Medicare Advantage Overview Proprietary Confidential Information What is

Medicare Advantage Overview Proprietary & Confidential Information

What is Medicare (Fee-For-Service)? Medicare is a Federal health plan for individuals who are 65+ or disabled and therefore eligible for Social Security benefits Medicare ID Card Medicare is… • A health plan managed by the Federal government • A portion of healthcare costs are paid through premiums, deductibles, and coinsurance • Eligible to people 65+ or disabled and receiving Social Security disability benefits 2

How Does Medicare Work? Medicare Fee-For-Service (FFS) is made up of Medicare Parts A and B, and it pays for ~80% of healthcare costs Covered by Medicare Parts A & B (FFS) Part A covers: • • Hospital Skilled Nursing Facility (SNF) Part B covers: • • • Doctors visits Ambulance service Physical therapy Outpatient care Annual wellness exam Not Covered by Medicare Parts A & B Part A + Part B (FFS) does NOT cover: • • • Prescription drugs Case management Other extras 3

What is Medicare Supplement Insurance (Medigap)? Medigap is extra health insurance that you buy from a private company to pay health care costs not covered by Original Medicare Covered by Medicare Supplement covers: • • • * medicare. gov Co-payments Deductibles Health care if you travel outside the U. S. Not Covered by Medicare Supplement does NOT cover: • • Long-term care Dental care Vision care Hearing aids Eyeglasses Private-duty nursing Prescription drugs (in most cases) 4

Medicare Advantage vs. Medicare Supplement Medicare Advantage VS. Medicare Supplement How It Works Pays for your medical expenses in place of Original Medicare Perks Adds perks such as dental, vision, hearing and wellness No Perks Included Drug Coverage Covers services you need (after Part A and B) including Part D Still need to get separate prescription coverage (Part D) Monthly Premium Lower monthly premiums - Some plans have $0 premiums The monthly premiums are higher Age & Tobacco Use Age and tobacco use will not affect monthly premium Age and tobacco use will affect monthly premium Doctors Can see in-network providers for care or OON providers at an additional cost Flexibility to see any doctor who accepts Original Medicare Pays for Medicare-eligible services after Original Medicare (Parts A and B) pays its share 5

What is Medicare Advantage? Medicare Advantage is a single, easy-to-manage, often less expensive plan Comprehensive Coverage in One Medicare Plan • Medicare Advantage (Part C) combines: – Part A + Part B + Part D (Rx drug coverage) = Part C – PLUS extras such as fitness benefits, wellness incentives, as well as vision, dental and hearing aid coverage – AND only one company pays your claims, instead of two, like with a Medicare Supplement plan or FFS For one easy-to-manage, often less expensive plan 6

What’s the “Advantage” in Medicare Advantage? Medicare advantage has several key benefits over FFS primarily for patients but also for physicians: Care Management Manages care throughout the patient experience to create a simple and seamless experience Preventative Care Financial Protection Delivers care focused on prevention with Ensure viable providers and an emphasis on the patient’s physical coverage while providing pathway wellness for appeals Financial Protection Provides out-of-pocket maximums and Financial Protection dependable & timely claims payments Ensure viable providers and coverage while providing pathway for appeals Benefits to Patient Benefits to Physician Additional Benefits Financial Protection Supplies patients with additional Ensure viable providers and benefits such as dental, vision, hearing coverage while providing pathway aids & fitness benefits for appeals Quality Financial Ensures reliable. Protection providers and adequate coverage patients and Ensure viableforproviders coverage while providing pathway for appeals Streamlined Payments Provides financial adjustments through HCC and MLR analysis when requested 7

How Does Medicare Advantage Affect Patient Outcomes? Medicare Advantage maintains statistical evidence for increased positive patient outcomes 33% fewer emergency room Visits 21% more spending on preventative care services 23% fewer inpatient stays 6% lower spending on diabetes care 17% lower inpatient spending 5% lower outpatient spending 8 *healthpayerintelligence. com

Will MA Continue to Grow & Remain Important? Research suggests that Medicare Advantage has large growth potential in the next 5 years as CMS is making an effort to guide patients in this direction MA Growth 1, 2, 3 Why does MA Continue to Grow? 20 21% MA Growth Projected by 2025 18 16 14 12 10 Members (Millions) 10 10 11 12 12 13 8 • Proven strong market preference over traditional Medicare • High revenue rate • Highest expected enrollment growth rate of all Medicarefocused commercial products 3 6 4 2 - • Changing demographics - aging of the population 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 January 1, 2019, federal legislation requires all Medicare Cost plans to discontinue in service areas where at least two competing MA plans meeting specific enrollment thresholds are available | 2 Effective January 1, 2020, Med. Supp plans that offer Part B first dollar coverage will be discontinued. This impacts Plan C and F, but existing policyholders prior to January 1, 2020 will be grandfathered and can maintain these plans | 3 CMS, “Monthly Enrollment by Plan” and “Landscape Source Files” • CMS is making an effort to guide patients in this direction 1 Effective 9

If you have questions, please contact your provider relations specialist. 10