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1. Your presenter today:<PresenterName> <Presenter Title>

2. Today’s Topics • Medicare Part D overview • Your 2015 Blue Cross MedicareRx (PDP)SMPlan Options • Enrolling in Blue Cross MedicareRxSM • Questions

3. Your Presenter Today • I am an Authorized Agent licensed to sell health insurance in Oklahoma and have been certified to sell Prescription Drug Plan products for Blue Cross and Blue Shield of Oklahoma. I may be compensated based upon your enrollment in a plan. • I am here to help you make an informed decision about selecting a Medicare Prescription Drug Plan.

4. Medicare Part D Overview • Medicare Part D helps to pay for your covered prescription medications • Also referred to as prescription drug coverage or prescription drug plan (PDP)

5. Eligibility • Must have Medicare Part A and/or Part B • Must live in the Part D plan’s service area • If you are covered by an employer or union: • Could affect your benefits • Call Benefits Administrator • Read plan communications

6. Medicare Part D Enrollment There are three enrollment periods: 1. Annual Enrollment Period (AEP) • October 15 to December 7 • Enroll for the first time or switch plans • Effective date: January 1 • Note:If you like what you have, there is no need to switch

7. Medicare Part D Enrollment 2. Initial Enrollment Period (IEP) • Enroll when you first become eligible: • 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 • Effective date: Generally, first of the month following enrollment, or first of birthday month

8. Medicare Part D Enrollment 3. Special Enrollment Period (SEP) • Enroll or switch plans due to special circumstances • Moving to a new state • Enrolling in or disenrolling from a Part C Plan • Eligible for Low Income Subsidy assistance • Enrolling in both Medicare and Medicaid • Retiree losing group health coverage • Other situations that may be applicable • Effective date: Generally, first of the month following enrollment

9. What Happens If You Postpone Enrollment? • You may have higher premiumsunless you had “creditable” coverage • You will be assessed 1% of the Medicare base beneficiary premium for every month in which you were eligible to enroll but did not enroll Note: You will not be charged a late enrollment penalty if your situation changes and you need to buy Part D, as long as you had creditable coverage and you apply within 63 days of the end of your creditable coverage.

10. Examples of Creditable Coverage • Some group health plans’ retiree coverage • State pharmacy assistance program • Veterans Affairs coverage • Military coverage, including TRICARE

12. Medicare Part D Phases Deductible • Annual Deductible:$320This means you pay the first $320in approved drug costs before your Part D benefits begin Let’s look at the 2015 CMS designated plan design: $320 Initial Limit $2,970 $2,930 The Gap $4,700 $4,750 Catastrophic

13. Medicare Part D Phases Deductible • Initial Coverage Limit: $2,960 What counts toward the Initial Coverage Limit? • Once you have met your deductible, you typically pay a fixed amount (copay) to fill an approved prescription • Your Part D plan pays the balance of the drug cost for the prescription $320 Initial Limit $2,960 The Gap $4,700 $4,750 Catastrophic

14. Medicare Part D Phases Deductible • Coverage Gap: $2,960 to $4,700 • You will reach the Coverage Gap after you and your plan have reached $2,960in drug costs • You will then be responsible for allcosts while in the Coverage Gap, until you reach $4,700 in True Out-Of-Pocket (TrOOP) costs • Note: During this time, you may be eligible for a 55% discount on brand name drugs and a35% discount on generic drugs at the time of purchase $320 Initial Limit $2,960 • TrOOP • $4,700 • ( = Deductible + Initial Limit + Out-Of-Pocket Costs ) Catastrophic

15. Medicare Part D Phases Deductible • Catastrophic Coverage:$4,700 • Medicare pays 95% of your approved drug costs once you reach the True Out-Of-Pocket (TrOOP) maximum at $4,700 $320 Initial Limit $2,960 • TrOOP $4,700 Catastrophic

16. TrOOP – True Out-Of-Pocket Costs • The TrOOP maximum amount is the amount of money you need to spend to reach Catastrophic Coverage • Thereafter you pay a minimum cost share of $2.65for generic or $6.60 for brand name drugs, and 5% for specialty drugs for the remainder of 2015 • TrOOP consists of: • Deductible = $320 in 2015 • Copays or coinsurance you pay in 2015 • Once you reach $4,700 out of your own pocket, the Medicare Catastrophic Coverage benefit begins

17. During the gap, all plans offer a manufacturer discount on brand name drugs* Your cost share for generics is decreasing each year* Gap Discounts Brand Drug A = $60 Gap Coverage = None Member Pays $27.00 Plan’s payment responsibility: $3.00 Manufacturer Discount$30 Amount towardTrOOP: $57.00 Generic Drug B =$20 Gap Coverage = None, but 35% discount applies Member Pays$13.00 (65% of the $20 generic Rx cost) Discount $7.00(35% of the $20 Generic Rx cost) Amount toward TrOOP: $13.00 *Discounts during the gap are available to members who do not receive extra help. Members who receive extra help have limited income and qualify for up to 100% of drug costs including monthly premium, annual deductibles and copays/coinsurance.

18. Phasing Out the Coverage Gap:Part D Cost Sharing 2013-2020 Generic Drugs in the Gap Brand-Name Drugs in the Gap Rx MfrDiscount Part Dplan pays 65% 45% You pay Source: CMS

19. Part D-IRMAA • Part D-IRMAA stands for Part D income-related monthly adjustment amount • Effective January 1, 2011 • An additional amount for Medicare Part D drug coverage • Pay your Part D-IRMAA directly to Medicare, not to your plan • Required by law to pay the Part D-IRMAA based on your income, even if you have drug benefits through a union or employer-sponsored Medicare drug plan

20. Formulary • List of prescription drugs covered by a health insurance company • Varies between health insurance companies

21. Formulary: Could It Change? • Under certain conditions, a Part D plan can make changes during the year by: • Adding or removing drugs based on safety concerns • Moving a drug to a higher or lower cost sharing tier (usually only when a brand goes off its patent) • Adding utilization management (step therapy, prior authorization, quantity limits, etc.)

22. Medicare Part D Formulary Exceptions • The Exception Process ensures access to medically necessary Medicare-covered prescription drugs • Enrollees can request an exception if: • The enrollee is using a drug that has been removed from the formulary • A non-formulary drug is prescribed and medically necessary • The cost-sharing tier of a drug an enrollee is using changes • A drug covered under a more expensive cost-sharing tier is prescribed because the less expensive drug is medically inappropriate

25. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.Limitations, copayments, and restrictions may apply.Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. *You must continue to pay your Medicare Part B premium

26. Blue Cross MedicareRx Formulary • Save money by switching to a generic • Talk to your doctor or pharmacist • To receive benefits, use Blue Cross MedicareRx network pharmacies or mail-order service except in an emergency • With preferred network pharmacies and mail-order, you may purchase a 90-day supply of an eligible prescription drug and pay only two and a half months of copays instead of three • Some network pharmacies are NOT preferred; they do not offer lower copays for a 90-day supply

27. Blue Cross MedicareRx Pharmacy Network • Save at any one of these or other preferred network pharmacies and their affiliates: • Walgreens, CVS, Walmart • Other pharmacies are available in our network • Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances. Limitations, copayments, and restrictions may apply. • Pharmacies nationwide • Peace of mind while traveling

28. Online Plan Selector and Online Formulary Finder www.getblueok.com/pdp

30. Three Enrollment Periods 1. Annual Enrollment Period (AEP) • October 15 to December 7 • Enroll for the first time or switch plans • Effective date: January 1 2. Initial Enrollment Period (IEP) • Enroll when you first become eligible • 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65 • Effective date: generally, first of the month following enrollment, or first of birthday month 3. Special Enrollment Period (SEP) • Enroll or switch plans due to special circumstances • Effective date: generally, first of the month following enrollment

31. Ready to Enroll? Next Steps • Meet with an Authorized Agent • Review the Summary of Benefits • Complete the Enrollment Application

32. The Disenrollment Period January 1 to February 14: If you would like to change your Medicare coverage, you may choose to disenroll from your Medicare Part D prescription drug plan. During this period, you cannotdo the following: • Switch from Original Medicare to a Medicare Advantage Plan • Switch from one Medicare Advantage Plan to another • Switch from one Medicare Prescription Drug Plan to another • Join, switch, or drop a Medicare Medical Savings Account Plan

34. Resources Medicare • Phone: 1-800-MEDICARE (1-800-633-4227) • TTY1-877-486-2048 • 24 hours a day / 7 days a week • Web: http://www.medicare.gov Social Security • Phone 1-800-772-1213 • TTY 1-800-325-0778 • Between 7 a.m. and 7 p.m., Monday – Friday • Web: www.ssa.gov

35. Prescription drug plan provided by Blue Cross and Blue Shield of Oklahoma, which refers to HCSC Insurance Services Company (HISC), an independent licensee of the Blue Cross and Blue Shield Association. A Medicare-approved Part D sponsor. Enrollment in HISC’s plan depends on contract renewal.