P.O. Box 29830 Hot Springs, AR 71903-0830 >000011 9306444 FRANK 123 ANY LANE MELBOURNE FL 32904 Toll-Free 1-800-240-4228, TTY 711 8 a.m. to 8 p.m. local time, 7 days a week 08-07-2015 Member ID: 922751837 Dear Frank, Welcome to AARP MedicareComplete (HMO). Medicare has approved your enrollment in our plan, and we look forward to helping you live a happier and healthier life. Your coverage begins 01-01-2016. In this letter you will find information to help you get started, so you can make the most out of your plan. When should I use my member ID card? Your new member ID card is enclosed. Please show this card every time you get health care services or fill a prescription at a network pharmacy. If you also have Medicaid, be sure to show your Medicaid ID card at the same time. What are my costs? Your premium (monthly payment) is $0.00. You may need to pay more if: You add optional supplemental benefits (riders) Your plan includes any deductibles, co-pays or co-insurance You have a Late Enrollment Penalty (LEP). You can find more information about the LEP on the last page of this letter. If you qualify for Medicare's Extra Help program or have Medicaid, you may have lower costs or pay nothing. How do I pay? If you owe a monthly premium, you can choose how you want to pay: Pay automatically from your bank account with Electronic Funds Transfer (EFT) 03106 9306444 0000 0000011 0000011 267 2 114
Pay automatically from your Social Security Administration (SSA) or Railroad Retirement Board (RRB) check Pay by check If you have not signed up for one of the automatic payment options we will send you a monthly bill you can use to pay by check. Please note: If you signed up for an automatic payment option you may still receive a monthly bill for a few months until your automatic payment starts. Until then, you can use the monthly bill to pay by check. You can change your payment option anytime throughout the year. What doctors or providers can I see? Your plan has a network. This is a Health Maintenance Organization (HMO) plan. That means you'll need to get your care from network doctors and hospitals. If you use a provider that isn't in our network, you may have to pay for these services yourself. However, emergency or urgently needed care or out-of-area dialysis services are covered wherever you need it. Providers in the network can change at any time. Which pharmacies should I use? We have a large service area with many pharmacies where you can have your prescriptions filled. Your plan may not pay for prescriptions filled at out-of-network pharmacies, except in an emergency. To find network pharmacies in your area: Look in your Pharmacy Directory Visit www.aarpmedicarecomplete.com Call us toll-free at 1-800-240-4228, TTY 711 What happens next? Now that you're a member of the plan, here's what you can expect next. Welcome Call. We'll give you a call to welcome you to the plan and answer any questions. Getting Started Guide and Plan Details. This includes your Evidence of Coverage, Provider Directory, Pharmacy Directory and Formulary (drug list). Health Survey. We'll ask you a few short questions about your health. This will help us connect you to more programs and services. You can find more information about your new plan on the next page. Thank you for choosing AARP MedicareComplete (HMO) for your health care insurance. We're here if you have any questions. You can call us toll-free at 1-800-240-4228, TTY 711, 8 a.m. to 8 p.m. local time, 7 days a week. You can also find this number on the back of your member ID card.
Sincerely, The UnitedHealthcare Team
More Information Can I get help with my prescription drug costs? People with limited incomes may qualify for Medicare's Extra Help program. This program helps pay your prescription drug costs. If you qualify: Medicare could pay for 75% or more of your monthly premiums, annual deductibles and prescription co-pays or co-insurance You won't have a coverage gap or a Late Enrollment Penalty (LEP) You can change plans at any time. If you lose Extra Help during the year, you can change plans for two months after you're notified that you no longer qualify. Many people qualify for Extra Help and don't even know it. If you'd like to apply or want more information, visit www.socialsecurity.gov/prescriptionhelp or call 1-800-772-1213, TTY 1-800-325-0778. You can also contact or visit your local Social Security office. If you think you qualify, but you don't have or can't find proof, please call Customer Service. What is a Late Enrollment Penalty (LEP)? Will I have to pay one? A Late Enrollment Penalty (LEP) is an amount Medicare adds to your monthly premium. If you have an LEP, you'll need to pay it for as long as you have Medicare Prescription Drug coverage. This penalty is required by law. It's designed to encourage people to enroll in a Medicare Drug plan when they are first eligible. You may owe an LEP if: You didn't join a Medicare Drug plan when you were first eligible for Medicare AND You didn't have other prescription drug coverage that met Medicare's minimum standards OR You had a break in coverage of at least 63 days We'll send you a separate letter if you owe an LEP. If you had an LEP with your last plan, you'll also have one with this new plan. For more information about the LEP call us toll-free at 1-800-240-4228, TTY 711. If you still have questions you can contact Medicare at the number below. What if I have Medigap (Medicare Supplemental Insurance) coverage? Now that you're a member of this Medicare Advantage plan, you don't need a Medigap or supplemental plan. You should contact your Medigap plan to cancel your policy. Enrolling in this Medicare Advantage plan will not automatically disenroll you from your Medigap plan. If this is the first time you've enrolled in a Medicare Advantage plan, you may have a trial period during which you can disenroll from this plan and switch back to a Medigap policy.
For more information about Medigap and the Late Enrollment Penalty (LEP), visit www.medicare.gov or call Medicare at 1-800-633-4227, TTY 1-877-486-2048, 24 hours a day, 7 days a week. When can I make changes to my coverage? Once enrolled in our plan, you can make changes only during certain times of the year. You can switch, drop or join a Medicare plan from October 15 through December 7. This is the Open Enrollment Period. From January 1 through February 14 anyone enrolled in a Medicare Advantage plan can disenroll from that plan and return to Original Medicare. If you disenroll during this time you can join a stand-alone Medicare Prescription Drug (Part D) plan during the same period. If you join a Medicare Prescription Drug (Part D) plan you'll be automatically disenrolled from our plan and returned to Original Medicare. You can change plans at other times of the year if you meet certain special exceptions or are a member of certain types of plans. Some examples of these special exceptions are if you move out of your plan's service area, or want to join a plan in your area with a 5-star rating, or if you qualify for Medicare's Extra Help program. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan's contract renewal with Medicare.