Your 2017 Kaiser Permanente Guide to Medicare. Kaiser Permanente Senior Advantage (HMO) Kaiser Permanente Medicare Plus (Cost) Y0043_N accepted

Transcription

1 Your 2017 Kaiser Permanente Guide to Medicare Kaiser Permanente Senior Advantage (HMO) Kaiser Permanente Medicare Plus (Cost) Y0043_N accepted

2 Gain knowledge and confidence in choosing the right Medicare coverage

3 Understand the ABCDs of Medicare and get key insights into Kaiser Permanente Whether you re enrolling in Medicare for the first time or shopping for a new plan to better suit your needs, we can help you make a confident, informed decision. We created this useful guide to provide the information you need to help you choose the right Medicare coverage. You ll also get a better understanding of what Kaiser Permanente has to offer, with easy guides and steps that explain the benefits of becoming a Kaiser Permanente member. TABLE OF CONTENTS Original Medicare: an overview 2 Understanding your basic Medicare options 3 Understanding prescription drug coverage 6 Choosing the right Medicare coverage 8 Enrollment periods 9 Medicare Star Quality Ratings 10 Questions & answers about the Ratings 11 Discover what a Kaiser Permanente Medicare health plan has to offer 14 Predictable costs and a low monthly premium 15 A wide selection of great doctors and specialists 15 Convenient features to make staying healthy easy 16 Designed to support all your healthcare needs 17 Benefits to help manage your prescription drug costs 17 Nationwide locations for your convenience 19 1

4 Original Medicare: an overview Understanding Parts A, B, C & D Medicare is a federal health insurance program that covers millions of Americans. This basic health insurance provision is a part of Social Security. To be eligible for Medicare, you must be a legal U.S. citizen and a resident for 5 years. 2

5 Understanding your basic Medicare options Original Medicare is fee-for-service health coverage managed by the federal government. It includes both Part A and Part B. PART A Hospital insurance Part A helps cover your inpatient care, if you meet certain conditions, in Medicare-certified hospitals and other facilities. These include the following: Hospitals and inpatient rehabilitation facilities Inpatient stays in a skilled nursing facility (not custodial or long-term care) Hospice care services Home health care services Inpatient care in a religious, nonmedical health care institution WHEN YOU TURN 65, you are eligible to receive Medicare Part A without having to pay premiums if the following conditions apply: You already get retirement benefits from Social Security or the Railroad Retirement Board. You are eligible to get Social Security or Railroad benefits but haven t yet filed for them. You or your spouse worked for at least 10 years and paid Medicare taxes. IF YOU ARE UNDER AGE 65, you can get Part A without having to pay premiums if you meet one of the following conditions: You have received Social Security or Railroad Retirement Board disability benefits for 24 months. You have end-stage renal disease and meet certain requirements. IF YOU AREN T ELIGIBLE FOR PREMIUM-FREE PART A, and you meet citizenship and residency requirements, you may be able to buy it if you meet one of the following conditions: You didn t work or didn t pay enough Medicare taxes while you worked, and you are 65 or older. You are disabled and have returned to work. In most cases, if you choose to buy Part A, you must also enroll in Part B and pay the monthly Part B premium. You can enroll by calling Social Security at (TTY for the deaf, hard of hearing, or speech impaired), Monday through Friday, 7 a.m. to 7 p.m., or by going online to SocialSecurity.gov. If you have Part A, HOSPITAL (PART A) is printed on your red, white, and blue Medicare card. If you have limited income and resources, your state may help you pay for Part A, Part B, or both. 3

6 PART B PART C 4 Medical insurance Part B helps cover medically necessary services like doctors services, outpatient care, and other medical services not covered under Part A. Part B also helps cover many preventive screenings such as mammograms, Pap tests, colorectal and prostate cancer screenings, and heart disease and diabetes screenings. Part B helps cover tests such as X-rays and blood work; medical equipment, such as wheelchairs and walkers; outpatient physical therapy; mental health care; and ambulance services. If enrolled in Part B, you pay a monthly premium, which is typically deducted from your Social Security check. The Part B premium is $ per month. Part B premiums are higher for people with annual incomes over $85,000 ($170,000 per couple). You also pay a $ Part B annual deductible before Medicare starts to pay its share for covered services. Note: The above dollar amounts are for 2016 and may change in If you have Part B, MEDICAL (PART B) is printed on your red, white, and blue Medicare card. As you can see, Original Medicare doesn t cover all medical costs. You can buy additional coverage through private health plans to help cover those expenses Original Medicare doesn t cover. Medicare Advantage Part C, also known as Medicare Advantage, is offered by private insurance companies that are approved by Medicare and includes both Part A and Part B. Some Medicare Advantage plans also include Part D prescription drug coverage for an extra cost. Medicare pays an amount for your coverage each month to these private health plans. In many plans, you pay a copayment for covered services, and you may be required to see plan physicians. For plans that require you to use network providers, Medicare and the plan will not pay for routine care from out-of-network providers. DIFFERENT TYPES OF MEDICARE ADVANTAGE PLANS: Health Maintenance Organization (HMO) plans Point-of-Service (HMO-POS) plans Preferred Provider Organization (PPO) plans Private Fee-for-Service (PFFS) plans Medical Savings Account (MSA) plans Special Needs Plans (SNP) RATES What you pay depends on the following: If the plan charges a monthly premium in addition to your Part B premium If the plan pays any of your monthly Part B premium If you are subject to a Part D late enrollment penalty Your yearly deductible Your copayments and coinsurance The types of services you will need Whether the plan includes a limit on out-of-pocket costs

7 ELIGIBILITY You may join a Medicare Advantage plan if you meet the following qualifications: You have Medicare Parts A and B. You live in the service area of the plan, if applicable. You don t have end-stage renal disease (exceptions apply). You enroll when the plan is accepting enrollment (for example, during the Annual Enrollment Period or during a Special Enrollment Period). MEDICARE COST PLANS Like Medicare Advantage plans, Medicare Cost plans are a type of health plan available through private insurance companies in certain areas of the country. Cost plans may offer extra benefits and may include Medicare prescription drug coverage. You can either get your Medicare prescription drug coverage from the plan, if offered, or from a Medicare Prescription Drug Plan (PDP). With a Cost plan, if you go to a non-network provider, the services are usually covered under Original Medicare. If you have Part A and Part B and go to a non-network provider, the services are covered under Original Medicare. You would pay the Part A and Part B Original Medicare coinsurance and deductibles. PART D Prescription drug coverage To get Part D, you must join a Medicare Cost or Medicare Advantage plan that includes prescription drug coverage or join a separate Medicare Prescription Drug Plan. These plans are administered by insurance companies and private companies approved by Medicare. Each plan can vary in cost and drugs covered. Financial assistance that could reduce or eliminate Part D premiums, deductibles, and copayments is available for people on Medicare with limited incomes. If you think you might qualify for Extra Help, contact Social Security at , Monday through Friday, 7 a.m. to 7 p.m. TTY users should call Or visit SocialSecurity.gov. A Cost plan allows you to do the following: Join even if you only have Part B Join a plan with Part D coverage any time the plan is accepting new members (for example, during the Annual Enrollment Period) Join a plan without Part D coverage any time during the year Leave any time and return to Original Medicare 5

8 Understanding prescription drug coverage Part D factors to keep in mind All prescription drug, Medicare Advantage, and Medicare Cost plans that offer Part D must provide coverage that is equivalent to or better than the standard Part D benefit. These plans have the ability to enhance the standard Part D benefit by any or all of these means: Removing the deductible Including cost shares that are different from, but equivalent to or better than, the standard benefit Covering certain drugs through the coverage gap Part D plans must keep track of your drug expenses as well as their own. For any month that you receive pharmacy services, you will receive a statement of activity, called an Explanation of Benefits (EOB), which shows all of your Part D drug purchases, along with updated cost and expense information. When you meet certain dollar limits established by Medicare, you will move through the Part D coverage stages and pay different cost shares. These dollar limits change each calendar year. There are different kinds of costs you pay throughout the year with standard Medicare Part D prescription drug coverage 6 MONTHLY PART D PREMIUM A premium is your monthly cost to maintain coverage. Monthly premium amounts vary by plan. Some plans have no monthly premium. You pay your monthly Part D premium in addition to the Part B premium. YEARLY DEDUCTIBLE This is the amount you must pay each year for your prescriptions before your plan starts to pay its share. Some plans have no deductible, so you get coverage immediately. INITIAL COVERAGE STAGE Once you have reached your annual deductible amount (if any), you pay your share (as a fixed copayment or coinsurance amount), and your plan pays its share for covered drugs up to a specified drug cost limit. You then enter the coverage gap stage. COVERAGE GAP STAGE Most Medicare health plans with Part D coverage have a coverage gap. This means that after you and your plan have spent a certain amount in drug costs, then you have to pay more for your drugs while you are in the gap. The amount you have to pay varies by plan. While the standard Part D benefit provides some coverage in the gap that allows beneficiaries to pay 51 percent of generic drug costs and 40 percent of the price for brand-name drugs (plus a portion of the dispensing fee), some plans may provide more coverage. Once you reach a certain limit in out-of-pocket expenses (copayments, coinsurance, and deductible, if any), you will get catastrophic coverage. Note: If you receive Extra Help in paying your drug costs, you won t have a coverage gap; however, you may pay a small copayment or coinsurance amount according to your level of help.

9 CATASTROPHIC COVERAGE STAGE Medicare Prescription Drug Plans provide special coverage if you spend a specified out-of-pocket amount. This is called catastrophic coverage. It ensures that once you have paid a certain amount for your covered drugs, you only pay a small share of the cost for the rest of the calendar year. Other important considerations GENERIC DRUGS CAN SAVE YOU EVEN MORE MONEY As you look at formularies, you ll often see listings for generics and more costly brand-name prescription drugs. Generic drugs have the same active ingredients as brand-name drugs. Ask your health care provider about prescribing generic options for your condition that can help you keep costs down. YOU LL WANT TO KEEP AN EYE ON YOUR FORMULARY Pharmaceutical research leads to advances in prescription drugs, and new generic drugs are introduced to the market every day. That s why you ll want to make sure you stay up-to-date on which drugs are included in your plan s formulary. When the list does change, it will be posted on the plan s website, or the plan may tell you about it. Occasionally, you may need to consult with your doctor on what formulary changes mean for you. Every plan has a coverage determination process, so you can request coverage for a Part D medication that is not covered on the plan s formulary. Understanding formularies A formulary is the list of medications covered by a plan and approved by CMS. All formularies must comply with applicable law. However, formularies aren t identical, so it s important to pay close attention as you re comparing them. The differences may be significant to you. 7

10 Choosing the right Medicare coverage The chart below can help you make the right Medicare coverage choice. Review the details and find the coverage that best represents your needs and preferences. MEDICARE COVERAGE WHAT IS IT? CONSIDER THIS COVERAGE IF Original Medicare (Part A and Part B) Original Medicare covers medical services and hospitalization. You pay deductibles and coinsurance. Original Medicare does not cover most prescription drugs, vision, or hearing. You can afford the deductibles and coinsurance, you only want basic medical and hospital benefits, and you want to visit the doctors and hospitals of your choice. Medicare Advantage plans These plans cover the same medically necessary services as Original Medicare and may offer extra benefits, such as vision. Most plans include Medicare Part D prescription drug coverage. Many plans generally limit you to receiving services through network doctors. You want coverage that includes more than just Parts A and B. Medicare Cost plans These plans cover Original Medicare services and sometimes additional benefits such as vision. You can go to a non-network provider (you must pay Original Medicare cost sharing, including deductibles). Some Cost plans include Part D prescription drug coverage allowing you to receive drug coverage through a single plan or you can join a separate Medicare Prescription Drug Plan. You can join even if you only have Part B. You want coverage that includes more than just Part A and Part B. You also want the freedom to see any doctor you choose and don t mind paying Original Medicare cost sharing to see non-network providers. Medicare Supplement Insurance plans (also called Medigap plans) If you choose Original Medicare, you can purchase these plans to help you pay for most out-of-pocket health care costs that Original Medicare doesn t cover, like deductibles and coinsurance. You need coverage for out-of-pocket expenses left by Original Medicare, and you want to see the doctors and hospitals of your choice. 8 Medicare Part D Prescription Drug Plans These plans add prescription drug coverage to your Original Medicare, Medicare Advantage, or Medicare Cost plan coverage. You have Original Medicare, Medicare Advantage, or Medicare Cost coverage and want to add Part D prescription drug coverage without any other extra benefits.

11 Enrollment periods You can enroll in Medicare health or Prescription Drug Plans only during certain times of the year, or based on certain special circumstances. Listed below are the 3 enrollment periods: Initial Enrollment Period (IEP) This is a 7-month period of enrollment for those who are about to become eligible for Medicare. It starts 3 months before the month of your 65th birthday and ends 3 months after that month. Annual Enrollment Period (AEP) The AEP begins October 15 and runs through December 7. This is the period of time when you can join, drop, or switch plans. Any change you make is effective January 1 of the following year. Special Enrollment Period (SEP) There are special circumstances that may qualify you to make one plan change per year: A Medicare health plan in your service area is awarded 5 stars by CMS. The 5 star SEP begins on December 8 and concludes on November 30. You move permanently out of your health plan s service area. You are entitled to both Medicare and Medicaid. Your current plan terminates its contract with the Centers for Medicare & Medicaid Services (CMS). You qualify for Extra Help with your drug plan costs. You lose your employer group or trust fund sponsored coverage and can now enroll as an individual. Note: With Cost plans, you may do the following: Join a plan that doesn t include Part D anytime during the year Join even if you only have Part B Leave anytime and return to Original Medicare 9

12 Medicare star quality ratings Now you have a smart, easy way to compare Medicare health plans. It s called the Medicare Star Quality Ratings. The ratings are developed every year by the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program. Whether you re choosing or changing coverage, these ratings are a simple, fair way to compare plans in your area and they may be the single most important resource you use. How the Medicare star quality ratings work Medicare health plans are given an overall rating from 5 Stars («««««) to 1 Star («) out of 5 Stars, based on the plan s performance in major categories. What the number of stars means: «««««Excellent performance ««««Above average performance «««Average performance ««Below average performance «Poor performance What do the stars rate? The Medicare Star Quality Ratings, developed by the Centers for Medicare & Medicaid Services (CMS), rate Medicare health and prescription drug plans based on major categories that include: Preventive Care Chronic Care Prescription Drug Services Customer Service Member Satisfaction Each individual Medicare health plan is assigned an overall rating from 5 stars to 1, with 5 stars being the highest rating for excellence. The ratings are updated annually based on ongoing monitoring and analysis. These ratings are a simple and objective way to help you compare Medicare health plans for overall quality and service, so you can have complete confidence in your choice. Make a more informed choice To learn more about Kaiser Permanente s Medicare Star Ratings, please visit kp.org/medicare. 10

13 Questions & answers about the Ratings Q: Where can I find the Medicare star rating for my current Medicare health plan? A: Go to Medicare s Plan Finder on medicare.gov and search by plan name. You can also search by the ID number listed on your plan s member ID card. Your results will be better if you enter both the plan name and plan ID on the search page. The results page will show you the Medicare Star Quality Rating for that plan. You can also get plan ratings by calling the Medicare Program at MEDICARE ( ). TTY: , 24 hours a day, 7 days a week. Q: Is there a way to compare a Kaiser Permanente Medicare Advantage plan and/or Medicare Cost plans? A: Yes. You can use the ratings to compare Medicare Advantage and/or Cost plans across nine areas of performance, if the plan is located in the same general area. To request that information, call the number above. Q: What sources are used to determine the Medicare star quality ratings? A: The star ratings strategy is consistent with CMS Three Aims (better care, healthier people/healthier communities, and lower costs through improvements), with measures spanning the following 5 broad categories: Outcomes: Outcome measures focus on improvements to a beneficiary s health as a result of the care that is provided. Intermediate outcomes: Intermediate outcome measures help move closer to true outcome measures. Controlling Blood Pressure is an example of an intermediate outcome measure where the related outcome of interest would be better health status for beneficiaries with hypertension. Patient experience: Patient experience measures represent beneficiaries perspectives about the care they have received. Access: Access measures reflect issues that may create barriers to receiving needed care. Plan Makes Timely Decisions about Appeals is an example of an access measure. Process: Process measures capture the method by which health care is provided. 11

14 Questions & answers about the Ratings - continued Q: What exactly does CMS evaluate for each plan s Part C coverage? A: CMS looks at the following Part C measures when deciding each plan s Medicare Star Rating. STAYING HEALTHY: SCREENINGS, TESTS, AND VACCINES Breast cancer screening Colorectal cancer screening Annual flu vaccine Improvement or maintenance of members physical health Improvement or maintenance of members mental health Monitoring members physical activity Adult body mass index (BMI) assessment MEMBER EXPERIENCE WITH HEALTH PLAN Getting needed care Getting appointments and care quickly Customer service Members overall rating of health care quality Members overall rating of the health plan Care coordination HEALTH PLAN CUSTOMER SERVICE Timely decisions about member appeals Review of appeals decisions Availability of TTY/TDD and foreign language options MANAGING CHRONIC (LONG-TERM) CONDITIONS Special needs plan (SNP) care management 1 Care for older adults medication review 1 Care for older adults functional status assessment 1 Care for older adults - pain assessment 1 Osteoporosis management for women who have had a fracture Eye exams for members with diabetes Kidney disease monitoring for members with diabetes Blood sugar control for members with diabetes Control for high blood pressure Rheumatoid arthritis management Reducing the risk of falling among members Plan all-cause readmissions HEALTH PLAN MEMBER COMPLAINTS, PROBLEMS GETTING SERVICES, AND IMPROVEMENT IN THE HEALTH PLAN S PERFORMANCE Number of complaints about the health plan per 1,000 members Members choosing to leave the health plan Beneficiary access and performance problems Health plan quality improvement 12 1 Special Needs Program (SNP) only.

15 Q: What does CMS review for each plan s Part D coverage? A: CMS evaluates the following Part D measures when deciding each plan s Medicare Star Rating. DRUG PLAN CUSTOMER SERVICE Availability of TTY/TDD and foreign language options Timely decisions about member appeals Fairness of plan s denials to member appeals PATIENT SAFETY AND ACCURACY OF DRUG PRICING Drug plan gives accurate price information for Medicare s Plan Finder Website Not prescribing certain drugs with a high risk of side effects when there may be safer drug choices Medication adherence for oral diabetes medications Medication adherence for hypertension (ACEI or ARB) Medication adherence for cholesterol (statins) Medication therapy management MEMBER EXPERIENCE WITH DRUG PLAN Members overall rating of the drug plan Getting needed prescription drugs DRUG PLAN MEMBER COMPLAINTS, PROBLEMS GETTING SERVICES, AND IMPROVEMENT IN THE DRUG PLAN S PERFORMANCE Member complaints about the drug plan Members choosing to leave the drug plan Beneficiary access and performance problems Drug plan quality improvement We re here to answer your questions Please keep in mind that there are important details about eligibility and coverage that may affect you. If you have questions, here are some helpful resources: Call MEDICARE ( ), 24 hours a day, 7 days a week. TTY users should call Or visit Medicare.gov. Call the Social Security office at , Monday through Friday, 7 a.m. to 7 p.m. TTY users should call Or visit SocialSecurity.gov. 13

16 Discover what a Kaiser Permanente Medicare health plan has to offer Our Medicare health plan is here to help you thrive As a Kaiser Permanente Medicare health plan member, you get more than a health plan From predictable costs and wellness benefits to a great selection of doctors and the freedom to change anytime, you ll experience the benefits of having a Medicare health plan that supports your goals and helps you thrive. Take some time to read about some of the ways we offer more than Original Medicare, and keep them in mind when you re looking for a Medicare health plan that best fits your needs. Feel confident with Star quality For peace of mind knowing that you are getting a quality plan, check out how highly rated our Medicare health plan is at kp.org/medicare. 14

17 Predictable costs and a low monthly premium With a Kaiser Permanente Medicare health plan, you pay no additional cost for preventive services like your annual wellness visit, mammograms, prostate exams, flu shots, and cholesterol tests. A wide selection of great doctors and specialists At Kaiser Permanente, you have a wide selection of great doctors to choose from, and all of our available doctors welcome Kaiser Permanente Medicare health plan members. It s easy to go online and read our doctors profiles to get a better sense of who they are before you choose. Plus, you can switch to another Kaiser Permanente doctor at any time. 1 If you are already a member and joining our Medicare health plan, you can stay with the health care team you know and trust. Access to specialists You have access to a full range of specialists, including cardiologists, orthopedists, audiologists, and more. No matter what kind of medical specialist you need, you re covered. 1 The provider network may change at any time. You will receive notice when necessary. 15

18 Convenient features to make staying healthy easy Online tools to manage your health, 24/7 * With My Health Manager, you can your doctor s office, view most test results, refill prescriptions, and schedule or cancel appointments all online. You can even download the Kaiser Permanente mobile app at no cost, to manage your health on the go. Everything you need, usually under one roof When you visit a Kaiser Permanente facility, you can see your doctor, get lab work or X-rays done, and pick up your prescriptions often in one trip. In many regions, specialists offices and hospitals are also at the same location. Electronic medical records keep your health care team connected * When you receive care at a Kaiser Permanente medical facility, our electronic medical records system ensures that everyone on your team doctors, nurses, pharmacists, lab technicians, and specialists are connected and have immediate access to your most up-to-date records. This way, they can share the latest medical information about you and all stay on the same page. 16

19 Designed to support all your health care needs With Kaiser Permanente Senior Advantage (HMO) or Kaiser Permanente Medicare Plus (Cost), you ll get Parts A and B and have access to emergency and urgent care services. With most of our plans, you ll also get the Kaiser Permanente Medicare Prescription Drug Benefit, which is our Medicare Part D prescription drug coverage. Most Kaiser Permanente health plans that include Part D offer additional coverage for generic drugs during the coverage gap. You can even choose to add Advantage Plus to your Kaiser Permanente Senior Advantage plan, which covers valuable dental, hearing, and extra vision benefits. This way, it s easier to take care of your health care needs with just one plan, and one bill. Benefits to help manage your prescription drug costs Our formulary is selected in consultation with a team of our health care providers to determine both the most economical and effective medications and is approved by CMS. Under our Part D benefit, each drug on our formulary is assigned one of 6 drug tiers that have a different cost sharing depending on your plan and coverage stage. Please check the Summary of Benefits or Evidence of Coverage (EOC) for the Part D cost sharing according to your plan. Tier 1: Preferred generic drugs Includes generic drugs used to manage certain ongoing conditions like asthma, diabetes, and high blood pressure Tier 2: Generic drugs Covers all other generics Tier 3: Preferred brand-name drugs Covers commonly prescribed brand-name drugs on our formulary Tier 4: Nonpreferred brand-name drugs Includes other brand-name drugs on our formulary Tier 5: Specialty-tier drugs Covers high-cost medications prescribed for certain conditions Tier 6: Injectable Part D vaccines Covers preventive vaccines at no extra charge in most of our plans 17

20 While you re in the gap, Kaiser Permanente has you covered The Medicare Part D coverage gap raises your prescription drug expenses once you and the plan have spent a specified dollar amount on prescription drugs. With the Kaiser Permanente Medicare Prescription Drug Benefit, you may pay lower cost shares than with the standard Part D benefit for generic prescription drugs in the coverage gap and pay 58 percent (plus a portion of the dispensing fee) for brand-name and specialty-tier drugs. Most Kaiser Permanente health plans that include Part D offer additional coverage for generic drugs during the coverage gap. Most Kaiser Permanente prescription refills can be mailed to your home ** As a member, when you order prescription refills from a Kaiser Permanente pharmacy by telephone, online through My Health Manager, or through our Kaiser Permanente mobile app you can use the mail-order option and have your refills sent to your home at no extra charge. Even better, you may receive up to a 3-month supply at a lower cost share when you request home delivery saving you time and money (restrictions and limits may apply). 18

21 Nationwide locations for your convenience You can find Kaiser Permanente medical facilities, doctors offices, labs, pharmacies, and other health care services throughout the country. Northern California Southern California Colorado Georgia Hawaii Oregon and Washington Maryland, Virginia, and Washington, D.C. Emergency and urgent care 1 As a Kaiser Permanente Medicare health plan member, you re covered for emergency and urgent care anywhere in the U.S. or anywhere in the world. 2 A Medicare health plan designed to help you thrive Kaiser Permanente Medicare health plans may offer you more than Medicare alone. To find out how, please reach out to the resources listed in this booklet so that you can choose the Medicare health plan that s right for you. Visit us online at kp.org/medicare to enroll or learn more about our Medicare health plans, Medicare Star Quality Ratings, and what they mean for you. FOR MORE INFORMATION Call (TTY 711 for the deaf, hard of hearing, or speech impaired), 7 days a week, 8 a.m. to 8 p.m., or visit kp.org/medicare. 1 If you need emergency or out-of-area urgent care, you can get care from any provider. Check your Evidence of Coverage (EOC) for details. 2 In the Mid-Atlantic States Region, all Direct Pay Kaiser Permanente Medicare Plus High Option Cost and Standard Option Cost plan members have worldwide emergency care and urgent care coverage, and all Direct Pay Kaiser Permanente Medicare Plus Basic Option Cost plan members have emergency care and urgent care coverage while inside the United States and its territories only. 19

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24 Kaiser Foundation Health Plan, Inc. 393 E. Walnut St. Pasadena, CA Kaiser Foundation Health Plan of Colorado E. Dakota Ave. Denver, CO Kaiser Foundation Health Plan of Georgia, Inc. Nine Piedmont Center 3495 Piedmont Road NE Atlanta, GA Kaiser Foundation Health Plan, Inc. 711 Kapiolani Blvd. Tower Suite 400 Honolulu, HI Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc East Jefferson St. Rockville, MD Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St. Suite 100 Portland, OR kp.org/medicare Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings Kaiser Permanente contract #H0524, H0630, H1170, H1230, H2150, H9003. * When receiving care at a Kaiser Permanente facility. All online features may not be available in some areas. ** For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 10 business days. If not, please call: Northern California: , Monday through Friday, 8 a.m. to 6 p.m.; Southern California: , Monday through Friday, 7 a.m. to 7 p.m.; Colorado: (TTY/TDD ), Monday through Friday, 8 a.m. to 6 p.m.; Georgia: or toll free , 7 days a week, 24 hours; Hawaii: , Monday through Friday, 8:30 a.m. to 5 p.m.; Maryland, Virginia, and the District of Columbia: or toll free , Monday through Friday, 8 a.m. to 7 p.m.; Washington and Oregon: , Monday through Friday, 8 a.m. to 4:30 p.m. In California, Kaiser Permanente is an HMO plan and a Cost plan with a Medicare contract. In Hawaii, Oregon, Washington, Colorado, and Georgia, Kaiser Permanente is an HMO plan with a Medicare contract. In Virginia, Maryland, and the District of Columbia, Kaiser Permanente is a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Please recycle September 2016 en