Medicare Made Simple. Helping you navigate Medicare enrollment O65BROGUIDE (3/15)

Transcription

1 Medicare Made Simple Helping you navigate Medicare enrollment O65BROGUIDE (3/15)

2 Table of Contents What is Medicare?... 1 Original Medicare basics.. 3 Getting comprehensive coverage Original Medicare and Supplemental coverage.. 12 Medicare Advantage (Part C) Other plan types Medicare prescription drug coverage (Part D) Glossary of key terms Exclusions and Limitations In the past, you ve probably had someone there to help you choose the right health insurance whether it was family, friends or your company s Human Resources department. Now you re sitting at a crossroads with lots of unanswered questions about where to turn next. Here at CareFirst BlueCross BlueShield (CareFirst), we understand Medicare and want to guide you along the way. We are here to help simplify things as you make your decision on Medicare coverage.

3 What is Medicare? A brief history Created in 1965, Medicare is a health insurance program for individuals age 65 and over and for those who meet certain special criteria. The program now covers over 43 million people throughout the United States and is projected to continually increase in the coming years. Oversight and enforcement for all Medicare plans is provided by the Centers for Medicare and Medicaid (CMS). Projected Medicare Eligible Population* Persons eligible for Medicare (in millions) Note: Increments in years are uneven. *Source: U.S. Census Bureau, Population Estimates and Projections

4 Understanding Medicare Medicare is comprised of four parts. The chart below summarizes what each part covers. Medicare Part A Hospital Insurance Inpatient care in hospitals Skilled nursing facility care Hospice care Home health care Medicare Part B Doctor Insurance Services from doctors and other health care providers Outpatient care Home health care Durable medical equipment Some preventive services 2 Medicare Part C Medicare Advantage Covers all the same benefits and services as Medicare Parts A & B Run by Medicare-approved private insurance companies Usually includes Medicare prescription drug coverage (Part D) as part of the plan May include extra benefits and services (for an extra cost) Medicare Part D Prescription Drug Coverage Provides coverage for prescription drugs Run by Medicare-approved private insurance companies May help lower your prescription drug costs and help protect against higher costs in the future

5 Original Medicare basics

6 Part A and Part B are considered to be Original Medicare and are administered by the federal government. Some people receive Part A and Part B automatically starting the first day of the month they turn age 65 because they are already receiving Social Security or Railroad Retirement benefits. If you are automatically enrolled, you ll receive a red, white and blue Medicare card in the mail three months before your 65th birthday. If you are not already receiving Social Security or Railroad Retirement benefits, you will need to apply for Medicare Parts A and B. In most cases, Medicare Part B coverage will be listed on your Medicare card when you receive it. However, this coverage is voluntary. You are not required to keep Part B (medical) coverage. If you do not want it, or if you would like to wait to receive Part B coverage (if you are postponing retirement, for example), follow the instructions that come with the card and send the card back. If you keep the original card that you receive, you are essentially agreeing to keep Part B and will be responsible for Part B premiums. 4

7 A closer look at Medicare Part A Medicare Part A covers your hospital stays and other medical facility costs including: Inpatient care in hospitals Skilled nursing facility Hospice care Home health care Inpatient care in a religious non-medical health care institution Most people are automatically enrolled in Part A on the first day of the month they turn age 65 because they receive benefits through Social Security or Railroad Retirement. The premiums for Part A are based on the number of quarters worked in your lifetime, or the number of quarters your spouse has worked. If you paid Medicare taxes while working at least 120 months (40 quarters), you won t have to pay a premium for Part A. If you (or your spouse) did not work the required 40 quarters, you may be able to purchase Medicare Part A. The chart below will give you a better idea of how the Part A premium is applied based on the number of quarters worked Monthly Part A Premium $600 $400 $200 $0 Less than 30 quarters quarters 40 or more quarters 5

8 Refer to the glossary at the end of this Guide for details on Benefit Periods. When you receive Part A coverage, you are responsible for paying a deductible, copayment and/or coinsurance during each benefit period throughout the year. The charts below will help you determine the out-of-pocket costs you are responsible for paying each benefit period before Medicare Part A begins to pay its share. Inpatient Hospital Stay Length of Stay What You Pay Days 1 60 in benefit period $1,288 member deductible Days in benefit period $322 copayment, per day Days in benefit period $644 coinsurance, per day (Lifetime Reserve Days) Skilled Nursing Facility Length of Stay What You Pay Days in benefit period $161 coinsurance, per day Each day after Day 100 in All costs for stay benefit period Did you know that according to AAA, seniors are safe drivers compared to other age groups, since they often reduce risk of injury by wearing seat belts, observing speed limits and not drinking and driving? 6

9 A closer look at Medicare Part B Medicare Part B helps cover your medically-necessary doctor services including: Inpatient and outpatient doctor visits Inpatient and outpatient medical services Inpatient and outpatient surgical services and supplies Physical and speech therapies Diagnostic tests Durable medical equipment Outpatient wellness exams and preventive care Approved home health and clinical lab services In order to receive Part B coverage, you must: Be enrolled in Medicare Part A Pay a monthly premium of $121.80* (in 2016). The other gaps There are many services which Medicare Part A and Part B do not cover. If you need certain services that are not covered under Medicare Part A and Part B, you ll have to pay for them yourself, unless: You have other insurance (or Medicaid) to cover the costs, or You re in a Medicare health plan that covers these services What does Part B not cover? Yearly deductible of $ percent of medical expenses for inpatient and outpatient physician services 20 percent of outpatient mental health services Some of the services Medicare does not cover are listed below. For a full list, visit Medical and surgical charges above Medicareapproved amounts Outpatient prescription drugs Acupuncture Cosmetic surgery Dental care and dentures Custodial care (long-term care) Hearing aids Routine eye care and most eyeglasses Routine foot care Because the benefits listed above are not covered by Medicare, they are not covered by Medicare supplemental coverage (Medigap). * Some people may pay a higher Part B premium if their modified adjusted gross income as reported on their IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount. 7

10 8 Original Medicare doesn t cover it all Here s a real-life example to illustrate the costs you could be responsible for under Medicare Part A. Days 0 60 For the first 60 days of her inpatient stay within the benefit period, Mary will be responsible for a $1,288 member deductible. Mary was admitted to the hospital as an inpatient. Days If Mary s inpatient stay extends beyond the initial 60-day period during the same benefit period, for the next 30 days she is receiving inpatient care, she will be responsible for an additional copayment of $322 for each additional day she is in the hospital. So, in total, Mary is now responsible for: + $1,288 deductible $322 x number of additional days she is in the hospital, for days If Mary s inpatient stays reach 90 consecutive days in the same benefit period, her total out-of-pocket cost will be $10,948. *The total out-of-pocket costs were calculated based on an individual staying a full 150 consecutive days as an inpatient in the hospital within the same benefit period. The out-of-pocket costs an individual will pay can vary, depending on where they are within a benefit period. To determine out-of-pocket costs, an individual should pay close attention to the benefit period cycle. Days Though it is unlikely, if Mary s inpatient stay extended beyond 90 days within the same benefit period, she would enter her Lifetime Reserve Days. For the next 60 days of the same benefit period that Mary is an inpatient, she will be responsible for an additional $644 coinsurance, per day. So, for Mary s total 150-day inpatient stay at the hospital, she could be responsible for: + + $1,288 deductible $322 x number of additional days she is in the hospital for days $644 x number of additional days she is in the hospital, for days That is $49,588 * in out-ofpocket costs if she has Original Medicare alone.

11 Getting comprehensive coverage

12 When mapping out your Medicare route, there are options to consider: Medicare and Medigap (Supplemental Plans) Monthly premiums in addition to Part B premiums unless you choose a plan that covers your Part B premium Can switch Medicare Supplemental plans at any time during the year No referrals required Freedom to choose any doctor, specialist or hospital that accepts Medicare Foreign travel coverage available Guaranteed acceptance during your Open Enrollment period or you could be underwritten Predictable out-of-pocket costs Prescription drug coverage available separately 10

13 Referrals may be required and you may need to use network specialists Usually includes prescription drug coverage Medicare Advantage Low or no monthly premiums in addition to your Part B premium Plan terms and rates vary widely Only allowed to switch Medicare Advantage plans during specific periods during the year Only emergency coverage in U.S. Network restrictions usually apply Guaranteed acceptance during your Open Enrollment 11

14 Careful! Do not confuse Medicare Parts A D with Medigap Plans A N. For example, you could have Medicare Part A and Part B and then purchase Medigap Plan A to fill in the gaps. As you can see from the previous section and Mary s example on page 8, Part A and Part B have deductibles, copays and coinsurance charges. A serious illness or lengthy hospital stay could put a big dent in your retirement savings if you rely on Part A and Part B alone. That s why it s important for you to have additional coverage. Here are your options for obtaining comprehensive health insurance coverage when you become Medicare eligible: Original Medicare and supplemental coverage Medicare supplemental plans, or Medigap plans, are designed to supplement Original Medicare by paying for those health care costs the gaps in coverage that Original Medicare doesn t pay. Medicare will pay its share first, and then your Medigap plan will pay its share. With a Medigap plan, you can go to any doctor, specialist or hospital that accepts Medicare. Medigap explained Medigap plans are offered through private health insurance companies. The federal government has outlined the coverage for 11 different Medigap plans, identified alphabetically (e.g. Plan A, Plan B, etc.). Each is tied to a specific benefit and coverage level as described by the government. What this means is that your benefits will be the same no matter the company you choose. 12 However, that does not make every carrier the same. Each carrier decides which of the 11 plans to offer (CareFirst offers 8 of the 11). Many also offer advantages such as lower monthly premiums, special discounts and online tools to better serve their members.

15 Enrolling in Medigap You must meet both of the following conditions in order to enroll in a Medigap plan: Must be age 65 or older Must be enrolled in Medicare Part B If you qualify, you ll enter your Open Enrollment period which lasts for six months beginning the first day of the month that you are first enrolled in Medicare Part B. If you miss your Open Enrollment period and decide later that you want Medigap coverage, you risk: Denial of coverage More expensive monthly premiums What can doctors charge me? A doctor or provider who accepts assignment, which is when your doctor or provider agrees to accept the Medicare-approved amount as full payment for covered services, cannot collect more than the Medicare deductible or coinsurance from you. A doctor or provider who does NOT accept assignment can charge up to 15 percent over Medicare s approved amounts and require you to pay the entire charge at the time of your appointment. 13

16 14 What you pay with Original Medicare vs. what you pay with CareFirst Medigap plans With Original Medicare alone, You Pay: Hospital Services (Part A) Inpatient hospital deductible Choose Medigap Plan A and You Pay: Choose Medigap Plan B and You Pay: $1,288 $1,288 $0 $0 Hospital days $322/day $0 $0 $0 Hospital days $644/day $0 $0 $0 (lifetime reserve) 365 days after All Costs $0 $0 $0 hospital benefits stop Skilled nursing facility days $161/day $161/day $161/day $0 Medical Expenses (Part B) Medical expense $166 $166 $166 $0 deductible Medical expenses 20% 0% 0% 0% after deductible Excess charges 100% 100% 100% 0% above Medicareapproved amounts Other Expenses Foreign country emergency care (up to $50,000 lifetime max) Choose Medigap Plan F and You Pay: 100% 100% 100% $250 deductible, then 20%

17 Choose Medigap High-Deductible Plan F* and You Pay: Choose Medigap Plan G and You Pay: Choose Medigap Plan L** and You Pay: Choose Medigap Plan M and You Pay: Choose Medigap Plan N and You Pay: $0 after plan deductible $0 after plan deductible $0 after plan deductible $0 after plan deductible $0 after plan deductible $0 after plan deductible 0% after plan deductible 0% after plan deductible $250 deductible after plan deductible, then 20% $0 $322 $644 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $40.25/day $0 $0 $166 $166 $166 $166 0% 5% 0% Office visit: Up to $20; ER visit: Up to $50 0% 100% 100% 100% $250 deductible, then 20% 100% $250 deductible, then 20% $250 deductible, then 20% Dollar amounts shown are the 2016 deductibles, copayment and coinsurance. These amounts may change on January 1, * With High-Deductible Plan F, there is an annual plan deductible of $2,180; after you meet the $2,180 annual plan deductible, you pay $0. ** With Plan L, there is an outof-pocket limit of $2,480; After you meet $2,480 in out-of-pocket expenses, you pay $0. 15

18 The coverage you need All Medigap plans provide you with: Coverage for the 20 percent of costs not paid by Medicare Coverage for your eligible copays and deductibles Coverage for other medical services (for example: outpatient services) The opportunity to let you make choices about your health care When deciding which Medigap plan is right for you, it is important to consider a few key features that differ among the 11 standardized plans: How much can I afford to spend on supplemental coverage? How much am I comfortable paying out-of-pocket before my supplemental coverage begins? Does my doctor accept Medicare s reimbursement as payment for his services? Will I be traveling out of the country for an extended period of time? Your monthly premium budget Each plan charges a different monthly premium based on the kind of coverage you desire. Deductible and yearly out-of-pocket costs Each plan covers a certain percentage of your medical expenses, while you cover the rest. Balanced billing protection If you see a doctor who does not accept Medicare s reimbursement as payment in full for services (some doctors charge you up to 15% more than Medicare allows), Medigap Plans G, F and High-Deductible F will protect against these extra charges. Coverage for foreign travel Some plans offer coverage to you even when you are out of the country. Others do not. Keep in mind that services not covered by Original Medicare are not covered by Medigap. To compare each Medigap plan, consult the chart on pages and decide which plan is right for you. 16

19 Medicare Advantage (Part C) An alternative to Original Medicare and a Medicare supplemental plan is Medicare Advantage (MA), commonly referred to as Medicare Part C. MA plans are Medicare-approved private health insurance plans that provide all of your Part A (hospital) and Part B (medical) coverage and must include medically-necessary services. Many of these plans include prescription drug coverage (Medicare Part D) as part of the core plan benefits. MA plans often have restricted networks, which means that individuals who choose to enroll in MA may have to see specific doctors and go to certain hospitals within the plan s network to receive care. In addition, each Medicare Advantage plan can charge different out-of-pocket costs and have different rules for how you receive services. Key plan features of Medicare Advantage: Not guaranteed renewable Beneficiaries are locked in to the plan until the next available enrollment opportunity unless the beneficiary qualifies for a special enrollment period Not underwritten Year-to-year contract with the federal government Enrollment only allowed during certain times of the year, unless you are enrolling when you are first eligible 17

20 The most common plan options are: HMOs (Health Maintenance Organization), PPOs (Preferred Provider Organization) and PFFS (Private Fee-for-Service) plans. The chart below provides a comprehensive overview of all the plan types available through Medicare Advantage. HMO: PPO: PFFS: SNP: HMP: MSA: You can only go to doctors, other health care providers or hospitals in the plan s network except in an emergency. You may also require a referral from your PCP. You have the option to use doctors, hospitals and other health care providers in- or out-of-network, but you will generally pay more for out-of-network. Commonly called Private Fee For Service plans, these plans are similar to Original Medicare and allow you to go to any doctor, other health care provider, or hospital as long as they agree to treat you. The plan will determine how much it will pay and you will pay once you receive care. Special Needs Plans provide specialized and focused health care for people who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions. HMP Point of Service plans are HMO plans that allow for certain out-of-network services for a higher copayment or coinsurance. Medical Savings Accounts are high deductible health plans that are joined to a bank account. Medicare deposits money into the account that you can use for health services throughout the year; however, this does not cover prescription drugs, thus you will need to join Medicare Part D coverage. 18

21 Enrolling in Medicare Advantage There are three specified times you can join a Medicare Advantage plan: When you first become eligible for Medicare A seven-month period that begins three months before the month of your 65th birthday, includes the month of your 65th birthday, and continues three months after the month of your 65th birthday. If you get Medicare due to a disability You can join during the seven-month period that begins three months before your 25th month of disability and ends three months after your 25th month of disability. Between October 15 and December 7 every year Anyone can join, switch, or drop a Medicare Advantage plan during this Open Enrollment period. Coverage will begin on January 1. There are a few exceptions to the above enrollment periods, known as Special Enrollment Periods, during which you may join, switch or drop a Medicare Advantage plan. The life events are as follows: You move out of or into a plan s service area You have Medicaid You live in an institution (like a nursing home) You qualify for Extra Help (a Medicare program that helps people with limited income pay for Medicare costs) Each year, between January 1 and February 14, Medicare Advantage members have the opportunity to leave their plan and return to Original Medicare. If your Medicare Advantage plan included prescription drug coverage, you also have until February 14 to join Medicare Part D Plan for prescription drug coverage. Coverage will begin the first day of the month after your request to change. During this period, you will not be able to: Switch from Original Medicare to Medicare Advantage Switch from one Medicare Advantage plan to another Switch from one Medicare prescription drug plan to another Join, switch or drop a Medicare Medical Savings Account plan 19

22 Other plan types Thanks to the internet, the term Silver Surfers has a whole new meaning. According to the U.S. Census Bureau, in 2013 the number of seniors age 65+ using the internet is now over 62 percent. Many internet users search for everything from simple travel directions to planning the trip of a lifetime. In addition to Medigap and Medicare Advantage plans, there are a few other plans that can either work with or replace Original Medicare: Employer group plans come directly from an individual s current or former employer. You should check with the benefits administrator of your employer or retiree group before changing or replacing your health plan to keep from possibly losing coverage. You may be able to use employer coverage along with the new plan you join. Cost plans are available based on an annual contract with CMS. When an individual enrolls in a cost plan, he or she does not assign their original Medicare benefits. Instead, the individual retains their coverage for Medicare-eligible services outside the network. Then: For Part A Services, Medicare is the primary payer and the cost plan is secondary For Part B Services, the cost plan is the single primary payer It s important to keep in mind that cost plans are not guaranteed renewable and are not supplement plans. In addition, Medicare reimburses the health plan for the cost of any covered services. Programs of All-Inclusive Care for the Elderly (PACE) combine medical, social, and long-term care services for frail individuals to help them stay independent and living in their community for as long as possible, while receiving the high-quality care they need. PACE plans are available only in states that have chosen to offer them under Medicaid. To be eligible for a PACE plan, an individual must: Be 55 years old or older Live in the service area of the PACE program Be certified as eligible for a nursing home 20

23 Medicare prescription drug coverage (Part D)

24 Medicare prescription drug coverage, or Part D, was created to help cover the costs of your prescription drugs. In order to be eligible for enrollment in a Part D plan, you must either: Please Note! If you miss this enrollment period and go without an equal or better prescription drug plan for more than 62 continuous days, you will be charged a late enrollment penalty when you apply for Part D. 22 Be enrolled in Medicare Part B, or Be enrolled in a Medicare Advantage plan (Part C) If you choose to enroll in Part D, you will have to pay an additional premium on top of your Part B premium. The best time to enroll in a Part D plan is during your Initial Enrollment Period. This period begins three months before the month of your 65th birthday and ends three months after your birthday month. Using Part D coverage There are four drug payment stages for prescription drug coverage. See below (and illustration at right) for the various stages and the standard amounts for Keep in mind, each plan has its own list of drugs that are covered. This is referred to as the plan s formulary or drug list. The formulary specifies the cost-sharing amounts based on the tier that a drug is listed under. Stage 1: Yearly deductible stage Begins when the beneficiary fills his or her first prescription Ends when a deductible of up to $360 is met Stage 2: Initial coverage stage Beneficiaries and health plan share drug costs until total shared cost reaches $3,310 Stage 3: Coverage gap stage For brand name drugs: Beneficiaries receive a 50 percent discount at the point of sale In 2016, the plan then pays 5 percent, and you pay the remaining 45, which counts toward the coverage gap For generic drugs: The plan pays 42 percent of the cost, and you pay 58 percent toward the coverage gap Beneficiaries remain in the gap until their true out-of-pocket costs (deductible, Stage 2 and 3 costsharing) reach $4,850 Stage 4: Catastrophic coverage stage Your plan pays most of your costs for the rest of the year If you need help paying for prescription drug costs, you may be eligible for an extra help program offered to people who meet minimum income requirements. To see if you re eligible, call or visit

25 Beware of the doughnut hole! Most of the prescription drug plans have a coverage gap, also known as a doughnut hole. Once your prescription drug costs exceed your limit, you Stage 1 Stage 2 Stage 3 the doughnut hole Stage 4 enter the doughnut hole. In this stage you may be responsible for covering all of your prescription drug costs until you reach a fixed amount. Once that amount is reached, you will qualify for catastrophic coverage and the cost to you will be minimal. 23

26 Glossary of key terms Admitted: when an individual is placed under the supervision of the hospital for at least one night and is too sick to stay at home, requires 24-hour nursing care, and/or is receiving medications and undergoing tests/surgery that can only be performed in the hospital setting. Assignment: when your doctor or provider agrees to accept the Medicare-approved amount as full payment for covered services. Benefit period: a specific period of time that begins the day you are formally admitted as an inpatient in a hospital or skilled nursing facility, and ends when you have not received any type of inpatient care for 60 days in a row. Coinsurance: the percentage of the allowed benefit that you pay after you meet your deductible. Copayment (copay): a fixed dollar amount you pay when you visit a doctor or other provider of service. Cost-Sharing: the part of your health care costs that your plan doesn t pay is your share; see deductible, copayment, coinsurance. Deductible: this is the amount you must pay before the insurance company or Medicare begins to pay its portion of the claims. Doughnut hole: also known as the Coverage Gap in Medicare Part D prescription drug coverage; a temporary limit on what the drug plan will cover for drugs that begins after an individual and the drug plan have spent a pre-determined amount on covered drugs. Home care: skilled nursing and related services provided to patients in a home setting. Other home care services include physical therapy, occupational therapy, speech therapy, medical social services, home health services and medical supplies and equipment. Hospice: a program or facility that provides care, comfort, and support services for terminally ill patients and their families. Hospice care concentrates on reducing the severity of disease symptoms, rather than halting or delaying progression of the disease itself. Inpatient: a patient who has been formally admitted to the hospital under a doctor s orders. 24

27 Lifetime reserve days: additional days Medicare will pay for when you re in a hospital for more than 90 consecutive days of the same benefit period, but once used, cannot be renewed. Individuals have 60 total lifetime reserve days for their lifetime. Out-of-pocket max: the most you will have to pay for medical and prescription drugs in a calendar year. Outpatient: a patient who is not hospitalized overnight but who visits a hospital, clinic or associated facility for diagnosis or treatment and is discharged on the same day. Premium: the money you pay each month for your plan based on where you live, family size and other variables. Skilled nursing facility care (SNF): a level of care that requires the daily involvement of a skilled nursing or rehabilitation staff like physical therapy and intravenous injections. You qualify only after a 3-day minimum hospital stay for a related illness or injury for up to 100 days in a benefit period that includes semi-private room and meals. Medicare doesn t cover long-term care or custodial care in this setting. 25

28 Exclusions and Limitations DISTRICT OF COLUMBIA AND MARYLAND SUBROGATION Subrogation gives CareFirst BlueCross BlueShield a legal right to recover benefits that have been provided under this Policy when a third party is liable. This provision applies only to the amount of benefits paid by CareFirst BlueCross BlueShield for services where the third party is liable. Medicare has separate subrogation rights that Medicare may pursue separately. 1. You shall notify CareFirst BlueCross BlueShield as soon as reasonably possible that a third party may be liable for the services for which benefits are being paid. 2. To the extent that benefits are paid under this Policy, CareFirst BlueCross BlueShield shall be subrogated and succeed to any rights or recovery You receive against any person or organization. 3. You shall pay to CareFirst BlueCross BlueShield the amount recovered by suit, settlement, or otherwise from any third party or third party s insurer to the extent of the benefits paid under this Policy. The amount paid to CareFirst BlueCross BlueShield will be reduced by CareFirst BlueCross BlueShield s pro-rata share of the court costs and legal fees incurred to produce such settlement. 4. You shall take any action, furnish information and assistance, and execute papers that CareFirst BlueCross BlueShield may require to facilitate enforcement of these rights. You shall not commit any action prejudicing the rights and interests of CareFirst BlueCross BlueShield under this Policy. DISTRICT OF COLUMBIA AND VIRGINIA EXCLUSIONS Benefits will not be provided under this Policy for the following: 1. Any service, supply or item that is not a Medicare eligible expense as determined by Medicare. 2. Unless stated otherwise in this Plan, any service, supply or item for which no actual determination was made by Medicare that the specific service, supply or item is a Medicare eligible expense. 3. Any amount that duplicates benefits actually provided on your behalf by Medicare. 4. Any amount that exceeds the Medicare fee schedule set by the Medicare program. 5. For care furnished by or received as a result of a Provider referral that is prohibited by law. 6. For Plan A: This Policy does not provide coverage for the Medicare Part A or Part B deductibles. 7. For Plans B, N, G, L, M: This Policy does not provide coverage for the Medicare Part B deductible. MARYLAND EXCLUSIONS Benefits will not be provided under this Policy for the following: 1. Any amount that duplicates benefits actually provided on your behalf by Medicare. 2. Any claim for a benefit that is not specifically described in the Basic (Core) Benefits or Additional Benefits Sections of this Policy. 26 The purpose of this brochure is the solicitation of insurance.

29 MARYLAND PRE-EXISTING CONDITIONS LIMITATIONS For Medigap Plans A, B, F, High-Deductible Plan F and N, check your enrollment application to see if a pre-existing conditions waiting period or a reduction in the pre-existing conditions waiting period applies to your coverage. No benefits will be provided for services rendered during the first 90 days of coverage under this Policy for a preexisting condition if you are applying for Plans A, B, F, High- Deductible Plan F and Plan N. However, if you are applying for Plans G, L or M, the pre-existing condition waiting period does not apply. A pre-existing condition is any condition for which medical advice or treatment was recommended by or received from a physician within 6 months before the effective date of this Policy. Covered services rendered to treat pre-existing conditions, and any complications arising out of a pre-existing condition, will be covered under this Policy if the covered service is rendered after this Policy has been in effect for 90 days. If immediately prior to the effective date of this Policy You were covered under any other Medicare Supplemental Policy, the period of time You were covered under the prior Policy will be credited to this 90 days waiting period. THE BENEFITS DESCRIBED ARE ISSUED UNDER POLICIES: CFMI/MG PLAN A (6/10), CFMI/MG PLAN B (6/10), CFMI/MG PLAN F (6/10), CFMI/MG PLAN N (6/10), CFMI/MG PLAN HI DED F (6/10), CFMI/2010 PLAN HI F SOB (6/10), MD/CF/MG PLAN A (6/10), MD/CF/MG PLAN B (6/10), MD/CF/MG PLAN F (6/10), MD/CF/MG PLAN N (6/10), MD/CF/MG PLAN HI DED F (6/10), MD/CF/2010 PLAN HI F SOB (6/10), CFMI/MG PLAN G (2/12), CFMI/MG PLAN L (2/12), CFMI/MG PLAN M (2/12), MD/ CF/MG PLAN G (2/12), MD/CF/MG PLAN L (2/12), MD/CF/MG PLAN M (2/12), as amended DC/CF/MG PLAN A (6/10), DC/CF/MG PLAN B (6/10), DC/CF/ MG PLAN F (6/10), DC/CF/MG PLAN HI DED F (6/10), DC/CF/ MG PLAN N (6/10), DC/CF/2010 PLAN HI F SOB, DC/CF/MG PLAN G (2/12), DC/CF/MG PLAN L (2/12), DC/CF/MG PLAN M (2/12), as amended VA/CF/MG PLAN A (6/10), VA/CF/MG PLAN B (6/10), VA/CF/ MG PLAN F (6/10), VA/CF/MG PLAN HI DED F (6/10), VA/CF/ MG PLAN HI F SOB (6/10), VA/CF/MG PLAN N (6/10), VA/CF/ MG PLAN G (2/12), VA/CF/MG PLAN L (2/12), VA/CF/MG PLAN M (2/12), as amended Neither CareFirst BlueCross BlueShield nor its agents represent, work for or are compensated by the Federal or State government or Medicare. CareFirst BlueCross BlueShield is a private not-for-profit health service plan. If you reside in either Prince George s or Montgomery counties then a Group Hospitalization and Medical Services, Inc. policy will be issued. For Baltimore City and all other Counties in the State of Maryland a CareFirst of Maryland, Inc. policy will be issued. Not connected with or endorsed by the U.S. Government or the Federal Medicare Program. 27

30 Still not sure which pathway to comprehensive coverage is right for you? Contact your broker today. Get personal service at no additional cost to you. 28

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32 CONNECT WITH US: CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc., which are independent licensees of the Blue Cross and Blue Shield Association. Registered trademark of the Blue Cross and Blue Shield Association. Registered trademark of CareFirst of Maryland, Inc. O65BROGUIDE (3/15) BOK5463-1S (12/15)