passing the baton: transitioning to retiree health benefits presented by susan jones
TRANSCRIPT
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Passing the Baton: Transitioning to Retiree Health Benefits
Presented bySusan Jones
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For discussion…
• Eligibility• Plan Choices• Program Provisions• Medicare
– Overview– Enrollment– Coordination with the State Program– Prescription Drug Coverage
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Eligibility
• Must be a retiring state employee receiving an immediate (not deferred) VRS retirement benefit or periodic benefit from an ORP
• Must have been eligible for state coverage as an active employee at the time of retirement (not Extended Coverage)
• Must enroll within 31 days of retirement date
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… and Not Eligible
• Coverage is declined at retirement (except waiver)
• Enrollment is not completed within 31 days of retirement
• Retirement benefit is deferred• Coverage is cancelled
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Coverage Begins…
The first day of the first full month of retirement
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Eligible Dependents
Same as active employees
• Legal spouse• Children
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Plan Choices
• Non-Medicare Plans
• Medicare Plans
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Current Non-Medicare Plans
• COVA Care/COVA Connect• COVA Care/COVA Connect with optional
benefits– Out-of-Network– Expanded Dental– Out-of-Network and Expanded Dental– Vision, Hearing and Expanded Dental– Out-of-Network, Vision, Hearing and Expanded Dental
• Regional Plan – Kaiser Permanente• COVA HDHP• TRICARE Supplement
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Non-Medicare Retiree Group
2628
431
949
383
1930
1780
92
53 23733
COVA Care/Connect Basic - 2,628
CC w/Out of Network - 431
CC w/Expanded Dental - 949
CC w/Out of Net/Exp Dental - 383
CC w/Vision/Hearing/Exp Dental - 1,930
CC w/Out Net/Vision/Hearing/Exp Dental - 1,780
COVA HDHP - 92
Kaiser - 53
TRICARE Supplement - 23
Waived - 733
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Medicare Supplemental Plan Options
• Advantage 65• Advantage 65 with
Dental/Vision• Advantage 65
Medical Only• Advantage 65
Medical Only with Dental/Vision
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Medicare Retiree Group
5,999
18,971
922
1,979
1,803
3,120Advantage 65 - 5,999
Advantage 65 w/DV - 18,971
Advantage 65 Med Only - 922
Advantage 65 Med Only w/DV - 1,979
Option 1 - 1,803
Option 2 - 3,120
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Changes Allowed at Retirement
• Enroll from active waive into single coverage
• Decrease membership• Waive to active/retiree
coverage as dependent (and return in the future per plan provisions)
• Plan change• Decline/cancel coverage –
no return to program
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NOT Allowed at Retirement
• Increase in membership
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Allowable Changes After Retirement
• Changes Consistent with Qualifying Midyear Events
• Membership Reduction (prospective)
• Cancellation (prospective )• Open Enrollment (non-
Medicare only)• Certain Medicare-
Coordinating Plan Changes (prospective)
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Required Change
To a Medicare-coordinating plan immediately upon Medicare eligibility
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NOTE: Active Employees
If covered based on current employment, Part B can be declined without penalty (no break in creditable coverage for 63 or more days)
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Medicare 101
• What is it?• How do I get
it?• What do I
need?• How much
does it cost?
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What is it?Medicare Eligibility
• At age 65• Before age 65
–Disability–End Stage
Renal Disease
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What is it?Original Medicare Plan
• Medicare Part A – Hospital Insurance– Inpatient care– Skilled nursing facility– Hospice
• Medicare Part B – Medical Insurance– Doctors’ services– Preventive care
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What is it?Medicare Part D
• Outpatient Prescription Drug Coverage
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What is it?Medicare Part C
NOT ORIGINAL MEDICARE• Medicare Advantage
Plans• Medicare PPO Plans• Medicare HMO Plans• Medicare Private Fee-
for-Service Plans• Medicare Special Needs
Plans
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How do I get it?Enrollment – A, B
• If no SSA/RRB benefits, you must actively enroll in A and B
• Automatic enrollment if you are already getting SSA/RRB benefits
• Declining Part B– Special Enrollment Period– General Enrollment Period– Late Enrollment Penalty
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How do I get it?Enrollment – D
• Initial Enrollment• Special Enrollment• Annual
Coordinated Election Period
• Late Enrollment Penalty
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What do I need?To Summarize:
• You must have Medicare Parts A and B (Original Medicare)when your retirement begins if you enroll in the State Retiree Health Benefits Program to avoid a gap in coverage!
• You can get Part D through or outside of the state program.
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How much does it cost?Cost for Medicare Only
• Part A – usually no cost
• Part B - $99.90 for 2012 (unless IRMA)
• Part D – cost based on elected plan ($38 average premium—IRMA/LIS)
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The State Program
How does the State Retiree Health Benefits Program work with Medicare?
•Plan Provisions•Premium Cost
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How Does Advantage 65 Work?
2012 Medicare Benefit
A65 Benefit
Hospital Inpatient (Part A)
You pay Deductible/Copay$1,156, $289, $578
A65 pays all but $100+Additional AC for 365 Days
Physician and Other Services (Part B)
Generally, 80% coverage
Pays 20% after $140 deductible
Outpatient Prescription Drug (Part D)
Based on chosen plan Can elect enhanced Med D benefit with A65
Routine Dental Not covered Optional
Routine Vision Not covered Optional
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Enhanced Part D Provisions
• Formulary– Exceptions/appeals
• Tiers• Excluded Drugs• Coverage Stages
– Deductible– Initial– Coverage Gap/Medicare
Coverage Gap Discount Program
– Catastrophic
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Medicare Must Approve Part D:
• Enrollment• Disenrollment
–Only one plan• Penalties
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Premium Cost
• Retiree pays the full cost of coverage
• Health Insurance Credit (VRS) if eligible
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How is Premium Paid?
• VRS Benefit Deduction
• Direct Bill– Automatic Bank
Draft– Online payments
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July 2012 through June 2013Plan Single Two-Person Family
CC/CC Basic $491 $909 $1,328
CC/CC + Out of Network $503 $925 $1,351
CC/CC +Exp Dental $506 $939 $1,373
CC/CC + Vision/Hrg/ED $519 $961 $1,402
CC/CC + OON/Exp Dental $518 $955 $1,395
CC/CC + OON/VH/ED $531 $977 $1,424
COVA HDHP $392 $727 $1,062
Kaiser Regional HMO $516 $951 $1,386
Tricare Supplement $60 $119 $160
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2013 Premium Cost
Advantage 65 $237
Advantage 65 with Dental/Vision
$271
Advantage 65 – Medical Only $139
Advantage 65 – Medical Only with Dental/Vision
$173
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Your Decision at Retirement…
• Is the state program the best choice for me?
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Resourceswww.dhrm.virginia.gov
– Retiree Fact Sheets
www.medicare.gov– 800-MEDICARE
www.ssa.gov– 800-772-1213
Medicare COB– 800-999-1118
VICAP– 800-552-3402
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Questions
Thank you!