Part A - Hospitals Part A helps pay the costs of a stay in a hospital or skilled nursing facility, home health care, hospice care, and medicines administered to inpatients. Hospital Stay In 2012, you pay $1,156 deductible per benefit period $0 for the first 60 days of each benefit period $289 per day for days 61–90 of each benefit period $578 per “lifetime reserve day” after day 90 of each benefit period (up to a maximum of 60 days over your lifetime) Skilled Nursing Facility Stay In 2012, you pay $0 for the first 20 days of each benefit period $ per day for days 21–100 of each benefit period All costs for each day after day 100 of the benefit period Part B - Doctors Part B helps pay bills for physicians and outpatient services such as rehab therapy, lab tests and medical equipment. It also covers doctors' services in the hospital and most medicines administered in a doctor's office. Deductible $140 for 2012 Coinsurance (you pay) 20% -For Part B services, the coinsurance is usually 20% of the Medicare-approved amount after you have met the $140 deductible for Medicare Part B sets an amount payable for each medical service or supply that a person with Medicare receives. This is called the "Medicare-allowable" or "Medicare-approved" amount, which is based on a fee schedule. Part C is a different way you can choose to receive your Medicare benefits. It consists of a variety of private health plans, known as Medicare Advantage plans, that cover Part A, Part B and (often) Part D services in one package. (See "Figuring Out Your Choices.")(See "Figuring Out Your Choices.") Part D - Prescriptions Part D helps pay the cost of prescription drugs that you use at home, plus insulin supplies and some vaccines. To get this coverage, you must enroll in a private Part D drug plan or in a Medicare Advantage plan that includes Part D drugs. (See"Figuring Out Your Choices.")(See"Figuring Out Your Choices.") Benefit Period —The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods. These contractors, called “health plan sponsors” or Medicare Advantage Organizations (MAOs), offer Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private-Fee-for-Service (PFFS) plans, and more, to Medicare beneficiaries. These private plans must cover the same services and benefits that are available through the Original Medicare program.

HMO vs PPO How HMOs and PPOs Differ The following outline compares some of the features of HMOs and PPOs. These are general rules and you should speak with your human resources office at work or directly with your health plan. If you are in the process of deciding between enrolling in a HMO or PPO, you often can compare the plans by going online to the plans' websites to learn about the available benefits and costs. Which health care providers must I choose? HMO: You must choose doctors, hospitals, and other providers in the HMO network. PPO: You can choose doctors, hospitals, and other providers from the PPO network or from out-of-network. If you choose an out-of-network provider, you most likely will pay more. Do I need to have a primary care physician (PCP)? HMO: Yes, your HMO will not provide coverage if you do not have a PCP. PPO: No, you can receive care from any doctor you choose. But remember, you will pay more if the doctors you choose are not "preferred" providers. How do I see a specialist? HMO: You will need a referral from your PCP to see a specialist (such as a cardiologist or surgeon) except in emergency situations. Your PCP also must refer you to a specialist who is in the HMO network. PPO: You do not need a referral to see a specialist. However, some specialists will only see patients who are referred to them by a primary care doctor. And, some PPOs require that you get a prior approval for certain expensive services, such as MRIs. Do I have to file any insurance claims? HMO: All of the providers in the HMO network are required to file a claim to get paid. You do not have to file a claim, and your provider may not charge you directly or send you a bill. PPO: If you get your healthcare from a network provider you usually do not need to file a claim. However, if you go out of network for services you may have to pay the provider in full and then file a claim with the PPO to get reimbursed. The money you receive from the PPO will most likely be only part of the bill. You are responsible for any part of the doctor's fee that the PPO does not pay. How do I pay for services in the network? HMO: The only charges you should incur for in-network services are copayments for doctor's visits and other services such as procedures and prescriptions.copayments PPO: In most PPO networks you will only be responsible for the copayment. Some PPOs do have an annual deductable for any services, in network or out of network.annual deductable How do I pay for services out of the network? HMO: Except for certain types of care that may not be available from a network provider, you are not covered for any out-of-network services. PPO: If you choose to go outside the PPO network for your care, you will need to pay the provider and then get reimbursed by the PPO. Most likely, you will have to pay an annual deductable and coinsurance. For example, if the out-of-network doctor charged you $200 for a visit, you are responsible for the full amount if you have not met your deductable. If you have met the deductable, the PPO may pay 60%, or $120 and you will pay 40%, or $80.coinsurance

Humana AdvantageMediGap Doctors:We know which Drs. Are included (e.g. Ershlier) Costs: NOTE: not a $-$ comparison – do not have information on Humana premiums from Don & Punch. Same as 2010: -Premiums -Part A (hospitals) -Part B (Drs.) -Part D (Prescriptions) No limit to out-of-pocket Costs vary by health/age Portability:Not portable (e.g. would have to change plans to one supported in AZ) Portable (e.g. could simply switch to Drs./Services in AZ, minor adjustment to fees.

KaizerHumana AdvantageMediGap Doctors:We know which Drs. Are included (e.g. Ershlier) Costs: NOTE: not a $-$ comparison – do not have information on Humana premiums from Don & Punch. Same as 2010: -Premiums -Part A (hospitals) -Part B (Drs.) -Part D (Prescriptions) No limit to out-of-pocket Costs vary by health/age Coverage Portability:Not portable (e.g. would have to change plans to one supported in AZ) Portable (e.g. could simply switch to Drs./Services in AZ, minor adjustment to fees.

Doughnut Hole What IS the Doughnut Hole? The “doughnut hole” refers to a gap in prescription drug coverage under Medicare Part D. In 2011, once you reach $2,840 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance,) you will be in the coverage gap. During this gap in coverage, if you are not receiving Extra Help (the low-income subsidy), you pay the full costs for prescription drugs. When your total out-of-pocket costs reach $4,550, you qualify for catastrophic coverage.” At that point, you are responsible for only 5% of your prescription drug costs for the rest of the year. Starting in 2011, you will get a 50% discount on brand-name drugs and a 7% discount on generic prescription drugs while you are in the coverage gap. Because of the Affordable Health Care Act of 2010, the coverage gap/ “Doughnut Hole” will gradually narrow until it disappears in If you want to see whether you are eligible for the Medicare Extra Help Program, check out Benefits Quicklink.Benefits Quicklink To share your experiences with the doughnut hole calculator and ask questions, visit the Medicare Part D online community group.Medicare Part D online community group Find out more about how the new health care law helps people who fall into the doughnut hole this year by checking out this fact sheet.fact sheet Learn more about the doughnut hole at this AARP Bulletin guide on Medicare Prescription Drug Coverage.AARP Bulletin

MediGap Medigap insurance, which is sold by private companies, helps pay for costs that Medicare doesn’t cover, such as copayments and deductibles. Medigap coverage is available only to people who have Original Medicare Parts A and B.Medigap Original Medicare Parts A and B If you opted for a Medicare Advantage health plan (aka Part C), you cannot also buy a Medigap policy. Although you do have out-of-pocket expenses with Medicare Advantage, they are typically not as great as with Original Medicare.Medicare Advantage health plan (aka Part C) As a general rule, if you are younger than 65 and on Medicare due to disability, you are not eligible to enroll in a Medigap plan. Exceptions exist, however. Contact your state insurance department for more information. Eleven standard Medigap policies are available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary.state insurance department By law, you can choose only one of these plans. Insurers are not allowed to sell more than one Medigap plan to you. If your spouse is covered by Medicare and also wants Medigap coverage, he or she will need to buy a separate policy.choose only one of these plans Generally, standard Medigap policies cover some or all of the cost of: Your Part A deductible and coinsurance (i.e. the 20 percent Medicare doesn't cover) for hospital stays Your portion of your doctor’s bills for Part B services The first three pints of blood annually, if needed Hospice care coinsurance Medigap plans do not cover: Long-term care to help you bathe, dress, eat or use the bathroom Vision care, eyeglasses, hearing aids or dental care Private-duty nursing Prescription drugs, or any out-of-pocket costs for Part D plans Before Buying a Medigap Policy When deciding what to do, review what other health insurance you have in addition to Medicare, if any. If you already have a comprehensive retiree health plan to supplement Original Medicare, you may not need a Medigap plan. If your retiree policy provides more- generous benefits, or benefits not covered by Medicare or Medigap policies, you should think carefully before dropping your retiree health plan for a less expensive choice. (You might not be able to get that employer plan back once you drop it.) Check with your union or your former employer’s benefits manager or health plan to make sure you understand all the stipulations. Can you accept some restrictions on your care? If so, Medicare Select is a Medigap policy that limits the providers you can see. Costs can be lower than with standard Medigap policies because Medicare Select policies cover services only at certain hospitals and through specific doctors. Your state insurance department can tell you if there are Medicare Select plans in your state and give you more information about them.state insurance department MediGap Qs: -Doctors – HMO/PPO? -Cost – premium, copay, out of pocket max -Medigap vs Advantage? When does medigap make sense? -Prescriptions?

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