getting started with your uc medicare plan...rebecca preza ucsb health care facilitator program...
TRANSCRIPT
![Page 1: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/1.jpg)
Rebecca PrezaUCSB Health Care Facilitator Program
893-4201 or [email protected]
New to Medicare
Getting started with your
UC Medicare Plan
![Page 2: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/2.jpg)
This presentation is intended for communication purposes only.
Please see plan documents and http://ucnet.universityofcalifornia.edu
for complete information.
2
![Page 3: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/3.jpg)
RASC – Retirement Administration Services Center
UC retiree health plans
UC pension and survivor benefits
1-800-888-8267
http://ucal.us/askrasc
HICAP - Health Insurance Counseling and Advocacy Program
Medicare information and assistance
1-800-434-0222
Resources
3
![Page 4: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/4.jpg)
UCNet http://ucnet.universityofcalifornia.edu
Webinars, plan information and rates
Social Security http://www.ssa.gov
Apply for Medicare Benefits
Medicare http://www.medicare.gov
Original Medicare coverage and publications
“Your Medicare Benefits” booklet
Web Resources
4
![Page 5: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/5.jpg)
Introduction to Medicare
How UC Medical Plans Work
Cost of Care
Prescription Drugs
Behavioral Health
UC Medical Premiums
Medicare Enrollment Process
Topics – 2018 Plan Year
5
![Page 6: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/6.jpg)
UC requires all retirees and family members to enroll in Medicare, if eligible.
“Coordinating” your UC medical plan with Medicare helps sustain the retiree health program
*Exception*If you live outside the USA, you are not required to enroll in Medicare
UC Retiree Health & Medicare
6
![Page 7: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/7.jpg)
1. Apply for Medicare Parts A and B
2. Complete and return the enrollment form that RASC mails to your home
3. Show physician your new Medicare and UC medical ID card at your next visit
It’s easy as 1-2-3
7
![Page 8: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/8.jpg)
Original Medicare
Foundation for UC Medicare Plans
Introduction to
Medicare
![Page 9: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/9.jpg)
Federal program that provides medical insurance to:
People over 65
People with disabilities
Specific medical conditions
Covers most medical services
Does not pay total cost of care
Foundation for all UC Medicare plans
What is Medicare?
9
![Page 10: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/10.jpg)
Medicare Cards- Old vs. New
10
“Old” Card
“New” Card
(Coming April 2018)
![Page 11: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/11.jpg)
You may be eligible based on:
Your own work history
Work history of your spouse
Contact Social Security if you havequestions about eligibility or to enroll.
Who is eligible for Medicare?
11
![Page 12: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/12.jpg)
Medicare starts on the 1st of the month in which you turn 65, for most.
**If your birthday lands on the 1st of the month then Medicare starts the 1st of the prior month**
When does Medicare start?
12
![Page 13: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/13.jpg)
Doctors
Lab tests
Physical therapy
Preventive care
In-patient hospital
Home health care
Skilled nursing facility
Hospice care
Three Parts of Medicare
13
Part B - MedicalPart A - Hospital
![Page 14: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/14.jpg)
Three Parts of Medicare
14
Part D - Prescription Drugs
UC bundles Part D coverage with the UC medical plan
![Page 15: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/15.jpg)
Physician “accepts assignment”
Certified with Medicare
Will accept the Medicare rate for services
Physician does not “accept assignment”
Certified with Medicare
May charge up to 15% more than the Medicare rate for services – YOU pay additional charge
Physician does not take Medicare
Not certified with Medicare
Medicare and UC plans will not pay for “Medicare Covered” services
3 Types of Medicare Providers
15
![Page 16: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/16.jpg)
Medicare &
Medical Insurance
Medically Necessary Care
Long Term Care
Insurance
Activities of Daily Living
Skilled Nursing Facility
Home Health Care
Physical Therapy
Bathing
Dressing
Eating
Personal HygieneWalking
Cooking
Housekeeping
Medical vs Long Term Care
16
![Page 17: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/17.jpg)
Original Medicare Costs
17
![Page 18: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/18.jpg)
Part A – Hospital
No Monthly Premium
$1,316 Deductible per spell of illness
Graduated cost for stays over 60 days
Part B – Medical
$134 Monthly Premium (for most)
Deducted from Social Security check or you pay
20% coinsurance for most services
Part D – Drugs
No additional cost with UC medical plans (for most)
2018 Medicare Costs
18
![Page 19: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/19.jpg)
Medicare Part B and D premiums may be higher for retirees with incomes over:
$85,000 – single
$170,000 – married
“Medicare Premiums: Rules For Higher-Income Beneficiaries” on SSA.gov
Income Related Adjustment
19
![Page 20: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/20.jpg)
Transition to UC Medicare Plan
20
![Page 21: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/21.jpg)
Your UC Medicare plan IS your supplement plan
UC also provides a Part D drug plan
“Medicare doesn’t cover everything”
21
Do you need a Medicare supplement or drug plan?
You don’t need to purchase an individual Medicare supplement or drug plan
unless you want to suspend your UC coverage
![Page 22: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/22.jpg)
Medicare & UC work together
22
Medicare and UC plan pay most of your medical expenses
Medicare A, B & D UC Medicare Plans
![Page 23: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/23.jpg)
Transfer to UC Medicare Plan
23
Non-Medicare Plan UC Medicare Plan
Health Net Blue & Gold Health Net Seniority Plus
Kaiser Kaiser Senior Advantage
UC Care PPO Medicare PPO
Core Medicare PPO
Health Savings Plan Medicare PPO
All medical plans have a Medicare version
![Page 24: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/24.jpg)
When may I change to a
different UC Medicare plan?
24
![Page 25: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/25.jpg)
Non-Medicare retiree or family remain in your current medical plan (except HSP)
Medicare eligible retiree or family enroll in Medicare & UC Medicare plan
What happens to my family when
I enroll in Medicare?
25
![Page 26: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/26.jpg)
When a family has both
non-Medicare & Medicare members
Split Families – Partner Plans
26
Non-Medicare Members Medicare Members
Health Net Blue & Gold Health Net Seniority Plus
Kaiser Kaiser Senior Advantage
UC Care PPO Medicare PPO
Core Medicare PPO
UC Health Savings Plan is not available to split families
![Page 27: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/27.jpg)
How UC Medicare Plans Work
![Page 28: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/28.jpg)
Medicare plans may have different:
Plan benefits Costs Service areas Medical providers Behavioral Health providers Enrollment/de-enrollment process
UC Medicare Plans
28
![Page 29: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/29.jpg)
“Coordination” with Medicare
29
HMO Advantage
Health Net Seniority Plus
Kaiser Senior Advantage
You assign your Medicare to the insurance plan
Cannot use Medicare outside the plan
Medicare Supplements
Medicare PPO
Medicare PPO w/o Rx
High Option
Medicare is primary payer
Anthem is secondary
![Page 30: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/30.jpg)
Choice of Physician
30
HMO Advantage
Health Net Seniority Plus
Kaiser Senior Advantage
You select PCP
PCP coordinates care
PCP refers to specialists
Specialists limited to medical group
![Page 31: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/31.jpg)
Sansum & Jackson are only groups in SB area
If your PCP is with Santa Barbara Select IPA:
Change to a Sansum or Jackson primary care physician
Change to Medicare PPO
No HNSP in Santa Maria
Change to Medicare PPO
No HNSP in Ventura County
Change to Medicare PPO or Kaiser
Health Net Seniority Plus
Service Area Limitations
31
![Page 32: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/32.jpg)
Choice of Physician
32
Medicare Supplements
Medicare PPO
Medicare PPO w/o Rx
High Option
Medicare providers for Medicare services
Anthem or
non-Anthem
providers for “additional services”
![Page 33: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/33.jpg)
Cost of Medical Care
![Page 34: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/34.jpg)
HMOs have copays for care
34
Service Copay
Deductible $0
Office Visit $20
Urgent Care $20
Emergency Room $65
Outpatient Surgical Center $100
Inpatient Hospital $250
Health Net Seniority PlusKaiser Senior Advantage
![Page 35: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/35.jpg)
Vision with Health Net
35
Health Net Seniority Plus
Vision benefit similar to VSP
Routine exam by medical group
Eyewear by EyeMed providers
No additional monthly premium
![Page 36: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/36.jpg)
Medicare PPO and High Option have:
Deductibles
What you pay for services before the plan pays
Coinsurance
Your share of the cost for services
You pay a % of services
Anthem Plan Costs
36
![Page 37: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/37.jpg)
Anthem pays:
Medicare Part A & B deductibles
Medicare PPO – you pay:
$100 Plan deductible/year for “additional services”not covered by Medicare
High Option – you pay:
$50 Plan deductible/year for “additional services” not covered by Medicare
Deductibles
37
![Page 38: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/38.jpg)
Services NOT covered by Medicare, but covered by UC plans
Acupuncture
Behavioral health care with non-Medicare clinicians
Hearing aids
Services in foreign countries
You pay:
Annual plan deductible
20% of allowed costs
Additional Anthem Services
38
![Page 39: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/39.jpg)
Who pays?
Medicare pays 80%
Total after Medicare
Anthem pays
You pay for services
Office Visit Example
39
Medicare Allowable = $150
Medicare
PPO
$120
$30
(80%) $24
$6
High
Option
$120
$30
(100%) $30
$0
![Page 40: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/40.jpg)
Who pays?
Anthem pays
You pay for services
Hospital Example
40
Medicare
PPO
$1,316
$0
Stay of 1-60 days
Medicare Part A Deductible = $1,316
Medicare pays balance of bill
High
Option
$1,316
$0
![Page 41: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/41.jpg)
Who pays?
Anthem pays
You pay for services
Skilled Nursing Example
41
Medicare
PPO
80%$131.60/day
$32.90/day
1st to 20th day
Paid in full by Medicare
Medicare pays all but $164.50 per day
21st to 100th day
Daily rate = $164.50
High
Option
100%
$0
![Page 42: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/42.jpg)
Are you traveling out of US?
HMO Emergency & Urgent Care Copays
Medicare PPO$100 annual deductible
20% of billed amount
High Option$50 annual deductible20% of billed amount
42
![Page 43: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/43.jpg)
Medicare Summary Notice
Describes what Medicare pays
Explanation of Benefits (EOB)
Describes what the insurance plan pays
Bills & Statements
What you pay the provider
Documents!
43
![Page 44: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/44.jpg)
After you pay the following amount for medical and behavioral health expenses, the plan pays 100% of the costs for the rest of the year.
See plan document for limitations.
Medical Out-of-Pocket Maximums
44
Medicare Plan Maximum
Health Net Seniority Plus $1,500
Kaiser Senior Advantage $1,500
Medicare PPO $1,500
High Option $1,050
![Page 45: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/45.jpg)
Prescription Drugs
45
![Page 46: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/46.jpg)
Medicare Part D is bundled with all plans
Except Medicare PPO without Rx
Copays
Some formulary (drug list) changes
ID cards with Part D logo
HMO members receive 1 card
Anthem members receive 1 card
NO additional premium for Part D, for most
Prescription Drugs - Part D
46
![Page 47: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/47.jpg)
Health Net
Kaiser*
Medicare PPO
High Option
Retail (30 day)• Generic• Brand• Non-formulary
$5$25
$40*
$10$30$45
Mail Order (90 day) • Generic• Brand• Non-formulary
*See plan documents for Kaiser
$10$50
$80*
$20$60$90
Prescription Drug Copays
47
![Page 48: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/48.jpg)
After you pay the following amount for prescriptions drugs, the plan pays 100% of the costs for the rest of the year.
See plan document for limitations.
Prescription Drug Maximums
48
Medicare Plan Rx Maximum
Health Net Seniority Plus $2,000
Kaiser Senior Advantage $5,000
Medicare PPO $5,000
High Option $5,000
![Page 49: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/49.jpg)
Medicare allows only 1 Part D drug plan
You may keep or enroll in a non-UC Part D plan and the Medicare PPO without Rx plan
The non-UC drug plan must have “creditable coverage” - pays on average as much as the standard Medicare drug plan
Medicare PPO without Rx
49
Do you have another retiree or individual Part D drug plan?
![Page 50: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/50.jpg)
Retirees with graduated eligibility may want to consider this plan
Ask about this option during Open Enrollment
Medicare PPO without Rx
50
Do you have less than ??? years of UCRP service credit?
![Page 51: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/51.jpg)
Behavioral Health
51
All medical plans cover mental health care and substance abuse treatment
Coverage and provider networks differ
![Page 52: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/52.jpg)
Medicare – Behavioral Health
52
Medicare Plan Behavioral Health Plan
Health Net Seniority Plus MHN with Medicare
Kaiser Senior Advantage Kaiser
Medicare PPOMedicare
Anthem or Non-Medicare
High Option Medicare
Anthem or Non-Medicare
Medicare plans have different clinicians
![Page 53: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/53.jpg)
Behavioral Health Costs
53
Medicare Plan Copays
Health Net Seniority Plus $20 for individual visit$10 for group visit
$250 inpatient hospitalizationKaiser Senior Advantage
Notify your behavioral health plan prior to your first visit
![Page 54: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/54.jpg)
Behavioral Health Costs
Medicare Plan Medicare Clinician
Non-MedicareClinician
Medicare PPOYou pay 20% of balance after
Medicare
After deductible,You pay 20%
High Option You pay zeroAfter deductible,
You pay 20%
54
![Page 55: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/55.jpg)
UC Medical Premiums
55
![Page 56: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/56.jpg)
Each year UC determines the maximum contribution paid toward a retiree’s medical and dental insurance
Some retirees receive the maximum UC contribution
Some retirees have graduated eligibility
and receive a % of the maximum amount
(If hired after 1/1/1990 with less than 20 years of UCRP service credit)
Maximum UC Contribution
56
![Page 57: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/57.jpg)
Premiums change when you or a family member enroll in Medicare
Maximum UC Contribution – find premiums on UCnet rate chart
Contact Retirement Administration Service Center (RASC)- 1-800-888-8267
Where do I find rates?
57
![Page 58: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/58.jpg)
1. All family members in Medicare
2. One or more are not in Medicare
3. Non-Medicare Plans
All family members under 65
4. Non-Medicare Age 65 and Over
UC Retiree did not coordinate with Social Security when employed
No one in family eligible for Medicare
Rates are same as employees in category 2
Rate Chart - Maximum UC Contribution
58
![Page 59: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/59.jpg)
Medicare Part B Reimbursement
59
If Your Premium is zero, you may receive a full or partial "reimbursement" of your Medicare Part B premium.
![Page 60: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/60.jpg)
Medicare Part B
$134 – standard rate in 2017
Deducted from Social Security check or you pay directly
UC Medical
Deducted from UC pension check
Part B Reimbursement added to check
Your Monthly Premiums
60
![Page 61: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/61.jpg)
61
![Page 62: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/62.jpg)
Are you moving?
62
Available in US UC Care Core Health Savings Plan Medicare PPO High Option
Must live in
CA Service Area
Health Net
Kaiser
![Page 63: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/63.jpg)
Are you moving out of US?
63
Available when LIVING out of US UC Care Core
![Page 64: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/64.jpg)
Living out of California in US
ALL family members in Medicare
UC makes annual $3000 contribution to Health Reimbursement Account (HRA) for each member
UC contribution is subject to graduated eligibility
Use HRA money to purchase individual Medicare supplement plan & Part D through OneExchange
Use excess HRA money to pay medical expenses and Part B premium
Unused HRA money will roll over to next year
OneExchange – Out of CA
64
![Page 65: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/65.jpg)
UC Retiree Insurance Program will notify you in August if you are required to transfer from the UC medical plan to a local Medicare plan
You will be directed to call a OneExchangecounselor for information about plan options and assistance enrolling
You will select from Medicare Supplement plans and Part D (Drug) plans that are available where you are living
OneExchange – Enrollment
65
![Page 66: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/66.jpg)
1) Enroll in Medicare
2) Complete UC forms
Enrolling in Medicare
![Page 67: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/67.jpg)
Three months before you or a family member turns 65, RASC will mail the retiree:
Written notice to apply for Medicare with Social Security
UC enrollment form to transition to the Medicare version of your UC medical plan
Mailing from RASC
67
![Page 68: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/68.jpg)
UC retiree or family member, turning 65 and….
Receiving Social Security pension now
NOT yet receiving Social Security pension
How to enroll in Medicare
68
![Page 69: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/69.jpg)
You are automatically enrolled by SSA.
Social Security will send you a Medicare card in the mail a few months before you turn 65.
The card should have “effective dates” for Medicare Parts A & B.
Receiving Social Security Now
69
![Page 70: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/70.jpg)
About three months before you turn 65
Go to local Social Security office
OR enroll on http://www.ssa.gov/
Apply for Medicare Parts A & B
If NOT eligible for Medicare request a denial letter from Social Security
NOT receiving Social Security
70
![Page 71: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/71.jpg)
Once you have your Medicare card or confirmation of enrollment
Complete the form you received from RASC
Fax or mail the form to UC by two months prior to your Medicare effective date
Call RASC if your Medicare or UC forms are delayed: 800-888-8267
UC Enrollment Forms
71
![Page 72: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/72.jpg)
Medicare Enrollment Timeline
72
JAN FEB MAR APR MAY JUN JUL
If no response,
penalty deducted
from pension check
RASC sends
letter & formsRASC sends
letter & calls
$419 $419 $419
65th Birthday Medical
benefits
terminated
![Page 73: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/73.jpg)
RASC will transfer your enrollment to the Medicare version of your medical plan
Insurance will enroll you in a Medicare Part D (drug) plan
Insurance will send you new ID cards
RASC & Insurance
73
![Page 74: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/74.jpg)
Enrolling in Medicare Plan
74
RASC sendsyou
UC form
You apply for
Medicare A & B
with SSA
SSA confirms
enrollment
You send
UC form to RASC
RASC & Insurance
update your plan
Insurance enrolls you
in Part D
Insurance sends you
new ID card
You inform
providers of
new plan
![Page 75: Getting started with your UC Medicare Plan...Rebecca Preza UCSB Health Care Facilitator Program 893-4201 or Rebecca.preza@hr.ucsb.edu New to Medicare Getting started with your UC Medicare](https://reader033.vdocuments.mx/reader033/viewer/2022042206/5ea8d8a0737115056d089c6a/html5/thumbnails/75.jpg)
75