2012 Premiums and Select Cost Sharing

You must continue to pay your Medicare Part B premium. The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. For more information contact the plan. Limitations, copayments, and restrictions may apply. 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 (1800-633-4227). 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 Your Medicaid Office.

1) Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. Individuals must have both Part A and Part B to enroll. Members may enroll in the plan only during specific times of the year. For more information contact the plan. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor CareMore will be responsible for the costs.

2) Members must use network pharmacies to access prescription drug benefits, except under non-routine circumstances, quantity limitations and restrictions may apply.

3) CareMore Reliance / Diabetes (HMO SNP) is a Coordinated Care plan with a Medicare Advantage contract. Contracts offered in California, Nevada and Arizona. This plan is available to anyone who has chronic Diabetes Mellitus. Eligible beneficiaries can enroll at any time.

4) CareMore Breathe (HMO SNP) is a Coordinated Care plan with a Medicare Advantage contract. Contracts offered in California, Nevada and Arizona. This plan is available to those who have been diagnosed with a Chronic Lung Disease. Eligible beneficiaries can enroll at any time.

5) CareMore Heart (HMO SNP) is a Coordinated Care plan with a Medicare Advantage contract. Contracts offered in California, Nevada and Arizona. This plan is available to anyone who has been diagnosed with cardiovascular disease or chronic heart failure. Eligible beneficiaries can enroll at any time.

6) CareMore ESRD (HMO SNP) is a Coordinated Care plan with a Medicare Advantage contract. Contracts offered in California. This plan is available to anyone who has been diagnosed with End-Stage Renal Disease requiring dialysis. Eligible beneficiaries can enroll at any time.

7) CareMore Connect (HMO SNP) is Coordinated Care plan with a Medicare Advantage contract but without a contract with the California Medicaid program. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You may qualify for assistance with lower co-pays, premiums, deductibles, and/or coinsurance. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help that beneficiaries may receive. Contact CareMore for further details. Eligible beneficiaries can enroll at any time.

8) CareMore Touch (HMO SNP) is a is a Coordinated Care plan with a Medicare Advantage contract. Contracts offered in California, Nevada and Arizona. This plan is available to Medicare Beneficiaries residing in a contracted Long Term Care Facility or those reside in the community and require the same level of care as some one in a nursing home. Eligible beneficiaries can enroll at any time.