Annual Notice of Changes for 2016

Transcription

1 WeCare Essentia (HMO-POS) offered by WeCare of Forida, Inc. Annua Notice of Changes for 2016 You are currenty enroed as a member of WeCare Essentia (HMO). Next year, there wi be some changes to the pan s costs and benefits. This booket tes about the changes. You have from October 15 unti December 7 to make changes to your Medicare coverage for next year. Additiona Resources This information is avaiabe for free in other anguages. Pease contact our Customer Service number at for additiona information. (TTY users shoud ca ). Hours are Monday-Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are avaiabe Monday-Sunday, 8 a.m. to 8 p.m. Customer Service aso has free anguage interpreter services avaiabe for non-engish speakers. Esta información se encuentra disponibe en otros idiomas gratis. Por favor comuníquese con nuestro Servicio a Ciente amando a , para información adiciona. (Los usuarios de TTY deben amar a ). E horario es de unes a viernes de 8 a.m. a 8 p.m. Entre e 1 de Octubre y e 14 de Febrero, os representantes están disponibes de unes a domingo de 8 a.m. a 8 p.m., hora de este. Servicio a ciente también tiene servicios disponibes de interpretación a otros idiomas gratis para personas que no haban ingés. This booket is aso avaiabe in different formats, incuding audio compact disc (CD). Pease ca Customer Service if you need pan information in another format (phone numbers are printed on the back cover of this booket). H1032_FL030203_WCM_CMB_ENG CMS Accepted Form CMS ANOC/EOC (Approved 03/2014) OMB Approva WeCare 2015 FL6091CMB66942E_0615

2 WeCare Essentia (HMO-POS) Annua Notice of Changes for About WeCare Essentia (HMO-POS) WeCare (HMO-POS) is a Medicare Advantage Organization with a Medicare contract. Enroment in WeCare (HMO-POS) depends on contract renewa. When this booket says we, us, or our, it means WeCare of Forida, Inc. When it says pan or our pan, it means WeCare Essentia (HMO-POS). Think about Your Medicare Coverage for Next Year Each fa, Medicare aows you to change your Medicare heath and drug coverage during the Annua Enroment Period. It s important to review your coverage now to make sure it wi meet your needs next year. Important things to do: o o o o o Check the changes to our benefits and costs to see if they affect you. Do the changes affect the services you use? It is important to review benefit and cost changes to make sure they wi work for you next year. Look in Sections 2.1, 2.2 and 2.5 for information about benefit and cost changes for our pan. Check the changes to our prescription drug coverage to see if they affect you. Wi your drugs be covered? Are they in a different tier? Can you continue to use the same pharmacies? It is important to review the changes to make sure our drug coverage wi work for you next year. Look in Section 2.6 for information about changes to our drug coverage. Check to see if your doctors and other providers wi be in our network next year. Are your doctors in our network? What about the hospitas or other providers you use? Look in Section 2.3 for information about our Provider and Pharmacy Directory. Think about your overa heath care costs. How much wi you spend out-of-pocket for the services and prescription drugs you use reguary? How much wi you spend on your premium? How do the tota costs compare to other Medicare coverage options? Think about whether you are happy with our pan. If you decide to stay with WeCare Essentia (HMO-POS):

3 WeCare Essentia (HMO-POS) Annua Notice of Changes for If you want to stay with us next year, it s easy - you don t need to do anything. If you decide to change pans: If you decide other coverage wi better meet your needs, you can switch pans between October 15 and December 7. If you enro in a new pan, your new coverage wi begin on January 1, Look in Section 3.2 to earn more about your choices. Summary of Important Costs for 2016 The tabe beow compares the 2015 costs and 2016 costs for WeCare Essentia (HMO-POS) in severa important areas. Pease note this is ony a summary of changes. It is important to read the rest of this Annua Notice of Changes and review the encosed Evidence of Coverage to see if other benefit or cost changes affect you. Monthy pan premium* * Your premium may be higher or ower than this amount. (See Section 2.1 for detais.) $0.00 $0.00 Maximum out-of-pocket amount This is the most you wi pay out-of-pocket for your covered Part A and Part B services. (See Section 2.2 for detais.) $6,700 $6,700

4 WeCare Essentia (HMO-POS) Annua Notice of Changes for Doctor office visits Primary care visits: $0 per visit Primary care visits: $0 per visit Inpatient hospita stays Incudes inpatient acute, inpatient rehabiitation, ong-term care hospitas and other types of inpatient hospita services. Inpatient hospita care starts the day you are formay admitted to the hospita with a doctor s order. The day before you are discharged is your ast inpatient day. Part D prescription drug coverage (See Section 2.6 for detais.) Speciaist visits: $15 per visit You pay a $75 per day for Days 1-8 $0 per day for Days 9-90 $0 for additiona hospita days. No imit to the number of days covered by the pan. Cost share appies Per admission. Speciaist visits: $30 per visit You pay a $100 per day for Days 1-8 $0 per day for Days 9-90 Cost share appies Per admission. Deductibe: $0 Deductibe: $0

5 WeCare Essentia (HMO-POS) Annua Notice of Changes for Copayment/Coinsurance during the Initia Coverage Stage: Drug Tier 1: Preferred Cost- Sharing: $0.00 Standard Cost- Sharing: $0.00 Drug Tier 2: Preferred Cost- Sharing: $10.00 Standard Cost- Sharing: $16.00 Drug Tier 3: Preferred Cost- Sharing: $25.00 Standard Cost- Sharing: $35.00 Drug Tier 4: Preferred Cost- Sharing: $60.00 Standard Cost- Sharing: $75.00 Drug Tier 5: Preferred Cost- Sharing: 33% Standard Cost- Sharing: 33% Copayment/Coinsurance during the Initia Coverage Stage: Drug Tier 1: Standard Cost- Sharing: $0.00 Drug Tier 2: Standard Cost- Sharing: $13.00 Drug Tier 3: Standard Cost- Sharing: $36.00 Drug Tier 4: Standard Cost- Sharing: 38% Drug Tier 5: Standard Cost- Sharing: 33%

6 WeCare Essentia (HMO-POS) Annua Notice of Changes for Annua Notice of Changes for 2016 Tabe of Contents Think about Your Medicare Coverage for Next Year... 2 Summary of Important Costs for SECTION 1 Uness You Choose Another Pan, You Wi Be Automaticay Enroed in WeCare Essentia (HMO-POS) in SECTION 2 Changes to Benefits and Costs for Next Year... 7 Section 2.1 Changes to the Monthy Premium... 7 Section 2.2 Changes to Your Maximum Out-of-Pocket Amount.. 7 Section 2.3 Changes to the Provider Network... 8 Section 2.4 Changes to the Pharmacy Network... 9 Section 2.5 Changes to Benefits and Costs for Medica Services... 9 Section 2.6 Changes to Part D Prescription Drug Coverage SECTION 3 Deciding Which Pan to Choose Section 3.1 If you want to stay in WeCare Essentia (HMO-POS) Section 3.2 If you want to change pans SECTION 4 Deadine for Changing Pans SECTION 5 Programs That Offer Free Counseing about Medicare SECTION 6 Programs That Hep Pay for Prescription Drugs SECTION 7 Questions? Section 7.1 Getting Hep from WeCare Essentia (HMO-POS).. 21 Section 7.2 Getting Hep from Medicare... 22

7 WeCare Essentia (HMO-POS) Annua Notice of Changes for SECTION 1 Uness You Choose Another Pan, You Wi Be Automaticay Enroed in WeCare Essentia (HMO-POS) in 2016 On January 1, 2016, WeCare of Forida, Inc. wi be combining WeCare Essentia (HMO) with one of our pans, WeCare Essentia (HMO-POS). If you have not done anything to change your Medicare coverage by December 7, 2015, we wi automaticay enro you in our WeCare Essentia (HMO-POS). This means starting January 1, 2016, you wi be getting your medica and prescription drug coverage through WeCare Essentia (HMO-POS). If you want to, you can change to a different Medicare heath pan. You can aso switch to Origina Medicare. If you want to change, you must do so between October 15 and December 7. The information in this document tes you about the differences between your current benefits in WeCare Essentia (HMO) and the benefits you wi have on January 1, 2016 as a member of WeCare Essentia (HMO-POS). Section 2 Changes to Benefits and Costs for Next Year Section 2.1 Changes to the Monthy Premium Monthy premium (You must aso continue to pay your Medicare Part B premium.) $0.00 $0.00 Your monthy pan premium wi be more if you are required to pay a ate enroment penaty. If you have a higher income, you may have to pay an additiona amount each month directy to the government for your Medicare prescription drug coverage. Your monthy premium wi be ess if you are receiving Extra Hep with your prescription drug costs Section 2.2 Changes to Your Maximum Out-of-Pocket Amount To protect you, Medicare requires a heath pans to imit how much you pay out-of-pocket during the year. This imit is caed the maximum

8 WeCare Essentia (HMO-POS) Annua Notice of Changes for out-of-pocket amount. Once you reach this amount, you generay pay nothing for covered Part A and Part B services for the rest of the year. Maximum out-of-pocket amount Your costs for covered medica services (such as s) count toward your maximum out-of-pocket amount. Your costs for prescription drugs do not count toward your maximum out-of-pocket amount. $6,700 $6,700 Section 2.3 Changes to the Provider Network Once you have paid $6,700 out-of-pocket for covered Part A and Part B services, you wi pay nothing for your covered Part A and Part B services for the rest of the caendar year. Our network has changed more than usua for An updated Provider and Pharmacy Directory is ocated on our website at You may aso ca Customer Service for updated provider information or to ask us to mai you a Provider and Pharmacy Directory. We strongy suggest that you review our current Provider and Pharmacy Directory to see if your providers (primary care provider, speciaists, hospitas, etc.) are sti in our network. It is important that you know that we may make changes to the hospitas, doctors and speciaists (providers) that are part of your pan during the year. There are a number of reasons why your provider might eave your pan but if your doctor or speciaist does eave your pan you have certain rights and protections summarized beow: Even though our network of providers may change during the year, Medicare requires that we furnish you with uninterrupted access to quaified doctors and speciaists. When possibe we wi provide you with at east 30 days notice that your provider is eaving our pan so that you have time to seect a new provider. We wi assist you in seecting a new quaified provider to continue managing your heath care needs.

9 WeCare Essentia (HMO-POS) Annua Notice of Changes for If you are undergoing medica treatment you have the right to request, and we wi work with you to ensure, that the medicay necessary treatment you are receiving is not interrupted. If you beieve we have not furnished you with a quaified provider to repace your previous provider or that your care is not being appropriatey managed you have the right to fie an appea of our decision. If you find out your doctor or speciaist is eaving your pan pease contact us so we can assist you in finding a new provider and managing your care. Section 2.4 Changes to the Pharmacy Network Amounts you pay for your prescription drugs may depend on which pharmacy you use. Medicare drug pans have a network of pharmacies. In most cases, your prescriptions are covered ony if they are fied at one of our network pharmacies. Our network incudes a mai service pharmacy with preferred mai service cost-sharing, which may offer you ower cost-sharing than the standard cost-sharing offered by other pharmacies within the network. Our network has changed more than usua for An updated Provider and Pharmacy Directory is ocated on our website at You may aso ca Customer Service for updated provider information or to ask us to mai you a Provider and Pharmacy Directory. We strongy suggest that you review our current Provider and Pharmacy Directory to see if your pharmacy is sti in our network. Section 2.5 Changes to Benefits and Costs for Medica Services We are changing our coverage for certain medica services next year. The information beow describes these changes. For detais about the coverage and costs for these services, see Chapter 4, Medica Benefits Chart (what is covered and what you pay), in your 2016 Evidence of Coverage.

10 WeCare Essentia (HMO-POS) Annua Notice of Changes for INPATIENT SERVICES Inpatient Hospita Stays You pay a $75 per day for Days 1-8 $0 per day for Days 9-90 $0 for additiona hospita days. No imit to the number of days covered by the pan. You pay a $100 per day for Days 1-8 $0 per day for Days 9-90 Cost share appies Per admission Cost share appies Per admission Inpatient Menta Heath Care You pay a $75 per day for Days 1-8 $0 per day for Days 9-90 You pay a $150 per day for Days 1-8 $0 per day for Days 9-90 Skied Nursing Faciity (SNF) Cost share appies Per admission You pay a $0 per day for Days 1-20 $ per day for Days Cost share appies Per admission You pay a $0 per day for Days 1-20 $160 per day for Days OUTPATIENT SERVICES Cost share appies Per benefit period Speciaist Visit You pay a $15 Cost share appies Per benefit period

11 WeCare Essentia (HMO-POS) Annua Notice of Changes for Other Professiona Services (such as nurse practitioner, physician assistant or cinica nurse speciaist) You pay a $15 You pay a $0 for services performed in a PCP office. Chiropractic Services Medicare-Covered Chiropractic Visit You pay a $15 Routine Chiropractic Visit You pay a $15 each visit for 24 visits every year Podiatry Services Medicare-Covered Podiatry Visit You pay a $15 Psychiatric Services Individua Session You pay a $15 Group Session You pay a $5 Outpatient Menta Heath Care Individua Session You pay a $15 Group Session You pay a $5 Outpatient Substance Abuse Care Individua Session You pay a $15 Group Session You pay a $5 for services performed in a speciaist s office. You pay a $20 You pay a $20 each visit for 12 visits every year You pay a $40 You pay a $40 You pay a $40 You pay a $40 You pay a $50 You pay a $50

12 WeCare Essentia (HMO-POS) Annua Notice of Changes for Outpatient Hospita Care Surgica Services You pay a $25 Non-Surgica Services You pay a $25 Ambuatory Surgica Center (ASC) You pay a $15 Ambuance Services You pay a $100 You pay a $100 You pay a $100 You pay a $75 You pay a $200 Urgenty Needed Services and Emergency Care Co-pay is the same as above if admitted to the hospita. Emergency Care You pay a $65 Urgenty Needed Services You pay a $20 Wordwide Coverage (for Emergency or Urgenty Needed Services) Wak-in and Pharmacy Cinics You pay a $65 There is a $25,000 maximum coverage for wordwide emergency or urgent care. You pay a $15 Outpatient Rehabiitation Services Occupationa Therapy You pay a $15 Physica Therapy and/or Speech/Language Therapy You pay a $15 Co-pay is the same as above if admitted to the hospita. You pay a $75 You pay a $25 You pay a $75 There is a $25,000 maximum coverage for wordwide emergency or urgent care. You pay a $25

13 WeCare Essentia (HMO-POS) Annua Notice of Changes for Cardiac Rehabiitation At a Physician's Office You pay a $15 At an Outpatient Hospita You pay a $25 Pumonary Rehabiitation At a Physician's Office You pay a $15 At an Outpatient Hospita You pay a $25 Diagnostic Tests, X-Rays, Lab Services, and Radioogy Services Basic Diagnostic Tests (such as aergy test or EKG) Advanced Diagnostic Tests (such as cardiac stress test) Therapeutic Radioogy At a Provider's Office or Freestanding Faciity You pay a $20 You pay a $50 You pay a $15 At an Outpatient Hospita You pay a $15 ADDITIONAL SERVICES Denta Services Medicare-Covered Denta You pay a $15 You pay a $75 You pay 20% of the tota cost

14 WeCare Essentia (HMO-POS) Annua Notice of Changes for Routine Denta (imitations and excusions appy) Hearing Services Medicare-Covered Hearing Exam (diagnostic hearing exams ony) Fuoride treatments and Comprehensive services are not covered. You pay a $0 copay for covered routine preventive services which are not subject to an annua maximum doar amount. You pay a $15 Vision Services Medicare-Covered Eye Exam You pay a $15 Point-of-Service (POS) (see your Evidence of Coverage for a compete ist of covered services) POS benefit is not covered. You pay a $0 copay for one fuoride treatment per year and the foowing Comprehensive services: periodontics, extractions, restorative and other ora/maxiofacia surgery. The maximum benefit amount of $500 every year appies to a covered routine services Pease refer to your Evidence of Coverage for covered services. You pay 45% of the tota cost Section 2.6 Changes to Part D Prescription Drug Coverage Changes to Our Drug List Our ist of covered drugs is caed a Formuary or Drug List. A copy of our Drug List is in this enveope.

15 WeCare Essentia (HMO-POS) Annua Notice of Changes for We made changes to our Drug List, incuding changes to the drugs we cover and changes to the restrictions that appy to our coverage for certain drugs. Review the Drug List to make sure your drugs wi be covered next year and to see if there wi be any restrictions. If you are affected by a change in drug coverage you can: Work with your doctor (or other prescriber) and ask the pan to make an exception to cover the drug. We encourage current members to ask for an exception before next year. To earn what you must do to ask for an exception, see Chapter 9 of your Evidence of Coverage (What to do if you have a probem or compaint (coverage decisions, appeas, compaints)) or ca Customer Service. Work with your doctor (or other prescriber) to find a different drug that we cover. You can ca Customer Service to ask for a ist of covered drugs that treat the same medica condition. In some situations, we are required to cover a one-time, temporary suppy of a non-formuary in the first 90 days of coverage of the pan year or coverage. (To earn more about when you can get a temporary suppy and how to ask for one, see Chapter 5, Section 5.2 of the Evidence of Coverage.) During the time when you are getting a temporary suppy of a drug, you shoud tak with your doctor to decide what to do when your temporary suppy runs out. You can either switch to a different drug covered by the pan or ask the pan to make an exception for you and cover your current drug. Meanwhie, you and your doctor wi need to decide what to do before your temporary suppy of the drug runs out. Perhaps you can find a different drug covered by the pan that might work just as we for you. You can check the formuary on our website or ca Customer Service to ask for a ist of covered drugs that treat the same medica condition. This ist can hep your doctor to find a covered drug that might work for you. You and your doctor can aso ask the pan to make an exception for you and continue to cover the drug. You can ask for an exception in advance for next year and we wi give you an answer to your request before the change takes effect. There are certain requirements that must be met so to earn what you must do to ask for an exception, see the Evidence of Coverage that was incuded in the maiing with this Annua Notice of Changes. Look for Chapter 9 of the Evidence of Coverage (What to do if you have a probem or compaint (coverage

16 WeCare Essentia (HMO-POS) Annua Notice of Changes for decisions, appeas, compaints).) If you received a favorabe formuary exception during 2015 you may not need to obtain a new formuary exception in At the time of the approva, we woud have indicated in the approva notice how ong the authorization is vaid. Changes to Prescription Drug Costs Note: If you are in a program that heps pay for your drugs ( Extra Hep ), the information about costs for Part D prescription may not appy to you. We have incuded a separate insert, caed the Evidence of Coverage Rider for Peope Who Get Extra Hep Paying for Prescription Drugs (aso caed the Low Income Subsidy Rider or the LIS Rider ), which tes you about your drug costs. If you get Extra Hep and didn t receive this insert with this packet, pease ca Customer Service and ask for the LIS Rider. Phone numbers for Customer Service are in Section 7.1 of this booket. There are four drug payment stages. How much you pay for a Part D drug depends on which drug payment stage you are in. (You can ook in Chapter 6, Section 2 of your Evidence of Coverage for more information about the stages.) The information beow shows the changes for next year to the first two stages - the Yeary Deductibe Stage and the Initia Coverage Stage. (Most members do not reach the other two stages - the Coverage Gap Stage or the Catastrophic Coverage Stage. To get information about your costs in these stages, ook at Chapter 6, Sections 6 and 7, in the encosed Evidence of Coverage.) Changes to the Deductibe Stage Stage 1: Yeary Deductibe Stage Because we have no deductibe, this payment stage does not appy to you. Because we have no deductibe, this payment stage does not appy to you. Changes to Your Cost-sharing in the Initia Coverage Stage

17 WeCare Essentia (HMO-POS) Annua Notice of Changes for For drugs on Non-Preferred Brand Drugs, your cost-sharing in the initia coverage stage is changing from ment to coinsurance. Pease see the foowing chart for the changes from 2015 to To earn how ments and coinsurance work, ook at Chapter 6, Section 1.2, Types of out-of-pocket costs you may pay for covered drugs in your Evidence of Coverage. Stage 2: Initia Coverage Stage During this stage, the pan pays its share of the cost of your drugs and you pay your share of the cost. Your cost for a one-month suppy at a network pharmacy: Tier 1 (Preferred Generic Drugs): Standard cost-sharing: You pay $0.00 per prescription. Preferred cost-sharing: You pay $0.00 per prescription. Your cost for a one-month suppy at a network pharmacy: Tier 1 (Preferred Generic Drugs): Standard cost-sharing: You pay $0.00 per prescription. Tier 2 (Non-Preferred Generic Drugs): Standard cost-sharing: You pay $16.00 per prescription. Tier 2 (Generic Drugs): Standard cost-sharing: You pay $13.00 per prescription. Preferred cost-sharing: You pay $10.00 per prescription. Tier 3 (Preferred Brand Drugs): Standard cost-sharing: You pay $35.00 per prescription. Tier 3 (Preferred Brand Drugs): Standard cost-sharing: You pay $36.00 per prescription. Preferred cost-sharing: You pay $25.00 per prescription.

18 WeCare Essentia (HMO-POS) Annua Notice of Changes for For 2015 you paid a $75.00 ment for drugs on this tier. For 2016 you wi pay 38% coinsurance for drugs on this tier. The costs in this row are for a one-month (30-day) suppy when you fi your prescription at a network pharmacy. For information about the costs for a ong-term suppy or for mai service prescriptions, ook in Chapter 6, Section 5 of your Evidence of Coverage. We changed the tier for some of the drugs on our Drug List. To see if your drugs wi be in a different tier, ook them up on the Drug List. Tier 4 (Non-Preferred Brand Drugs): Standard cost-sharing: You pay $75.00 per prescription. Preferred cost-sharing: You pay $60.00 per prescription. Tier 5 (Speciaty Tier Drugs): Standard cost-sharing: You pay 33% of the tota cost. Preferred cost-sharing: You pay 33% of the tota cost. Once your tota drugs costs have reached $2,960, you wi move to the next stage (the Coverage Gap Stage). Tier 4 (Non-Preferred Brand Drugs): Standard cost-sharing: You pay 38% of the tota cost. Tier 5 (Speciaty Tier Drugs): Standard cost-sharing: You pay 33% of the tota cost. Once your tota drugs costs have reached $3,310, you wi move to the next stage (the Coverage Gap Stage). Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages - the Coverage Gap Stage and the Catastrophic Coverage Stage - are for peope with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. For information about your costs in these stages, ook at Chapter 6, Sections 6 and 7, in your Evidence of Coverage.

19 WeCare Essentia (HMO-POS) Annua Notice of Changes for Section 3 Deciding Which Pan to Choose Section 3.1 If you want to stay in WeCare Essentia (HMO-POS) To stay in our pan you don t need to do anything. If you do not sign up for a different pan or change to Origina Medicare by December 7, you wi automaticay stay enroed as a member of our pan for Section 3.2 If you want to change pans We hope to keep you as a member next year but if you want to change for 2016 foow these steps: Step 1: Learn about and compare your choices You can join a different Medicare heath pan, -- OR-- You can change to Origina Medicare. If you change to Origina Medicare, you wi need to decide whether to join a Medicare drug pan and whether to buy a Medicare suppement (Medigap) poicy. To earn more about Origina Medicare and the different types of Medicare pans, read Medicare & You 2016, ca your State Heath Insurance Assistance Program (see Section 5), or ca Medicare (see Section 7.2). You can aso find information about pans in your area by using the Medicare Pan Finder on the Medicare website. Go to and cick Find heath & drug pans. Here, you can find information about costs, coverage, and quaity ratings for Medicare pans. Step 2: Change your coverage To change to a different Medicare heath pan, enro in the new pan. You wi automaticay be disenroed from WeCare Essentia (HMO-POS). To change to Origina Medicare with a prescription drug pan, enro in the new drug pan. You wi automaticay be disenroed from WeCare Essentia (HMO-POS). To change to Origina Medicare without a prescription drug pan, you must either:

20 WeCare Essentia (HMO-POS) Annua Notice of Changes for Send us a written request to disenro. Contact Customer Service if you need more information on how to do this (phone numbers are in Section 7.1 of this booket). or Contact Medicare, at MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenroed. TTY users shoud ca Section 4 Deadine for Changing Pans If you want to change to a different pan or to Origina Medicare for next year, you can do it from October 15 unti December 7. The change wi take effect on January 1, Are there other times of the year to make a change? In certain situations, changes are aso aowed at other times of the year. For exampe, peope with Medicaid, those who get Extra Hep paying for their drugs, and those who move out of the service area are aowed to make a change at other times of the year. For more information, see Chapter 10, Section 2.3 of the Evidence of Coverage. If you enroed in a Medicare Advantage pan for January 1, 2016, and don t ike your pan choice, you can switch to Origina Medicare between January 1 and February 14, For more information, see Chapter 10, Section 2.2 of the Evidence of Coverage. Section 5 Programs That Offer Free Counseing about Medicare The State Heath Insurance Assistance Program (SHIP) is a government program with trained counseors in every state. In Forida, the SHIP is caed Serving Heath Insurance Needs of Eders (SHINE). Serving Heath Insurance Needs of Eders (SHINE) is independent (not connected with any insurance company or heath pan). It is a state program that gets money from the Federa government to give free oca heath insurance counseing to peope with Medicare. Serving Heath Insurance Needs of Eders (SHINE) counseors can hep you with your Medicare questions or probems. They can hep you understand your Medicare pan choices and answer questions about switching pans. You

21 WeCare Essentia (HMO-POS) Annua Notice of Changes for can ca Serving Heath Insurance Needs of Eders (SHINE) at TTY users shoud ca Section 6 Programs That Hep Pay for Prescription Drugs You may quaify for hep paying for prescription drugs. Section 7 Extra Hep from Medicare. Peope with imited incomes may quaify for Extra Hep to pay for their prescription drug costs. If you quaify, Medicare coud pay up to 75% or more of your drug costs incuding monthy prescription drug premiums, annua deductibes, and coinsurance. Additionay, those who quaify wi not have a coverage gap or ate enroment penaty. Many peope are eigibe and don t even know it. To see if you quaify, ca: MEDICARE ( ). TTY users shoud ca , 24 hours a day/7 days a week; The Socia Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users shoud ca, (appications); or Your State Medicaid Office (appications). Prescription Cost-sharing Assistance for Persons with HIV/AIDS. The AIDS Drug Assistance Program (ADAP) heps ensure that ADAP-eigibe individuas iving with HIV/AIDS have access to ife-saving HIV medications. Individuas must meet certain criteria, incuding proof of State residence and HIV status, ow income as defined by the State, and uninsured/under-insured status. Medicare Part D prescription drugs that are aso covered by ADAP quaify for prescription cost-sharing assistance through the Forida AIDS Drug Assistance Program. For information on eigibiity criteria, covered drugs, or how to enro in the program, pease ca Forida AIDS Drug Assistance Program at (TTY users shoud ca ) Questions? Section 7.1 Getting Hep from WeCare Essentia (HMO-POS) Questions? We re here to hep. Pease ca Customer Service at (TTY ony, ca ) We are avaiabe for

22 WeCare Essentia (HMO-POS) Annua Notice of Changes for phone cas Monday Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are avaiabe Monday Sunday, 8 a.m. to 8 p.m. Cas to these numbers are free. Read your 2016 Evidence of Coverage (it has detais about next year's benefits and costs) This Annua Notice of Changes gives you a summary of changes in your benefits and costs for For detais, ook in the 2016 Evidence of Coverage for WeCare Essentia (HMO-POS). The Evidence of Coverage is the ega, detaied description of your pan benefits. It expains your rights and the rues you need to foow to get covered services and prescription drugs. A copy of the Evidence of Coverage is incuded in this enveope. Visit our website You can aso visit our website at As a reminder, our website has the most up-to-date information about our provider network (Provider and Pharmacy Directory) and our ist of covered drugs (Formuary/Drug List). Section 7.2 Getting Hep from Medicare To get information directy from Medicare: Ca MEDICARE ( ) You can ca MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca Visit the Medicare website You can visit the Medicare website ( It has information about cost, coverage, and quaity ratings to hep you compare Medicare heath pans. You can find information about pans avaiabe in your area by using the Medicare Pan Finder on the Medicare website. (To view the information about pans, go to and cick on Find heath & drug pans ). Read Medicare & You 2016 You can read the Medicare & You 2016 Handbook. Every year in the fa, this booket is maied to peope with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most

23 WeCare Essentia (HMO-POS) Annua Notice of Changes for frequenty asked questions about Medicare. If you don t have a copy of this booket, you can get it at the Medicare website ( or by caing MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca