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Your Guide to Understanding Medicare

Agent Use Only This data is subject to plan year changes

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What is Medicare? History of Medicare: A federal health insurance program enacted in July 1965 under Lyndon B. Johnson. It was designed for people 65 and older and for individuals with certain disabilities. Medicare Eligibility Basics: People aged 65+ Individuals with certain disabilities People with ESRD (End Stage Renal Disease) or ALS

The 4 Parts of Medicare (A, B, C, D): Medicare Part A (Hospital Insurance)

• Inpatient Hospital Care • Skilled Nursing Facility Care • Hospice Care • Home Health Care

Medicare Part B (Medical Insurance) • Services from doctors and other health care providers • Outpatient care • Home Health Care • Durable medical equipment • Some preventive services

Medicare Part C (Medicare Advantage Plans) • Includes all benefits and services covered under Part A and Part B • Most include Part D • Managed by private insurers • May include extra benefits (dental, vision, hearing, gym membership, etc.)

Medicare Part D (Prescription Drug Coverage) • Helps cover the cost of medications • Managed by private insurers • May be stand-alone or included in MAPD

Training & Development: *Review the CMS Publication “Medicare & You”

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Medicare Alphabet Medicare Eligibility Overview: Standard Medicare Eligibility

• Beneficiaries should consider enrolling in Medicare 3 months before they turn 65

• Enrollment eligibility is determined by age, creditable coverage, and applying for SS income • Beneficiaries may apply online at Medicare.gov or in person at SS • Medicare Part B is an option that may be delayed if the beneficiary or dependent has

creditable coverage Underage Disability

• Individuals receiving SSDI for 24 months will be enrolled in Part A & B prior to age 65 Part A – Hospital Insurance (deductible applies): Effective on the 1st of the month (if the beneficiary was born on the first of the month, coverage becomes

effective the 1st of the prior month) $0 monthly premium if the beneficiary worked and paid taxes on 40 quarters of Medicare-covered

employment (amount variable) $240 monthly premium if the beneficiary worked and paid taxes on 30-39 quarters (amount variable) $437 monthly premium if the beneficiary worked and paid taxes on under 30 quarters (amount variable) Required for a beneficiary to enroll in a Medicare Supplement or Medicare Advantage policy

Part B – Medical Insurance (80/20%): Effective on the 1st of the month (if the beneficiary was born on the first of the month, coverage becomes

effective the 1st of the prior month) Monthly premiums will be deducted from the beneficiary’s SS check (must be paid quarterly if the

beneficiary is not receiving a SS check) May be rejected or delayed if the beneficiary has creditable coverage 10% penalty per year if the beneficiary doesn’t have creditable coverage Required for a beneficiary to enroll in a Medicare Supplement or MAPD policy Premiums are subject to Income Related Monthly Adjustment Amount (IRMAA) Premiums range from $135.50 - $460.50

Part C – Medicare Advantage: Plan types are HMO, PPO, Cost Plans, PFFS, and MSA Medicare pays the health plan to manage care – around $800+ per member per month

(PM/PM) to manage all medical costs Must have Medicare Part A & Part B to enroll

Part D – Prescription Drug Coverage: Optional benefit that beneficiaries can reject; may be subject to penalty Phase 1 – Deductible (some plans have a partial or no deductible) Phase 2 – Initial Coverage Limit of $3,820 Phase 3 – Coverage Gap (Donut Hole) the beneficiary pays coinsurance of 25% brand/25% generics Phase 4 – Catastrophic Coverage ends when the beneficiary meets the annual TROOP of $5,100 and

then the beneficiary pays max 5% 1% penalty per month for every month of Part D eligibility without credible coverage

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Medicare Insurance Choices to Supplement Original Medicare

Agent role: educate beneficiaries on Medicare basics and guide them to make an informed decision on a Medicare plan suited for their needs.

Tuck Away; use MAPD Card

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Medicare Acronyms/Terms CMS Center for Medicare/Medicaid Services AHIP America’s Health Insurance Plans (national advocacy & training) FFS Fee for Service (Original Medicare) Medigap Medicare Supplement MA Medicare Advantage without PDP MAPD Medicare Advantage with PDP PDP Prescription Drug Plan PFFS Private Fee for Service Cost Plans Type of MAPD plan in MN, ND, SD MSA Medicare Advantage MSA (Medical Savings Account) PCP Primary Care Physician (your family go-to doctor) HMO Health Maintenance Organization (PCP is required) PPO Preferred Provider Organization POS Point of Service (HMO) SNP Special Needs Plan (low income, chronic condition) MSP Medicare Savings Program QMB-Plus Qualified Medicare Beneficiary (lowest of income) SLMB Specified Low Income Beneficiary (partial low income) QI1 Qualifying Individual – 1 (partial low income) LIS Limited Income Subsidy (federally funded medication assistance) Medicaid State Health programs for low income ESRD End Stage Renal Disease MOOP Maximum Out of Pocket (cap on total out of pocket expenses)

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MAPD & PDP Election Periods IEP Initial Election Period (the 7-month eligibility window for initial enrollment into Medicare

Parts A & B and one enrollment into a PDP) ICEP Initial Coverage Election Period (the 7-month eligibility window for initial

enrollment into Medicare and one enrollment into an MAPD) AEP Annual Election Period (10/15 - 12/7 of current year with annual option to move, add,

drop, and change a PDP and an MAPD) SEP Special Election Period (qualifiers: low income, relocation out of service area, loss of

coverage, low income status is limited to one change per quarter) OEP Open Enrollment Period (1/1/20 - 03/31/20 with the option to move from MAPD to

MAPD, HMO to HMO, PPO to HMO, etc.)

Training & Development: *Review the CMS Publication “Understanding Medicare Part C & D Enrollment Periods”

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Medicare Supplement Reference Guide Medicare Supplement/Medicap Learning Tools: www.medicare.gov

• Great resource for all Medicare related questions Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare

• Learn most of what you need to know in one booklet Any Complete Medicare Supplement Kit

• Brochure, rates, outline of coverage, shopper’s guide Medicare Supplement/Medicap marketing guidelines: Cold calling allowed Must adhere to DNC requests Respect allowable calling hours Door knocking is allowable for Medicare Supplements Email marketing is allowable (must follow CAN-SPAM Act rules)

What is a Medicare Supplement/Medigap policy? Insurance that fills the gaps in original Medicare is offered in 47 States: Modernized Plans A through

N (F, G, & N are the most popular; Plans C & F will not be available to new enrollees in 2020) Massachusetts, Minnesota, Wisconsin: State Mandated Plans – Basic Plan & Extended Basic Plan Generally, Medicare Supplements are guaranteed renewable; if the beneficiary pays the premium, it

must stay in force POLICY – guaranteed renewable policy CERTIFICATE – generally guaranteed renewable certificate of the policy holder

• This plan can be terminated if all certificates are terminated due to catastrophic claims loses (the beneficiary has 63 days after receiving the termination letter to purchase any other Medicare Supplement with no underwriting)

What is needed to get a Medicare Supplement/Medigap policy: Original Medicare Parts A & B Must qualify Medically except during Open Enrollment or for Guarantee Issue Rights

Pros of a Medicare Supplement/Medigap policy: A beneficiary can see any doctor in the U.S. who is willing to accept Medicare; national coverage

is great for snowbirds, frequent travelers, etc. Has automatic claims filing and virtually no paperwork Has manageable monthly costs with monthly premiums vs. unpredictable co-pays Some policies offer additional perks such as gym memberships, dental and eye discounts, etc.

Cons of a Medicare Supplement/Medigap policy: The monthly premium Does not include a Part D A beneficiary must expect annual rate increases Reactive approach to health care

How is the rate calculated? Each carrier may determine rates by the following:

• Age, gender, smoker status, health conditions, zip code, plan type, modal premium, and

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household discounts Are there rate increases?

• Yes; all plans generally raise rates between 1-8% per year Rate guarantees

• This depends on the company (check with the company you represent generally every 6-12 months) Medicare Supplement/Medigap Underwriting: Beneficiaries have a 6-month open enrollment window (starts from the effective date of their Part B)

• Beneficiaries don’t need to answer Medical questions and pre-existing conditions do not apply • Tobacco/non-tobacco status will apply with most carriers

63-day Guarantee Issue (GI) Rights • If a beneficiary is losing credible coverage from their employer, from a Medicare Supplement

or a Medicare Advantage policy, or leaving the service area, they have 63 days to provide proof of the loss (via a notification letter from said company) and will thereby become eligible to enroll into any other Medicare Supplement with no underwriting

General Underwriting: Applies to beneficiaries who fall outside of the Open Enrollment window or GI Rights A beneficiary is required to answer 10-20 medical questions Plan may request Medical records from the beneficiary Plan may require phone interviews with the beneficiary Medication verification from the beneficiary is required The beneficiary’s application may be accepted, rated up, or declined

Covered Services/Claims: Once requested services are “Medicare Approved,” the Medicare Supplement policy will fill the

gap depending on the type of plan (some plans fill the entire gap and some plans have co-insurance)

When can a Medicare Supplement/Medigap policy be purchased? Anytime during the year! Be careful! Agents selling a Medicare Supplement during Medicare Advantage lock-in (04/01– 12/31)

may not be able to offer a Medicare Supplement if the beneficiary is locked-in to their MAPD plan Part D Coverage: Beneficiaries need to consider Part D to avoid the 1% PM penalty The IEP, AEP, OEP, SEP rules must be followed to ensure beneficiaries do not get in a situation

that will prevent them from enrolling in a PDP

Training & Development: *Review a Medicare Supplement packet

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Part D Reference Guide

4 Phases to Part D Coverage: Phase 1 – Deductible (the beneficiary may or may not have a deductible)

• Plans can use the full $435 deductible, reduce it, or not have it at all • Some plans may cost less out of pocket annually with a $435 deductible (agents should run the

annual costs on Medicare.gov to verify) • Generally, the beneficiary must meet this deductible before their tier co-pays apply (some plans

may waive the deductible on Tiers 1 & 2 drugs) Phase 2 – Initial Coverage Limit (the beneficiary pays approximately 25%)

• This is the core of a Part D plan (75% coverage) • The beneficiary pays the tier co-pays listed in the Summary of Benefits until their total yearly

medication costs reach $4,020 (paid by the beneficiary and the plan combined) Phase 3 – Coverage Gap/Donut Hole (the beneficiary pays a co-insurance)

• The beneficiary is responsible for any applicable co-insurance for generics and brands • The coverage gap begins after the total yearly drug cost reaches $3,820 (paid by the beneficiary

and the plan combined) • After the beneficiary enters the Coverage Gap (not everyone will), they pay 25% co-insurance

for generic drugs or 25% coinsurance for brand name drugs Phase 4 – Catastrophic Coverage (beneficiary pays max 5%)

• After the yearly out of pocket drug costs reach $6,350 (including drugs purchased through retail and mail order), the beneficiary pays the greater of 5% of cost or $3.40 generic and $8.50 for all other

Keys to Part D:

Agents should understand and explain the 4 Phases to Part D Coverage properly (the Summary of Benefits is a good guide) • Many experienced agents have difficulty explaining this section • Prescription Drug coverage is highly utilized, so agents should make sure their clients fully

understand it Formulary (list of covered medications)

• Every Part D plan has a formulary • If the drug is not on the list, it isn’t covered • Tier 1 – Preferred Generic • Tier 2 – Generic • Tier 3 – Preferred Brand • Tier 4 – Non-Preferred Brand • Tier 5 – Specialty Tier *The lower the tier, the lower the cost; the higher the tier, the higher the cost.

Part D reference guide: Pharmacy Networks

• Every PDP plan has a network of pharmacies • Some include main national chains with 60,000+ stores while others may be limited to certain

major retailers • It is important for agents to know if their clients prefer to get their medications at a specific location

so you can notify them of the tier co-pays, network, and mail order service options (some PDP plans offer discounts at “Preferred Pharmacies”)

Mail Order

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• Most PDP plans offer a mail order program • Some companies offer discounts for mail order • This program provides convenience to the beneficiary

Key things to remember: • The national average premium for Part D is $35.XX a month • Some plans cost as little as $12+/mo with a deductible and some as much as $100+/mo with no

deductible • Agents are advised to check the plan formulary via www.medicare.gov to ensure the beneficiary’s

medications are listed • Agents may also want to utilize www.goodrx.com as an alternative resource • Drug tiers, monthly premiums, and co-pays are subject to change annually • Note: a PDP cannot be added to an MAPD, as it would kick out the MAPD • Note: a PDP cannot be added to a PPO • Note: stand-alone PDP’s work along with Medicare Supplements, Original Medicare,

MSA’s, and PFFS plans

Training & Development: *Visit and peruse www.medicare.gov *Review the carrier PDP Packets

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Part D Comparison Instructions (MAPD/PDP) www.medicare.gov

Notes before starting this process:

• This process can change from time to time as Medicare updates their website • Have a pen and paper handy for any notes • Have ALL the medication names, dosages, and frequency

www.medicare.gov Towards the top left of the page, click on the green tab marked “Find health & drug

plans.” Under the box titled Basic Search, enter the beneficiary’s zip code and click “Find Plans.”

• Step 1 – Enter Information: select the type of plan the beneficiary currently has and select if the beneficiary receives any state assistance, then click “Continue to Plan Results.”

• Step 2 – Select Your Current Health and Drug Plan: select the health and drug plan the beneficiary has and click “Continue.”

• Step 3 – Enter Your Drugs: if the beneficiary doesn’t take any medication you can click on “I don’t want to add drugs now.” If they do take medications, start entering each one under the area that says, “Type the name of your drug” (the name of the medication usually starts populating as you start typing and will allow you to select the correct name). Once the medications are selected, you will be able to choose dosage, quantity, and frequency of use. This step is critical in determining the medication cost for the current year. Click on “Add drug and dosage” once you have entered all the medications, then scroll down and click “My Drug List is Complete.”

• Step 4 – Select Your Pharmacies: this step allows you to select a pharmacy in the beneficiary’s area. To select a pharmacy, click “Add Pharmacy.” Once this is completed, click “Continue to plan results.” Note: pharmacy selection can impact results.

• Step 5 – Refine Your Plan Results: the list of tabs on the left side of the page allows you to refine your plan results by picking Prescription Drug Plans (PDP), Medicare health plans with medication coverage (MAPD), or Medicare health plans without medication coverage (MA). Click “Continue to Plan Results.”

To compare plans, select up to three boxes on the left of the plan and click “Compare Plans.” Plan Results: available plans will be listed on the left based on annual cost. The premium is included

in the annual cost; remember that it’s possible for a higher monthly premium to be less expensive annually based on formulary, etc.

Once you compare the plans side by side, you can further explore details of a specific plan by clicking on the options available. The list of the expected expenses is easy to print out to estimate the costs for the remainder of the year.

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Additional Programs & Information Low Income Subsidy (LIS):

• National federal prescription assistance program • A beneficiary’s income & assets determine eligibility • https://secure.ssa.gov/i1020/start (link for information and application) • Agents are encouraged to attend carrier-sponsored or FMO-sponsored LIS trainings • Agents should be aware that it can take 2 weeks for a beneficiary to be approved for LIS;

once approved, this will provide them with an SEP to enroll into an MAPD/PDP plan Veterans Program (VA):

• The VA program is separate from Medicare • The VA program is NOT creditable coverage for Medicare Part B • The VA program is creditable coverage for Part D • Veterans may use both VA coverage and MAPD/PDP coverage • The VA program has various benefit levels

Tricare (Military):

• Tricare is a military benefit but is different than the VA • Tricare coordinates coverage with Medicare • It pays first for active duty and pays second for inactive duty • Because it coordinates with Original Medicare, offering a Medicare Supplement or

MAPD plan may not be advisable Group Medical (Employer):

• Be sure to review the beneficiary’s coverage carefully • Compare Part B cost (IRMAA) • Compare medication costs (group plans don’t have a coverage gap) • Be mindful of spousal and dependent coverage disruption

Retiree Coverage:

• Most beneficiaries will have Parts A & B • Confirm that the beneficiary has the option to rejoin the plan if they desire • Compare costs of medication, max OOP, providers, etc. • Verify state availability and network of providers

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Medicare Advantage Reference Guide Medicare Advantage Learning Tools:

• AHIP – required annual training by most plans • Individual carrier certifications – required annually to sell MAPD plans • Agents are encouraged to proactively develop relationships with local carrier

broker managers, attend carrier trainings, etc. • MAPD Sales Kit – Summary of benefits, provider directory, formulary, Evidence of Coverage,

and CMS approved sales presentations CMS marketing guidelines:

• Agents should review the CMS “Medicare Communications & Marketing Guidelines (MCMG’s)” • Agents are encouraged to consult their upline about any compliance questions • Agents should be aware that non-compliant activity may result in contract termination,

corrective action plans, additional training, and monetary penalties Scope of Appointment (SOA):

• Required document for PDP and MAPD appointments • Scopes must be completed prior to any PDP or MAPD discussion • Agents must keep all Scope’s on file for 10 years regardless of whether a plan is sold or not • Must scope any and all Medicare beneficiaries present during a sales presentation

Medicare Advantage Plans Overview: HMO – Health Maintenance Organization (plans are county and state specific)

• The beneficiary must select a Primary Care Physician from the plan provider list • Referrals are required to see specialists (in most cases) • Pro-active care approach

PPO – Preferred Provider Organization (plans are county and state specific) • The beneficiary can use in- and out-of-network doctors (may have balance billing in OON

situations) • Provides more flexibility than HMO’s; has limited PPO offerings; costs more OON but the

beneficiary saves by using in-network doctors PFFS – Private Fee for Service Plan (plans are county and state specific)

• The beneficiary can use any doctor in the U.S. willing to accept the terms and conditions of the plan

• Fewer of these plans are being offered nationally MSA – Medical Savings Account

• The beneficiary receives an annual deposit from the plan in to an MSA account; any un-used amount will roll over to the next year

• The deposited dollars can be used for any MSA QME • The beneficiary may use any provider willing to accept Medicare • No referrals required • Does not include Part D

Pros of a Medicare Advantage Plan:

• Reduced monthly premium vs. a Medicare Supplement • Additional services offered (gym membership, dental, vision, hearing, etc.) • Most plans include Part D coverage • A good all-in-one option to coordinate all parts of Medicare

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Cons of a Medicare Advantage Plan:

• Limited to in-network providers • Prior Authorization may be required for certain benefits • Urgent and emergent care only outside of plan service area (HMO) • Providers may leave the network at anytime • 20% co-insurance (same as Original Medicare for certain benefits)

How to compare plans:

• www.medicare.gov: agents can review benefits, annual medication costs, star ratings (these are compliant to share with consumers)

• www.PellegriniandAssociates.com: agents can review carrier benefits • Summary of Benefits: review the premiums, co-pays, formulary, and other important

information Do Medicare Advantage Plans require underwriting? Limited situations will keep a beneficiary out of an MAPD plan.

• The beneficiary must live in the service area and have Parts A & B • No ESRD allowed (this is changing in 2021) • Chronic Special Needs Plans will require condition verification from provider

- Diabetes & Heart is the most common How does a beneficiary access care?

• Use network providers • Use MAPD or PDP member card • Beneficiary will pay co-pays at point of service

When can a beneficiary enroll into an MAPD or a PDP?

• IEP or ICEP (3 months before, month of, or 3 months after Parts A & B effective dates) • SEP (loss of coverage, permanent move outside of service area, low income, chronic SNP) • AEP (10/15 – 12/7) • OEP (1/1 – 3/31)

Chronic Disease Special Needs Medicare Advantage – C-SNP: Chronic Special Needs Plans are special products designed to manage specific diseases. They are filed as a unique product with Medicare and must treat and meet many specific requirements to be classified as a C-SNP. Provides chronic disease management Plans are required to demonstrate improvement amongst its population of members Often it can cost a carrier more money to offer this type of coverage as it requires more management MAPD companies get a higher reimbursement PM/PM to manage this population

• Diabetes - A beneficiary must have type 1 or 2 diabetes - The plan may offer lower co-pays for diabetic services (shoes, medication, specialists)

The plan may help manage and control diabetes-related challenges • Heart

- A beneficiary must have been diagnosed with chronic heart failure - The plan may offer lower co-pays for heart related services and medications

• Lung - A beneficiary must have emphysema or other specified lung diseases qualified by the plan

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and Medicare - The plan may offer lower co-pays for lung services and specialists

• ESRD - A beneficiary must have ESRD to join these types of plans - This plan is not popular or wide spread

Dual Eligible (Medicare & Medicaid) Medicare Advantage – D-SNP:

• This is a program designed to assist the low-income population • This plan may be called different things in different states • A beneficiary must qualify financially for these programs, have very limited or somewhat

limited income and resources and apply annually • Beneficiaries that have Medicaid & Medicare are referred to as Dual Eligible (Medi-Medi)

Training & Development: *Attend local training to learn more about this program and to know if you are authorized to offer

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How Providers Work with Medicare Plans Medicare Supplement: Providers will either accept Medicare or they won’t.

• Accept Medicare Assignment (Medicare rates) - A doctor or hospital that accepts assignment is willing to treat

the beneficiary and accept Medicare payment as full payment • Accept Medicare but NOT Assignment (Medicare rates)

- A doctor or hospital will bill Medicare but isn’t satisfied with the payment level - Doctors and hospitals can legally bill 15% above Medicare Allowable (Excess

Charges) but anything more is illegal • Don’t Accept Medicare

- Pay cash - Find a new provider

Medicare Advantage:

HMO – Health Maintenance Organization • Network-based managed care plan • The beneficiary must select a Primary Care Physician (PCP) • In most cases, the beneficiary must see their PCP and get a referral to a specialist • Some HMO’s may offer the option of no referral at an additional cost or as a unique advantage

over another HMO PPO – Preferred Provider Organization

• This type of product allows a beneficiary both in- and out-of-network access to doctors • No PCP required • Allows a beneficiary to save by using in-network doctors and hospitals • Allows a beneficiary to use out-of-network doctors anywhere in the country (agents should

confirm with the plan) PFFS – Private Fee for Service

• This product allows a beneficiary to visit any doctor in the U.S. willing to accept the company’s terms and conditions

• Doctors may refuse service to a beneficiary on a per-patient/per-visit basis • A beneficiary should check with their doctor to see if they accept this plan before the agent

sells this type of product, or certainly before the beneficiary uses the services (this does not apply to urgent/emergent care)

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Medicare & Product Pros & Cons Original Medicare (FFS – Fee for Service): Pros

• Discounted health insurance plan for people 65+ • Covers a wide range of services • A beneficiary can see any doctor in the U.S. that accepts Medicare • A beneficiary can add Part D to Original Medicare

Cons • No first dollar coverage subject to deductibles and co-insurance • Some doctors don’t take Medicare Assignment (full payment from Medicare) • A beneficiary has unlimited out of pocket expenses

Original Medicare + Medicare Supplement & Part D (Assuming Plan F is full coverage): Pros

• A beneficiary can see any doctor in U.S. that accepts Medicare • This coverage will fill the gaps of Original Medicare • Part B excess charges may be covered on certain plans • Services must be Medicare approved for Medicare Supplement coverage • Ideal for anyone seeking minimal OOP • Great for those who travel and want access to nationwide doctors • Beneficiaries would need to add Part D to avoid the penalty and receive medication coverage • Guaranteed renewable, beneficiaries just need to pay their premiums • Modernized benefits, rate shopping key, and underwriting • Manageable rate increases ranging from 1-8+% annually • Some programs have rate guarantees for 6-12 months • Most have automatic claims filing which is convenient for beneficiaries • Some products have gym memberships and other discount programs included at no extra cost

Cons • Premium may be more than the beneficiary can afford down the road • Beneficiaries must expect annual rate increases • No built-in comprehensive dental or vision benefits • A beneficiary must qualify medically outside of Open Enrollment and GI Period

Medicare Advantage – HMO (Health Maintenance Organization): Pros

• $0-$100 premiums on average • All plans have $6,700 MOOP or lower • Most will include a Part D drug plan • Focused on preventative care with a proactive approach • May offer Healthy Behavior incentives • Dental, vision, hearing, and OTC benefits are included or optional • May include gym membership (Silver Sneakers, Silver & Fit, etc.) • Special Needs Programs available (Diabetes, Heart, Lung) to beneficiaries with certain diseases • Special Low-Income programs available for those on Medicaid • No health underwriting required except for ESRD

Cons • Potential high hospital per-day co-pays (depending on the plan) • Some benefits match those of Original Medicare (20% co-insurance)

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• May require Prior Authorization for certain services • A beneficiary must use doctors and specialists that are in-network; referrals are required • Provides only urgent and emergent care out of plan service area • Plan benefits will change every year and must be reviewed annually • A beneficiary is typically locked-in all for nine months (exceptions: SEP for low income,

relocating out of the service area, etc.) Medicare Advantage – PPO (Preferred Provider Organization): Pros

• Referrals may not be required • In- and out-of-network options available; more flexibility than an HMO • This plan generally provides travel benefits • Dental, vision, hearing, and OTC benefits are included or optional • May include gym membership (Silver Sneakers, Silver & Fit, etc.) • Provides out-of-network benefits but OON costs sharing may be higher • MOOP $3,000-$6,700 in-network and $3,000-$10,000 out-of-network • No health underwriting required except for ESRD

Cons • Beneficiary may be balance billed for out-of-network services • Premiums are generally higher than those of HMO’s • Some benefits match those of Original Medicare (20% co-insurance or higher)

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Pellegrini & Associates Resources Experience:

• 20 years of insurance sales experience • 10 years senior product distribution

Portfolio: MAPD (13):

• Aetna • Allina Health Aetna • Allwell/Centene • Bright Health • BCBSAZ • BCBS HCSC • Cigna • Health Choice • Humana • Imperial • Lasso • UAHP • UHC

Med Supp (10): • Aetna • Amerigroup • Bankers Fidelity • BCBSAZ • BCBS HCSC • Cigna CSB • GTL • Humana • Mutual of Omaha/OIC/UofO • UHC

PDP (8): • Amerigroup • BCBSAZ • BCBS HCSC • Humana • Mutual of Omaha • SilverScript • UHC • WellCare

Hospital Indemnity (3): • Aetna • Bankers Fidelity • GTL

Final Expense (4): • Aetna • Bankers Fidelity • Gerber

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• Mutual of Omaha/UofO Living Promise Agent Benefits:

• Easy agent onboarding process • Live and web-based trainings • Experienced broker support staff • Co-op marketing • Retail opportunities • 100% fully vested commission paid by the carrier (a few exceptions) • Agent & agency development • Exclusive Agent Portal at www.PellegriniandAssociates.com

- 24/7 access - Free quote tool - Carrier contacts, business submission guidelines, product information, certification links,

compliance - Much more!

Back Office Team: Our dedicated professional staff is available to assist with contracting, new business, commissions, compliance, materials, general guidance, and much more.

• Bill Pellegrini – President & Founder (Bill@PellegriniandAssociates.com) • Nicole Reyes – Contracting Specialist (Nicole@PellegriniandAssociates.com) • Sarah Williams – Office Manager/Marketing (Sarah@PellegriniandAssociates.com) • Marci Dougherty – Broker Support Specialist (Marci@PellegriniandAssociates.com) • Lindsey Peden – Broker Support Specialist (Lindsey@PellegriniandAssociates.com) • Nanci Pippett – Agent Marketer (Nanci@PellegriniandAssociates.com)

Office:

• Monday through Friday 8:00 am – 5:00 pm staff hours • 8433 N. Black Canyon Hwy., Ste 178, Phenix, AZ 85021, (P) 602-368-4422, (TF) 866-731-6112 • Conference room, training room, agent office, agent resource center stocked with Medicare

products

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Additional Tools & Resources Medicare & You guide:

• Medicare beneficiaries receive this booklet annually • Easy to read, search, and teach beneficiaries about Medicare and options

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare:

• Mandatory guide to leave behind with every Medicare Supplement sale • 50-page guide that teaches beneficiaries how to shop for a Medicare Supplement • A must-read guide for agents – own this guide and become a pro!

www.Medicare.gov: • One of the best tools available • Search for anything in the search tool • Run medications and compare PDP & MAPD plans

Carrier Agent Portals:

• Agent Toolkits • Marketing Materials • Mail Pieces • Training Guides • Branded and non-branded resources

UHC Election Period Booklet:

• A must-have tool for MAPD and PDP producers • Excellent resource to confirm available election periods

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Medicare Quote Form

For agent use only. Not for consumers.

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For agent use only. Not for consumers. Agent Password Tracker Form

Carrier/Agent # Website, Username & Password, Products Notes Pellegrini & Associates

Inc www.PellegriniandAssociates.com Username: first and last name (lower cased, no space) Password: NPN

AHIP

https://www.ahipmedicaretraining.com Username: Password:

AETNA Agent # Agency #

www.aetna.com Username: Password:

ALLINA HEALTH AETNA

Agent # Agency #

http://www.allinahealthaetna.com Username: Password:

ALLWELL Agent # Agency #

https://broker.brokersecureportal.com Username: Password:

BCBSAZ Agent # Agency #

https://www.azbluemedicare.com/ Username: Password:

BCBS HCSC Agent # Agency #

https://producers.hcsc.net/producers/login Username: Password:

BRIGHT HEALTH Agent # Agency #

https://brighthealthplan.com/ Username: Password:

CIGNA Agent # Agency #

https://www.cigna.com/medicare/cigna-healthspring Username: Password:

HEALTH CHOICE Agent # Agency #

www.hcgenerations.com Username: Password:

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Carrier/Agent # Website, Username & Password, Products Notes HUMANA

Agent # Agency #

www.humana.com Username: Password:

LASSO Agent # Agency #

https://lassohealthcare.com/ Username: Password:

MUTUAL OF OMAHA Agent # Agency #

https://producer.mutualofomaha.com Username: Password:

SILVERSCRIPT Agent # Agency #

www.silverscriptagentportal.com Username: Password:

UAHP Agent # Agency #

https://www.banneruca.com/ Username: Password:

UHC Agent # Agency #

www.unitedhealthproducers.com Username: Password:

WELLCARE Agent # Agency #

www.wellcare.com Username: Password:

Agent # Agency #

Username: Password:

Agent # Agency #

Username: Password:

Agent # Agency #

Username: Password:

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Generic Permission to Contact sheets

Dental / Vision Hospital Indemnity Life / Final Expense

Medicare Advantage Medicare Supplement Part D / Prescription Drug Low Income Subsidy / Extra Help

REQUEST AN INSURANCE CONSULTATION

By providing my phone number, I agree to have an authorized licensed agent call me to provide me with more information. You are not required to complete this form but have chosen to do so at your discretion.

First Name: ___________________________ Last Name: _______________________________

Address: _________________________________________________________________________

Phone: ( __________ ) __________________ Best time to call: __________ AM/PM _________

Email Address: ____________________________________________________________________

Yes! I want more information!

REQUEST AN INSURANCE CONSULTATION

Yes! I want more information!

Dental / Vision Hospital Indemnity Life / Final Expense

Medicare Advantage Medicare Supplement Part D / Prescription Drug Low Income Subsidy / Extra Help

First Name: ___________________________ Last Name: _______________________________

Address: _________________________________________________________________________

Phone: ( __________ ) __________________ Best time to call: __________ AM/PM _________

Email Address: ___________________________________________________________________

By providing my phone number, I agree to have an authorized licensed agent call me to provide me with more information. You are not required to complete this form but have chosen to do so at your discretion.

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