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C D P H P ® M E D I C A R E C H O I C E S

Choosing the Right Medicare Coverage Y0019_18_3584 Accepted

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Choosing the Right Medicare CoverageWe want you to make the right choice, even if you don’t choose a Medicare plan from CDPHP®. This guide is designed to help you sort through your options and select the type of Medicare coverage that will work best for you.

You may want to review other information, but using this booklet can at least help you prepare to ask the right questions. It may turn out that staying with Original Medicare—Medicare Part A (hospital coverage) and Medicare Part B (doctor visits)—is the best solution for you. Or, you may find that a Medicare product offered by some other carrier is better suited to your specific needs.

We would like to help you avoid being “penny wise and pound foolish.” That is, spending too little and having to face a lot of uncovered medical bills. You need to be sure that you don’t end up with gaps in your coverage. At the same time, you don’t want to spend too much on benefits you may never use. It is worth taking your time to locate the right coverage for your situation, at a cost you can afford.

CDPHP® is an HMO with a Medicare contract. Enrollment in CDPHP Medicare Choices depends on contract renewal. Individuals must have both Part A and Part B to enroll. Except in limited circumstances, members may enroll in the plan only during specific times of the year. Contact CDPHP for more information.

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Where to Begin?Start by making sure you know what coverage is available to you. If you’re not sure, your local County Office for the Aging and your employer are reliable sources. Again, you will want to be careful that you don’t end up with too much coverage that wastes your money on benefits and services already available to you.

If you are eligible for supplemental coverage through your employer, speak with your health benefits administrator before making any decisions. Sometimes the rules prohibit you from changing your mind after you have already enrolled in a plan. For example, if you opt out of an employer-sponsored plan for a private health plan but later decide you want to rejoin the employer program, you may no longer be eligible*.

If you don’t already have supplemental coverage, the other options that are available to you include:

fOriginal Medicare (Fee-for-Service)

fMedicare Advantage plans with and without drug coverage

fMedicare Supplement insurance (also known as Medigap)

fMedicare Part D only (also known as prescription drug or “PDP” plans)

Parts A and BIf you won’t have any retiree insurance beyond Medicare, there are two basic questions you need to answer:

1. Will you have Medicare Part A coverage within the next three months?

2. Will you have Medicare Part B coverage within the next three months?

If you answered “yes” to both these questions, then you may be eligible for additional medical Medicare benefits with a Medicare Advantage or Medicare Supplement plan. If you answered “no” to either question, then you cannot join a Medicare Advantage or Medicare Supplement plan at this time until you are established with Medicare Parts A and B.

*Rules may prohibit you from re-joining a plan after you opt out.

4** You must continue to pay your Medicare Part B premium.

You can sign up for Original Medicare (Parts A and B) during the three months before your 65th birthday. You can sign up for Medicare in one of two ways:

1. You are automatically signed up for Original Medicare when you turn 65 if you are getting Social Security or Railroad Retirement payments. You’ll receive a package of Medicare information, including your Medicare card, in the mail. Call the Social Security Administration at 1-800-772-1213 if you do not get your information package by your 65th birthday.

2. You need to sign up for Original Medicare yourself if you aren’t getting Social Security or Railroad Retirement payments. You can sign up by calling or visiting the Social Security office nearest you.

The monthly Part B premiums you pay (generally through your Social Security check) entitle you to valuable health care benefits. But Original Medicare coverage has its limitations and you will be responsible for cost-sharing when you use the benefits. For this reason, many people consider purchasing additional Medicare coverage through CDPHP or another health plan.

Parts C and DPart C refers to a Medicare Advantage plan that can be purchased from CDPHP and many other insurance carriers. It takes the place of your Part A and Part B coverage and provides additional benefits that Original Medicare does not offer.** Prescription drug coverage, known as Part D, can also be part of a Medicare Advantage plan or can be purchased separately.

Medicare Advantage plans offer things like fitness programs and annual physicals and may help cover deductibles and coinsurances not paid by Medicare Part A and Part B. There are several options available and premium payments for just about any budget.

Plus, Medicare Advantage plans often cover wellness benefits and services that are not available through Original Medicare.

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Factors that Will Drive Your DecisionBecause everyone’s life situation and health status are unique, you will need to decide what coverage level works best for you.

Factors to consider are: fYour physicians—Do you have a personal physician or specialists you would like to continue seeing? Make sure they are in the network of any Medicare health plan you select.

fYour hospital—Do you prefer a specific hospital? Make sure the hospital of your choice is in the network of any Medicare health plan you select.

fYour prescriptions—Are you regularly taking brand-name drugs, or is your prescription usage low, with generic alternatives available?

fYour travel—Will you spend part of the year in Florida or another area of the country? Some plans can only cover you within a certain geographic area. Some offer partial benefits for care sought outside the service area.

fYour budget—Having additional coverage may give you a feeling of security, but there’s no sense paying for more coverage beyond what you need.

Think about your own priorities and review the scenarios in this brochure, then begin your own process of deciding which health plan option is the best fit for you.

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JoeJoe, a newly-retired auto mechanic and a recent widower, paid off his mortgage and has enough in the bank for a modest retirement. When shopping for a Medicare plan, he’s looking for a budget-friendly, high-quality plan that includes prescription coverage for his blood pressure medication. Joe would like to keep his own doctors and is also looking for a plan with fitness and wellness benefits.

Joe’s priorities: fLow-cost coverage that includes prescriptions.

fThe ability to see his current doctors.

fFitness and wellness benefits.

Joe’s choice: Because he is on a fixed income and prefers to continue seeing the same doctors, the low-premium CDPHP Basic Rx HMO plan is the best option. It includes prescription drug coverage and offers no-cost access to local gyms through CDPHP Senior Fit®, so Joe can exercise and stay healthy without having to pay more. He also pays a lower copay by seeing an Enhanced Primary Care doctor who provides higher quality care and a better overall patient experience.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.

Making every cent count.

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The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.

Bill and MariaBill and Maria own a popular restaurant and are in the process of turning over the business to their daughter. Both recently celebrated their 65th birthdays and are looking for a Medicare plan. They’ve had coverage through CDPHP for years and don’t want to switch health plans. Because of the restaurant’s success, Bill and Maria built up their savings and are prepared for the cost of health care in retirement. They’re healthy and active and don’t need the additional coverage more expensive Medicare plans offer. The occasional trip south is a possibility, but they plan to spend most of their time in the area so they can see their new grandson.

Bill and Maria’s priorities: fA low-cost plan.

fOptions so they can maintain their active lifestyle.

fThe coverage they need from a health plan they know and trust.

Bill and Maria’s choice: Because the couple needs minimum coverage and will stay local most of the year, the economical CDPHP $0 Medicare Rx HMO plan is the right decision. It includes the benefits they need for optimal health, as well as a range of value-added services that will enable them to stay active and take advantage of reduced costs, including CDPHP Senior Fit®, an allowance for preventive dental services, and the CVS ExtraCare Health Card. Plus, they will have access to the expansive CDPHP provider and pharmacy network.

Quality coverage with some extras.

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Paul and Nancy fPaul and Nancy are looking forward to retiring and traveling more. They’re both in reasonably good health but would like to start exercising more. Nancy, whose mother died from cancer last year, wants to ensure that the necessary support is in place should one of them fall ill, and Paul, who had cataract surgery last year, would like vision coverage included. The couple doesn’t mind paying a slightly higher premium if it means they’re getting more for their money.

Paul and Nancy’s priorities: fFitness and wellness benefits.

fA support program in case of illness.

fVision coverage.

Paul and Nancy’s choice: Paul and Nancy have been pleased with the coverage provided by a CDPHP HMO plan through their employer. In retirement, CDPHP Value Rx HMO would be a great fit because it offers high-quality vision, prescription, and dental coverage in addition to worldwide emergency coverage for when they travel. Plus, with programs like CDPHP® Health AllySM and Senior Fit®, the couple will have the added security of knowing their health and wellness needs will be met.

The right coverage for the right price.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.

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Medicare Advantage WorksAfter analyzing your situation and reviewing your options, you may decide that a Medicare Advantage (MA) medical-only plan or a Medicare Advantage Prescription Drug (MA-PD) medical and prescription drug plan is your best choice.

Beyond your basic health care needs, like prescription drugs, doctor visits, and hospitalization, MA and MA-PD plans can include wellness options, like fitness programs and no-cost wellness classes.

MA and MA-PD plans also can provide support and help you with your health care decisions. Many plans offer access to specially trained health professionals—such as dieticians and nurses—who provide no-charge assistance that’s available at any time, day or night.

For chronic health concerns, experienced and knowledgeable case managers are available to help you manage your condition and the lifestyle changes that can often arise as a result. From coordinating your care to assisting local agencies with arranging vital community services, case managers are an important component of MA and MA-PD plans.

BEYOND BASIC

HEALTH CARE

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1 Through CDPHP Senior Fit®, our Medicare members get no-cost gym access to participating Capital District YMCAs, the Rudy A. Ciccotti Family Recreation Center, the Beltrone Living Center, Glens Falls YMCA, SilverSneakers®, and Curves® locations, as well as Sunnyview Lifestyle Wellness Center.

Tailoring Your OptionsThe examples in this brochure highlight some of the options available to you, but you are encouraged to continue the decision-making process on your own.

Why Pick CDPHP?With so many health plans out there to choose from, what sets CDPHP® apart?

fCDPHP was established in 1984 by doctors concerned about preserving the quality and affordability of health care. It is still dedicated to that vision and continues to be physician-driven.

fCDPHP offers Medicare Advantage HMO plans that are cost-effective, easy to use, and provide real value for your money.

fCDPHP Medicare plans provide a full range of medical benefits and are available to beneficiaries with Medicare Parts A and B. For a CDPHP Medicare Advantage or MA-PD plan, you must also live in our service area. Dental and vision coverage are included with all plans. You can also add Part D drug coverage if you wish.

fCDPHP Medicare plans also give you the opportunity to consolidate your expenses for health care and wellness services. Why pay for a gym membership or full price for eyeglasses or massage therapy? With CDPHP Medicare Choices HMO plans, gym access is covered in full1 and items like eyeglasses can be obtained at a reduced cost. We try to design our plans to help keep you healthy without breaking your budget.

fShould you have a question or concern, our live, local customer service representatives will help you get the information you need quickly and efficiently.

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COVERAGE YOU CAN

TRUST

Take the Next StepWe have given you a snapshot of some of the options available to you. If you would like to talk over your decision or ask questions about CDPHP, please call a CDPHP Medicare sales representative at (518) 641-3400 or toll free at 1-888-519-4455. There is also a TTY/TDD line for the hearing impaired: 711.

Our hours are 8 a.m. - 8 p.m. seven days a week, October 1 – February 14. From February 15 – September 30, Monday – Friday, our hours are 8 a.m. - 8 p.m. A voice messaging service is used weekends, after-hours, and federal holidays. Calls will be returned within one business day.

You can also get more information about Medicare by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. That line is open 24 hours a day, seven days a week.

You may also want to visit www.cdphp.com or www.medicare.gov on the web.

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.

Ask us about our STAR RATING!

CDPHP® Medicare Advantage (HMO) Service AreaAlbany, Broome, Chenango, Columbia, Delaware, Essex, Fulton, Greene, Hamilton, Herkimer, Madison, Montgomery, Oneida, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Warren, and Washington counties in New York state.

CDPHP refers to Capital District Physicians’ Health Plan, Inc., a Medicare-approved HMO plan. CDPHP has a contract with Medicare to offer and provide Medicare Part C medical and Medicare Part D prescription coverage. To join, you must have Medicare Parts A and B and live in our service area.

CDPHP is an HMO with a Medicare contract. Enrollment in CDPHP Medicare Choices depends on contract renewal.

Capital District Physicians’ Health Plan, Inc. 500 Patroon Creek Boulevard, Albany, NY 12206-10 57 (518) 641-3400 or 1-888-519-4455

www.cdphp.com

17-3584 | Form#7328-0717

Visit us at www.cdphp.com for more information.

Get fitness tips, wellness ideas, and more! Connect with us:

Discrimination is Against the LawCDPHP® complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Multi-language Interpreter Services:ATTENTION: If you speak a non-English language, language assistance services, free of charge, are available to you. Call 1-888-248-6522 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-248-6522 (TTY: 711)

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-248-6522（TTY：711）