Medicare & You

For city of Phoenix Retirees Presented by city of Phoenix Personnel Department Benefits Office

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Introduction

 Presenters  Kathy Bird, Benefits Analyst II  Carol Dodd, Benefits Analyst II  Topics  All the Medicare Parts (A, B, C & D)  How Medicare works with the city’s retiree coverage

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Purpose and Goals

 Basic information about Medicare  How the city’s retiree coverage works with Medicare.

 Representatives from CIGNA and BlueCross/BlueShield available after the meeting.

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Medicare & You

 You are eligible for Medicare on the 1 st the month in which you are turning 65.

day of

Example:

65 th Birthday – March 23, 2010 Medicare eligible - March 1, 2010

 You are also eligible for Medicare if you have qualified for Social Security Disability Income (SSDI) for the previous two years. Medicare enrollment is automatic when disabled.

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Medicare Part A

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Your Choices at 65

Basic Medicare

Part A Part B Part D

Medicare Part C

Part A Part B Part D + additional coverage

City Retiree Medical Coverage

Part A Part B + coverage comparable to active employee coverage

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Medicare Part A

Helps cover inpatient care in a hospital

 You’re automatically enrolled at age 65  $1,068 annual deductible (increases to $1,100 in 2010)  Can be co-insurance  Also covers skilled nursing care, hospice, and home health care, to a point, if eligible  Skilled Nursing facility limited to 20 days

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Medicare Part B

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Medicare Part B

Helps pay for outpatient medical care

 A monthly premium

($96.40 in 2009; $110.50 in 2010)

and an annual deductible are required.

 80% of the Medicare approved amount is covered  If a physician or hospital does not accept Medicare, you are also liable for the charges above the Medicare approved amount (to a limit). These are called “excess charges.”  Does not cover most preventive care, vision or hearing expenses.

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Medicare Part B:

Do I have to enroll?



YES!

Whether you have the city’s retiree medical coverage or you enroll in a Medicare Part C Advantage plan through private carrier, you must enroll in Medicare Part B!

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Your Medicare Card

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Medicare Part B

What if I’m eligible, but I didn’t enroll?

 If you don’t enroll during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins the following July.

However, your monthly premium increases 10% for each 12-month period you were eligible for, but did not enroll in, Part B.

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Medicare Part B

What if I’m still working at 65?

 If you are 65 or older and covered under a group health plan, you can delay enrolling in Medicare Part B without penalty. The rules allow you to:  Enroll in Medicare Part B any time while you are covered under the group health plan based on current employment; or  Enroll in Medicare Part B during the eight-month period that begins with the month your group health coverage ends, or the month employment ends—whichever comes first.

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Medicare Part C:

Private Insurance Option

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Medicare Part C

Private Insurance Option

 If you have Medicare Parts A and B, you can join a Medicare Advantage plan.

 Medicare Advantage Plans provide additional coverage and may include prescription drug coverage.

 If your Medicare Advantage Plan does not include pharmacy coverage, you need to enroll in Medicare Part D.

 Offers additional benefits such as hearing, vision and dental services, and health and wellness programs.

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Medicare Part C

Private Insurance Option

 You can enroll in a Medicare Advantage plan during their annual election period from November 15 – December 31.

 Plan designs: HMO, PPO, Private Fee For Service  Carriers: CIGNA, Humana, SecureHorizons, SCAN, Health Net, Aetna, and more.

 Sign over your Medicare benefits and (usually) pay an additional premium each month. Check each Medicare Advantage plan as some do not charge a monthly premium.

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Medicare Part C

Questions you should ask

      Is there an additional premium (above and beyond the Medicare Part B premium)?

Are referrals needed? Is there a network of providers? Are your providers included?

What is the prescription drug coverage? Are your medications covered?

What are the deductibles and co-pays?

Will the plan cover you out-of-state?

How does coverage and cost compare to the city’s retiree medical coverage?

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Medicare Part C

Use the Plan Compare Tool at www.medicare.gov

Here you can compare a variety of plan options and see who has the lowest out of pocket costs.

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Medicare Part D

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Medicare Part D

Prescription Drug Coverage

 Helps cover the cost of prescription drugs.

 May be offered on a stand-alone basis or in conjunction with a Medicare Advantage plan.

 Do not sign up for a Medicare Part D plan if you have the city’s retiree medical coverage!

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Medicare Part D

Prescription Drug Coverage Major Out-of-Pocket Costs with Medicare Part D

Annual Deductible = $310.00 25% of the next $2,830 = $707.50

100% of the next $3,610 After that: $2.50/generic, $6.30/brand or 5% whichever is greater

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Medicare Part D

Prescription Drug Coverage Rx Cost

The first $310 The next $2,830

You Pay

$310.00

$707.50

Medicare Pays

$0 $2,122.50

The next $3,610 $3,610.00

$0

Totals $4,627.50

$2,122.50

Then: $2.50/generic, $6.30/brand or 5% whichever is more

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Important Dates for Medicare



November 15 – December 31

 Annual Enrollment Period  This is when you can enroll in or change your Medicare Advantage plan and/or Medicare Part D plan.

 Changes are effective January 1

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Important Dates for Medicare



January 1 – March 31

 Open Enrollment Period  This is when you can enroll in Medicare Part B if you are a late enrollee. Coverage would begin July 1 st .

 Penalties may apply.

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Medicare and City Retiree Medical Coverage

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Medicare Part D & City Coverage

 If you want to remain in the city’s medical coverage, do NOT enroll in Medicare Part D.

 When you are enrolled in Medicare Part A and B, your prescriptions continue to be covered through CVS/Caremark.

 You can use most pharmacies such as CVS, Walgreens, Fry’s, Safeway, Wal-Mart, etc.

 Mail order available

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With City Coverage …

NO MEDICARE PART D

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Medicare & City Coverage

Costs

 Medicare Part B premium is deducted from your Social Security check.  You will see a reduction in the cost of your city retiree medical premium reflected in your pension check.

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Medicare & City Coverage

Signing up for Medicare Part B reduces your monthly premium for city medical coverage. Here’s one example: CIGNA HMO BCBS HMO BCBS PPO Single Coverage, No Medicare Part B $513.00/month $467.27/month $472.91/month Single Coverage, With Medicare Part B $438.85/month $399.32/month $404.16/month 29

Medicare & City Coverage

How does Medicare coordinate with CIGNA or BCBS?

 You receive a Medicare Summary Notice (MSN) every 3 months from Noridian.

 Retain the Medicare Summary Notices received for up to 2 years.

 Your healthcare provider also receives this notice.

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Medicare & City Coverage

 Most Medicare providers don’t charge co-pays.

 If you receive a bill from a provider, please contact CIGNA or BlueCross/BlueShield.

 Remember, there are CIGNA, BCBS and CVS/Caremark reps on-site in the Benefits Office to assist you.

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Medicare & City Coverage

 CIGNA may send out a “Request for More Information” document. They are looking for the Medicare MSN. They can set up a “crossover” for claims.

 BlueCrossBlueShield (BCBS) sets up a “crossover” for claims to transfer from Medicare to the providers.

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Medicare & City Coverage

Can I re-enroll in the city’s plan?

 Yes. If you want to re-enroll with the city at a future time, you may do so during the city’s Open Enrollment or upon loss of other group coverage or during Medicare’s Annual Enrollment Period.

 If you choose to waive and enroll in a Medicare product, this is not group coverage.

 You will need to provide proof of continuous, comparable coverage, including prescription drug coverage.

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Retiree Dental Coverage

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Announcing Retiree Dental Choice!

Dental HMO

Monthly Cost Retiree Retiree +1 Family $18.36

$33.17

$58.46

Retiree

Dental PPO

Monthly Cost $34.08

Retiree +1 Family $75.72

$110.75

The monthly cost will be deducted from your pension check each month.

Informational fliers can be picked up in the back of the room!

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General Information

 Same network of dentists as the employee Dental PPO and the employee Dental HMO plans.

 Must be enrolled for at least 12 months.

 Dental plan year will become the same as the medical plan year.

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Important Retiree Dental PPO Information

 Tier 3 coverage (i.e., crowns, bridges, dentures, root canals) requires a 12-month waiting period.

This waiting period is waived IF YOU ENROLL as of March 1, 2010.

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Important Retiree Dental Dates

 Information packets will be mailed in early January  Open Enrollment: January 11 – January 29  Coverage begins March 1, 2010

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Medicare & You

 Questions?

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