Geisinger Gold. Your Guide to. We ll help you choose the Medicare Advantage Plan that s right for you.

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1 Your Guide to Geisinger Gold We ll help you choose the Medicare Advantage Plan that s right for you. APB_NJ_2015 Y0032_H2792_14202_5 CMS Approved 8/11/14

2 We ll help you every step of the way. Meridian Health is proud to offer Geisinger Gold, one of the top ten Medicare Advantage plans in the nation*, to Medicare beneficiaries in Monmouth and Ocean counties. With Geisinger Gold, you get comprehensive coverage, superb wellness and preventive care programs, extensive disease management programs, and affordable rates. You can trust that you ll receive high quality care from committed doctors and nurses right in your community. With a Geisinger Gold Medicare Advantage plan, you have more ways to receive the right care at the right time from the right place. Together, we are committed to improving your health and Taking Care of New Jersey. You can speak with a Geisinger Gold Sales Counselor who understands your concerns, listens to your needs, and gives you the kind of straightforward information you need to make the best decision. There s no obligation. Call us today, and we can help you enroll right over the phone! For your convenience, you can also enroll online at MeridianGeisingerGold.com. To Find Out More Call today! TDD: a.m. to 8 p.m., (7 days a week, Oct Feb. 14) 8 a.m. to 8 p.m., (Mon. - Fri., Feb Sept. 30) MeridianGeisingerGold.com *NCQA s Medicare Health Insurance Plan Rankings For more information about the rankings, please visit MedicaidandMedicareHealthPlanRankings aspx Cover Photo: Stockbyte/Stockbyte/Thinkstock

3 Table of Contents What makes Geisinger Gold a smart choice for me?...4 Get more for your money...5 Choosing the best plan for you...6 Medicare Advantage Plan Overview What is a Medicare Advantage plan?...9 Are prescription drugs covered?...9 What if I spend time outside the Geisinger Gold service area?...9 Are my doctors in the network?...9 Who is eligible?...9 When can I enroll?...9 Do I qualify for a low income subsidy...10 How do I enroll?...10 When will my coverage become effective?...10 What if I change my mind? Medicare Advantage Premiums by County of Residence...11 Here s what you ll pay with Geisinger Gold Medicare Prescription Drug Coverage (Part D) Medicare Advantage Benefits Overview What else should I know about Medicare Advantage plans?...16

4 BananaStock/BananaStock/Thinkstock To Find Out More Call today! TDD: a.m. to 8 p.m., (7 days a week, Oct Feb. 14) 8 a.m. to 8 p.m., (Mon. - Fri., Feb Sept. 30) MeridianGeisingerGold.com

5 What makes Geisinger Gold a smart choice for me? Geisinger Gold is one of the top ten Medicare Advantage plans in the nation.* *NCQA s Medicare Health Insurance Plan Rankings For more information about the rankings, please visit MedicaidandMedicareHealthPlanRankings aspx Dedicated to Better Health Providing quality health care coverage at affordable costs is Geisinger Gold s primary mission. For nearly 20 years, we ve been dedicated to working with physicians and hospitals to provide superior health care coverage to the residents in the counties we serve. Our position as the #1 ranked Medicare Advantage plan in Pennsylvania and one of the top ten in the nation* is proof of our dedication to our members. Steven R. Youso President and CEO Geisinger Health Plan Geisinger Gold Medicare Advantage 4

6 Get more for your money. When you join a Geisinger Gold Medicare Advantage plan you continue to get all of your Medicare Part A & B benefits, plus additional benefits. Geisinger Gold Medicare Advantage plans include a wide range of cost-saving features and benefits not available with Medicare Parts A and B. Low Cost Prescription Drug Medicare Parts A and B You must pay your Part B premium No Geisinger Gold Medicare Advantage plans Plans starting at $0 a month; you must continue to pay your Part B premium. Prescription drug coverage with generic drug copays as low as $3 is available. Out-of-Pocket Protection No Yes: Most plans have an annual limit on how much you pay in deductibles and copays. Routine Dental Services No Yes, with most plans. Hearing Aid Benefit No Yes, with most plans. Routine Vision/ Eyewear Benefits No Yes, with most plans. Fitness Membership No Yes, with most plans. Care Management Programs for heart conditions, diabetes, blood pressure, kidney disease and much, much, more! No Yes, with our Classic (HMO) and Preferred (PPO) plans. Coverage of preventive services, including certain health screenings and immunizations Yes Services covered with $0 copay for all Geisinger Gold plans (For Reserve (MSA) plan deductible must be met) 5 Geisinger Gold Medicare Advantage

7 Choosing the best plan for you Geisinger Gold offers a wide-array of health plans which include: traditional HMO, Preferred Provider Organization (PPO), and Medical Savings Account (MSA). While each of the plans we offer will provide you with outstanding health care coverage, finding the right plan for you is too important to leave to guesswork. That s why Geisinger Gold Sales Counselors provide expertise and guidance that makes it easy for you to get the affordable health coverage you want. In fact, we can walk you through the entire process answering all your questions and helping you enroll in a plan that fits both your needs and budget. Geisinger Gold offers a variety of choices. To get started, think about what s important to you. If you want a plan that s easy on the budget, consider one of our Medicare Advantage HMO or PPO plans. If flexibility is important to you, consider our Reserve (MSA) plan. It offers the freedom to choose any doctor or hospital, anywhere in the U.S., that accepts Medicare and agrees to see you. Jupiterimages/Stockbyte/Thinkstock Geisinger Gold Medicare Advantage 6

8 Medicare Advantage Plan Overview Geisinger Gold Classic Rx (HMO) Geisinger Gold Classic Rx (HMO) is an HMO plan that offers more comprehensive protection and lower out-of-pocket costs than you get with Original Medicare. A Primary Care Physician works to coordinate your medical care. Covered services including hospitalization, routine office visits, physicals, immunizations, diagnostic tests and x-rays, are covered with affordable, predictable costs. Vision, hearing, dental, and fitness benefits, as well as prescription drug coverage, are included. Geisinger Gold Preferred Rx (PPO) Geisinger Gold Preferred Rx (PPO) is a PPO plan that offers predictable costs and the freedom to choose any doctor or hospital you wish. No Primary Care Physician selection or referrals are needed. You can use any provider who is part of our network, and you have the flexibility to use out-of-network providers at a higher out-of-pocket cost. Vision, hearing, dental, and fitness benefits, as well as prescription drug coverage, are included. Wavebreakmedia Ltd/Wavebreak Media/Thinkstock 7 Geisinger Gold Medicare Advantage

9 Geisinger Gold Reserve (MSA) plan Available statewide, this Medicare Advantage Plan option puts you in control of your health care dollars. It combines a high-deductible insurance plan with a savings account to pay your medical bills. There s no monthly premium and you have the freedom to choose any medical professional who accepts Medicare and agrees to see you. Here s how it works: Geisinger Gold deposits $1,200 a year (provided by Medicare) into your Medical Savings Account to help pay qualified medical expenses such as doctor visits, diagnostics tests such as X-rays, inpatient hospital stays, etc. This $1,200 can help meet your annual $3,900 deductible. Once the deductible is met, Geisinger Gold pays all Medicare covered expenses in full. Any money left in your Medical Savings Account at the end of the calendar year rolls over to the next year. Example 1: Over time, your MSA account can pay for plan-covered expenses, resulting in no cost to you. You can use the funds deposited to your MSA account first to pay for medical expenses. If you do not use all the money in your MSA account, that money carries over to the next year, and is added to your annual deposit. The funds in your MSA account can build over time to meet your full annual deductible. $3,900 Annual Deductible - Geisinger Gold Pays Costs After Deductible is Met Account Balance (Deposit) Medical Costs $1,200 Paid by MSA Balance (Carry Over + Balance Deposit) Carry Over $1900 Account Balance Account (Carry Medical Balance Carry Over to New Over+ Deposit) $2,300 Costs Paid by MSA Account Medical Balance Costs Carry Paid Year $900 Over Account to New by MSA to New Year Account $1100 Year $500 $700 $800 $1,400 Year 1 Year 2 Year 3 In each year, medical costs are less than the MSA account balance, resulting in no cost to you, and a higher starting balance each new year due to carry over. Example 2: Plan-Covered Expenses Exceed the Deductible For the year, your medical costs total $2,700 $10,000 (to meet $1,200 $3,900 deductible) $6,100 MSA You Geisinger Account Pay Gold Pays Pays Geisinger Gold Medicare Advantage 8

10 Geisinger Gold Medicare Advantage Answers to frequently asked questions What is a Medicare Advantage plan? Medicare Advantage plans were created to give Medicare recipients greater benefits than original Medicare (Medicare Parts A & B) alone. They follow guidelines set by Medicare, but may offer a wide variety of additional benefits and plan options. When you re insured with a Medicare Advantage plan, you still have Medicare. But your coverage is administered by a private company, rather than by the government. So instead of presenting your Medicare Card for services, you ll use your Medicare Advantage Card. Are prescription drugs covered? Yes! With Geisinger Gold, you can get all your coverage from a single source, with generic drug copays as low as $3. You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: MEDICARE ( ). TTY/TDD user should call , 24 hours a day/7 days a week; The Social Security Administration at between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY/TDD users should call ; or your state Medicaid office. What if I spend time outside the Geisinger Gold service area? Medical emergency services are covered worldwide under all of our HMO and PPO plans. Geisinger Gold Preferred (PPO) plans have in- and out-of-network coverage, with no referrals required. Your out-of-pocket expenses will be higher if you use providers who are not members of the network. Geisinger Gold Reserve (MSA) members can go to any medical professional that accepts Medicare and agrees to see them. Are my doctors in the network? Visit MeridianGeisingerGold.com for the most up-to-date information about our network. There you will find information about the Health Plan s participating primary care physicians, specialists, mental health providers, hospitals and other services, including durable medical equipment vendors, radiology facilities and more. You can also call a Geisinger Gold Sales Counselor who will help you find a doctor and answer any questions you may have. Who is eligible? You are eligible to join a Geisinger Gold Medicare Advantage plan as long as you have Medicare Parts A and B; live in the health plan s service area; and do not have End-Stage Renal Disease (ESRD). If you are interested in Geisinger Gold Reserve (MSA), additional restrictions may apply. When can I enroll? Medicare beneficiaries can enroll for Geisinger Gold Medicare Advantage coverage at certain times of the year. Annual Election Period - Oct Dec. 7 You can enroll in or switch to a new Medicare Advantage plan or Medicare Advantage prescription drug plan during the Annual Election Period (AEP). For 2015 coverage, the Annual Election Period is from October 15 to December 7,

11 Geisinger Gold Medicare Advantage Answers to frequently asked questions Initial Coverage Election Period When you turn 65 (or when you retire) or otherwise become eligible for Medicare, you qualify for an Initial Election Period. This is a seven-month period that begins three months before your birthday month the month of and 3 months after you are first eligible for both Medicare Part A and Part B. Beyond your Initial Election Period, certain circumstances may make you eligible to enroll for coverage at any time. Eligibility for these Special Election Periods include a change in residence, delayed retirement, disability, loss of benefits if your existing plan s contract is not renewed by Medicare, loss of low income subsidy or special needs status. Please call for more information. Do I qualify for a low income subsidy? If you have limited resources and income, you may be eligible for a Low Income Subsidy. This subsidy provides help with monthly premiums, annual deductibles, and prescription drug copayments related to a Medicare prescription drug plan. Incremental and full subsidies are awarded, based on income and asset testing using federal guidelines. Low Income Subsidies are administered by the Social Security Administration and the Center for Medicare and Medicaid Services. How do I enroll? We make enrollment easy. During the Annual Election Period for Medicare beneficiaries, you can talk to one of our local Geisinger Gold Sales Counselors for advice and assistance. Once you decide what plan is right for you, the Sales Counselor can complete your enrollment right over the phone! You can also visit MeridianGeisingerGold.com for plan information and to enroll online. In-person enrollment meetings may also be available. When will my coverage become effective? If you enroll between October 15 and December 7, 2014, your coverage will become effective on January 1, What if I change my mind? Between January 1 and February 14, you can disenroll from a Medicare Advantage plan and return to Original Medicare. As a result of this change, you would be eligible to enroll in a stand-alone Prescription Drug Plan (PDP). You will not be able to make any further changes until the next Annual Election Period (unless you qualify for a special election period during the year). The annual disenrollment period does not apply for Geisinger Gold Reserve (MSA). To Find Out More Call today! TDD: 711 Special Enrollment Hours 8 a.m. to 8 p.m., (7 days a week, Oct Feb. 14) 8 a.m. to 8 p.m., (Mon. - Fri., Feb Sept. 30) Geisinger Gold Medicare Advantage 10

12 2015 Medicare Advantage Premiums by County of Residence Monmouth Ocean Classic Rx (HMO) $0 $0 Preferred Rx (PPO) $109 $109 Reserve 100 (MSA) $0 $0 Here s what you ll pay with Geisinger Gold Medicare Prescription Drug Coverage (Part D). Classic Rx Annual Deductible: $0 Initial Coverage Until total yearly drug costs reach $2,960, a member pays: Retail Tier 1: $6 copay for 1 month (30 day) supply, $18 copay for 3 month (90 day) supply Retail Tier 2: $20 copay for 1 month (30 day) supply, $60 copay for 3 month (90 day) supply Retail Tier 3: $39 copay for 1 month (30 day) supply, $117 copay for 3 month (90 day) supply Retail Tier 4: $85 copay for 1 month (30 day) supply, $255 copay for 3 month (90 day) supply Retail Tier 5: 33% coinsurance for one month (30 day) supply Preferred Rx Annual Deductible: $0 Initial Coverage Until total yearly drug costs reach $2,960, a member pays: Retail Tier 1: $3 copay for 1 month (30 day) supply, $9 copay for 3 month (90 day) supply Retail Tier 2: $18 copay for 1 month (30 day) supply, $54 copay for 3 month (90 day) supply Retail Tier 3: $39 copay for 1 month (30 day) supply, $117 copay for 3 month (90 day) supply Retail Tier 4: $85 copay for 1 month (30 day) supply, $255 copay for 3 month (90 day) supply Retail Tier 5: 33% coinsurance for one month (30 day) supply 11 Geisinger Gold Medicare Advantage

13 Coverage Gap (all plans) After total yearly drug costs reach $2,960, but before a member s yearly out-of-pocket reaches $4,700, members enter the coverage gap. While in the gap, Geisinger Gold members still have access to Tier 1 generic medications for as low as $3 (depending on your plan) for a 30-day supply. For other medications, member pays 65% of the cost for the generic medications and 45% of the cost for brand medications. For example, you would pay $45 for a $100 brand-name drug and $6.50 for a $10 generic version of that drug. Catastrophic Coverage (all plans) After yearly out-of-pocket drug costs reach $4,700, a member pays $2.65 copay for generic (including brand drugs treated as generic) and $6.60 copay for all other drugs or 5% coinsurance, whichever amount is greater. Fuse/Thinkstock Geisinger Gold Medicare Advantage 12

14 Medicare Advantage Benefits Overview Classic Rx (HMO) In-Network Annual Medical Deductible $0 Annual Medical Out of Pocket Maximum $6,700 Inpatient Hospital Care $345 days for 1-5 $0 days 6-90 Skilled Nursing Facility Care $0 days 1-20 $156 days $0 days (no prior hospital stay required) Emergency Care/Urgent Care $65/$15 (Waived if admitted) Primary Care/Specialty Care Provider $5/$15 Outpatient Lab/Diagnostic Tests $15/20% Outpatient X-Rays $25 Outpatient MRI, CT, PET Scans 20% Outpatient Ambulatory Surgery 30% Ambulance Services (each way) $200 (Waived if admitted) Durable Medical Equipment 20% Dental Services (Preventive): Oral Exam (with or without cleaning) Preventive Dental X-Rays Vision Exam (Medical-Medicare-covered) ($0 for glaucoma screen - office visit copay may apply) $0; every 6 months $0 bitewing only or $0 panoramic and all other types (1 per year) $20 Vision Exam (Routine) Routine Contact Lenses or Eyeglasses (Lenses and Frames) Hearing Exams - Diagnostic Routine Hearing Aides/Fitting for Hearing Aids Medicare Part D Prescription Drug Coverage $20; 1 per year $200 maximum benefit every 2 years $20, 1 per year $0; $1000 maximum benefit every 3 years (fitting/eval. falls under this limit) Included Geisinger Gold Reserve 100 (MSA): All covered services paid in full after annual deductible is met. For more information, please visit MeridianGeisingerGold.com or call us today at Geisinger Gold Medicare Advantage

15 Preferred Rx (PPO) In-Network Annual Medical Deductible $0 Annual Medical Out of Pocket $6,700 Maximum Inpatient Hospital Care $225 days 1-8 $0 days 9-90 Skilled Nursing Facility Care $0 days 1-20 $156 days $0 days Out-of-Network $0 $10,000 20% 20% Emergency Care/Urgent Care $65/$25 (Waived if admitted) Primary Care/Specialty Care Provider $10/$25 $15/$30 Outpatient Lab/Diagnostic Tests $10/20% 20%/20% Outpatient X-Rays $25 20% Outpatient MRI, CT, PET Scans 30% 35% Outpatient Ambulatory Surgery $250 20% Ambulance Services (each way) $200 (Waived if admitted) Durable Medical Equipment 20% 20% Dental Services (Preventive): Oral Exam (with or without cleaning) Preventive Dental X-Rays Vision Exam (Medical-Medicarecovered) ($0 for glaucoma screen - office visit copay may apply) $65/$25 (Waived if admitted) $200 (Waived if admitted) $0; every 6 months 20%; every 6 months $0 bitewing only or 20% $0 panoramic and all other types (1 per year) $25 $30 Vision Exam (Routine) $25, 1 per year $30, 1 per year Routine Contact Lenses or Eyeglasses (Lenses and Frames) Hearing Exams - Diagnostic Routine Hearing Aides/Fitting for Hearing Aids Medicare Part D Prescription Drug Coverage $200 benefit max every 2 years $200 benefit max every 2 years $25, 1 per year $30, 1 per year $0; $1000 maximum benefit every 3 years (fitting/eval. falls under this limit) Included $0; $1000 maximum benefit every 3 years (fitting/eval. falls under this limit) Some dental and vision services may be covered by Medicare. Call for details. Geisinger Gold Medicare Advantage 14

16 FPO for image Fuse/Thinkstock To Find Out More Call today! TDD: a.m. to 8 p.m., (7 days a week, Oct 1. - Feb. 14) 8 a.m. to 8 p.m., (Mon. - Fri., Feb Sept. 30) MeridianGeisingerGold.com 15 Geisinger Gold Medicare Advantage

17 What else should I know about Medicare Advantage plans? Geisinger Gold Medicare Advantage HMO, PPO and MSA plans are offered by Geisinger Health Plan/Geisinger Quality Options, Inc., health plans with a Medicare contract. Continued enrollment in Geisinger Gold depends on annual contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Secure (HMO SNP) members must meet certain eligibility requirements. Secure 1 (HMO SNP) costs may vary based on the level of Extra Help you receive. Please contact the plan for further details. A sales person will be present at meetings with information and applications. For accommodation of persons with special needs at sales meetings call (TTY/ TDD users should call 711). Members must get their prescriptions from network pharmacies. In case of emergency, members may go to a non-network pharmacy. You may only enroll in one prescription drug plan at a time. If you are enrolled in a Medicare Advantage plan which offers prescription drug coverage, you must take your prescription drug coverage from that plan. Prescription drug coverage from Geisinger Gold is offered exclusively to Geisinger Gold members. You cannot enroll in a standalone prescription drug plan, unless you disenroll from your Medicare Advantage plan. If you are enrolled in a Medicare Supplement or Medical Savings Account plan, you can enroll in any stand-alone prescription drug plan. from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins. Medicare MSA Plans don t cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate Medicare Prescription Drug Plan. You must file Form 1040, US Individual Income Tax Return, along with Form 8853, Archer MSA and Long-Term Care Insurance Contracts with the Internal Revenue Service (IRS) for any distributions made from your Medicare MSA account to ensure you aren t taxed on your MSA account withdrawals. You must file these tax forms for any year in which an MSA account withdrawal is made, even if you have no taxable income or other reason for filing a Form MSA account withdrawals for qualified medical expenses are tax free, while account withdrawals for non-medical expenses are subject to both income tax and a fifty (50) percent tax penalty. Tax publications are available on the IRS website at irs.gov or from TAX-FORM ( ). There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan at (TTY 711) for additional information. MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money Geisinger Gold Medicare Advantage 16

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20 Talk to us about the many options available to you. Geisinger Gold Sales Counselors are offering free consultations without any obligation. Call us today, and we can help you enroll right over the phone! For your convenience, you can also enroll online at MeridianGeisingerGold.com. To Find Out More Call today! TDD: a.m. to 8 p.m., (7 days a week, Oct Feb. 14) 8 a.m. to 8 p.m., (Mon. - Fri., Feb Sept. 30) MeridianGeisingerGold.com Crestwood Village Shopping Center 550 County Route 530, Suite 20 Whiting, NJ APB_NJ_2015 APB