MINNESOTA 2018 MEDICARE PLANS MEDICA SIGNATURE SOLUTION SM Medicare Supplement Plan Options Coverage Details CHA52681-700318A
NATIONWIDE CHOICE AND COVERAGE. Medica Signature Solution gives you the best of all worlds the freedom to choose your doctor without any network restrictions and the security of knowing you have predictable coverage that goes with you from one end of the country to the other. 2 Talk with an expert consultant you can trust. Call 1-800-918-2151 TTY: 711 to speak with a Medicare consultant who can help you evaluate your situation and make the best coverage choice for you and your budget. Attend a free Medicare Workshop. To find a workshop near you, visit medica.com/ MedicareWorkshops. You ll learn everything you need to know about Medicare and the affordable plan options from Medica. Get the details online. Visit medica.com/medicare for valuable information and resources to help you make the best coverage decisions.
COAST-TO-COAST PEACE OF MIND Looking for a Medicare plan that s easy to budget for and easy to use no matter where you are? Signature Solution gives you that and more by paying important costs that Medicare does not cover. You decide the level of coverage you want. All options include: Choice see any provider that accepts Medicare Freedom travel or move anywhere in the U.S. No surprises medical coverage you can count on with no unexpected costs Affordability competitively-priced premiums for the value you need Medica. The first word in Medicare. Medica is a Minnesota plan that has been providing reliable coverage and exceptional service to our members for over 40 years. We know Medicare and we know Minnesota so you can rest assured that you will receive the local support you need no matter what changes you face down the road. All the plan features you want and more» copays for most medical services» Plan options to fit your needs» Free SilverSneakers fitness membership with access to 13,000 facilities nationwide» Personal support services to help you get the care you need» Discounts on products and services that enhance your life» Benefits that don t change from year to year unless you want them to NEED PART D DRUG COVERAGE? See page 7. 3
SIGNATURE SOLUTION PUTS YOU IN CONTROL Signature Solution supplements Original Medicare, which includes Part A and Part B. Part A helps pay for hospital costs for inpatient and skilled nursing care. Most people don t pay a premium for Part A but there is an annual deductible. Part B helps pay for medical costs for doctor visits, tests, outpatient treatment and some medical equipment. You must pay a monthly premium, deductible and coinsurance for Part B. Signature Solution is a Medicare Supplement plan that helps pay costs not covered by Original Medicare, like Medicare deductibles and coinsurance. How much is covered depends on the options that you select. Choose from two plan options:» Basic - with this plan you are able to add up to four riders that enhance your coverage in specific ways or you can choose to select the base plan with no additional riders» Extended Basic this plan provides very comprehensive coverage and no additional riders are available. Our two Signature Solution plans provide the following core benefits. The means you are covered. Coverage Basic Plan Extended Basic Plan Part A coinsurance Part B coinsurance First three pints of blood each year Hospice Part A coinsurance 100% skilled nursing facility coinsurance* 100% home health care services and medical supplies 80% emergency care outside U.S. 80% non-emergency care outside U.S. Preventive care Up to $120 annually *You must meet Medicare s requirements. 4
If you choose the Basic plan, you can add any or all of these optional riders:» Rider 1 Part A covers the annual Medicare Part A deductible of $1,340 for 2018» Rider 2 Part B covers the annual Medicare Part B deductible of $183 for 2018» Rider 3 Part B Excess Charges covers costs for providers that charge more than Medicare allows» Rider 4 Preventive Care plan pays up to $120 annually for non-medicare covered services like vision exams, hearing screenings and other routine screenings. Premium Rates Each Signature Solution plan has two types of premium rates available. The Standard rate is for people who use tobacco products and the Tobacco-Free rate is for those who don t. If you add one or more riders to the Basic plan, the cost for each rider you select is added to the Basic plan premium each month. Basic Plan Extended Basic Plan Tobacco-Free Rate Standard Rate Tobacco-Free Rate Standard Rate Base Premium $163.60 $190.50 $228.00 $262.20 Rider 1: Part A deductible covered $38.90 $44.70 Rider 2: Part B deductible covered $15.10 $15.10 Rider 3: Part B excess charges covered $.90 $1.00 Rider 4: Preventive care $2.20 $2.50 Total with all optional riders $220.70 $253.80 5
SELECT YOUR COVERAGE LEVEL Signature Solution gives you options to fit your needs and budget. You can simply select the Extended Basic plan or choose the Basic plan with or without addional riders. We can help you make the best choice for you. Basic Plan Extended Basic Plan RIDERS No Riders With Rider 1 With Rider 2 With Rider 3 With Rider 4 All Riders n/a Part A Deductible Covered Covered Covered Part B Deductible Covered Covered Covered Part B Excess Charges Covered Covered Preventive Care Covered Covered Covered BENEFIT YOU PAY YOU PAY Primary Care * * With Rider 2 * * With All Riders Specialist Visit * * * * Urgent Care * * * * Diagnostic Tests * * * * Lab & Radiology Services / X-ray * * * * Diabetes Supplies * * * * Part B drugs (Part D drugs not covered) * * * * Outpatient Care * * * * Emergency U.S. * * * * Foreign Emergency 20% 20% 20% 20% 20% 20% 20% Foreign Non-Emergency 100% 100% 100% 100% 100% 100% 20% Inpatient Hospital Days 0 60 Days 61-90 Up to $1,340** With Rider 1 Up to $1,340** Up to $1,340** Up to $1,340** With All Riders Skilled Nursing Care *** Up to $120 per year / *Once you pay your annual Part B deductible of $183 for 2018. / ** Annual Part A deductible *** Up to 100 days each benefit period. You must meet Medicare s requirements. Extended Basic also provides 80% coverage for days 101-120. 6
Add Part D drug coverage Medica can help you get a plan that fits your needs It s easy to add prescription drug coverage to your Signature Solution medical plan. Medica can help you select and enroll in a stand-alone Part D plan that gives you the coverage you need at an affordable price. Call Medica today to learn more or talk to your broker. Enjoy the perks of being a Medica member Change your benefits if you need to You can keep your same benefits from one year to the next guaranteed. But if your needs change, Signature Solution is flexible enough to change with you. In fact, you can change your coverage options at any time of the year. You are not limited to an annual election period. Access your plan information anytime, anywhere Mymedica.com is a one-stop member resource that puts your health plan benefits and activity at your fingertips. Take advantage of an array of self-service tools that give you access to your Medica plan information 24/7, 365 days a year. You can track your medical claims, order a replacement ID card and more. Get help from your local customer service team As a Medica member, you will always receive the caring, personal service you deserve from local Medicare experts. Our health plan specialists can answer your questions and help you maximize your coverage. It s just one more reason to choose Medica. 7
EXTRAS TO HELP KEEP YOU HEALTHY A reliable Medicare plan is only one piece of the puzzle when it comes to maintaining your health. We give you the extra resources you need to stay healthy each and every day. Stay Active with SilverSneakers Signature Solution includes a FREE SilverSneakers membership. This program helps people age 65 and over improve their well being through a variety of fitness options.» More than 13,000 participating fitness locations nationwide» Enroll at multiple locations simultaneously» Access to classes, exercise equipment and other amenities Visit SilverSneakers.com for a complete list of facilities and options. Save on Medical Alert Systems Medica members have access to discounts on retail prices for a variety of medical alert service options from Philips Lifeline, a medical alert provider in the U.S. Discounts on Hearing Aids Medica members receive up to a 20 percent discount on hearing aids through hi HealthInnovations. Choose from a variety of models that come with nationwide support. Save on Lasik Vision Correction As a Medica member, you have access to discounts of up to 50 percent off Lasik vision correction through the Qualsight Laser Vision Correction Program. The program provides you with a national network of accredited and experienced Lasik surgeons to choose from. Get the Health Information You Need As a Medica member, you will receive our Focus on Health newsletter three times a year. It is full of practical information to help you maintain or improve your well being, including content on topics like preventive care, common health conditions, safety tips, healthy recipes, Medicare updates and more! 8
PERSONAL SUPPORT SERVICES Signature Solution includes a number of special services to make your life easier so you have more time to focus on the things you enjoy. These services are provided at no additional cost to you and are strictly confidential. Consult with a Nurse 24/7 You and your family have a place to turn for trusted advice and information when you need it most. Through the HealthAdvocate Nurseline TM, highly-trained nurses are available to help answer your questions about symptoms, medications and health conditions. These nurses can provide medical evaluation and direction to appropriate care (911, ER or urgent care for life-threatening conditions). And they can offer self-care tips and symptom relief for non-urgent conditions. Get Personal Advocacy Support Have questions about your Medica plan coverage? Need help navigating the often complex medical system? Personal Health Advocates will help you tackle health and insurancerelated questions from finding the right doctor to answering any claims questions. They can even assist you in making an appointment with that hard-to-reach doctor. Your personal Health Advocate can also help you research resources like adult daycare, assisted living, long-term care and in-home care. Access Online Wellness Information Looking for new ways to help improve your health and wellness? HealthAdvocate s online resource center for Medica members is your one-stop, online support system that puts a large library of health videos and a variety of health assessments at your fingertips. 9
HOW TO ENROLL IN MEDICA SIGNATURE SOLUTION Eligibility You are eligible to enroll in Medica Signature Solution if you:» Are enrolled in Medicare Part A and Part B» Are a resident of Minnesota at the time of enrollment Enrollment area Signature Solution is available to residents of all Minnesota counties. (You must be a Minnesota resident at the time of enrollment.) There are three ways to enroll in a Signature Solution plan. Choose the one that works best for you: Submit your completed paper forms via mail, fax or web. Mail to: Medica Medicare Solutions PO Box 6300 Eau Claire, WI 54702-9713 Or fax to: 1-855-250-2166 Or upload securely at: Call 1-800-918-2151 TTY: 711 for fast and easy enrollment over the phone. Go to medica.com/medicare to easily complete your enrollment online. Complete and sign a paper application and submit via mail, fax or web. (You can request a paper application by calling 1-800-918-2151, TTY: 711.) medica.com/enrollmentupload When to Enroll The best time to enroll in a Medicare Supplement plan (also known as a Medigap plan) is during the six-month Medigap Open Enrollment Period which begins the month you re first enrolled in Medicare Part B. During this time you can buy any Medicare Supplement (Medigap) policy sold in your state, regardless of your health. You can apply for coverage at any time after your Medigap Open Enrollment Period too though you could be required to provide your health history and be medically underwritten. 10
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Call toll free at 1-800-918-2151 TTY: 711 MEDICA. THE FIRST WORD IN MEDICARE. Hours of operation: October 1 February 14 8 a.m. to 8 p.m. Central, seven days a week February 15 September 30 8 a.m. to 8 p.m. Central, Monday-Friday Visit us online at medica.com/medicare. Locate a Medicare Workshop near you at medica.com/medicareworkshops. Find a broker in your community at medica.com/medicare. Centers for Medicare & Medicaid Services (CMS) Toll free at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048) Hours of operation: 24 hours a day, seven days a week medicare.gov Social Security Administration Toll free at 1-800-772-1213 (TTY 1-800-325-0778) Hours of operation: 7 a.m. to 7 p.m., Monday-Friday ssa.gov Follow Medica: The SilverSneakers fitness program is provided by Tivity Health, an independent company. Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. 2017 Tivity Health, Inc. All rights reserved. HealthAdvocate is a trademark of Health Advocate, Inc. 2018 Medica. Medica is a registered service mark of Medica Health Plans. Signature Solution SM is a service mark of Medica Health Plans. Medica refers to the family of health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company, Medica Self-Insured and Medica Health Management, LLC. CHA52681-700318A