UPDATE BENEFITS A LOOK INSIDE. What s New for 2018? Plan Compare Chart. How to use the NEW Hearing Aid Benefit. Wellness Visits

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1 BENEFITS UPDATE A PUBLICATION FOR SUMMACARE MEDICARE MEMBERS 2018 BENEFITS A LOOK INSIDE PAGE 2 What s New for 2018? PAGE 3 Plan Compare Chart PAGE 5 How to use the NEW Hearing Aid Benefit PAGE 7 Wellness Visits 1 H3660_18_147 Accepted

2 Dear SummaCare Medicare Member: Thank you for your membership! We re pleased to share this Benefits Update publication as follow-up to the recent Annual Notice of Change mailing you received in September. We re including important information about new benefits as well as things you should know to maximize your coverage. Please keep in mind that all of our plans offer: Vision and dental coverage New! Hearing aid coverage $0 copay for network primary care office visits $0 copay for preferred generic drugs Free one-on-one Health Coaching to improve wellness Free gym memberships through the SilverSneakers fitness program We look forward to serving you in 2018! What s new for 2018? Thank you to all who responded to our recent Member Survey. We listened to your feedback and made changes to our Medicare Advantage plans which will be effective January 1, A few highlights are below. Refer to your recently mailed Annual Notice of Change/Evidence of Coverage for complete information on benefit changes and coverage for Coverage for Hearing Aids We re pleased to work with Homelink and Amplifon in offering coverage for hearing aids. Refer to page 5 for information on how to use your hearing aid benefit beginning January 1, Lower copays for outpatient lab services Lower copays for routine hearing and vision exams in some plans Our $0 premium Topaz (HMO) plan is now available in three additional counties: Allen, Hancock and Lorain. The chart on the next page lists key benefits with each SummaCare Medicare Advantage plan. Please note: Not all plans are available in all counties. If you feel your needs would be better met by a different SummaCare Medicare Advantage plan, you can switch to another SummaCare plan during the Annual Election Period which ends on December 7. Sincerely, Linda Taylor-Richardson Director, Medicare Retention and Outreach 2 SummaCare 2018 Benefit Updates

3 2018 SummaCare Medicare In-Network Benefits SummaCare Medicare Topaz* (HMO) SummaCare Medicare Ruby* (HMO) Northeast $40 Northwest $55 SummaCare Medicare Sapphire (HMO-POS) Northeast $76 Northwest $105 SummaCare Medicare Emerald (HMO-POS) Northeast only $180 Monthly Plan Premium Northeast $0 Northwest $0 Medical Deductible None None None None Out-of-Pocket Maximum $3,800 $3,600 $3,600 $3,400 Primary Care Office Visit Copay $0 $0 $0 $0 Specialist Office Visit Copay $45 $40 $40 $25 Inpatient Hospital Visits $295 copay/day for 1-5; $0 after day 5 $275 copay/day for 1-6; $0 after day 6 $275 copay/day for 1-6; $0 after day 6 $250 copay/day for 1-7; $0 after day 7 Outpatient Lab Copay $0 to $20 $0 to $8 $0 to $8 $0 to $4 Yearly Vision Hardware Allowance Pharmacy Deductible $100 $150 $150 $200 $150 combined; only applies to drug Tiers 3 & 4 None None None Tier 1 Preferred Generic Drugs $0 $0 $0 $0 Tier 2 Generic Drugs $15 $15 $15 $10 Tier 3 Preferred Brand Drugs $47 $47 $47 $45 Tier 4 Brand Drugs $100 $100 $100 $95 *Topaz and Ruby members must use in-network providers except for emergency, urgent care and renal dialysis services. $0 premium is not available in all counties. You must continue to pay your Medicare Part B premium. If you want to stay in your current SummaCare plan: Do Nothing. You will automatically be re-enrolled in your current plan. If you want to switch to another SummaCare plan: Call Us - Change your plan over the telephone by calling toll free TTY call Please allow up to 30 minutes to complete this process with a SummaCare representative. Request Information be Mailed to You We can mail you more detailed plan materials to review, along with a form to complete if you want to change plans. Complete and return the form to SummaCare. Please call us at the number above to request this information. Go Online - Go to and select Members to download and print a Plan Change Request Form. Send the completed form to SummaCare, P.O Box 3620, Akron, OH Remember, if you want to change plans, you must do so by December 7, Your change will be effective January 1,

4 New! Lower copays for 90-day supply of medications at retail pharmacies For those who like the convenience of receiving a 90-day supply of your maintenance or long-term medications, SummaCare now offers lower copays for Tier 2 and Tier 3 medications when you receive a 90-day supply of these medications at a retail pharmacy. You can still choose to receive these medications through our mail service provider, MedImpact, and save on your copays but, now you have the option of choosing a retail pharmacy and will receive the same cost savings on copays as mail service. Don t forget about Dental and Vision benefits this year! As you know, as of January 1, 2017, we added coverage for preventive dental services (one cleaning, one exam and one bitewing x-ray). We also added a vision hardware benefit allowance to SummaCare Medicare Advantage plans. If you haven t used these benefits yet, consider making an appointment for these important services before the end of the year. Specific coverage amounts for your plan and provider network information can be found in your current member materials. 4 SummaCare 2018 Benefit Updates

5 SummaCare s New Hearing Aid Benefit How do I begin? Accessing your benefit is as easy as 1-2-3! Simply follow these steps: Call Amplifon at (TTY ) and a Patient Care Advocate will assist you in finding a hearing care provider near you. The Patient Care Advocate can explain the process and help you make an appointment with a hearing care provider. Information will be sent to you and the hearing clinic to ensure you receive all the benefits offered through your SummaCare benefit. Do hearing aids really work? Hearing aids have advanced considerably. HOMELINK s Doctor of Audiology has worked with the professionals at Amplifon to select hearing aid models from ten leading companies that can help improve how you hear. Types of Hearing Aids Invisible in the Canal (IIC) Completely in the Canal (CIC) Canal (ITC) Full Shell (ITE) Behind the Ear (BTE) Reciever in Canal (RIC) What brand of hearing aid is best? There is no one right answer because everyone is different. However, you have access to a select group of hearing aids from 10 manufacturers with your $795 copay per hearing aid. The hearing care professional can help determine what option is right for you. Why the HOMELINK Hearing Aid Program is powered by Amplifon. Risk-free 60-day trial - 100% money-back guarantee HOMELINK works through Amplifon s fully credentialed clinics to provide the only in-network hearing services for SummaCare. The providers can either test your hearing or use any valid hearing test, as long as the test was completed in the last six months. Providers create custom hearing solutions and hearing aids from several manufacturers subject to a $795 copay per hearing aid. Your SummaCare Hearing Healthcare Package Select group of custom hearing aid solutions from several manufacturers subject to a $795 copay per hearing aid. Continuous Care - one year free follow-up and a three-year warranty 5

6 How to prevent falls at home Make Your Home Safe About half of all falls happen at home, but the hazards that cause them are easy to spot and fix. 1. Clear your walkways and stairs. Shoes, books, and low decorative items (such as vases and baskets) are examples of things you could trip over. 2. Use an adhesive to keep your rugs down. You may want to get rid of small throw rugs, which can slip easily and cause you to fall. 9. If it s dim or dark outside, turn the lights on before you walk. Leave them on if it will be dark when you get back home. 10. Sprinkle salt or kitty litter on slippery or icy sidewalks. This ll give you more traction and help you avoid slipping. 11. If you need to, use a cane or walker. If your doctor says it s a good idea, take his advice. And listen to your body if you re feeling unstable. 3. Put non-slip mats in the bottom of your bathtub or on the floor of your shower. Wet surfaces are always dangerous. 4. Put handrails on your staircases, and use them. You may want to have grab bars put in your shower stall and next to your toilet. 5. Make sure your house is well-lit. Turn the lights on whenever you plan to be in a room or walkway -- even if you re just passing through. Keep a flashlight with new batteries near your bed, too. 6. Keep items you use often (like cooking supplies) in low, easy-to-reach places. You re more likely to fall if you have to reach for something up high or use a stool. 7. Don t walk around in slippers, stockings, or socks. Avoid going barefoot, too. Instead, wear lowheeled, comfortable shoes with rubber soles. They can keep you from slipping on slick surfaces like tile and wood floors. 8. If the sidewalk is wet or it might be icy, walk on the grass. Even if you re not sure, don t take the chance. 12. Check the curb height before you step up onto or down from a sidewalk. Surprises can lead to falls, so be prepared. 6 SummaCare 2018 Benefit Updates

7 Important Information: Coverage for Annual Wellness Exams When you arrive for your appointment, confirm that your provider knows that you are there for your Welcome to Medicare visit or Annual Wellness Visit. If your provider performs a regular routine physical and not a Welcome to Medicare visit or Annual Wellness Visit, please note that this will not be covered under your SummaCare Medicare Advantage plan. You will be responsible for the cost of the routine physical. To maintain good health, it s important to visit your primary care physician at least annually for a wellness exam. A Welcome to Medicare visit is covered within the first 12 months that you have Medicare Part B Medicare, and then annually thereafter it s called an Annual Wellness Visit. You should know that these covered visits are more extensive than a regular routine physical. The Welcome to Medicare visit and the Annual Wellness Visit typically include such things as: A review of your medical and mental health Assessment of risk factors and/or current conditions and treatment options available Review of recommended preventive screenings including immunizations Health advice and referrals to other providers/services as needed (such as weight loss, nutrition or smoking cessation) Overall advice on how to stay healthy Because we encourage these moreextensive annual wellness exams, SummaCare Medicare Advantage plans do not provide coverage for routine annual physicals. To ensure coverage, here are some tips to keep in mind as you schedule your annual wellness exam: When scheduling your appointment with your provider, specifically request a Welcome to Medicare visit (if you re new to Medicare Part B) or an Annual Wellness Visit if you re not new to Medicare Part B. It s important that you use these terms so that your provider will understand the service you are requesting. Don t Forget your Flu Shot! Members can receive a FREE flu shot from either an in-network pharmacy or a SummaCare provider. 7

8 SummaCare is an HMO and HMO- POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Questions? Contact Customer Service at or toll free (TTY ) From October 1 through February 14, a representative will be available to take your call from 8:00 a.m. until 8:00 p.m., seven days a week. From February 15 through September 30, a representative will be available to take your call from 8:00 a.m. until 8:00 p.m., Monday through Friday. Cut This Out and Take to the Doctor with You Next time you visit your doctor, talk to him or her about these important topics: u u u Have you had a fall recently? Does your balance or walking seem a little off? Ask about balance and problems walking. Have you had bladder control issues? Do you have urinary incontinence concerns? Ask what you can do to improve bladder control. Have you been limited in your physical activity? Are you able to move a table, push a vacuum cleaner, climb several flights of stairs? Ask how much exercise you need. Tell Your Friends! Do you know someone who is thinking about their Medicare options or getting ready to retire and is new to Medicare? Our Medicare team can share how Medicare works and explain the choices available. Call Us: (TTY ) Monday through Friday from 8 a.m. to 8 p.m. u Have you accomplished less because of emotional problems? Have you skipped social events because you feel blue? Ask how you can feel calm and peaceful. See our full 2018 Plan Compare Chart at: 8 SummaCare 2018 Benefit Updates