Typically, you are eligible for Original Medicare if you or your spouse worked for at least ten years in Medicare-covered employment, you are 65 years or older, and a citizen or permanent resident of the United States. Certain applicants under 65 may be eligible if they have a disability or End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant).

You are eligible for Medicare Part A at age 65 if:

• You are eligible or already receive retirement benefits from Social Security or the Railroad Retirement Board.
• You or your spouse had Medicare-covered government employment.

If you are under 65, you can get Part A without having to pay premiums if:

• You have received Social Security or Railroad Retirement Board disability benefits for 24 months.
• You have end-stage renal disease and meet certain requirements.

Although you are exempt from paying premiums for Part A if you meet one of these conditions, you must pay for Part B if you want to receive its benefits. This payment is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not receive any of the above payments, Medicare sends you a bill for your Part B payment every three months.

Note: You will be eligible for Medicare when you turn 65 even if you are not eligible for Social Security retirement benefits.

Health Net's Responsibilities
Upon your (member) disenrollment from the plan, Health Net must:

• Provide you with an acknowledgement and confirmation of disenrollment notice.
• Provide you with a denial of or rejection by CMS of disenrollment, if applicable.
• Inform you about Medigap rights during a special enrollment period.
• Provide advance notice in the event you are involuntarily disenrolled and explain reasons for disenrollment.
• Provide advance notice in the event your enrollment in a Group Medicare Advantage plan is ending.

Member Responsibilities

• You must make a written request for disenrollment prior to the 1st of the month in which disenrollment is intended.
• You can only disenroll during qualifying election periods such as the Annual Election Period (October 15 - December 7), or if you qualify for a Special Election period (SEP). The Medicare Advantage Disenrollment Period (MADP), from January 1 to February 14th allows you to return to Original Medicare. You would then be eligible for a SEP and may request enrollment in a PDP.

Member Notifications

• You will be advised that upon disenrollment from Medicare Advantage with a Part D plan, that unless you obtain another Part D plan, or otherwise elect another type of creditable prescription drug coverage, that you may be subject to a Late Enrollment Penalty should a lapse in coverage occur for 63 or more days.
• You will be reminded that if you do not enroll in another Medicare Advantage Plan or Medicare Advantage Plan with Prescription Drug coverage, that you will be enrolled in Original Medicare.

Medicare Advantage Eligibility Requirements
Anyone entitled to Medicare Part A and enrolled in Part B may apply for Health Net's Medicare Advantage (MA) plans. Medicare beneficiaries can only enroll in these plans during certain times of the year and must continue to pay their Medicare Part B premiums. Applicants must also reside in the plan's service area.

Beneficiaries enrolled in an MA Plan may not enroll in a PDP, unless they are a member of a Private Fee-for-Service MA Plan (PFFS) that does not provide Medicare prescription drug coverage, a Medical Savings Account MA Plan (MSA), or an 1876 Cost Plan.

Contract Renewal and Termination Procedures
All Medicare Advantage Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

Need More Information?
The benefits described on the Health Net website are only a summary for informational purposes. It is not a contract. The actual complete terms and conditions of the health plan can be found in the Evidence of Coverage (EOC) document.

For full information on a specific plan's benefits, including information on premium withhold or direct bill options, other exclusions, limitations, or restrictions to services not already identified in this section, and how to obtain this material in an alternate format, please Contact Us.

Medicare Advantage Eligibility Requirements
Anyone entitled to Medicare Part A and enrolled in Part B may apply for Health Net's Medicare Advantage (MA) plans. Medicare beneficiaries can only enroll in these plans during certain times of the year and must continue to pay their Medicare Part B premiums. Applicants must also reside in the plan's service area.

The Medicare prescription drug benefit is only available to members who are enrolled in a
Health Net Medicare Advantage with Part D (MA-PD) plan. Eligible Medicare beneficiaries enrolled in Health Net's MA-PD plans must use network pharmacies to receive their pharmacy benefits (except under non-routine circumstances when you cannot reasonably use network pharmacies).

Beneficiaries who are already enrolled in a Health Net MA-PD plan must receive their Medicare prescription drug benefits through that plan and can only be enrolled in one MA-PD plan at a time. Beneficiaries enrolled in an MA Plan may not enroll in a PDP, unless they are a member of a Private Fee-for-Service MA Plan (PFFS) that does not provide Medicare prescription drug coverage, or an 1876 Cost Plan.

Important Part D Information
Medicare offers prescription drug coverage (Part D) to everyone with Medicare. However, Medicare Part D does not operate the same as Parts A and B, as it is not available from the government. To get Medicare prescription drug coverage, you must join a plan run by a Medicare-approved private insurance company, like Health Net.

This benefit is available to you in one of two ways: either combined with medical coverage in a Medicare Advantage Prescription Drug (MA-PD) Plan, or as a standalone Medicare Prescription Drug Plan (PDP), which adds drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, Medicare Medical Savings Account (MSA) Plans, and Medigap (also called "Medicare Supplement Insurance") policies.

To get coverage, start by choosing a health insurance company. Each company's plans will vary, so choose a plan that works best for you.

Low Income Subsidy (LIS) Inquiries
People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify won't have a coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a portion of this premium, we will bill you for the amount that Medicare doesn't cover.

Contract Renewal and Termination Procedures
All Medicare Advantage Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

Need More Information?
The benefits described on the Health Net website are only a summary for informational purposes. It is not a contract. The actual complete terms and conditions of the health plan can be found in the Evidence of Coverage (EOC) document.

For full information on a specific plan's benefits, including information on premium withhold or direct bill options, other exclusions, limitations, or restrictions to services not already identified in this section, and how to obtain this material in an alternate format, please Contact Us.

HMO Plans
In-network providers are those providers who are contracted with Health Net. Out-of-network providers are those who do not have a contract with Health Net and who accept Medicare. Members enrolled in Health Net Medicare Advantage (MA) HMO plans must receive all routine care from in-network plan providers, except in emergency or urgent care situations or for out-of-area renal dialysis. If Health Net MA HMO members obtain routine care from out-of-network plan providers, neither Medicare nor Health Net will be responsible for the costs. In most cases, you will need to be referred by your primary care physician to receive services from a specialist. If you do not have a referral before you receive services from a specialist, you may have to pay for these services yourself.

PPO Plans
In-network providers are those providers who are contracted with Health Net. Out-of-network providers are those who do not have a contract with Health Net and who accept Medicare. Members enrolled in Health Net MA Preferred Provider Organization (PPO) plans can receive care from out-of-network providers. Receiving care from an out-of-network provider may cost more than receiving care from Health Net's in-network providers, except in emergency or urgent care situations. Health Net will reimburse PPO plan members for mandatory supplemental services received in or out-of-network as long as the services are medically necessary. PPO members do not need a referral if they are going to see an out-of network provider. Again, member copayments for covered services may be more if obtaining services from out of-network providers.

Out-of-network/non-contracted providers are under no obligation to treat members, except in emergency situations. For decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please contact us or see the Evidence of Coverage for more information, including cost-sharing that applies to out-of-network services.

The types of pharmacies that are part of the Health Net network include Retail, Mail Order, Specialty, Home Infusion, Long-Term Care (LTC) and Indian Health Service/Tribal/Urban Indian Health Program (I/T/U). To obtain additional network pharmacy information, please Contact Us.

As our friends and relatives grow older, they may need assistance with some of their health care decisions. Health Net recognizes that you may not be familiar with the basics of Medicare and other types of senior services.

Medicare is health insurance for individuals who are 65 and older, or individuals who are under 65 with certain disabilities. It is also available to any age individuals with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant). Individuals turning 65 will automatically become enrolled in the Medicare program if they are already receiving Social Security benefits.

As a caregiver, it is important to know what kind of health coverage your charge currently has. If they have standard Medicare, you should know if they have Part A (hospital), Part B (medical), or Part D (prescription drug). If they have coverage through a private health plan like
Health Net, you should know what type of plan they have, like Medicare Advantage (like HMO or PPO) or a Prescription Drug Plan.

If the member is unsure, this information can be found on their Medicare card, which is mailed out three months prior to their 65th birthday. If the Medicare card is not available for you to review, call the local Medicare office or ask the member to complete an authorization form that will allow you access to their personal Medicare information. To request a form from the Medicare office, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. If the person you are caring for does not have Medicare, you should find out when they will be eligible to enroll in the program.

For more details about being a caregiver and Medicare, visit the official Medicare website.

Medicare & You
The official Medicare handbook for Medicare programs is updated every year. Download your free copy at the Medicare website or call the Medicare helpline to request a mailed copy. For online tools relating to drug plans, Medicare Advantage, and Medigap, go to www.medicare.gov .

Social Security Administration
The toll-free Social Security helpline can answer your questions regarding eligibility and enrolling in Medicare or Social Security benefits, disability benefits, and the cost of Medicare coverage. Call 1-800-772-1213, TTY 1-800-325-0778 or go to www.ssa.gov.

Administration on Aging
For help in finding local, state, and community-based organizations that serve older adults and their caretakers in your area, call 1-800-677-1116 or go to www.eldercare.gov.