand alone MedicarePart D plan.PACE—Programs of All Inclusive Care for the Elderly(not available in MN in 2010)Demonstrations or Pilot Programs(not available in MN in 2010)Quick Tip 3For easy electronic access to your Medicare billingstatements, register at www.mymedicare.govMedicare Part D: Medicare Prescription Drug CoverageWhat you need to know• Part D is an optional private insurance plan that coverspart of your outpatient prescription drugs costs.• There are 2 ways you can get Medicare Part D coverage:nStand Alone Medicare Prescription Drug PlannAlso known as PDPsnThese are plans that only provide Medicare Part Dcoverage.nThey add the prescription drug benefit to yourOriginal Medicare, some Medicare Cost Plans, andsome Private-Fee-For-Service Plans.nMedicare Advantage Plans or Other MedicareHealth PlansnAlso known as MA-PDsnThese plans provide your Medicare Part A, Part B andPart D coverage – all through one plan.• Anyone who is covered by Medicare Part A and/orMedicare Part B is eligible for Medicare Part D.• Generally you will pay a monthly premium for the Part Dcoverage. You may also have additional out-of-pocket costsincluding deductibles, co-insurance and/or co-pays.• Low Income Subsidy or Extra Help, also known as LIS, isavailable for beneficiaries with limited income and assets.See the section on Medicare Savings Programs and LowIncome Subsidy or Extra Help in this guide.About the Medicare Part D Late Enrollment Penalty• If you do not enroll in Medicare Part D plan when you arefirst eligible for Medicare Part A and/or Part B, and you donot have other creditable prescription drug coverage (referto definitions), you may have to pay a Medicare Part Dmonthly premium penalty when you do enroll.• The penalty also applies if you have a break in yourMedicare Part D coverage or other creditable coverage forat least 63 days in a row.• The Part D premium penalty is 1% of the current nationalbase beneficiary premium ($32 in 2010) for each full,uncovered month that you were eligible to enroll in a PartD plan but did not.• The amount of the Part D monthly premium penaltyyou pay will change in January of each year most likelywill increase. This is because the national base beneficiarypremium changes every year and it is the amount usedto recalculate the Part D premium penalty for the newcalendar year.16

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Example: You did not have creditable prescription drugcoverage. Your initial enrollment period for Medicare PartD ended on May 15, 2006. You waited to join a MedicarePart D plan until December 2008 and your Part D coveragebecame effective on January 1, 2009. Since you were notenrolled in a Medicare Part D for 7 months in 2006 (Junethrough December), all 12 months in 2007, and all 12months in 2008, you will have to pay a 31% (1% for eachfull, uncovered month that you were eligible to enroll in aMedicare drug plan but didn’t) penalty. Since the nationalbase beneficiary premium for 2009 was $30.36, you willbe charged $9.40 ($9.41 rounded to the nearest $.10)each month in addition to your plan monthly premium.This amount will change each year when the national basebeneficiary premium changes.Beyond the BasicsThere are some important things you should know aboutMedicare that are beyond the basics. Some of these areexplained below.• Medicare Assignment is when providers agree toaccept Medicare’s approved amount as payment in full.Medicare pays the provider directly. The provider canonly bill you the deductible and co-insurance amounts.Not all Medicare providers accept assignment.nThe Minnesota Factor: Since 1996, all MinnesotaMedicare providers, with the exception of ambulanceand medical equipment suppliers, are not permitted tobill you for any charges beyond the Medicare deductibleand co-insurance, as long as you are a Minnesotaresident. This is known as the Minnesota Charge Limitand Mandatory Medicare Assignment Law.• Advanced Beneficiary Notice is a form completed byproviders to give you written notice that your services oritem may not be covered by Medicare.nProviders only issue an Advanced Beneficiary Notice toyou when there is a doubt that the service or item is notmedically necessary and will probably not be coveredby Medicare.nReceiving a properly completed ABN from yourprovider, means you have been notified that the serviceor item may not be covered by Medicare and you mayhave to pay the bill.• Medicare Secondary Payer Rule requires that Medicarenot pay until other insurers have paid first.nThis rule applies if:nYou have Medicare and have other health insurancethrough an employer group health plan for currentemployees (not retirees) and spousesnYou have a Worker’s Compensation claim for care providednYou have medical care related to an accident thatautomobile and/or liability insurance coversnMedicare pays first and the Medicare Secondary Ruledoes not apply to the following:nMedicare supplemental policy coveragenRetiree group insurancenTRICARE for LifenMedicaid (Medical Assistance in MN)• Federal law requires that Medicaid (MedicalAssistance) be the payer of last resort.• Coordination of Benefits (COB) andMedicare QuestionnairesnMedicare must make sure that Medicare pays onlywhen it is supposed to pay your claims.nThe Centers for Medicare & Medicaid (CMS) workswith a national Coordination of Benefits contractorto collect and manage information about your otherinsurance coverage.nThis information is obtained from your answers toquestionnaires you receive from the COB contractor. Itis important you respond to the questionnaires.nThere are two types of COB questionnaires youmay receive:nInitial Enrollment Questionnaire (IEQ)• Three months before you become eligible forMedicare you will receive a four page questionnairefor you to describe any of your other healthinsurance coverage. The COB needs to find out ifyou have an employer group health plan that willpay before Medicare.nMedicare Secondary Claim Development Questionnaire• Seeks specific information about an insurancecarrier if you indicate you have other benefitsthrough employer coverage, worker’s compensation,or under automobile no-fault insurance.Important!Answer the questionnaires carefully. Wrong answers canresult in delaying Medicare payments for many months.To correct problems call the COB contractorat 1-800-999-1118 or send a letter to:Medicare Coordination of BenefitsP.O. Box 33847,Detroit, MI 48232You may also want to call the Senior LinkAge Line ®at 1-800-333-2433 for help.17

Health Care Choices for Minnesotans on MedicareMedicare Parts A, B, C and D Enrollment: What you need to knowEnrollmentPeriodPart A and Part B Initial Enrollment Period (IEP)Part A and Part B General Enrollment Period (GEP)Part B Special Enrollment Period (SEP)Applies toMedicare A, B, C and/or D?Part APart BPart APart BPart BLength ofenrollmentperiod?7 months 120 days per yearJanuary 1–March 31 of each year8 monthsWhen does it begin and end?Medicare eligibility due to age:7 month time frame3 months before your 65 th birthday;1 month of your 65 th birthday;3 months after the month of a your 65 th birthday.Medicare eligibility due to disability:first day of the 25 th month of receiving SocialSecurity Disability Insurance (SSDI) or certaindisability benefits from the Railroad RetirementBoard.January 1–March 31 of each year Begins the month after your employment ends or theemployer group health care coverage ends, which everhappens first.Important: Even if you take COBRA benefits, the8-month SEP begins when your employment ends.Medicare eligibility due to ALS (Lou Gehrig’sdisease):first day of the month your Social Security orRailroad Retirement Board disability benefitsbegin.EnrollmentprocessIf you are eligible for Medicare and also eligiblefor retirement or disability benefits, you willautomatically be enrolled in Medicare Parts Aand B. Social Security will mail you a packet,including your Medicare card.IMPORTANT: If you do not want to enroll in PartB, you need to follow the instructions containedwithin the information you receive from SocialSecurity. A penalty may apply if you enroll at alater date and did not have employer health groupcoverage.If you are not receiving Social Security or RailroadRetirement benefits, due to retirement or disabilityyou will need to enroll in Medicare on your ownwith the Social Security Administration (phone1-800-772-1213; website ssa.gov).People who did not enroll in Part A orB during their IEP, or terminated theirPart A or Part B benefits and want tore-enroll, may enroll in either or bothPart A and/or Part B during the GeneralEnrollment Period (GEP). If you enrollduring the GEP, your benefits will beginthe following July 1.You can sign up for Part A and/or Part B without apenalty anytime that you or your spouse (or familymember if you’re disabled) are working, and you’recovered by a group health plan through the employer orunion based on that work. If that coverage ends, you cansign up during the 8-month period that begins the monthafter the employment ends or the group health plancoverage ends, whichever happens first.Only available if you, your spouse, (or family member ifyou are disabled) are working, and you’re covered by agroup health plan through the employer or union basedon that work.18

A publication of the Minnesota Board on Aging Senior LinkAge Line ®When willMedicare coverage begin?What happens if you do not enrollwhen eligible?Specialinformation• If you enroll (or are automatically enrolled) inMedicare during the first three months of theinitial enrollment period, Medicare coveragestarts on the 1 st day of the month in which youturn age 65.• If you enroll in the month of your 65 th birthday,coverage starts on the 1 st day of the next month.• If you enroll in the 5 th month of your IEP,coverage will start 2 months after enrollment.• If you enroll in the 6 th or 7 th month of the IEP,coverage will start 3 months after enrollment.If receiving disability benefits from Social Securityor RRB, coverage will start the first day of the 25 thmonth after your benefits begin.If you do not enroll in Medicare Part A when firsteligible, you may have to pay a penalty equal to10% of the current Part A premium.If you delay your enrollment into Part B untilthe GEP, you may have to pay a late enrollmentpenalty equal to 10% of the current Part Bpremium amount for each 12-month period youdelayed enrollment. The penalty applies unlessyou had creditable coverage from an employergroup health plan.If you have end-stage renal disease (ESRD)and need dialysis on a regular basis or a kidneytransplant, you can get Medicare Part A and PartB within 3 months of your first dialysis treatment.July 1 1 st day of the month following enrollment into Medicare.If you delay your enrollment into PartB until the GEP, you may have to pay alate enrollment penalty equal to 10%of the current Part B premium amountfor each 12-month period you delayedenrollment. The penalty applies unlessyou had creditable coverage from anemployer group health plan.Varies, possible penalty.If you are 65 years old or older and owethe penalty, you have to pay the penaltyfor as long as you are enrolled in Part B.If you are younger than 65, haveMedicare because of a disability andowe the penalty, the Part B penalty willend when you turn 65 and qualify forMedicare coverage based on age.Call the Senior LinkAge Line ® at 1-800-333-2433 formore information.19

Health Care Choices for Minnesotans on MedicareMedicare Parts A, B, C and D Enrollment: What you need to knowEnrollmentPeriodPart C Initial Coverage Election Period (ICEP)Part C Medicare Advantage Open Enrollment Period (OEP)Part C Special Enrollment Period (SEP)Applies toMedicare A, B, C and/or D?Part C Part C Part CLength ofenrollmentperiod?7 monthsMust have both Medicare Part Aand Part B.120 days per yearJanuary 1–March 31 of each yearVariesWhen does it begin and end?Medicare eligibility due to age:7-month time frame3 months before your 65 th birthdaymonth;1 month of your 65 th birthday;3 months after the month of your65 th birthday.Medicare eligibility due to disabilityunder age 65: begins 21 st month ofreceiving Social Security DisabilityInsurance (SSDI) or certaindisability Railroad Retirementbenefits; ends at the end of the27 th month of receiving SocialSecurity or Railroad Retirementbenefits.Already eligible for Medicare due todisability but turn age 65:7-month time frame3 months before your 65 th birthdaymonth;1 month of your 65 th birthday;3 months after the month of your65 th birthdayImportant: If you sign up for aMedicare Advantage Plan duringthis time, you can drop that planat any time during the next 12months and go back to OriginalMedicare.January 1–March 31 of each year Changes in where you live:1. Move to a new address: If you tell your plan before you move,your chance to switch plans begins 1 month before you moveand continues for 2 full months after you move.If you tell your plan after you move, your chance to switch plansbegins the month you tell your plan, plus 2 more full months.2. Move back to the U.S.: Your chance to join lasts for 2 fullmonths after the month you move back to the U.S.3. Moved into, reside in, or just moved out of a skilled nursingfacility or long-term care hospital: Your chance to join, switch,or drop coverage lasts as long as you live in the institutionand for 2 full months after the month you move out of theinstitution.4. Released from jail: Your chance to join lasts for 2 full monthsafter the month you’re released from jail.Changes where you lose your current coverage:1. You’re no longer eligible for Medical Assistance (Medicaid).Your chance to change lasts for 2 full months after the monthyou find out you’re no longer eligible for Medical Assistance.If you lose your coverage for the following year, your chance tochange is between January 1–March 31.2. You leave coverage from your employer or union (includingCOBRA coverage).Your chance to join lasts for 2 full months after the monthyour coverage ends.3. You involuntarily lose other drug coverage that is as good asMedicare drug coverage (creditable coverage), or your othercoverage changes and is no longer creditable.Your chance to join lasts for 2 full months after the monthyou lose your creditable coverage.4. You have drug coverage through a Medicare Cost Plan andyou leave the plan.Your chance to join lasts for 2 full months after the monthyou drop your Medicare Cost Plan.20

A publication of the Minnesota Board on Aging Senior LinkAge Line ®EnrollmentprocessEnrollment in Medicare Part C isnot automatic.You must enroll in a specificplan to be enrolled in MedicareAdvantage (Part C).If you have a Medicare Advantage Planwith drug coverage, you can do one ofthe following:• Switch to a different MedicareAdvantage Plan with drug coverage.• Drop your Medicare Advantage Plan, goback to Original Medicare, and join aMedicare Prescription Drug Plan.If you have a Medicare Advantage Planwithout drug coverage, you can do one ofthe following:• Switch to a different MedicareAdvantage Plan that doesn’t have drugcoverage.• Switch back to Original Medicare.If you have Original Medicare and aMedicare Prescription Drug Plan, youcan join a Medicare Advantage Plan thatincludes drug coverage.Refer to above.If you have Original Medicare with nodrug coverage, you can join a MedicareAdvantage Plan that doesn’t includedrug coverage.IMPORTANT: You can’t make anychanges to your drug coverage duringthis period. If you already have drugcoverage, you must keep it, eitherthrough a Medicare Advantage Plan or aMedicare Prescription Drug Plan. If youdon’t have drug coverage, you can’t addit during this period.This chart continued on next page.21

Health Care Choices for Minnesotans on MedicareEnrollmentPeriodWhen willMedicare coverage begin?What happens if you do not enrollwhen eligible?SpecialinformationThis chart continued from previous page.Part C Initial Coverage Election Period (ICEP)Part C Medicare Advantage Open Enrollment Period (OEP)Part C Special Enrollment Period (SEP)Example 1: Your 65 th birthdaymonth is April. Your IEP for PartB is January 1 to July 31. Theeffective date of your Part A andPart B benefits is April 1, thusyour ICEP for MA plans (Part C)is January 1 (3 months before theeffective date for both Parts A andB benefits) to July 31 (the last dayof your Part B IEP).First day of the month following themonth you enroll.Example: You decide to enroll in PlanXYZ on January 4 th . Your plan enrollmentwill take effect on February 1.VariesExample 2: Your 65 th birthdaymonth is April and your IEP forParts A and B is January 1 to July31. You do not enroll in Part Bbecause you continue to work andare covered by your employer’sgroup health plan. You retire andthen enroll in Part B which becomeseffective December 1 of that sameyear. Your ICEP to enroll in an MAplan is September 1 (3 monthsbefore the effective date for bothParts A and B) to November 30(the last day of the month precedingyour effective date for bothParts A and B benefits).Varies, may not be able to enroll inPart C plan.Varies, may not be able to enroll inPart C plan.Varies, may not be able to enroll in Part C plan.If you have Medicare Part A andenroll in Medicare Part B duringthe General Enrollment Period(GEP) of January 1–March 31,your Medicare Part C IECP isfrom April 1–June 30.Call the Senior LinkAge Line ® at1-800-333-2433 for more information.Additional SEPs may apply. Call the Senior LinkAge Line ®at 1-800-333-2433 for more information.22

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Parts A, B, C and D Enrollment: What you need to knowEnrollment Period Part D Initial Enrollment Period (IEP)Part C and Part D Annual Election Period (AEP)Part D Special Enrollment Period (SEP)Applies to Medicare A, B, C and/or D?Part D Part CPart DPart DLength of enrollment period? If you are new to Medicare, theIEP is the same as the IEP forPart A and/or Part B.47 days per yearNovember 15–December 31of each yearVariesWhen does it begin and end? Medicare eligibility due to age:7 month time frame3 months before your 65 thbirthday month;1 month of your 65 th birthday;3 months after the month of your65 th birthday.Medicare eligibility due to disability:3 months before 25 th month ofreceiving your Social SecurityDisability Insurance (SSDI) orRailroad Retirement Board (RRB)disability benefits;25 th month of receiving yourSocial Security DisabilityInsurance (SSDI) or RailroadRetirement Board (RRB) disabilitybenefits;3 months after 25 th month ofreceiving your Social SecurityDisability Insurance (SSDI) orRailroad Retirement Board (RRB)disability benefits.Medicare eligibility due to ALS(Lou Gehrig’s disease): first dayof the month your Social SecurityDisability Insurance (SSDI) orRailroad Retirement Board (RRB)disability benefits begin.November 1–December 31of each yearChanges in where you live:1. Move to a new address: If you tell your plan before youmove, your chance to switch plans begins 1 month beforeyou move and continues for 2 full months after you move.If you tell your plan after you move, your chance to switchplans begins the month you tell your plan, plus 2 more fullmonths.2. Move back to the U.S.: Your chance to join lasts for 2 fullmonths after the month you move back to the U.S.3. Moved into, reside in, or just moved out of a skillednursing facility or long-term care hospitalYour chance to join, switch, or drop coverage lasts as longas you live in the institution and for 2 full months after themonth you move out of the institution.4. Released from jail: Your chance to join lasts for 2 fullmonths after the month you’re released from jail.Changes where you lose your current coverage:1. You’re no longer eligible for Medical Assistance (Medicaid).Your chance to change lasts for 2 full months after the monthyou find out you’re no longer eligible for Medical Assistance.If you lose your coverage for the following year, yourchance to change is between January 1–March 31.2. You leave coverage from your employer or union (includingCOBRA coverage).Your chance to join lasts for 2 full months after the monthyour coverage ends.3. You involuntarily lose other drug coverage that is as goodas Medicare drug coverage (creditable coverage), or yourother coverage changes and is no longer creditable. Your chance to join lasts for 2 full months after the monthyou lose your creditable coverage.4. You have drug coverage through a Medicare Cost Plan andyou leave the plan.Your chance to join lasts for 2 full months after the monthyou drop your Medicare Cost Plan.This chart continued on next page.23

Health Care Choices for Minnesotans on MedicareThis chart continued from previous page.Enrollment process Enrollment in Medicare Part D is notautomatic. You must enroll in a specific planto receive your Part D benefit. This couldbe a stand-alone Medicare Part D plan or aMedicare Advantage plan with Part D coverage.If you don’t enroll in a Medicare drug planduring the initial enrollment period you canonly enroll at the end of each year duringthe Annual Election Period (November 15 –December 31) or if you qualify for a SpecialEnrollment Period.You can1. Change from Original Medicare to a MedicareAdvantage Plan; OR2. Change from a Medicare Advantage Plan back toOriginal Medicare; OR3. Switch from one Medicare Advantage Plan toanother Medicare Advantage Plan; OR4. Switch from a Medicare Advantage Plan thatdoesn’t offer drug coverage to another MedicareAdvantage Plan that offers drug coverage.; OR5. Switch from a Medicare Advantage Plan that offersdrug coverage to another Medicare Advantage Planthat doesn’t offer drug coverage; OR6. Join a Medicare Prescription Drug Plan; OR7. Switch from one Medicare Prescription Drug Planto another Medicare Prescription Drug Plan; OR8. Drop your Medicare Prescription Drug coveragecompletely.Refer to above.When will Medicare coverage begin?• If you enroll (or are automatically enrolled) inMedicare during the first three months of theinitial enrollment period, Medicare coveragestarts on the 1st day of the month in whichyou turn age 65 or 25 th month of receivingdisability benefits.• If you enroll in the month of your 65 thbirthday or 25 th month of receiving disabilitybeneftis, coverage starts on the 1st day ofthe next month. If you enroll in the 5 th monthof your IEP, coverage will start 2 monthsafter enrollment.• If you enroll in the 6 th or 7 th month of theIEP, coverage will start 3 months afterenrollment.January 1 VariesWhat happens if you do notenroll when eligible?If you don’t enroll in a Medicare drug planduring the initial enrollment period you can onlyenroll at the end of each year during the AnnualElection Period (November 15–December 31) orif you qualify for a Special Enrollment PeriodVaries, possible Part D penalty. Varies, possible penalty.Special information People who have Medicare due to a disabilityhave another Part D IEP when they turn age 65.If you do not have Medicare Part A and enroll inMedicare Part B during the General EnrollmentPeriod (GEP) of January 1 – March 31, yourMedicare Part D IEP is from April 1 – June 30.Call the Senior LinkAge Line® at 1-800-333-2433 formore information.Additional SEPs may apply.Call the Senior LinkAgeLine® at 1-800-333-2433for more information.24

Medicare Enrollment Period RemindersPart B1. Part B Initial Enrollment Period:This is a seven-month window: three months beforeyou reach 65, the month you reach 65 and threemonths after.• Important: For most people, a 10% penalty is addedto the Part B premium for each 12-month period youcould have had Part B but didn’t enroll. The exceptionis if you qualify for a Special Enrollment Period. Thepenalty continues for as long as you have Part B.• Part B payments can be waived if you are still working,as long as your employment or group coverage does notend during the Initial Enrollment Period.• To opt out of Part B in the Initial Enrollment Period,you must return an opt-out notice to Social Security.2. Part B Special Enrollment Period:The window for Part B enrollment without a premiumpenalty applies if you waived Part B during your InitialEnrollment Period because you (or your spouse) hadcoverage through an employer group health plan. Youmay enroll in Part B at any time while covered throughan employer plan or when you retire. If you wait toenroll in Part B until you retire, the Special EnrollmentPeriod begins when active employment ends or whenemployer coverage ends (whichever occurs first) andlasts for eight months.• To use the Special Enrollment Period:nContact Social Security four months before youretire or when your employer or union coverageends, whichever is first.nRequest Employer Verification Form 40B fromSocial Security and have your employer fill it outand send it in to Social Security to activate yourSpecial Enrollment.nKeep a copy of the form to send in with your enrollmentform.• Important information about COBRA andMedicare Part B:nIf you already have COBRA when you enroll inMedicare, your COBRA coverage usually ends onthe date you enroll in Medicare.nIf you have COBRA and become Medicare-eligible,you should enroll in Part B immediately becauseyou are not entitled to a Special Enrollment Period(SEP) when COBRA ends.nYour spouse and dependents may keep COBRA forup to 36 months, regardless of whether you enroll inMedicare during that time.A publication of the Minnesota Board on Aging Senior LinkAge Line ®25nIf you already have Medicare when you become eligiblefor COBRA, you must be allowed to enroll in COBRA.nUnless you qualify for Medicare because you haveESRD, Medicare acts as the primary payer andCOBRA as the secondary payer, so you may wantto stay enrolled in Medicare Part B, if you can affordCOBRA.nYou may wish to take COBRA if you have veryhigh medical expenses and your COBRA plan offersyou generous extra benefits, like prescription drugcoverage.nIf you are 65 and have COBRA coverage on anemployer’s policy, you should still enroll in Part B,because you will not get a Special Enrollment Periodwhen COBRA ends. You must sign up for Part Bduring the first eight months you have COBRAcoverage to avoid the late enrollment penalty in theGeneral Enrollment Period.nFor additional information about COBRA coveragein Minnesota, call the Minnesota Department ofCommerce at 651-296-2488 or 1-800-657-3602.3. Part B General Enrollment Period• If you do not enroll in Part B in the Initial orSpecial Enrollment Period, you can use the GeneralEnrollment Period January 1 through March 31.• Coverage starts the following July 1 of the year inwhich you enroll.• You can be charged the 10% Part B premium penaltyfor each year you were late enrolling and did not haveemployer group health coverage.nThis charge increases annually as Medicarepremiums increase and will continue for yourlifetime or as long as you are on Part B.nAn exception applies to people enrolled in aMedicare Savings Program (QMB, SLMB, QI-1)where the Part B penalty is waived.

Health Care Choices for Minnesotans on MedicarePart C1. Enrollment rules for Medicare Advantage plans• You may switch Medicare Advantage plans, with orwithout Part D, or dis-enroll from a Medicare Advantageplan during the Part D Annual Election Period fromNovember 15 through December 31 each year.• You can enroll in a Medicare Advantage plan up totwice per year, unless you use a Special EnrollmentPeriod.• There is the Medicare Advantage Plan OpenEnrollment Period from January 1 through March 31of each year.nYou may not add Part D if you don’t already have itand you may not drop Part D if you have it as partof your Medicare Advantage plan.2. Medicare Advantage Special Enrollment PeriodsIf any of the following situations applies to you, youmay leave your Medicare Advantage plan any timewithin the first 12 months and enroll in OriginalMedicare Part A and B with a separate Part D plan andin a Medicare supplement with no health screeningrequired:• You enrolled in a Medicare Advantage plan for the firsttime when first eligible for Medicare at age 65.• You previously had Original Medicare Part A andB, plus a supplement, and you decided to enroll ina Medicare Advantage plan for the first time to try itout during the last Annual Election Period or OpenEnrollment Period.3. Medicare Advantage and Medicare SupplementsIf you join a Medicare Advantage health plan (or otherMedicare health plan) for the first time, you havespecial rights to buy a Medicare supplement policy ifyou return to Original Medicare within 12 months ofenrolling in a Medicare Advantage or other Medicarehealth plan.The rules allow that:• If you had a Medicare supplement policy before youjoined, you may be able to get the same policy back ifthe company still sells it.nThe Medicare supplement policy can no longer haveprescription drug coverage even if you had it before,but you may be able to join a stand alone MedicarePrescription Drug Plan.• If you joined a Medicare Advantage or other Medicarehealth plan when you were first eligible for Medicare,you can choose from any Medicare supplement policy.• If you buy a Medicare SELECT policy you also haverights to change your mind within 12 months and switchto a standard Medicare supplement policy.Medicare Part DLate enrollment penaltyIf you don’t enroll in Medicare Part D during your InitialEnrollment Period for Part D, you may be subject to apremium penalty.• Equal to 1% of the national average premium for everymonth you didn’t enroll when first eligible.• If you have creditable coverage, the penalty will notapply as long as you were not without the creditableprescription drug coverage for 63 consecutive days.• Percentage is based on the current year’s national averagepremium, which is approximately $32 in 2010.• The penalty continues for as long as you have Part D.• The penalty is waived for those on the Part D Extra Helpprogram (LIS).Still working?• If your coverage at work includes prescription drugcoverage that is at least as good as the standard MedicarePart D benefit, you don’t need to enroll in Medicare PartD at that time.• You will want to avoid the Part D late enrollmentpenalty by making sure your employer or union coverageis “creditable” (as least as good as the current Part Dbenefit).• Your employer’s insurance company must send youcreditable coverage notices, either a letter or informationpacket, when requested, and at a minimum, prior toNovember 15 of each year.• Keep the notice to ensure you will be able enroll in PartD later with no penalty.• If your prescription drug coverage at work is notcreditable, you must sign up for Part D at age 65 orface the premium penalty later. This is the case even ifyou waive Part B because of current employer healthinsurance.26

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Part D Special Enrollment PeriodThis is a window for enrolling in Part D that avoids apremium penalty. Timelines vary. Here are some commonexamples:• Monthly window: Change plans once per monthwith no penalty1. You have Medical Assistance (Medicaid) or any of theMedicare Savings Programs (QMB, SLMB or QI-1)or Part D Extra Help (LIS).2. You live in an institution (including a nursing home).• Two-month window:1. You move out of a long-term care facility.2. You had been working, you retire and creditable drugcoverage ends.3. You lose creditable coverage through no fault of your own.• Three-month window:1. You voluntarily drop your employer creditablecoverage during open enrollment.2. You lose your Extra Help (LIS) to help withMedicare Part D costs.3. You move outside your Part D plan’s coverage area.• This window starts the month you notify your oldplan, if notification is after the move.• If you don’t notify your old plan, your SpecialEnrollment Period is from the sixth month throughthe eighth month after your move, otherwise youmust wait for the Annual Election period and besubject to a penalty for the months you no longerhad Part D coverage.Medicare Advantage Plan open enrollment period optionsIf you have this type ofhealth care coverage:Medicare Advantage planwith Part D coverage.Medicare Advantage planwith Part D coverage.You can make a one-time switch* annually from January 1 to March 31 to:A different Advantage plan withPart D coverage.Original Medicare with a stand-alonePart D plan.Provided you had:Part D coverage as of Jan. 1in the year you are switching.Part D coverage as of Jan. 1in the year you are switching.Original Medicare with astand-alone Part D plan.Advantage plan with Part D coverage. Part D coverage as of Jan. 1in the year you are switching.Medicare Advantage planwith no Part D coverage.Original Medicare withno Part D coverage.Original Medicare with no Part D coverage.Advantage plan with no Part D coverage.You cannot add Part D if youdid not have it before Jan. 1.You will need to wait untilNov. 15 through Dec. 31.You cannot add Part D if youdid not have it before Jan. 1.You will need to wait untilNov. 15 through Dec. 31.*The change is effective the first day of the month following the month you made the change.27

Health Care Choices for Minnesotans on MedicareMedicare and People with DisabilitiesImportant things to know if you are under age 65People under 65 are entitled to Medicare if they receiveSocial Security Disability Insurance (SSDI) benefits, haveend-stage renal disease (ESRD), or Amyotrophic LateralSclerosis (ALS), known as Lou Gehrig’s disease.The Rules for Social Security Disability Insurance(SSDI)Social Security Disability Insurance (SSDI) is a federalprogram that provides monthly cash benefits to you andcertain family members if you have worked, paid SocialSecurity taxes, and now have a disability that prevents youfrom working.Social Security uses a five step process to determinewhether or not you meet the criteria for “disability”. Youmust meet all five criteria listed below to be determined“disabled”.1. Are you working at a level of “Substantial GainfulActivity”? If you are working and your countablegross monthly earnings (your earnings before taxes arededucted) are higher than the Substantial GainfulActivity (SGA) level, you will not be determineddisabled. In 2010, SGA for people with disabilities is$1,000 ($1,640, if you are blind) per month.2. Is your condition “severe”? Your condition must beexpected to last at least 12 consecutive months or toresult in death. Your condition must also significantlyinterfere with basic work-related activities for yourclaim to be considered.3. Is your condition on Social Security’s List ofImpairments? If your condition is on the list, you canmove on to the next step. If your condition is not onthe list, Social Security will have to determine that yourcondition is as severe as a condition that is on the listfor you to move on to the next step.4. Can you do the work you did previously? If yourcondition prevents you from doing the same work youdid before, you can move on to the next step. If yourcondition doesn’t prevent you from doing the work youdid before, you won’t be determined disabled.5. Can you do any other type of work? If you can’tperform the work you used to do, Social Security willevaluate your skills and your condition to see if thereis other work you could do at the Substantial GainfulActivity (SGA) level.It may take 3-5 months for the Social SecurityAdministration to make a decision in your case. If youare in need of public health insurance, you may want toconsider applying at your local county social services fora Minnesota Health Care Program. To qualify for someMinnesota Health Care Programs, like Medical Assistance(Medicaid), you need to be certified disabled by the SocialSecurity Administration. If however, your application isstill pending or you are appealing the decision, you canalso be certified disabled by Minnesota’s State MedicareReview Team (SMRT). SMRT is a division withinMinnesota’s Department of Human Services that decideswhether or not you meet the state criteria for “blind” or“disabled” status.The SSDI Waiting Period for Medicare CoverageYou must qualify for, and receive SSDI benefits to beeligible for Medicare.Once approved for SSDI, you must wait 5 months beforethe SSDI cash benefit begins, then an additional 24months before you begin receiving Medicare benefits. Ifyou receive benefits because you have Amyotrophic LateralSclerosis (ALS), known as Lou Gehrig’s disease, you canget Medicare the first month you receive SSDI payments.If you have end-stage renal disease (ESRD), Medicarebegins the third month of kidney dialysis, or the month ofa kidney transplant, whichever is first.Health Care Coverage Options During the Medicare Waiting PeriodYou may be able to get help paying for medical costsduring the waiting period through:• Medical Assistance (Medicaid)• MinnesotaCare• Employer sponsored health coverage through a current,former, or spouse’s employer• Minnesota Comprehensive Health Association (MCHA)• COBRA coverage28

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Enrollment and SSDIMedicare Part A and B• After the 24 month waiting period for Medicare, youwill be automatically enrolled in Medicare Parts A and B.• Medicare Initial Enrollment Period for Part A and PartB is 7 months long. It begins with the 25th month youreceived Social Security Disability Insurance (SSDI).• If you don’t need Part B coverage due to employer grouphealth coverage, you may delay enrollment so you don’thave to pay the monthly Part B premium.• Work closely with the Social Security Administrationif you decide to delay Part B enrollment. If you do notmeet the requirements, enrolling in Medicare Part B later(but prior to age 65) usually requires you to pay a lateenrollmentpremium penalty.Medicare Part C: Medicare Advantage• After the 24 month waiting period for Medicare, youcan choose to enroll in a Medicare Advantage plan toreceive all of your Medicare Part A, Part B and oftenMedicare Part D benefits if you live within the MedicareAdvantage plan service area.• Medicare Advantage Initial Coverage Election Period(ICEP) begins 3 months before entitlement to PartA and Part B and ends either on the last day of yourMedicare Part B initial enrollment period or the last dayof the month preceding entitlement to both Part A andPart B, whichever is later. The ICEP is 7 months long.Medicare Part D: Medicare Prescription Drug Benefit• You will not be automatically enrolled into a MedicarePart D plan unless you are also enrolled in MedicalAssistance (Medicaid) through your local county socialservices agency.• Medicare Part D Initial Enrollment Period (IEP) is7 months long. It begins with the 25th month youreceived Social Security Disability Insurance (SSDI).• You can choose to receive your Medicare Part D benefitsby enrolling in either a Stand Alone Prescription DrugPlan or a Medicare Advantage plan that includes Part Dcoverage.Returning to Work and Medicare (under age 65)Social Security wants to encourage people on SSDI toreturn to work. To help facilitate this, they’ve designedprogram rules and work incentives to make it easierfor people to test their ability to return to work. A fewexamples of work incentives are:• Trial Work Period. Social Security provides people onSSDI a nine-month “Trial Work Period” to test thewaters and decide if they’re able to re-enter (or more fullyenter) the workforce. During your Trial Work Period,you can work and earn any level of income while stillmaintaining your full SSDI benefit. The 9 months doesnot need to be consecutive and your trial work periodwill last until you accumulate 9 months within a rolling60-month period.nIn 2010, a trial work month is any month within yourTrial Work Period that your gross earnings exceed $720.nYou will continue to be eligible for Medicare as long asyou’re a receiving SSDI cash benefit, and for up to 93months (7 years, 9 months) after your SSDI Trial WorkPeriod ends.• Extended Period of Eligibility. Once you’ve used up all9 Trial Work Period months within a 60 month window,your Trial Work Period is over and your 36-monthExtended Period of Eligibility (EPE) begins. Duringyour EPE, you will continue to receive SSDI benefitsas long as your gross monthly earnings don’t exceed theSubstantial Gainful Activity (SGA) level (in 2010, theSGA level is $1,000 per month; $1,640 if you’re blind).• Medical Assistance for Employed Persons withDisabilities (MA-EPD). MA-EPD allows Minnesotanswith disabilities who work to receive Medical Assistance(Medicaid) at relatively low cost. To be eligible, youmust have a disability; be between the ages of 16 and 64;and have more than $65 in gross earnings each month.You must also pay a monthly premium, based on yourincome and household size, and have no more than$20,000 in assets (not counting retirement accounts andpersonal belongings). Your spouse’s income and assets arenot counted.29

Health Care Choices for Minnesotans on MedicareMedicare Enrollment Periods, Health Screening and Turning Age 65• When you turn age 65, you will be entitled to anotherinitial enrollment period for Medicare Part B.nIf you enrolled in Medicare Part B due to a disabilityand had to pay a premium penalty because you did notenroll when initially eligible, once you turn age 65, youwill no longer have to pay the premium penalty.• When you turn age 65, you will be entitled to anotherinitial enrollment period for Medicare Part D.• When you turn age 65, you will be entitled to anotherMedicare Supplement (Medigap) open enrollmentperiod with no health screening. This applies if youvoluntarily dis-enrolled from Medicare Part B becauseyou had employer group health plan coverage due toemployment.The Disability Linkage Line ® is an integral partof the MinnesotaHelp Network which includes:• Disability Linkage Line ® 1-866-333-2466• Senior LinkAge Line ® 1-800-333-2433• Veterans Linkage Line 1-888-546-5838(1-888-LinkVet)• www.MinnesotaHelp.info ®Questions?If you are under age 65 and have a disability please callthe Disability Linkage Line ® at 1-866-333-2466 forpersonalized assistance with understanding your options.The Disability Linkage Line ® is open from 8:30 a.m.-5:00p.m. Monday–Friday.The Disability Linkage Line ® is a free statewidecomprehensive information, referral and assistance servicefor people with disabilities, chronic illnesses, and theirrepresentatives. Disability Linkage Line ® specialists provideobjective one-to-one assistance to help people learn aboutand manage their health care and other benefit options, aswell as access community supports and services.Disability Linkage Line ® is a service of the MinnesotaDepartment of Human Services and provided locallyin all 87 counties by the Metropolitan Center forIndependent Living and Southeastern Minnesota Centerfor Independent Living.Quick Tip 4Disability Linkage Line ® (1-866-333-2466)Areas of expertise include:• Disability benefits and programs• Building accessibility and home modifications• Assistive technology• Personal Assistance Services• Transition services• Accessible housing• Disability awareness and rights30

A publication of the Minnesota Board on Aging Senior LinkAge Line ®DefinitionsAppeal (Part A, B, C and D): A special kind of complaintyou make if you disagree with certain kinds of decisionsmade by Original Medicare or by your health plan. Youcan appeal if you request a health care service, supply orprescription that you think you should be able to get fromyour health plan, or you request payment for health careyou already received, and Medicare or the health plan deniesthe request. You can also appeal if you are already receivingcoverage and Medicare or the plan stops paying. Thereare specific processes your Medicare Advantage plan, otherMedicare health plans, Medicare Part D plans, or OriginalMedicare must use when you ask for an appeal.Benefit period (Part A): The way that Original Medicaremeasures your use of hospital and skilled nursing facility(SNF) services. A benefit period begins the day you go intoa hospital or skilled nursing facility. The benefit period endswhen you haven’t received any inpatient hospital care (orskilled care in a SNF) for 60 days in a row. If you go into ahospital or a skilled nursing facility after one benefit periodhas ended, a new benefit period begins. You must pay theinpatient hospital deductible for each benefit period. Thereis no limit to the number of benefit periods.Capitation (Part C): Medicare payment system forMedicare Advantage plans where the plan receives a fixeddollar amount to provide all Medicare covered services foreach Medicare beneficiary enrolled in the plan, no matterhow few or how many services a beneficiary uses.Catastrophic coverage (Part D): This is the higher level ofcoverage (95% or more) you receive for all covered drugsafter you have paid more than $4,550 for your prescriptionsin 2010.COBRA Continuation of Health Coverage(Consolidated Omnibus Budget Reconciliation Actof 1986): Gives workers and their families who losehealth benefits the right to choose to continue grouphealth benefits provided by their group health plan forlimited periods of time under certain circumstances suchas voluntary or involuntary job loss, reduction in the hoursworked, transition between jobs, death, divorce, and otherlife events. The person may be required to pay the entirepremium for coverage up to 102 percent of the cost ofthe plan.Co-insurance (Part A, B, C and D): An amount youare required to pay as your share of the cost for servicesafter you pay any deductibles. Co-insurance is usually apercentage (for example, 20%).Co-payment (Part A, B, C and D): An amount you arerequired to pay as your share of the cost for a medicalservice or supply, like a doctor’s visit or a prescription. A copaymentis usually a set amount, rather than a percentage.For example, you might pay $10 or $20 for a doctor’s visitor prescription.Creditable Prescription Drug Coverage (Part D):Prescription drug coverage (for example, from an employeror union) that is expected to pay, on average, at least asmuch as Medicare’s standard prescription drug coverage.People who have this kind of coverage when they becomeeligible for Medicare can generally keep that coveragewithout paying a penalty, if they decide to enroll inMedicare prescription drug coverage later.Custodial Care (Part A, B and C): Non-skilled personalcare, such as help with activities of daily living like bathing,dressing, eating, getting in or out of a bed or chair, movingaround, and using the bathroom. It may also include thekind of health-related care that most people do themselves,like using eye drops. In most cases, Medicare doesn’t pay forcustodial care.Deductible (Part A, B, C and D): The amount you mustpay for health care, Medicare, prescription drug plan oryour other insurance before it begins to pay.Donut hole (Part D coverage gap): In 2010, once youreach $2,830 in total covered prescription drug costs, youwill have a coverage gap where you must pay the full cost ofyour prescription drugs until your total out-of-pocket drugcosts reach $4,550. This is also known as the donut hole.Durable Medical Equipment (DME): Includes itemssuch as home oxygen equipment, hospital beds, walkers,wheelchairs, commodes, prosthetics, orthotics and othersupplies are covered under Medicare Part B. All DMEproviders must be accredited by Medicare as of Oct. 1,2009.Extra Help with Medicare Prescription Drug Plan Costs(Part D)–also knows as Low Income Subsidy (LIS):A federal subsidy for people with limited income andresources to help pay for Part D. People with Extra Help(LIS) do not have a donut hole and have limited MedicarePart D out-of-pocket costs.Fee-For-Service (FFS): Medicare reimbursement paymentsystem where Medicare pays a provider a fee for each serviceperformed.31

Health Care Choices for Minnesotans on MedicareFormulary (Part D): A list of specific prescription drugsthat a Medicare Part D plan, insurance company or healthplan will cover subject to limits and conditions.Generic Drug (Part D): A chemically equivalent copy of adrug designed from a brand name drug that has an expiredpatent. A generic drug is typically less expensive than thebrand name drug and sold under a common or “generic”name for the drug, not the brand name.Grievance (Part C and Part D): A complaint about theway your Medicare health plan is giving care. For example,you may file a grievance if you have a problem calling theplan or if you are unhappy with the way a staff person at theplan has behaved toward you. A grievance is not the wayto deal with a complaint about a treatment decision or aservice that is not covered.Health Maintenance Organization (HMO–Part C): Atype of Medicare Advantage Plan that is available in someareas of the country. Plans must cover all Medicare Part Aand Part B health care. Some HMOs cover extra benefits,like extra days in the hospital. In most HMOs, you can onlygo to doctors, specialists, or hospitals on the plan’s list exceptin an emergency. Your costs may be lower than in OriginalMedicare.Health Insurance Portability and Accountability Actof 1996 (HIPAA): Protects employees’ health insurancecoverage when they change or lose their jobs. It also providesstandards for privacy and security of health informationrecords and transactions.Medical Assistance (Minnesota’s Medicaid program):Federal/State program that pays for health care services forlow-income Minnesotans. Eligibility for Medical Assistanceis determined by your county human services office.Medicare Advantage Plan (Part C): A plan offered by aprivate company that contracts with Medicare to provideyou with all your Medicare Part A and Part B benefits.Medicare Advantage Plans are Health MaintenanceOrganizations, Regional Preferred Provider Organizations,Private Fee-for-Service Plans, Special Need Plans andMedicare Medical Savings Accounts. If you are enrolled ina Medicare Advantage Plan, Medicare services are coveredthrough the plans, and are not paid for under OriginalMedicare.Medicare Advantage Prescription Drug Plan (MA-PD–Part C and D): A Medicare Advantage plan that offersMedicare Prescription Drug coverage and Part A and Part Bbenefits in one plan.Medicare-approved amount (Part A and B): In OriginalMedicare, this is the amount a doctor or supplier can bepaid, including what Medicare pays and any deductible,co-insurance or co-pay that you pay. It may be less thanthe actual amount charged by the doctor or supplier.In Minnesota, only Minnesota ambulance and medicalequipment suppliers are allowed to bill Minnesota Medicarebeneficiaries beyond the Medicare approved amount.Medicare supplement or Medigap policy (Part A and B):Medicare supplemental insurance policies sold by privateinsurance companies to fill gaps in Original Medicarecoverage. These policies work only with the OriginalMedicare plan. In Minnesota, there are generally three typesof Medicare supplemental policies sold– Basic, ExtendedBasic and Medicare SELECT.Original Medicare (Part A and B): Medicare Parts A andB let you go to any doctor, hospital or other health careprovider who accepts Medicare and will take new Medicarepatients. Unless you have a Medicare supplemental policyor additional coverage, you must pay deductibles and coinsurance.Premium (Part B, C and D): The amount you paymonthly for Part B, Part C and Part D coverage. Mostpeople do not pay a premium for Medicare Part A.Tiers (Part D): To have lower costs, many Part D plansplace drugs into different “tiers,” which cost differentamounts. For example, Tier 1 may be generic drugs; Tier 2may be brand name drugs.32

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Supplements (Medigap) in MinnesotaA Medicare supplement (Medigap) policy is healthinsurance sold by private insurance companies tofill gaps in Original Medicare coverage. Medicaresupplement policies don’t work with any other typeof health insurance, including Medicare AdvantagePlans, employer/union group coverage, VeteransAdministration (VA) benefits, or TRICARE. Medicaresupplement policies help pay your share (co-insurance,co-payments, or deductibles) of the costs of Medicarecoveredservices. Some Medicare supplement policiescover certain costs not covered by Original Medicare.If you are in Original Medicare and you have a Medicaresupplement policy, Medicare will pay its share of theMedicare-approved amounts for covered health care costs.Then your Medicare supplement policy pays its share.In Minnesota, Basic and Extended Basic Medicaresupplements must offer the same basic benefits, nomatter which insurance company sells it. Cost is usuallythe only difference between Medicare supplementpolicies sold by different insurance companies.What should I know before purchasing aMedicare supplement policy?• You must have Medicare Part A and Part B to buy aMedicare supplement policy.• You pay a premium for your Medicare supplementpolicy to the private insurance company, in additionto your monthly Part B premium that you pay toMedicare.• A Medicare supplement policy only covers oneperson. If you and your spouse both want Medicaresupplement coverage, you each will have to buyseparate Medicare supplement policies.• You can buy a Medicare supplement policy from anyinsurance company that is licensed in Minnesota tosell one to you.• All Medicare supplement policies are guaranteedrenewable even if you have health problems. Theinsurance company can’t cancel your Medicaresupplement policy as long as you pay the premium.• Although some Medicare supplement policies soldin the past covered prescription drugs, no newMedicare supplement policies are allowed to includeprescription drug coverage.• If you want prescription drug coverage, you may wantto join a Stand Alone Medicare Prescription DrugPlan (Part D) offered by private companies approvedby Medicare.33I. Open EnrollmentMedicare Supplement Open Enrollment Period• The best time to buy a Medicare supplement policy isduring your Medicare supplement open enrollmentperiod.• For most people, this period lasts for 6 months andbegins on the first day of the month in which you areage 65 or older and enrolled in Medicare Part B.• In Minnesota, if you re-enroll in Medicare Part B, youwill have another 6 month open enrollment period.Examples:nYou are under age 65, receive Social SecurityDisability Insurance (SSDI) and enroll in MedicarePart B after the required Medicare 24 month waitingperiod. You will have a 6 month open enrollmentperiod that begins the month you enroll in MedicarePart B.nWhen you turn age 65, you will receive another 6month open enrollment period.nYou continue to work beyond age 65 and receiveemployer group health coverage. As a result, you donot enroll in Medicare Part B when you are eligibleat age 65.nWhen your employer group health coverage ends,and you enroll in Medicare Part B, you will have a6 month open enrollment period.nYou voluntarily dis-enroll from Medicare Part Bbecause you become employed after you enrollin Part B and you receive employer group healthcoverage.nWhen your employer group health coverage endsand you re-enroll in Medicare Part B, you willreceive another 6 month open enrollment period.• During open enrollment, an insurance company can’tuse medical underwriting. This means the insurancecompany can’t do any of the following:nRefuse to sell you any Medicare supplement policyit sells.nMake you wait for coverage to start (except asexplained later).nCharge you more for a Medicare supplement policybecause of your health problems.

Health Care Choices for Minnesotans on MedicareAn important note about loss of Medicaresupplemental policy coverageIn Minnesota, if you lose your supplemental coveragethrough no fault of your own, you can purchase a BasicMedicare supplement policy with up to three additionalriders, or you can purchase a Medicare SELECT policy.• You must apply for the new policy within 63 days oflosing coverage to ensure that your health status will notaffect your ability to get a new policy.Common situations where you could lose yoursupplemental insurance coverage:• You are enrolled in an employer’s group health plan thatsupplements Medicare and the plan terminates or stopsproviding Medicare supplement benefits.• You voluntarily leave the employer plan.• You are enrolled in a Medicare Advantage plan, otherMedicare plan, or a Medicare SELECT plan, but areno longer eligible because you moved out of the plan’sservice area.II. Medicare Supplement Policies, MedicareAdvantage Plans, Other Medicare Plans, andStand Alone Prescription Drug PlansIf you join a Medicare Advantage plan or other Medicareplan for the first time, and you do not want to staywith the plan, you have special rights to buy a Medicaresupplement policy if you return to Original Medicarewithin 12 months of enrolling in the Medicare Advantageor Other Medicare plan.• If you had a Medicare supplement policy before youjoined the plan, you may be able to get the same planback if the company still sells it in Minnesota.• Medicare supplement policies can no longer includeprescription drug coverage, even if you had it before,but you may be able to join a Stand Alone MedicarePrescription Drug Plan.• If you joined a Medicare Advantage plan or OtherMedicare plan when you were first eligible for Medicare,you can choose from any Medicare supplement policysold in Minnesota.• This also applies if you purchase a Medicare SELECTpolicy and decide you do not want to stay with it. Youcan switch to a Basic Medicare supplement policy within12 months of purchasing the Medicare SELECT policy.III. Minnesota Comprehensive Health Association(MCHA)Since 1976, Minnesota has provided an option for peopleto get health insurance coverage who have been deniedcoverage by the private market because of a pre-existinghealth condition. MCHA is also referred to as Minnesota’shigh risk pool for health insurance. MCHA is regulatedby the Minnesota Department of Commerce andadministered by Medica.MCHA offers• Individual deductible health insurance policies for peoplewithout Medicare• Basic Medicare supplement policynExtended Basic Medicare supplement is no longeravailable through MCHA.You may be eligible for MCHA Basic Medicaresupplement policy if:• You are enrolled in both Part A and B of Medicare.• You have been a resident of Minnesota for the six monthsimmediately preceding your application for MCHAcoverage.• You have been rejected for other health coverage or havea preexisting condition limitation.• You have been the “holder” of a policy or certificateof Medicare supplement coverage which has beenterminated by an insurer for reason other thannonpayment of premium.• You have been treated within the last three years for oneof the special “presumptive conditions”.Examples of the 47 presumptive conditions include,but are not limited to:nInsulin dependent diabetesnStrokenAlzheimer’s diseasenMultiple SclerosisnParkinson’s diseaseCall MCHA Customer Service at 1-800-325-3540for more information.34

A publication of the Minnesota Board on Aging Senior LinkAge Line ®In Minnesota, there are 2 types of Medicare supplements–Basic and Extended Basic. For most policies sold,Minnesota does not use the alphabet policy systemof naming Medicare supplements A through M.All Medicare supplemental policies sold in Minnesotaexceed the benefits required by the federal governmentMN now has policies K, L, M and N (refer below).Information about the specific companies that may be sellingthese policies was not available.There are currently 24 companies selling Medicaresupplements in Minnesota.All Medicare supplemental policies sold in Minnesotato Medicare beneficiaries age 65 and older must also besold to Medicare beneficiaries under age 65 enrolled inMedicare. This is not required in most states.All Medicare supplemental policies sold in Minnesotaare “community rated”. This means that you cannot becharged a higher premium based just on your age or healthstatus. Everyone with the policy, regardless of age or healthstatus, pays the same premium. There are 2 exceptions–higher premium can be charged if you are a smoker andpremiums may differ between rural and urban areas ofMinnesota.Policy K Policy L Policy M Policy NHigh Deductible Policy High Deductible Policy Covers 50% of the MedicarePart A deductibleCovers 100% of the MedicarePart A deductibleIn 2010, the out-ofpocketlimit is $4,620In 2010, the out-ofpocketlimit is $2,310Covers 100% MedicarePart B co-insuranceCovers 100% of the MedicarePart B co-insurance exceptup to a $20 office visit copayand up to $50 co-pay foremergency roomCovers the skilled nursingfacility co-insuranceCovers the skilled nursingfacility co-insuranceCovers foreign travelemergencyCovers foreign travelemergency35

Health Care Choices for Minnesotans on MedicareCompany Basic PlanAdmiral Life Insurance Company of AmericaRural SmokerRural Non-smokerUrban SmokerUrban Non-smoker$100$90$121.41$109.25Part ADeductible$25$22.50$30.41$27.33Part BDeductible$11.25$11.25$11.25$11.2580% PartB Excess100% Part BExcess$2.50$2.25$3.08$2.67Prevention$5.92$5.33$7.25$6.50ExtendedBasic$305.58$275.08$387.08$344.00Bankers Life and Casualty $171 $51.58 $10.58 $3.67 $2.58 $324.92Blue Cross and Blue ShieldSmokerNon-smokerCombined Insurance of AmericaSmokerNon-smokerContinental GeneralRuralUrbanContinental Life of Brentwood TennesseeRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerGenworth Life and Annuity Insurance CompanyRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerGuarantee Life TrustUrbanRuralHumana Insurance CompanyRural 1 SmokerRural 1 Non-smokerRural 2 SmokerRural 2 Non-smokerUrban SmokerUrban Non-smoker$156$134$196.92$170.42$157.67$173.42$103.92$93.58$117.42$105.75$104.83$94.41$117.92$106.17$201.92$168.08$147$125$136$116$155$132$81$70$22.42$19.42$53.42$58.75$26.83$24.08$30.33$27.25$23.67$21.33$26.67$24$81.67$68.08$48$40$48$40$48$40$11$11$8.08$7$11.08$11.08$11.25$11.25$11.25$11.25$10.33$10.33$10.33$10.33$11.50$11.50$11$11$11$11$11$11$45$30$13.67$11.83$6.17$6.75$5.33$4.92$6$5.58$4.92$4.42$5.50$5$3.58$3$6$5$6$5$6$5$5$5$5$5$8.42$9.25$4.25$3.67$4.83$4.17$3.83$3.50$4.25$3.92$10$9$9$8$11$10$562$447$510.60$460.85$263.50$289.83$237.58$213.75$268.50$241.50$218.17$196.50$245.50$221.08$523.08$436.83$312$267$289$248$330$28336

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Lincoln Heritage LifeRural SmokerRural Non-smokerUrban 1 SmokerUrban 1 Non-smokerUrban 2 SmokerUrban 2 Non-smokerMinnesota Comprehensive HealthAssociationSmokerNon-smokerMutual of OmahaRural SmokerRural Non-smokerUrban Smoker 1Urban Non-smoker 1Urban Smoker 2Urban Non-smoker 2Pennsylvania LifeUrban SmokerUrban Non-smokerRural 2 SmokerRural 2 Non-smokerRural 1 SmokerRural 1 Non-smokerRoyal Neighbors of AmericaRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerSanford Health Plan of MNSmokerNon-smokerState Farm MutualRuralUrban$158.08$142.25$192$172.67$180.67$162.50$205.75$164.83$201.92$175.67$217.50$189.25$235.58$205$149.67$127.41$141.33$124.50$133.08$113.25$113.50$102.17$137.75$124.08$115.75$104.17$109.50$113.92$38.92$34.92$47.25$42.42$44.50$39.92$40.17$32.25$49.08$42.75$49.08$42.75$49.08$42.75$52.50$44.67$49.58$42.17$46.67$39.66$30.83$27.75$37.42$33.75$30.42$27.42$32.08$33.42$9.25$9.25$11.17$11.17$10.50$10.50$11.25$11.25$11.25$11.25$11.25$11.25$11.25$11.25$7.92$7.92$7.92$7.92$7.92$7.92$10.92$10.92$10.92$10.92$9.17$9.17$.33$.33$7.08$6.33$8.67$7.75$8.17$7.25$5.75$5.17$6.92$6.33$5.58$4.17$6.33$5.75$7.67$6.92$7.17$6.50$9.58$8.17$9.08$7.75$8.58$7.25$4.42$4$5.42$4.97$339.42$305.50$412.08$370.92$387.83$349.17$257.58$208.33$458.50$398.83$493.75$429.58$534.83$457$382.83$325.83$361.58$307.75$340.33$289.67$272.17$245.08$330.33$297.58$347.17$312.42$318.58$331.42The information provided here changes frequently. Please contact the individual insurance company or the Minnesota Department ofCommerce Market Assurance Division at 651-296-2488 or 1-800-657-3602 for the most current rate information.37

Health Care Choices for Minnesotans on MedicareState Mutual ICRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerCompany Basic PlanSterling Life Insurance CompanyRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerThrivent Financial for LutheransSmokerNon-smokerUnicare Life and Health Insurance CompanyRuralUrbanUnited HealthCare AARPSmokerNon-smoker$142.75$128.50$183.50$165.25$134.75$115.92$156.58$134.75$130.17$118.33$89$100$141$121.75Part ADeductible$35.33$31.83$45.42$40.92$34.67$29.83$34.67$29.83$37.67$34.25$29.25$29.25Part BDeductible$11.25$11.25$11.25$11.25$10.92$10.92$10.92$10.92$10.17$9.2580% PartB Excess100% Part BExcess$5.75$5.17$7.42$6.67Prevention$4.83$4.42$6.25$5.67$4.67$4.67$4.67$4.67ExtendedBasic$297.58$268.08$382.67$344.67$199.33$171.50$226.25$194.67$244.83$222.58$195$219$220.75$190.75United National $137.83 $35.67 $7.67 $12.08 $303.92United Teacher AssociationRural SmokerRural Non-smokerUrban SmokerUrban Non-smokerUnited World Life ICRural SmokerRural Non-smokerUrban Smoker 1Urban Non-smoker 1Urban Smoker 2Urban Non-smoker 2$117.75$98.17$130.83$109$119.75$104.17$129$112.17$139.75$121.58$29.50$24.58$32.75$27.25$30.67$26.58$30.67$26.67$30.67$26.67$11.25$11.25$11.25$11.25$11.25$11.25$7.08$6.17$7.08$6.17$7.08$6.17$171.75$143.08$190.75$159$321.17$279.42$345.83$300.92$374.67$325.92The information provided here changes frequently. Please contact the individual insurance company or the Minnesota Department ofCommerce Market Assurance Division at 651-296-2488 or 1-800-657-3602 for the most current rate information.38

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Companies Selling Medicare Supplements in MinnesotaCompany Name Phone NumberAdmiral Life Insurance Company of America 1-800-321-0102Bankers Life and Casualty 1-800-621-3724Blue Cross and Blue Shield of Minnesota 1-800-531-6686Combined Insurance of America 1-800-544-5531Continental General 1-800-545-8905Continental Life of Brentwood Tennessee 1-866-465-1023Genworth Life and Annuity Insurance Company 1-866-465-1023Guarantee Life Trust 1-800-323-6907Humana Insurance Company 1-800-457-4708Lincoln Heritage Life 1-800-438-7180Minnesota Comprehensive Health Association 1-800-325-3540Mutual of Omaha 1-800-366-3298Pennsylvania Life 1-888-802-9497Royal Neighbors of America 1-800-770-4561Sanford Health Plan of MN 1-888-605-9277State Farm Mutual 1-877-734-2265State Mutual IC 1-800-321-3102Sterling Life Insurance Company 1-888-858-8551Thrivent Financial for Lutherans 1-800-847-4836Unicare Life and Health Insurance Company 1-888-949-5384United HealthCare AARP 1-800-523-5800United National 1-800-365-8208United Teacher Association 1-877-229-0293United World Life IC 1-800-366-3298Quick Tip 5The Minnesota Departmentof Commerce ConsumerResponse Team (CRT)can help resolve disputesbetween you and yourinsurance company. In the Twin Cities metro areacall (651) 296-2488 or statewide toll free at 1-800-657-3602.39

Health Care Choices for Minnesotans on Medicare2010 Comprehensive List of Minnesota Medicare PlansIncluded in Health Care ChoicesMedicare SELECT Plans (4 options)1. Blue Cross Blue Shield of Minnesota Senior Gold2. HealthPartners Senior Health Advantage3. Medica Select Solution4. Sanford SelectMedicare Cost Plans (15 options)5. Blue Cross Blue Shield of Minnesota Platinum BlueCore Plan6. Blue Cross Blue Shield of Minnesota Platinum BlueChoice Plan7. Blue Cross Blue Shield of Minnesota Platinum BlueComplete Plan8. HealthPartners Freedom Plan I9. HealthPartners Freedom Plan II, No Rx10. HealthPartners Freedom Plan II, Standard Rx11. HealthPartners Freedom Plan III, No Rx12. HealthPartners Freedom Plan III, Standard Rx13. HealthPartners Freedom Plan III, Standard Plus Rx14. HealthPartners Freedom Plan III, Enhanced Rx15. Medica Prime Solution Value16. Medica Prime Solution Basic with Modified StandardRx Rider17. Medica Prime Solutions Basic with Enhanced Rx18. Medica Prime Solution Enhanced with ModifiedStandard Rx Rider19. Medica Prime Solution Enhanced with Enhanced RxMedicare Advantage Local HMO Plans (8 options)20. HealthPartners Classic21. Metropolitan Health Plan North Star AdvantageBasic Plan22. UCare Minnesota for Seniors Value, Metro23. UCare Minnesota for Seniors Value, Greater Minnesota24. UCare Minnesota for Seniors Value Plus, Metro25. UCare Minnesota for Seniors Value Plus, GreaterMinnesota26. UCare Minnesota for Seniors Classic Plan, Metro27. UCare Minnesota for Seniors Classic Plan, GreaterMinnesotaMedicare Advantage Regional Preferred ProviderOrganization Plans (4 options)28. Blue Cross Blue Shield of Minnesota MedicareBlueRegional PPO29. HumanaChoice 00630. HumanaChoice 00731. HumanaChoice 009Medicare Advantage Private-Fee-For-Service Plans(35 options)32. AveraAdvantage Value Plus33. AveraAdvantage Premium Plus34. Humana Gold Choice 0235. Humana Gold Choice 0336. Humana Gold Choice 07237. Medica Advantage Solution Standard38. Medica Advantage Solution Standard with Rx39. Medica Advantage Solution Choice40. Sterling Basic Plus41. Sterling Option I42. Sterling Option II43. Sterling Option IV44. SecureHorizons Medicare Direct Rx Plan 145. SecureHorizons Medicare Direct Rx Plan46. UniCare SecurityChoice Classic47. UniCare SecurityChoice Plus 02048. UniCare SecurityChoice Plus 08949. Universal American Today’s Options Value 16550. Universal American Today’s Options Value 17351. Universal American Today’s Options Value 18152. Universal American Today’s Options Value powered byCCRx 14253. Universal American Today’s Options Value powered byCCRx 15054. Universal American Today’s Options Value powered byCCRx 15855. Universal American Today’s Options Value powered byCCRx 16656. Universal American Today’s Options Value powered byCCRx 17457. Universal American Today’s Options Value powered byCCRx 18258. Universal American Today’s Options Premier 16359. Universal American Today’s Options Premier 17160. Universal American Today’s Options Premier 17961. Universal American Today’s Options Premierpowered by CCRx 14040

A publication of the Minnesota Board on Aging Senior LinkAge Line ®62. Universal American Today’s Options Premier poweredby CCRx 14863. Universal American Today’s Options Premier poweredby CCRx 15664. Universal American Today’s Options Premier poweredby CCRx 16465. Universal American Today’s Options Premier poweredby CCRx 17266. Universal American Today’s Options Premier poweredby CCRx 180Medicare Advantage Special Need Plans for Chronic Conditions (3 options)67. Medica Complete Solution Chronic Lung Disorders68. Medica Complete Solution–Dementia69. Medica Complete Solution–Diabetes, CardiovascularDisease, Heart FailureMedicare Advantage Special Need Plans for Duals age 65 and Older (8 options)70. Blue Cross Blue Shield of Minnesota SecureBlue HMO71. HealthPartners Classic MSHO72. IMCare Classic73. Medica Dual Solution74. Metropolitan Health Plan MSHO75. PrimeWest Senior Health Complete76. South Country Health Alliance SeniorCare Complete77. UCare MSHOMedicare Advantage Special Need Plans for Duals under age 65 (6 options)78. Blue Cross Blue Shield Blue Plus of MinnesotaCareBlue HMO79. Cornerstone Solutions80. Medica AccessAbility81. PrimeWest Prime Health Complete82. UCare Connect83. South Country Health Alliance AbilityCareMedicare Part D Stand Alone Prescription Drug Plans (46 options)84. Aetna Medicare Rx Essentials85. Aetna Medicare Rx Plus86. Aetna Medicare Rx Premier87. BlueCross BlueShield of Minnesota MedicareBlue RxStandard88. BlueCross BlueShield of Minnesota MedicareBlue RxEnhanced89. BlueCross BlueShield of Minnesota MedicareBlue RxPremier90. BravoRx91. CIGNA Medicare Rx Plan One92. CIGNA Medicare Rx Plan Two93. CIGNA Medicare Rx Plan Three94. Coventry AdvantraRx Value95. Coventry AdvantraRx Premier96. Coventry AdvantraRx Premier Plus97. EnvisionRx Plus Silver98. EnvisionRx Plus Gold99. First Health Part D Secure100. First Health Part D Premier101. HealthNet Orange Option 1102. HealthNet Orange Option 2103. HealthSpring Prescription Drug Plan Reg 25104. Humana Standard105. Humana Enhanced106. Humana Complete107. Medco Medicare PDP Value108. Medco Medicare PDP Choice109. Medco Medicare PDP Access110. RxAmerica Advantage Freedom Plan111. RxAmerica Advantage Star Plan112. Silverscript Value113. Silverscript CVS Caremark Plus114. Silverscript CVS Caremark Complete115. Sterling Rx116. UniCare MedicareRx Rewards Standard117. UniCare MedicareRx Rewards Plus118. United American Medicare Part D Silver Plan119. United American Medicare Part D PDP120. UnitedHealthcare AARP MedicareRx Saver121. UnitedHealthcare AARP MedicareRx Preferred122. UnitedHealthcare AARP MedicareRx Enhanced123. Universal American Community CCRx Basic PDP124. Universal American Community CCRx Choice PDP125. Universal American Community CCRx Gold PDP126. Universal American PrescribaRx Bronze PDP127. Universal American PrescribaRx Gold PDP128. WellCare Classic129. WellCare Signature41

Health Care Choices for Minnesotans on MedicareMedicare SELECT PlansMedicare SELECT Planswww.bluecrossmn.com/medicareSenior Gold SM651-662-2583; 1-877-662-2583TTY: 1-866-582-11588 a.m. to 8 p.m. CST, dailywww.healthpartners.comSenior Health Advantage952-883-5600; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through FridayService Area Available statewide. Must be a Minnesota resident at time ofapplication. Minnesota participating providers must be usedfor services received in the service area.Hospital Inpatient You pay $0 for each Medicare-covered stay.You are covered for unlimited days each benefit period.Available in 31 Minnesota counties.100% coverage for unlimited days as authorized byparticipating physicians. Covers Medicare deductiblesand co-pays in full for eligible hospital stays asdetermined by Medicare and HealthPartners.Physician/Outpatient You pay $0 for Medicare-covered services. 100% coverage of Medicare Part B deductiblesand co-insurance through participating physiciansand hospitals.Emergency Services/Urgent Care You pay $0 for each Medicare-covered emergency room orurgent care visit within the U.S. You pay 20% for emergencyservices outside of the U.S.Preventive Services You pay $0 for Medicare-covered immunizations andcancer screenings. An optional preventive care benefit isavailable and provides coverage for a routine physical,eye exam and hearing screening. This benefit is limited to$120 per calendar year for members with effective datesof 6/1/2010 or later.In U.S.: 100% coverage of Medicare deductibles andco-insurance for eligible emergency and urgent care.Outside U.S.: 80% coverage for emergency and urgentcare.100% coverage for annual routine physician exams,immunizations, routine eye and hearing exams, routinemammograms and pap smears, routine cancer tests andscreenings.Diagnostic Tests, X-rays and Lab Services You pay $0 for Medicare-covered services. 100% coverage for Medicare-eligible services.Physical/Speech/Occupational Therapy You pay $0 for Medicare-covered services. 100% coverage for Medicare-eligible services.Home Health Care You pay $0 for Medicare-covered services. No additional coverage beyond Medicare.Mental Health You pay $0 for Medicare-covered services. 100% of Medicare deductibles and co-insurance foreligible services. There is a 190-day lifetime limit ina Medicare-certified psychiatric facility.Chemical Dependency You pay $0 for Medicare-covered services.Additional benefits: you pay 20% of eligible expenses forresidential and non-residential treatment.Inpatient: 100% coverage for up to 73 days percalendar based on Medicare-approved criteria.Outpatient: 100% coverage for Medicare-coveredservices received from participating providers.42

Medicare SELECT PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care You pay $0 for Medicare-covered services. 100% coverage for up to 100 days per benefit period.Three-day prior hospital stay required, based onMedicare eligibility criteria.Durable Medical Equipment You pay $0 for Medicare-covered services. 100% coverage of Medicare deductibles and co-insurancethrough participating providers; must meet Medicareguidelines.Dental You pay $0 for Medicare-covered services. 100% coverage of all Medicare eligible services.Optional dental coverage available for $34.70 per month.Chiropractic You pay $0 for Medicare-covered services. 100% coverage for manipulation of the spine for subluxationthrough HealthPartners network of chiropractors.Travel Benefits You pay $0 nationwide for Medicare-covered services froma Medicare provider. Participating providers must be usedin Minnesota. You pay 20% for emergency services outsidethe U.S.Non-emergency out-of-network services: Members mayuse their Medicare benefits but are responsible for allMedicare deductibles, co-insurance and services notcovered by Medicare.Outside the U.S.: No coverage for non-emergency,non-urgently needed services.Medicare Part B Drugs You pay $0 for Medicare-covered Part B prescription drugs. • 100% coverage for Part B co-insurance• 80% coverage for injectable insulinMedicare Part D Outpatient Prescriptions Plan does not offer Part D coverage. To add Part Dprescription drug coverage, enroll in a Stand AloneMedicare Part D plan.Discounts/Special Programs 24-hour nurse advice line, fitness program, stop-smokingsupport, vision and hearing discounts, health guides, onlinemember center, online wellness center, Rx Advantageprescription drug discount program.Number of Providers In-Network The Aware ® network includes approximately 29,000physicians and other providers and nearly 8,000 clinics,hospitals and other facilities. No referrals needed.Enrollment Status/Health Screening Eligible residents of Minnesota may enroll at any time unlessthey are “locked in” to a Medicare Advantage plan. No healthhistory required during the first 6 months of your enrollmentin Medicare Part B. Health history may be required after6-month open enrollment period expires unless guaranteedissuerules or other unique circumstances apply.Plan does not offer Part D coverage. To add Part Dprescription drug coverage, enroll in a Stand AloneMedicare Part D plan.Optical discounts at selected providers.• 163 hospitals• More than 5,800 primary care physicians• More than 23,000 specialists• Enrollment open• No health screeningMaximum Annual Out-of-Pocket Costs Not applicable. Not applicable.Monthly Premium Plan Only-Tobacco Free: $194Plan Only-Standard: $256Optional coverage for annual routine physical, hearingscreening and eye exam: $5Plan Only-Tobacco Free: $221.40Plan Only-Standard: $287.9043

Health Care Choices for Minnesotans on MedicareMedicare SELECT PlansMedicare SELECT Planswww.medica.comMedica Select Solution ®952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 800-906-54328 a.m. to 8 p.m. CST, 7 days a weekwww.sanfordhealthplan.comSanford Select1-605-328-7200; 1-888-605-92778 a.m. to 5 p.m. CSTService Area Available in more than 75 counties throughout Minnesota. Cottonwood, Jackson, Lac qui Parle, Lincoln, Lyon,Martin, Murray, Nobles, Pipestone, Redwood, Rock,Watonwan and Yellow Medicine counties in Minnesota.Hospital Inpatient You pay $0 for unlimited days as authorized by Medica, coversMedicare deductibles and co-insurance in full for eligiblehospital stays as determined by Medicare and Medica.Physician/Outpatient You pay $0 for each Medicare-covered visit to an outpatienthospital facility.Emergency Services/Urgent Care You pay $0 for emergency services within the U.S.You pay 20% for emergency services while traveling abroad.(80% coverage outside the U.S.)Preventive Services You pay $0 for one yearly routine health assessment, routineimmunizations, annual routine eye and hearing exams,routine mammograms and pap smears, routine cancer testsand screenings.Diagnostic Tests, X-rays and Lab Services You pay $0 for each Medicare-covered visit for diagnostictests, X-rays and lab services.Physical/Speech/Occupational Therapy You pay $0 for each Medicare-covered visit for physical,occupational and speech therapy.Part A co-insurance and deductible.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Part A co-insurance and deductible. Part B deductibleand co-insurance.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Home Health Care You pay $0 for Medicare-covered home health care services. Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Mental Health Inpatient: Same as hospital inpatient benefits. There isa 190-day lifetime limit in a psychiatric hospital.Outpatient: You pay $0 for Medicare-covered servicesreceived from participating providers.Chemical Dependency Inpatient: You pay $0 for up to 73 days per calendar yearas authorized by Medica. Covers Medicare deductibles andco-insurance in full for eligible hospital stays as determinedby Medicare and Medica.Outpatient: You pay $0 for Medicare-covered servicesreceived from participating providers.Covered the same as any other medical condition.Covered the same as any other medical condition.44

Medicare SELECT PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care You pay $0 for up to 100 days per benefit period.A three-day prior hospital stay is required, based onMedicare eligibility criteria.Durable Medical Equipment You pay $0 for Medicare-eligible durable medical equipmentpurchased through Medica providers. Must meet Medicareguidelines.Dental Optional dental coverage is available for $38.00 per month. None.Part A co-insurance plus coverage for 100% of allPart A eligibile expenses after the deductible.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Chiropractic You pay $0 for manipulation of the spine for subluxationthrough Medica’s network of chiropractors.Travel Benefits Non-emergency out-of-network services: Members may usetheir Medicare benefits but are responsible for all Medicaredeductibles and co-insurance.Medicare Part B Drugs You pay 20% of the cost for Medicare-covered Part Bmedications.Medicare Part D Outpatient Prescriptions Plan does not offer Part D coverage. To add prescription drugcoverage, enroll in a Stand Alone Medicare Part D plan.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.80% of covered expenses.Part B co-insurance or co-pay amount (20% ofMedicare-approved expenses) after the deductible.Plan does not offer Part D coverage. To add prescription drugcoverage, enroll in a Stand Alone Medicare Part D plan.Discounts/Special Programs Prescription drug savings program under Select Solution Basic. Up to 25% discount off retail prices on lenses, framesand routine eye exams at network providers. Up to 15%discount off retail prices on all brands of hearing aidsand routine hearing exams at network providers. Up to25% discount off cash price on all prescription drugsat network pharmacies (cannot be used with otherprescription drug discount cards or Part D drug plans).Number of Providers In-Network There are almost 30,000 providers at more than 4,000offices, clinics and hospitals in MN, WI, ND and SD.More than 96% of Minnesota providers participate in thisnetwork. No referral necessary to go to network physicians,specialists and hospitals.Enrollment Status/Health Screening Enrollment open. Health screened after 12-month windowof Medicare Part B enrollment.Network applies to elective inpatient hospitalizationand outpatient surgery services only. 34 participatingfacilities.Enrollment open. No health screening.Maximum Annual Out-of-Pocket Costs Not applicable. On the Extended Plan only, $1,000.Monthly Premium Basic Non-smoker: $269.40Extended Basic Non-smoker: $296.10Basic Smoker: $330.60Extended Basic Smoker: $363.40Basic Non-smoker: $105.93Extended Basic Non-smoker: $247.09Basic Smoker: $120.45Extended Basic Smoker: $281.0245

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost Planswww.bluecrossmn.com/medicarePlatinum Blue SM Core Plan (Cost) H2461-005651-662-2583; 1-877-662-2583TTY: 1-866-582-11588 a.m. to 8 p.m. CST, dailyService Area The service area includes all 87 counties in Minnesota. Youmust reside in the service area to remain enrolled in the plan.Hospital Inpatient $400 co-pay for each Medicare-covered hospital stay.Plan covers 90 days each benefit period, plus any lifetimereserve days.Physician/Outpatient 20% co-insurance for each primary care doctor visit for Medicarecoveredbenefits. 20% co-insurance for each in-area, networkurgent care Medicare-covered visit. 20% co-insurance for eachspecialist visit for Medicare-covered benefits. 20% co-insurance foreach Medicare-covered ambulatory surgical center visit. 20% coinsurancefor each Medicare-covered outpatient hospital facility visit.Emergency Services/Urgent Care $50 co-pay for each Medicare-covered emergency room visit.Worldwide coverage. $50 co-pay for each Medicare-covered urgentlyneeded care visit.Preventive Services When you get Medicare Part B, you can get a one-timephysical within the first 12 months of your new Part Bcoverage. The coverage does not include lab tests.Routine exams not covered. $0 co-pay for flu and pneumoniavaccines. $0 co-pay for Hepatitis B vaccine. $0 co-pay foreach Medicare-covered bone mass measurement, colorectalcancer screening, mammogram, pap smear and pelvic examsand prostate cancer screening.Diagnostic Tests, X-rays and Lab Services 20% co-insurance for Medicare-covered:• diagnostic procedures and tests• X-rays• diagnostic radiology services (not including X-rays)• therapeutic radiology services$0 co-pay for Medicare-covered lab servicesPhysical/Speech/Occupational Therapy 20% co-insurance for each Medicare-covered occupationaltherapy, physical therapy, and or speech/language therapy visit.www.bluecrossmn.com/medicarePlatinum Blue SM Choice Plan (Cost) H2461-006651-662-2583; 1-877-662-2583TTY: 1-866-582-11588 a.m. to 8 p.m. CST, dailyThe service area includes all 87 counties in Minnesota. Youmust reside in the service area to remain enrolled in the plan.$100 co-pay for each Medicare-covered hospital stay.$0 co-pay for additional hospital days. No limit to the numberof days covered by the plan each benefit period.$10 co-pay for each primary care doctor visit for Medicarecoveredbenefits. $10 co-pay for each in-area, network urgentcare Medicare-covered visit. $10 co-pay for each specialist visitfor Medicare-covered benefits. $50 co-pay for each Medicarecoveredambulatory surgical center visit. $0 to $50 co-pay foreach Medicare-covered outpatient hospital facility visit.$50 co-pay for each Medicare-covered emergency room visit.Worldwide coverage. $50 co-pay for each Medicare-coveredurgently needed care visit.$0 co-pay for routine physical exams. Limited to 1 exam everyyear. $0 co-pay for flu and pneumonia vaccines. $0 co-payfor Hepatitis B vaccine. $0 co-pay for each Medicare-coveredbone mass measurement, colorectal cancer screening,mammogram, pap smear, pelvic exams and prostate cancerscreening. $0 co-pay for additional colorectal cancerscreenings, mammograms, pap smears and pelvic exams andprostate cancer screenings. No limit on the number of coveredcolorectal cancer screenings, mammograms, pap smears andpelvic exams and prostate cancer screenings. $0 co-pay for upto one routine hearing test every year. $0 co-pay for up to oneroutine eye exam every year.$0 co-pay for Medicare-covered:• lab services• diagnostic procedures and tests• X-rays• therapeutic radiology services• diagnostic radiology services (not including X-rays)$10 co-pay for each Medicare-covered occupational therapy,physical therapy, and or speech/language therapy visit.46

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Home Health Care $0 co-pay for Medicare-covered home health visits. $0 co-pay for Medicare-covered home health visits.Mental Health 20% co-insurance for each Medicare-covered individual orgroup therapy visit. $400 co-pay for each Medicare-coveredhospital stay. You get up to 190 days in a psychiatrichospital in a lifetime.Chemical Dependency 20% co-insurance for each Medicare-covered individual orgroup therapy visit.Skilled Nursing Care For Medicare-covered SNF staysDays 1–20: $0 co-pay per day.Days 21–100: $133.50 co-pay per day.Plan covers up to 100 days each benefit period. Three-day priorhospital stay is required.$10 co-pay for each Medicare-covered individual or grouptherapy visit. $100 co-pay for each Medicare-covered hospitalstay. You get up to 190 days in a psychiatric hospital in alifetime.$10 co-pay for each Medicare-covered individual or grouptherapy visit.$0 co-pay for SNF services. Plan covers up to 100 days eachbenefit period. Three-day prior hospital stay is required.Durable Medical Equipment 20% co-insurance for Medicare-covered items. 20% co-insurance for Medicare-covered items.Dental 20% co-insurance for Medicare-covered dental benefits. $0 co-pay for Medicare-covered dental benefits.Chiropractic 20% co-insurance for each Medicare-covered chiropractic visit. $10 co-pay for each Medicare-covered chiropractic visit.Travel Benefits Travel throughout the United States for up to nine months andreceive plan benefits from any provider that accepts Medicare.No referrals needed. You’ll pay the same cost sharing for medicalservices that you normally would pay within the plan service area.All costs you incur under this benefit are applied to the out-ofpocketmaximum.Medicare Part B Drugs 20% co-insurance for Part B-covered chemotherapy drugs andother Part B-covered drugs.Travel throughout the United States for up to nine months andreceive plan benefits from any provider that accepts Medicare.No referrals needed. You’ll pay the same cost sharing for medicalservices that you normally would pay within the plan service area.All costs you incur under this benefit are applied to the out-ofpocketmaximum.20% co-insurance for Part B-covered chemotherapy drugs andother Part B-covered drugs.Medicare Part D Outpatient Prescriptions Plan does not offer prescription drug coverage. Plan does not offer prescription drug coverage.Discounts/Special Programs The plan covers the following health/wellness education benefits:• health club membership/fitness classes• 24-hour nurse advice line• $0 co-pay for each Medicare-covered smoking cessationcounseling session.Number of Providers In-Network The Platinum Blue network includes approximately 29,000physicians and other providers and nearly 8,000 clinics,hospitals and other facilities. No referrals needed.Enrollment Status/Health Screening Eligible residents of Minnesota may enroll at any time unlessthey are “locked in” to a Medicare Advantage plan. Individualswith end-stage renal disease are generally not eligible to enrollin Platinum Blue unless they are members of BCBS organizationorganization and have been since their dialysis began.Maximum Annual Out-of-Pocket Costs $3,000 $3,000$0 co-pay for hearing aids. $0 co-pay for up to one hearingaid fitting evaluation every year. $450 limit for fittingevaluations and hearing aids every year. $0 co-pay for up toone pair of glasses every two years. $0 co-pay for up to onepair of contacts every two years. $125 limit for non-Medicarecoveredeye wear every two years. The plan covers thefollowing health/wellness education benefits:• health club membership/fitness classes• 24-hour nurse advice line• $0 co-pay for each Medicare-covered smoking cessationcounseling session.The Platinum Blue network includes approximately 29,000physicians and other providers and nearly 8,000 clinics,hospitals and other facilities. No referrals needed.Eligible residents of Minnesota may enroll at any time unlessthey are “locked in” to a Medicare Advantage plan. Individualswith end-stage renal disease are generally not eligible to enrollin Platinum Blue unless they are members of BCBS organizationand have been since their dialysis began.Monthly Premium $29 $7947

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost Planswww.bluecrossmn.com/medicarePlatinum Blue SM Complete Plan (Cost) H2461-007651-662-2583; 1-877-662-2583TTY: 1-866-582-11588 a.m. to 8 p.m. CST, dailyService Area The service area includes all 87 counties in Minnesota. You mustreside in the service area to remain enrolled in the plan.Hospital Inpatient $0 co-pay. No limit to the number of days covered by the planeach benefit period.Physician/Outpatient $0 co-pay for each primary care doctor visit for Medicarecoveredbenefits. $0 co-pay for each in-area, network urgent careMedicare-covered visit. $0 co-pay for each specialist visit forMedicare-covered benefits. $0 co-pay for each Medicare-coveredambulatory surgical center visit. $0 co-pay for each Medicarecoveredoutpatient hospital facility visit.Emergency Services/Urgent Care $0 co-pay for each Medicare-covered emergency room visit.Worldwide coverage. $0 co-pay for each Medicare-coveredurgently needed care visit.Preventive Services $0 co-pay for routine physical exams. Limited to 1 exam everyyear. $0 co-pay for flu and pneumonia vaccines. $0 co-pay forHepatitis B vaccine. $0 co-pay for each Medicare-covered bonemass measurement, colorectal cancer screening, mammogram,pap smear and pelvic exams and prostate cancer screening. $0co-pay for additional colorectal cancer screenings, mammograms,pap smears and pelvic exams and prostate cancer screenings.No limit on the number of covered colorectal cancer screenings,mammograms, pap smears and pelvic exams and prostate cancerscreenings. $0 co-pay for up to one routine hearing test everyyear. $0 co-pay for up to one routine eye exam every year.Diagnostic Tests, X-rays and Lab Services $0 co-pay for Medicare-covered:• lab services• diagnostic procedures and tests• X-rays• therapeutic radiology services• diagnostic radiology services (not including X-rays)Physical/Speech/Occupational Therapy $0 co-pay for each Medicare-covered occupational therapy,physical therapy and/or speech/language therapy visit.www.healthpartners.comFreedom Plan I, No Rx H2462 -004952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through FridayAll 87 Minnesota counties.You pay $300 deductible for each Medicare-covered stay. Thereis no coverage for additional non-Medicare-covered days.You pay 20% co-insurance for Medicare-covered visits.Emergency services in the U.S.: You pay $50 for eachMedicare-covered emergency room visit.Emergency services out of the U.S.: No coverage exceptunder limited circumstances.Urgent care in the U.S.: You pay 20% for Medicare-covered visits.Urgent care outside the U.S.: No coverage except underlimited circumstances.100% coverage for Medicare-covered services.You pay 0-20% co-insurance for Medicare-covered services.You pay 20% co-insurance for Medicare-covered services.48

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost Planswww.healthpartners.com/medicareFreedom Plan II, No Rx H2462 -007952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Fridaywww.healthpartners.com/medicareFreedom Plan II, Standard Rx H2462 -008952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Fridaywww.healthpartners.com/medicareFreedom Plan III, No Rx H2462 -010952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through FridayService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Hospital Inpatient You pay $150 for each Medicare-covered stay.Unlimited days.Physician/Outpatient You pay $15 co-pay for Medicare-coveredvisits.Emergency Services/Urgent Care Emergency services in the U.S.:You pay $50 for each Medicare-coveredemergency room visit.Emergency services out of the U.S.:You pay 20% worldwide.Urgent care in the U.S.: You pay $15 foreach Medicare-covered visit.Urgent care outside the U.S.: You pay20% co-insurance worldwide.Preventive Services 100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.Diagnostic Tests, X-rays and Lab ServicesPhysical/Speech/Occupational TherapyYou pay $150 for each Medicare-covered stay.Unlimited days.You pay $15 co-pay for Medicare-coveredvisits.Emergency services in the U.S.:You pay $50 for each Medicare-coveredemergency room visit.Emergency services out of the U.S.:You pay 20% worldwide.Urgent care in the U.S.: You pay $15 foreach Medicare-covered visit.Urgent care outside the U.S.: You pay20% co-insurance worldwide.100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.100% coverage. 100% coverage. 100% coverage.You pay $15 co-pay for each Medicarecoveredvisit.Home Health Care 100% coverage for Medicare-coveredhome health care visits based on Medicareapprovedcriteria.Mental Health You pay $15 co-pay for each Medicarecoveredvisit.Chemical Dependency You pay $15 co-pay for each Medicarecoveredvisit.Skilled Nursing Care 100% coverage for up to 100 days perbenefit period. Three-day prior hospitalstay required.You pay $15 co-pay for each Medicarecoveredvisit.100% coverage for Medicare-coveredhome health care visits based on Medicareapprovedcriteria.You pay $15 co-pay for each Medicarecoveredvisit.You pay $15 co-pay for each Medicarecoveredvisit.100% coverage for up to 100 days perbenefit period. Three-day prior hospitalstay required.100% coverage for Medicare-covered stays.Unlimited days.100% coverage for Medicare-coveredvisits.Emergency services in the U.S.:100% coverage for each Medicare-coveredemergency room visit.Emergency services out of the U.S.:You pay 20% worldwide.Urgent care in the U.S.: 100% coveragefor each Medicare-covered visit.Urgent care outside the U.S.: You pay20% co-insurance worldwide.100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.100% coverage for each Medicarecoveredvisit.100% coverage for Medicare-coveredhome health care visits based onMedicare-approved criteria.100% coverage for each Medicarecoveredvisit.You pay $15 co-pay for each Medicarecoveredvisit.100% coverage for up to 100 days perbenefit period. Three-day prior hospitalstay required.Durable Medical Equipment You pay 20% for each Medicare-covered item. You pay 20% for each Medicare-covered item. You pay 20% for each Medicare-covered item.50

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Dental 100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.Chiropractic You pay $15 co-pay for each Medicarecoveredvisit.Travel Benefits The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.Medicare Part B Drugs 80% coverage for Medicare-covered Part Boutpatient prescription drugs.100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.You pay $15 co-pay for each Medicarecoveredvisit.The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.80% coverage for Medicare-covered Part Boutpatient prescription drugs.Medicare Part D Outpatient Prescriptions None. Deductible: $125 for brand name tierdrugs only.Brand Name Drugs: $40 co-pay.Generic Drugs: $10 co-pay.Specialty: 25% co-insurance.Shingles Vaccine: $40 co-pay.Mail order is available.Over 1,100 participating pharmacies.Discounts/Special Programs Freedom Frequent Fitness program at noextra cost.Number of Providers In-Network • 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment Status/Health Screening Enrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member. Nohealth screening.Freedom Frequent Fitness program at noextra cost.• 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member.No health screening.Maximum Annual Out-of-Pocket Costs $3,000 $3,000 $3,000100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.100% coverage for each Medicarecoveredvisit.The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.80% coverage for Medicare-covered Part Boutpatient prescription drugs.None.Freedom Frequent Fitness program at noextra cost.• 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member.No health screening.Monthly Premium $90 Plan Only (No Part D): $90Plan including Part D: $97.10$13051

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost Planswww.healthpartners.com/medicareFreedom Plan III, Standard Rx H2462-011952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Friday;For Part D: 8 a.m. to 8 p.m., 7 days a week.www.healthpartners.com/medicareFreedom Plan III, Standard Plus Rx H2462-014952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Friday;For Part D: 8 a.m. to 8 p.m., 7 days a week.www.healthpartners.com/medicareFreedom Plan III, Enhanced Rx H2462-012952-883-5601; 1-800-247-7015TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Friday;For Part D: 8 a.m. to 8 p.m., 7 days a week.Service Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Hospital Inpatient 100% coverage for each Medicare-coveredstay. Unlimited days.100% coverage for each Medicare-coveredstay. Unlimited days.Physician/Outpatient 100% coverage for Medicare-covered visits. 100% coverage for Medicare-coveredvisits.Emergency Services/Urgent Care Emergency services in the U.S.:100% coverage for each Medicare-coveredemergency room visit.Emergency services outside the U.S.:You pay 20% co-insurance worldwide.Urgent care in the U.S.: 100% coveragefor each Medicare-covered visit.Urgent care outside the U.S.: You pay 20%co-insurance worldwide.Preventive Services 100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.Emergency services in the U.S.:100% coverage for each Medicarecoveredemergency room visit.Emergency services outside the U.S.:You pay 20% co-insurance worldwide.Urgent care in the U.S.: 100% coveragefor each Medicare-covered visit.Urgent care outside the U.S.: You pay20% co-insurance worldwide.100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.Diagnostic Tests, X-rays and Lab Services 100% coverage. 100% coverage. 100% coverage.100% coverage for each Medicarecoveredstay. Unlimited days.100% coverage for Medicare-coveredvisits.Emergency services in the U.S.:100% coverage for each Medicarecoveredemergency room visit.Emergency services outside the U.S.:You pay 20% co-insurance worldwide.Urgent care in the U.S.: 100%coverage for each Medicare-coveredvisit.Urgent care outside the U.S.: You pay20% co-insurance worldwide.100% coverage for annual physicalexams, routine eye and hearing exams,immunizations, bone mass measurement,routine mammograms and pap smears,routine cancer tests and screenings.Physical/Speech/Occupational Therapy 100% coverage for each medical visit. 100% coverage for each medical visit. 100% coverage for each medical visit.Home Health Care 100% coverage for Medicare-coveredhome health care visits based on Medicareapprovedcriteria.Mental Health 100% coverage for each Medicarecoveredvisit.100% coverage for Medicare-coveredhome health care visits based onMedicare-approved criteria.100% coverage for each Medicarecoveredvisit.100% coverage for Medicare-coveredhome health care visits based onMedicare-approved criteria.100% coverage for each Medicarecoveredvisit.Chemical Dependency 100% coverage for each Medicare-covered visit. 100% coverage for each Medicare-covered visit. 100% coverage for each Medicare-covered visit.Skilled Nursing Care 100% coverage for up to 100 days perbenefit period. Three-day prior hospital stayrequired.100% coverage for up to 100 days perbenefit period. Three-day prior hospitalstay required.100% coverage for up to 100 days perbenefit period. Three-day prior hospitalstay required.52

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment You pay 20% for each Medicare-covereditem.Dental 100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.You pay 20% for each Medicare-covereditem.100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.You pay 20% for each Medicare-covereditem.100% coverage for one oral exam, onecleaning and one X-ray per year. Optionalcomprehensive dental plan available for amonthly premium of $36.70.Chiropractic 100% coverage for each Medicare-covered visit. 100% coverage for each Medicare-covered visit. 100% coverage for each Medicare-covered visit.Travel Benefits The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.Medicare Part B Drugs 80% coverage for Medicare-coveredPart B outpatient prescription drugs.Medicare Part D Outpatient Prescriptions Deductible: $100 brand name tier drugs only.Brand Name Drugs: $40 co-pay.Generic Drugs: $9 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: $40 co-pay.Mail order is available.Over 1,100 participating pharmacies.Discounts/Special Programs Freedom Frequent Fitness program at noextra cost.Number of Providers In-Network • 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment Status/Health Screening Enrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member.No health screening.The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.80% coverage for Medicare-coveredPart B outpatient prescription drugs.Deductible: $125 for brand name tier drugs only.Brand Name Drugs: $40 co-pay.Generic Drugs: $10 co-pay.Specialty Drugs: 25% co-insurance.Extra Coverage: Donut hole coverage forgeneric drugs at $10.Shingles Vaccine: $40 co-pay.Mail order is available.Over 1,100 participating pharmacies.Freedom Frequent Fitness program at noextra cost.• 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member.No health screening.Maximum Annual Out-of-Pocket Costs $3,000 $3,000 $3,000The Extended Absence benefit providesplan level of coverage for up to nineconsecutive months when outside theservice area but within the U.S. You mayuse your Medicare benefits outside theplan network but in most cases will beresponsible for all Medicare deductibles,co-insurance and ineligible charges.Extended Absence benefit not availableoutside the U.S.80% coverage for Medicare-coveredPart B outpatient prescription drugs.Deductible: $125 brand name tier drugs only.Brand Name Drugs: $45 co-pay.Generic Drugs: $10 co-pay.Specialty Drugs: 25% co-insurance.Extra Coverage: All formulary drugs aftermember co-pay in the donut hole.Shingles Vaccine: $45 co-pay.Mail order is available.Over 1,100 participating pharmacies.Freedom Frequent Fitness program at noextra cost.• 243 hospitals• Over 6,000 primary care physicians• 24,700 specialists• No referral necessary to go to networkphysicians, specialists and hospitalsEnrollment open. If you have end-stagerenal disease, you cannot enroll unless youare a current HealthPartners member.No health screening.Monthly Premium Plan Only (No Part D): $130Plan Including Part D Premium: $144.60Plan Only (No Part D): $130Plan Including Part D Premium: $182.40Plan Only (No Part D): $130Plan Including Part D Premium: $297.5053

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost Planswww.medica.comPrime Solution ® Value H2450-007952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties.www.medica.comPrime Solution ® Basic withModified Standard Rx Rider H2450-001952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekHospital Inpatient You pay $400 for each Medicare-covered stay. You pay $100 for each Medicare-covered stay.Physician/Outpatient 20% of the cost for each primary care, network urgent care andspecialist visit for Medicare-covered benefits. 20% of the cost foreach Medicare-covered ambulatory surgical or outpatient hospitalfacility visit.Emergency Services/Urgent Care • $50 co-pay for each Medicare-covered emergency room visit(worldwide coverage)• $50 co-pay for each Medicare-covered urgent care visit (notcovered outside the U.S. except under limited circumstances)Preventive Services You pay 20% for routine mammograms and pap smears, routinecancer tests and screenings, diagnostic hearing exams andHepatitis B vaccine.Diagnostic Tests, X-rays and LabServicesYou pay 20% of the cost for Medicare-covered lab services,diagnostic procedures and tests, X-rays, diagnostic radiologyservices and therapeutic radiology services.You pay $10 co-pay per Medicare-covered office visit.You pay $50 for each Medicare-covered surgery in an ambulatorysurgical center or in an outpatient hospital facility.• $50 co-pay for each Medicare-covered emergency room visit• $50 co-pay for each Medicare-covered urgent care visitYou pay $0 for an annual routine health assessment, Medicareeligibleimmunizations, annual routine eye and hearing exams,routine mammograms and pap smears, routine cancer tests andscreenings. You are covered up to $450 each year for fittingevaluations and hearing aids. You pay $10 co-pay for eachdiagnostic hearing exam.$10 co-pay for Medicare-covered lab services, diagnostic proceduresand tests, X-rays, diagnostic radiology services and therapeuticradiology services.Physical/Speech/Occupational Therapy You pay 20% of the cost for each Medicare-covered visit. $10 co-pay for each Medicare-covered visit.Home Health Care You pay $0 for Medicare-covered home health visits. You pay $0 to $10 for Medicare-covered home health visits.Mental Health You pay 20% of the cost for each individual or group visit. $10 co-pay for each individual or group visit for Medicare-covered benefits.Chemical Dependency Outpatient: You pay 20% of the cost for each individual or groupvisit for Medicare-covered benefits.Skilled Nursing Care Days 1-20: There is no co-pay for Medicare-covered servicesreceived at a skilled nursing facility. Three-day prior hospitalstay required.Days 21-100: $137.50 co-pay each day.$10 co-pay for each individual or group visit for Medicare-coveredbenefits.There is no co-pay for Medicare-covered services receivedat a skilled nursing facility. Three-day prior hospital stayrequired. You are covered for 100 days each benefit period.Durable Medical Equipment You pay 20% of the cost for Medicare-covered items and supplies. You pay 20% of the cost for Medicare-covered items and supplies.Dental You must go to network providers. In general, you pay 100% fornon-Medicare-covered dental services. You pay 20% for accidentaldental services.You must go to network providers. In general, you pay 100% fornon-Medicare-covered dental services. You pay 20% for accidentaldental services. For an additional monthly premium, riders areavailable that help with dental services.54

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chiropractic You pay 20% of the cost for Medicare-covered benefits.(Manual manipulation of the spine to correct displacement ormisalignment of a joint or body part).Travel Benefits Non-emergency out-of-network services: You may use yourMedicare benefits, but in most cases are responsible for allMedicare deductibles, co-insurance and ineligible charges, unlessyou activate your Extended Absence Option.$10 co-pay for Medicare-covered benefits. (Manualmanipulation of the spine to correct displacement ormisalignment of a joint or body part).Non-emergency out-of-network services: You may use yourMedicare benefits, but in most cases are responsible for allMedicare deductibles, co-insurance and ineligible charges, unlessyou activate your Extended Absence Option.Medicare Part B Drugs You pay 20% for Medicare-eligible Part B medications. You pay 20% for Medicare-eligible Part B medications.Medicare Part D OutpatientPrescriptionsDeductible: $55Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment.Extra Services: Medication Therapy Management.Mail order is available.There are 1,400 network pharmacies.Discounts/Special Programs Health and wellness education, SilverSneakers ® Fitness Programand coverage for preventive services.Number of Providers In-Network Almost 30,000 providers at more than 4,000 offices, clinics andhospitals in MN, WI, ND and SD. More than 96% of Minnesotaproviders participate in this network. No referral necessary to go tonetwork physicians, specialists and hospitals.Enrollment Status/Health Screening Enrollment open except for end-stage renal disease, unlesspreviously enrolled in a Medica plan. No health screening.Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment.Extra Services: Medication Therapy Management.Mail order is available.There are 1,400 network pharmacies.Maximum Annual Out-of-Pocket Costs $3,000 in-network services. $3,000 in-network services.Health and wellness education, SilverSneakers ® Fitness Programand coverage for preventive services.Almost 30,000 providers at more than 4,000 offices, clinics andhospitals in MN, WI, ND and SD. More than 96% of Minnesotaproviders participate in this network. No referral necessary to go tonetwork physicians, specialists and hospitals.Enrollment open except for end-stage renal disease, unlesspreviously enrolled in a Medica plan. No health screening.Monthly Premium Plan Only: $40Plan with Part D Premium: $78Plan Only: $74Plan with Part D Premium: $112.90Quick Tip 6Beginning in January 2013, Medicare Part D will begincovering benzodiazepines and barbiturates to treat epilepsy,cancer or a chronic mental health disorder. Currently, thesedrugs cannot be covered by Medicare Part D.55

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chiropractic $10 co-pay for Medicare-covered benefits.(Manual manipulation of the spine to correctdisplacement or misalignment of a joint or body part).Travel Benefits Non-emergency out-of-network services: You may use yourMedicare benefits, but in most cases are responsible for allMedicare deductibles, co-insurance and ineligible charges,unless you activate your Extended Absence Option.$0 co-pay for Medicare-covered benefits.(Manual manipulation of the spine to correctdisplacement or misalignment of a joint or body part).Non-emergency out-of-network services: You may use yourMedicare benefits, but in most cases are responsible for allMedicare deductibles, co-insurance and ineligible charges,unless you activate your Extended Absence Option.Medicare Part B Drugs You pay 20% for Medicare-eligible Part B medications. You pay 20% for Medicare-eligible Part B medications.Medicare Part D OutpatientPrescriptionsDeductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Extra Services: Generic drugs in the donut hole at $10 co-pay andMedication Therapy Management.Shingles Vaccine: Tier 2 co-payment.Mail order is available.There are over 1,400 network pharmacies.Discounts/Special Programs Health and wellness education, SilverSneakers ® Fitness Programand coverage for preventive services.Number of Providers In-Network Almost 30,000 providers at more than 4,000 offices,clinics and hospitals in MN, WI, ND and SD. More than96% of Minnesota providers participate in this network.No referral necessary to go to network physicians,specialists and hospitals.Enrollment Status/Health Screening Enrollment open except for end-stage renal disease, unlesspreviously enrolled in a Medica plan. No health screening.Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Extra Services: Medication Therapy Management.Shingles Vaccine: Tier 2 co-payment.Mail order is available.There are 1,400 network pharmacies.Health and wellness education, SilverSneakers ® FitnessProgram and coverage for preventive services.Maximum Annual Out-of-Pocket Costs $3,000 in-network services. $3,000 in-network services.Almost 30,000 providers at more than 4,000 offices,clinics and hospitals in MN, WI, ND and SD. More than96% of Minnesota providers participate in this network.No referral necessary to go to network physicians,specialists and hospitals.Enrollment open except for end-stage renal disease, unlesspreviously enrolled in a Medica plan. No health screening.Monthly Premium Plan Only: $74Plan with Part D Premium: $141.90Plan Only: $120Plan with Part D Premium: $158.90Quick Tip 7The MinnesotaHelp Network has local access and outreachsites in your community where you can go for information andassistance. Call the Senior LinkAge Line® at 1-800-333-2433 orDisability Linkage Line ® at 1-866-333-2466 for a site near you.57

Health Care Choices for Minnesotans on MedicareMedicare Cost PlansMedicare Cost PlansService Area All 87 Minnesota counties.www.medica.comPrime Solution ® Enhanced withEnhanced Rx H2450-006952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekHospital Inpatient There is no co-pay for Medicare-covered services at anin-network facility.Physician/Outpatient • No co-pay for Medicare-covered office visits• No co-pay for Medicare-covered surgery in an outpatienthospital facility or ambulatory surgical centerEmergency Services/Urgent Care • $0 co-pay for each Medicare-covered emergency roomvisit (worldwide coverage)• $0 co-pay for each Medicare-covered urgent care visit(not covered outside the U.S. except under limitedcircumstances)Preventive Services You pay $0 for an annual routine health assessment,Medicare-eligible immunizations, annual routine eye andhearing exams, routine mammograms and pap smears,routine cancer tests and screenings. You are covered up to$450 each year for fitting evaluations and hearing aids.Diagnostic Tests, X-rays and LabServices$0 co-pay for Medicare-covered lab services, diagnosticprocedures and tests, X-rays, diagnostic radiology services(not including X-rays) and therapeutic radiology services.Physical/Speech/Occupational Therapy $0 co-pay for each Medicare-covered PT/ST/OT visit.Home Health Care You pay $0 for Medicare-covered home health visits.Mental Health $0 co-pay for each individual or group visit for Medicarecoveredbenefits.Chemical Dependency $0 co-pay for each individual or group visit for Medicarecoveredbenefits.Skilled Nursing Care There is no co-pay for Medicare-covered services receivedat a skilled nursing facility. Three-day prior hospital stayrequired. You are covered for 100 days each benefit period.Quick Tip 8The Minnesota Board on Aging Senior LinkAgeLine ® is the federally designated State HealthInsurance Assistance Program (SHIP) forMinnesota.• The Centers for Medicare & MedicaidServices (CMS) requires every state tohave a SHIP that provides local one-to-onecounseling and assistance to people withMedicare and their families.• As the Minnesota SHIP, the Senior LinkAgeLine ® provides local, free, objectivecomprehensive phone and in personcounseling in all 87 counties of Minnesota• The assistance is provided locally throughyour Area Agency on Aging.• One number is all you need: 1-800-333-2433.58

Medicare Cost PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment There is no co-pay for Medicare-covered items and supplies.Dental You must go to network providers. In general, you pay100% for non-Medicare-covered dental services.For an additional monthly premium, riders are availablefor non-Medicare-covered dental services. You pay 20%for accidental dental services.Chiropractic $0 co-pay for Medicare-covered benefits. (Manualmanipulation of the spine to correct displacement ormisalignment of a joint or body part).Travel Benefits Non-emergency out-of-network services: You may use yourMedicare benefits, but in most cases are responsible for allMedicare deductibles, co-insurance and ineligible charges,unless you activate your Extended Absence Option.Medicare Part B Drugs You pay 20% for Medicare-eligible Part B medications.Medicare Part D OutpatientPrescriptionsDeductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Extra Services: Generic drugs in the donut hole at $10co-pay and Medication Therapy Management.Shingles Vaccine: Tier 2 co-payment.Mail order is available.There are 1,400 network pharmacies.Discounts/Special Programs Health and wellness education, SilverSneakers ® FitnessProgram and coverage for preventive services.Number of Providers In-Network Almost 30,000 providers at more than 4,000 offices,clinics and hospitals in MN, WI, ND and SD. More than96% of Minnesota providers participate in this network.No referral necessary to go to network physicians,specialists and hospitals.Enrollment Status/Health Screening Enrollment open except for end-stage renal disease,unless previously enrolled in a Medica plan. No healthscreening.Maximum Annual Out-of-Pocket Costs $3,000 in-network services.Monthly Premium Plan Only: $120Plan with Part D Premium: $187.90Quick Tip 9The Minnesota Board on Aging sponsorsGetting There, a series broadcast on TwinCities Public Televisions’ Minnesota Channel.The ten part series covers Medicare, Housing,Finances, Technology, Independence, Fitnessand Nutrition, Relevance, Lifelong Learning,Transportation and Civic Engagement. To view the programs online go to www.mnchannel.org/partners/gettingthere/59

Health Care Choices for Minnesotans on MedicareMedicare Advantage Local HMO PlansMedicare Advantage Local HMO Planswww.healthpartners.com/medicareHealthPartners Classic H9005-007952-883-5600; 1-877-207-1214TTY: 1-800-443-01568 a.m. to 6 p.m., Monday through Friday;For Part D: 8 a.m. to 8 p.m., 7 days a weekService Area Available in 13 Minnesota counties: Anoka, Carver, Chisago,Dakota, Hennepin, Isanti, Ramsey, Rice, Scott, Sherburne,Washington, Wright and Greenbush and Princeton townshipsin Mille Lacs county.www.northstaradvantage.orgNorth Star Advantage Basic Plan H5750-0031-866-897-9958; 1-866-897-9958TTY: 1-800-627-42278 a.m. to 8 p.m.Anoka, Carver, Dakota, Hennepin, Ramsey, Scott andWashington counties in Minnesota.Hospital Inpatient 100% coverage for each Medicare-covered stay. Unlimited. $250 co-pay for each stay of unlimited days.Physician/Outpatient 100% coverage for Medicare-covered primary and specialtycare visits.Emergency Services/Urgent Care Worldwide coverage with a $30 co-pay for each Medicarecoveredemergency room visit; waived if admitted to thehospital for the same condition within 24 hours.Urgent care In-network: 100% coverage for Medicarecoveredvisits.Urgent care out-of-network: $30 co-pay for each Medicarecoveredurgent care visit in and out of U.S.Preventive Services 100% coverage for annual physical exams, routine eye andhearing exams, immunizations, bone mass measurement,routine mammograms and pap smears, routine cancer testsand screenings.$25 co-pay for each primary care visit or specialty visitfor Medicare-covered services.Worldwide coverage with a $50 co-pay for each Medicarecoveredemergency room visit.Urgent care: $25 co-pay.No co-pay for Medicare-covered routine physical exams,bone mass measurements, colorectal cancer screenings,pap smears, pelvic exams, some immunizations,mammograms and prostate cancer screenings. $25 co-payfor Medicare-covered hearing and vision services.Diagnostic Tests, X-rays and Lab Services 100% coverage. $25 co-pay for lab services. $50 co-pay for otherMedicare-covered diagnostic tests and X-rays.Physical/Speech/Occupational Therapy 100% coverage. $25 co-pay for each visit.Home Health Care 100% coverage for Medicare-covered home health visits. No co-pay. Unlimited visits based on Medicare-approved criteria.Mental Health Outpatient: $10 member co-pay for each Medicare-covered visit.Inpatient: 100% coverage for Medicare-covered stays.190 day limit in a psychiatric hospital.Outpatient: $25 co-pay for each individual/grouptherapy visit.Inpatient: You pay $250 deductible for each Medicarecoveredstay at a network hospital. 190-day lifetimemaximum.Chemical Dependency 100% coverage for each Medicare-covered visit. Outpatient: $25 co-pay for each individual/group therapyvisit.Inpatient: You pay $250 deductible for each stay ofunlimited days.60

Medicare Advantage Local HMO PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care 100% coverage for up to 100 days per benefit period. Priorhospital stay may be waived by the plan.$250 co-pay for each stay at a Medicare-certified skillednursing facility. No prior hospital stay is required. Plancovers up to 100 days each benefit period.Durable Medical Equipment 90% coverage for each Medicare-covered item and supplies. You pay 20% of the cost for each Medicare-covered item.Dental 100% coverage for preventive dental. Optionalcomprehensive dental coverage is available for an additional$26.60 per month.Preventive services coverage $25 co-pay. $0 co-pay forthe following preventive dental benefits: up to one oralexam every year and one cleaning every year.Chiropractic 100% coverage for each Medicare-covered visit. Manual manipulation of the spine to correct subluxation.You pay $25 co-pay for each primary care doctor officevisit for Medicare-covered services.Travel Benefits 80% coverage of Medicare-allowable charges up to$100,000 per calendar year for non-urgent, non-emergencymedical services obtained outside the state of Minnesota andwithin the U.S. (pre-authorization is not required).Medicare Part B Drugs 80% coverage for Medicare-covered Part B outpatientprescription drugs.Medicare Part D Outpatient Prescriptions Deductible: $310Brand Name Drugs: 25% co-insurance.Generic Drugs: 25% co-insurance.Specialty Drugs: 25% co-insurance.Shingles Vaccine: 25% co-insurance.Mail order is available.Over 1,100 participating pharmacies.Discounts/Special Programs Hearing aids—50% coverage up to $1,000 maximumevery 2 years.Number of Providers In-Network • 9 hospitals• 289 primary care physicians• More than 20,100 specialistsEnrollment Status/Health Screening Enrollment open. If you have end-stage renal disease youcannot enroll unless you are a current HealthPartnersmember. No health screening.Point of Service benefit for select specialty servicesprovided outside the MHP North Star plans’ network ofcontracted providers.Out-of-network portability: Same co-pay as network forout-of-network hospital and specialty services. See healthplan for specifics.100% coverage for Medicare Part B-covered prescriptiondrugs only.Deductible: $0Brand Name Drug: $35 co-pay.Generic Drug: $12 co-pay.Specialty Drug: $70 co-pay.Extra Services and Coverage: Generics covered in the donut hole.Shingles Vaccine: $0 co-pay.Mail order is available.All major chain pharmacies are participating pharmacies.Vision services—glasses, contacts, lenses and framescovered one pair per year up to $75. Disease managementcovered. Hearing aids covered, one per year, $500 limit.Motion fitness benefit.1,500 to 2,000Enrollment open. No health screening, except people withend-stage renal disease are not eligible.Maximum Annual Out-of-Pocket Costs $3,000 Once you pay $3,350 in expenses for any plan service peryear, the plan pays 100% of costs. (Part D costs excluded.)Monthly Premium $427.20 $124.7061

Health Care Choices for Minnesotans on MedicareMedicare Advantage Local HMO PlansMedicare Advantage Local HMO Planswww.ucare.orgUCare for Seniors Value Metro H2459-001612-676-3500; 1-877-523-1518TTY: 612-676-6810 or 1-800-688-25348 a.m. to 8 p.m.www.ucare.orgUCare for Seniors Value Greater MN H2459-005612-676-3500; 1-877-523-1518TTY: 612-676-6810 or 1-800-688-25348 a.m. to 8 p.m.Service Area Available in metro service area including Twin Cities/St. Cloud. Available in all Greater Minnesota counties.Hospital Inpatient $300 co-pay per admission for Medicare-covered stays. $300 co-pay per admission for Medicare-covered stays.Physician/Outpatient • $0 co-pay for each primary care doctor office visit forMedicare-covered services• $30 co-pay for each specialist visit for Medicare-coveredservicesEmergency Services/Urgent Care Worldwide emergency services covered in full after a $50co-pay for each Medicare-covered emergency room visit.Co-pay is waived if admitted to the hospital for the samecondition within 24 hours.Preventive Services $0 co-pay for annual physical, hearing exam, visionexam, immunizations, routine mammogram, pap smears,colorectal cancer screening, and bone mass measurement.Diagnostic Tests, X-rays and Lab Services $25 co-pay per procedure type for each Medicare-coveredservice.Physical/Speech/Occupational Therapy Physical therapy and speech-language pathology:$30 co-pay per visit; Occupational therapy: $0 co-pay forMedicare-covered services.• $0 co-pay for each primary care doctor office visit forMedicare-covered services• $30 co-pay for each specialist visit for Medicare-coveredservicesWorldwide emergency services covered in full after a $50co-pay for each Medicare-covered emergency room visit.Co-pay is waived if admitted to the hospital for the samecondition within 24 hours.$0 co-pay for annual physical, hearing exam, visionexam, immunizations, routine mammogram, pap smears,colorectal cancer screening, and bone mass measurement.$25 co-pay per procedure type for each Medicare-coveredservice.Physical therapy and speech-language pathology:$30 co-pay per visit; Occupational therapy: $0 co-pay; forMedicare-covered services.Home Health Care $0 co-pay for Medicare-covered visits. $0 co-pay for Medicare-covered visits.Mental Health Oupatient: $30 co-pay for Medicare-covered individual/group visits.Inpatient: $300 co-pay per admission for Medicarecoveredstays.Lifetime max: 190 days in a psychiatric hospital.Chemical Dependency Outpatient: $25 co-pay for Medicare-covered individual/group visits.Inpatient: $300 co-pay per admission for Medicarecoveredstay.Skilled Nursing Care Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $125 co-pay per day for Medicarecoveredstays.Oupatient: $30 co-pay for Medicare-covered individual/group visits.Inpatient: $300 co-pay per admission for Medicarecoveredstays.Lifetime max: 190 days in a psychiatric hospital.Outpatient: $25 co-pay for Medicare-covered individual/group visits.Inpatient: $300 co-pay per admission for Medicarecoveredstay.Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $125 co-pay per day for Medicarecoveredstays.Durable Medical Equipment 20% co-insurance for the cost of each Medicare-covered item. 20% co-insurance for the cost of each Medicare-covered item.Dental No coverage. No coverage.62

Medicare Advantage Local HMO PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chiropractic $0 co-pay for Medicare-covered visits (manual manipulationof the spine to correct subluxation only). Must use networkchiropractor.$0 co-pay for Medicare-covered visits (manual manipulationof the spine to correct subluxation only). Must use networkchiropractor.Travel Benefits Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($25 co-pay), and non-urgentservices covered under Point-of-Service which is 80% ofthe Medicare-approved amount within the United Stateswith some exceptions.Medicare Part B Drugs 20% co-insurance. 20% co-insurance.Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($25 co-pay), and non-urgentservices covered under Point-of-Service which is 80% ofthe Medicare-approved amount within the United Stateswith some exceptions.Medicare Part D Outpatient Prescriptions None. Enrolling in a stand-alone Medicare Part D plan willdisenroll you from this health plan.Discounts/Special Programs UCan! Activity Network with health club savings, a do-ityourselfkit, and fitness classes. Health Connection nurseline available 24/7.Number of Providers In-Network • 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment Status/Health Screening Enrollment open during annual, open, initial and specialelection periods, if eligible. No health screening, exceptfor end-stage renal disease.Maximum Annual Out-of-Pocket Costs $3,400 in a calendar year for Medicare-covered services(excludes Part D).Monthly Premium $35 $44None. Enrolling in a stand-alone Medicare Part D plan willdisenroll you from this health plan.UCan! Activity Network with health club savings, a do-ityourselfkit, and fitness classes. Health Connection nurseline available 24/7.• 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment open during annual, open, initial and specialelection periods, if eligible. No health screening, exceptfor end-stage renal disease.$3,400 in a calendar year for Medicare-covered services(excludes Part D).Quick Tip 10Get your free cookbook that includes helpful health related information, Fraud Free Pasta and Other Tasty Recipes and Tips to Prevent HealthCare Fraudat www.mnaging.org/pdf/SMP_Cookbook_printer_friendly.pdf63

Health Care Choices for Minnesotans on MedicareMedicare Advantage Local HMO PlansMedicare Advantage Local HMO Planswww.ucare.orgUcare for Seniors Value Plus Metro H2459-013612-676-3500; 1-877-523-1518TTY: 612-676-6810 or 1-800-688-25348 a.m. to 8 p.m.Service Area Available in metro service area including Twin Cities/St. Cloud.www.ucare.orgUCare for Seniors Value Plus Greater MN H2459-014612-676-3500; 1-877-523-1518TTY: 1-800-688-25348 a.m. to 8 p.m.Available in all counties in Greater MN.Hospital Inpatient $300 co-pay per admission for Medicare-covered stays. $300 co-pay per admission for Medicare-covered stays.Physician/Outpatient • $0 co-pay for each primary care doctor office visit forMedicare-covered services• $30 co-pay for each specialist visit for MedicarecoveredservicesEmergency Services/Urgent Care Worldwide emergency services covered in full after a$50 co-pay for each Medicare-covered emergency roomvisit. Co-pay is waived if admitted to the hospital forthe same condition within 24 hours.Preventive Services $0 co-pay for annual physical, hearing exam,vision exam, immunizations, cancer screenings,routine mammogram, pap smears, colorectal cancerscreening, and bone mass measurement.• $0 co-pay for each primary care doctor office visit forMedicare-covered services• $30 co-pay for each specialist visit for Medicare-coveredservicesWorldwide emergency services covered in full after a $50 copayfor each Medicare-covered emergency room visit. Co-payis waived if admitted to the hospital for the same conditionwithin 24 hours.$0 co-pay for annual physical, hearing exam,vision exam, immunizations, cancer screenings,routine mammogram, pap smears, colorectal cancerscreening, and bone mass measurement.Diagnostic Tests, X-rays and Lab Services $25 co-pay per procedure type for Medicare-covered services. $25 co-pay per procedure type for Medicare-covered services.Physical/Speech/Occupational Therapy Physical therapy and speech-language pathology:$30 co-pay per visit; Occupational therapy: $0 co-payfor Medicare-covered services.Physical therapy and speech-language pathology:$30 co-pay per visit; Occupational therapy: $0 co-payfor Medicare-covered services.Home Health Care $0 co-pay for Medicare-covered visits. $0 co-pay for Medicare-covered visits.Mental Health Outpatient: $30 co-pay for Medicare-covered individual/group visit.Inpatient: $300 co-pay per admission for Medicarecoveredstays.Lifetime max: 190 days in a psychiatric hospital.Chemical Dependency Outpatient: $25 co-pay for Medicare-coveredindividual/group visits.Inpatient: $300 co-pay per admission for Medicarecoveredstays.Skilled Nursing Care Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $125 co-pay per day for Medicare-covered stay.Outpatient: $30 co-pay for Medicare-covered individual/group visit.Inpatient: $300 co-pay per admission for Medicarecoveredstays.Lifetime Max: 190 days in a psychiatric hospital.Outpatient: $25 co-pay for Medicare-coveredindividual/group visits.Inpatient: $300 co-pay per admission for Medicare-coveredstays.Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $125 co-pay per day for Medicare-covered stay.64

Medicare Advantage Local HMO PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment 20% co-insurance for the cost of each Medicarecovereditem.Dental No coverage. No coverage.20% co-insurance for the cost of each Medicarecovereditem.Chiropractic $0 co-pay for Medicare-covered visits (manualmanipulation of spine to correct subluxation only).Must use network chiropractor.Travel Benefits Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($25 co-pay), and non-urgentservices covered under Point-of-Service which is 80%of the Medicare-approved amount within the UnitedStates with some exceptions.Medicare Part B Drugs 20% co-insurance. 20% co-insurance.$0 co-pay for Medicare-covered visits (manualmanipulation of spine to correct subluxation only).Must use network chiropractor.Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($25 co-pay), and non-urgentservices covered under Point-of-Service which is 80%of the Medicare-approved amount within the UnitedStates with some exceptions.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $30 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $60 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: $30 co-pay (brand name drug).Mail order is available; 90-days for 2 co-pays formaintenance drugs at many retail pharmacies andthrough mail order.Over 1,000 participating pharmacies.Discounts/Special Programs UCan! Activity Network with health club savings,a do-it-yourself kit, and fitness classes; Health Connectionnurse line available 24/7.Number of Providers In-Network • 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment Status/Health Screening Enrollment open during annual, open, initial andspecial election periods, if eligible. No healthscreening, except for end-stage renal disease.Maximum Annual Out-of-Pocket Costs $3,400 in a calendar year for Medicare-coveredservices (excludes Part D).Monthly Premium $64 $62.50Deductible: $0Brand Name Drugs: $30 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $60 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: $30 co-pay (brand name drug).Mail order is available; 90-days for 2 co-pays for maintenancedrugs at many retail pharmacies and through mail order.Over 1,000 participating pharmacies.UCan! Activity Network with health club savings,a do-it-yourself kit, and fitness classes; Health Connectionnurse line available 24/7.• 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment open during annual, open, initial and specialelection periods, if eligible. No health screening, except forend-stage renal disease.$3,400 in a calendar year for Medicare-covered services(excludes Part D).65

Health Care Choices for Minnesotans on MedicareMedicare Advantage Local HMO PlansMedicare Advantage Local HMO Planswww.ucare.orgUCare for Seniors Classic Plan Metro H2459-002612-676-3500; 1-877-523-1518TTY: 1-800-688-25348 a.m. to 8 p.m.www.ucare.orgUCare for Seniors Classic Plan Greater MN H2459-006612-676-3500; 1-877-523-1518TTY: 1-800-688-25348 a.m. to 8 p.m.Service Area Available in metro service area including Twin Cities/St. Cloud. Available in all counties in Greater Minnesota.Hospital Inpatient $150 co-pay per admission for Medicare-covered stays. $150 co-pay per admission for Medicare-covered stays.Physician/Outpatient • $0 co-pay for each primary care doctor office visit forMedicare-covered services• $15 co-pay for each specialist visit for MedicarecoveredservicesEmergency Services/Urgent Care Worldwide emergency services covered in full after a $50co-pay for each Medicare-covered emergency room visit.Co-pay is waived if admitted to the hospital for the samecondition within 24 hours.Preventive Services $0 co-pay for annual physical exam, hearing exam,vision exam, immunizations, routine mammogram, papsmears, colorectal cancer screening, and bone massmeasurement.• $0 co-pay for each primary care doctor office visit forMedicare-covered services• $15 co-pay for each specialist visit for MedicarecoveredservicesWorldwide emergency services covered in full after a $50co-pay for each Medicare-covered emergency room visit.Co-pay is waived if admitted to the hospital for the samecondition within 24 hours.$0 co-pay for annual physical exam, hearing exam,vision exam, immunizations, routine mammogram, papsmears, colorectal cancer screening, and bone massmeasurement.Diagnostic Tests, X-rays and Lab Services $0 co-pay for Medicare-covered services. $0 co-pay for Medicare-covered services.Physical/Speech/Occupational Therapy Physical therapy and speech-language pathology:$15 co-pay per visit; Occupational therapy: $0 co-payfor Medicare-covered services.Physical therapy and speech-language pathology:$15 co-pay per visit; Occupational therapy: $0 co-payfor Medicare-covered services.Home Health Care $0 co-pay for Medicare-covered visits. $0 co-pay for Medicare-covered visits.Mental Health Outpatient: $15 co-pay for Medicare-covered individual/group visits.Inpatient: $150 co-pay per admission for Medicarecoveredstays.Lifetime max: 190 days in a psychiatric hospital.Chemical Dependency Outpatient: $0 co-pay for Medicare-covered individual/group visits.Inpatient: $150 co-pay per admission for Medicarecoveredstays.Skilled Nursing Care Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $75 co-pay per day for Medicarecoveredstays.Outpatient: $15 co-pay for Medicare-covered individual/group visits.Inpatient: $150 co-pay per admission for Medicarecoveredstays.Lifetime max: 190 days in a psychiatric hospital.Outpatient: $0 co-pay for Medicare-covered individual/group visits.Inpatient: $150 co-pay per admission for Medicarecoveredstays.Days 1-20: $0 co-pay for Medicare-covered stays.Days 21-100: $75 co-pay per day for Medicarecoveredstays.Durable Medical Equipment 20% co-insurance for the cost of each Medicare-covered item. 20% co-insurance for the cost of each Medicare-covered item.66

Medicare Advantage Local HMO PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Dental $0 co-pay for preventive services including oral exam androutine cleaning twice per calendar year (plus 1 additionalperiodontic cleaning once per calendar year), bitewingX-rays every 12 months, and full mouth X-rays every 5years. Optional comprehensive dental coverage availablefor an additional $20 per month.Chiropractic $0 co-pay for Medicare-covered visits (manualmanipulation of spine to correct subluxation only).Must use network chiropractor.Travel Benefits Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($20 co-pay), and non-urgentservices covered under Point-of-Service which is 80% ofthe Medicare-approved amount within the United Stateswith some exceptions.Medicare Part B Drugs 20% co-insurance. 20% co-insurance.$0 co-pay for preventive services including oral exam androutine cleaning twice per calendar year (plus 1 additionalperiodontic cleaning once per calendar year), bitewingX-rays every 12 months, and full mouth X-rays every 5years. Optional comprehensive dental coverage availablefor an additional $20 per month.$0 co-pay for Medicare-covered visits (manualmanipulation of spine to correct subluxation only).Must use network chiropractor.Worldwide emergency services ($50 co-pay), worldwideurgently needed services ($20 co-pay), and non-urgentservices covered under Point-of-Service which is 80% ofthe Medicare-approved amount within the United Stateswith some exceptions.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $30 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $60 co-pay.Specialty Drugs: 25% co-insurance.Extra Services and Coverage: Generic tier 1 drugscovered in the donut hole with an $8 co-pay.Shingles Vaccine: $30 (brand name drug).Mail order is available; 90-days for 2 co-pays formaintenance drugs at many retail pharmacies andthrough mail order.Over 1,000 participating pharmacies.Discounts/Special Programs $500 hearing aid benefit every 36 months, $75 annualeyewear benefit, and the UCan! Activity Network withhealth club savings, a do-it-yourself kit, and fitnessclasses. Health Connection nurse line available 24/7.Deductible: $0Brand Name Drugs: $30 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $60 co-pay.Specialty Drugs: 25% co-insurance.Extra Services and Coverage: Generic tier 1 drugscovered in the donut hole with an $8 co-pay.Shingles Vaccine: $30 (brand name drug).Mail order is available; 90-days for 2 co-pays formaintenance drugs at many retail pharmacies andthrough mail order.Over 1,000 participating pharmacies.$500 hearing aid benefit every 36 months, $75 annualeyewear benefit, and the UCan! Activity Network withhealth club savings and a do-it-yourself kit. HealthConnection nurse line available 24/7.Number of Providers In-Network • 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment Status/Health Screening Enrollment open during annual, open, initial and specialelection periods, if eligible. No health screening, exceptfor end-stage renal disease.Maximum Annual Out-of-Pocket Costs $3,400 in a calendar year for Medicare-covered services(excludes Part D).Monthly Premium $110 $129• 6,620 physicians• 14,106 specialists• 213 hospitalsEnrollment open during annual, open, initial and specialelection periods, if eligible. No health screening, exceptfor end-stage renal disease.$3,400 in a calendar year for Medicare-covered services(excludes Part D).67

Health Care Choices for Minnesotans on MedicareMedicare Advantage Regional Preferred Provider PlansMedicare Advantage Regional Preferred Provider Planswww.YourMedicareSolutions.comMedicareBlue SM PPO (Regional PPO) R5566-005651-662-2583; 1-877-662-2583TTY: 1-866-582-11588 a.m. to 8 p.m. CST, dailywww.humana-medicare.comHumanaChoice H6609-0061-800-833-2312TTY: 1-877-833-4486Monday–SaturdayService Area All 87 Minnesota counties. Anoka, Becker, Benton, Big Stone, Brown, Carver, Cass, Chippewa,Chisago, Clay, Crow Wing, Dakota, Douglas, Fairbault, Grant, Hennepin,Hubbard, Isanti, Lac qui Parle, Lincoln, Lyon, Mahnomen, Meeker, Murray,Nicollet, Otter Tail, Pipestone, Polk, Pope, Ramsey, Redwood, Renville,Scott, Sherburne, Stearns, Swift, Todd, Traverse, Wadena, Washington,Watonwan, Wilken, Wright and Yellow Medicine counties in Minnesota.You must live in one of these areas to join this plan.Hospital Inpatient In-network for Medicare-covered hospital stays:Days 1–3: $225 co-pay per day.Days 4–90: $0 co-pay per day.For additional hospital days:Days 91–94: $225 co-pay per day.No limit to the number of days covered by the plan each benefit period.Physician/Outpatient In-network:Emergency Services/Urgent Care• $25 co-pay for each primary care doctor visit for Medicare-coveredbenefits• $35 co-pay for each specialist visit for Medicare-covered benefits• $150 co-pay for each Medicare-covered ambulatory surgicalcenter visit• $0 to $150 co-pay for each Medicare-covered outpatient hospitalfacility visit• $25 to $35 co-pay for each Medicare-covered urgentlyneeded care visit within the U.S.• $50 co-pay for Medicare-covered emergency room visits worldwidewhich is waived if admitted to the hospital within one day of theemergency room visitPreventive Services • $0 for flu, pneumonia and Hepatitis B immunizations• $0 to $35 co-pay for Medicare-covered colorectal cancer screenings• $0 to $25 co-pay for Medicare-covered screening mammograms• $0 co-pay for Medicare-covered prostate cancer screening, papDiagnostic Tests, X-rays and Lab ServicesPhysical/Speech/Occupational Therapysmears and pelvic exams. Separate office visit cost sharing of$25 co-pay may apply• $25 co-pay for one routine physical, $35 co-pay for one Medicarecoveredroutine eye and one routine hearing exam per year• $0 to $150 co-pay for Medicare-covered lab services and diagnosticprocedures and tests• $0 to $150 co-pay or 20% of the cost for Medicare-covered X-rays,diagnostic radiology and therapeutic radiology services. Separateoffice visit cost sharing of $25, emergency room cost sharing of$50 or surgery cost sharing of $150 may apply$35 co-pay for Medicare-covered physical/speech/language/occupational therapy visits.In-network: $225 co-pay per day (days 1-7) per each Medicare-coveredadmission. Remaining balance up to the Medicare allowed amount coveredin full. No additional co-pays for related professional or ancillary serviceswhile inpatient.In-network: Medicare-covered physician services covered in full, subject toa $15 co-pay (primary care doctor), or $35 co-pay (specialist). Outpatienthospital services, including laboratory, X-ray and surgical, subject to $150co-pay. Chemotherapy and renal dialysis subject to 20% co-insurance.30% co-insurance for Medicare-covered services.One annual routine physical with limited lab and radiology covered in fullafter $0 (primary care) co-pay. Medicare-approved cancer screenings andimmunizations covered in full when no other services are provided. Routinehearing test every 2 years covered in full after $35 co-pay.In-network: $0-$35 co-pay (or 20% of cost) for Medicare-covereddiagnostic procedures and tests, X-rays, diagnostic radiology andtherapeutic radiology. $0 co-pay for Medicare-covered lab services in a freestanding lab facility.In-network: $35 co-pay ( or 20% of cost) Medicare-covered physical/speech/language/occupational therapy visits.68

Medicare Advantage Regional Preferred Provider Plans A publication of the Minnesota Board on Aging Senior LinkAge Line ®Home Health Care $0 co-pay for Medicare-covered home health visits. In-network $0 co-pay for Medicare-covered home health visits andservices.Mental Health $35 co-pay for each Medicare-covered outpatient individualor group visit.Chemical Dependency $35 co-pay for each Medicare-covered outpatient individual or groupvisit.Skilled Nursing Care $0 co-pay for days 1-20 and $125 co-pay per day for daysDurable MedicalEquipment21-100. Plan covers up to 100 days per benefit period.No hospital stay is required.In-network outpatient: $35 co-pay.In-network outpatient: $35 co-pay (or 20% of cost).In-network: Days 1-14 covered in full.$100 co-pay each day for days 15-100.(No three-day inpatient qualification stay required).20% co-insurance for the cost for Medicare-covered items. In-network: 20% co-insurance for Medicare-covered durable medicalequipment. Equipment must meet Medicare medical necessity guidelines.Dental In general, preventive dental benefits (such as cleaning) are notcovered. $35 co-pay for Medicare-covered dental benefits.Chiropractic 20% of the cost for each Medicare-covered visit (manualmanipulation of the spine to correct a displacement or misalignmentof a joint or body part).Travel Benefits You receive in-network benefits for Medicare-covered services outsidethe 7-state service area (and border counties). All out-of-pocketcosts incurred under this benefit are applied to the combined in-andout-of-networkmaximum. In-network benefits for Medicare-coveredservices outside the 7-state service area (and border counties) for upto six months. All out-of-pocket costs incurred under this benefit areapplied to the combined in-and-out-of-network maximum.Medicare Part B Drugs 20% of the cost for Part B covered drugs and Part B coveredMedicare Part D OutpatientPrescriptionsDiscounts/SpecialProgramsNumber of Providers In-NetworkEnrollment Status/Health Screeningchemotherapy drugs.Deductible: $310Brand Name Drugs: 23% co-insurance.Generic Drugs: 13% co-insurance.Non-preferred Brand Name Drugs: 50% co-insurance.Specialty Drugs: 25% co-insurance.Shingles Vaccine: 50% co-insurance.Extra Services and Coverage: Extended supplies (up to 90 days) ofmaintenance drugs are available through mail order pharmacy serviceand certain network retail pharmacies.Mail order is available.More than 59,000 participating pharmacies nationwide.MedicareBlue Values Program-discounts on vision exams, eyewear,laser surgery, hearing exams and hearing aids.In-network: Limited to coverage provided under original Medicare andsubject to a $35 co-pay. Routine dental care not covered.In-network: Medicare-covered services. $35 co-pay per visit.$50 co-pay for Medicare-covered emergency room visits. Worldwidecoverage. Co-pay waived if admitted to the hospital within 24 hours for thesame condition.In-network: 20% co-insurance for the cost for Medicare-covered Part Bdrugs and for Part B chemotherapy drugs.None.SilverSneakers ® Fitness program. Dental, hearing and vision discounts.QuitNet smoking cessation program and Medicare-covered smokingcessation program $15 (primary care) or$35 co-pay (specialist). 24-hour nurse hotline. Chronic condition diseasemanagement programs.More than 40,000. Over 10,000 participating physicians and providers in Minnesota. Nationalreciprocity.You must enroll during a valid election period as defined by theCenters for Medicare and Medicaid Services. Federal regulationsdo not allow enrolling people with end-stage renal disease unlesstransferring from a BlueCross and BlueShield of Minnesotacommercial plan. If you develop ESRD while a member, you cannotbe dis-enrolled for that reason. No health screening.Maximum Annual In-network: $3,350Out-of-Pocket Costs In- and Out-of-network: $8,350Monthly Premium $57.30 $0Enrollment open during annual, open and initial election periods. Specialelection periods available if eligible.End-stage renal disease ineligible. No health screening.In-network: $6,000In- and Out-of-network: $7,50069

Health Care Choices for Minnesotans on MedicareMedicare Advantage Regional Preferred Provider PlansMedicare Advantage Regional Preferred Provider Planswww.humana-medicare.comHumanaChoice H6609-0071-800-833-2312TTY: 1-877-833-4486Monday–Saturdaywww.humana-medicare.comHumanaChoice H6609-0051-800-833-2312TTY: 1-877-833-4486Monday–SaturdayService Area Carlton, Itasca, Koochiching, Lake, Pine and St. Louiscounties in Minnesota. You must live in one of these areas tojoin the plan.Hospital Inpatient In-network: $200 co-pay per day (days 1-7) per eachMedicare-covered admission. Remaining balanceup to the Medicare allowed amount covered in full.No additional co-pay for related professional or ancillaryservices while inpatient.Physician/Outpatient In-network: Medicare-covered physician servicescovered in full, subject to a $10 (primary care doctor),or $30 (specialist) co-pay. Outpatient hospital services,including laboratory, X-ray and surgical, subject to$50-$150 co-pay. Chemotherapy and renal dialysissubject to 20% co-insurance.Anoka, Becker, Benton, Big Stone, Brown, Carver, Cass,Chippewa, Chisago, Clay, Crow Wing, Dakota, Douglas,Fairbault, Grant, Hennepin, Hubbard, Isanti, Lac qui Parle,Lincoln, Lyon, Mahnomen, Meeker, Murray, Nicollet, OtterTail, Pipestone, Polk, Pope, Ramsey, Redwood, Renville,Scott, Sherburne, Stearns, Swift, Todd, Traverse, Wadena,Washington, Watonwan, Wilken, Wright and Yellow Medicinecounties in Minnesota. You must live in one of these areas tojoin this plan.In-network: $200 co-pay per day (days 1-8) per eachMedicare-covered admission. Remaining balance up to theMedicare allowed amount covered in full. No additionalco-pay for related professional or ancillary services whileinpatient.In-network: Medicare-covered physician services coveredin full, subject to a $10 (primary care doctor), or $30(specialist) co-pay. Outpatient hospital services, includinglaboratory, X-ray and surgical subject to $50-$150co-pay. Chemotherapy and renal dialysis subject to 20%co-insurance.Emergency Services/Urgent Care $35 co-pay. Emergency is $50 co-pay. Urgent care is $35 co-pay.Preventive Services One annual routine physical with limited lab and radiologycovered in full after $0 (primary care) co-pay. Medicareapprovedcancer screenings and immunizations covered infull when no other services are provided. Routine hearingtest every 2 years covered in full after $30 co-pay.Diagnostic Tests, X-rays and Lab Services In-Network: $0- $50 co-pay for Medicare-covered diagnosticprocedures and tests, X-rays, diagnostic radiology andtherapeutic radiology. $0 co-pay for Medicare-covered labservices in a free standing lab facility.Physical/Speech/Occupational Therapy In-network: $30-$50 co-pay for Medicare-coveredoccupational, physical and speech therapy.Home Health Care In-network: $0 co-pay for Medicare-covered home healthvisits and services.One annual routine physical with limited lab and radiologycovered in full after $0 (primary care) co-pay. Medicareapprovedcancer screenings and immunizations covered infull when no other services are provided. Routine hearingtest every 2 years covered in full after $30 co-pay.In-network: $0-$50 co-pay for Medicare-covereddiagnostic procedures and tests, X-rays, diagnosticradiology and therapeutic radiology. $0 co-pay forMedicare-covered lab services in a free standing labfacility.In-network: $30-$50 co-pay for Medicare-coveredoccupational, physical and speech therapy.In-network: $0 co-pay for Medicare-covered home health visitsand services.70

Medicare Advantage Regional Preferred Provider Plans A publication of the Minnesota Board on Aging Senior LinkAge Line®Mental Health In-network outpatient: $30 co-pay. In-network outpatient: $30 co-pay.Chemical Dependency In-network outpatient: $50 co-pay. In-network outpatient: $50 co-pay.Skilled Nursing Care In-network: Days 1-14 covered in full. $100co-pay each day for days 15-100.(No three-day inpatient qualification stay required).Durable Medical Equipment In-network: 20% co-insurance for Medicare-covereddurable medical equipment. Equipment must meetMedicare medical necessity guidelines.Dental In-network: Limited to coverage provided under originalMedicare and subject to a $30 co-pay. Routine dental carenot covered.In-network: Days 1-14 covered in full.$100 co-pay each day for days 15-100.(No three-day inpatient qualification stay required).In-network: 20% co-insurance for Medicare-covereddurable medical equipment. Equipment must meetMedicare medical necessity guidelines.In-network: Limited to coverage provided under originalMedicare and subject to a $30 co-pay. Routine dental carenot covered.Chiropractic In-network: Medicare-covered services. $30 co-pay per visit. In-network: Medicare-covered services. $30 co-pay per visit.Travel Benefits $50 co-pay for Medicare-covered emergency room visits.Worldwide coverage. Co-pay waived if admitted to thehospital within 24 hours for the same condition.Medicare Part B Drugs In-network: 20% co-insurance of the cost for MedicarecoveredPart B drugs and for Part B chemotherapy drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $42 co-pay.Generic Drugs: $6 co-pay.Non-preferred Brand Name Drugs: $80 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: Cost share determined by place oftreatment (physician office versus pharmacy).Extra Services and Coverage: $0 co-pay generic mailorder through RightSource.Mail order is available.Over 65,000 participating pharmacies nationwide.Discounts/Special Programs SilverSneakers ® Fitness program. Dental, hearing andvision discounts. QuitNet smoking cessation program andMedicare-covered smoking cessation program $15 co-pay(primary care) or $35 co-pay (specialist). 24-hour nursehotline. Chronic condition disease management programs.Number of Providers In-Network Over 10,000 participating physicians and providers inMinnesota. National reciprocity.Enrollment Status/Health Screening Annual open enrollment period, November 15 toDecember 31 of each year. End-stage renal diseaseineligible. No health screening.Maximum Annual Out-of-Pocket Costs In-network: $4,000In- and Out-of-network: $6,000Monthly Premium $50 $53$50 co-pay for Medicare-covered emergency room visits.Worldwide coverage. Co-pay waived if admitted to the hospitalwithin 24 hours for the same condition.In-network: 20% co-insurance of the cost for Medicare-coveredPart B drugs and for Part B chemotherapy drugs.Deductible: $0Brand Name Drugs: $42 co-pay.Generic Drugs: $9 co-pay.Non-preferred Brand Name Drugs: $80 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: Cost share determined by place oftreatment (physician’s office versus pharmacy).Extra Services and Coverage: $0 co-pay for generic mailorder through RightSource.Mail order is available.Over 65,000 participating pharmacies nationwide.SilverSneakers ® Fitness program. Dental, hearing andvision discounts. QuitNet smoking cessation program andMedicare-covered smoking cessation program $15 co-pay(primary care) or $35 co-pay (specialist). 24-hour nursehotline. Chronic condition disease management programs.Over 10,000 participating physicians and providers inMinnesota. National reciprocity.Enrollment open during annual, open and initial electionperiods. Special election periods available if eligible.End-stage renal disease ineligible. No health screening.In-network: $4,000In- and Out-of-network: $6,00071

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.AveraAdvantage.comAveraAdvantage Value Plus H5421-1341-800-999-3947TTY: 1-800-888-96808 a.m.-8 p.m., 7 days a weekwww.AveraAdvantage.comAvera Advantage Premier Plus H5421-1331-800-999-3947TTY: 1-800-888-96808 a.m.-8 p.m., 7 days a weekService Area Lincoln, Lyon and Pipestone counties in Minnesota. Lincoln, Lyon and Pipestone counties in Minnesota.Hospital Inpatient $495 co-pay per stay. $195 co-pay per stay.Physician/Outpatient $125 hospital co-pay.$125 ambulatory surgical center co-pay.$20 primary care provider co-pay.$40 specialist co-pay.$75 hospital co-pay.$75 ambulatory surgical center co-pay.$10 primary care physician co-pay.$25 specialist co-pay.Emergency Services/Urgent Care $50 co-pay ER; $35 co-pay urgent care. $50 co-pay ER; $35 co-pay urgent care.Preventive Services $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% co-insurance lab and diagnostic procedures;20% co-insurance radiology.Physical/Speech/Occupational Therapy $20 co-pay. $15 co-pay.0% co-insurance lab and diagnostic procedures;20% co-insurance radiology.Home Health Care 20% co-insurance. 15% co-insurance.Mental Health 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100.Durable Medical Equipment 20% co-insurance. 20% co-insurance.Dental Medicare-covered only. Medicare-covered only.Chiropractic $40 co-pay. $25 co-pay.Travel Benefits None. None.Medicare Part B Drugs 20% co-insurance. 20% co-insurance.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Donut Hole Coverage: Generics only.Shingles Vaccine: $65 co-pay.Mail order is not available.Contact plan for list of participating pharmacies.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Donut Hole Coverage: Generics only.Shingles Vaccine: $65 co-pay.Mail order is not available.Contact plan for list of participating pharmacies.72

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Discounts/Special Programs None. None.Number of Providers In-Network Contact plan for list of providers. Contact plan for a list of network providers.Enrollment Status/Health Screening Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,250Monthly Premium Plan Only: $27Plan with Part D Premium: $37Plan Only: $62Plan with Part D Premium: $83Quick Tip 11Medicare and Outpatient Mental Health CoverageBeginning in January 2010 through December 2013, Medicare Part B coverage for outpatient mental health services will increase to be equal to other Medicare Part B outpatient services.Year Medicare coverage You payBefore January 1, 2010 50 percent 50 percentJanuary 1, 2010–December 31, 2011 55 percent 45 percentJanuary 1, 2012–December 31, 2012 60 percent 40 percentJanuary 1, 2013–December 31, 2013 65 percent 35 percentJanuary 1, 2014 80 percent 20 percent73

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.humana-medicare.comHuman Gold Choice H2944-021-800-833-2312TTY: 1-877-833-4486Monday–Saturdaywww.humana-medicare.comHuman Gold Choice H2944-031-800-833-2312TTY: 1-877-833-4486Monday–SaturdayService Area All 87 Minnesota counties. All 87 Minnesota counties.Hospital Inpatient $225 co-pay per day (days 1-7) per each Medicare-coveredadmission. Remaining balance up to the Medicare-allowedamount covered in full. No additional co-pay for relatedprofessional or ancillary services while inpatient.Physician/Outpatient Medicare-covered physician services covered in full,subject to a $15 co-pay (primary care doctor), or$35 co-pay (specialist). Outpatient hospital services,including laboratory, X-ray and surgical, subject to25% co-insurance. Radiation therapy, chemotherapyand renal dialysis subject to 20% co-insurance.Emergency Services/Urgent Care $50 co-pay for emergency room services. 20% of the costfor Medicare-covered ambulance benefits.Preventive Services One annual routine physical with limited lab and radiologycovered in full after $0 (primary care) co-pay. Medicareapprovedcancer screenings and immunizations covered infull when no other services are provided. Routine hearingtest every 2 years covered in full after $35 co-pay.Diagnostic Tests, X-rays and Lab Services $15 to $35 co-pay (or 20% to 25% of the cost) forMedicare-covered diagnostic procedures and tests, X-rays,diagnostic radiology and therapeutic radiology. $0 co-pay forMedicare-covered lab services in a free-standing lab facility.Physical/Speech/Occupational Therapy $35 co-pay per visit or 20% to 25% of the cost,no maximum or cap.$225 co-pay per day (days 1-7) per each Medicare-coveredadmission. Remaining balance up to the Medicare-allowedamount covered in full. No additional co-pay for relatedprofessional or ancillary services while inpatient.Medicare-covered physician services covered in full,subject to a $15 co-pay (primary care doctor), or$35 co-pay (specialist). Outpatient hospital services,including laboratory, X-ray and surgical, subject to25% co-insurance. Radiation therapy, chemotherapyand renal dialysis subject to 20% co-insurance.$50 co-pay. $100 co-pay for ambulance.One annual routine physical with limited lab and radiologycovered in full after $0 (primary care) co-pay. Medicareapprovedcancer screenings and immunizations covered infull when no other services are provided. Routine hearingtest every 2 years covered in full after $35 co-pay.$0- $125 co-pay for Medicare-covered lab services. $15-$125 co-pay for Medicare-covered diagnostic proceduresand tests, X-rays and diagnostic and therapeutic radiology.$35-$125 co-pay per visit per Medicare-covered therapies.Home Health Care No co-pay for Medicare-covered home health visits and services. No co-pay for Medicare-covered home health visits and services.Mental Health Outpatient: $35 co-pay. Outpatient: $35 co-pay.Chemical Dependency Outpatient: 25% co-insurance. Outpatient: $125 co-pay.Skilled Nursing Care Days 1-14: Covered in full.Days 15-100: $100 co-pay each day. (No three-day inpatient qualification stay required.)Days 1-14: Covered in full.Days 15-100: $100 co-pay each day. (No three-day inpatientqualification stay required.)Durable Medical Equipment In-network 20% co-insurance for Medicare-covereddurable medical equipment. Equipment must meetMedicare medical necessity guidelines.In-network 20% co-insurance for Medicare-covereddurable medical equipment. Equipment must meetMedicare medical necessity guidelines.74

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Dental Limited to coverage provided under Original Medicare andsubject to a $35 co-pay. Routine dental care not covered.Limited to coverage provided under Original Medicare andsubject to a $35 co-pay. Routine dental care not covered.Chiropractic Medicare-covered services. $35 co-pay per visit. Medicare-covered services. $35 co-pay per visit.Travel Benefits No provider networks. Enrollees may see any providerwilling to accept the terms and conditions of paymentunder the Humana Gold Choice plan. Worldwide travelbenefit: When outside the U.S. for not more than 60consecutive days, emergency and urgently needed servicesare covered. Co-insurance is 20% of Medicare-coveredservices, up to a maximum benefit of $25,000 annuallywith a $250 annual deductible.Medicare Part B Drugs 20% of the cost for Medicare-covered Part B drugs and forPart B chemotherapy drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $42 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $80 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: Cost share determined by place oftreatment (physician office versus pharmacy).Mail order is available.Extra Services and Coverage: $0 co-pay generic. Mail orderthrough RightSource.65,000 participating pharmacies nationwide.Discounts/Special Programs SilverSneakers ® Fitness program. Dental, hearing andvision discounts. QuitNet smoking cessation program andMedicare-covered smoking cessation program $15 (primarycare) or $35 (specialist) co-pay. 24 hour nurse hotline.Number of Providers In-Network This is a non-network plan. Enrollees may use the servicesof any provider eligible to be paid by Medicare and willingto accept the terms and conditions of the Humana GoldChoice plan. For information on terms and conditions,contact Humana Gold Choice’s Provider Relations.Enrollment Status/Health Screening Annual open enrollment period, November 15 to December31 of each year. End-stage renal disease ineligible.No health screening.Maximum Annual Out-of-Pocket Costs $5,000 (Excludes Rx, worldwide coverage, and monthlypremiums).Monthly Premium $58 $85No provider networks. Enrollees may see any providerwilling to accept the terms and conditions of paymentunder the Humana Gold Choice plan. Worldwide travelbenefit: When outside the U.S. for not more than 60consecutive days, emergency and urgently needed servicesare covered. Co-insurance is 20% of Medicare-coveredservices, up to a maximum benefit of $25,000 annuallywith a $250 annual deductible.20% of the cost for Medicare-covered Part B drugs and forPart B chemotherapy drugs.Deductible: $0Brand Name Drugs: $42 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $80 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: Cost share determined by place oftreatment (physician office versus pharmacy).Mail order is available.Extra Services and Coverage: $0 co-pay generic. Mail orderthrough RightSource.65,000 participating pharmacies nationwide.SilverSneakers ® Fitness program. Dental, hearing andvision discounts. QuitNet smoking cessation program andMedicare-covered smoking cessation program $15 (primarycare) or $35 (specialist) co-pay. 24 hour nurse hotline.Chronic condition disease management programs.This is a non-network plan. Enrollees may use the servicesof any provider eligible to be paid by Medicare and willingto accept the terms and conditions of the Humana GoldChoice plan. For information on terms and conditions,contact Humana Gold Choice’s Provider Relations.Annual open enrollment period, November 15 to December31 of each year. End-stage renal disease ineligible.No health screening.$5,000 (Excludes Rx, worldwide coverage, and monthlypremiums).75

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planshumana-medicare.comHumana Gold Choice H2944-0721-800-833-2312; 1-800-833-2312TTY: 1-877-833-4486Monday-Saturdaywww.medica.comMedica Advantage Solution SM Standard H2410-001952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekService Area All 87 Minnesota counties. Select counties in Minnesota and North Dakota.Hospital Inpatient $225 co-pay per day (days 1-7) per each Medicare-coveredadmission. Remaining balance up to the Medicare-allowedamount covered in full. No additional co-pay for relatedprofessional or ancillary services while inpatient.Physician/Outpatient Medicare-covered physician services covered in full,subject to a $15 co-pay. (primary care doctor), or $35co-pay (specialist). Outpatient hospital services, includinglaboratory, X-ray and surgical, subject to 25% co-insurance.Radiation therapy, chemotherapy and renal dialysis subjectto 20% co-insurance.Emergency Services/Urgent Care $50 co-pay for emergency room services.20% co-insurance of the cost for Medicare-coveredambulance benefits.Preventive Services One annual routine physical with limited lab and radiologycovered in full after $0 (primary care) co-pay. Medicareapprovedcancer screenings and immunizations covered infull when no other services are provided. Routine hearing testevery 2 years covered in full after $35 co-pay.Diagnostic Tests, X-rays and LabServices$0 to $35 co-pay (or 25% of the cost) for Medicare-covereddiagnostic procedures and tests, X-rays, diagnostic radiologyand therapeutic radiology. $0 co-pay for Medicare-coveredlab services in a free-standing lab facility.Physical/Speech/Occupational Therapy $35 co-pay per visit or 20% to 25% of the cost,no maximum or cap.$550 for each Medicare-covered hospital stay. You paynothing for additional hospital stays.You pay $15 co-pay for each primary care doctor visit forMedicare-covered services. You pay $30 co-pay for eachspecialist visit for Medicare-covered services.$50 co-pay for each Medicare-covered emergency room visit.Worldwide emergency coverage when traveling outside the U.S.a $50 co-pay applies. $15 to $30 co-pay or 20% co-insurancefor the cost of each Medicare-covered urgent care services.One covered annual preventive exam per year. No co-pay forcolorectal cancer screening, immunizations, mammograms,pap smears, pelvic exams or prostate cancer screening.You pay $15 to $30 co-pay (or 20% of the cost) forMedicare-covered services depending on where servicesare received.$30 co-pay for each Medicare-covered PT/OT/ST visit.Home Health Care No co-pay for Medicare-covered home health visits and services. No co-pay for Medicare-covered home health visits.Mental Health Outpatient: $35 co-pay. Outpatient: $30 co-pay for each Medicare-coveredindividual or group therapy visit.Inpatient: You pay $550 co-pay for each Medicare-coveredhospital stay.Chemical Dependency Outpatient: 25% co-insurance. $30 co-pay for each Medicare-covered individual/group visit.Skilled Nursing Care Days 1-7: Covered in full.Days 8-100: $84 co-pay per day. (No three-day inpatienthospital stay is required).Days 1-20: $0 co-pay each day.Days 21-100: $120 co-pay each day.No three-day hospital stay is required.Coverage is for 100 days each benefit period.76

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment In-network: 20% co-insurance for Medicare-covered durablemedical equipment. Equipment must meet Medicare medicalnecessity guidelines.Dental Limited to coverage provided under original Medicare andsubject to a $35 co-pay. Routine dental care not covered.You pay 25% co-insurance for each Medicare-covered item.You pay 100% for preventative dental services. You pay $30co-pay for Medicare-covered dental services.Chiropractic Medicare-covered services. $35 co-pay per visit. $30 co-pay for each Medicare-covered visit (manualmanipulation of spine to correct a displacement ormisalignment of a joint or body part).Travel Benefits No provider networks. Enrollees may see any provider willing toaccept the terms and conditions of payment under the HumanaGold Choice plan. Worldwide travel benefit: When outside theU.S. for not more than 60 consecutive days, emergency andurgently needed services are provided. Co-insurance is 20%of Medicare-covered services, up to a maximum benefit of$25,000 annually with a $250 annual deductible.Medicare Part B Drugs 20% of the cost for Medicare-covered Part B drugs and forPart B chemotherapy drugs.Medicare Part D Outpatient Prescriptions Deductible: $310Brand Name Drugs: 25% co-insurance after deductible.Generic Drugs: 25% co-insurance after deductible.Non-preferred Brand Name Drugs: 25% co-insurance afterdeductible.Specialty Drugs: 25% co-insurance after deductible.Shingles Vaccine: Cost share determined by place of treatment(physician office versus pharmacy).Extra Services and Coverage: Contact plan. Mail order is available.65,000 participating pharmacies available nationwide.Discounts/Special Programs SilverSneakers ® Fitness program. Dental, hearing and visiondiscounts. QuitNet smoking cessation program and Medicarecoveredsmoking cessation program $15 co-pay (primarycare) or $35 co-pay (specialist). 24 hour nurse hotline.Number of Providers In-Network This is a non-network plan. Enrollees may use the servicesof any provider eligible to be paid by Medicare and willingto accept the terms and conditions of the Humana GoldChoice plan. For information on terms and conditions contactHumana Gold Choice’s Provider Relations.Enrollment Status/Health Screening Annual open enrollment period, November 15 toDecember 31 of each year. End-stage renal diseaseineligible. No health screening.Maximum Annual Out-of-Pocket Costs $5,000 (Excludes Rx, worldwide coverage, and monthlypremiums).Monthly Premiums $164 $9This plan does not contract with a provider network. You maysee any Medicare doctor, specialist or hospital that acceptsMedicare payment and accepts terms, conditions andpayment rate of Medica Health Plans. Worldwide emergencycoverage when traveling outside the U.S. A $50 co-payapplies for emergency services.20% co-insurance for Part B drugs.Medicare Part D outpatient prescriptions are not covered withthis plan.You pay 100% for hearing aids. You pay $30 for eachMedicare-covered hearing exam (diagnostic hearing exams).You pay $30 for each routine hearing test up to one testevery year.This plan does not contract with a provider network. You maysee any Medicare doctor, specialist or hospital that acceptsMedicare payment and accepts terms, conditions andpayment rate of Medica Health Plans.Enrollment open. New enrollees with end-stage renal diseaseare not eligible. No health screening.$3,35077

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.medica.comMedica Advantage Solution SMStandard with Rx H2410-015952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekwww.medica.comMedica Advantage Solution SMChoice H2410- 009952-992-2345; 1-800-906-5432TTY: 1-800-855-2880 and ask for 1-800-906-54328 a.m. to 8 p.m. CST, 7 days a weekService Area Select counties in Minnesota and North Dakota. Select counties in Minnesota and North Dakota.Hospital Inpatient $550 for each Medicare-covered hospital stay.You pay nothing for additional hospital stays.Physician/Outpatient You pay $15 for each primary care doctor visit for Medicarecoveredservices. You pay $30 for each specialist visit forMedicare-covered services.Emergency Services/Urgent Care $50 co-pay for each Medicare-covered emergency room visit.Worldwide emergency coverage when traveling outside the U.S.a $50 co-pay applies. $15 to $30 co-pay or 20% co-insurancefor the cost of each Medicare-covered urgent care services.Preventive Services One covered annual preventive exam per year. No co-pay forcolorectal cancer screening, immunizations, mammograms,pap smears, pelvic exams or prostate cancer screening.Diagnostic Tests, X-rays and Lab Services You pay $15 to $30 co-pay (or 20% of the cost) for Medicarecoveredservices depending on where services are received.Days 1-60: $1,100 deductible.Days 61-90: $275 co-pay each day.Days 91-150: $550 co-pay per lifetime reserve day.Coverage is for 90 days each benefit period.You pay 20% co-insurance for primary care doctor visit forMedicare-covered benefits. You pay 20% co-insurance for eachspecialist visit for Medicare-covered services. You pay 20%co-insurance for each Medicare-covered visit in an ambulatorysurgical center or in an outpatient hospital facility.You pay 20% co-insurance up to $50 for each Medicare-coveredemergency room visit (not covered outside the U.S. except underlimited circumstances). You pay 20% co-insurance for eachin-area, network Medicare-covered urgent care visit.20% co-insurance for an annual routine health assessment,annual routine eye and hearing exams, routine mammogramsand pap smears, routine cancer tests and screenings.There is no co-pay for flu and pneumonia vaccines.You pay 20% co-insurance for Medicare-covered services.Physical/Speech/Occupational Therapy $30 co-pay for each Medicare-covered PT/OT/ST visit. You pay 20% co-insurance for each Medicare-coveredPT/OT/ST visit.Home Health Care There is no co-pay for Medicare-covered home health visits. You pay $0 co-pay for Medicare-covered home health visits.Mental Health Outpatient: $30 co-pay for each Medicare-covered individualor group therapy visit.Inpatient: You pay $550 co-pay for each Medicare-coveredhospital stay.You pay 50% co-insurance for each individual or groupvisit for Medicare-covered benefits.Chemical Dependency $30 co-pay for each Medicare-covered individual/group visits. Outpatient: You pay 20% co-insurance for each individual orgroup visit for Medicare-covered benefits.Skilled Nursing Care Days 1-20: $0 co-pay per day.Days 21-100: $120 co-pay per day.No prior hospital stay is required.Coverage is for 100 days each benefit period.Days 1-20: $0 co-pay per day.Days 21-100: $137.50 co-pay per day.Three-day prior hospital stay required.You are covered for 100 days each benefit period.78

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment You pay 25% co-insurance of the cost for each Medicarecovereditem.Dental You pay 100% for preventive dental services. You pay$30 co-pay for Medicare-covered dental services.Chiropractic $30 co-pay for each Medicare-covered visit (manualmanipulation of spine to correct a displacement ormisalignment of a joint or body part).Travel Benefits This plan does not contract with a provider network. You maysee any Medicare doctor, specialist or hospital that acceptsMedicare payment and accepts terms, conditions andpayment rate of Medica Health Plans. Worldwide emergencycoverage when traveling outside the U.S. A $50 co-payapplies for emergency services.You pay 20% co-insurance of the cost for Medicare-covered itemsand supplies.You must go to network providers. In general, you pay100% for non-Medicare-covered dental services. You pay20% co-insurance of Medicare-covered dental services.You pay 20% co-insurance for Medicare-covered benefits(manual manipulation of the spine to correct displacement ormisalignment of a joint or body part).This plan does not contract with a provider network. You maysee any Medicare doctor, specialist or hospital that acceptsMedicare payment and accepts terms, conditions and paymentrate of Medica Health Plans.Medicare Part B Drugs 20% co-insurance for Part B drugs. After $155 deductible, you pay 20% co-insurance forMedicare-eligible Part B medications.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $74 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment; call plan.Extra Services and Coverage: Medication TherapyManagement available.Mail order is available.Over 1,400 network pharmacies. Please check website for details.Discounts/Special Programs You pay 100% for hearing aids. You pay $30 co-pay for eachMedicare-covered hearing exam (diagnostic hearing exams). Youpay $30 co-pay for each routine hearing test up to one test everyyear.Number of Providers In-Network This plan does not contract with a provider network. You maysee any Medicare doctor, specialist or hospital that acceptsMedicare payment and accepts terms, conditions andpayment rate of Medica Health Plans.Enrollment Status/Health Screening Enrollment open. New enrollees with end-stage renal diseaseare not eligible. No health screening.Maximum Annual Out-of-Pocket Costs $3,350 N/ADeductible: $310Brand Name Drugs: 25% co-insurance.Generic Drugs: 25% co-insurance.Non-preferred Brand Name and Specialty Drugs: 25% coinsurance.Shingles Vaccine: 25% co-insurance.Extra Services and Coverage: Medication TherapyManagement available.Mail order is available.Over 1,400 network pharmacies. Please check website for details.Written health education materials, including newsletters;additional smoking cessation; health club membership/fitnessclasses; nursing hotline.This is a non-network plan. See the plan for specifics.Enrollment open. New enrollees with end-stage renal diseaseare not eligible. No health screening.Monthly Premiums $0 $29.1079

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.sterlingplans.comSterling Basic Plus SM H5006-0181-888-858-8544 (Enrollment); 1-888-858-8572 (Sales)TTY: 1-888-858-85675 a.m.-8 p.m. PST, 7 days a weekService Area Segment 1: Anoka, Carver, Chisago, Dakota, Hennepin,Isanti, Ramsey, Scott, Sherburne, Washington, Wrightcounties. Segment 2: Aitkin, Becker, Beltrami, Benton,Big Stone, Blue Earth, Brown, Carlton, Cass, Chippewa,Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dodge,Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant,Houston, Hubbard, Itasca, Jackson, Kanabec, Kandiyohi,Kittson, Koochiching, Lac qui Parle, Lake of the Woods,Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin,McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray,Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington,Pine, Pipestone, Polk, Pope, Red Lake, Redwood, Renville,Rice, Rock, Roseau, Sibley, St Louis, Stearns, Steele,Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca,Watonwan, Wilkin, Winona, Yellow Medicine counties.www.sterlingplans.comSterling Option I ® H5006-0141-888-858-8544 (Enrollment); 1-888-858-8572 (Sales)TTY: 1-888-858-85675 a.m.-8 p.m. PST, 7 days a weekSegment 1: Anoka, Carver, Chisago, Dakota, Hennepin, Isanti,Ramsey, Scott, Sherburne, Washington, Wright counties.Segment 2: Aitkin, Becker, Beltrami, Benton, Big Stone,Blue Earth, Brown, Carlton, Cass, Chippewa, Clay, Clearwater,Cook, Cottonwood, Crow Wing, Dodge, Douglas, Faribault,Fillmore, Freeborn, Goodhue, Grant, Houston, Hubbard,Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching,Lac qui Parle, Lake of the Woods, Le Sueur, Lincoln, Lyon,Mahnomen, Marshall, Martin, McLeod, Meeker, MilleLacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman,Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope,Red Lake, Redwood, Renville, Rice, Rock, Roseau, Sibley,St Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse,Wabasha, Wadena, Waseca, Watonwan, Wilkin, Winona,Yellow Medicine counties.Hospital Inpatient Hospital Inpatient: $200 co-pay for each day(s) up to 5days. Benefit for unlimited days. Hospice: Only Sterlingadded benefits (non-Medicare) are covered during hospiceelection period.Physician/Outpatient Primary care doctor office visit: $20 co-pay; Specialistdoctor office visit: $40 co-pay; Medicare-covered podiatrycare: $40 co-pay (Member pays cost of non-Medicarecoveredservices).Emergency Services/Urgent Care Medically necessary ambulance trips: $100 co-pay foreach Medicare-covered trip (enrollee pays cost for milesbeyond nearest facility capable of providing services);Emergency room care: $50 co-pay (waived if admittedwithin 24 hours for the same condition); Urgently neededcare: $20 or $40 co-pay depends on specialty.Preventive Services No cost-share for the following services: bone massmeasurement, colorectal cancer screening exams forthose age 50 and older, screening mammogram, yearlyscreening mammograms, pap smear and pelvic exam for allwomen every 2 years, yearly pap smear for women at highrisk, screening exams for prostate cancer, cardiovascularscreening blood tests, immunizations, Welcome to MedicarePreventive Physical in first 12 months of Part B coverage.Diagnostic Tests, X-rays and Lab Services Medicare-covered laboratory services, diagnostic proceduresand tests-no cost-share; Medicare-covered X-rays, diagnosticradiology procedures and therapeutic radiology services-15% co-insurance.Hospital Inpatient: $150 co-pay for each day(s) up to 5days. Benefit for unlimited days; Hospice: Only Sterlingadded benefits (non-Medicare) are covered during hospiceelection period.Primary care doctor office visit: $20 co-pay; Specialistdoctor office visit: $40 co-pay; Medicare-covered podiatrycare: $40 co-pay (Member pays cost of non-Medicarecoveredservices).Medically necessary ambulance trips: $100 co-pay for eachMedicare-covered trip (enrollee pays cost for miles beyondnearest facility capable of providing services); Emergencyroom care: $50 co-pay (waived if admitted within 24 hoursfor the same condition); Urgently needed care: $20 or $40co-pay depends on specialty.No cost-share for the following services: bone massmeasurement, colorectal cancer screening exams forthose age 50 and older, screening mammogram, yearlyscreening mammograms, pap smear and pelvic exam for allwomen every 2 years, yearly pap smear for women at highrisk, screening exams for prostate cancer, cardiovascularscreening blood tests, immunizations, Welcome to MedicarePreventive Physical in first 12 months of Part B coverage.Medicare-covered laboratory services, diagnostic proceduresand tests-no cost-share; Medicare-covered X-rays, diagnosticradiology procedures and therapeutic radiology services-10% co-insurance.Physical/Speech/Occupational Therapy Outpatient rehab services: 15% co-insurance. Outpatient rehab services: 10% co-insurance.80

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Home Health Care No co-insurance. No co-insurance.Mental Health Inpatient care in a freestanding psychiatric clinic:$200 co-pay for each day(s) up to 5 days coverage for atotal of 190 days in a lifetime. Part B covers some servicesafter lifetime max.Outpatient: 50% co-insurance.Chemical Dependency Outpatient: 50% co-insurance. Outpatient: 50% co-insurance.Skilled Nursing Care Day 1-10: $0 co-pay.Day 11-100: $50 co-pay per day.Durable Medical Equipment 20% co-insurance (recommend pre-notification for apurchase over $750).Dental Medicare-covered dental: $0 co-pay for Medicare-coveredoffice visit and 15% co-insurance for Medicare-coveredoutpatient services in a facility. Preventive dental-oral exam,cleaning, fluoride and X-rays-covered up to $200 a year(member pays amount over the $200).Chiropractic Chiropractic care for manual manipulation of the spineto correct acute subluxation only: $20 co-pay (cost ofnon-Medicare-covered services including routine care aremember responsibility).Inpatient care in a freestanding psychiatric clinic:$150 co-pay for each day(s) up to 5 days coverage for atotal of 190 days in a lifetime. Part B covers some servicesafter lifetime max.Outpatient: 50% co-insurance.Day 1-10: $0 co-pay.Day 11-100: $50 co-pay per day.20% co-insurance (recommend pre-notification for a purchaseover $750).Medicare-covered dental: $0 co-pay for Medicare-coveredoffice visit and 10% co-insurance for Medicare-coveredoutpatient services in a facility. Preventive dental-oralexams, cleanings, fluoride and X-rays covered up to $300(member pays amount over the $300).Chiropractic care for manual manipulation of the spine tocorrect acute subluxation only: $20 co-pay (cost ofnon-Medicare-covered services including routine care aremember responsibility).Travel Benefits Worldwide urgent care for first 60 days per trip (onlyMedicare-covered services): Yearly, within first 60 days oftravel: $150 deductible, then 15% co-insurance of billedcharges to $25,000.Medicare Part B Drugs 20% co-insurance for Medicare-covered services (includingchemotherapy drugs).Worldwide urgent care for first 60 days per trip (onlyMedicare-covered services): Yearly, within first 60 days oftravel: $100 deductible, then 10% co-insurance of billedcharges to $25,000.20% co-insurance for Medicare-covered services (includingchemotherapy drugs).Medicare Part D Outpatient Prescriptions Part D coverage is not included with this plan. Part D coverage is not included with this plan.Discounts/Special Programs SilverandFit ® program provides free health clubmemberships at participating facilities or choice of at-homefitness kits.Number of Providers In-Network No network restrictions. Your doctor or hospital is notrequired to agree to accept the plan’s terms and conditions,and thus may choose not to treat you, with the exceptionof emergencies. If your doctor or hospital does not agreeto accept our payment terms and conditions, they maychoose not to provide health care services to you, exceptin emergencies. Providers can find the plan’s terms andconditions on website at: www.sterlingplans.com.Enrollment Status/Health Screening Enrollment open, except end-stage renal disease not eligible.No health screening.SilverandFit ® program provides free health clubmemberships at participating facilities or choice of at-homefitness kits.No network restrictions. Your doctor or hospital is notrequired to agree to accept the plan’s terms and conditions,and thus may choose not to treat you, with the exceptionof emergencies. If your doctor or hospital does not agreeto accept our payment terms and conditions, they maychoose not to provide health care services to you, exceptin emergencies. Providers can find the plan’s terms andconditions on website at: www.sterlingplans.com.Enrollment open, except end-stage renal disease not eligible.No health screening required.Maximum Annual Out-of-Pocket Costs $5,000 None.Monthly Premiums Segment 1: $39Segment 2: $59Please refer to service area list to determine your segmentby county.Segment 1: $59Segment 2: $94Please refer to service area list to determine your segmentby county.81

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.sterlingplans.comSterling Option II ® H5006-0171-888-858-8544 (Enrollment); 1-888-858-8572 (Sales)TTY: 1-888-858-85675 a.m.-8 p.m. PST, 7 days a weekService Area Segment 1: Anoka, Carver, Chisago, Dakota, Hennepin, Isanti, Ramsey,Scott, Sherburne, Washington, Wright counties. Segment 2: Aitkin,Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carlton, Cass,Chippewa, Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dodge,Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Houston,Hubbard, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching,Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon,Mahnomen, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison,Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail,Pennington, Pine, Pipestone, Polk, Pope, Red Lake, Redwood, Renville,Rice, Rock, Roseau, Sibley, St Louis, Stearns, Steele, Stevens, Swift,Todd, Traverse, Wabasha, Wadena, Waseca, Watonwan, Wilkin, Winona,Yellow Medicine counties.Hospital Inpatient Hospital inpatient: $150 co-pay for each day(s) up to 5 days.Benefit for unlimited days. Hospice: Only Sterling added benefits(non-Medicare) are covered during hospice election period.Physician/Outpatient Primary care doctor office visit: $20 co-pay; Specialist doctoroffice visit: $40 co-pay; Medicare-covered podiatry care:$40 co-pay (member pays cost of non-Medicare-covered services).Emergency Services/Urgent Care Medically necessary ambulance trips: $150 co-pay for eachMedicare-covered trip (enrollee pays cost for miles beyond nearestfacility capable of providing services); Emergency room care:$50 co-pay (waived if admitted within 24 hours for the samecondition); Urgently needed care: $20 or $40 co-pay (depends onspecialty).Preventive Services No cost-share for the following services: bone mass measurement,colorectal cancer screening exams for those age 50 and older,screening mammogram, yearly screening mammograms, papsmear and pelvic exam for all women every 2 years, yearly papsmear for women at high risk, screening exams for prostate cancer,cardiovascular screening blood tests, immunizations, Welcome toMedicare Preventive Physical in first 12 months of Part B coverage.Diagnostic Tests, X-rays and LabServicesMedicare-covered laboratory services, diagnostic procedures andtests-no cost-share; Medicare-covered X-rays, diagnostic radiologyprocedures and therapeutic radiology services-15% co-insurance.Physical/Speech/Occupational Therapy Outpatient rehab services: 15% co-insurance.Home Health Care No co-insurance.Quick Tip 12The Minnesota Board on Aging, withassistance from the Minnesota LegalServices Coalition, produced theguide Planning Ahead: Who will makedecisions for you? Planning Ahead covers• Informal arrangements• Formal arrangements• Legal planning tools• Power of attorney• Trusts• Guardianships and conservatorships• Health care directives• Health care options• Funeral planning• Organ and tissue donation• WillsYou can download and printa copy of Planning Ahead byvisiting www.mnaging.org/pdf/PlanningAheadBooklet_2009.pdf82

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Mental Health Inpatient care in a freestanding psychiatric clinic: $150 co-payfor each day(s) up to 5 days coverage for a total of 190 days in alifetime. Part B covers some services after lifetime max.Outpatient: 50% co-insurance.Chemical Dependency Outpatient: 50% co-insurance.Skilled Nursing Care Day 1-10: $0 co-pay.Days 11-100: $50 co-pay per day.Durable Medical Equipment 20% co-insurance (recommend pre-notification for a purchaseover $750).Dental Medicare-covered dental: $0 co-pay for Medicare-covered officevisit and 15% co-insurance for Medicare-covered outpatientservices in a facility. Preventive dental (1 each) exam, cleaning,fluoride and X-rays-covered up to $100 a year (member paysamount over the $100).Chiropractic Chiropractic care for manual manipulation of the spine to correctacute subluxation only: $20 co-pay (cost of non-Medicare-coveredservices including routine care are member responsibility).Travel Benefits Worldwide urgent care for first 60 days per trip (only Medicarecoveredservices): Yearly, within first 60 days of travel: $150deductible, then co-insurance of 15% of billed charges to$25,000.Medicare Part B Drugs 20% co-insurance for Medicare-covered services (includingchemotherapy drugs).Medicare Part D Outpatient Prescriptions Deductible: $225Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Partial coverage. Cost varies.Mail order is available. See pharmacy locator atwww.sterlingplanspharmacy.com/pharmacy.php.Discounts/Special Programs SilverandFit ® program provides free health club memberships atparticipating facilities or choice of at-home fitness kits.Number of Providers In-Network No network restrictions. Your doctor or hospital is not required toagree to accept the plan’s terms and conditions, and thus maychoose not to treat you, with the exception of emergencies. If yourdoctor or hospital does not agree to accept our payment terms andconditions, they may choose not to provide health care services toyou, except in emergencies. Providers can find the plan’s termsand conditions on website at: www.sterlingplans.com.Enrollment Status/Health Screening Enrollment open, except end-stage renal disease not eligible.No health screening for enrollment.Maximum Annual Out-of-Pocket Costs None.Monthly Premiums Segment 1: $99Segment 2: $107Please refer to service area list to determine your segmentby county.83

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.sterlingplans.comSterling Option IV ® H5006-0161-888-858-8544 (Enrollment); 1-888-858-8572 (Sales)1-888-858-85675 a.m.-8 p.m. PST, 7 days a weekService Area Segment 1: Anoka, Carver, Chisago, Dakota, Hennepin, Isanti, Ramsey, Scott,Sherburne, Washington, Wright counties. Segment 2: Aitkin, Becker, Beltrami,Benton, Big Stone, Blue Earth, Brown, Carlton, Cass, Chippewa, Clay, Clearwater,Cook, Cottonwood, Crow Wing, Dodge, Douglas, Faribault, Fillmore, Freeborn,Goodhue, Grant, Houston, Hubbard, Itasca, Jackson, Kanabec, Kandiyohi, Kittson,Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon,Mahnomen, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray,Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk,Pope, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Sibley, St Louis, Stearns,Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Watonwan, Wilkin,Winona, Yellow Medicine counties.Hospital Inpatient Hospital inpatient: $150 co-pay for each day(s) up to 5 days. Benefit for unlimiteddays. Hospice: Only Sterling added benefits (non-Medicare) are covered duringhospice election period.Physician/Outpatient Primary care doctor office visit: $20 co-pay; Specialist doctor office visit: $40 co-pay;Medicare-covered podiatry care: $40 co-pay (member pays cost of non-Medicarecoveredservices).Emergency Services/Urgent Care Medically necessary ambulance trips: $150 co-pay for each Medicare-covered trip(enrollee pays cost for miles beyond nearest facility capable of providing services);Emergency room care: $50 co-pay (waived if admitted within 24 hours for the samecondition); Urgently needed care: $20 co-pay or $40 co-pay (depends on specialty).Preventive Services No cost-share for the following services: bone mass measurement, colorectalcancer screening exams for those age 50 and older, screening mammogram,yearly screening mammograms, pap smear and pelvic exam for all women every2 years, yearly pap smear for women at high risk, screening exams for prostatecancer, cardiovascular screening blood tests, immunizations, Welcome to MedicarePreventive Physical in first 12 months of Part B coverage.Diagnostic Tests, X-rays and Lab Services Medicare-covered laboratory services, diagnostic procedures and tests-no costshare;Medicare-covered X-rays, diagnostic radiology procedures and therapeuticradiology services-15% co-insurance.Physical/Speech/Occupational Therapy Outpatient rehab services: 15% co-insurance.Home Health Care No co-insurance.Mental Health Inpatient care in a freestanding psychiatric clinic: $150 co-pay for each day(s) up to5 days coverage for a total of 190 days in a lifetime. After lifetime maximum, Part Bcovers; Outpatient: 50% co-insurance.Quick Tip 13If you have Medicare PartD and are not enrolled inMedical Assistance, youshould consider applyingfor the Extra Help, alsoknown as Low IncomeSubsidy (LIS) to help youpay for your MedicarePart D plan costs. There is no risk or cost to apply. Contact theSenior LinkAge Line ®at 1-800-333-2433for more information oryou can apply online atsecure.ssa.gov/apps6z/i1020/main.html84

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chemical Dependency Outpatient: 50% co-insurance.Skilled Nursing Care Day 1-10: $0 co-pay.Days 11-100: $50 co-pay per day.Durable Medical Equipment 20% co-insurance (recommend pre-notification for a purchase over $750).Dental Medicare-covered dental: $0 co-pay for Medicare-covered office visit and 15%co-insurance for Medicare-covered outpatient services in a facility. Preventivedental-oral exam, cleaning, fluoride and X-rays-$400 benefit for dental/hearing/vision combined (member pays amount over the $400 for dental/vision/hearingcombined).Chiropractic Chiropractic care for manual manipulation of the spine to correct acutesubluxation only: $20 co-pay (cost of non-Medicare-covered services includingroutine care are member responsibility).Travel Benefits Worldwide urgent care for first 60 days per trip (only Medicare-covered services):Yearly, within first 60 days of travel: $150 deductible, then 15% co-insurance ofbilled charges to $25,000.Medicare Part B Drugs 20% co-insurance for Medicare-covered services (including chemotherapy drugs).Medicare Part D Outpatient Prescriptions Deductible: $225Brand Name Drugs: $36 co-pay.Generic Drugs: $10 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Partial coverage.Mail order is available.See pharmacy locator at www.sterlingplanspharmacy.com/pharmacy.php.Discounts/Special Programs Silver & Fit ® program provides free health club memberships at participatingfacilities or choice of at-home fitness kits. E-mail consults (e-consults) and phoneconsults: $24 per e-mail or phone call. Limit $240 per year for both e-mail andphone calls combined. Health risk assessments: Providers reimbursed $100per member per year for sending a health risk assessment to Sterling (only oneprovider per member). Medical records attestation: Providers reimbursed $50 permember per year for attestation that they keep medical records electronically (onlyone provider per member).Number of Providers In-Network No network restrictions. Your doctor or hospital is not required to agree to acceptthe plan’s terms and conditions, and thus may choose not to treat you, with theexception of emergencies. If your doctor or hospital does not agree to accept ourpayment terms and conditions, they may choose not to provide health care servicesto you, except in emergencies. Providers can find the plan’s terms and conditionson website at: www.sterlingplans.com.Enrollment Status/Health Screening Enrollment open, except end-stage renal disease not eligible.No health screening required.Maximum Annual Out-of-Pocket Costs $4,000Monthly Premiums Segment 1: $119Segment 2: $120 (Please refer to service area list to determine your segment by county.)85

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.SecureHorizons.comSecureHorizons Medicare Direct Rx Plan 1 H5435-00011-800-555-5757; 1-800-555-5757TTY: 1-800-387-10748 a.m.-8 p.m., 7 days a weekService Area Becker, Big Stone, Blue Earth, Brown, Carlton, Chippewa,Clay, Clearwater, Cottonwood, Douglas, Faribault, Fillmore,Freeborn, Grant, Houston, Jackson, Kandiyohi, Kittson, LeSueur, Lincoln, Lyon, Martin, Meeker, Morrison, Nicollet,Nobles, Otter Tail, Pennington, Pope, Red Lake, Redwood,Rice, Rock, Roseau, Sherburne, Stearns, Steele, Swift,Todd, Traverse, Wabasha, Wadena, Waseca, Washington,Watonwan, Wilkin and Winona counties in Minnesota.Hospital Inpatient Days 1-7: $225 co-pay per day.Days 8-90: $0 co-pay per day.Physician/Outpatient $15 co-pay primary care; $30 co-pay specialist; 20%co-insurance of the cost for each Medicare-coveredambulatory surgical center visit. 20% of the cost for eachMedicare-covered outpatient hospital facility visit.Emergency Services/Urgent Care $50 co-pay for Medicare-covered emergency room visits.Worldwide coverage. If you are admitted to the hospitalwithin 24 hours for the same condition, you pay $0 for theemergency room visit.Preventive Services $0 co-pay for bone mass measurement, colorectal cancerscreening exams, immunizations, mammograms (annualscreening), pap smears and pelvic exams, prostate cancerscreening exams, physical exams, smoking cessation,1 routine physical per year, one pair of eyeglasses or contactlenses after cataract surgery. $30 co-pay for exams todiagnose and treat diseases and conditions of the eye.$30 co-pay for up to one routine eye exam every year.Diagnostic Tests, X-rays and LabServices$10 co-pay for Medicare-covered lab services. $0 to $10co-pay for Medicare-covered diagnostic procedures andtests. $16 co-pay for Medicare-covered X-rays.20% for the cost for Medicare-covered diagnostic radiologyservices. 20% co-insurance for the cost for Medicarecoveredtherapeutic radiology services.Physical/Speech/Occupational Therapy $30 co-pay for Medicare-covered physical/speech/language/occupational therapy visits.www.SecureHorizons.comSecureHorizons Medicare Direct Rx Plan H5435-014-01-800-555-5757; 1-800-555-5757TTY: 1-800-387-10748 a.m.-8 p.m., 7 days a weekBecker, Big Stone, Blue Earth, Brown, Carlton, Chippewa,Clay, Clearwater, Cottonwood, Douglas, Faribault, Fillmore,Freeborn, Grant, Houston, Jackson, Kandiyohi, Kittson, LeSueur, Lincoln, Lyon, Martin, Meeker, Morrison, Nicollet,Nobles, Otter Tail, Pennington, Pope, Red Lake, Redwood,Rice, Rock, Roseau, Sherburne, Stearns, Steele, Swift,Todd, Traverse, Wabasha, Wadena, Waseca, Washington,Watonwan, Wilkin and Winona counties in Minnesota.Days 1-7: $250 co-pay per day.Days 8-90: $0 co-pay per day.$15 co-pay primary care, $30 co-pay specialist, 20%co-insurance of the cost for each Medicare-coveredambulatory surgical center visit. 20% co-insurance of the costfor each Medicare-covered outpatient hospital facility visit.$50 co-pay for Medicare-covered emergency room visits.Worldwide coverage. If you are admitted to the hospitalwithin 24 hours for the same condition, you pay $0 for theemergency room visit.$0 co-pay for immunizations, mammograms (annualscreening), pap smears and pelvic exams, prostate cancerscreening exams, physical exams, smoking cessation,one routine physical per year and one pair of eyeglasses orcontact lenses after cataract surgery. $30 co-pay for examsto diagnose and treat disease and conditions of the eye.$30 co-pay for up to one routine eye exam every year.$10 co-pay for Medicare-covered lab services. $0 to $10co-pay for Medicare-covered diagnostic procedures andtests. $16 co-pay for Medicare-covered X-rays.20% co-insurance for the cost for Medicare-covereddiagnostic radiology services. 20% co-insurance for thecost for Medicare-covered therapeutic radiology services.$30 co-pay for Medicare-covered physical/speech/language/occupational therapy visits.86

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Home Health Care $0 co-pay for each Medicare-covered home health visit. $0 co-pay for each Medicare-covered home health visit.Mental Health $40 co-pay for Medicare-covered individual visits.$30 co-pay for Medicare-covered group visits.Chemical Dependency $40 co-pay for Medicare-covered individual visits.$30 co-pay for Medicare-covered group visits.Skilled Nursing Care Day 1- 30: $95 co-pay per day.Day 31-100: $0 co-pay per day.No three-day hospital stay required.$40 co-pay for each Medicare-covered individual therapy visit.$30 co-pay for each Medicare-covered group therapy visit.$40 co-pay for Medicare-covered individual visits.$30 co-pay for Medicare-covered group visits.Days 1-26: $110 co-pay per day.Day 27-100: $0 co-pay per day.No three-day hospital stay is required.Durable Medical Equipment 20% co-insurance for the cost of Medicare-covered items. 20% co-insurance for the cost of Medicare-covered items.Dental In general, preventive dental benefits (such as cleaning)are not covered. $30 co-pay for Medicare-covered dentalbenefits.Chiropractic $30 co-pay for each Medicare-covered visit. Medicarecoveredchiropractic visits are for manual manipulationof the spine to correct subluxation (a displacement ormisalignment of a joint or body part) if you get it from achiropractor or other qualified providers.In general, preventive dental benefits (such as cleaning)are not covered. $30 co-pay for Medicare-covered dentalbenefits.$30 co-pay for each Medicare-covered visit. Medicarecoveredchiropractic visits are for manual manipulationof the spine to correct subluxation (a displacement ormisalignment of a joint or body part) if you get it from achiropractor or other qualified providers.Travel Benefits Worldwide emergency coverage. Worldwide emergency coverage.Medicare Part B Drugs 20% of the cost for Part B-covered chemotherapy drugsand other Part B-covered drugs.20% of the cost for Part B-covered chemotherapy drugs andother Part B-covered drugs.Medicare Part D Outpatient Prescriptions No Part D coverage. Deductible: $0Brand Name Drugs: $42 co-pay.Generic Drugs: $6-$116 co-pay.Non-preferred Brand Name Drugs: $80-$230 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: Covered at cost-sharing above.Mail order is available.Discounts/Special Programs None. None.Number of Providers In-Network No network of providers. No network of providers.Enrollment Status/Health Screening Open enrollment. No health screening during open enrollment. Open enrollment. No health screening during open enrollment.Maximum Annual Out-of-Pocket Costs $4,250 $4,600 in-network.Monthly Premiums $0 $2087

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Physical/Speech/Occupational Therapy $35-$50 co-pay for each Medicare-covered occupationaltherapy visit. $35 -$50 co-pay for each physical and/orspeech therapy visit.$35-$50 co-pay for each Medicare-covered occupationaltherapy visit. $35 -$50 co-pay for each physical and/or speechtherapy visit.Home Health Care $0 co-pay for Medicare-covered home health visits. $0 co-pay for Medicare-covered home health visits.Mental Health Outpatient: $40 copay.Inpatient: $280 co-pay per stay days 1-6. (190-daylifetime limit.)Outpatient: 50% co-insurance.Inpatient: $275 co-pay per stay days 1-5. $1,375 out-ofpocketyearly limit. (190-day lifetime limit.)Chemical Dependency $40 co-pay for Medicare-covered individual/group visit. $30 co-pay for Medicare-covered individual/group visit.Skilled Nursing Care Days 1-20: $0 co-pay each day.Days 21-100: $130 co-pay each day.No prior hospital stay is required.Coverage is for 100 days each benefit period.Durable Medical Equipment You pay 20% co-insurance of the cost for Medicarecoveredequipment.Days 1-20: $0 co-pay each day.Days 21-100: $130 co-pay each day.No prior hospital stay is required.Coverage is for 100 days each benefit period.You pay 20% co-insurance of the cost for Medicare-coveredequipment.Dental You pay 100% for routine dental services. You pay 100% for routine dental services.Chiropractic $35 co-pay for each Medicare-covered visit (manualmanipulation of spine to correct subluxation).Travel Benefits This plan does not contract with a provider network.You may see any licensed physician who can provideservices to Medicare beneficiaries and who is willing toaccept the terms and conditions of the plan. Worldwideemergency room coverage when traveling outside the U.S.A $50 co-pay applies.$35 co-pay for each Medicare-covered visit (manualmanipulation of spine to correct subluxation).This plan does not contract with a provider network.You may see any licensed physician who can provide servicesto Medicare beneficiaries and who is willing to accept theterms and conditions of the plan. Worldwide emergencyroom coverage when traveling outside the U.S. A $50 co-payapplies (waived if admitted to the hospital within 72 hours forthe same condition.)Medicare Part B Drugs 20% co-insurance for the cost for Part B-covered drugs. 20% co-insurance for the cost for Part B-covered drugs.$5,000 out-of-pocket limit on Part B drugs.Medicare Part D Outpatient Prescriptions This plan does not offer prescription drug coverage. Deductible: $0Brand Name Drugs: $44 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $85 co-pay.Specialty Drugs: 33% co-insurance.Donut Hole Coverage: Many generics at $8 co-pay.Mail order is available.Contact plan for a list of participating pharmacies.Discounts/Special Programs None. None.Number of Providers in Network This plan does not contract with a provider network. Youmay see any licensed physician who can provide servicesto Medicare beneficiaries and who is willing to accept theterms and conditions of the plan.This plan does not contract with a provider network. Youmay see any licensed physician who can provide services toMedicare beneficiaries and who is willing to accept the termsand conditions of the plan.Enrollment Status/Health Screening Open enrollment. Enrollment open during annual open enrollment period,November 15 to December 31 of each year. End-stage renaldisease not eligible. No health screening required.Maximum Annual Out-of-Pocket Costs $5,000 $5,000 out-of-pocket limit applies to all Medicare-coveredservices.Monthly Premiums $0 $2389

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.unicare.com/medicareUniCare SecurityChoice Plus H0540-0891-888-949-5384TTY: 1-800-241-68948 a.m.-8 p.m., 7 days a weekService Area Aitkin, Benton, Cass, Faribault, Itasca, Kanabec,Koochiching, Le Sueur, Marshall, McLeod, Meeker,Nicollet, Pope, Renville, Roseau, Scott, Sherburne, Sibley,Wadena and Wright counties in Minnesota.Hospital Inpatient For a Medicare-covered stay at a hospital, you pay:Days 1-6: $280 co-pay each day.Days 7-90: $0 co-pay each day $1,680 maximum outof-pocketlimit per year. There is no co-pay for additionalMedicare-covered days received at a hospital and you arecovered for unlimited days each benefit period.Physician/Outpatient $25 co-pay for each primary care doctor office visit forMedicare-covered services; $35 co-pay for each specialistvisit for Medicare-covered service; Medicare-coveredambulatory surgical center visits: $35-$200 co-pay;outpatient hospital facility visit: $35 to $200 co-pay.Emergency Services/Urgent Care $50 co-pay for each Medicare-covered emergency room visit(waived if admitted to the hospital). Worldwide coverage.Urgent care: Cost sharing is the same as doctor office visits.Preventive Services One annual physical exam covered for $0 co-pay.$0 co-pay for Medicare-covered bone mass measurement,colorectal screenings, flu, pneumonia and Hepatitis Bvaccines, screening mammograms, pap smears, pelvicexams, prostate cancer screening. One routine hearingexam every year covered for a $35 co-pay. Annual routineeye exam covered with $35 co-pay.Diagnostic Tests, X-rays and Lab Services $35 co-pay for Medicare-covered lab services. $75 to $125co-pay for Medicare-covered diagnostic procedures, tests,X-rays, diagnostic radiology services. 20% co-insurance for thecost for Medicare-covered therapeutic radiology services.Physical/Speech/Occupational Therapy $35 to $50 co-pay for each Medicare-covered service.Home Health Care $0 co-pay for Medicare-covered home health visits.Mental Health Outpatient: $40 co-pay.Inpatient: $280 co-pay per stay days 1-6. $1,680out-of-pocket yearly limit. (190-day lifetime limit).Chemical Dependency $40 co-pay for Medicare-covered individual/group visit.Quick Tip 14The Minnesota Board on Aging is the gateway to services for Minnesotaseniors and their families. The MinnesotaBoard on Aging ensures that olderMinnesotans and their families areeffectively served by the state and localpolicies and programs in order to age welland live well. Visit www.mnaging.org formore information about the MinnesotaBoard on Aging.90

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care Days 1-20: $0 co-pay each day.Days 21-100: $130 co-pay each day.No prior hospital stay is required.Durable Medical Equipment You pay 20% of the cost for Medicare-covered equipment.Dental You pay 100% for routine dental services.Chiropractic $35 co-pay for each Medicare-covered visit (manualmanipulation of spine to correct subluxation).Travel Benefits This plan does not contract with a provider network. Youmay see any licensed physician who can provide servicesto Medicare beneficiaries and who is willing to accept theterms and conditions of the plan. Worldwide emergencyroom coverage when traveling outside the U.S. A $50 copayapplies.Medicare Part B Drugs 20% of the cost for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $44 co-pay.Generic Drugs: $8 co-pay.Non-preferred Brand Name Drugs: $85 co-pay.Specialty Drugs: 33% co-insurance.Donut Hole Coverage: Many generics at $8 co-pay.Mail order is available.Contact plan for a list of participating pharmacies.Discounts/Special Programs None.Number of Providers In-Network This plan does not contract with a provider network. Youmay see any licensed physician who can provide servicesto Medicare beneficiaries and who is willing to accept theterms and conditions of the plan.Enrollment Status/Health Screening Enrollment open during annual open enrollment period,November 15 to December 31 of each year. End-stagerenal disease not eligible. No health screening required.Maximum Annual Out-of-Pocket Costs $5,000 out-of-pocket limit applies to all Medicare-coveredservices.Monthly Premiums $55Quick Tip 15Become a certified volunteer with theSenior LinkAge Line ® to help othersunderstand Medicare and long-term careoptions. Volunteers are needed in all 87counties of Minnesota. Complete training,mentoring and certification provided at nocost to you. Call the Senior LinkAge Line ®at 1-800-333-2433 to get involved!91

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.Dental Medicare-covered only. Medicare-covered only. Medicare-covered only.Chiropractic $50 co-pay. $50 co-pay. $50 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.Medicare Part D Outpatient Prescriptions No drug coverage offered through plan. No drug coverage offered through plan. No drug coverage offered through plan.Discounts/Special Programs None. None. None.Number of Providers In-Network Contact plan for list of providers. Contact plan for list of providers. Contact plan for list of providers.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums $65 $85 $100Quick Tip 16Senior LinkAge Line ® (1-800-333-2433)Areas of expertise include:• Medicare• Long-term care options counseling• Minnesota Long-term Care Partnership• Prescription drug expense assistance for all ages• Caregiver Planning and Support• Health Insurance counseling• Application and forms assistance93

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-1421-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydaywww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-1501-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydaywww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-15811-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayService Area Blue Earth, Carlton, Chippewa, Houstonand Winona counties in Minnesota.Brown, Douglas, Kandiyohi, Kittson, Martin,Nicollet, Nobles, Pennington, Redwood,Rock and Wilkin counties in Minnesota.Faribault, Otter Tail and Red Lakecounties in Minnesota.Hospital Inpatient Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.Physician/Outpatient $245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Emergency Services/Urgent Care $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay.Preventive Services $0 co-pay. $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.Physical/Speech/Occupational Therapy $50 co-pay. $50 co-pay. $50 co-pay.0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.Home Health Care 20% co-insurance. 20% co-insurance. 20% co-insurance.Mental Health 50% co-insurance. 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100. $100 co-pay days 21-100.Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.Dental Medicare-covered only. Medicare-covered only. Medicare-covered only.Chiropractic $50 co-pay. $50 co-pay. $50 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.94

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5-$35 co-pay.Non-preferred Brand Name Drugs: $35-$65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $35-$65 co-pay.Mail order is not available.Contact plan for list of networkpharmacies.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5-$35 co-pay.Non-preferred Brand Name Drugs: $35-$65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $35-$65 co-pay.Mail order is not available.Contact plan for list of networkpharmacies.Discounts/Special Programs None. None. None.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5-$35 co-pay.Non-preferred Brand Name Drugs: $35-$65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $35-$65 co-pay.Mail order is not available.Contact plan for list of networkpharmacies.Number of Providers In-Network Contact plan for more information. Contact plan for more information. Contact plan for more information.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums Plan Only: $20Plan with Part D Premium: $26Plan Only: $17Plan with Part D Premium: $23Plan Only: $53Plan with Part D Premium: $63Quick Tip 17Make sure to get your one-time Welcome to Medicarephysical exam within 12 months of signing up forMedicare Part B. The Welcome to Medicare physicalexam includes:• Review of medical history, including preventivescreenings and services• Blood pressure, vision, height and weight checks• Information about end-of-life planning, includingadvance directives• A written plan for you to follow with your screeningsand other preventive services you should get.95

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-1661-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydaywww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-1741-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydaywww.Universal-American-Medicare.comToday’s Options Value powered by CCRx (PFFS)H5421-1821-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayService Area Becker, Beltrami, Benton, Big Stone,Cass, Clay, Clearwater, Cottonwood,Dakota, Fillmore, Freeborn, Goodhue,Grant, Hubbard, Isanti, Itasca,Jackson, Koochiching, Le Sueur,Meeker, Morrison, Polk, Pope,Renville, Rice, Roseau, Scott,Sherburne, St Louis, Stearns, Steele,Swift, Todd, Wabasha, Wadena,Waseca, Washington, Watonwan andWright counties in Minnesota.Carver, Chisago, Crow Wing, Dodge,Kanabec, Lake of the Woods,Mahnomen, Marshall, McLeod,Mille Lacs, Mower, Murray, Norman,Ramsey, Traverse and Yellow Medicinecounties in Minnesota.Aitkin, Anoka, Cook, Hennepin,Lac qui Parle, Lake, Olmsted, Pine,Sibley and Stevens counties inMinnesota.Hospital Inpatient Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.Physician/Outpatient $245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Days 1-5: $350 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$245 co-pay hospital, $145 co-payambulatory surgical center, $25co-pay primary care provider, $50co-pay specialist.Emergency Services/Urgent Care $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay.Preventive Services $0 co-pay. $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.Physical/Speech/Occupational Therapy $50 co-pay. $50 co-pay. $50 co-pay.0% co-insurance lab and diagnosticprocedures, 20% co-insuranceradiology.Home Health Care 20% co-insurance. 20% co-insurance. 20% co-insurance.Mental Health 50% co-insurance. 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100. $100 co-pay days 21-100.96

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.Dental Medicare-covered only. Medicare-covered only. Medicare-covered only.Chiropractic $50 co-pay. $50 co-pay. $50 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.Medicare Part D Outpatient Prescriptions Deductible: $310Brand Name Drugs: 25% copay.Generic Drugs: 25% co-insurance.Non-preferred Brand Name Drugs: 25% co-insurance.Specialty Drugs: 25% co-insurance.Shingles Vaccine: 25% co-insurance.Mail order is not available.Contact plan for list of networkpharmacies.Deductible: $310Brand Name Drugs: 25% copay.Generic Drugs: 25% co-insurance.Non-preferred Brand Name Drugs: 25% co-insurance.Specialty Drugs: 25% co-insurance.Shingles Vaccine: 25% co-insurance.Mail order is not available.Contact plan for list of networkpharmacies.Discounts/Special Programs None. None. None.Deductible: $310Brand Name Drugs: 25% copay.Generic Drugs: 25% co-insurance.Non-preferred Brand Name Drugs: 25% co-insurance.Specialty Drugs: 25% co-insurance.Shingles Vaccine: 25% co-insurance.Mail order is not available.Contact plan for list of networkpharmacies.Number of Providers In-Network Contact plan for list of providers. Contact plan for list of providers. Contact plan for list of providers.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums Plan Only: $66Plan with Part D Premium: $76Plan Only: $85Plan with Part D Premium: $99Plan Only: $100Plan with Part D Premium: $114Quick Tip 18An ombudsman is an independent consumer advocate.• In Minnesota, the Office of Ombudsman for Long-termCare provides information and consultation about yourrights that apply to long-term care facilities, home andcommunity based settings and home care services.• The Ombudsman investigates long-term care consumercomplaints, works to resolve individual concerns andidentify problems as well as advocate for changes toresolve the problems.• Call 1-800-657-3591 to get connected to the MinnesotaOffice of Ombudsman for Long-term Care.97

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.Universal-American-Medicare.comToday’s Options Premier H5421-1631-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayService Area Becker, Beltrami, Benton, Big Stone,Cass, Clay, Clearwater, Cottonwood,Dakota, Fillmore, Freeborn, Goodhue,Grant, Hubbard, Isanti, Itasca, Jackson,Koochiching, Le Sueur, Meeker,Morrison, Polk, Pope, Renville, Rice,Roseau, St Louis, Scott, Sherburne,Stearns, Steele, Swift, Todd, Wabasha,Wadena, Waseca, Washington, Watonwanand Wright counties in Minnesota.www.Universal-American-Medicare.comToday’s Options Premier H5421-1711-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayCarver, Chisago, Crow Wing, Dodge,Kanabec, Lake of the Woods, McLeod,Mahnomen, Marshall, Mille Lacs,Mower, Murray, Norman, Ramsey,Traverse and Yellow Medicine countiesin Minnesota.www.Universal-American-Medicare.comToday’s Options Premier H5421-17911-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayAitkin, Anoka, Cook, Hennepin,Lac qui Parle, Lake, Olmsted, Pine,Sibley and Stevens counties inMinnesota.Hospital Inpatient Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.Physician/Outpatient $150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Emergency Services/Urgent Care $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay.Preventive Services $0 co-pay. $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% lab and diagnostic procedures,20% radiology.0% lab and diagnostic procedures,20% radiology.Physical/Speech/Occupational Therapy $15 co-pay. $15 co-pay. $15 co-pay.0% lab and diagnostic procedures,20% radiology.Home Health Care 15% co-insurance. 15% co-insurance. 15% co-insurance.Mental Health 50% co-insurance. 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100. $100 co-pay days 21-100.Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.Dental Medicare-covered only services. Medicare-covered only services. Medicare-covered only services.98

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chiropractic $40 co-pay. $40 co-pay. $40 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.Medicare Part D Outpatient Prescriptions No drug coverage offered through plan. No drug coverage offered through plan. No drug coverage offered through plan.Discounts/Special Programs None. None. None.Number of Providers In-Network Contact plan for list of providers. Contact plan for list of providers. Contact plan for list of providers.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums $104 $124 $134Quick Tip 19When making decisions about your health care, housing,long-term care, caregiver matters, and other major lifechanging decisions, it is best to:• Ask for help• Find out about all of your options• Ask questions and keep asking until you fully understandyour options• Be aware that there is free objective help available toyou no matter where you live in Minnesota by calling theSenior LinkAge Line ® at 1-800-333-2433 or visitingwww.MinnesotaHelp.info ®99

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1401-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayService Area Blue Earth, Carlton, Chippewa,Houston and Winona counties inMinnesota.www.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1481-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayBrown, Douglas, Kandiyohi, Kittson,Martin, Nicollet, Nobles, Pennington,Redwood, Rock and Wilkin counties inMinnesota.www.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1561-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayFaribault, Otter Tail and Red Lakecounties in Minnesota.Hospital Inpatient Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.Physician/Outpatient $150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Emergency Services/Urgent Care $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay.Preventive Services $0 co-pay. $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.Physical/Speech/Occupational Therapy $15 co-pay. $15 co-pay. $15 co-pay.0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.Home Health Care 15% co-insurance. 15% co-insurance. 15% co-insurance.Mental Health 50% co-insurance. 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100. $100 co-pay days 21-100.Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.Dental Medicare-covered only services. Medicare-covered only services. Medicare-covered only services.Chiropractic $40 co-pay. $40 co-pay. $40 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.100

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Discounts/Special Programs None. None. None.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Number of Providers In-Network Contact plan for list of providers. Contact plan for list of providers. Contact plan for list of providers.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums Plan Only: $47Plan with Part D Premium: $64Plan Only: $81Plan with Part D Premium: $120Plan Only: $99Plan with Part D Premium: $146Quick Tip 20The MinnesotaHelp Network is looking for new partnersto help expand the local access and outreach sites in all 87counties of Minnesota. To get more information about becominga site, as well as free training and materials, call the SeniorLinkAge Line ® at 1-800-333-2433. Each Area Agency onAging manages the access and outreach sites through theSenior LinkAge Line ® .101

Health Care Choices for Minnesotans on MedicareMedicare Advantage Private-Fee-For-Service PlansMedicare Advantage Private-Fee-For-Service Planswww.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1641-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayService Area Becker, Beltrami, Benton, Big Stone,Cass, Clay, Clearwater, Cottonwood,Dakota, Fillmore, Freeborn, Goodhue,Grant, Hubbard, Isanti, Itasca,Jackson, Koochiching, Le Sueur,Meeker, Morrison, Polk, Pope,Renville, Rice, Roseau, Scott,Sherburne, St Louis, Stearns, Steele,Swift, Todd, Wabasha, Wadena,Waseca, Washington, Watonwan andWright counties in Minnesota.Hospital Inpatient Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.Physician/Outpatient $150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.www.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1721-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayCarver, Chisago, Crow Wing, Dodge,Kanabec, Lake of the Woods,Mahnomen, Marshall, McLeod,Mille Lacs, Mower, Murray, Norman,Ramsey, Traverse and Yellow Medicinecounties in Minnesota.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.www.Universal-American-Medicare.comToday’s Options Premier powered by CCRx (PFFS)H5421-1801-800-996-8867TTY: 1-800-777-90838 a.m. to 8 p.m.in your local time zone everydayAitkin, Anoka, Cook, Hennepin,Lac qui Parle, Lake, Olmsted, Pine,Sibley and Stevens counties inMinnesota.Days 1-5: $250 co-pay each day.Days 6-90: $0 co-pay each day.No limit to the number of days coveredby the plan each benefit period.$150 co-pay hospital, $75 co-payambulatory surgical center, $15co-pay primary care provider, $40co-pay specialist.Emergency Services/Urgent Care $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay. $50 ER co-pay, $35 Urgent care co-pay.Preventive Services $0 co-pay. $0 co-pay. $0 co-pay.Diagnostic Tests, X-rays and Lab Services 0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.Physical/Speech/Occupational Therapy $15 co-pay. $15 co-pay. $15 co-pay.0% co-insurance lab and diagnosticprocedures, 20% co-insurance radiology.Home Health Care 15% co-insurance. 15% co-insurance. 15% co-insurance.Mental Health 50% co-insurance. 50% co-insurance. 50% co-insurance.Chemical Dependency 50% co-insurance. 50% co-insurance. 50% co-insurance.Skilled Nursing Care $100 co-pay days 21-100. $100 co-pay days 21-100. $100 co-pay days 21-100.Durable Medical Equipment 20% co-insurance. 20% co-insurance. 20% co-insurance.102

Medicare Advantage Private-Fee-For-Service PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Dental Medicare-covered only services. Medicare-covered only services. Medicare-covered only services.Chiropractic $40 co-pay. $40 co-pay. $40 co-pay.Travel Benefits N/A N/A N/AMedicare Part B Drugs 20% co-insurance. 20% co-insurance. 20% co-insurance.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Discounts/Special Programs None. None. None.Deductible: $0Brand Name Drugs: $35 co-pay.Generic Drugs: $5 co-pay.Non-preferred Brand Name Drugs: $65 co-pay.Specialty Drugs: 33% co-insurance.Shingles Vaccine: $65 co-pay.Donut Hole Coverage: Generics only.Mail order is not available.Contact plan for list of networkpharmacies.Number of Providers In-Network Contact plan for list of providers. Contact plan for list of providers. Contact plan for list of providers.Enrollment Status/Health Screening Open enrollment. Open enrollment. Open enrollment.Maximum Annual Out-of-Pocket Costs $3,400 $3,400 $3,400Monthly Premiums Plan Only: $107Plan with Part D Premium: $151Plan Only: $135Plan with Part D Premium: $186Plan Only: $150Plan with Part D Premium: $203Quick Tip 21Get your free, individualized plan through the Long-term Care Choices Navigator for Seniors,Families and Caregivers at http://longtermcarechoices.minnesotahelp.info. Your plan will help you figure outwhat you need to live well and age well, includingproviding you with local community resources.103

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Chronic ConditionsMedicare Advantage Special Need Plans for Chronic ConditionsChronic Conditions Required to beEligible for Plan Enrollmentwww.medica.comMedica Complete Solution ®Chronic Lung Disorders H7526-003952-992-2030; 1-800-266-2157TTY: 1-800-855-2880 and ask for 1-800-266-21578 a.m. to 8 p.m. CST, 7 days a weekChronic Lung Disorders. Dementia.www.medica.comMedica Complete Solution ®Dementia H7526-001952-992-2030; 1-800-266-2157TTY: 1-800-855-2880 and ask for 1-800-266-21578 a.m. to 8 p.m. CST, 7 days a weekService Area Select counties in Minnesota. Select counties in Minnesota.Hospital Inpatient You pay $100 for each Medicare-covered stay. You pay $100 for each Medicare-covered stay.Physician/Outpatient $0 co-pay for primary care doctor visits for Medicarecoveredbenefits and in-area network urgent care Medicarecoveredvisits. $10 co-pay for each specialist visit forMedicare-covered benefits. $25 co-pay for each Medicarecoveredambulatory surgical center and outpatient hospitalfacility visit.Emergency Services/Urgent Care You pay $50 co-pay for each Medicare-covered emergencyroom visit. (Worldwide coverage) You pay $50 co-pay foreach Medicare-covered urgently needed care visit.Preventive Services $0 co-pay for routine mammograms and pap smears,routine cancer tests and screenings, diagnostic hearingexams and Hepatitis B vaccine.Diagnostic Tests, X-rays and Lab Services There is no co-pay for Medicare-covered lab services.You pay $25 co-pay for Medicare-covered diagnosticprocedures, tests, X-rays, diagnostic radiology services.$10 co-pay for therapeutic radiology services.Physical/Speech/Occupational Therapy You pay $10 co-pay for each Medicare-covered physical,speech/language and occupational therapy visit.$0 co-pay for primary care doctor visits for Medicarecoveredbenefits and in-area network urgent care Medicarecoveredvisits. $10 co-pay for each specialist visit forMedicare-covered benefits. $25 co-pay for each Medicarecoveredambulatory surgical center and outpatient hospitalfacility visit.You pay $50 co-pay for each Medicare-covered emergencyroom and urgent care visit. (Worldwide coverage)$0 co-pay for routine mammograms and pap smears,routine cancer tests and screenings, diagnostic hearingexams and Hepatitis B vaccine.There is no co-pay for Medicare-covered lab services.You pay $25 co-pay for Medicare-covered diagnosticprocedures, tests, X-rays, diagnostic radiology services.$10 co-pay for therapeutic radiology services.You pay $10 co-pay for each Medicare-covered physical,speech/language and occupational therapy visit.Home Health Care $0 for Medicare-covered home health visits. $0 for Medicare-covered home health visits.Mental Health You pay $100 for each Medicare-covered hospital stay.You pay $10 for each Medicare-covered individual or grouptherapy visit.Chemical Dependency Outpatient: You pay $10 co-pay for each individual or groupvisit for Medicare-covered benefits.Skilled Nursing Care $0 co-pay for Medicare-covered services received at askilled nursing facility. Plan covers up to 100 days eachbenefit period.Durable Medical Equipment You pay 20% of the cost for Medicare-covered items andsupplies.You pay $100 for each Medicare-covered hospital stay.You pay $10 for each Medicare-covered individual or grouptherapy visit.Outpatient: You pay $10 co-pay for each individual or groupvisit for Medicare-covered benefits.$0 co-pay for Medicare-covered services received at askilled nursing facility. Plan covers up to 100 days eachbenefit period. No prior hospital stay is required.You pay 20% of the cost for Medicare-covered items andsupplies.104

Medicare Advantage Special Need Plans for Chronic ConditionsA publication of the Minnesota Board on Aging Senior LinkAge Line ®Dental In general, you pay 100% for non-Medicare-covered dentalservices. You pay $10 co-pay for Medicare-covered dentalservices.Chiropractic You pay $10 for Medicare-covered benefits. (Manualmanipulation of the spine to correct displacement ormisalignment of a joint or body part).In general, you pay 100% for non-Medicare-covered dentalservices. You pay $10 co-pay for Medicare-covered dentalservices.You pay $10 for Medicare-covered benefits. (Manualmanipulation of the spine to correct displacement ormisalignment of a joint or body part).Travel Benefits Must activate Extended Absence Option for travel in the U.S. Must activate Extended Absence Option for travel in the U.S.Medicare Part B Drugs You pay 20% for Medicare-eligible Part B medications. You pay 20% for Medicare-eligible Part B medications.Medicare Part D Outpatient Prescriptions No Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $67 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment.Extra Services and Coverage: Medication Therapy Management.Mail order is available.Over 1,400 network pharmacies. Please see website for details.Discounts/Special Programs Written health education materials, including newsletters;additional smoking cessation; health club membership/fitness classes; nursing hotline.Number of Providers In-Network Open access. Open access.No Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $67 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment.Extra Services and Coverage: Medication Therapy Management.Mail order is available.Over 1,400 network pharmacies. Please see website for details.Written health education materials, including newsletters;additional smoking cessation; health club membership/fitness classes; nursing hotline.Enrollment Status/Health Screening Enrollment open. No health screening. Enrollment open. No health screening.Maximum Annual Out-of-Pocket Costs $3,000 $3,000Monthly Premiums $79.30 $110.70Quick Tip 22Get a free copy of the Minnesota Health Care Directive for you complete by visiting www.mnaging.org/advisor/directive.htm. This is also known as an Advanced Directive or Living Will.105

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Chronic ConditionsMedicare Advantage Special Need Plans for Chronic ConditionsChronic Conditions Required to beEligible for Plan Enrollmentwww.medica.comMedica Complete Solution ®Diabetes, Cardio Dis and HF H7526-004952-992-2030; 1-800-266-2157TTY: 1-800-855-2880 and ask for 1-800-266-21578 a.m. to 8 p.m. CST, 7 days a weekDiabetes, Cardiovascular Disease and Heart Failure.Service Area Select counties in Minnesota.Quick Tip 23www.MinnesotaHelp.info ® statewide resourcedatabase has a Senior Link special sectionfor seniors, their families and caregivers thatmake it easier to find day-to-day things liketransportation, meals, chore services andother help to remain in the community. Go to the Senior Link under the SpecialTopics at www.MinnesotaHelp.info ® .Hospital Inpatient You pay $100 for each Medicare-covered stay.Physician/Outpatient $0 co-pay for primary care doctor visits for Medicarecoveredbenefits and in-area network urgent careMedicare-covered visits. $10 co-pay for each specialistvisit for Medicare-covered benefits. $25 co-pay foreach Medicare-covered ambulatory surgical center andoutpatient hospital facility visit.Emergency Services/Urgent Care You pay $50 co-pay for each Medicare-covered emergencyroom visit. (Worldwide coverage) You pay $50 co-pay foreach Medicare-covered urgently needed care visits.Preventive Services $0 co-pay for routine mammograms and pap smears, routinecancer tests and screenings, diagnostic hearing exams andHepatitis B vaccine.Diagnostic Tests, X-rays and Lab Services There is no co-pay for Medicare-covered lab services.You pay $25 co-pay for Medicare-covered diagnosticprocedures, tests, X-rays, diagnostic radiology services.$10 co-pay for therapeutic radiology services.Physical/Speech/Occupational Therapy You pay $10 co-pay for each Medicare-covered physical,speech/language and occupational therapy visit.Home Health Care $0 for Medicare-covered home health visits.Mental Health You pay $100 for each Medicare-covered hospital stay.You pay $10 for each Medicare-covered individual or grouptherapy visit.Chemical Dependency Outpatient: You pay $10 co-pay for each individual or groupvisit for Medicare-covered benefits.Skilled Nursing Care $0 co-pay for Medicare-covered services received at askilled nursing facility. Plan covers up to 100 days eachbenefit period.106

Medicare Advantage Special Need Plans for Chronic ConditionsA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment You pay 20% of the cost for Medicare-covered items andsupplies.Dental In general, you pay 100% for non-Medicare-covered dentalservices. You pay $10 co-pay for Medicare-covered dentalservices.Chiropractic You pay $10 for Medicare-covered benefits. (Manualmanipulation of the spine to correct displacement ormisalignment of a joint or body part).Travel Benefits Must activate Extended Absence Option for travel in the U.S.Medicare Part B Drugs You pay 20% for Medicare-eligible Part B medications.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $34 co-pay.Generic Drugs: $10 co-pay.Non-preferred Brand Name Drugs: $67 co-pay.Specialty Drugs: 25% co-insurance.Shingles Vaccine: Tier 2 co-payment.Extra Services and Coverage: Medication Therapy Management.Mail order is available.Over 1,400 network pharmacies. Please see website for details.Discounts/Special Programs Written health education materials, including newsletters;additional smoking cessation; health club membership/fitness classes; nursing hotline.Number of Providers In-Network Open access.Enrollment Status/Health Screening Enrollment open. No health screening.Maximum Annual Out-of-Pocket Costs $3,000Monthly Premiums $58.30Quick Tip 24www.MinnesotaHelp.info ® statewide resourcedatabase has a Disability Link special sectionthat makes it easier for people with disabilitiesto explore options and make decisions aboutservices, benefits, employment, health care,and more. Go to Disability Link under theSpecial Topics at www.MinnesotaHelp.info ® .107

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Age 65 and OlderMedicare Advantage Special Need Plans for Duals Age 65 and OlderMust have both Medicare and Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifyYes.Must be age 65 or older Yes.www.bluecrossmn.com/public/secureblueSecureBlue HMO H2425-001651-662-3584; 1-866-477-1584TTY: 651-662 8700 or toll-free 1-888-878-01378 a.m.–8 p.m. CST, 7 days a weekService Area The service area for this plan includes: Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chippewa, Chisago, Clay,Cook, Cottonwood, Crow Wing, Dakota, Faribault, Fillmore, Houston, Isanti, Jackson, Kandiyohi, Kittson, Koochiching,Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison,Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood,Rice, Rock, Roseau, Scott, Sherburne, Stearns, St. Louis, Swift, Todd, Wadena, Washington, Watonwan, Wilkin,Winona, Wright, and Yellow Medicine counties in Minnesota. You must live in one of these areas to join the plan.Hospital Inpatient In most cases, you must go to doctors, specialists, other health care providers, and hospitals that are in our network.If you go to the providers in our network, you will not need a referral.In-network: $0 yearly deductible and $0 co-pay for Medicare- or Medicaid-covered services.Physician/Outpatient In most cases, you must go to doctors, specialists, other health care providers, and hospitals that are in our network.If you go to the providers in our network, you will not need a referral.In-network: $0 co-pay for Medicare- or Medicaid-covered primary care doctor visits, network urgent care visits or specialistdoctor visits.Emergency Services/Urgent Care Ambulance services: In-network*: $0 co-pay for Medicare- or Medicaid-covered services.Emergency care general*: $0 co-pay for Medicare- or Medicaid-covered services.Urgently needed care: $0 co-pay for Medicare- or Medicaid-covered services.*NOT covered outside the U.S. and Canada except under limited circumstances. Contact the plan for more details.Preventive Services In-network: $0 co-pay for Medicare- or Medicaid-covered bone mass measurement; colorectal cancer screening exams; flu,pneumonia and Hepatitis B vaccinations; mammograms; prostate cancer screenings; pap smears and pelvic exams; renaldialysis; nutrition therapy for end-stage renal disease; hearing services; physical exams; routine podiatry (up to 4 visits peryear for members without underlying medical conditions). Vision services: $0 co-pay for Medicare- or Medicaid-covered eyeexams, a pair of eyeglasses, a pair of eyeglasses or contact lenses after each cataract surgery, or contact lenses for certainconditions when eyeglasses will not work. Eyeglasses limited to one pair every 24 months under Medicaid unless medicallynecessary. Annual glaucoma screenings covered for people at risk. Online Weight Watchers: $0 co-pay. Contact plan fordetails. Routine transportation: $0 co-pay for Medicaid-covered services. Acupuncture: $0 co-pay for Medicaid-coveredservices for chronic pain in limited conditions.Diagnostic Tests, X-rays and Lab Services In-network: $0 co-pay for Medicare- or Medicaid-covered:• Lab services• Diagnostic procedures and tests• X-rays• Diagnostic radiology services (not including X-rays)• Therapeutic radiology services108

Medicare Advantage Special Need Plans for Duals Age 65 and OlderA publication of the Minnesota Board on Aging Senior LinkAge Line ®Physical/Speech/Occupational Therapy Outpatient rehabilitation in-network: $0 co-pay for Medicare- or Medicaid-covered physical/speech/language/occupationaltherapy visits.Home Health Services In-network: $0 co-pay for Medicare- or Medicaid-covered services.Mental Health Inpatient in-network: $0 yearly deductible and $0 co-pay for Medicare- or Medicaid-covered services. Outpatient: $0 co-payfor Medicare- or Medicaid-covered services.Chemical Dependency In-network: $0 co-pay for Medicare- or Medicaid-covered services.Skilled Nursing Care In-network: $0 yearly deductible. $0 co-pay for Medicare- or Medicaid-covered services. The plan covers up to 100 dayseach Medicare Part A benefit period. For Medicaid-covered stays, the plan covers up to 180 days of nursing facility roomand board. No prior hospital stay required.Durable Medical Equipment In-network: $0 co-pay for Medicare- or Medicaid-covered items.Dental In-network: $0 co-pay for Medicare- or Medicaid-covered services.Chiropractic In-network: $0 co-pay for Medicare- or Medicaid-covered services. Chiropractic visits are for manual manipulation of the spineto correct a displacement or misalignment of a joint or body part and Medicaid-covered X-rays when needed to get a diagnosisof subluxation of the spine.Travel Benefits Out-of-area services are covered for an emergency that needs treatment right away, post-stabilization care, medicallynecessary urgent care when you are outside of the plan service area, and covered services that are not available in the planservice area. Services are not covered when received from providers located outside the United States and Canada.Medicare Part B Drugs Drugs covered under Medicare Part B–General: $0 yearly deductible for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: You pay the Part D co-payments per prescription covered on the formulary until the total costs that youhave paid and the total costs the plan has paid reaches $4,550 for the calendar year. Once the total costs reach $4,550 theplan will pay all of the costs for your drugs until the end of the year.Shingles Vaccine: Covered at cost sharing listed above. Call plan.Extra Services and Coverage: Medicaid covered prescriptions are covered with a $0 co-pay.Mail order is not available.59,000 participating pharmacies nationwide.Discounts/Special Programs Health/Wellness education smoking cessation: Covered for Medicare- or Medicaid-covered services if ordered by your doctor.In-network: $0 co-pay for the following Medicare- or Medicaid-covered health/wellness smoking cessation education benefits:Safety benefit: Annual maximum of $750 toward home safety items or services that promote safety, prevention of injury andencourage maximum function. $0 co-pay. Contact plan for details.Home fitness kit: $0 co-pay. Contact plan for details.Care coordination: In-network: $0 co-pay for Medicaid-covered services.Interpreter services: Interpreter services are available to help you get covered services. Oral interpretation is available for anylanguage. $0 co-pay for Medicaid-covered services.Number of Providers In-Network More than 59,000Enrollment Status/Health Screening Voluntary program with continuous open enrollment for people who meet age, service area residence, and qualify forMedicaid (Medical Assistance) income/resource requirements. No health screening.Maximum Annual Out-of-Pocket Costs $0Monthly Premiums $0109

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Age 65 and OlderMedicare Advantage Special Need Plans for Duals Age 65 and OlderMust have both Medicare and Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifywww.healthpartners.comClassic MSHO H2422-002-0952-883-5050; 1-800-247-7015TTY: 952-883-6060 or 1-800-443-01568 a.m.–6:00 p.m.Yes. Yes.Must be age 65 or older Yes. Yes.www.imcare.orgIMCare Classic H2417-001218-327-6188; 1-800-843-9536 ext. 2188TTY: 218-327-5549 or 1-800-422-0312 ext. 2549Service Area Anoka, Benton, Carver, Chisago, Dakota, Hennepin,Ramsey, Scott, Sherburne, Stearns, Washington, andWright counties in Minnesota.Itasca county.Hospital Inpatient 100% coverage for Medicare- or Medicaid- covered services. In-network: You will not be charged additional cost sharingfor professional services. $0 yearly deductible. $0 co-pays forMedicare- or Medicaid-covered services. Plan covers 90 dayseach benefit period. Except in an emergency, your doctor musttell the plan that you are going to be admitted to the hospital.Physician/Outpatient 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-coveredprimary care doctor visits. $0 co-pay for Medicare- orMedicaid-covered in-network urgent care visits. $0 co-pay forMedicare- or Medicaid-covered specialist doctor visits.Emergency Services/Urgent Care 100% coverage. Not covered outside the U.S. and Canadaexcept under limited circumstances.General: $0 co-pay for Medicare- or Medicaid-covered services.Not covered outside the U.S. and Canada except under limitedcircumstances. Contact the plan for more details.Preventive Services 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for the following Medicare- or Medicaidcoveredservices: bone mass measurement, colorectal cancerscreening exams, immunizations (flu vaccine, Hepatitis Bvaccine, pneumonia vaccine; No referral necessary for flu andpneumonia vaccines), mammograms (annual screening), papsmears and pelvic exams, prostate cancer screening exams.Diagnostic Tests, X-rays and Lab Services 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-covered labservices, diagnostic procedures and tests, X-rays, diagnosticradiology services (not including X-rays), and therapeuticradiology services.Physical/Speech/Occupational Therapy 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-coveredphysical/speech/language/occupational therapy visits.Home Health Services 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-covered homehealth visits.Mental Health 100% coverage for Medicare- or Medicaid- covered services. Inpatient in-network: same deductible and co-pay as inpatienthospital care.Outpatient in-network: $0 co-pay for Medicare- or Medicaidcoveredservices.110

Medicare Advantage Special Need Plans for Duals Age 65 and OlderA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chemical Dependency 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-coveredservices.Skilled Nursing Care 100% coverage for up to 100 days each benefit period. ForMedicaid-covered stays, up to 180 days of nursing facilityroom and board. No prior hospital stay is required.In-network: $0 yearly deductible. $0 co-pay for SNF services.You will not be charged additional cost sharing for professionalservices. Plan covers up to 100 days each benefit period;Three-day prior hospital stay is required.Durable Medical Equipment 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-covered items.Dental 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-coveredservices. In general, preventive dental benefits (such ascleaning) are not covered.Chiropractic 100% coverage for Medicare- or Medicaid- covered services. In-network: $0 co-pay for Medicare- or Medicaid-covered services.Chiropractic visits are for manual manipulation of the spine tocorrect displacement or misalignment of a joint or body part.Travel Benefits No coverage. Emergency and urgent care benefits as described above.Medicare Part B Drugs 100% coverage. General: $0 yearly deductible for Part B-covered drugs.$0 co-pay for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Full coverage.Shingles Vaccine: $3.30 or $6.30 co-pays.Extra Services and Coverage: Additional drug coverageunder Medicaid.Mail order is available.More than 1,110 participating pharmacies.Discounts/Special Programs • Care Coordination• 100% coverage for dental crowns up to $2,000 max• Additional 2nd pair of eye glasses• Tints and coating on either 1st and/or 2nd pair of eye glasses• 2nd pair of shoe orthotics• 2nd pair of orthotic shoes• Additional comprehensive dental benefits• Denture relines and adjustmentsNumber of Providers In-Network • 21 hospitals• 113 primary care clinics• 9,203 specialty locations• 212 facility locationsEnrollment Status/Health Screening Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Maximum Annual Out-of-Pocket Costs $0 $0Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Co-pay amounts for all medicationsremain the same if they are on the formulary.Shingles Vaccine: Covered in full.Mail order is available. See pharmacy network list on planwebsite.$0 co-pay for each Medicare and Medicaid-covered smokingcessation counseling program, including written healtheducation materials, additional smoking cessation and otherwellness benefits. Care coordination.250 physicians and providers.Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Monthly Premiums $0 $0111

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Age 65 and OlderMedicare Advantage Special Need Plans for Duals Age 65 and OlderMust have both Medicare and Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifywww.medica.comMedica Dual Solution ® H2458-002952-992-2030; 1-800-266-2157TTY: 1-800-855-2880 and ask for 1-800-266-21578 a.m. to 8 p.m. CST, 7 days a weekYes. Yes.Must be age 65 or older Yes. Yes.MHP4LIFE.ORGMHP MSHO H2457-0021-888-562-8000; 1-888-562-8000TTY: 1-800-627-35298 a.m. to 8 p.m.Service Area Select Minnesota counties. Anoka, Carver, Hennepin and Scott counties in Minnesota.Hospital Inpatient You pay $0 for each Medicare-covered stay. $0 yearly deductible and $0 co-pay for Medicare- or-Medicaid covered services.Physician/Outpatient $0 co-pay for each primary care doctor visit for Medicarecoveredbenefits; in-area, network urgent care Medicarecoveredvisit and $0 co-pay for each specialist doctor visit forMedicare-covered benefits.Emergency Services/Urgent Care $0 co-pay for Medicare-covered emergency room visits.$0 co-pay for Medicare-covered urgent care visits.Preventive Services $0 co-pay for routine mammograms and pap smears, routinecancer tests and screenings, diagnostic hearing exams, bonemass measurement, colorectal cancer screenings, pneumoniavaccines and Hepatitis B vaccine.$0 co-pay for Medicare- or Medicaid-covered primary doctor,specialist doctor and network urgent care visits.$0 co-pay for Medicare- and Medicaid-covered services.Not covered outside the U.S.$0 co-pay for Medicare- or Medicaid-covered flu, pneumonia,or Hepatitis B vaccines, and annual screening mammograms(for women 40 and over), colorectal cancer screening exams,pap smears, and prostate screening exams (for men 50+).Diagnostic Tests, X-rays and Lab Services $0 co-pay for Medicare-covered lab services. $0 co-pay for in-network Medicare- or Medicaid-covered services.Physical/Speech/Occupational Therapy $0 co-pay for Medicare- or Medicaid-covered physical/speech/language/occupational therapy visits.$0 co-pay for Medicare- or Medicaid-covered physical/speech/language/occupational therapy visits.Home Health Services $0 co-pay for Medicare-covered home health visits. $0 co-pay for in-network Medicare- or Medicaid-coveredservices.Mental Health $0 co-pay for Medicare-covered mental health visits.$0 co-pay for each Medicare-covered visit with a psychiatrist.In-patient: $0 yearly deductible and $0 co-pay for MedicareorMedicaid-covered services.Chemical Dependency Outpatient: $0 co-pay for Medicare-covered visits. $0 yearly deductible and $0 co-pay for Medicare- orMedicaid-covered services.Skilled Nursing Care $0 co-pay. $0 yearly deductible and $0 co-pay for Medicare- orMedicaid-covered services. The plan covers up to 100days for each Medicare Part A benefit period. For Medicaidcovered stays, the plan covers up to 180 days of nursingfacility room and board. No prior hospital stay is required.112

Medicare Advantage Special Need Plans for Duals Age 65 and OlderA publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment $0 co-pay for Medicare-covered items. $0 co-pay for in-network Medicare- or Medicaid-coveredservices.Dental In general, preventive dental benefits (such as cleaning) notcovered. $0 co-pay for Medicare-covered dental benefits.Chiropractic $0 co-pay for Medicare-covered benefits. Chiropracticvisits are for manual manipulation of the spine to correctdisplacement or misalignment of a joint or body part andMedicaid-covered X-rays when needed to get a diagnosis ofsubluxation of the spine.Travel Benefits Must activate Extended Absence option for travel in the U.S.Call plan.$0 co-pay for in-network Medicare- or Medicaid-coveredservices.$0 co-pay for in-network Medicare- or Medicaid-coveredservices for manual manipulation of the spine to correct adisplacement or misalignment of a joint or body part andX-rays when needed to get a diagnosis of subluxation ofthe spine.Medicare Part B Drugs $0 yearly deductible for Part B-covered drugs. $0 yearly deductible for Part B drugs.$0 co-pay for Part B drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Co-payment amounts for allmedications remain the same.Shingles Vaccine: Tier 2 co-payment.Extra Services and Coverage: Medication TherapyManagement available.Mail order is available.1,400 participating pharmacies. Please check website for details.Discounts/Special Programs $0 co-pay for routine foot care, such as toenail cutting andcorn removal when medically necessary with or withoutMedicare-approved diagnosis. $0 co-pay for palliative careservices that relieve pain and symptoms of chronic or seriousillnesses. $0 co-pay for non-Medicare-covered massagetherapy limited to two visits per year. Care Coordination.Number of Providers In-Network Open access. 100+ clinics.None.Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Full coverage of formulary drugs.Shingles Vaccine: $0 co-pay.Mail order is available.More than 1,110 participating pharmacies.Care coordination included. YMCA membership.Enrollment Status/Health Screening Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Maximum Annual Out-of-Pocket Costs $0 $0Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Monthly Premiums $0 $0113

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Age 65 and OlderMedicare Advantage Special Need Plans for Duals Age 65 and OlderMust be enrolled in Medical Assistance(Medicaid) to qualifyYes.Must be age 65 or older Yes.www.mnscha.orgSeniorCare Complete H2419-0011-866-567-7242TTY: 1-877-824-56118 a.m. to 8 p.m., 7 days a weekService Area The Minnesota counties of Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue,Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena and Waseca countiesin Minnesota.Hospital Inpatient In-network: You will not be charged additional cost sharing for professional services.$0 yearly deductible. $0 co-pays for Medicare- or Medicaid-covered services. In mostcases, you must go to network hospitals.Physician/Outpatient In-network: $0 co-pay for Medicare- or Medicaid-covered primary care doctor visits. $0co-pay for Medicare- or Medicaid-covered in-network urgent care visits. $0 co-pay forMedicare- or Medicaid-covered specialist doctor visits. In most cases, you must go tonetwork doctors, specialists and other health care providers. No referral is necessaryto see any network provider. Members must choose a primary care provider uponenrollment, however, they can switch primary care providers at any time by callingMember Services.Emergency Services/Urgent Care General: $0 co-pay for Medicare- or Medicaid-covered services. Not covered outside theU.S. and Canada except under limited circumstances. Contact the plan for more details.Preventive Services In-network: $0 co-pay for the following Medicare- or Medicaid-covered services: bonemass measurement (for people with Medicare who are at risk), colorectal cancerscreening exams (for people with Medicare age 50 and older, no age limit for Medicaidcoveredservices), immunizations (flu vaccine, Hepatitis B vaccine–for people withMedicare who are at risk, pneumonia vaccine); mammograms, pap smears and pelvicexams, prostate cancer screening exams, and tobacco cessation program.Diagnostic Tests, X-rays and Lab Services In-network: $0 co-pay for Medicare- or Medicaid-covered lab services, diagnosticprocedures and tests, X-rays, diagnostic radiology services (not including X-rays), andtherapeutic radiology services.Physical/Speech/Occupational Therapy In-network: $0 co-pay for Medicare- or Medicaid-covered physical/speech/language/occupational therapy visits.Home Health Services In-network: $0 co-pay for Medicare- or Medicaid-covered services.Mental Health Inpatient in-network: same deductible and co-pay as inpatient hospital care.Outpatient in-network: $0 co-pay for Medicare- or Medicaid-covered services.Must have both Medicare and Medicaid.Quick Tip 25Moving out of yourhome may not be youronly choice. There aremany questions you mayneed answers to beforeyou move out of yourhome. Can services thatyou need be broughtto your home insteadof moving? Would yourfinances stretch fartherif you remain in yourown home? The SeniorLinkAge Line ® can helpyou get the answers you need to help youremain in your home.Call 1-800-333-2433.114

Medicare Advantage Special Need Plans for Duals Age 65 and OlderA publication of the Minnesota Board on Aging Senior LinkAge Line ®Chemical Dependency In-network: $0 co-pay for Medicare- or Medicaid-covered services.Skilled Nursing Care In-network: $0 yearly deductible. $0 co-pay for Medicare- or Medicaid-coveredservices. The plan covers up to 100 days each Medicare Part A benefit period. ForMedicaid-covered stays, the plan covers up to 180 days of nursing facility roomand board. No prior hospital stay is required.Durable Medical Equipment In-network: $0 co-pay for Medicare- or Medicaid-covered items.Dental In-network: $0 co-pay for Medicare- or Medicaid-covered services.Chiropractic In-network: $0 co-pay for Medicare- or Medicaid-covered services. Chiropractic visits arefor manual manipulation of the spine to correct displacement or misalignment of a jointor body part, and X-rays when needed to get a diagnosis of subluxation of the spine.Travel Benefits Emergency and urgent care benefits as described above.Medicare Part B Drugs General: $0 yearly deductible for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Co-pay amounts for all medications remain the same ifthey are on the formulary.Shingles Vaccine: Covered in full.Mail order is not available.Several hundred participating pharmacies in Minnesota. The plan offers nationalin-network prescription drug coverage.Discounts/Special Programs Health and wellness education: Disease management programs for diabetes, heartdisease, asthma and postpartum depression. Staff provide educational materials andsupport to help manage these serious chronic diseases. Fitness program: Members whowork out at least 8 days per month at a participating health club can receive up to $20off their health club membership fees. Community education rewards program: Planwill cover up to $14 of the registration fee for most Community Education classes (upto 5 per registration session). Care coordination.Number of Providers In-Network Hundreds of clinics and hospitals, thousands of doctors and specialists throughoutMinnesota and bordering states.Enrollment Status/Health Screening Voluntary program with continuous open enrollment for people who meet age,service area residence, and qualify for Medicaid (Medical Assistance) income/resource requirements. No health screening.Maximum Annual Out-of-Pocket Costs $0Monthly Premiums $0Quick Tip 26For statewide help withveterans programs andservices, call the Veterans Linkage Lineat 1-888-546-5838115

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Age 65 and OlderMedicare Advantage Special Need Plans for Duals Age 65 and OlderMust have both Medicare and Medicaid.www.primewest.orgPrimeWest Senior Health Complete H2416-0011-800-366-2906TTY: 1-800-523-3529 or 7118 a.m. to 8 p.m., 7 days a weekwww.ucare.orgUCare MSHO H2456-002612-676-3554; 1-800-707-1711TTY: 612-676-6810 or 1-800-688-2534Must be enrolled in Medical Assistance(Medicaid) to qualifyYes. Yes.Must be age 65 or older Yes. Yes.Service Area Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard,McLeod, Meeker, Pipestone, Pope, Renville, Stevens andTraverse counties in Minnesota.Hospital Inpatient Covered. $0 co-pay.Aitkin, Anoka, Benton, Blue Earth, Carlton, Carver, Cass,Chippewa, Chisago, Cottonwood, Crow Wing, Dakota,Dodge, Faribault, Fillmore, Hennepin, Houston, Isanti,Jackson, Kandiyohi, Kittson, Lac qui Parle, Le Sueur,Lincoln, Lyon, Marshall, Martin, Mille Lacs, Morrison,Mower, Murray, Nicollet, Nobles, Norman, Olmsted, OtterTail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood,Rice, Rock, Roseau, Sherburne, St. Louis, Stearns, Swift,Todd, Wabasha, Wadena, Washington, Watonwan, Winona,Wright and Yellow Medicine counties in Minnesota.Physician/Outpatient Covered. $0 co-pay.Emergency Services/Urgent Care Covered. $0 co-pay.Preventive Services Covered. $0 co-pay.Diagnostic Tests, X-rays and Lab Services Covered. $0 co-pay.Physical/Speech/Occupational Therapy Covered. $0 co-pay.Home Health Services Covered. $0 co-pay.Mental Health Covered. $0 co-pay.Chemical Dependency Covered. $0 co-pay.Skilled Nursing Care Covered. $0 co-pay.Durable Medical Equipment Covered. $0 co-pay.Dental Covered. $0 co-pay.Chiropractic Covered. $0 co-pay.Travel Benefits Covered. $0 co-pay.Medicare Part B Drugs Covered. $0 co-pay.116

Medicare Advantage Special Need Plans for Duals Age 65 and OlderA publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Co-pay amounts for all medicationsremain the same.Shingles Vaccine: $0/$3.30/$6.30 co-pays.Mail order is not available.More than 1,110 participating pharmacies.Deductible: $0Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Generic Drugs: $1.10, $2.50 or $0 co-pays.Non-preferred Brand Name Drugs: $3.30, $6.30 or $0 co-pays.Specialty Drugs: $3.30, $6.30 or $0 co-pays.Actual co-pays are based on income and living arrangements.Donut Hole Coverage: Co-payment amounts for all medicationsremain the same.Shingles Vaccine: Covered in full.Mail order is available.Contact plan for comprehensive pharmacy directory.Discounts/Special Programs Care coordination. Members eligible for an additional $300/annually for certainextra preventive and comprehensive dental benefits that arenot covered by Medical Assistance. Limitations apply. Membersare eligible to receive a free monthly membership with no duesat a YMCA of their choice. Limitations apply. Members can geta Strong and Stable Kit filled with tools and information to helpimprove their strength and make their home safer; QUITPLANsmoking cessation program; Community education discounts;Transportation. Limitations apply. Care coordination.Number of Providers In-Network 1,200+ contracted facilities. Contact plan for a comprehensive provider directory.Enrollment Status/Health Screening Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Maximum Annual Out-of-Pocket Costs $0 $0Voluntary program with continuous open enrollment forpeople who meet age, service area residence, and qualifyfor Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Monthly Premiums $0 $0Quick Tip 27Medicare and Medicaid can be confusing. In Minnesota, Medicaid is known as Medical Assistance.It is health care coverage for Minnesotans of all ages who have limited income and few resources.Medical Assistance eligibility and enrollment is handled by your county social service office.117

Medicare Advantage Special Need Plans for Duals Under Age 65A publication of the Minnesota Board on Aging Senior LinkAge Line ®Durable Medical Equipment In-network: $0 co-pay for Medicare- or Medicaid-covered items.Dental In-network: $0 co-pay for Medicare- or Medicaid-covered services.Chiropractic In-network: $0 co-pay for Medicare- or Medicaid-covered services. Chiropractic visits are for manual manipulation of thespine to correct a displacement or misalignment of a joint or body part and Medicaid-covered X-rays when needed to geta diagnosis of subluxation of the spine.Travel Benefits Out-of-area services are covered for an emergency that needs treatment right away, post-stabilization care, medicallynecessary urgent care when you are outside of the plan service area, and covered services that are not available in theplan service area. Services are not covered when received from providers located outside the United States and Canada.Medicare Part B Drugs Drugs covered under Medicare Part B – General: $0 yearly deductible for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Non-preferred Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Specialty Drugs: $0, $3.30 or $6.30 co-pays.Actual co-pays are based on income and living arrangements.Shingles Vaccine: Covered at co-payments listed above.Donut Hole Coverage: You pay the Part D co-payments per prescription covered on the formulary with the total costs thatyou have paid and the total costs the plan has paid reaches $4,550 for the calendar year. Once the total costs reach$4,550, the plan will pay all of the costs for your drugs until the end of the year.Extra Services and Coverage: Medicaid-covered prescriptions are covered with a $0 co-pay. Mail order is not available.More than 59,000 participating pharmacies nationwide.Discounts/Special Programs Health/wellness education smoking cessation: Covered for Medicare- or Medicaid-covered services if ordered by your doctor.In-network: $0 co-pay for the following Medicare- or Medicaid-covered health/wellness smoking cessation education benefits:Safety benefit: Annual maximum of $750 toward home safety items or services that promote safety, prevention of injury andencourage maximum function. $0 co-pay. Contact plan for details.Home fitness kit: $0 co-pay. Contact plan for details.Care coordination in-network: $0 co-pay for Medicaid-covered services.Interpreter services: Interpreter services are available to help you get covered services. Oral interpretation is available for anylanguage. $0 co-pay for Medicaid-covered services.Number of Providers In-Network More than 59,000.Enrollment Status/Health Screening You may be eligible to join this plan if you: Are at least 18 years of age and under age 65; and have a certified disabilitythrough the Social Security Administration or the State Medical Review Team; and/or have been determined by thecounty to have a developmental disability (DD) and are receiving DD waiver services or are living in an intermediate carefacility for people with DD; and receive Medicaid (Medical Assistance) from the state with or without Medicare PartsA and B; and live in the service area. All cost sharing in this summary of benefits is based on your level of Medicaideligibility. Please call CareBlue (HMO) to find out if you are eligible to join.Maximum Annual Out-of-Pocket Costs $0Monthly Premiums $0119

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Under Age 65Medicare Advantage Special Need Plans for Duals Under Age 65 Must have Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifywww.cornerstone-solutions.orgCornerstone Solutions H5750-0041-866-601-8962TTY: 1-800-627-35298 a.m. to 8 p.m.Yes. Yes.Must be age 65 or older No. Must be 18-64 years of age and have a disabilty certifiedby Social Security or the State Medicare Review Team (SMRT).Service Area Hennepin county. Select Minnesota counties.www.medica.comMedica AccessAbility ® H7526-002952-992-2030; 1-800-266-2157;TTY: 1-800-855-2880 ask for 1-800-266-21578 a.m. to 8 p.m. CST, 7 days a weekNo. Must be 18-64 years of age and have a disabilty certifiedby Social Security or the State Medicare Review Team (SMRT).Hospital Inpatient $0 yearly deductible and $0 co-pay for Medicare- orMedicaid-covered services.Physician/Outpatient In-network: $0 yearly deductible and $0 co-pay forMedicare- or Medicaid-covered primary care doctor visits,specialist care doctor visits and network urgent care visits.Emergency Services/Urgent Care $0 co-pay for Medicare- and Medicaid-covered services.Not covered outside the U.S. and Canada except underlimited circumstances.Preventive Services $0 co-pay for Medicare- or Medicaid-covered flu,pneumonia, or Hepatitis B vaccines; annual screeningmammograms (for women 40 and over); colorectal cancerscreening exams, pap smears; and prostate screeningexams (for men 50+).Diagnostic Tests, X-rays and LabServicesIn-network: $0 co-pay for Medicare- or Medicaid-coveredlab services, diagnostic procedures and tests, X-rays,diagnostic radiology services, and therapeutic radiologyservices.Physical/Speech/Occupational Therapy In-network: $0 co-pay for Medicare- or Medicaid-coveredphysical therapy/speech/language/occupational therapyvisits.Home Health Services In-network: $0 co-pay for Medicare- or Medicaid-coveredservices.Mental Health $0 yearly deductible and $0 co-pay for Medicare- orMedicaid-covered services.Chemical Dependency $0 yearly deductible and $0 co-pay for Medicare- orMedicaid-covered services.$0 yearly deductible. $0 co-pay for Medicare- orMedicaid-covered services.$0 co-pay for each primary care doctor visit for Medicarecoveredbenefits; in-area, network urgent care visits andspecialist doctor visit for Medicare-covered benefits. You mustgo to network doctors, specialists, and hospitals. No referralrequired for network doctors, specialists, and hospitals.$0 co-pay for Medicare- or Medicaid-covered emergencyand urgent services.$0 co-pay for routine mammograms and pap smears,routine cancer tests and screenings, diagnostic hearingexams and Hepatitis B vaccine.$0 co-pay for Medicare- or Medicaid-covered lab services,diagnostic procedures and tests, X-rays, diagnosticradiology and therapeutic services.$0 co-pay for Medicare- or Medicaid-covered services.$0 co-pay for Medicare- or Medicaid-covered physicaltherapy/speech/language/occupational therapy visits.$0 co-pay for Medicare- or Medicaid-covered services.$0 yearly deductible. $0 co-pay for Medicare- or Medicaidcoveredservices.Outpatient: $0 co-pay for Medicare- or Medicaid-coveredservices.120

Medicare Advantage Special Need Plans for Duals Under Age 65A publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care $0 yearly deductible and $0 co-pay for MedicareorMedicaid-covered services The plan covers up to 100days each Medicare Part A benefit period. For Medicaidcoveredstay, the plan covers up to 180 days of nursingfacility room and board. After that, Medical Assistanceprovides coverage. No prior hospital stay is required.Durable Medical Equipment In-network: $0 yearly deductible and $0 co-pay forMedicare- or Medicaid-covered services.Dental In-network: $0 yearly deductible and $0 co-pay forMedicare- or Medicaid-covered services.Chiropractic In-network: $0 co-pay for Medicare- or Medicaid-coveredservices for manual manipulation of the spine to correct adisplacement or misalignment of a joint or body part andX-rays when needed to get a diagnosis of subluxation ofthe spine.$0 yearly deductible. $0 co-pay for Medicare- orMedicaid-covered services.$0 co-pay for Medicare- or Medicaid-covered services. Up to$100 maximum annual benefit to cover items such as grabbars, commodes, etc.$0 co-pay for Medicare- or Medicaid-covered services.$0 co-pay for Medicare- or Medicaid-covered services formanual manipulation of the spine to correct displacementor misalignment of a joint or body part and MedicaidcoveredX-rays when needed to get a diagnosis ofsubluxation of the spine.Travel Benefits None. Must activate Extended Absence Option for travel in theU.S. Call plan.Medicare Part B Drugs $0 yearly deductible for Part B-covered drugs. $0 yearly deductible for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Actual co-pays are based on income and living arrangements.Shingles Vaccine: $0 co-pay.Donut Hole Coverage: You pay the Part D co-payments perprescription covered on the formulary.Mail order is available.Participating pharmacies nationwide.Discounts/Special Programs Care coordination and routine transportation. $0 co-pay forMedicaid-covered services. Also in-network: $0 co-pay forMedicare- or Medicaid-covered eye exams, a pair of eyeglasses,eyeglasses or contacts after cataract surgery, and contactlenses if eyeglasses will not work. Also YMCA membership.Number of Providers In-Network 130+ Open access.Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Non-preferred Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Specialty Drugs: $0, $3.30 or $6.30 co-pays.Actual co-pays are based on income and livingarrangements.Shingles Vaccine: Tier 2 co-payment.Donut Hole Coverage: You pay the Part D co-payments perprescription covered on the formulary.Extra Services and Coverage: Medication TherapyManagement available.Mail order is available.More than 1,400 participating pharmacies. Please checkwebsite for details.Written health education materials, including newsletters;additional smoking cessation; health club membership/fitness classes. $100 maximum annual allowance forhealth and safety items, such as grab bars and commodes.Enrollment Status/Health Screening Voluntary program with continuous open enrollment forpeople who meet age, service area residence, disabilityand qualify for Medicaid (Medical Assistance) income/resource requirements. No health screening.Maximum Annual Out-of-Pocket Costs $0 $0Voluntary program with continuous open enrollment forpeople who meet age, service area residence, disabilityand qualify for Medicaid (Medical Assistance) income/resource requirements. No health screening.Monthly Premiums $0 $0121

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Under Age 65Medicare Advantage Special Need Plans for Duals Under Age 65 Must have Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifywww.primewest.orgPrime Health Complete H2926-0011-877-600-4913TTY: 1-800-627-3529 or 7118 a.m.-8 p.m., 7 days a weekYes. Yes.www.ucare.orgUCare Connect H2459-016612-676-3554; 1-800-707-1711TTY: 612-676-6810 or 1-800-688-2534Must be age 65 or older No. Must be 18-64 years of age. No. Must be 18-64 years of age.Service Area Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard,McLeod, Meeker, Pipestone, Pope, Renville, Stevens andTraverse counties in Minnesota.Hospital Inpatient Covered. $0 co-pay.Anoka, Benton, Blue Earth, Carlton, Carver, Cass,Chippewa, Chisago, Cottonwood, Dakota, Dodge, Faribault,Fillmore, Hennepin, Houston, Isanti, Jackson, Kandiyohi,Lac qui Parle, Le Sueur, Lincoln, Lyon, Martin, Mille Lacs,Mower, Murray, Nicollet, Nobles, Olmsted, Pine, Ramsey,Renville, Rice, Rock, Scott, Sherburne, St. Louis, Stearns,Washington, Watonwan, Winona, Wright and YellowMedicine counties in Minnesota.Physician/Outpatient Covered. $0 co-pay.Emergency Services/Urgent Care Covered. $0 co-pay.Preventive Services Covered. $0 co-pay.Diagnostic Tests, X-rays and Lab Services Covered. $0 co-pay.Physical/Speech/Occupational Therapy Covered. $0 co-pay.Home Health Services Covered. $0 co-pay.Mental Health Covered. $0 co-pay.Chemical Dependency Covered. $0 co-pay.Skilled Nursing Care Covered. $0 co-pay.Durable Medical Equipment Covered. $0 co-pay.Dental Covered. $0 co-pay.Chiropractic Covered. $0 co-pay.Travel Benefits Covered. $0 co-pay.Medicare Part B Drugs Covered. $0 co-pay.122

Medicare Advantage Special Need Plans for Duals Under Age 65A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Non-preferred Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Specialty Drugs: $0, $3.30 or $6.30 co-pays.Actual co-pays are based on income and living arrangements.Shingles Vaccine: $0, $3.30 or $6.30 co-pays.Donut Hole Coverage: Co-pay amounts for all medicationsremain the same.Mail order is not available.1,100 participating pharmacies.Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Non-preferred Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Specialty Drugs: $0, $3.30 or $6.30 co-pays.Actual co-pays are based on income and living arrangements.Shingles Vaccine: $0 co-pay.Donut Hole Coverage: Members will continue to pay theirco-pays as described above.Mail order is available.Contact plan for a comprehensive provider directory.Discounts/Special Programs None. Members are eligible for an additional $300/annually forcertain extra preventive and comprehensive dental benefitsthat are not covered by Medical Assistance. Limitationsapply. Members are eligible to receive a free monthlymembership with no dues at a YMCA of their choice.Limitations apply. Members can get a Strong and StableKit filled with tools and information to help improve theirstrength and make their home safer; QUITPLAN smokingcessation program; Community education discounts;Transportation. Limitations apply. Car seat program.Number of Providers In-Network 1,200+ contracted facilities. Contact plan for a comprehensive provider directory.Enrollment Status/Health Screening Voluntary program with continuous open enrollment forpeople who meet age, service area residence, disability andqualify for Medicaid (Medical Assistance) income/resourcerequirements. No health screening.Maximum Annual Out-of-Pocket Costs $0 $0Voluntary program with continuous open enrollment forpeople who meet age, service area residence, disabilityand qualify for Medicaid (Medical Assistance) income/resource requirements. No health screening.Monthly Premiums $0 $0Quick Tip 28RxConnect is a service of the Minnesota Board on Aging and Senior LinkAge Line ® thathelps Minnesotans of all ages find and apply for options to help pay for prescription drugs. Get RxConnect help by calling the Senior LinkAge Line ® at 1-800-333-2433.123

Health Care Choices for Minnesotans on MedicareMedicare Advantage Special Need Plans for Duals Under Age 65Medicare Advantage Special Need Plans for Duals Under Age 65 Must have Medicaid.Must be enrolled in Medical Assistance(Medicaid) to qualifyYes.www.mnscha.orgAbilityCare H5703-0011-866-567-7242TTY: 1-877-824-56118 a.m.-8 p.m., 7 days a weekMust be age 65 or older No. Must be 18-64 years of age and have a disability certified by Social Security orthe State Medical Review Team (SMRT).Service Area Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley,Steele, Todd, Wabasha, Wadena and Waseca counties in Minnesota.Hospital Inpatient In-network: $0 yearly deductible. You will not be charged additional cost-sharing forprofessional services. $0 co-pay for Medicare- or Medicaid-covered services.In most cases, you must go to network hospitals.Physician/Outpatient In-network: $0 co-pay for Medicare- or Medicaid-covered primary care doctor visits.$0 co-pay for Medicare- or Medicaid-covered in area, network urgent care visits. $0co-pay for Medicare- or Medicaid-covered specialist doctor visits. In most cases, youmust go to network doctors, specialists and other health care providers. No referralis necessary to see any network provider. Members must choose a primary careprovider upon enrollment, however, they can switch primary care providers at anytime by calling Member Services.Emergency Services/Urgent Care General: $0 co-pay for Medicare- or Medicaid-covered services. Not covered outside theU.S. and Canada except under limited circumstances. Contact the plan for more details.Preventive Services In-network: $0 co-pay for the following Medicare- or Medicaid-covered services:bone mass measurement, colorectal cancer screening exams, immunizations,mammograms, pap smears and pelvic exams, prostate cancer screening exams, andtobacco cessation program.Diagnostic Tests, X-rays and Lab Services In-network: $0 co-pay for Medicare- or Medicaid-covered lab services, diagnosticprocedures and tests, X-rays, diagnostic radiology services (not including X-rays),and therapeutic radiology services.Physical/Speech/Occupational Therapy In-network: $0 co-pay for Medicare- or Medicaid-covered physical/speech/language/occupational therapy visits.Quick Tip 29Call the DisabilityLinkage Line ® at 1-866-333-2466 for statewidehelp with• employment• disability benefits• home modifications• assistive technology• personal careassistance• disability awarenessand rights• Special Needs BasicCare PlansHome Health Services In-network: $0 co-pay for Medicare- or Medicaid-covered services.Mental Health Outpatient: $0 co-pay for in-network Medicare- or Medicaid-covered services.Inpatient: The same deductible and co-pay as inpatient hospital care. $0 yearlydeductible. $0 co-pay for Medicare- or Medicaid-covered services.Chemical Dependency In-network: $0 co-pay for Medicare- or Medicaid-covered services.124

Medicare Advantage Special Need Plans for Duals Under Age 65A publication of the Minnesota Board on Aging Senior LinkAge Line ®Skilled Nursing Care In-network: $0 yearly deductible. $0 co-pay for Medicare- or Medicaid-coveredservices. The plan covers up to 100 days for each Medicare Part A benefit period.For Medicaid-covered stays, the plan covers up to 100 days of nursing facility roomand board. After that, Medical Assistance provides coverage. No prior hospital stayis required.Durable Medical Equipment In-network: $0 co-pay for Medicare- or Medicaid-covered services.Dental In-network: $0 co-pay for Medicare- or Medicaid-covered services.Chiropractic In-network: $0 co-pay for Medicare- or Medicaid-covered services. Chiropracticvisits are for manual manipulation of the spine to correct a displacement ormisalignment of a joint or body part and X-rays when needed to get a diagnosis ofsubluxation of the spine.Travel Benefits Emergency and urgent care benefits as described above.Medicare Part B Drugs General: $0 yearly deductible for Part B-covered drugs.Medicare Part D Outpatient Prescriptions Deductible: $0Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Generic Drugs: $0, $1.10 or $2.50 co-pays.Non-preferred Brand Name Drugs: $0, $3.30 or $6.30 co-pays.Specialty Drugs: $0, $3.30 or $6.30 co-pays.Actual co-pays are based on income and living arrangements.Shingles Vaccine: $0 co-pay.Donut Hole Coverage: Members will continue to pay their co-pays as described above.Mail order is not available.Hundreds of participating pharmacies.Discounts/Special Programs Health and Wellness Education: Disease management programs for diabetes, heartdisease, asthma and postpartum depression. Staff provide educational materialsand support to help manage these serious chronic diseases. Fitness Program:Members who work out at least 8 days per month at a participating health club canreceive up to $20 off their health club membership fees. Community EducationRewards Program: Staff will cover up to $15 of the registration fee for mostcommunity education classes (up to 5 per registration session).Number of Providers In-Network Hundreds of clinics and hospitals, thousands of doctors and specialists throughoutMinnesota and bordering states.Enrollment Status/Health Screening Voluntary program with continuous open enrollment for people who meet age,service area residence, disability and qualify for Medicaid (Medical Assistance)income/resource requirements. You can enroll and disenroll at any time. Generallycannot accept persons with end-stage renal disease. If you are enrolled and developend-stage renal disease, you can remain enrolled in the plan. No health screening.Maximum Annual Out-of-Pocket Costs $0Monthly Premiums $0Quick Tip 30If you are disabled andconsidering returningto work, the MinnesotaWork IncentivesConnection can helpanswer your questionsabout the impact on yourbenefits if you do returnto work. Help is availablestatewide by calling themat 1-800-976-6728.125

Health Care Choices for Minnesotans on MedicarePrograms to Help You Save MoneyMedicare Savings Programs and Medicare Part D Extra HelpIf you are one of the many Minnesotans who worry abouthow to pay for your Medicare Part A, B and D relatedcosts, help is available.The Medicare Savings Programs (MSP) may be your bestoption to help lower your out-of-pocket Medicare relatedcosts. If you qualify for one of the Medicare SavingsPrograms, you could save thousands of dollars in one yearalone with your Medicare Part A, B and D costs.• If you enroll in a benchmark plan,nyou will not be charged a monthly premiumnyou will not pay an annual Medicare Part D deductiblenyou will not have a coverage gap, also known as thedonut holenyour will pay a co-pay for each covered Medicare PartD prescription drug (maximum of $6.30 in 2010)• You can choose to enroll in any Stand Alone MedicarePart D plan, but if the plan you select is not a benchmarkplan, you will be charged a monthly amount.What are the Medicare Savings Programs?There are three types of Medicare Savings Programsavailable in Minnesota:• Qualified Individual (QI-1)• Service Limited Medicare Beneficiary (SLMB)• Qualified Medicare Beneficiary (QMB)All three of the programs pay the Medicare Part Bpremium for you. In 2010, the Medicare Part B premiumwill increase to $110.50. This alone could save you morethan $1,300 in 2010. QMB also helps pay for other outof-pocketexpenses, such as your Medicare Part A and Bdeductibles, co-insurance and co-pays. While the resource/asset limit is the same for each Medicare Savings Program,the income limits do vary. A chart is available on page 128that provides the income and resource limits for each ofthe Medicare Savings Programs.How does this help with my Medicare Part Dprescription drug costs?If you are enrolled in one of the Medicare SavingsPrograms, you automatically receive what is called theMedicare Part D “Low-Income Subsidy”, also knownas LIS or Extra Help. There are different levels of theMedicare Part D Low Income Subsidy (Extra Help), butall levels reduce your out-of-pocket costs for the MedicarePart D prescription drug benefit.Medicare Part D Full Low Income Subsidyor Full Extra Help• If based on your income and resources, you qualify forthe Medicare Part D Low Income Subsidy (LIS) levelknown as Full Extra Help, your Medicare Part D outof-pocketcosts for your covered prescription drugs willbe limited to co-pays as long as you enroll in one of theStand Alone Medicare Part D benchmark plans.What is a benchmark plan?There are eight benchmark plans in Minnesota for 2010.These are Stand Alone Medicare Part D prescription drugplans available to Minnesotans with Full Low IncomeSubsidy (Full Extra Help) at a $0 premium. The eightbenchmark plans in Minnesota for 2010 are:• Aetna Medicare Rx Essentials• Community CCRx Basic• BravoRx• Prescriba Pathway Bronze Plan• First Health Part D Premier• Silverscript Value• HealthSpring Prescription Drug Plan• United Healthcare AARP Medicare Rx SaverHow do I apply for a Medicare Savings Program?You will have to fill out a Minnesota Health CarePrograms Application. You can access the application threedifferent ways.• You can find it online at the Minnesota Department ofHuman Services website at http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3417-ENG.• You can contact your county social services departmentand they will mail an application to you.• You can contact the Senior LinkAge Line ® at 1-800-333-2433. The Senior LinkAge Line ® will assist you withobtaining and completing an application if you wanthelp. Help is available by phone and in-person.126

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Additional Low Income Subsidy (LIS) or Extra Helpwith Prescription Drug CostsSometimes you may not be eligible, or may not want toapply for a Medicare Savings Program, but you still needhelp with prescription drug costs. If this is you, theremay be another Low Income Subsidy (LIS) or ExtraHelp option. Low Income Subsidy (LIS) or Extra Help isavailable through the Social Security Administration forthose who meet the income and resource/asset limits. Youmay have tried applying for the Low Income Subsidy (LIS)or Extra Help in the past but did not qualify. Because ofchanges that took effect in January 2010 with income andresource/asset limits, you may want to apply again to see ifyou now qualify.How does the Low Income Subsidy or Extra Help work?If you qualify for the Low Income Subsidy (LIS) or ExtraHelp, you will receive some help with your prescriptiondrug costs. There is Full and Partial Low Income Subsidy(LIS) or Extra Help available.• If you qualify for Partial Low Income Subsidy (LIS)or Extra Help you will pay a lower premium for yourMedicare Part D prescription drug plan, have a smallerannual deductible and lower co-insurance and co-paysfor your covered prescription drugs.• If you qualify for Full Low Income Subsidy (LIS) orExtra Help, you will not have a premium if you enroll ina “benchmark plan”. You will not have a deductible andwill not pay more than $6.30 copay for each prescriptiondrug that is on your Medicare Part D plan formulary.• In addition, for both Full and Partial Low IncomeSubsidy or Extra Help you will not have to worry aboutpaying full price for prescription drugs in the coveragegap or donut hole since you will not have one.I received an application for Low Income Subsidy orExtra Help in the mail. I already receive this benefit.What do I have to do?Every year the Social Security Administration selectsindividuals to go through a “redetermination process” tosee if they still qualify for the Low Income Subsidy (LIS)or Extra Help. If you receive the Low Income Subsidy(LIS) or Extra Help application in the mail from SocialSecurity, you must return the application within 30 days inorder to continue to receive the Low Income Subsidy (LIS)or Extra Help. If you do not return the application, youwill lose your Low Income Subsidy (LIS) or Extra Helpbenefit. If you would like help filling out the applicationor have questions about this process, please call the SeniorLinkAge Line® at 1-800-333-2433 for assistance.How do I apply for the Low Income Subsidy (LIS)or Extra Help?You must apply through the Social SecurityAdministration using their application. You can find theonline application at https://secure.ssa.gov/apps6z/i1020/main.html.• Senior LinkAge Line® is available to help you fill out theapplication by calling 1-800-333-2433.• Senior LinkAge Line® can even do the online applicationwith you either over the phone or in person, so you don’thave to complete any paperwork.127

Health Care Choices for Minnesotans on MedicarePrograms that can save you money if you have MedicareName of ProgramMonthly IncomeGuidelinesAsset/ResourceGuidelinesSummary of ProgramHow to Apply for ProgramMedicare Part D Low IncomeSubsidy (LIS) and Extra HelpPartial LIS$1,353.75-$1,218.39 single$1,821.25-$1,639.14couple$12,510 single$25,010 couple• Reduced monthlyMedicare Part Dplan premium• Reduced annualPart D deductible• Reduced MedicarePart D out-ofpocketcosts andco-payments• No Medicare Part Ddonut holeContact Social Security at 1-800-772-1213or apply online at www.socialsecurity.gov.You can also call the Senior LinkAgeLine ® at 1-800-333-2433 for help withcompleting the application in person oronline.Medicare Part D Low IncomeSubsidy (LIS) and Extra HelpFull LIS$1,218.38 or lesssingle$1,639.13 or lesscouple$8,100 single$12,910 couple• No monthlypremium with someplans• No annualdeductible• No co-insurance• No Medicare Part Ddonut hole• Pay only co-pays foreach prescriptionContact Social Security at 1-800-772-1213or apply online at www.socialsecurity.gov.You can also call the Senior LinkAge Line ® at1-800-333-2433 for help with completingthe application in person or online.Qualified Individual(QI-1)$1,239 single$1,660 couple$10,000 single$18,000 couplePays your monthlyMedicare Part BpremiumContact your local county social servicesoffice or call the Senior LinkAge Line ® at1-800-333-2433.Service Limited MedicareBeneficiary (SLMB)$1,103 single$1,477 couple$10,000 single$18,000 couplePays your monthlyMedicare Part BpremiumContact your local county social servicesoffice or call the Senior LinkAge Line ® at1-800-333-2433.Qualified Medicare Beneficiary(QMB)$887 single$1,235 couple$10,000 single$18,000 coupleCovers all MedicarePart A and PartB deductibles,co-insurance, copays,and pays yourmonthly Part Bpremium.Contact your local county social servicesoffice or call the Senior LinkAge Line ® at1-800-333-2433.Please note: If you enroll in a Medicare Savings Program (QMB, SLMB or QI-1) you will automatically receive the Full LIS and Extra Help.128

Senior Partners Care ProgramFor seniors and disabled persons on MedicareA publication of the Minnesota Board on Aging Senior LinkAge Line ®If you are low-to moderate-income and are enrolledin Medicare, you may be eligible for Senior PartnersCare (SPC).Agencies that administer the Senior Partners Care Programwork with participating medical providers to provideeligible Medicare recipients with affordable health careincluding hospitals, clinics and physicians. Providersthat participate with Senior Partners Care have agreed toaccept Medicare payments as payment in full; all Medicareco-pays and deductibles are waived. Virtually all TwinCities hospitals and many hospitals and clinics in GreaterMinnesota participate in the program.Senior Partners Care is now being administered in themetro area and in other counties statewide by Volunteersof America-MN. (SPC was formerly a program of theMinnesota Senior Federation.) Please contact Volunteersof America-MN at 612-617-7817 for an application andmore information.If you live in Greater Minnesota, please contactthe Greater Minnesota Health Care Coalition at1-888-694-5055 to see if there is a program in yourarea and to receive contact information.What are the eligibility requirements for SPC?• You must be on Medicare Part A and Part B. There is noage limit as long as you are on Medicare Part A and B.• You must meet income and asset guidelines to qualify.Your monthly income cannot be more than $1,805 ifyou are single; $2,428 for a couple. Your assets for eithersingle or couples cannot be more than $43,785. The assetlimitation does not include your homestead property andone vehicle.• You cannot be enrolled in a Private Fee-for-Service Planor any type of Medicare Advantage plan.• You may not be receiving benefits from MedicalAssistance or Qualified Medicare Beneficiary (QMB).(See “Medicare Savings Programs” in this guide).Are there any fees for SPC?No mandatory fees or premiums are required, but you maybe asked to pay a nominal administrative annual donation.The money helps defray the cost of administering theSenior Partners Care program. If you are unable to paydue to hardship, you can call for a waiver.Whom should I call with questions?Call Volunteers of America-MN at 612-617-7817if you live in the metro area or surrounding counties.Call Greater Minnesota Health Care Coalition at1-888-694-5055 if you live in Greater Minnesota.Quick Tip 31www.MinnesotaHelp.info ® is a database of communityservices including government, non-profit and some for-profit agencies.• It can help you find human services, information andreferral, financial assistance, and other forms of help.• It is especially rich in resource information for seniors and their caregivers; people with disabilitiesand their caregivers; parents and families; and lowincome people.• www.MinnesotaHelp.info ® is sponsored by the MinnesotaBoard on Aging and the Minnesota Department ofHuman Services as well as other partners.• The Minnesota Board on Aging manages the website.129

Health Care Choices for Minnesotans on MedicarePart D Decision StepsHow do you make decisions about Part D? Part D isoptional insurance, and you must select and enroll in aplan for coverage. Should you enroll?New to Medicare?Some points to consider if you are 65 and on eitherPart A or Part B of Medicare:• Decide whether you need coverage for prescription drugsnow – or whether you may need it in the future. There’sa premium penalty of 1% per month for not enrollingwhen you could do so. This is life-long and it adds up.For example, if you wait to enroll for five years = 60%monthly penalty.• Don’t forget that if you’re married, your spouse must signup for Part D individually.• Your Initial Enrollment Period for signing up for Part Dwithout a penalty is three months before you turn 65,the month you are 65 and three months after.• Look into what Medicare calls Extra Help for Part D,also known at Low Income Subsidy (LIS). See charts onpage 128.• If you are on Medical Assistance or a Medicare SavingsProgram (QMB, SLMB, QI-1), you will be enrolledin a Part D plan automatically. You can change plansmonthly. Your costs will be limited to co-pays.• If you are still working at age 65 and have an employerplan or you are on a retiree plan, find out if the drugcoverage is “creditable.” If it is, you can delay gettingPart D with no penalty. If it isn’t, ask if you can get PartD without losing your current health care plan. Note:Veterans and TRICARE drug coverage is creditable.• Find out the true retail costs of the drugs you are takingor may take in the future. This is what you’d pay with nodrug coverage. You might think of Part D a bit like “autoinsurance,” where you may not need it now, but wantsome future protection.• Part D plans can be drugs-only (stand-alone plans) ormight be included in a health care plan like a MedicareAdvantage plan or Cost plan. See “Types of Plans” inthis guide. If you like these inclusive plans, you’ll want tocheck Part D information within each health care planyou are considering.• Whether you choose a stand-alone plan or or a healthcare plan that includes Part D, ask about current andprojected drug costs and rules, including:• What are the annual deductibles and monthlypremiums?• How much are the co-pays for the different levels ofdrugs (generics, brand name drugs, non-formulary drugs,specialty drugs)?• Does the plan have “step therapy,” “prior authorization”and “quantity limits” for your drugs? (See the definitionson pages 31-32.) Your doctor may or may not be able toget you exemptions from the plan.• Be aware of the Part D donut hole, also know as coveragegap.• Does the plan cover all of your prescriptions? Call theplan or see the plan’s website for the list (formulary) ofdrugs it will cover.• Which drug stores or pharmacies will the plan allow youto use? Again, call the plan or see the plan’s website for alist of pharmacies.• If you travel regularly, call the Part D plan to ask aboutcoverage outside of its service area.• Consider convenience and customer service. Someplans have service ratings. You also can tell a bit aboutcustomer service when you call a plan directly.• You can change plans during open enrollment fromNovember 15 through December 31 each year.• The best place to go for comprehensive MedicarePart D plan information is www.Medicare.gov.Already have a Part D plan?Open enrollment is every November 15 throughDecember 31 during Part D’s Annual Election Period. PartD plans can and do change annually. Joining a new planends coverage in the old one automatically. Here are pointsto consider:• Are your drugs still on the plan’s formulary? The AnnualNotice of Change from your plan shows whether yourdrugs were dropped from the plan’s list of covered drugs.• If you have applied for Extra Help for Part D and havebeen rejected because you included life insurance valuesand in-kind support as assets or income, you shouldapply again. In 2010 these are no longer considered. See“Extra Help” in this guide. Also, in March 2010, incomeand asset levels may increase.The Senior LinkAge Line ® can help you understand youroptions. Call 1-800-333-2433.130

A publication of the Minnesota Board on Aging Senior LinkAge Line ®2010Part D Standard BenefitNo Extra Help (LIS)5%95% Catastrophic BenefitDrug CostsOver $6,440 (co-pays of $2.50/$6.30)100% $2,830.01–$6,44025% 75%$310 DeductibleMonthly Premium$301.01–$2,830$.01–$310Beneficiary CostsPart D Plan2010Part D Partial Extra Help (LIS)• Lower premiums• Lower deductibles• Lower co-insurance• No donut holeCo-Pays $2.50/$6.30Catastrophic BenefitOver $6,440Drug Costs15% 85%$63.01–$6,440$63 Deductible $.01–$63Sliding Scale Premiums will varyBeneficiary CostsPart D Plan2010Part D Full Extra Help (LIS)• No premiums if in benchmark plan• No deductible• No co-insurance• No donut hole• No monthly cap on co-paysCatastrophic Benefit• 100% Plan• No co-paysOver $6,440Co-pays $.01–$6,440No premiums. No deductibles.Co-pays$1.10/$3.30 < 100% FPL$2.50/6.30 > 100% FPLDrug CostsBeneficiary CostsPart D Plan131

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.aetnamedicare.comAetna Medicare RxEssentials S5810-0591-800-529-5586TTY: 1-888-760-47488 a.m.-8 p.m.www.aetnamedicare.comAetna Medicare RxPlus S5810- 2291-800-529-5586TTY: 1-888-760-47488 a.m.-8 p.m.www.aetnamedicare.comAetna Medicare RxPremier S5810- 1951-800-529-5586TTY: 1-888-760-47488 a.m.-8 p.m.Service Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$28.30 $33.40 $82.90Part D Annual Deductible $310 $0 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $30 co-pay preferred. $38 co-pay preferred. $37 co-pay preferred.• Generic Drug: $3 co-pay preferred. $28 co-pay non-preferred. $5 co-pay preferred. $32 co-pay non-preferred. $6 co-pay preferred. $36 co-pay non-preferred.• Non-preferredBrand Name Drug:$70 co-pay. $80 co-pay. $81 co-pay.• Specialty Drug: 25% co-insurance. 33% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/A N/ADoes the Part D Plan Provide AnyDonut Hole Coverage?No. No. Yes; Tier 1 covered in the gap.Does Part D Cover theShingles Vaccine?Yes. Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeShingles vaccine is a non-preferred brandand the non-preferred brand co-pay will berequired. Additionally, Aetna will reimbursefor the vaccine administration fee up to amaximum of $19.Shingles vaccine is a non-preferred brandand the non-preferred brand co-pay will berequired. Additionally, Aetna will reimbursefor the vaccine administration fee up to amaximum of $19.Shingles vaccine is a non-preferred brandand the non-preferred brand co-pay will berequired. Additionally, Aetna will reimbursefor the vaccine administration fee up to amaximum of $19.Provide Part D ExtraServices and Coverage(if it applies)Aetna PDP members are eligible forall Aetna Extras including:Aetna Fitness discount program: preferred rate ongym memberships and access to discounts on athomeweight-loss programs, home fitness options,and one-on-one health coaching services.Aetna Vision discount program: Up to 40% offthe retail prices of eyeglass frames, savings forall types of lenses, and up to 15% off Lasikprocedures.Tier 1 and Tier 2 coverage of benzodiazepinesand barbiturates. Aetna PDP members are alsoeligible for all Aetna Extras including:Aetna Fitness discount program: preferred rateon gym memberships and access to discountson at-home weight-loss programs, home fitnessoptions, and one-on-one health coachingservices.Tier 1 and Tier 2 coverage of benzodiazepinesand barbiturates. Aetna PDP members arealso eligible for all Aetna Extras including:Aetna Fitness discount program: preferredrate on gym memberships and access todiscounts on at-home weight-loss programs,home fitness options, and one-on-one healthcoaching services.132

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Aetna Weight Management discount program:Save on weight-loss programs and productsfrom Jenny Craig and eDiets.Aetna Natural Products and Services discountprogram: Access to discounts on over-thecountervitamins, herbal and nutritionalsupplements, and natural products. Reducedrates from participating chiropractors andacupuncturists.Aetna Vision discount program: Up to 40% offthe retail prices of eyeglass frames, savings forall types of lenses, and up to 15% off Lasikprocedures.Aetna Weight Management discount program:Save on weight-loss programs and productsfrom Jenny Craig and eDiets.Aetna Natural Products and Services discountprogram: Access to discounts on over-thecountervitamins, herbal and nutritionalsupplements, and natural products. Reducedrates from participating chiropractors andacupuncturists.Aetna Vision discount program: Up to 40% offthe retail prices of eyeglass frames, savingsfor all types of lenses, and up to 15% offLasik procedures.Aetna Weight Management discount program:Save on weight-loss programs and productsfrom Jenny Craig and eDiets.Aetna Natural Products and Services discountprogram: Access to discounts on over-thecountervitamins, herbal and nutritionalsupplements, and natural products. Reducedrates from participating chiropractors andacupuncturists.Is Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith Plan60,000 pharmacies participate with Aetnanationwide.60,000 pharmacies participate with Aetnanationwide.60,000 pharmacies participate with Aetnanationwide.Quick Tip 32A Long-term Care Consultation (LTCC) can help you make decisions aboutyour long-term care needs in order to help you stay in your home andreceive services.• There is no charge to you for a LTCC and it is available regardless of yourincome and resource levels.• The LTCC is conducted by your county social services and/or countypublic health staff and includes the expertise of both social workers andpublic health nurses.• To get more information and get connected for a county LTCC, pleasecall the Senior LinkAge Line® at 1-800-333-2433.133

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.YourMedicareSolutions.comMedicareBlue Rx (PDP),Standard S5743-001651-662-2583; 1-877-622-2583TTY: 1-866-582-11588 am to 8 p.m., dailywww.YourMedicareSolutions.comMedicareBlue Rx (PDP),Enhanced S5743-003651-662-2583; 1-877-622-2583TTY: 1-866-582-11588 am to 8 p.m., dailywww.YourMedicareSolutions.comMedicareBlue Rx (PDP),Premier S5743-004651-662-2583; 1-877-622-2583TTY: 1-866-582-11588 am to 8 p.m., dailywww.mybravohealth.comBravoRx S5998-0291-800-723-9209TTY: 1-800-964-25618 a.m.-8 p.m. Eastern, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$43.70 $37.20 $96.20 $36.10Part D Annual Deductible $310 $165 $0 $310Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: Level 2: 22% co-insurance forcovered preferred brand.Level 2: $35 co-pay for coveredpreferred brand.Level 2: $38 co-pay for coveredpreferred brand.25% co-insurance up to initialcoverage limit (total drug costs of$2,830).• Generic Drug: Level 1: 10% co-insurance forcovered generic.Level 1: $4 co-pay for coveredgeneric.Level 1: $4 co-pay for coveredgeneric.25% co-insurance up to initialcoverage limit (total drug costs of$2,830).• Non-preferredBrand Name Drug:Level 3: 50% co-insurance forcovered brand.• Specialty Drug: Covered specialty:25% co-insurance.Level 3: 50% co-insurance forcovered brand.Covered specialty:28% co-insurance.Level 3: 50% co-insurance forcovered brand.Covered specialty:33% co-insurance.• Tiered Drug: N/A N/A N/A N/AN/A25% co-insurance up to initialcoverage limit (total drug costs of$2,830).Does the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; $4 co-pay for Level 1: Coveredgeneric drugs; 100% for all otherlevels of covered drugs.No.Does Part D Cover theShingles Vaccine?If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeYes. Yes. Yes. Yes.Covered at Level 3: Coveredbrand and is a one time dose.Impact on members depends onin-network use.Covered at Level 3: Coveredbrand and is a one time dose.Impact on members depends onin-network use.Covered at Level 3: Coveredbrand and is a one time dose.Impact on members depends onin-network use.25% co-insurance up to initialcoverage limit (total drug costs of$2,830).134

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Provide Part D ExtraServices and Coverage(if it applies)Extended supplies (up to 90 days)of maintenance drugs are availablethrough mail order pharmacyservice and certain in-network retailpharmacies.MedicareBlue Values Program:discounts on vision exams, eyewear,laser surgery, hearing exams andhearing aids.Extended supplies (up to 90 days)of maintenance drugs are availablethrough mail order pharmacyservice and certain in-network retailpharmacies.MedicareBlue Values Program:discounts on vision exams, eyewear,laser surgery, hearing exams andhearing aids.Extended supplies (up to 90 days)of maintenance drugs are availablethrough mail order pharmacyservice and certain in-network retailpharmacies.MedicareBlue Values Program:discounts on vision exams, eyewear,laser surgery, hearing exams andhearing aids.N/AIs Mail Order Available? Yes. Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanMore than 59,000 nationwide. More than 59,000 nationwide. More than 59,000 nationwide. 1,037Quick Tip 33The MinnesotaHelp Network is a vital and rapidly expandingAging and Disability Resource Centers (ADRC) system ofactivities that inform, educate and support your health andlong-term care decisions as well as help you access benefits andservices.• The MinnesotaHelp Network provides a visible and trustedplace where older adults, caregivers and persons withdisabilities of all ages and income levels can access long-termsupports and services.• The MinnesotaHelp Network is a statewide network availablein all 87 counties of Minnesota that will provide you with linksto resources and services, and assist you in weeding throughavailable options and navigating processes to access services.• The MinnesotaHelp Network includesn Senior LinkAge Line ® 1-800-333-2433n Disability Linkage Line ® 1-866-333-2466n Veterans Linkage Line 1-888-546-5838n www.MinnesotaHelp.info®n Community partners such as libraries, clinics, work forcecenters, hospitals, senior centers and many othersn More than 200 community based locations135

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.cignamedicarerx.comCIGNA Medicare Rx ®Plan One (PDP) S5617-1231-800 735-1459TTY: 1-800 322-14518 a.m.-8 p.m., local time, 7 days per weekwww.cignamedicarerx.comCIGNA Medicare Rx ®Plan Two (PDP) S5617-1251-800 735-1459TTY: 1-800 322-14518 a.m.-8 p.m., local time, 7 days per weekwww.cignamedicarerx.comCIGNA Medicare Rx ®Plan Three (PDP) S5617-1951-800 735-1459TTY: 1-800 322-14518 a.m.-8 p.m., local time, 7 days per weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$54.40 $41.70 $68.60Part D Annual Deductible $310 $100 deductible except on generics. $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $29 co-pay. $8 co-pay. $35 co-pay.• Generic Drug: $3 co-pay. $0 co-pay. $6 co-pay.• Non-preferredBrand Name Drug:$90 co-pay. $38 co-pay. $60 co-pay.• Specialty Drug: 25% co-insurance. $88 co-pay. 33% co-insurance.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; Many generics and few brands;25% co-insurance—retail, long-term care,preferred mail order pharmacies; 40% co-insurance—non preferred mail order pharmacies.Does Part D Cover theShingles Vaccine?Yes. Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeCost of the vaccine and administration may becharged independently depending on where youget them. Call the plan for clarification whengetting a vaccination.Cost of the vaccine and administration may becharged independently depending on where youget them. Call the plan for clarification whengetting a vaccination.Cost of the vaccine and administration may becharged independently depending on where youget them. Call the plan for clarification whengetting a vaccination.136

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®Provide Part D ExtraServices and Coverage(if it applies)The Healthy Rewards program offers discountson health and wellness products and services.• Fitness club discounts: Savings up to 60%• Vision exams, eyewear and contacts:Discounts for vision services including visionexams through the EyeMed Select Network.Over 30,000 providers are now available atSears ® , JC Penney ® , Pearle Vision ® , Target ® ,and other independent locations• Hearing exams and aids: Savings up to40% on hearing tests and 25% on hearingaids and hearing aid batteries.• Chiropractic/acupuncture/massage therapy:Savings up to 25%Additional programs and discounts areavailable for:• Weight and nutrition• Smoking cessation• Dental care products• Laser vision careThe Healthy Rewards program offers discountson health and wellness products and services.• Fitness club discounts: Savings up to 60%• Vision exams, eyewear and contacts:Discounts for vision services including visionexams through the EyeMed Select Network.Over 30,000 providers are now available atSears ® , JC Penney ® , Pearle Vision ® , Target ® ,and other independent locations• Hearing exams and aids: Savings up to40% on hearing tests and 25% on hearingaids and hearing aid batteries.• Chiropractic/acupuncture/massage therapy:Savings up to 25%Additional programs and discounts areavailable for:• Weight and nutrition• Smoking cessation• Dental care products• Laser vision careThe Healthy Rewards program offers discountson health and wellness products and services.• Fitness club discounts: Savings up to 60%• Vision exams, eyewear and contacts:Discounts for vision services including visionexams through the EyeMed Select Network.Over 30,000 providers are now available atSears ® , JC Penney ® , Pearle Vision ® , Target ® ,and other independent locations• Hearing exams and aids: Savings up to40% on hearing tests and 25% on hearingaids and hearing aid batteries.• Chiropractic/acupuncture/massage therapy:Savings up to 25%Additional programs and discounts areavailable for:• Weight and nutrition• Smoking cessation• Dental care products• Laser vision careIs Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanOver 58,000 network pharmacies nationwide. Over 58,000 network pharmacies nationwide. Over 58,000 network pharmacies nationwide.Quick Tip 34There are more than 500,000 Minnesotans who are caregivers andprovide unpaid help for older adults and adults with disabilities inMinnesota. Help is available. Go to www.mnaging.org/advisor/caregiver.htm to download a copy of the Minnesota Board on Aging Care WellResource Sheet. Call the Senior LinkAge Line ® at 1-800-333-2433 tofind out about caregiver support services in your local area.137

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug PlansCoventrywww.AdvantraRx.comAdvantraRx Value S5674-0321-800-882-3822TTY: 1-888-788-40108 a.m.-8 p.m., 7 days a weekCoventrywww.AdvantraRx.comAdvantraRx Premier S5674-0331-800-882-3822TTY: 1-888-788-40108 a.m.-8 p.m., 7 days a weekCoventrywww.AdvantraRx.comAdvantraRx Premier Plus S5674-0351-800-882-3822TTY: 1-888-788-40108 a.m.-8 p.m., 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$34.70 $47.20 $62Part D Annual Deductible $100 $0 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: 18% co-insurance.16% co-insurance for 90 day mail order.18% co-insurance.16% co-insurance for 90 day mail order.19% co-insurance.12% co-insurance for 90 day mail order.• Generic Drug: $6 co-pay for 30-day.$18 co-pay for 90-day.• Non-preferredBrand Name Drug:$11 co-pay for 30-day.$33 co-pay for 90-day.$25 co-pay for 30-day.$75 co-pay for 90-day.$62.50 co-pay for 90 day mail order.61% co-insurance. 51% co-insurance. 75% co-insurance.• Specialty Drug: 30% co-insurance. 33% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/A Tier I: $5 per 30-day/$15 for 90-day; $12.50for preferred generics 90 day mail order.Does the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; Preferred generics only; $15 for30-day/$45 co-pay for 90-day.Does Part D Cover theShingles Vaccine?If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeProvide Part D ExtraServices and Coverage(if it applies)Yes. Yes. Yes.61% co-insurance. 51% co-insurance. 19% co-insurance.Some over-the-counter drugs are covered at$0 co-pay.Some over-the-counter drugs are covered at$0 co-pay.Some over-the-counter drugs are provided ata $0 co-pay. Some Part D excluded drugs areprovided at a Tier 1 co-pay.Is Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith Plan1,174, but network is national. 1,174, but network is national. 1,174, but network is national.138

Stand Alone Medicare Prescription Drug Plans www.FirstHealthPartD.comwww.FirstHealthPartD.comwww.envisionrxplus.comwww.envisionrxplus.comFirst Health Part D-Premier S5768-1221-800-588-3322TTY: 1-888-788-40108 a.m.-8 p.m., 7 days a weekFirst Health Part D-Secure S5768-1071-800-588-3322TTY: 1-888-788-40108 a.m.-8 p.m., 7 days a weekEnvisionRx Plus Gold S7694-059866-250-2005; 866-250-2005TTY: 866-763-963024 hours a day, 7 days a weekEnvisionRx Plus Silver S7694-025866-250-2005TTY: 866-763-963024 hours a day, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDP$42.20 $50 $22.80 $37.20Monthly Premium Part D Annual Deductible $310 $150 $175 $150 Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: 25% co-insurance. Preferred brand $25 co-insurance. 20% co-insurance; 18%11% co-insurance. co-insurance for 90 day mail order. • Generic Drug: 25% co-insurance. Preferred generics $4 co-insurance. $4 co-pay for 30-day supply. $7 co-pay for 30-day supply.$12 co-pay for 90-day supply. $21 co-pay for 90-day supply.A publication of the Minnesota Board on Aging Senior LinkAge Line ®49% co-insurance. 46% co-insurance.25% co-insurance. Non-preferred brand 25%co-insurance.• Non-preferredBrand Name Drug:• Specialty Drug: 25% co-insurance. 25% co-insurance. 28% co-insurance. 29% co-insurance. • Tiered Drug: N/A N/A N/A N/A No. No. No. No. Does the Part D Plan ProvideAny Donut Hole Coverage?Yes. Yes. Yes. Yes.Does Part D Cover theShingles Vaccine?25% co-insurance. 25% co-insurance. 49% co-insurance. 46% co-insurance.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeSome over-the-counter drugs areprovided at a $0 co-pay.Some over-the-counter drugs areprovided at a $0 co-pay.There is a value added servicethat allows a specific listing ofnon-covered Part D drugs to processat 100% co-pay.There is a value added servicethat allows a specific listing ofnon-covered Part D drugs to processat 100% co-pay.Provide Part D ExtraServices and Coverage(if it applies) Is Mail Order Available? Yes. Yes. Yes. Yes.1,174, but network is national. 1,174, but network is national.1,125 contracted pharmaciesin Minnesota.1,125 contracted pharmaciesin Minnesota.Number of Pharmaciesin MN that Participatewith Plan139

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.healthnet.comHealthNet Orange Option 1 S5678-0561-800-806-8811TTY: 1-800-929-99558 a.m.-8 p.m.www.healthnet.comHealthNet Orange Option 2 S5678-0551-800-806-8811TTY: 1-800-929-99558 a.m.-8 p.m.www.healthspring.comHealth Spring PrescriptionDrug Plan-Reg 25 S5932-025615-291-7024; 1-800-331-6293TTY: 1-866-845-72308 a.m. – 8 p.m., 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$34.40 $62.40 $32Part D Annual Deductible $310 $0 $310Part D Cost Sharing and Co-paysPer Prescription Drug:• Brand Name Drug: $42 co-pay for preferrred brand name. $35 co-pay for preferrred brand name. 25% co-insurance in initial coverage phase; 100%co-insurance in coverage gap; greater of $2.50generic/$6.30 brand or 5% in catastrophic phase.• Generic Drug: $4 co-pay for preferrred generic. $5 co-pay. 25% co-insurance in initial coverage phase; 100% incoverage gap; greater of $2.50 generic/$6.30 brandco-pay or 5% co-insurance in catastrophic phase.• Non-preferredBrand NameDrug:$95 co-pay. $95 co-pay. N/A• Specialty Drug: 25% co-insurance. 33% co-insurance. 25% co-insurance in initial coverage phase; 100%co-insurance in coverage gap; greater of $2.50generic/$6.30 brand co-pay or 5% co-insurance incatastrophic phase.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. No.Does Part D Cover theShingles Vaccine?If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeYes. Yes. Yes.25% of contracted rate. Check with plan. 25% co-insurance in initial coverage phase; 100% incoverage gap; greater of $2.50 generic/$6.30 co-paybrand or 5% co-insurance in catastrophic phase.Provide Part D ExtraServices and Coverage(if it applies)N/A N/A N/AIs Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanMany. Many. Over 60,000 pharmacies in network. 500 independentpharmacies in MN, plus chain pharmacies.140

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®www.humana-medicare.comHumana Standard H5884-0831-800-706-0872TTY: 1-877-833-4486Monday-Saturdaywww.humana-medicare.comHumana Enhanced S5884-0231-800-706-0872TTY: 1-877-833-4486Monday-Saturdaywww.humana-medicare.comHumana Complete H5884-0531-800-706-0872TTY: 1-877-833-4486Monday-SaturdayService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$44.30 $33.50 $104.10Part D Annual Deductible $310 $0 $0Part D Cost Sharing and Co-paysPer Prescription Drug:• Brand Name Drug: 25% co-insurance from preferred pharmacy. $45 co-pay at preferred pharmacy. $45 co-pay at preferred pharmacy.• Generic Drug: 15% co-insurance from preferred pharmacy. $7 co-pay at preferred pharmacy. $7 co-pay at preferred pharmacy.• Non-preferred Drug: 43% co-insurance from preferred pharmacy. $75 co-pay at preferred pharmacy. $75 co-pay at preferred pharmacy.• Specialty Drug: N/A 33% co-insurance at preferred pharmacy. 33% co-insurance at preferred pharmacy.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; Preferred generics only $7 co-pay.Does Part D Cover theShingles Vaccine?Yes. Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeShingles vaccine covered at 43% co-insurance. Shingles vaccine has $75 co-pay. Shingles vaccine has $75 co-pay.Provide Part D ExtraServices and Coverage(if it applies)$0 co-pay on preferred generic throughRightSource. Over-the-counter discount.Dental, vision and hearing discounts available.$0 co-pay on preferred generic throughRightSource. Over-the-counter discount.Dental, vision and hearing discounts available.$0 co-pay on preferred generic throughRightSource. Over-the-counter discount.Dental, vision and hearing discounts available.Is Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith Plan65,000+ nationwide. 65,000+ nationwide. 65,000+ nationwide.141

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.medcomedicare.comwww.medcomedicare.comwww.medcomedicare.comMedco Medicare PDP-Value S5660-1271-800-758-4531TTY: 1-800-716-323124 hours a day, 7 days a weekMedco Medicare PDP-Choice S5660-0251-800-758-4531TTY: 1-800-716-323124 hours a day, 7 days a weekMedco Medicare PDP-Access S5660-1951-800-758-4531TTY: 1-800-716-323124 hours a day, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$47.70 $39.80 $77.70Part D Annual Deductible $310 $100 $0Part D Cost Sharing and Co-paysPer Prescription Drug:• Brand Name Drug: 25% co-insurance. $36-$40 co-pay. $40 co-pay.• Generic Drug: 25% co-insurance. $6 co-pay. $6 co-pay.• Non-preferredBrand Name Drug:25% co-insurance. 75% co-insurance. 75% co-insurance.• Specialty Drug: 25% co-insurance. 30% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes. Generics only.Does Part D Cover theShingles Vaccine?Yes. Call plan. Yes. Call plan. Yes. Call plan.Provide Part D ExtraServices and Coverage(if it applies)N/A N/A N/AIs Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanMany. Many. Many.142

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®www.Meds4Medicare.comAdvantage Freedom Plan S5644-0591-800-429-6686TTY: 1-877-279-03718 a.m. to 8 p.m., 7 days a weekwww.Meds4Medicare.comAdvantage Star Plan S5644-0801-800-429-6686TTY: 1-877-279-03718 a.m. to 8 p.m., 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$48.50 $56.50Part D Annual Deductible $0 $310Part D Cost Sharing and Co-paysPer Prescription Drug:• Brand Name Drug: 33% co-insurance. 25% co-insurance.• Generic Drug: $2.50-$15 co-pay. $3.50 co-pay.• Non-preferredBrand Name Drug:45% co-insurance. 45% co-insurance.• Specialty Drug: 33% co-insurance. 25% co-insurance.• Tiered Drug: N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No.Does Part D Cover theShingles Vaccine?Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for Enrollee33% co-pay. 25% co-pay.Provide Part D ExtraServices and Coverage(if it applies)Free membership in CVS Caremark ExtraCare ®health program.Free membership in CVS Caremark ExtraCare ®health program.Is Mail Order Available? Yes. Yes.Number of Pharmaciesin MN that Participatewith Plan1,144 1,144Quick Tip 35Surf’s up! Register for a freeSenior Surf Day in your areathat will teach you how to findMedicare information and fightMedicare fraud while surfing theInternet. Call the Senior LinkAgeLine ® at 1-800-333-2433 to getenrolled. Senior Surf Day classesare available in all 87 countiesof Minnesota.143

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.silverscript.comSilverscript Value S5601-0501-866-552-6106TTY: 1-866-552-62888:00 a.m. to 2:00 a.m. ET, 7 days a weekwww.silverscript.comCVS Caremark Plus S5601-0511-866-552-6106TTY: 1-866-552-62888 a.m. to 2:00 a.m. ET, 7 days a weekwww.silverscript.comCVS Caremark Complete S5601-0961-866-552-6106TTY: 1-866-552-62888 a.m. to 2:00 a.m. ET, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$37.30 $56.90 $83.60Part D Annual Deductible $310 $50 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: Preferred: $21.50 co-pay retail; $53.75 co-paymail order.$25-$75 co-pay. $39-$98 co-pay.• Generic Drug: $8 co-pay retail; $14 co-pay mail order. $2.50-$7.50 co-pay. $2.50-$19 co-pay.• Non-preferredBrand Name Drug:$95.00 co-pay retail; $261.25 co-pay mail order. $90-$248 co-pay. $90-$270 co-pay.• Specialty Drug: 25% co-insurance. 31% co-insurance. 33% co-insurance.• Tiered Drug: NA N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; CVS Caremark Complete Plan covers allformulary generics in the coverage gap.Does Part D Cover theShingles Vaccine?Yes. Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeZostavax is covered as a preferred brand drug. Zostavax is covered as a preferred brand drug. Zostavax is covered as a preferred brand drug.Provide Part D ExtraServices and Coverage(if it applies)ExtraCare health program: This program isfree to members of SilverScript InsuranceCompany’s Prescription Drug Program. As amember of a SilverScript Insurance drug plan,you will receive a 20%* discount on CVS/pharmacy brand health-related products. Withyour ExtraCare card, you can use your benefitat more than 6,900* CVS/pharmacy storesnationwide. CVS store brand health-relatedExtraCare health program: This program isfree to members of SilverScript InsuranceCompany’s Prescription Drug Program. As amember of a SilverScript Insurance drug plan,you will receive a 20%* discount on CVS/pharmacy brand health-related products. Withyour ExtraCare card, you can use your benefitat more than 6,900* CVS/pharmacy storesnationwide. CVS store brand health-relatedExtraCare health program: This program isfree to members of SilverScript InsuranceCompany’s Prescription Drug Program. As amember of a SilverScript Insurance drug plan,you will receive a 20%* discount on CVS/pharmacy brand health-related products. Withyour ExtraCare card, you can use your benefitat more than 6,900* CVS/pharmacy storesnationwide. CVS store brand health-related144

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®items include (but are not limited to) CVS/pharmacy ® Ibuprofen (compare to Advil ® ),CVS/pharmacy ® Allergy Relief (compare toClaritin ® ), CVS/pharmacy ® Acid Reducer 150(compare to Zantac ® 150), CVS/pharmacy ®Nasal Decongestant (compare to Sudafed ® )and many others. There are more than 1,300eligible health-related CVS store brand andexclusive brand products.items include (but are not limited to) CVS/pharmacy ® Ibuprofen (compare to Advil ® ),CVS/pharmacy ® Allergy Relief (compare toClaritin ® ), CVS/pharmacy ® Acid Reducer 150(compare to Zantac ® 150), CVS/pharmacy ®Nasal Decongestant (compare to Sudafed ® )and many others. There are more than 1,300eligible health-related CVS store brand andexclusive brand products.items include (but are not limited to) CVS/pharmacy ® Ibuprofen (compare to Advil ® ),CVS/pharmacy ® Allergy Relief (compare toClaritin ® ), CVS/pharmacy ® Acid Reducer 150(compare to Zantac ® 150), CVS/pharmacy ®Nasal Decongestant (compare to Sudafed ® )and many others. There are more than 1,300eligible health-related CVS store brand andexclusive brand products.Is Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith Plan1,135 1,135 (37 preferred pharmacies). 1,135 (37 preferred pharmacies).Quick Tip 36Veterans Linkage Line (1-888-546-5838)Areas of expertise include:• Veterans benefits• Homeless veterans• Veteran and dependent education• Veterans Administration Medical Center issues• TRICARE• Veterans homes• Veterans counseling145

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.sterlingplans.comSterling Rx ® S4802-0301-866-445-9792 (Enrollment); 1-888-858-8572 (Sales)TTY: 1-888-858-856724 hrs a day, 7 days a weekwww.medicarerxrewards.comMedicareRxRewards Standard S5960-1311-866-892-5334TTY: 1-800-241-68948 a.m.-8 p.m., 7 days a weekwww.medicarerxrewards.comMedicareRxRewards Plus S5960-1561-866-892-5334TTY: 1-800-241-68948 a.m.-8 p.m., 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$50.40 $37.70 $38.60Part D Annual Deductible $310 (For brand name drugs only) $310 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $31 co-pay. 25% co-insurance. $43-$129 co-pay.• Generic Drug: $9 co-pay. $6.50-$19.50 co-pay. $7-21 co-pay.• Non-preferredBrand Name Drug:N/A 25% co-insurance. $85-$255 co-pay.• Specialty Drug: 25% co-insurance. 25% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. No.Does Part D Cover theShingles Vaccine?Yes-Partial. Out-of-pocket cost for enrollee varies.Call plan.No. No.Provide Part D ExtraServices and Coverage(if it applies)None. N/A N/AIs Mail Order Available? Yes. Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanSee pharmacy locator atwww.sterlingplanspharmacy.com/pharmacy.php.Many. Many.www.uamedicarepartd.com146

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®www.uamedicarepartd.comUA Medicare PartD Silver Plan S5755-0631-866-299-3406TTY: 1-866-524-41708 a.m. to 8 p.m., 7 days a weekwww.uamedicarepartd.comUA Medicare Part DPDP S5755-0281-866-299-3406TTY: 1-866-524-41708 a.m. to 8 p.m., 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$49.50 $53.20Part D Annual Deductible $105; Deductible does not apply to generic drugs. $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $45 co-pay for 34-day supply; $113 co-payfor 90-day mail-order supply.$36 co-pay for 34-day supply; $72 co-payfor 90-day mail-order supply.• Generic Drug: $4 co-pay for 34-day supply; $10 co-payfor 90-day mail-order supply.$7 co-pay for 34-day supply; $18 co-payfor 90-day mail-order supply.• Non-preferredBrand Name Drug:$90 co-pay for 34-day supply; $225 co-payfor 90-day mail-order supply.$72 co-pay for 34-day supply; $144 co-payfor 90-day mail-order supply.• Specialty Drug: 25% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No.Does Part D Cover theShingles Vaccine?No. No.Provide Part D ExtraServices and Coverage(if it applies)N/A N/AIs Mail Order Available? Yes. Yes.Number of Pharmaciesin MN that Participatewith PlanMany. Many.Quick Tip 37If you are a grandparent raising a grandchild, checkout the MinnesotaHelp.info ®Youth Resource Advisor at www.youth.minnesotahelp.info/resourcenavigator. This tool letsyou create an individualizedplan and guides you to resourcesin your local community thatcan assist both you and yourgrandchild.147

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug Planswww.AARPMedicareRx.comAARP MedicareRx Saver S5921-2471-888-867-5575TTY: 71124 hours a day, 7 days a weekwww.AARPMedicareRx.comAARP MedicareRx Preferred S5920-0241-888-867-5575TTY: 71124 hours a day, 7 days a weekwww.AARPMedicareRx.comAARP MedicareRx Enhanced S5921-2491-888-867-5575TTY: 71124 hours a day, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$31.20 $43.30 $76.50Part D Annual Deductible $310 $0 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $25 co-pay. $42 co-pay. $42 co-pay.• Generic Drug: $6 co-pay. $7 co-pay. $7 co-pay.• Non-preferredBrand Name Drug:$95 co-pay. $69 co-pay. $90 co-pay.• Specialty Drug: 25% co-insurance. 33% co-insurance. 33% co-insurance.• Tiered Drug: All drugs on this plan's formulary are tiered 1-4. All drugs on this plan's formulary are tiered 1-4. All drugs on this plan's formulary are tiered 1-4.Does the Part D Plan ProvideAny Donut Hole Coverage?No. No. Yes; Many generics. The member pays $14for tier 1 generic drugs.Does Part D Cover theShingles Vaccine?Yes. Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for Enrollee$25 co-pay (Zostavax ® covered in all threeAARP plans in 2010).$42 co-pay (Zostavax ® covered in all threeAARP plans in 2010).$42 co-pay (Zostavax ® covered in all threeAARP plans in 2010).Provide Part D ExtraServices and Coverage(if it applies)N/A N/A This plan provides discounts from 15% to 55% ondrugs not covered by CMS and Medicare. Membersusing their Part D plan card can receive thesediscounts at the pharmacy. Prescription vitamins, antianxietyand erectile dysfunction drugs are examples.Is Mail Order Available? Yes. Co-pay discounts and free shipping directly todoor when preferred mail pharmacy used.Yes. Co-pay discounts and free shipping directly todoor when preferred mail pharmacy used.Yes. Co-pay discounts and free shipping directly todoor when preferred mail pharmacy used.Number of Pharmaciesin MN that Participatewith Plan1,080 1,080 1,080148

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®www.Universal-American-Medicare.comCommunity CCRx Basic (PDP) S5803-0941-866-423-5040TTY: 1-866-684-53518 a.m. to 8 p.m. in your local time zone every daywww.Universal-American-Medicare.comCommunity CCRx Choice (PDP) S5803-1621-866-423-5040TTY: 1-866-684-53518 a.m. to 8 p.m. in your local time zone every daywww.Universal-American-Medicare.comCommunity CCRx Gold (PDP) S5803-2421-866-423-5040TTY: 1-866-684-53518 a.m. to 8 p.m. in your local time zone every dayService Area All 87 Minnesota counties. All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$33.80 $40.10 $79.50Part D Annual Deductible $310 $150 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: 30% co-insurance. $35 co-pay for preferred brand name;$105 co-pay for 90-day supply.$35 co-pay for preferred brand name;$105 co-pay for 90-day supply.• Generic Drug: $0 co-pay. $5 co-pay; $15 co-pay for 90-day supply. $6 co-pay; $18 co-pay for 90-day supply.• Non-preferredBrand Name Drug:60% co-insurance. $65 co-pay; $195 co-pay for 90-day supply. $65 co-pay; $195 co-pay for 90-day supply.• Specialty Drug: N/A 29% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No. No.Does Part D Cover theShingles Vaccine?Yes. Yes. No.If Yes, Shingles VaccineOut-of-Pocket Cost for EnrolleeProvide Part D ExtraServices and Coverage(if it applies)60% co-insurance. $65 Call plan.N/A N/A N/AIs Mail Order Available? No. No. No.Number of Pharmaciesin MN that Participatewith Plan1,119 1,119 1,119149

Health Care Choices for Minnesotans on MedicareStand Alone Medicare Prescription Drug PlansStand Alone Medicare Prescription Drug PlansUniversal Americanwww.Universal-American-Medicare.comPrescribaRx Bronze (PDP) S5597-2591-800-823-9990TTY: 1-800-777-90838 a.m. to 8 p.m. in your local time zone every dayUniversal Americanwww.Universal-American-Medicare.comPrescribaRx Gold (PDP) S5597-0571-800-823-9990TTY: 1-800-777-90838 a.m. to 8 p.m. in your local time zone every dayService Area All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$34.50 $37.80Part D Annual Deductible $310 $150Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: 25% co-insurance. $43 co-pay.• Generic Drug: 25% co-insurance. $6 co-pay.• Non-preferredBrand Name Drug:N/A N/A• Specialty Drug: 25% co-insurance. 29% co-insurance.• Tiered Drug: N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No.Does Part D Cover theShingles Vaccine?Yes. Yes.If Yes, Shingles VaccineOut-of-Pocket Cost for Enrollee25% co-insurance. $43 co-pay.Provide Part D ExtraServices and Coverage(if it applies)N/A N/AIs Mail Order Available? Yes. Yes. 2 co-pays for 90-day supply.Number of Pharmaciesin MN that Participatewith Plan1,119 1,119Quick Tip 38To replace a lost or damagedSocial Security card, call 1-800-772-1213 or go to www.ssa.gov/ssnumber/Quick Tip 39www.Medicare.gov is the officialMedicare website that includeseverything from ordering aMedicare publication to findinga doctor in Minnesota thatparticipates in Medicare.150

Stand Alone Medicare Prescription Drug PlansA publication of the Minnesota Board on Aging Senior LinkAge Line ®www.wellcare.comWellCare Classic S5967-1621-888-908-5252TTY: 1-888-816-52527 a.m. to 2 a.m. ET, 7 days a weekwww.wellcare.comWellCare Signature S5967-0591-888-908-5252TTY: 1-888-816-52527 a.m. to 2 a.m. ET, 7 days a weekService Area All 87 Minnesota counties. All 87 Minnesota counties.Part D PDPMonthly Premium$40.90 $49.70Part D Annual Deductible $310 $0Part D Cost Sharingand Co-pays PerPrescription Drug:• Brand Name Drug: $36 co-pay. $42 co-pay.• Generic Drug: $4 co-pay. $0 co-pay.• Non-preferredBrand Name Drug:$77 co-pay. $85 co-pay.• Specialty Drug: 25% co-insurance. 33% co-insurance.• Tiered Drug: N/A N/ADoes the Part D Plan ProvideAny Donut Hole Coverage?No. No.Does Part D Cover theShingles Vaccine?No. No.Provide Part D ExtraServices and Coverage(if it applies)None. None.Is Mail Order Available? No. No.Number of Pharmaciesin MN that Participatewith PlanN/A N/AQuick Tip 40Medicare does not pay for mostlong-term care services. It isbetter to plan sooner ratherthan later to meet your longtermcare needs.Quick Tip 41Go to http://www.mnaging.org/pdf/SMP_Healthcare_Journal.pdf to get a free copy of thePersonal Health Care Journal tohelp you take an active role inyour own health care.151

Health Care Choices for Minnesotans on MedicareYour Rights: Medicare Part A, B, C and D AppealsYou have the right to appeal any decision about yourMedicare services. This is true whether you are in OriginalMedicare, a Medicare Advantage plan, other Medicare planor Medicare Part D stand alone prescription drug plan. IfMedicare does not pay for an item or service you have beengiven, or if you are not given an item or service you thinkyou should get, you can appeal.Fast Track Appeals under Original MedicareIf you are receiving Medicare services from a hospital, askilled nursing facility, a home health agency, an outpatientrehabilitation facility, or a hospice, you have the right to askfor a fast or expedited appeal if you think that your coveredservices are ending too soon.At least two days before your health care services will end,these types of Medicare providers must give you a writtennotice, usually called “Important Message from Medicare”or “Notice of Medicare Provider Non-coverage.” The noticewill explain how you can appeal to Medicare’s QualityImprovement Organization (QIO), a private contractorhired by Medicare to decide this type of appeal. You can askyour doctor for medical information to help your appeal.In Minnesota, our QIO is Stratis Health. If you believe youare being discharged from the hospital too soon, did notreceive the proper quality of care or will lose any servicesyou had been receiving from a provider, you should callStratis Health right away to appeal these decisions. StratisHealth has phone numbers for each type of complaint inorder to assist you as quickly as possible.You must contact Stratis Health (QIO) to ask for a fastappeal no later than noon of the day before your Medicareservices will end. If you meet this deadline for a fast appealand the QIO decides your services should end, Medicarewill continue to pay only until the next day at noon. Youwill be responsible for any charges after that time. If StratisHealth decides your care should continue, Medicare willcontinue the coverage for as long as it decides the care ismedically necessary.If you did not meet the time deadline for a fast appeal, youstill have standard appeal rights and should contact StratisHealth immediately.Original Medicare Part A and B Appeal RightsIf you are enrolled in Original Medicare, you can file anappeal if you think Medicare should have paid for, ordid not pay enough for, an item or service you received.If you file an appeal, ask your doctor or provider for anyinformation related to the bill that might help your case.Your appeal rights are on the back of the Explanation ofMedicare Benefits or Medicare Summary Notice that ismailed to you from the company that handles bills forMedicare. The notice will also tell you why your bill was notpaid and what appeal steps you can take.Stratis Health1-866-894-1327Appeal your date of discharge.1-877-624-1414Appeal discontinuing services outsidea hospital setting.1-800-443-4323Quality of care complaint.152

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Original Medicare Part A and B Appeals Process• Medicare Summary Notice (MSN) is issued to you quarterly if you have received any Medicare services or supplies.• The MSN lists all of the services or supplies that were billed to Medicare for a 90 day period of time.• If you disagree with a claims decision on your MSN, you have the right to file an appeal.Original Medicare Part A and Part B Appeals processLevel/Type of Appeal Time Limit Amount at Issue Who Handles Appeal?RedeterminationQualified IndependentContractor (QIC)ReconsiderationYou must request within120 days of receiptof the notice of initialdetermination (MedicareSummary Notice).You must request within180 days from the date ofreceipt of the notice of theredetermination.No minimumamount required.No minimumamount required.Medicare Administrative Contractor—different staff than those that made theInitial Determination.Medicare Part AQIC Part A West ProjectMAXIMUS Federal Services, Inc.QIC Part A West ProjectP.O. Box 62410King of Prussia, PA 19406Phone: 484-688-8900 or 1-800-MEDICAREMedicare Part BFirst Coast Service Options (FCSO)FCSO–QIC Part B NorthP.O. Box 45208Jacksonville, Florida 32232-5029Phone: 904-791-6330 or1-800-MEDICAREPart B Durable Medical EquipmentRiver Trust SolutionsDME QICRiverTrust Solutions, Inc.1 Cameron Hill CircleSte 0011Chattanooga, TN 37402-0011Phone: 423-535-4386 or 1-800-MEDICAREAdministrative LawJudge Hearing (ALJ)You must request within 60days after the receipt of thereconsideration notice.2010 minimum amount= $130Office of Medicare Hearings and AppealsCleveland, Ohio (Mid-West Field Office –including MN)BP Tower, Suite 1300,200 Public Square,Cleveland, OH 44114-2316Phone: 866-236-5089Medicare AppealsCouncil(MAC)You must request within60 days from the date ofreceipt of the ALJ decision.No minimumamount required.Department of Health and Human ServicesDepartmental Appeals BoardMedicare Appeals Council, MS 6127Cohen Building Room G-644330 Independence Ave., S.W.Washington, D.C. 20201Phone: 202-565-0100Federal District CourtYou must request within60 days of the date of theMAC’s decision.2010 minimum amount= $1,260U. S. District Court: District of Minnesota153

Health Care Choices for Minnesotans on MedicareMedicare Advantage (Part C) AppealsMedicare Advantage plans are private companies thatinclude inpatient, outpatient, and drug coverage throughenrollment in a managed care plan (HMO, PPO, PFFS,etc.). Medicare Advantage beneficiaries have appeal rightsthat are similar to Original Medicare beneficiaries’ appealrights.If you are in a Medicare managed care plan, you can file anappeal if your plan will not pay for, does not allow, or stopsa service that you think should be covered or provided.If you think your health could be seriously harmed bywaiting for a decision about a service, ask the plan for a fastdecision. The plan must answer you within 72 hours.The Medicare managed care plan must tell you in writinghow to appeal. After you file an appeal, the plan will reviewits decision. Then, if your plan does not decide in yourfavor, the appeal is reviewed by an independent organizationthat works for Medicare, not for the plan. See your plan’smembership materials or contact your plan for details aboutyour Medicare appeal rights.Level/Type of AppealOrganizationalDeterminationFirst Level of AppealReconsideration by Plan:If you disagree with yourMedicare AdvantagePlan’s decision, you,your representative, oryour doctor may ask fora reconsideration as thefirst level of appeal. Ifyour plan decides or yourdoctor tells the plan thatyour life or health is atrisk, the plan must givean expedited decision.Reconsideration byIndependent ReviewEntity (IRE)Medicare Advantage and Other Medicare Plans (Part C) AppealsTime LimitThe Medicare Advantage plan must give youits decision within 14 calendar days afterthe date your plan received your requestand 72 hours for an Expedited OrganizationDetermination request.You have 60 days to file yourReconsideration request.The Medicare Advantage plan must giveyou its decision within 30 calendar days fora standard request, 60 calendar days for apayment request, and 72 hours for a fast(expedited) appeal.You have 60 days to request IREReconsideration, however, the MedicareAdvantage Plan is required to forward yourcase to the IRE for review if they deny yourreconsideration request. The IRE’s decisionwill come within 30 calendar days for astandard request, 60 calendar days for apayment request, and 72 hours for a fast(expedited) appeal.Administrative Law Judge You must request the hearing within 60 days(ALJ)of your unfavorable reconsideration decision.Medicare AppealsCouncil (MAC)Federal District CourtYou have 60 days to request an appeal tothe Medicare Appeals Council if you disagreewith the ALJ decision.You have 60 days to file an action in FederalDistrict Court.Amount at IssueNo minimumamount required.No minimumamount required.No minimumamount required.2010 minimumamount =$130No minimumamount required.2010 minimumamount = $1,260Medicare Advantage PlanWho Handles Appeal?Medicare Advantage PlanIf plan denies coverage, your case must be forwarded to theIndependent Review Entity (MAXIMUS)Independent Review Entity for MNMAXIMUS Federal Services, Inc.Medicare Managed Care Reconsideration Project50 Square Drive, Suite 210 Victor, New York 14564Phone: 585-425-5210 or 1-800-MEDICAREOffice of Medicare Hearings and AppealsCleveland, Ohio (Mid-West Field Office – including MN)BP Tower, Suite 1300,200 Public Square,Cleveland, OH 44114-2316Phone: 866-236-5089Department of Health and Human ServicesDepartmental Appeals BoardMedicare Appeals Council, MS 6127Cohen Building Room G-644330 Independence Ave., S.W.Washington, D.C. 20201Phone: 202- 565-0100U. S. District Court: District of Minnesota154

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Medicare Prescription Drug (Part D) AppealsIf you are in a Medicare prescription drug plan, youcan appeal a decision not to provide or pay for a Part Dprescription drug that you believe the plan should provideor pay for. The word “provide” includes such things asauthorizing prescription drugs, paying for prescriptiondrugs, or continuing to provide a Part D prescription drugthat you have been getting. The Medicare prescriptiondrug plan must tell you in writing how to request anappeal.If you request a standard appeal, the plan must answer youwithin 7 calendar days after receiving your request. If you(or your physician) think your health could be seriouslyharmed by waiting up to 7 calendar days for a decision,you or your physician can ask the plan for a fast appeal. Ifthe request is approved, the plan must answer you within72 hours.After you file an appeal, the plan will review its decision. Ifthe plan does not decide in your favor, you can appeal thedecision to an Independent Review Organization (IRE)that works for Medicare, not for the plan. See your planmembership materials or contact your plan for detailsabout your appeal rights.Medicare Advantage (Part C) and Medicare Part DGrievancesA grievance is any complaint or dispute, (other than onethat involves an organization determination), expressingdissatisfaction with any aspect of the operations, activities,or behavior of a Medicare health plan, or its providers,regardless of whether remedial action is requested.You must file the grievance either orally or in writing nolater than 60 days after the triggering event or incidentprecipitating the grievance.Listed below are some examples of problems that aretypically dealt with through the plan grievance process:• Problems getting an appointment, or having to wait a longtime for an appointment• Disrespectful or rude behavior by doctors, nurses or otherplan clinic or hospital staff• Difficulties getting through to the Part D plan155

Health Care Choices for Minnesotans on MedicareMedicare Part D AppealsLevel/Type of AppealTime LimitAmount at IssueWho Handles Appeal?Exception/Coverage Determination: You oryour prescriber may ask for an exceptionor a coverage determination from your PartD drug plan if it denies payment for yourprescription.This request must usually be in writing,unless your plan will accept it by phone.In most cases, your prescriber must faxthe information to your drug plan, statingthe medical reasons why no similar drugscovered by your plan can be substituted forthe prescribed drug.The drug plan has 72 hours(for a standard request) or24 hours (for an expeditedrequest) to notify you of itsdecision. If you disagreewith your drug plan’sdecision, you then proceedto the next appeal level.No minimumamount required.Your Medicare Prescription Drug planThe time limits for the drug plan’s decisionare much shorter than the limits for PartA and Part B decisions. In addition, if thedrug plan decides on its own or your doctoror prescriber tells the drug plan that yourlife or health is at risk, the drug plan mustmake a fast or expedited decision.First Level of Appeal:RedeterminationYou, your representative,doctor, or prescriber mustrequest a redeterminationwithin 60 days of the drugplan’s decision. The drugplan must decide withinseven calendar days for astandard request and 72hours for an expeditedrequest.No minimumamount required.Your Medicare Prescription Drug planReconsiderationIf you disagree with yourdrug plan’s decision, youhave 60 days to requestreconsideration fromMedicare’s IndependentReview Entity (IRE).The IRE must give you adecision within seven daysfor a standard appeal and72 hours for an expeditedrequest.No minimumamount required.Independent Review Entity for Minnesota:MAXIMUS Federal ServicesPart D QIC1040 First Ave. Suite 200King of Prussia, PA 19406Phone: 484-688-5600 or 877-240-6965Administrative Law Judge (ALJ)You must request thehearing within 60 daysof your unfavorablereconsideration decision.2010 minimum amount=$130Office of Medicare Hearings and AppealsCleveland, Ohio (Mid-West Field Office –including MN)BP Tower, Suite 1300,200 Public Square,Cleveland, OH 44114-2316Phone: 866-236-5089Medicare Appeals Council (MAC)You have 60 days to requestan appeal to the MedicareAppeals Council if youdisagree with the ALJ’sdecision.No minimumamount required.Department of Health and Human ServicesDepartmental Appeals BoardMedicare Appeals Council, MS 6127Cohen Building Room G-644330 Independence Ave., S.W.Washington, D.C. 20201Phone: 202- 565-0100Federal District CourtYou have 60 days to file anaction in Federal DistrictCourt.2010 minimum amount =$1,260U.S. District Court: District of Minnesota156

Health Care Fraud: Don’t Become a VictimA publication of the Minnesota Board on Aging Senior LinkAge Line ®Health care fraud affects thousands of individuals acrossthe country each year. It is estimated that billions of dollarsare lost each year because of scams and errors. Luckily, inMinnesota we do not experience a lot of fraud. However,there are several ways fraud or errors can occur within thehealth care system and Medicare. Some examples includeinappropriate marketing practices by plans, billing forservices that were never received, identity theft and more.The good news is that you can protect yourself so youdon’t fall victim to health care fraud.The annual enrollment period is a prime time for certaintypes of fraud to occur. However, there are strict guidelinesin place that outline marketing practices that Stand AlonePrescription Drug Plans and Medicare Advantage Plansmust follow. Most agents in Minnesota comply with therules, but sometimes there are exceptions. If you feel anagent or plan violates any of the marketing practices listedbelow, call the Senior LinkAge Line® at 1-800-333-2433to report the issue.Stand Alone Prescription Drug and Medicare Advantage Plans must:• Only use marketing materials that have been reviewedand approved by the Centers for Medicare & MedicaidServices (CMS)• Comply with the “Do Not Call” registry• Provide information in a professional manner• Use Minnesota licensed, certified or registeredindividuals to market plans• Medicare approved Prescription Drug Plans use this sealon their materialsStand Alone Prescription Drug and Medicare Advantage Plans may not:• Solicit door-to-door, unless invited• Send unsolicited email• Enroll people by phone unless the person calls them• Offer cash payment as an incentive to enroll• Pressure or scare a person into enrolling in a planOther types of fraud can occur throughout the year.Some examples of health care scams that are common inMinnesota include:• Free medical tests or supplies: Organizations advertisefor free tests, medical services or medical supplies. Inreturn, they ask for your Medicare, Social Security orinsurance numbers. Within a few weeks, Medicare oryour insurance will be charged for expensive services younever received or your identity may even be stolen.• Telemarketing scams: Scammers will pay a lot ofmoney for a list that contains names of individuals onMedicare. They then call people from the list pretendingto be someone from Medicare. When they call you,they will state you need a new Medicare card or theyneed to check on your benefits. They will ask you foryour personal information including Medicare number,Social Security number, sometimes even bank accountinformation. Soon, your identity, and maybe yourmoney, is stolen.• $299, $399, $499 scams: This scam is used to obtainyour bank account information, in addition to otherpersonal information. Sometimes, real companies usethis ploy to get you to pay for something, but do notreally offer anything in return. Most often, you will beasked to join a prescription drug plan or insurance planfor one annual payment of $299, $399 or $499. Theymay say that you will receive all your prescription drugsor health care under this plan. However, when you goto the pharmacy or are admitted to the hospital, youdiscover you do not really have any coverage to pay forthese costs.157

Health Care Choices for Minnesotans on MedicareKnowing how to protect yourself and your personalinformation is the best way to avoid billing errors oridentify theft. Here are some tips to help you protectyourself and others:• Treat your Medicare and Social Security cards like acredit card number. Never give these numbers to astranger.• Do not carry these cards with you unless you willneed it.• Remember, Medicare does not call, visit or sell youanything.• Record doctor visits, tests and procedures in a calendaror journal.• Read your Medicare Summary Notice (MSN). Comparethis to what you have recorded in your calendar orjournal. If you are being billed for services you neverreceived or billed twice for a service, call the SeniorLinkAge Line® to report it.• If a product or service is free, you should not have toprovide any personal information.• Never sign a blank form or a form you do notunderstand. Read all forms and don’t hesitate to ask forhelp from someone you trust if you do not understandthe form. You will almost never be required to sign upfor a plan or service the same day it is offered to you.Take time to get your questions answered.Sometimes you may disagree with a decision your doctoror health plan has made even though it is not fraud. Youdo have options in these situations. Please see the articleabout appeals in this publication.When you disagree with the quality of care or a decisionprovided by your health care provider or plan, you canappeal this decision.If you feel you are the victim of fraud, want to file acomplaint or would like to learn more about how toprotect yourself, please call the Senior LinkAge Line ®at 1-800-333-2433.158

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Beyond Medicare: Consider Your Long-Term Care Partnership Insurance Optionby Tina Armstrong, MN Dept of CommerceWhether or not to purchase long-term care insurance is adecision that can have a significant impact on your longtermfinancial security as well as your current monthlybudget. Especially now, when some long-term careinsurance premiums have increased significantly, it is veryimportant to fully understand what you are buying and ifyou can afford the cost of coverage.Long-term care (LTC) insurance first came on the marketabout 30 years ago to help people cover future nursinghome costs. When and if you need long-term care services,the policy will provide benefits that may allow you tokeep more of your personal savings. Today’s long-termcare policies offer more choices and cover more than justnursing home costs, but long-term care insurance may notbe right for everyone.Who Pays for Long-Term Care?Many people don’t realize until it’s too late that privatehealth insurance, Medicare, and private Medicaresupplement insurance will cover little, if any, long-term careexpenses. That leaves most people paying their long-termcare costs out of their own pockets until they have spentmost of their assets and can qualify for Medical Assistance(Medicaid). Also, if you are in need of long-term carebenefits, it is already too late to purchase a policy.Medical Assistance (Medicaid) eligibility requires you tomeet certain income and asset limits. Currently, abouthalf of all nursing home costs in Minnesota are paid byMedical Assistance for people who have wiped out mostof their assets and income paying for long-term careexpenses. Purchasing long-term care insurance, includinga Minnesota Long-term Care Partnership policy, can helpyou cover much of the cost of long-term care.What is the Minnesota Long-Term Care Partnership?Minnesota now has the Long-Term Care Partnership thatprovides an opportunity for you to purchase a specific typeof long-term care insurance policy, called a Long-TermCare Partnership policy. These policies permit you to gainadditional asset protection if later you need to apply forMedical Assistance (Medicaid) to help pay for your LTCservices.The Minnesota Long-Term Care Partnership was approvedon July 1, 2006. Under the Partnership, individuals whopurchase a long-term care insurance policy that meets thePartnership requirements, are provided additional assetprotection. The asset protection equals the amount thePartnership policy has paid in benefits if you later need toapply for Medical Assistance (Medicaid) to help pay forlong-term care services.Insurance10%Medicare17%Other5%Out-of-Pocket21%Medicaid/Medical Assistance47%Which Carriers Sell Minnesota Long-term CarePartnership Policies?More than 30 insurers sell long-term care insurance inMinnesota. To sell Partnership policies, insurers musthave their policies certified by the State of MinnesotaDepartment of Commerce. To view the current list ofcompanies offering certified Minnesota Long-Term CarePartnership policies, go to www.MinnesotaHelp.info ®and search for “Long-Term Care Partnership InsuranceCompanies”.How Does a Policy Qualify as Partnership?Long-Term Care Partnership policies must meet specificrequirements set down by the Federal government in theDeficit Reduction Act of 2005 (DRA).159

Health Care Choices for Minnesotans on MedicareIn order for an insurance company to market a policyas a Minnesota Long Term Care Partnership policy, thecompany:• Must certify the policy is tax-qualified;• Must make sure the policy includes specified consumerprotection requirements of the National Associationof Insurance Commissioners (NAIC) Long Term CareInsurance Model Act and Regulation; and• Make sure the policy meets requirements that specifyinflation protection be included based on the age of theMinnesota resident.What are the Inflation Protection Requirements inMinnesota for a Long-Term Care Partnership Policy?• If a policy is sold to a person under the age of 61, it mustprovide compound annual inflation protection to qualifyfor the Long-Term Care Partnership.• If a policy is sold to a person aged 61 through 75, thepolicy must provide some level of inflation protection toqualify for the Long-Term Care Partnership.• If a policy is sold to a person aged 76 or over, inflationprotection is not required in order for the policy toqualify for the Long-Term Care Partnership. However,the policyholder may wish to purchase inflationprotection.How Much do Minnesota Long-Term CarePartnership and Other Long-Term Care InsurancePolicies Cost?As with other types of insurance, the cost of long-termcare insurance varies according to the coverage you selectand other factors, such as your health, medical history, andmost importantly, your age when it is issued. The olderyou are when you purchase a policy, the more you will pay.However, the younger you are at the time of purchase, thelonger you will pay premiums.The choices offered and to be considered when purchasinga long-term care policy include the following:• Elimination period: The initial length of time you mustreceive long-term care before the policy starts payingbenefits.• Daily benefit: The maximum payment per day of caredefined in the policy.• Maximum benefit length: The total length of time thepolicy will pay benefits.• Maximum dollar benefit: The total benefits that couldbe paid. (This equals the daily benefit multiplied by themaximum benefit length in days.)• Non-forfeiture benefit: A reduced benefit that may beavailable if the policy lapses.• Type of coverage: Nursing home only, home health careonly, assisted living, or some combination of the three.• Inflation coverage: A periodic increase over time in thedaily benefit amount.Does the Purchase of Long-Term Care Insurance Make Sense Financially?The decision about whether or not to purchase long-termcare insurance is largely a matter of your current financialsituation, your expected future financial situation andwhat your long-term financial goals are.Long-Term Care Insurance may NOT be right for you if:• Your main source of income is your Social Securitybenefit or Supplemental Security Income (SSI).• You often have trouble paying for utilities, food,medicine or other important basic needs.• You have limited income and assets and would quicklybecome eligible for Medical Assistance (Medicaid) if youor your spouse had to go into a nursing home.• You cannot afford to pay $100 to $200 (or more) permonth for long-term care insurance premiums nowand into the future. This amount is in addition to otherhealth care policy or plan premiums you may be paying.nAs a rule of thumb, your premium should not be morethan 7% of your monthly income.nAs with any insurance, you must keep paying yourpremiums to keep the policy in force.nIf the premiums increase to the point you can nolonger afford the insurance, you may have to drop thecoverage, losing everything you’ve paid.• You have strong family support and know that familymembers will provide your long-term care needs,including continual help with daily activities such aseating, bathing and dressing.160

A publication of the Minnesota Board on Aging Senior LinkAge Line ®• You have sufficient income and assets to pay for you andyour spouse’s long-term care AND you are willing to useyour money to pay for long-term care.Long-term Care Insurance may be right for you if:• You can comfortably afford long-term care insurancepremiums, now and into the future, even if thepremiums increase.• You have assets that you want to protect and pass ontoyour family rather than using your assets to pay for longtermcare.• You want to pay for your own care and stay independentof the financial support of others.• You want the option to make your own choices aboutwhere and how you receive long-term care. Most longtermcare policies cover services provided in the home, atassisted living facilities or nursing homes.Shopping for Long-Term Care InsuranceThe time to shop for long-term care insurance is beforeyou need it.• The longer you wait, the higher your premium willbe and the greater your chances of developing adisqualifying illness or disability.• Buying long-term care insurance is an importantindividual decision and you should plan to spend sometime looking into the various policies available, gettinganswers to your questions, and weighing your options.• Insurance policies are legal contracts. Read and comparethe benefits of different policies before you buy oneand make sure you understand all of the provisions.Always read the policy before you buy it. Don’t rely onmarketing or sales literature to provide the informationyou need to make an informed decision.• The company or agent must disclose to the applicanteach premium rate increase on the policy to be offered orsimilar policy forms over the past ten years.• Consult with experts. Depending on your financialsituation, it may be important to consult with a financialplanner, tax advisor, accountant, or an attorney. His orher area of expertise may help you make the right choiceabout long-term care insurance.• Take your time. Do not be pressured into buying apolicy by an agent who tells you there is a limitedenrollment period. A good agent will not rush you.Discuss your decision with a friend or relative whosejudgment you respect. Allow yourself time to thoroughlyreview all the information available.• Check out your agent. Companies and agents sellinginsurance products must be licensed in Minnesota. Ifthe agent cannot verify that he or she is licensed, do notbuy from that person. Check with the Department ofCommerce to confirm an agent’s licensing status at www.insurance.mn.gov or call the Minnesota Department ofCommerce at 651-296-2488 or 1-800-657-3602.• Review the policy outline. Minnesota law requires theinsurance company to provide an “Outline of Coverage”form that clearly describes the policy’s benefits andlimitations. You should receive this before the agentpresents an application or enrollment form. The outlineshould also clearly define the differences between aMedicare supplement policy and a long-term careinsurance policy. Read the outline carefully. If you areshopping around, compare the policy outlines from thedifferent companies.Long-Term Care Insurance Shopping Tips• Shop around before you buy. Policies differ incoverage, cost, and service. Contact several companiesand compare the coverage carefully. Get completeinformation from the insurance agent or representativeyou are working with. Look for a company with longtermstability. Check with A.M. Best or other ratingsfirms who keep tabs on financial institutions.• The cheapest policy may not be the best policy for you.While you want to shop for a good value, be carefulabout selecting the lowest rates. If a company has itsrates set too low, that may be an indication that it willhave to raise its rates later, meaning your premiums canrise to a level you may not be able to afford.161

Health Care Choices for Minnesotans on Medicare• Check for pre-existing condition limitations. Minnesotalaw requires long-term care policies to cover pre-existingconditions, but there is an exclusion period of up to sixmonths before you will receive benefits.• Beware of offers to replace your coverage. Be cautiousif anyone suggests that you cancel your current policyand buy a replacement policy, especially if it is with adifferent company or if it involves a change in benefits.The new policy may impose new pre-existing conditionlimitations. If you want to switch to lower benefits toreduce your premium, your current company may bewilling to do so.• If you decide to buy, complete the applicationcarefully. Most companies ask for detailed medicalinformation. If you leave out any medical informationrequested, coverage could be canceled, reduced ordenied. Don’t believe anyone who tells you that yourmedical history on an application is not important.Before you sign the application, make sure all thequestions have been answered correctly. Don’t assume thecompany representative accurately filled in your healthinformation.• Do not pay cash. Pay by check, money order, or bankdraft made payable to the insurance company, not to theagent or anyone else.• Policy delivery should be prompt. The insurancecompany should deliver a policy within 30 days ofaccepting your application. If you do not receive it,contact the company and inquire about the delay.If 60 days go by without information, contact theDepartment of Commerce at 651-296-2488 or1-800-657-3602.Read your policy when you receive it. All policies arerequired to provide a 30-day right-to-examine period.During this period, check the application you signedfor accuracy. Read your policy and ask questions aboutanything you do not understand. Often family membersor friends can help. If you wish to cancel the policy, callthe insurance company and return the policy by mailwithin 30 days of receiving it. You are entitled to a fullrefund with no questions asked. If you decide to keep thepolicy, make sure your family or friends know where yourpolicy is, when the premiums are due, and how to submitclaims to the insurance company. Be prepared to select arelative or close friend the company can notify if you failto pay the premium.Where should you go for more information?It is important for people of all ages to be aware of thepotential advantages and disadvantages of long-termcare insurance in relation to their individual situation.In addition to consulting with a financial planner,accountant, or attorney to get answers for specificquestions, Minnesotans can call the Senior LinkAge Line ®for objective information and counseling on the subject oflong-term care.Senior LinkAge Line ® 1-800-333-2433www.MinnesotaHelp.info ®• Specialists with the Minnesota Board on Aging’s SeniorLinkAge Line ® can help you decide what you need.The Senior LinkAge Line ® is the federally designatedState Health Insurance Assistance Program (SHIP)for Minnesota and provides Minnesotans with free,comprehensive, objective information and personalassistance and counseling with long-term care optionsplanning, including long-term care insurance. Assistanceis provided by phone or in person in all 87 countiesof Minnesota. Call 1-800-333-2433 or have a livechat with a Senior LinkAge Line ® specialist at www.MinnesotaHelp.info ® .Minnesota Department of Commercewww.insurance.mn.gov85 7th Place East, Suite 600St. Paul, MN 55101-2198Consumer Response Team:651-296-2488 (or 1-800-657-3602)• If you have a complaint about an agent or a companyselling long-term care insurance in Minnesota, callthe Minnesota Department of Commerce ConsumerResponse Team at the number listed above. Your inquirymay trigger an investigation that could help you andother consumers as well.162

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Beyond Medicare: Everything You Need to Know About Minnesota’s Long-term Care Choices NavigatorWhat is it?The Minnesota Long-term Care ChoicesNavigator is an easy-to-use internet tool located atwww.longtermcarechoices.minnesotahelp.info.The Navigator helps you create a personalized plan, nomatter where you live in Minnesota, to help you or theperson you are helping find what is needed and availableto live well and age well in the community.How do I use the MN Long-term Care Choices Navigator?• Go to www.longtermcarechoices.minnesotahelp.info• You can become a registered user by completing the“Registered Users” information.• If you do not want to register, you can just click the“Begin the Process” link and get started.• The Navigator is a simple to use tool that walks youthrough the process step by step.• You begin by answering questions that will create apersonal plan for you, your spouse, partner, parent, orfriend.• If the question doesn’t fit your situation, you can skipthat question and move on to the next question.What do you need to do?You will:1. Be asked to create your plan profile2. Build your community plan3. Answer questions about• daily living needs• memory loss• health insurance• housing modifications• safety and security• planning ahead• housing options• living in your home• assisted living• nursing homeWhat will you receive?Based on your answers to the questions, the Long-termCare Choices Navigator will provide you with:• Service and phone numbers to connect you to helpingprofessionals in your local community.• Long-term care recommendations.• Next steps like having a family meeting, addressingsafety concerns, and honoring the wishes of the personneeding help.• Your finished plan for you to save and print.What is the finished plan?Based on how you answered the questions, you will receivea personalized plan that includes:• A list of specific formal and informal services• Web sites• Tip sheets• Documents with detailed informationYour completed plan can be saved to yourcomputer, printed out, or saved by registering atwww.longtermcarechoices.minnesotahelp.info.All saved plans require you to create your own usernameand password to protect your identity and confidentiality.The Minnesota Long-term Care Choices Navigator is thefirst of several decision-making and planning tools thatare available on www.MinnesotaHelp.info ® . A Planningfor Your Future decision-making and planning tool is indevelopment.If you have questions about the Long-term Care ChoicesNavigator, please call the Senior LinkAge Line ® at1-800-333-2433 or have a live chat with a Senior LinkAgeLine ® specialist by visiting www.MinnesotaHelp.info ® .163

Health Care Choices for Minnesotans on MedicareBeyond Medicare: Prevent Falls and Stay HealthyFalls can happen anytime, anyplace, and to anyone.If you can answer yes to any of the following questions,schedule an appointment with your doctor or health careprovider to discuss your fall risk.• Have you fallen in the past year?• How many times have you fallen in the past year?• Are you afraid of falling?Everyone wants to live healthy and independent lives.Unfortunately, many will fall, especially seniors, resultingin injuries that can lead to serious health problems. Ifyou or someone you know has fallen, you are not alone.Nationally, more than a third of older adults will fall eachyear. Falls are not a part of the natural aging process.Many different factors play a role in causing falls including:• arthritis• poor vision• depression• impaired cognition• low blood pressure • poor balancewhen sitting or • medicationslying down• impaired gait• muscle weakness • bone diseaseThe good news is that falls are preventable.You can lower your chances of falling by following thesesimple tips:• Move your body every day to feel better and enjoy life more.nThirty minutes a day of exercise is recommended.nBreak it into 10-15 minute blocks if that is easier – it’sthe total that matters.nTalk to your doctor or health care provider aboutexercise programs that are right for you.• Review medications with your pharmacist and doctoror health care provider.nMedications include prescription medicines, vitamins,herbal supplements and over-the-counter productsbought at a drug store.nIt might surprise you how many commonly takenmedications, or combinations of medications, have sideeffects that can cause a loss of balance or make you feelunsteady on your feet.• Most falls occur at home. Don’t give your feet a reason to trip.nRemove throw and scatter rugs.nMove extension, appliance and telephone cords out ofyour path.nWatch where your pets are sleeping or lying down.• A brighter home is a safer home.nLight the path between the bedroom and bathroomwith nightlights.nKeep your glasses, and lamp or flashlight, within easyreach of your bed.• Falls can occur outdoors too.nWhen you step outside, give your eyes time to adjust tothe outdoor light.nTake care when walking on slippery, wet or icy surfaces.nDon’t hesitate to use your cane or walking aid – stayingindependent may depend on it.• Everyone’s vision changes with age.nIt can happen gradually so you might not even notice it.nHave an eye doctor check your eyes at least once a year.nSchedule the appointment around your birthday tohelp you remember.• Your feet get you where you need to go.nIf they hurt, you will be less active, which couldincrease your risk of falling.nKeep your feet clean and dry.nTrim toenails regularly using a nail clipper. If you areunable to care for your feet see a podiatrist.nWear shoes with non-skid soles that support your feet.Follow these tips to stay independent and lower yourchances of falling. For more information on fall preventionplease visit: www.mnfallsprevention.org or call theSenior LinkAge Line ® at 1-800-333-2433.164

A publication of the Minnesota Board on Aging Senior LinkAge Line ®Resource ListThis is not intended to be a comprehensive list of resources forMinnesota. For the most comprehensive statewide Minnesotaresource information visit www.MinnesotaHelp.info.MinnesotaHelp Network1. Minnesota Senior LinkAge Line ® 1-800-333-24332. Minnesota Disability Linkage Line ® 1-866-333-24663. Minnesota Veterans Linkage Line 1-888-LinkVet (546-5838)4. www.MinnesotaHelp.info ®Minnesota Ombudsman OfficesOffice of the Ombudsman for Long-term Care651-431-2555 or 1-800-657-3591• Investigates and works to resolve complaints about nursinghomes, other long-term care residential services, home careservices and hospitals relating to health, safety, welfare, rights andgovernment benefits• Provides information and educational programs to enableconsumers to advocate for their own quality of care and qualityof life within the health and long-term care systemOffice of the Ombudsman for Mental Healthand Developmental Disabilities651-757-1800 or 1-800-657-3507• Promotes the highest attainable standards of treatment forpersons receiving services for mental illness, developmentaldisabilities and related conditions, chemical dependency andemotional disturbance• Receives and investigates complaints, and provides advocacy andmediation on behalf of individual clients, as well as the reviewand investigation of broad systemic issues, serious injuries anddeathsOmbudsman for State Managed Health Care651-431-2660 or 1-800-657-3729 ext. 61256• Assists persons enrolled in a health plan for their MedicalAssistance, General Assistance Medical Care, and MinnesotaCarehealth benefits in resolving service related problems, to ensurethat medically appropriate services are provided• Provides information about the managed health care complaintand appeal process available through the health plan and theStateOmbudsman for Crime Victims651-201-7310 or 1-800-247-0390• Investigates reports of victim rights violations or mistreatment ofcrime victims or witnesses by any element of the criminal justicesystem or victim/witness service provider• Provides information and assistance to crime victims andprovides county specific referrals throughout the State ofMinnesotaMinnesota SHIP (State Health Insurance Assistance Program)Senior LinkAge Line ®1-800-333-2433• Statewide service that provides free, comprehensive, objectiveinformation and personalized assistance and counseling in all87 counties of Minnesota• Federally designated State Health Insurance Assistance Program(SHIP) for MinnesotaMinnesota SMP (Senior Medicare Patrol)Senior LinkAge Line ®1-800-333-2433• Statewide network to fight health care fraud, waste and abuse• Learn more about to detect, prevent, and report health care fraudMinnesota QIO–Quality Improvement OrganizationStratis Health952-854-3306 or 1-800-444-3423• Protects Minnesota Medicare consumers andthe Medicare Trust FundMinnesota Insurance RegulatorMinnesota Department of Commerce651-296-2488 or 1-800-657-3602• Oversight and regulation of companies selling Medicaresupplements, Medicare SELECT plans, and long-term careinsurance policiesMinnesota Managed Care Plan RegulatorMinnesota Department of Health651-201-5100 or 1-800-657-3916• Licenses and regulates health plans at the state level• Handles complaints from consumers about health plansMedicare (national)1-800-633-4227 or www.medicare.govSocial Security (national)1-800-772-1213 or www.ssa.govRailroad Retirees Medicare Carrier (national)1-800-833-4455Minnesota Department of Health Office ofHealth Facility Complaints651-201-4201 or 1-800-369-7994• Acts upon complaints about services in hospitals, nursing homes,home health agencies and other supervised living facilitiesMinnesota Attorney General’s Citizens’ Assistance Line651-296-3353 or 1-800-657-3787• Accepts complaints from citizens on a large variety of consumermatters, such as insurance, cars, health care, banking, credit,utilities, debt collection, mortgages, charities, scams, and more165

Health Care Choices for Minnesotans on MedicareMinnesota Department of Veterans AffairsVeterans Linkage Line 1-888-546-5838• Assists Minnesota veterans and their dependents to obtainthe benefits and services provided by the U.S. Departmentof Veterans Affairs• Connects veterans and their dependents to County VeteransService Officers available in all 87 counties of MinnesotaMinnesota Area Agencies on AgingProvide assistance to seniors, local agencies and communities acrossthe state, including providing the Senior LinkAge Line ® serviceat the local level• Arrowhead Area Agency on Aging (Duluth)218-722-5545nCounties served: Aitkin, Carlton, Cook, Itasca,Koochiching, Lake, and St. Louis• Central Minnesota Council on Aging (St. Cloud)320-253-9349nCounties served: Benton, Cass, Chisago, Crow Wing, Isanti,Kanabec, Mille Lacs, Morrison, Pine, Sherburne, Stearns,Todd, Wadena, and Wright• Land of Dancing Sky Area Agency on Aging(Warren and Fergus Falls)218-745-6733 (Warren)218-739-4617 (Fergus Falls)nCounties served: Becker, Clay, Douglas, Grant, Otter Tail,Pope, Stevens, Traverse, Wilkin Beltrami, Clearwater, Hubbard,Kittson, Lake of the Woods, Polk, Mahnomen, Marshall,Norman, Pennington, Red Lake, Roseau• Metropolitan Area Agency on Aging (North St. Paul)651-641-8612nCounties served: Anoka, Carver, Dakota, Hennepin, Ramsey,Scott, and Washington• Minnesota Chippewa Tribe Area Agency on Aging (CassLake)218-335-8585nReservations Served: Bois Forte, Grand Portage, Leech Lake,and White Earth• Minnesota River Area Agency on Aging (Mankato)507-389-8866nCounties served: Big Stone, Blue Earth, Brown, Chippewa,Cottonwood, Faribault, Jackson, Kandiyohi, Lac qui Parle,Le Sueur, Lincoln, Lyon, Martin, McLeod, Meeker, Murray,Nicollet, Nobles, Pipestone, Redwood, Renville, Rock, Sibley,Swift, Waseca, Watonwan, and Yellow Medicine• Southeastern Minnesota Area Agency on Aging (Rochester)507-288-6944nCounties served: Dodge, Fillmore, Freeborn, Goodhue,Houston, Mower, Olmsted, Rice, Steele, Wabasha,and WinonaMinnesota Association of Centers for Independent Living320-529-9000Advocate for the independent living needs of people withdisabilities so they may live independently in the situation andcommunity of their choice• Rochester Southeastern Minnesota Center for Independent Living507-285-1815nProvides the Disability LinkAge Line ® service1-866-333-2466• Metropolitan Center for Independent Living(Minneapolis and St. Paul)651-646-8342nProvides the Disability LinkAge Line ® service1-866-333-2466• St. Cloud Independent Lifestyles320-529-9000• Moorhead FREEDOM701-478-0459• East Grand Forks OPTIONS218-773-6100• Center for Independent Living ofNortheastern Minnesota Hibbing218-262-6675• Mankato Southern Minnesota IndependentLiving Enterprises and Services507-345-7139• Southwestern Center for Independent Living Marshall507-532-2221Minnesota Board on Aging651-431-2500 or 1-800-882-6262• Provide objective information and promote public educationon ways to meet the changing needs of Minnesota’s olderpopulation to age well and live wellnSenior LinkAge Line ® , Ombudsman for Long-term Care,RxConnect TM , and www.MinnesotaHelp.info ® are services ofthe Minnesota Board on Aging• Partner with Area Agencies and others to administer and overseethe effective use of Older Americans Act and state funds tosupport older Minnesotans• Promote policies to the State Legislature, Governor and State Agenciesthat fairly reflect the needs and interests of older Minnesotans• Published the 2010 edition of Health Care Choices forMinnesotans on Medicare166

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Health Care Choices for Minnesotans on MedicareNotes:168

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Health Care Choices for Minnesotans on MedicareTop three reasonsto apply for extra help withMedicare prescription drug costs.123Big savings.You could save more than$3,300 per year in MedicarePart D drug costs.Free in person help.People are available in yourcommunity to help you apply.One number to call.One free number to call for it all–theSenior LinkAge Line® at 1-800-333-2433Top three reasons to apply for extra helpwith Medicare prescription drug costs.Don’t miss out on the savings!You may qualify and not even know it.Call 1-800-333-2433 now to find out more.If you don’t qualify for the extra help, theSenior LinkAge Line® may be able to assistyou with other things including looking atways to reduce your prescription drug andother health care costs.170

A publication of the Minnesota Board on Aging Senior LinkAge Line ®• Simple searching• Up-to-date service options• Map your services• Navigating help for family and friendsA service of the Minnesota Board on Aging, MinnesotaHelp.info ® is aWeb based tool designed to help people in Minnesota find human resources,information and referral, financial assistance and other forms of help.What kind of services are in MinnesotaHelp.info ® ?There are over 31,000 services to help people of all ages including:• Seniors • People with disabilities • Caregivers • And more...What if I don’t know what I need?MinnesotaHelp.info ® has interactive tools that can help you find outwhat you need and then help you navigate your way to it.How do I get started?Open a Web Browser and type inCan’t find what you’re looking for or just needadditional information? Live chat is available.Click on the MinnesotaHelp NOW! icon at thetop of the page to chat or leave an email.171

Health Care Choices for Minnesotans on MedicareThings weren’t always so complicatedThere’s health insurance,life insurance, Long-termCare Partnership and all theother things that go alongwith planning for a healthy,independent lifestyle.Your linkto an expert.Call 1-800-333-2433 and you willbe linked to local experts who will help youon the phone, in person and on the web with:• Any Medicare question• Prescription drug help• Long-term care options counseling• Caregiver planning and support includinghome and community based services• Planning for your future172