2021 Health-Directions Medicare Brochure

How do I get started with Medicare?

There are two enrollment options: 1. You are turning 65 2. You are over age 65, looking to retire and start Medicare? Option 1 You are turning 65, when can I sign up and how? During your Initial Enrollment period. This is a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. Your sign-up options are as follows: 1. Apply online through the Social Security Administration website- www.ssa.gov. It takes less than 10 minutes. There are no forms to sign and usually no documentation is required. Social Security will process your applica- tion and contact you if they need more information. Click on second blue link below to see How to Apply Online for Medicare Instructions. 2. Apply in person – Visit your local Social Security office. (you can call first to make an appointment or wait in line). Social Security Office Locator https://secure.ssa.gov/ICON/main.jsp

3. Apply by phone with Social Security – 1- 800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. After your application has been submitted and approved you will receive an enrollment confirma- tion letter within 2 - 2.5 weeks followed by your Red, White and Blue Medicare Health Insurance Card. Note: If you are already collect- ing Social Security benefits, you will get Medicare Part A and Part B automatically when you are first eligible and do not need to sign up. Medicare will send you a “Welcome to Medicare” packet 3 months before you turn 65. Note: If you have medical insur- ance coverage under a group health plan based on your or your spouse’s current employment, you may choose to delay enroll- ing into Medicare Part A and Part B at age 65. The size of the employer determines whether you may be able to delay Part A and Part B without having to pay a penalty if you enroll later. Click on second blue link below to see requirements.

First things first- Applying for Medicare

Image of typical Medicare Health Insurance Card

https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b https://www.ssa.gov/pubs/EN-05-10531.pdf

The month you turn 65 Initial Enrollment Period Chart Month before the month you turn 65 Month after the month you turn 65

3 2 1 Months before the month you turn 65 Months before the month you turn 65

Months after the month you turn 65 Months after the month you turn 65 If you wait until the last 4 months of your Initial Enrollment Period to sign up for Part A (if you have to buy it) and/or Part B, your coverage will be delayed. 1 2 3

Sign up early to avoid a delay in coverage. To get Part A (if you have to buy it) and/or Part B the month you turn 65, you must sign up during the first 3 months before the month you turn 65.

The following forms need to be completed to sign up for Medi- care: Request For Employment Information Form. This form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enroll- ment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment. Section A is completed by individual signing up for Medicare Part B and Section B is completed by your employer. Click on first blue link below. Application For Enrollment In Medicare Part B (Medical Insurance) Form. This form is your application for Medicare Part B (Medical Insurance) Click on second blue link below. Where to take the completed forms for processing: 1 . Visit your local social Security office. (you can call first to make an appointment or wait in line). Social Security Office Locator Click on third blue link below. 2. Fax the forms into your local Social Security office. After your forms has been submitted and approved you will receive an enrollment confirmation letter within 2-2.5 weeks followed by your updated Red, White and Blue Medicare Health Insurance Card.

Health Directions has recommended the most comprehensive plan within our budget and is always available to answer questions that arise regarding our coverage. Henry B. Medicare Supplemental Plan & Prescription Drug Plan

Option 2 You are over age 65, looking to retire and start Medicare. When can I sign up and how? If you have medical insurance coverage under a group health plan based on your or your spouse’s current employment, you may qualify for a Special Enrollment Period (SEP) that will let you sign up for Part B during: Any month you remain covered under the group health plan and your, or your spouse’s, employment continues; or The 8-month period that begins with the month after your group health plan coverage or the employment is based ends, whichever comes first. For example: If you know you are going to retire on 07/01/2021 and your employer coverage is also ending on that date, you want to start your Medicare enrollment process in June so your Medicare coverage is effective 07/01/2021. For a no-obligation strategy planning session call us today (203) 255-7700 https://www.health-directions.com

https://www.cms.gov/cms40b-application-enrollment-part-b https://secure.ssa.gov/ICON/main.jsp https://www.cms.gov/cms-l564-request-employment-information

Medicare is health insurance for: People 65 and older People under 65 with certain disabilities People of any age with End Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) What are the different parts of Medicare? Medicare Part A (Hospital Insurance) helps cover: Inpatient care in hospitals Skilled nursing facility care Hospice care Home health care Medicare Part B (Medical Insurance) helps cover: Services from doctors and other health care providers Outpatient care Home health care Some preventive services Medicare Part C (Medicare Advantage): Includes all benefits and services covered under Part A and Part B Run by Medicare-approved private insurance companies Usually includes Medicare prescription drug coverage (Part D) as part of the plan May include extra benefits and services for an extra cost

What Is Medicare?

Medicare Part D (Medicare prescription drug coverage): Helps cover the cost of prescription drugs Run by Medicare-approved private insurance companies May help lower your prescription drug costs and help protect against higher costs in the future

Image of typical Medicare Health Insurance Card

For a no-obligation strategy planning session call us today (203) 255-7700 https://www.health-directions.com

What are my Medicare coverage choices? There are 2 main ways to get your Medicare coverage— Original Medicare or a Medicare Advantage Plan. Use these steps to help you decide which way you would like to get your coverage.

Click on first blue link below to see Medicare Costs at a Glance.

https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance

START Step1: Decide how you want to get your coverage (select only one plan) Original Medicare Medicare Advantage Plan

Part A Hospital Insurance

Part B Medical Insurance

Part C Combines Part A, Part B, and usually Part D

Step 2: Decide if you need to add drug coverage

Step 2: Decide if you need to add drug coverage

Part D Prescription Drug Coverage (Most Medicare Advantage Plans cover prescription drugs. You may be able to add drug coverage in some plan types if not already included.)

Part D Prescription Drug Coverage

Step 3: Decide if you need to supplemental coverage Medicare Supplement Insurance (Medigap) policy

If you join a Medicare Advantage Plan, you can’t use or be sold a Medicare Supplement Insurance (Medigap) policy.

END

END

2021 Medicare Supplement Plan G Patient with a Supplemental Medical Insurance Plan

2021 Medicare Part A Part A is Hospital Insurance for confinement in a hospital or skilled nursing facility per benefit period.

How Original Medicare works with a Medicare Supplement Plan

When you are Hospitalized* for: 1- 60 Days

Medicare Covers: You Pay:

You Pay:

Most confinement costs after the required Medicare deductible All eligible expenses after patient pays a per-day co-payment All eligible expenses after patient pays a per-day co-payment (These are Lifetime Reserve Days that may never be used again)

$1,484 Deductible

$0

$371 A Day Co-payment as much as $11,130 $742 A Day Co-payment as much as $44,520 You Pay All Costs After 20 days $185.50 A Day Co-payment as much as $14,840

61- 90 Days

$0

91- 150 Days

$0

Nothing

151 Days or More *Skilled Nursing Confinement: Following an inpatient hospital stay of at least 3 days and enter a Medicare-approved skilled nursing facility within 30 days after hospital discharge and receive skilled nursing care Hospice Care: Must meet Medicare’s requirements, including a doctor’s certification of terminal illness Blood Must meet Medicare’s requirements, including a doctor’s certification of terminal illness

All Costs

First 20 Days: $0 21-100th Day: $0

All eligible expenses for the first 20 days; then all eligible expenses for days 21-100 after patient pays a per-day co-payment

101th Day and After:

All Costs

Medicare Co-payment/Coinsurance

All but very limited co-payment/coinsurance for outpatient drugs and inpatient respite care

$0

F irst 3 Pints: $0 Additional Amounts: $0

100% of approved amount after first 3 pints of blood

First 3 pints

*A benefit period begins on the first day you receive service as an inpatient and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

2021 Medicare Supplement Plan G Patient with a Supplemental Medical Insurance Plan

2021 Medicare Part B Part B is Medical Insurance and covers physicians services, outpatient care, tests, and supplies - per calender year.

On Expenses Incurred for: Annual Deductible Medical Expenses

Medicare Covers:

You Pay:

You Pay:

Incurred Expenses after the required Medicare deductible

$203 Annual Deductible 20% Of approved amount*

$203 Part B Deductible

$0

80% of approved amount

Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy; and diagnostic tests Above Medicare Approved Amounts Excess Doctor Charges**

All Costs

$0

0% above approved amount

Nothing for services

Generally 100% of approved amount

Clinical Laboratory Services Home Healthcare Outpatient Hospital Treatment Blood

$0

Nothing for services; 20% of approved amount* for durable medical equipment Coinsurance based on outpatient payment rates

$0

100% of approved amount; 80% of approved amount for durable medical equipment Medicare payment to hospital, based on out- patient procedure payment rates

$0

$0

First 3 pints plus 20% of approved amount for additional pints

80% of approved amount after first 3 pints of blood

*On all Medicare-covered expenses, a doctor or other healthcare provider may agree to accept Medicare assignments. This means the patient will not be required to pay any expenses in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare. **Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for a covered service. In 2021, the most a physician can charge for a service covered by Medicare is 115% of the approved amount for nonparticipating physicians (may vary state to state). Note: New York, the most a physician can charge for services covered by Medicare is 105% of the approved amount for nonparticipating physicians, For routine office visits covered by Medicare, a nonparticipating physician can charge up to 115% of the fee schedule amount.

Notes Once you have been billed $203 of Medicare approved amounts for covered services, your Part B deductible will have been met for the calender year.

How Original Medicare works with a Medicare Supplement Plan

2021 Medicare Part A Part A is Hospital Insurance for confinement in a hospital or skilled nursing facility per benefit period.

2021 Medicare Supplement Plan N Patient with a Supplemental Medical Insurance Plan

When you are Hospitalized* for: 1- 60 Days

Medicare Covers:

You Pay:

You Pay:

Most confinement costs after the required Medicare deductible All eligible expenses after patient pays a per-day co-payment All eligible expenses after patient pays a per-day co-payment (These are Lifetime Reserve Days that may never be used again)

$1,484 Deductible

$0

$371 A Day Co-payment as much as $11,130 $742 A Day Co-payment as much as $44,520 You Pay All Costs After 20 days $185.50 A Day Co-payment as much as $14,840

61- 90 Days

$0

91- 150 Days

$0

Nothing

151 Days or More *Skilled Nursing Confinement: Following an inpatient hospital stay of at least 3 days and enter a Medicare-approved skilled nursing facility within 30 days after hospital discharge and receive skilled nursing care Hospice Care: Must meet Medicare’s requirements, including a doctor’s certification of terminal illness Blood Must meet Medicare’s requirements, including a doctor’s certification of terminal illness

All Costs

First 20 Days: $0 21-100th Day: $0

All eligible expenses for the first 20 days; then all eligible expenses for days 21-100 after patient pays a per-day co-payment

101th Day and After:

All Costs

Medicare Co-payment/Coinsurance

All but very limited co-payment/coinsurance for outpatient drugs and inpatient respite care

$0

First 3 Pints: $0 Additional Amounts: $0

100% of approved amount after first 3 pints of blood

First 3 pints

*A benefit period begins on the first day you receive service as an inpatient and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

2021 Medicare Supplement Plan N Patient with a Supplemental Medical Insurance Plan

2021 Medicare Part B Part B is Medical Insurance and covers physicians services, outpatient care, tests, and supplies - per calender year.

On Expenses Incurred for: Annual Deductible Medical Expenses

Medicare Covers:

You Pay:

You Pay:

Incurred Expenses after the required Medicare deductible

$203 Annual Deductible 20% Of approved amount*

$203 Part B Deductible

Up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense

80% of approved amount

Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy; and diagnostic tests Above Medicare Approved Amounts Excess Doctor Charges**

All Costs

$0

0% above approved amount

Clinical Laboratory Services Home Healthcare Outpatient Hospital Treatment Blood

Nothing for services

Generally 100% of approved amount

$0

$0

Nothing for services; 20% of approved amount* for durable medical equipment Coinsurance based on outpatient payment rates

100% of approved amount; 80% of approved amount for durable medical equipment Medicare payment to hospital, based on out- patient procedure payment rates 80% of approved amount after first 3 pints of blood

$0

First 3 pints plus 20% of approved amount for additional pints

$0

*On all Medicare-covered expenses, a doctor or other healthcare provider may agree to accept Medicare assignments. This means the patient will not be required to pay any expenses in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare. **Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for a covered service. In 2021, the most a physician can charge for a service covered by Medicare is 115% of the approved amount for nonparticipating physicians (may vary state to state). Note: New York, the most a physician can charge for services covered by Medicare is 105% of the approved amount for nonparticipating physicians, For routine office visits covered by Medicare, a nonparticipating physician can charge up to 115% of the fee schedule amount.

Notes Once you have been billed $203 of Medicare approved amounts for covered services, your Part B deductible will have been met for the calender year.

2021 Medicare Supplement Plan G High Deductible

2021 Medicare Part A Part A is Hospital Insurance for confinement in a hospital or skilled nursing facility per benefit period.

How Original Medicare works with a Medicare Supplement Plan

When you are Hospitalized* for: 1- 60 Days

Medicare Covers:

You Pay:

You Pay:

Most confinement costs after the required Medicare deductible All eligible expenses after patient pays a per-day co-payment All eligible expenses after patient pays a per-day co-payment (These are Lifetime Reserve Days that may never be used again)

$1,484 Applied toward deductible $371 A Day Co-payment as much as $10,560 $742 A Day Co-payment as much as $44,520 You Pay All Costs After 20 days $185.50 A Day Co-payment as much as $14,840

$0 *

$0 *

61- 90 Days

$0 *

91- 150 Days

Nothing

365 Days or More *Skilled Nursing Confinement: Following an inpatient hospital stay of at least 3 days and enter a Medicare-approved skilled nursing facility within 30 days after hospital discharge and receive skilled nursing care Hospice Care: Must meet Medicare’s requirements, including a doctor’s certification of terminal illness Blood Must meet Medicare’s requirements, including a doctor’s certification of terminal illness

All Costs

All eligible expenses for the first 20 days; then all eligible expenses for days 21-100 after patient pays a per-day co-payment

First 20 Days: $0 21-100th Day: $0

101th Day and After:

All Costs

$0 *

Medicare Co-payment/Coinsurance

All but very limited co-payment/coinsurance for outpatient drugs and inpatient respite care

100% of approved amount after first 3 pints of blood

First 3 pints

First 3 Pints: $0 Additional Amounts: $0

* After $2,370 deductible you pay $0 This is not an up-front deductible. HDG option, you cover the Medicare out of pocket deductible and co-insurance until the total out-of-pocket of $2,370 is met, then the plan pays 100% of the covered services for the rest of the calender year.

*A benefit period begins on the first day you receive service as an inpatient and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

2021 Medicare Part B Part B is Medical Insurance and covers physicians services, outpatient care, tests, and supplies - per calender year.

2021 Medicare Supplement Plan G High Deductible

On Expenses Incurred for: Annual Deductible Medical Expenses

Medicare Covers:

You Pay:

You Pay:

Incurred Expenses after the required Medicare deductible

$0 *

$203 Annual Deductible 20% Of approved amount*

$0 *

80% of approved amount

Physician’s services for inpatient and outpatient medical/surgical services; physical/speech therapy; and diagnostic tests Above Medicare Approved Amounts Excess Doctor Charges**

$0 *

All Costs

0% above approved amount

Nothing for services

Generally 100% of approved amount

$0 *

Clinical Laboratory Services Home Healthcare Outpatient Hospital Treatment Blood

$0 *

Nothing for services; 20% of approved amount* for durable medical equipment Coinsurance based on outpatient payment rates

100% of approved amount; 80% of approved amount for durable medical equipment Medicare payment to hospital, based on out- patient procedure payment rates

$0 *

First 3 pints plus 20% of approved amount for additional pints

$0 *

80% of approved amount after first 3 pints of blood

* After $2,370 deductible you pay $0 This is not an up-front deductible. HDG option, you cover the Medicare out of pocket deductible and co-insurance until the total out-of-pocket of $2,370 is met, then the plan pays 100% of the covered services for the rest of the calender year.

*On all Medicare-covered expenses, a doctor or other healthcare provider may agree to accept Medicare assignments. This means the patient will not be required to pay any expenses in excess of Medicare’s approved charge. The patient pays only 20% of the approved charge not paid by Medicare. **Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for a covered service. In 2021, the most a physician can charge for a service covered by Medicare is 115% of the approved amount for nonparticipating physicians (may vary state to state). Note: New York, the most a physician can charge for services covered by Medicare is 105% of the approved amount for nonparticipating physicians, For routine office visits covered by Medicare, a nonparticipating physician can charge up to 115% of the fee schedule amount. Notes Once you have been billed $203 of Medicare approved amounts for covered services, your Part B deductible will have been met for the calender year.

What are the basic details of the 2021 Medicare Part D Program?* In general, Medicare Part D prescrip- tion drug plans provide insurance coverage for your prescription drugs - just like other types of insurance. Your Medicare prescription drug coverage can be provided by a "stand-alone" Medicare Part D plan (only prescription coverage) or a Medicare Advantage plan that includes prescription coverage (or an MA-PD that includes Medicare health and prescription drug coverage). If you join a Medicare Part D prescrip- tion drug plan, you will pay a monthly premium ranging from only a few dollars up to over 100 dollars. If you join a Medicare Advantage plan, you may have a $0 premium. Your monthly premiums will vary depending on the benefits of your selected Medicare Part D plan or Medicare Advantage plan and your resident state. Some Medicare Part D or Medicare Advantage plans have an initial deductible where you pay 100% of your prescription costs before your Part D prescription drug coverage or benefits begin. Other Medicare Part D or Medicare Advantage plans have no initial deductible or a $0 deduct- ible, providing you with coverage as soon as you purchase your first prescriptions. Please note, that you may pay a higher monthly premium for Medicare Part D plans with no initial deductible. Also, the amount of the initial deductible can (and proba- bly will) change each coverage year. Each Medicare prescription drug plan will have a list of prescription drugs or formulary that are covered by the plan. Drug lists or formularies can vary greatly from one prescrip- tion drug plan to the next.

So it is key that you ensure that your medications are covered by your chosen Medicare prescrip- tion drug plan. When you use your Medicare Part D plan after the initial deductible (if applicable), you will pay a certain part of your prescription costs and your Medicare prescrip- tion drug plan will pay a part of your drug costs. Your plan's cost-sharing (co-payments or co-insurance) will vary depending on the particular drug plan you choose. Stage 1: Deductible - you pay 100% The amount you pay of your medication costs before your plan pays its share Some plans do not have a deductible Stage 2: Both you and your insurance plan pay medication costs until the shared total drug costs equal $4,130 You're generally responsible for copays and coinsurance during this stage Stage 3: Coverage gap (donut hole) The coverage gap begins after you and your plan have spent $4,130 for covered drugs and ends when your out-of-pocket cost reaches $6,550 for them. During this gap in prescription Initial coverage - shared cost with insurance company

What is Part D Prescription Drug Coverage?

For a no-obligation strategy planning session call us today (203) 255-7700 https://www.health-directions.com

Stage 4: Catastrophic coverage stage - follows the coverage gap Begins when you reach the $6,550 coverage gap limit In this stage, you pay $9.20 for brand-name or $3.70 for generic drugs, or 5% of your medication

drug coverage, you may pay more for your drugs In this stage, you pay a maxi- mum of 25% of the plan's cost of brand-name drugs. You pay no more than 25% of the cost of generic drugs and the plan pays the rest Any medication-related deduct- ible, discounts you receive on covered brand-name drugs, coinsurance, co-payments and the amounts you pay in the coverage gap count towards the $6,550 limit

The Four Stages of your 2020 Medicare Part D Plan Based on the 2021 CMS defined standard Medicare Part D Plan

120%

100%

You pay 100% of retail drug cost before meeting $445 Initial Deductible

You pay 25% of retail drug cost before meeting $4,130 Initial Coverage Limit

You pay 25%

You pay approx. 5% of retail drug price after meeting $6,550 out-of-pocket

80%

of generic or brand-name retail drug price after meeting $4,130 Initial Cover- age Limit, and entering the Donut Hole

60%

limit and entering Catastrophic Coverage

40%

20%

0%

2021 Donut Hole Discount: 75% of Brand-name drug cost and 75% of Generic drug cost

Initial Deductible Initial Coverage Phase Coverage Gap or Donut Hole Catastrophic Coverage

*Reference information for the following Prescription Drug Plan section can be found in the following links:

https://q1medicare.com https://q1medicare.com

Medicare Advantage Plans Overview What are Medicare Advantage Plans? A Medicare Advantage Plan is another way to get your Medicare coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans:”are offered by Medicare approved private companies that must follow rules set by Medicare. If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insur- ance) coverage from the Medi- care Advantage Plan, not Original Medicare. How do Medicare Advantage Plans Work? When you join a Medicare Advan- tage Plan, Medicare pays a fixed amount for your coverage each month to the company offering that plan. These companies must follow Medicare's coverage rules. Medicare Advantage Plans have yearly contracts with Medicare. The plan must notify you about any changes before the start of the next enrollment year. If you join a Medicare Advantage Plan, you'll have all of the same rights and protections that you would have under Original Medicare. What’s Covered? Medicare Advantage Plans cover all Part A and Part B services. How- ever, if you're in a Medicare Advantage Plan, Original Medi- care will still cover the cost for hospice care, some new Medicare benefits, and some costs for

clinical research studies. In all types of Medicare Advantage Plans, you're always covered for emergency and urgent care. Some Medicare Advantage Plans offer extra coverage, for things like vision, hearing, dental, and other health and wellness programs. Plans have a yearly limit on what you pay out-of-pock- et for Part A and Part B covered services. Once you reach your plan's limit, you'll pay nothing for Part A and Part B covered services for the rest of the year. Who can join a Medicare Advantage Plan? When you join a Medicare Advan- age. You can join a Medicare Advantage Plan if: You have Part A and Part B You live in the plan's service area You're a U.S. citizen, U.S. national, or lawfully present in the U.S. You don't have End-Stage Renal Disease (ESRD), except as explained on page 14 What if I have other coverage? Talk to your employer, union, or other benefits administrator about their rules before you join a Medicare Advantage Plan. In some cases, if you join a Medicare Advantage Plan, you may still be able to use your employer or union coverage along with your Medicare Advan- tage Plan. In other cases, joining a Medicare Advantage Plan might cause you to lose your employer or union coverage for yourself, your spouse, and dependents.

What is a Medicare Advantage Plan?

When can I join, switch, or drop a Medicare Advantage Plan? You can only join, switch, or drop a Medicare Advantage Plan during the enrollment periods below: Initial Enrollment Period-When you first become eligible for Medicare, you can sign up during your Initial Enrollment Period. This is the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 If you sign up during the first 3 months of your Initial Enrollment Period, in most cases, your cover- age starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll the month you turn 65 or during the last 3 months of your Initial Enrollment Period, your start date for coverage will be delayed. General Enrollment Period- If you have Part A coverage and you get Part B for the first time during the General Enrollment Period (between January 1- March 31 each year), you can also join a Medicare Advantage Plan at that time. Your coverage may not start until July 1 Annual Election Period- Between October 15-December 7, anyone with Medicare can join, switch, or drop a Medicare Advantage Plan. Your coverage will begin on January 1, as long as the plan gets your request by December 7

Can I make changes to my coverage after December 7 Between January 1- March 31 each year, you can make these changes during the Medicare Advantage Open Enrollment Period: If you're in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage) During this period, you can't: Switch from Original Medicare to a Medicare Advantage Plan Join a Medicare Prescription Drug Plan if you're in Original Medicare Switch from one Medicare Prescription Drug Plan to another if you're in Original Medicare You can only make one change during this period, and any changes you make will be effec - tive the first of the month after the plan gets your request. If you're returning to Original Medicare and joining a drug plan, you don't need to contact your Medicare Advantage Plan to enroll. The dis-enrollment will happen auto- matically when you join the drug plan. Note: If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare.

What if I have a pre-existing condition? You can join a Medicare Advan- tage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD), for which there are special rules. See "Can I join A Medicare Advantage Plan if I have End-Stage Renal Disease (ESRD)?" on page 14. How can I join a Medicare Advantage Plan? Not all Medicare Advantage Plans work the same way. Before you join, you can find and compare Medicare health plans in your area by visiting: Medicare.gov/plan-compare. Once you understand the plan's rules and costs, use one of the links on the last page for a quote. Note: In certain situations ( like if you move), you may be able to join, switch, or drop a plan at other times.

For a no-obligation strategy planning session call us today (203) 255-7700 https://www.health-directions.com

Medicare Advantage Also known as Part C

Original Medicare

What are the differences between Original Medicare and Medicare Advantage?

Medicare Advantage is an "all-in-one" alternative to Original Medicare. These "bundled" plans include Part A, Part B, and usually Part D Plans may have lower out-of-pocket costs than Original Medicare In most cases, you'll need to use doctors who are in the plan's network Most plans offer extra benefits that Original Medicare doesn't cover- like vision, hearing, dental, and more

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) If you want drug coverage, you can join a separate Part D plan To help pay your out-of- pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supple- mental coverage You can use any doctor or hospital that takes Medicare, anywhere in the U.S.

Part A Part B

Part A Part B

Most plans includes: Part D Extra Benefits Some plans also include: Lower out-of-pocket

You can add: Part D

You can also add:

Supplemental Coverage

(Some examples include coverage

from a Medicare Supplement Insurance (Medigap) policy, or coverage from a former employer or union.)

Helpful “Medicare & You” Videos

The following pages contain Medicare related videos, forms and links

Medicare & You: Deciding to Sign-Up for Medicare Part B

Medicare & You: Different Parts Of Medicare

Medicare & You: Understanding Your Medicare Choices

2021 Benefits Quick Guide

Medicare Part A 2021 Premium, Deductibles & Co-pays

2021 Medicare Part B Premiums & Deductibles

Part A Premium

PART B Those with annual incomes: $88,001-$111,000 (single) or $176,001-$222,000 (married) $111,001-$138,000 (single) or $222,001 - $276,000 (married)

$148.50 per month $207.90 per month (2021) Part D (+ $12.30 to premium 2021) $297 per month (2021) Part D (+ $31.80 to premium 2021) Visit www.ssa.gov NO ASSET LIMITS FOR MSP No Estate Recovery after 1/1/10 DSS Benefits Line: 1-855-626-6632 Income(143% TFA) listed includes Husky C unearned income disregard of $351/single & $702.00/couple if each has unearned income Assets: $1600 single; $2,400 couple $203 per year (2021)

(30-39 quarters) (< 30 quarters)

$259 per month $471per month

Hospital Deductible

(per benefit period deductible)

$1,484

Hospital Co-pays *Lifetime reserve

Days 61-90 Days 91-150*

$371 per day $742 per day

For those over these amounts…

Skilled Nursing facility Co-Pay

Part B Deductible

$ 185.50 per day

Days 21-100

Medicare Savings Program (MSP) effective 3/20

SSA COLA (1/21) 1.3 % 2021 SSI $794 (one) or $1181 (couple)

Program

Status Single Single Single Single

Income Limit $2,245,04 / mo $2,457.84/ mo $2,617.44/mo

Status Couple Couple Couple Couple

Income Limit $3,032,07/ mo $3,319.47/ mo $3,535,02/ mo

QMB (Q01) 211% FPL SLMB (Q03) 231% FPL ALMB (Q04) 246% FPL Medicaid (Husky C) (for those 65+, blind or with a disability)

$984.49 (region A ) $874.38 (reg. B & C) Eff 1/20

$1507.09 (reg. A) $1398.41 (reg. B & C) Eff 1/20

Husky A (160% FPL)

Caretakers w/ children < 19 years Husky A eff 3/20 If you qualify for MSP, you will automatically qualify for Extra Help and the lower co-pays for Part D For two Magi: $2,299/mo

Medicare Part D Low Income Subsidy (LIS) for 2021 LIS level 1 CO-PAYS FOR MEDICATIONS: $3.70 - FORMULARY GENERIC DRUGS $9.20 - FORMULARY BRAND NAME DRUGS LIS Level 2: Medicaid recipients up < 100% FPL: $1.30/$4 Max $17/mo -No cost sharing during Fed Emergency Medicaid Waiver/perm. SNF–no co-pays (LIS Level 3) 2021 CT LIS Benchmark Premium- $35.16 2021 $33.06 base premium to calculate penalty Partial Low Income Subsidy Max Income (1/17/20)/ Assets for Partial Subsidy (1/21)

Medicaid Expanded Benefits (3/20) HUSKY D Household size MAGI Monthly Income (138%)

CT Health Insurance Exchange Access Health CT

Benefits Center- 1-855-805-4325 www.accesshealthct.com

1 person

$1468

Couple $1983 No asset limit restrictions Age 19-64 without Medicare without children. MAGI income. Apply at www.accesshealthct.com Supplemental Nutrition Assistance Program (SNAP)-eff 10/20 Information below is for 60 years old or older or persons with a disability Single person income - $1968/ mo (max (max benefit $374; min benefit $16) N o asset limit EXCEPT for members whose gross income is more than income listed above ( 185% of the FPL). Updated annually in October (asset limit over 185%: $3,500) benefit $204; min benefit $16) Couple income – $2,658/ mo

Next Open enrollment November 1 – December 15, 2020

DSS applications mailed to: DSS Connect Scanning Center P.O.Box 1320 Manchester, CT 06045-1320 New W-1LTC Medicaid LTSS - send to LTSS Application Centers Or apply online: www.connect.ct.gov

LIS ((1/20) Single (150%FPL)

$1,615*- *Includes $20 disregard

Assets under $14,790* (1/21) *includes $1500 burial

LIS Couples

$2,175*-

Assets under $29,520*(1/21)

Partial dual eligible pay deductible of $92 then 15% copayment up to $6,550 in 2021 then $3.70/$9.20

Eff 1/17/20 Single $1063 $1595

Questions only DSS Benefits Line: 1-855-626-6632

FPL 100% FPL 150% FPL

Couple $1,437 $2,155 CT Energy Assistance Program (CEAP) 10/20 Accepting applications now Deadline: May 3, 2021

Funded in part by the Administration for Community Living Grant 11/9/20 eff 1/1/21 Households with liquid assets that exceed these amounts may qualify if gross income, when added to excess liquid assets, is within guidelines. Households with heat included in rent with up to 60% of median income can qualify if rent is more than 30% of gross income. *Vulnerable households receive a higher basic benefit: Vulnerable Households include a household member who is age 60+ or a person with a disability, or child under age 6. (basics benefit $725 up to 100% FPG; $190 for renters) Crisis Assistance for those unable to secure primary deliverable fuel may be eligible for additional $710. Asset Limits apply: www.ct.gov/staywarm - (download & email/mail applications) Homeowners - $15,000 First date of delivery: 11/2/20 211 Renters – $12,000 Eligible for winter protection shutoff: 11/1/20-5/1/21

Household Size 1 person 2 people 3 people 4 people 5 people 6 people

60% median income

$37,645 $49,228 $60,811 $72,394 $83,977 $95,560

CHOICES 1-800-994-9422

CT Home Care Program for Elders State Funded - Level 1 Closed 7/17 State Funded –Level 2 Medicaid Waiver – Level 3 300% of SSI ($783) (updated 1/1/20) Applied Income starts at $2,127-200%FPL (3/1/20) Medicaid – Level 5 (3/20)

Functional Criteria

Income Guidelines

Asset Guidelines

One critical need

No income ceiling

Individual: $38,592; Couple: $51,456 (eff 1/20) 150% & 200% of CSPA Individual: $38,592 Couple: $51,456 (eff 1/20) 150% & 200% of CSPA Individual -$1600 Couple - $3200 (both receiving services) $27,328(one receiving services)1/20 A higher asset amount may be allowed when a spousal assessment is done (Excess home equity limit: $893,000)

Skilled nursing home level of care* Skilled nursing home level of care**

No income ceiling- 9% cost share

$2,349/month (1/20) Only the individual’s income is counted toward eligibility

1 or 2 critical needs

$1595 month (150% FPL)

Individual: $1,600 Medicaid groups: S01 – S04

State-CHCPED-Level 4 Individual: $38,592; Couple: $51,456 Limit 100 slots *Supervision or cueing ≥ 3 ADLs + need factor; hands- on≥3 ADLs; hands- on≥2 ADLs + need factor. Need factors: Behavioral or cognitive impairment requiring daily supervision to prevent harm or assist with prescribed medications beyond setting up of pills. Skilled nursing home LOC* No income ceiling Call 1-800-445-5394 to make referrals or refer online https://www.ascendami.com/CThomecareforelders/default Eff 1/1/2020 max irrevocable funeral service account $10,000; life insurance of face value $1500; 5 year look back of assets. Community Spousal Protected Amount (CSPA): Minimum $25,728 and max $128,640 (1/20) Home equity limit max: $893,000. Maximum Monthly Maintenance Needs Allowance-MMNA: $3,216.00 (1/20). Minimum: $2155 (7/20) Federal Poverty Levels are usually announced in March of each year

Other Long Term Services and Supports Options

Program

Eligibility

Benefits

How to Apply? Call 2-1-1 or www.ctmfp.com

Community First Choice

Anyone functioning at skilled nursing home level of care and on any type of Medicaid (i.e. Husky A, D, C, Med- Connect). No age restriction

Self-directed care; PCA (including family/friends, not spouse); Home delivered services; home modifications; assistive technology; Support Broker

Provision from the Affordable Care Act (ACA)

Information for Persons with Disabilities

Program

Eligibility

Income

Assets

Persons with a disability who have earned income. Proof of disability: Receiving SSD; Medicare Part A after SSD stops or fill out W-300MED (Voc. Med) or W-300T19 for medical review by DSS

Earned income up to $6,250/mo or $75,000/yearly. Premium could apply if income is above 200% FPL (questions on premium: 1-800-656-6684)

$10,000 ($15,000 couple) Excluding: car used for work/medical appts, home, approved retirement accts (i.e. IRA,401K) & approved DSS account for special employment expenses Apply W-1E or www.connect.ct.gov

MedConnect

(Medicaid for the Employed Disabled)

Bureau of Rehabilitation Services (BRS) BRS Benefits Counselor

Assist persons with disabilities wanting to return to work

1-800-537-2549

Benefits Specialist explain the benefits of working & how employment works with benefits 9-month trial test period to return to work. Individuals get full benefits regardless of money earned. Provide peer support, I&R, advocacy, independent skills training to persons with disabilities Tax-free savings accounts for people with a disability prior to age 26 to pay for qualified disability expenses. Identify, engage, refer & link adults 55 years old+ adults to individually tailored community treatment options.

1-800-773-4636 to find out your local contact www.portal.ct.gov/ADS

Ticket to Work

1-866-968-7842

Centers for Independent Living

www.cacil.net for contact information

ABLE Act Accounts www.ablenrc.org Senior Outreach & Engagement

1-888-609-3268 https://savewithable.com/ct/home.html https://portal.ct.gov/DMHAS/Programs- and-Services/Older-Adult-Services

Long-Term Care Medicaid Application Centers (for new W-1LTC Medicaid applications): 1)Waterbury Office, 279 Thomaston Ave., Waterbury, CT 06702 2) Bridgeport Office, 925 Housatonic Avenue, Bridgeport, CT 06606 3) New Haven Office, 50 Humphrey St., New Haven, CT 06513 4) Greater Hartford Office, 20 Meadow Rd., Windsor, CT 06095—For Statewide Medicaid Waiver HCBS Applications only

CHOICES 1-800-994-9422

Funded in part by the Administration for Community Living Grant 11/9/20 eff 1/1/21

State of Connecticut Department of Social Services Application for Medicare Savings Programs (QMB, SLMB, ALMB) Use this form to apply for Medicare Savings Program benefits. If you currently receive these benefits, please renew using the Renewal Form for Medicare Savings Programs (W-1QMBR).

W-1QMB (Rev 8/16)

Do you need a reasonable accommodation or special help to complete your application because you have a disability? Yes No If yes, complete the next question and see page 3 about how we can help . If you need a reasonable accommodation or special help, tell us what kind of help you need:

Tell us about yourself Name (first, middle, last)

Sex (M or F) Social Security #

Date of Birth

Home Street Address

City

State

Zip Code

Mailing Address (if different)

City

State

Zip Code

Best phone # to reach you

Marital Status (check one): Never Married

Married

Separated

Divorced

Widowed

This application is for (check one): Yourself only Yourself and your spouse

Spouse’s Name (first, middle, last)

Spouse’s Social Security #

Spouse’s Date of Birth

Title VI of the Civil Rights Act of 1964 allows us to ask for race and ethnic origin information. You do not have to give it to us. The information helps to make sure that we are following federal civil rights law. If you do not want to give us this information, it will not affect your application. Are you of Hispanic, Latino/a, or Spanish origin? No Yes (if yes, check all that apply) Mexican, Mexican-American or Chicano/a Cuban Puerto Rican Other Hispanic, Latino/a or Spanish Racial Heritage (check all that apply): White Black or African American American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Native Hawaiian Samoan Guamanian or Chamorro Other Pacific Islander Tell us about your citizenship status Are you a U.S. citizen? (check one) What is your alien registration number? What is your country of origin? What are the date and place that you came into the country? What is your sponsor’s name? (if applicable)

If no, what is your non-citizen status? (refugee, entrant, permanent resident, etc.)

Yes No Yes No

Yourself Your Spouse

Page 1 of 4

Return to: PO Box 1320, Manchester, CT 06045

Tell us about your medical insurance Check if you have Medicare Part A Medicare Claim #:_______________________________ Insurance other than Medicare, if any: Company name: Insurance for You Policy number: ________________________________ Group number: ________________________________ Check off all the services that are covered: Hospital Doctor/Surgical Dental Prescription Vision/Optical Long Term Care Policy start date: Stop date: Policy premium amount: $________ per _____________ Date you started paying this premium: _______________

or Part B . Check if your spouse has Medicare Part A

or Part B .

Insurance for Your Spouse

Medicare Claim #:______________________________ Insurance other than Medicare, if any: Company name: ______________________________ Policy number: _______________________________ Group number: ______________________________ Check off all the services that are covered: Hospital Doctor/Surgical Dental Prescription Vision/Optical Long Term Care Policy start date: Stop date: Policy premium amount: $_______ per ___________ Date you started paying this premium: ____________

Tell us about your income List all income that you and your spouse receive. List the amounts of income before any deductions are made. Examples of income are: Social Security, Supplemental Security Income (SSI), wages, pensions, disability benefits, worker’s compensation, unemployment compensation, interest, dividends, rental property income, alimony, and child support. Income for Yourself Income for Your Spouse Where does the money come from? How much do you receive? How often do Where does the money come from? How much do you receive?

How often do you receive it? (hourly, weekly, every other week, monthly, yearly)

you receive it? (hourly, weekly, every other week, monthly, yearly)

Wages (employer name):

Wages (employer name):

$

$

Interest:

Interest:

$

$

Social Security (type):

Social Security type):

$

$

Pension (company name):

Pension (company name):

$

$

IRA (name of bank):

IRA (name of bank):

$

$

Other (describe):

Other (describe):

$

$

Page 2 of 4

Return to: PO Box 1320, Manchester, CT 06045

Important information for you to know about your application  This application is a request for help from the Medicare Savings Programs only.  All the information given on this form is confidential and will only be used to administer the programs and will only be disclosed as permitted by law.  The Social Security numbers of everyone receiving or requesting assistance will be used to verify identity and eligibility. Social Security numbers will be checked against government databases, as permitted by law.  Information provided on this form may be verified to the extent permitted by law, including by checking government computer databases or directly with third parties such as employers or banks. If you need a reasonable accommodation or special help If you cannot do something we ask you to do because you have a disability, you may request a reasonable accommodation or special help. For example, we may be able to complete your application over the telephone if you cannot come into the office, help you get certain proofs, or give you extra time to provide information. Contact DSS at 1-855-626-6632 to request a reasonable accommodation or special help. If we do not agree to give you a reasonable accommodation or special help based on your disability, you can complain to the department’s Americans with Disabilities Act (ADA) coordinator. See the Non-Discrimination Statement on page 4. Please read carefully and sign below  I give permission to DSS, or any health insurer, provider, or any other entity providing services to me or my family under the Medicaid program, to release information about me or my family as necessary for the delivery of Medicaid program services and the administration of the Medicaid program, as permissible by federal or state law.  I certify under penalty of perjury that all the statements made on this form are true and complete to the best of my knowledge. I understand that I can be criminally or civilly prosecuted under state or federal law if I knowingly give incorrect information or fail to report something I should report. Any person who helped you complete this form or completed this form for you must also sign. Applicant’s Signature Date Spouse’s Signature Date

Helper or Representative’s Signature

Date

Relationship To Applicant

Permission to Share Information To permit the Department of Social Services to share information about your application, please identify the authorized individuals, agencies, or institutions that DSS may communicate with, and sign in the box.

Name:

Phone #

1

Address:

Name:

Phone #

2

Address:

Applicant’s Signature or Signature of Authorized Representative

Date

Page 3 of 4

Return to: PO Box 1320, Manchester, CT 06045

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