1

2020 Medicare Advantage Plans

Y0001_6013_16923_M Approved 08/2019

72.25.349.1©2019 Aetna Inc.

22

Maintaining your health means so much

more than just taking care of your physical

needs. That’s why Aetna’s been helping

people with Medicare since 1966 by taking

a total approach to your health and

wellness.

Welcome to Medicare for the whole you: body, mind and spirit.

3

We want every part of you to be its healthiest

Maintain financial wellness with

transparent medical and pharmacy

cost-sharing

Access to care from the doctors,

hospitals and pharmacies you know

and trust

Note: Some benefits may not be available in all plans or in all areas. You can check with your local representative for more details.

The coverage you need to care for your

dental, vision and hearing health

Stay active with our no-added

cost SilverSneakers® program

and exercises classes

4

We want every part of you to be its healthiest (continued)

Dedicated support team connects you

to local services that help make life

easier

In-home health screenings for your

convenience and peace of mind

Transportation services to get you safely

to your medical appointments

Take care of the whole you with

emotional support and mental health

services

Note: Some benefits may not be available in all plans or in all areas. You can check with your local representative for more details.

5

Understanding Medicare

6

The basics of MedicareImportant terms for understanding your insurance coverage

Coinsurance

The amount you may

have to pay as your

share of the cost for

medical services,

supplies or prescription

drugs (usually a

percentage).

Deductible

The amount you are

responsible to pay for

covered health care

services before your

insurance plan starts to

pay for most services.

Premium

The monthly amount

you pay for your

Medicare coverage (you

could have multiple

premiums).

Copayment

A set amount you may

have to pay as your

share of the cost for

medical services,

supplies or prescription

drugs (usually a set

dollar amount).

7

The four parts of Medicare

Government programs(Original Medicare)

A B

• Inpatient care

in hospitals

• Skilled nursing facility

care

• Hospice care

• Home health care

• Services from doctors

and other health care

providers

• Outpatient and

home health care

• Durable medical

equipment

• Some preventive

services

Hospital care Medical careYou pay a premium

Available at additional cost through a private insurer

Private medical plans

• Includes Part A and Part B

benefits and services

• Can include Medicare

PDP (Part D)

• May add extra benefits

and services

• Run by Medicare-approved,

private insurance companies

MedicareAdvantage

C

Private drug plans

• Helps cover the

cost of prescription drugs

• Helps protect against higher

costs in the future

• Run by Medicare-approved,

private insurance companies

Medicare prescription drug plan (PDP)

D

8Medicare AdvantageUnderstanding

9

What is Medicare Advantage?

Simple, all-in-one coverage from a private,

Medicare-approved company

Note: Medicare Advantage plans are not

Medigap plans (Medicare Supplement plans).

Medigap plans fill in the gaps of Original

Medicare.

* Many insurance companies combine

prescription drug coverage in their plans.

10

• You’ll use doctors in

the network.

• You might need a referral

to see a specialist.

HMOA health maintenance

organization

• You’ll use doctors in the

network.

• You may also go out of the

network, but often for a higher

copay or coinsurance, and may

require a referral.

HMO-POSA health maintenance

organization with a point

of service

• You can use doctors

and hospitals out of the

network, but often for

a higher copay.

PPOA preferred provider

organization

Types of Medicare Advantage (MA) plans

There are several types of Medicare Advantage plans. Here are three types of MA plans that Aetna

may offer in your area.

11Medicare Part DUnderstanding

12

Important terms for understanding your

prescription drug benefits

Formulary

A list of drugs

covered

by your plan.

Drug tiers

Each drug belongs

to a tier, which

determines how

much you’ll pay for

that drug.

Network

The pharmacy

options you have

for getting your

prescription drug

Transition Process

You may get a one-

time fill of a drug

that isn't covered

on the formulary

13

What you need to know about prescription drug coverage

Until you have reached

your deductible, you’ll

pay the full discounted

cost for your covered

drugs. Some plans have a

$0 deductible.

Deductible

Stage

1

After you have paid a

total of $4,020, you’ll pay

only part of the cost for

your covered drugs until

you reach $6,350.

Coverage gap

Stage

3

Once you have paid $6,350

you are out of the coverage

gap, and you’ll only pay a

small amount for your

covered drugs for the rest

of the year.

Catastrophic coverage

Stage

4

Initial coverage

Stage

2

After you have reached

your deductible, you’ll

pay only part of the cost

for your covered drugs.

See the Evidence of Coverage (EOC) for complete coverage information.

1414

Welcome to an incredible pharmacy network

Over 60,000 pharmacies in our network

More than 20,000 offer preferred

cost sharing

Find a full list of pharmacies near you with our

online directory at: AetnaMedicare.com

15

Preferred pharmacies

When you choose to get your

drugs at one of these retail

pharmacies, you’ll typically pay

a lower amount. We also have

many local independent

pharmacies.

Kmart

Kroger®

Meijer®

Price Chopper

Publix®

Safeway

Save Mart

ShopRite

Thrifty White

Walmart

Wegmans

Albertsons®

Bartell Drugs

Bi-Lo®

Brookshire Grocery

Coborns

Costco®

CVS Pharmacy

Dierbergs

Discount Drug Mart

Giant Eagle®

H-E-B®

Hy-Vee®

16

You can view our formularies at

AetnaMedicare.com.

Sometimes our formularies change

• Be sure to verify your medications and their tiers

when filling or refilling prescriptions.

• Call 1-855-338-7027 (TTY:711) 24/7 to get more

formulary information.

Important formulary tips

17

*The above are for safety purposes with your health in mind.

Your plan may also have these drug coverage rules:

Some drugs require prior

authorization. Your doctor must

first show a medical need for

you to use the drug before the

plan will cover it.

Prior authorization (PA)*

This places a limit on how

much you can get at one time.

Quantity limits (QL’s)*

You must first try another drug

on the plan’s formulary before

you can move up a “step” to a

higher tier drug.

Step therapy (ST)*

18

Medicare Part D late enrollment penalty

The late enrollment penalty

fee may be added to your

Part D premium if you don’t

have creditable prescription

drug coverage.

Note: If you get Extra Help, you don’t

pay a late enrollment penalty.

It 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

19

Need help with your Medicare costs? You may qualify.

Call 1-800-MEDICARE

(1-800-633-4227) (TTY: 1-877-486-2048)

24 hours a day/7 days a week or visit

www.medicare.gov

Call Social Security

1-800-772-1213 (TTY: 1-800-325-0778)

7 a.m. to 7 p.m.

Call your state Medicaid office

To see if you qualify:You may qualify for Extra Help if you

have limited income and resources

• Monthly plan premium

• Yearly deductible

• Coinsurance

• Copays

• Coverage gap

Extra Help is a Medicare program that helps pay some

Medicare prescription drug costs, such as:

20

It’s time to sign up

21

• Have both Medicare Parts A and B

• Live in the plan’s service area

• Are in an enrollment period

If you have questions, an Aetna

representative is here to answer them.

Note: If you have end stage renal disease (ESRD),

you can only join a Medicare Advantage plan in

certain situations.

You qualify if you:

22

What’s in the enrollment kit?

23

What are Medicare Star Ratings?

Each year, Medicare rates all health and prescription drug plans

based on a five-star quality rating system.

The Centers for Medicare and Medicaid Services (CMS), rates plans

on a scale of 1 to 5 stars, with 5 stars being the highest quality. They use

information from member satisfaction surveys, health plans

and health care providers to give overall performance star ratings to

plans. CMS Star Ratings can help you compare plans based on quality and

performance. You can find Aetna plan Star Ratings in your

area by visiting: AetnaMedicare.com/stars

24

Once you’re a member, you’ll get

24©2018 Aetna Inc.

Letters and

phone calls

from our

partners and us

Your ID card(expect to receive

in 10 – 15 days)

25Approach to Medicare

Aetna’s total

26

Aetna Medicare Advantage plans offer a total approach

Note: Some benefits may not be available in all plans or in all areas. You can check with your local representative for more details.

Care for your financial

wellness with upfront

costs that help you plan

Health coaching, fitness memberships and wellness

programs designed to help you manage your health

and age actively

Local support with health professionals

dedicated to your total wellness, and a team

that can help you find the health resources you

need near you

Prescription drug coverage with

allowances for over the counter

medications

Coverage for eyewear, hearing

aids and dental care annually

Thank you

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

This information is not a complete description of benefits. Call 1-855-368-9337 (TTY: 711) for more information. Members who get “extra help” are not required to fill

prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. Other pharmacies/physicians/providers are available in our network. Out-of-

network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your

Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Every year, Medicare evaluates plans based on a 5-star rating

system. Aetna Medicare’s pharmacy network includes limited lower cost preferred pharmacies in: rural Missouri, rural Maine and rural South Dakota. The lower costs advertised in

our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are

any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online

pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.

28

Now that you know a little bit more about

Medicare Advantage plans, you’re ready to workwith your local agent.

Be sure to ask about your

Provider

and pharmacy

networks

Premiums Prescription

drug coverage

Additional

benefits

Enrollment

process