Please read this information before proceeding. title (written in bold as shown here) NOTE:

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1 Please read this information before proceeding. There are certain guidelines to follow if you will continue to work, or if you plan to have Medicare as your only insurance. This packet explains the Medicare structure and guidelines. You will find reference sheets in this packet. It will be helpful to keep them in the order in which you find them. They will be referenced by title (written in bold as shown here) throughout. NOTE: Medicare is an individualized program you will not share your plan with spouse or family members. If you have an Employer Group Health Plan, a retiree plan, Veteran coverage or GIC, some of the Medicare options, eligibility, enrollment guidelines and deadlines vary. Because of this, we encourage you to meet with your employer or call your health plan, Medicare or SHINE to ensure that you understand the enrollment guidelines and that you do not incur Medicare financial penalties.

2 SHINE Counselors are trained and certified annually, and attend monthly meetings to ensure they are sharing up-to-date information with you. If you would like to meet with a SHINE Counselor, visit to call for an appointment. Dates and availability times vary. Due to high volume during Open Enrollment October 15-December 7, we may not always have appointments available, but we can assist by phone and/or . Simply call for information: (Press 3). You can also call MEDICARE ( ) at any time.

3 When to enroll in Medicare varies depending on your age and current health care coverage status? The Initial Enrollment Period for Medicare Parts A & B is around the 65 th birthday as shown above. You will NOT get notified to enroll unless you are receiving Social Security benefits, and you MAY get notified if you have a Health Connector Plan. The Initial Enrollment 7 month time frame: 3 months prior to 65 th birthday month Month of birthday* 3 months after 65 th birthday month *Your Medicare coverage begins on the 1 st of the month of your birthday, regardless of the actual date of your birthday. However, if your birthday is on the 1 st of the month, you are eligible on the 1 st of the month before your birthday. Note the delay in coverage start date if you enroll during the month of your birthday or during the 3 months following. Still working? If you have insurance coverage through active employment * of yourself or a spouse, you may be able to forego enrolling in Part B until that employer coverage ends. If you do not enroll in Part B within 8 months of leaving that coverage, you can only enroll between Jan 1-Mar 31, coverage to begin July 1. *COBRA usually does not qualify as coverage. If you are unsure about enrolling in Part B, check with your employer or a SHINE Counselor to determine when you should enroll. You may incur a lifetime financial penalty if you do not enroll in Part B when eligible. If you are receiving Social Security disability benefits for 2 consecutive years you will automatically be enrolled in Medicare on the 25 th month.

4 There are different ways you can enroll in Part A and/or Part B. (More information about Part A and Part B to follow). Enrollment begins at Social Security, whether you are receiving Social Security benefits or not. You can enroll: Online at Call Social Security: (TTY users ), Monday through Friday, 7AM to 7PM; or In-person at your local Social Security office.

5 Welcome to Medicare! This is what the current Medicare cards look like. The current Medicare Claim Number is your Social Security number with a suffix letter(s). If you receive benefits via your spouse, it will be your spouse s Social Security number with a suffix letter(s). The suffix letter reflects how you are receiving benefits. For example, if you have the letter A : you are receiving Medicare because you paid into the Social Security system. If you have the letter B or D, you are receiving benefits via a spouse or as a widow, etc. Beginning in April 2018 and through 2019, Medicare will send a new card with an assigned number that is not your Social Security number (SSN). More info on next two slides.

6 Medicare is issuing new Medicare cards with a number that is unique to you but will NOT be your Social Security number. This is what your new Medicare card will look like. Always protect this information as though you would your Social Security Number. Instructions for use of new card will be included with your card. The mailing will go out in waves so you may receive either card when you enroll in Medicare.

7 This information will help you with what to expect when you receive your new Medicare card.

8 Welcome to Medicare. Here are the options you have to choose from: There are two primary options to choose from when you decide to enroll in Medicare: ORIGINAL MEDICARE (left column) or a MEDICARE ADVANTAGE PLAN (right column) Both options include: Part A your hospital insurance and Part B your medical (dr. visits etc.) insurance Part A is free if you or a spouse have earned at least 40 quarters (10 years) through work history and paid FICA taxes to Social Security. There is a monthly premium for Part B that may change annually and this premium may vary according to your earned income. See Medicare Premiums for information on monthly premiums. If you have Medicare through a retiree plan or if you have veteran s benefits, you may or may not need a supplement and/or a Part D plan. For preventive service information under Part B, see Medicare Part B Preventive Services

9 Your Medicare Options: Left side: OPTION 1: ORIGINAL MEDICARE Medicare will cover 80% of cost of services under Part A & Part B. You are responsible for the remaining 20% of the cost. Because of this, after you enroll in Part A & B, you may also want to consider supplemental medical coverage otherwise known as a Medigap plan which helps to cover the 20% of costs that Medicare does not cover. Refer to Medicare Part A Benefits and Gaps/Medicare Part B Benefits and Gaps that compares your costs and benefits if you do not have a Medigap plan, vs costs and benefits if you have a Supplement Core, or a Supplement 1 Plan. (More on Medigap explanations will follow) Then, decide if you need a Prescription Drug Plan. There are many plans to choose from in Massachusetts as listed on Medicare Part D Stand Alone Prescription Drug Plans. Explanation on Part D to follow.

10 Your Medicare Options (cont.): Left side: OPTION 1: ORIGINAL MEDICARE Medicare will cover 80% of cost of services under Part A & Part B. You are responsible for the remaining 20% of the cost. Because of this, after you enroll in Part A & B, you may also want to consider supplemental medical coverage otherwise known as a Medigap plan which helps to cover the 20% of costs that Medicare does not cover. Refer to Medicare Part A Benefits and Gaps and Medicare Part B Benefits and Gaps that compares your costs and benefits if you do not have a Medigap plan, vs costs and benefits if you have a Supplement Core, or a Supplement 1 Plan. *Note: Medigap and Supplement are the same just two different terms. (More on Medigap explanations will follow) Then, decide if you need a Prescription Drug Plan. There are many plans to choose from in Massachusetts as listed on Medicare Part D Stand Alone Prescription Drug Plans. Explanation on Part D to follow.

11 Your Medicare Options (cont.): OR your other Medicare coverage option is: Right side: OPTION 2: MEDICARE ADVANTAGE PLAN (Also called Part C) These are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and possibly Private Fee For Service (PFFS). Your Medicare Advantage Plan choices are specific to the county you live in. Essex County Medicare Advantage Plans or Middlesex County Medicare Advantage Plans (Note the top of the page to ensure you are reviewing your county-specific plans.) These plans usually include Parts A, B and a Part D Drug Plan (You still pay a premium for Part B).The Drug Benefit column shows which plans have a drug plan included. *More on Medicare Advantage Plans to follow.

12 BACK TO OPTION 1: ORIGINAL MEDICARE - MEDIGAPS EXPLAINED To enroll in a Medigap plan, you must also be enrolled in Part A and Part B See: Medigap Plans as shown on next slide *The information on this sheet is similar to the Medicare Part A and Part B Benefits and Gaps but is more specific pertaining to Medigap Plans. There are two types of Medigap plans Supplement Core and Supplement 1. There are no network restrictions and Medigaps are accepted nation-wide by all Medicare approved providers. (Massachusetts is one of 3 states that have different Medigap structures than all other states) These plans sold by private insurance companies all provide the same coverage. For example, all Core plan benefits are the same, and all Supplement 1 plan benefits are the same they all just have different monthly premiums. Some may have additional benefits as indicated on the sheet. Refer to coverage/cost chart on side 2. *Ask about a New to Medicare discount if you choose any one of these plans. *Though many companies also sell Part D plans you do not have to enroll with the same company. For example, you can have a Medigap from one plan, and a Part D plan from another. More on Part D Plans later. \ *Note: Blue Cross Blue Shield (BCBS) offers the Medex Choice as shown on bottom of Medigap Plans sheet. This is a hybrid PPO/Medigap style plan with network providers, but with the benefits of a Medigap Supplement 1 Plan. Call BCBS if you would like further information on that option.

13 This is the front of the Medigap Plans sheet showing the companies that sell them in Note the different rates between Supplement Core & Supplement 1 depending on the companies offering the plans. They are all required to provide the same coverage (listed on page 2), regardless of the monthly premium. Some plans offer additional benefits as shown. The next slide shows the other side of this sheet and how the benefits differ between the Supplement Core and Supplement 1.

14 This is the back of the Medigap sheet showing the benefits under Part A & Part B in the first Benefit column. The next columns show various costs for the Medicare beneficiary in three columns: Costs for Beneficiary with Original Medicare This reflects the costs for you, the beneficiary, if you did not choose a Medigap plan. For example: no supplement = 20% of Medicare-approved costs, including a hospital co-pay of $1,340 for Inpatient Hospital Care Costs for Beneficiary with Supplement Core This reflects your cost share if you had a Supplement Core Costs for Beneficiary with Supplement 1 This reflects your cost share if you had a Supplement 1 Note (on first page) that Supplement 1 has a higher monthly premium, but no additional payments except for additional days in a Skilled Nursing Facility (Rehab) after 100 days.

15 After you enroll in Medicare and join a Part D plan you remain on the plan until the following January. However, you may have a Special Enrollment Period during the year for qualifying circumstances, or if you are a member of Prescription Advantage (more on Prescription Advantage on an upcoming slide). Medicare Open Enrollment period allows you to choose different Medicare options and plans each year from October 15 - December 7 to begin in January. If you do not make any changes, your plan will continue into January (but may have cost and formulary changes). To help you determine the most cost effective Part D plan with Original Medicare, you can send the completed sheet entitled MEDICARE PLAN COMPARISON and a SHINE Counselor will run a report showing a comparison of the top 2 or 3 most cost-effective plans for you to choose from. Or we encourage you to search on your own! More information to follow.

16 This explains why we encourage you to review your plans every year during Open Enrollment. As you can see in the slide above, many components of a drug plan can change year to year. Formulary: The list of medications that a plan covers can change every year. Deductibles: Some plans have deductibles and some don t, and some deductibles apply to only Tiers 3-5 Co-pays & co-insurance: Can change every year per plan Drug Tiers: Tier level determines your co-pay amount and tier levels can change plan to plan, and can change every year Preferred Pharmacy: Your costs can vary per pharmacy and can change every year.

17 Have you heard of the Coverage Gap? It is also referred to as the Donut Hole. This slide helps to explain how you as the beneficiary may reach Coverage Gap (Donut Hole). The numbers in the formula change each year, and what we are showing here are the numbers for 2018 Part D Coverage Costs. Refer to Coverage Gap Donut Hole Explained. Both pages of the sheet describe the same information, just in a different format. Your pharmacist, Part D Plan Finder results, or a SHINE counselor can help you determine if and when you will hit the Donut Hole. Not everybody reaches this Gap. It depends on the costs of your medications which may vary from plan to plan. This is another reason why we encourage annual review of your plans.

18 Enrolling in Prescription Advantage may help you with costs during the Coverage Gap. See explanation on the slide above. Prescription Advantage Rate Schedule Guide for Members Eligible for Medicare When reviewing this sheet, be sure you are on PAGE 1 Use this guide to determine eligibility based on your income. This is NOT a drug plan. This is a free State Pharmaceutical Assistance program for Categories S0-S4 and assists with coverage during the Coverage Gap/Donut Hole only. Category 5 members pay an annual membership fee of $200/yr for this program. We encourage you to determine if this cost would be beneficial for you or not. Being a member of Prescription Advantage also gives you one Special Enrollment Period per year which may help if you need to switch Part D plans any time during the year. Enroll in Prescription Advantage online: or by calling , Press 2.

19 Compare your costs! You can run a Part D plan comparison on your own, on See instructions on slide above or refer to the Medicare Plan Finder Guide. *You will find helpful tutorials on the web page as well. For a Personalized Search, you will need the information on your Medicare card, your date of birth and current zip code listed with Medicare, or for a General Search enter your zip code. To compare Medicare Advantage Plans look for the option Medicare Health Plans with Drug Coverage after entering medications on Step 4: Refine Your Plan Results. Information on Medicare Advantage Plans to follow.

20 OPTION 2 MEDICARE ADVANTAGE PLANS (Also known as PART C) To enroll in a Medigap plan, you must also be enrolled in Part A and Part B Medicare Advantage Plans (MA Plans) As mentioned earlier, these plans are county specific so be sure that you are looking at the correct side of this sheet depending on which county you reside in. Essex County Medicare Advantage Plans or Middlesex County Medicare Advantage Plans Note the Special Needs Plans approximately half way down the page those plans are only available if you qualify for Medicare and MassHealth Standard. Call SHINE for more information about eligibility: (Press 3) Note the Type of Plan column and Drug Benefit columns. You can compare Medicare Advantage Plans on Refer to the Medicare Plan Finder Guide Sheet Before enrolling in any plan, call the plan to ask if your Primary Care Physician and preferred hospital(s) are in the network. Also ask if the prescription drugs you currently take are covered in that particular plan, and what your co-pays (per medication) will be at your favorite pharmacy as costs may vary per pharmacy.

21 Some helpful tips on deciding which type of Medicare is best for you. Original Medicare with a Medigap Plan (OPTION 1), or Medicare Advantage Plan (OPTION 2). **Note: You will get more coverage with a Supplement 1 than a Supplement Core. Refer to list of benefits on the back of the Medigap for more information

22 See Eligibility Guidelines for Public Benefits Review the sheet based on your income and assets. If it looks as though you may qualify for any programs, contact SHINE and we will assist with next steps.

23 Dental Coverage Options for Seniors and Health Connector Dental Plans

24 Your personalized Medicare Summary Notice (MSN) is mailed to you quarterly and lists all services Medicare is billed for under your Medicare number. Or, you can review monthly by accessing your MSN on Review carefully to ensure accurate billing for all services. Help reduce Medicare Error, Fraud & Abuse that costs billions each year in the United States Call Senior Medicare Patrol (SMP) if you suspect error, fraud and/or abuse: *More on Senior Medicare Patrol on next slide.

25 Protection Recommendations Ask for your free Personal Health Care Journal by calling SMP: Keep updated list of medications Prepare for medical appointments Carry SMP Healthcare Journals when traveling ALWAYS compare SMP Personal Healthcare Journal entries to Explanation of Benefits from your plan, Medicare Summary Notice, and other bills/statements.

26 You can also access most of these resources on the internet: SHINE: AGE-INFO ( ), press 3 SHINE can help with all Medicare-related concerns Medicare: MEDICARE ( ) (always be sure you are on a.gov site) Massachusetts College of Pharmacy (MCPHS) Pharmacy Outreach Program: MCPHS can help find available cost savings for medications Prescription Advantage: AGE-INFO, press 2 Prescription Advantage can help with costs if you are in the Coverage Gap/Donut Hole. Senior Medicare Patrol (SMP): SMP can help resolve Medicare Error, Fraud and Abuse situations Medicare Advocacy Project (MAP): MAP is based at Greater Boston Legal Services

27 Thank you for your time and interest in the SHINE Program. We encourage you to share this free and unbiased resource with your friends and family! SHINE: Press 3