Medicare Advantage Your Way. New for 2014!

Medicare Advantage Your Way. New for 2014 !

Elderplan is a health plan with Medicare and Medicaid contracts. The benefit information provided herein is a brief summary, not a complete description of benefits. This is an advertisement. For more information, contact the plan. Medicare Election periods apply. Dual eligible members may enroll all year round.

H3347_EP13078 CMS Approved 09112013

Elderplan is a health plan with a Medicare contract. Individuals must have both Part A and Part B to enroll. You must continue to pay your Medicare Part B premium if not otherwise paid for by Medicaid. This information is available for free in other languages.

Members must receive all routine care from plan providers.

Authorization rules may apply for certain services. Limitations, co-payments and restrictions may apply. Members may enroll in Elderplan only during specific times of the year. Dual eligible members may enroll all year round. Contact Elderplan for more information. Plan materials are available in alternative formats or languages. Please call Elderplan’s Member Services Department at 1-800-353-3765 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m.–8 p.m., 7 days a week, to request materials in alternate formats.

Esta información puede estar disponible en diferentes idiomas o formatos. Si necesita obtener información en otro formato o idioma, comuníquese con el Servicio de Atención al Cliente al número que se menciona anteriormente.

Elderplan’s Medicare Prescription Drug benefit is only available to enrolled members.

If a beneficiary is already enrolled in a Medicare Advantage Part D (MA-PD) Plan, the enrollee must receive his/her Medicare Prescription Drug benefit through that plan.

Elderplan renews its contract with the Centers for Medicare and Medicaid Services (CMS) annually. Benefits beyond the current contract year are not guaranteed.

Elderplan’s pharmacy network includes retail, mail order, long-term care and home infusion pharmacies. For mail order information and additional information about network pharmacies, contact Elderplan’s Member Services Department at 1-800-353-3765 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m.–8 p.m., 7 days a week. Information may also be obtained by writing Elderplan, Attention: Member Services Department, 6323 Seventh Ave., 3rd Floor, Brooklyn, NY 11220-4711, or by visiting Elderplan’s website at www.elderplan.org.

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

Medicare beneficiaries may enroll in Elderplan through the CMS Medicare Online Enrollment Center, located at www.medicare.gov. For more information, contact Elderplan’s Member Services Department at 1-800-353-3765 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. –8 p.m., 7 days a week.

You may be able to get Extra Help to pay for your prescription drug premiums and costs.

To see if you qualify for Extra Help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;

• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or

ELDERPLAN FOR MEDICAID BENEFICIARIES (HMO SNP) page 12

ELDERPLAN EXTRA HELP (HMO) page 13

ELDERPLAN LONG-TERM CARE OPTIONS

page 17

ELDERPLAN CLASSIC ZERO PREMIUM (HMO)

page 14

Protect your health with the power of a Medicare plan from Elderplan.

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Elderplan gives you the power to get the most out of Medicare.

When it comes to Medicare, you want good value for

your money. That means choosing a health plan with

the right benefits for you, at the right price. Choosing

the right plan starts with understanding your health

care needs and the types of plans available. At

Elderplan, we understand how important making

the right choice is to you. That’s why you can count

on us — and our more than 25 years of experience

in serving the needs of New York City Medicare

beneficiaries — to help you find a plan that offers

benefits you need at a price you can afford.

Want the power to protect your health? Start here.

Begin by using this guide to find out more about Elderplan’s great, money-saving plans that offer you from among a choice of benefits, like:

• $0 monthly premiums that make it easier to reduce out-of-pocket costs¹

• Low-cost generic prescription drug coverage²

• $0 in-network primary care physician visits, so you can feel comfortable keeping in close contact with your doctor³

• In-home physician visits, so you can get the care you need in the comfort of your own home

• No-cost gym membership to help keep you fit and active (participating health clubs only)

• Over-the-counter benefit for health-related items that will keep more money in your pocket⁴

• Discounted acupuncture and massage services that broaden your choice of treatment options⁵

• Comprehensive dental coverage beyond preventive care, such as dentures, fixed bridges, root canal, fillings, periodontal services and much more⁶

• Free transportation for up to 28 trips a year⁷ to medical appointments

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Call 1-866-771-0636 toll-free (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week.

Or visit us at www.elderplan.org.

Elderplan gives you the power to choose a plan that’s right for you.

At Elderplan, we take pride in being able to offer you a variety of plan options. Take a minute to look over each plan. Then give us a call. We’ll sit down with you face-to-face and talk about your health care needs.

Then we can help you decide which plan option is right for you.

When you review the benefits offered by some of our most popular health plans, you’ll see why Elderplan is becoming the Medicare health plan of choice for more and more New Yorkers every day.

Do you have Medicare and Medicaid? Check out Elderplan for Medicaid Beneficiaries (HMO SNP) on page 12.

Do you qualify for Low Income Subsidy (Extra Help)? Check out Elderplan Extra Help (HMO) on page 13.

Are $0 premiums important to you? Check out Elderplan Classic Zero Premium (HMO) on page 14.

Interested in long-term care at home? Check out Elderplan Long-Term Care Options on page 17.

Still have questions? Call us today, and our benefits advisors will guide you through

our Medicare plans and recommend the right one for you.

Remember, the Centers for Medicare and Medicaid Services recommends you review your health plan coverage every year. Don’t wait to schedule an annual Medicare benefits checkup with Elderplan today. It’s like a checkup for your benefits that will

help keep you physically independent and save you money.

You want to protect your health.

We give you the power to find the Medicare plan that will help you do it.

Our Elderplan benefits advisors know all the ins

and outs of Medicare plans, so they can help you

find a plan that gives you the power to protect

your health. Simply give us a call, and we’ll set up

a complimentary face-to-face Medicare benefits

checkup appointment with you and one of our

friendly benefits advisors. They’re knowledgeable

Medicare plan professionals who’ll answer your

questions and help you get the right plan for the

right price. Because saving money on Medicare

means you can spend more of it enjoying life.

Now’s the time to check whether you have enough prescription coverage and the right benefits. Schedule your benefits checkup today.

For more than 25 years, Elderplan has been a not-for- profit health plan serving New Yorkers. We reinvest our earnings to bring you improved benefits and services.

That means we give you the power to protect your health by saving you money and offering you more benefits. We want you to get the most out of Medicare.

And that means helping you understand what Elderplan

and Medicare are all about. Read on to find answers to

commonly asked questions.

Call 1-866-771-0636 toll-free (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week.

Or visit us at www.elderplan.org.

What is Original Medicare?

It’s the federal health care program for people who are age 65 and older or people with disabilities.

How does it work?

When you have Medicare, money comes out of your Social Security check each month to help pay for some of the health care services you need — like visits to your doctor or a stay in the hospital.

What if I need benefits Original Medicare doesn’t cover?

That’s why Medicare Advantage plans like Elderplan were created — so you get more benefits, savings and choices. For example, with Elderplan you can choose from among plans with benefits and/or value-added services, such as:

• $0 visits to your regular in-network doctor³

• Low-cost generic prescription drug coverage²

• Over-the-counter benefits⁴

• No referrals to see in-network specialists³

• Comprehensive dental⁶

• No-cost gym membership at participating health clubs

• Discounted acupuncture and massage services⁵

• And much more!

Elderplan gives you more than Original Medicare … and less to worry about.

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Whether you’re new to Medicare or are already enrolled, Elderplan can help you choose the right plan for you.

New to Medicare?

Elderplan can help you face the challenges of transitioning to what can seem like a very complicated program.

To find out which plan provides the benefits that will help protect your health, start by asking yourself a few simple questions:

Do you take prescription medications?

Are preventive benefits important to you?

Would you prefer a plan with no monthly plan premium?

Already have Medicare?

Make sure your Medicare Plan gives you all the benefits you want, with plan options to choose from, including:

• The prescriptions you need at the right price

• $0 plan premiums

• $0 in-network doctor visits

• Up to $900 in over-the-counter benefits

• Free transportation for up to 28 trips per year to medical appointments

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As an Elderplan member, you’ll enjoy a number of extra-special advantages we know you’ll appreciate, including the fact that:

• Our members are also our neighbors — and we treat them that way

• We serve members in all five boroughs of NYC, Westchester, Nassau, Suffolk, Monroe and Rockland Counties

• We have a large network of doctors and specialists — so chances are your physician may be one of them

Pick up the phone now and dial 1-866-771-0636 toll-free (or TTY 1-800-662-1220

for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week. Or visit us at

www.elderplan.org.

ENROLL NOW!

Don’t wait. ENROLL NOW to make sure you have a Medicare plan that gives you the power to protect your health.

Most of our plans give Medicare and Medicaid

eligible beneficiaries the option to enroll year round.

However, for those only eligible for Medicare, the deadline to enroll in a Medicare plan is December 7, 2013 — so there’s no time to waste. If you don’t enroll before the deadline, and you’re not eligible for special election, you won’t have the chance to take advantage of all that Elderplan offers until 2015.

Either way, the clock is ticking, so take a moment to contact us today by calling 1-866-771-0636 toll-free (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week. Or visit us at www.elderplan.org.

Eligible for Medicare and Medicaid? Have an annual income of less than $17,235? Elderplan can give you the power to protect your

health now. You can enroll all year round.

Elderplan for Medicaid Beneficiaries (HMO SNP)

Created to help make sure Medicare beneficiaries who are eligible for Medicaid or another N.Y.S. medical assistance program⁸ get all the benefits they’re entitled to under both programs, Elderplan for Medicaid Beneficiaries (HMO SNP) provides benefits and/or value-added services that include:

• $0 monthly plan premium for eligible individuals^{1, 8}

• Low co-pays for office visits to any in-network doctor, specialist or other health care provider^{3, 8}

• Low co-pays for Part D prescription drug coverage²

• $900 a year for over-the-counter, health-related items⁴

• Free transportation for up to 28 trips a year⁷ to medical appointments

• No-cost gym membership at participating health clubs

• Discounted acupuncture and massage services⁵

Elderplan Extra Help (HMO)

Living on an annual income of $17,235 or less and resources that total less than $12,640 (based on 2013 single individual income limits)? You may be able to get Extra Help from the government paying for your prescription coverage while you are enrolled in Elderplan Extra Help (HMO). And when you pay less for Medicare coverage, you have more to spend on things you enjoy. Some plan benefits include:

• $0 network primary care physician visits³

• $0 for diabetes self-monitoring training and supplies

• Comprehensive dental care⁶

• $0 routine hearing exams⁶

• Discounted acupuncture and massage services⁵

• No-cost gym membership at participating health clubs

• $400 a year for over-the-counter, health-related items⁴

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ELDERPLAN EXTRA HELP (HMO) ELDERPLAN FOR MEDICAID BENEFICIARIES (HMO SNP)

Elderplan Classic Zero Premium (HMO)

Elderplan Classic Zero Premium (HMO) is a plan designed for beneficiaries who do not have Medicaid or Low Income Subsidy.

With Elderplan Classic Zero Premium (HMO), you get:

• $0 monthly plan premium¹

• Low-cost generic prescriptions drug coverage²

• $0 office visits to your primary care physician³

• Worldwide emergency care

• $0 gym membership at participating health clubs

• Discounted massage therapy⁵

• Preventive dental coverage⁶ ELDERPLAN

CLASSIC ZERO PREMIUM (HMO)

Get the power to protect your health with a Medicare plan from Elderplan.

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ELDERPLAN CLASSIC ZERO PREMIUM (HMO)

Which Elderplan option is right for you?

The simple answer is the one that gives you the most power to protect your health. To help make it easier to figure out which Elderplan option will do that, take a look through this quick summary of our most popular plans. In addition to comparing what our plans offer to what your current plan has, also think about what benefits you might need in the coming year. Want more options? Give us a call to find out about additional plans that might best suit your needs.

Elderplan for Medicaid Beneficiaries (HMO SNP)

This simple plan helps you get the most out of Medicare and Medicaid or other N.Y.S. assistance programs with:

• $0 co-payment or low co-payment for office visits^{3, 8}

• Low co-pays for Part D prescription drug coverage²

• $900 a year for over-the-counter, health-related items⁴

• Free transportation for up to 28 trips a year⁷ to medical appointments Elderplan Extra Help (HMO)

Designed to help people with limited income, this plan includes benefits that pay for:

• $0 in-network primary care physician benefits³

• Comprehensive dental⁶

• $400 a year for over-the-counter, health-related items⁴ Elderplan Classic Zero Premium (HMO)

This high-quality, affordable plan helps you be independent with:

• $0 monthly premium¹

• Preventive dental coverage⁶

• Low-cost generic prescription drug coverage² ELDERPLAN

LONG-TERM CARE OPTIONS

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Interested in long-term care at home?

Providing long-term care for you or a loved one can be expensive. If you require ongoing care or suffer from a chronic condition, you may require assistance with daily activities, such as eating, bathing and transportation. Elderplan offers two long-term care plans that will provide the care you need in the comfort of your own home.

Elderplan Plus Long-Term Care (HMO-SNP)

If you are receiving Medicare and Medicaid, plus need assistance with daily activities, Elderplan Plus Long-Term Care (HMO-SNP) can provide you with the long-term care services you need to stay in the comfortable surroundings of your own home. This plan offers services such as:

• Personal Care Worker • Care Management

• Home Care • Medical and Prescription Drug Coverage

• Transportation for medical services if medically necessary • $360 per year for over-the-counter, health-related items⁴ For more information about Elderplan Plus Long-Term Care (HMO-SNP), call 1-877-891-6447 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week.

HomeFirst Managed Long-Term Care (MLTC)

HomeFirst, one of the oldest MLTC plans in NY, helps people who receive or qualify for Medicaid and who might otherwise be in a nursing home with the care they need to safely stay at home. HomeFirst provides, arranges and coordinates health and long-term care services you or a loved one might need at home, including:

• Assistance with bathing, dressing and meals • Physical Therapy and Occupational Therapy

• Transportation to health-related appointments • Home-delivered meals

For more information about HomeFirst, call 1-866-694-3086 (or TTY 1-800-662-1220 for the hearing impaired),

between 8:30 a.m. – 5 p.m., Monday – Friday, or visit our website at www.homefirst.org. ELDERPLAN LONG-TERM CARE OPTIONS

Elderplan puts you in control of your health.

As an Elderplan member, you can look forward to services that will keep you connected with Elderplan, other members and the community at large:

• One-on-one information sessions to help you maximize your benefits

• Our member magazine, All Together Healthy

• Access to the MJHS award-winning Member to Member Program

With Elderplan health plans, you also enjoy saving money on preventive benefits designed to protect your health, now and in the years to come.

• Cancer screenings

• Flu and pneumonia shots

• Osteoporosis screenings

• Dental screenings⁶

• Hearing exams⁶

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Questions and answers about Elderplan.

How can I enroll in Elderplan?

1. Call 1-866-771-0636 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week.

2. Schedule an at-home appointment with one of our friendly benefits advisors who will help you enroll in a plan that meets your needs.

3. Or visit www.elderplan.org.

Does Elderplan offer more benefits than Original Medicare?

Yes, all of our plans include prescription drug coverage and some of our plans cover comprehensive dental and vision⁶ as well as annual over-the-counter allowance⁴ and transportation. None of these benefits are included in Original Medicare.

How can Elderplan offer so much more than Original Medicare without costing more?

Elderplan is a not-for-profit organization. By focusing our earnings on improving our products and services, we can offer a wide range of benefits at little or no additional cost.

Questions and answers about Elderplan (continued).

What is special election, and how do I know if I qualify?

Special election allows you to enroll any time during the year. If you are turning 65, have Low Income Subsidy, have both Medicare and Medicaid, receive Extra Help from the State, or are moving into the service area, you are entitled to a Special Election. Elderplan can help you determine if you are eligible.

Why is it important to do a benefits checkup?

Every year, health plans change their benefits and price structure. That’s why you should review your coverage once a year. We can help you take a look at your needs and compare options, so you can find an affordable plan that will give you the power to protect your health and your budget.

Still have questions about Elderplan? Call and talk to us. We can show you how to get the

benefits and savings you need. 1-866-771-0636 toll-free (or TTY 1-800-662-1220 for the

hearing impaired), between 8 a.m. – 8 p.m., 7 days a week. Or visit www.elderplan.org.

1 You must continue to pay your Medicare Part B premium unless paid for by the state medical assistance program.

2 References in this document to brand and generic drugs are based on a pharmacy benefit that must be ordered from the plan

formulary. Co-payments may apply and vary based on use of in- or out-of-network pharmacies and your yearly out-of-pocket drug costs. Please contact Elderplan for additional details.

3 You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine

care from out-of-network providers, neither Medicare nor Elderplan will be responsible for the costs.

4 Members in plans with this benefit may purchase over-the-counter (OTC) non-prescription drugs as well as health-related items

using a debit card at authorized retail stores. The benefit period is either monthly or quarterly depending on the plan. The benefit does not carry over from one quarter to the next or one month to another month depending on the plan.

5 The products and services described are neither offered nor guaranteed under our contract with the Medicare program. In

addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Elderplan grievance process.

6 In-network vision and hearing benefits and preventive dental benefits are available in Elderplan Classic Zero Premium (HMO) and

Elderplan Extra Help (HMO). In-network comprehensive dental is available in Elderplan Extra Help (HMO) plan.

7 The transportation benefit is designed to assist members in getting to medical appointments. The Elderplan Medicare for

Medicaid Beneficiaries (HMO SNP) plan covers 7 one way trips a quarter. The Elderplan Advantage for Nursing Home Residents (SNP) covers 6 one way trips a quarter.

8 Elderplan for Medicaid Beneficiaries (HMO SNP) is a dual eligible Special Needs Plan, available to Medicare beneficiaries who

receive N.Y.S. Medicaid or other assistance through N.Y.S. medical assistance programs. Premiums, co-pays, co-insurance and deductibles may vary based on the level of Extra Help that you may receive. Please contact the plan for further details.

Looking for a Medicare Plan that gives you powerful benefits and services to protect your health?

Call Elderplan at 1-866-771-0636 (or TTY 1-800-662-1220 for the hearing impaired), between 8 a.m. – 8 p.m., 7 days a week. Or visit www.elderplan.org.

Enroll today to start enjoying Elderplan benefits.

Please return the attached postage-paid reply card.

YES!

Please rush me more information and contact me, so I can find out how Elderplan can help.

By checking “yes” or providing my phone number below, I agree it’s okay to have a benefits advisor, who is a licensed sales agent, call to discuss Medicare Advantage Prescription Drug Plans.

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I would like more information about the following plan:

Elderplan for Medicaid Beneficiaries (HMO SNP) Elderplan Extra Help (HMO)

Elderplan Classic Zero Premium (HMO) Elderplan Long-Term Care Options

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