Y0001_6013_5423_FINAL1 approved 09/201580.25.315.1

2016 Medicare Advantage plans

Agenda

2

• Why choose Coventry Health Care?• Enrollment kit• Do you qualify?• How Medicare works• Enrollment period• Key terms• Plan benefits• Drug coverage• The Extra Help Program• BenefitsCheckUp®

• Extras• Support• Enrollment details

Coventry Health Care is part of the Aetna Family.

Coventry Health Care and Aetna have come together to meet the evolving needs of thepeople we serve. Together, we are committed to helping you live a healthier life. As we keepworking on becoming one company, our members will continue to be at the center ofeverything we do.

3

• The coverage choices we’ll discuss today are through your local Coventry Medicare plan.

• If you enroll, your 2016 coverage will be through Coventry Health Care, an Aetna company.

4

Why choose Coventry?

5

• We’re your neighborhood MedicareAdvantage plan.

• We make it easy with Medicare-approved health coverage and prescription drug coverage together in one plan, if you choose a plan with prescription drug coverage.

• You get access to the health careyou need from the doctors you trust.

• You get benefits beyond OriginalMedicare.

• We offer plans with no or lowmonthly plan premiums.

6

6

What is in the enrollment kit?What you learn today can help you make the right choice.

7

8

What you learn today can help youmake the right choice.

Do you qualify?

You are required to:• Have both Medicare Parts A & B• Live in the plan’s service area

If you have end stage renal disease (ESRD), you can only join a Medicare Advantage plan in certain situations.

9

How Medicare worksThe four parts of Medicare

Part AHospital insurance

Part BMedical insurance

Part CMedicare Advantage plans

Part DPrescription drug coverage

10

How Medicare Advantage (MA) works

• Provided by private insurance companies like Coventry

• Approved by the Centers for Medicare & Medicaid Services (CMS)

• Part A + Part B + Part D = MAPD (some MA plans don’t include Part D)

11

Medicare Advantage (MA) plans offer more

12

Medicare Advantage plans:

• Are sometimes called Part C plans

• Include everything that Original Medicare covers and may add things like prescription drug coverage, fitness and more

• Are offered by private companies approved by Medicare

• Are not Medigap plans (also called Medicare Supplement plans)

Note: Medigap plans fill in the gaps of Original Medicare.

When can you enroll in a Medicare Advantage plan?

13

Note: There are other times to enroll, such as when you are first eligible for Medicare.

Enrollment Period Dates Who

Annual Enrollment Period(AEP)

October 15 toDecember 7

When you can enroll in or disenroll from a Medicare plan. Enrollments during this time willbe effective January 1, 2016.

SpecialEnrollment Period (SEP)

Varies You may be able to join, switch or drop a Medicare Plan. Examples include:• You move out of your plan’s service area.• You have Medicaid.• You qualify for Extra Help.

What is the Medicare Part D late enrollment penalty?

The late enrollment penalty is a fee that maybe added to your Part D premium if you don’thave creditable prescription drug coverage.This penalty may apply if you don’t have creditable coverage when:

• Your initial enrollment period is over.• There’s a period of 63 days or more in a

row when you don’t have Part D or other creditable prescription drug coverage.

Note: If you get Extra Help, you don’t pay a late enrollment penalty.

14

Key Terms

15

• Cost share - The amount you pay when you get health care services orprescriptions.

• Deductible - The amount you must pay for health care or prescriptions before Original Medicare, your Medicare Advantage Plan, your prescription drug plan or your other insurance begins to pay.

• Copayment - An amount you may be required to pay as your share of the costfor a medical service or supply, like adoctor’s visit, hospital outpatient visit or aprescription drug on the formulary. A copayment is usually a set amount, ratherthan a percentage. For example, youmight pay $10 or $20 for a doctor’s visit or prescription drug.

• Coinsurance - An amount you may be required to pay as your share of the cost for services or prescription drugs after you pay any deductible. Coinsurance is usually a percentage (for example, 20%).

• Total drug cost - The amount of money bothyou and the plan spend on a prescriptiondrug.

• Premium - The monthly payment to Medicare,an insurance company or a Medicare plan forhealth or prescription drug coverage.

• True out-of-pocket costs (TrOOP) - The payments that count toward your Medicaredrug plan out-of-pocket threshold of $4,850 (for2016). TrOOP costs determine when yourcatastrophic coverage begins.

• Creditable coverage - Another source ofdrug coverage that is expected to pay, onaverage, at least as much as Medicare’sstandard prescription drug coverage.

Pharmacy network

16

If you choose a plan with prescription drug coverage:

• There are over 60,000 pharmacies in our network andmore than 30,000 are pharmacies that offer preferred cost-sharing.

• You can find a network pharmacy in the online networkdirectory at www.mycoventrymedicare.com.

Note: Pharmacies that offer preferred cost-sharing are not available on all plans in Floridaand Pennsylvania. Refer to the plan Summary of Benefits for more information.

Pharmacy savingsSome pharmacies offer preferred cost sharing

17

We want you to pay the lowest price possible for your drugs. Whenyou choose to get your drugs at one of these retail pharmacies, you’lltypically pay a lower amount.

And with over 30,000 retail pharmacies with preferred cost sharing, finding one is easy:AcmeAlbertsonsA-S Medical SolutionsLLCTM

Bi-LoBrookshire GroceryCobornsCostcoFarm FreshFred MeyerGiant Eagle

We also have many local independent pharmacies as wellVisit our network directory online at www.mycoventrymedicare.com to locate network pharmacies, including those that offer preferred cost sharing.

Note: Other Pharmacies are available in our network. Cost sharing for members who get Extra Help is the same at preferred and network pharmacies. The formulary and pharmacy network may change at any time. You will receive notice when necessary.

Harris TeeterHEBHy-VeeKrogerMeijersQuick CheckRoundy’sSafewaySam’s ClubSave-martSav-Mor

ShopkoShop N SaveShoppersSuper Valu PharmaciesTom ThumbThrifty WhiteWalgreensWalmartWeisWinn Dixie

Important formulary tips

18

• You can view our formularies online atwww.mycoventrymedicare.com.

• Sometimes our formularies can change.• We give you 60-day advance notification on certain

formulary changes.• We post formulary change notices on our website.

• Call 1-877-238-6211 (TTY: 711), 24 hours a day, seven days aweek to get more formulary information

19

Note: If you are receiving Extra Help, the coverage gap does not apply to you.

Prescription drug coverage: How it works

Deductible Initial Coverage

Coverage Gap (Donut Hole)

CatastrophicCoverage

You pay:Full discounted cost of formulary drugs until you reach your yearly deductible

You stay in thisstage until youhave paid your yearly deductible amount, if applicable.

You pay: Part of the cost for your drugs

For example:$2 per 30-day supply forlisinopril$45 per 30-day supply forCRESTOR

Your plan pays: Therest of the cost.Until thecombined amount (plus any deductible)reaches $3,310

After your totalyearly drug cost reaches $3,310:You pay: 45%* of the plan’s cost forcovered brand drugsand 58%* for coveredgeneric drugs*Some plans have additional coveragein the gap. You will pay a copayment/coinsurance forcovered drugs.

After your total covered out-of-pocket costs reach $4,850:

You pay: $2.95 for generics and $7.40for brand drugs, or5% of the total cost (whichever isgreater)

Guide for using your prescription drug benefit

20

• Formulary - A list of drugs covered by your plan

• Drug tiers - Each drug belongs toa tier, which determines howmuch you will pay for that drug

• Network - The pharmacy optionsyou have for getting yourprescription drugs

• Transition process - You may be able to get a one-time fill of a drug that is not covered on the formulary

Your plan may also have these drug coverage rules:

21

• Prior authorization (PA) - Prior authorization is a coverage rule in place for some drugs. If a drug has a PA, your doctor must first show it’s medically necessary for you to have the drug before the plan will cover it.

• Quantity limits - Limits on howmuch you can get at a time.

• Step therapy (ST) - Step therapy is a coverage rule in place for some drugs. If a drug has a ST, you must first try another drug on the plan’s formulary before you can move up a “step” to a more expensive drug.

Need help with your Medicare costs? You may qualify.

You may qualify for Extra Help if you have limited income and resources. Extra Help is a Medicare program that helps pay some Medicare prescription drug costs such as:

• Monthly plan premium• Yearly deductible• Coinsurance• Copayments• Coverage gap

To see if you qualify:

22

• Call 1-800-MEDICARE (1-800-633- 4227) (TTY: 1-877-486-2048), 24 hours a day/7 days a week

• Call Social Security 1-800-772-1213 (TTY: 1-800-325-0778), 7 a.m. to 7 p.m.

• Call your state Medicaid office or visit www.medicare.gov

More help is available – BenefitsCheckUp®

There are benefits you may be missing! BenefitsCheckUp quicklyfinds federal, state and private benefit programs available to helpyou save money on prescription drugs, utilities, taxes, meals andmore www.benefitscheckup.org/coventry

23

28

24

Plan benefits

25

Stay healthy with these Extras!

We offer you special programs to help you keep up your good health:

• Transitional care when you are released from the hospital

• Personalized health management for help with specific conditions,

like diabetes

• Fall and fracture prevention programs

• In-home health assessments at no extra cost to you

• Fitness benefits

26

You get 24/7 online support

• www.mycoventrymedicare.com: Find a doctor, search our plan drug list, compare plans and costs

27

Enrollment is as easy as 1-2-3!

Review your enrollment kit, then pick a plan.

2Complete the

enrollment form.

3Submit it to us.

1

3

You can also enroll atwww.mycoventrymedicare.com orwww.medicare.gov.

28

Enrollment - what happens next

When you fill out an enrollment form, your enrollment request goes through a short process:• We’ll review it and send it to

CMS for confirmation.• Once that process is

complete, we’ll send you a letter.

29

Once you’re a member, you’ll receive:

• Your ID card• Your Evidence of Coverage• A Formulary (if you sign up for a plan

with prescription drug coverage)• Letters and/or phone calls from

Coventry, Aetna and/or Aetnapartners

30

We’re here to help when you need us

Just call the Member Services number on your plan ID cardWe can help you with:

• Your claims• Your benefits• Using your plan• Finding a doctor• Doctor and specialist

referrals (if required)• Translation services

31

With Coventry you can get more

32

• We offer benefits beyondOriginal Medicare.

• Our Medicare Advantageplans offer you the same typeof benefits as OriginalMedicare (Parts A and B).

• Plus, we offer coverage foradditional benefits, such as prescription drug coverage,fitness and more.

• You can get all your benefits inone plan; you choose what’sright for you.

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs alsohave contracts with State Medicaid programs. Enrollment in our plans depends oncontract renewal. This information is not a complete description of benefits. Contactthe plan for more information. Limitations, copayments and restrictions may apply.Benefits, formulary, pharmacy network, provider network, premium and/orcopayments/coinsurance may change on January 1 of each year. See Evidence ofCoverage for a complete description of benefits, exclusions, limitations andconditions of coverage. Plan features and availability may vary by location. Youmust continue to pay your Medicare Part B premium.

33

Thank you

34