Transcript Understanding Medicare Options and Costs

State Health Plan Benefits
NC Association of Educators
March 18, 2015
Presentation Overview
• Medicare Eligible Plan Options
• 2015 Annual Enrollment Results
• Outreach Events
• Enrollment Distribution
• Aging into Medicare
• Disability
• Other Insurance/TRICARE
• Re-employment and State Health Plan
• 2016 Benefit Changes
• Transition of Services
2
State Health Plan Options for Non-Medicare Retirees
• Traditional 70/30 PPO Plan
• Enhanced 80/20 PPO Plan
• Consumer-Directed Health Plan (CDHP) with a Health
Reimbursement Account
3
State Health Plan Options for Medicare Retirees
• Humana Group Medicare Advantage (PPO) Base Plan
• Humana Group Medicare Advantage (PPO) Enhanced Plan
• UnitedHealthcare Group Medicare Advantage (PPO) Base Plan
• UnitedHealthcare Group Medicare Advantage (PPO) Enhanced Plan
• Traditional 70/30 Plan
Traditional 70/30 Plan – premium free for Medicare Primary members;
monthly premium for Medicare eligible spouses and/or dependents.
Base Plan – premium free for primary member; monthly premium for
Medicare eligible spouse and/or dependents.
Enhanced Plan – monthly premium for primary member ($33) and
Medicare eligible spouse and/or dependents
4
Medicare Primary Retiree Outreach Events
• During Sept-Oct 2014 prior to Annual Enrollment:
• 67 Medicare Primary Outreach Events were conducted in 38
counties.
• 3,419 individuals attended Outreach Events
• 53% of attendees completed a survey
• 97% were pleased that the State Health Plan has multiple choices for
Medicare primary retirees.
• 98% agreed that the information presented was helpful and easy to
understand.
• 99% agreed that the presenters were clear and knowledgeable.
• 95% agreed that the location was convenient.
• 87% heard about Annual Enrollment through the 1st mailer this year;
5% through a friend/family member; 8% through other means, such
as SHIIP or the Internet.
5
Plan Distribution Post Enrollment-Active/Non-Medicare Retirees
9,972, 3%
154,355,
42%
198,589,
55%
Traditional 70/30
Enhanced 80/20
CDHP
Subscriber counts only.
6
Plan Distribution Post Enrollment-Medicare Primary Retirees
Humana Base Plan
36,181, 27%
31,147, 23%
Humana Enhanced Plan
27,976, 21%
UHC Base
33,395, 25%
UHC Enhanced
Traditional 70/30
6,253, 4%
Traditional 70/30 results do not include dependent counts. Dependents are included
in the MAPDP results.
7
Aging Into Medicare
• Retirees aging into Medicare are automatically enrolled into
either Humana or UnitedHealthcare’s Group Medicare
Advantage Base Plan.
• 50/50 split between the two companies
• If you wish to select a different plan option other than the one
to which you are assigned, you will need to call the Eligibility
and Enrollment Support Center at 855-859-0966 or log into
ORBIT and change your plan through the eEnroll system.
• You will not be able to change plans again until the next
Annual Enrollment period.
8
Disability
• If you become eligible for Medicare due to disability, it is very
important for you to enroll in both Medicare Part A and Medicare
Part B.
• Do not overlook accepting Medicare Part B. Many people fail to
accept the offer to retroactively purchase Medicare Part B.
• State Health Plan becomes SECONDARY to Medicare as of the
Medicare eligibility date.
• Claims will be reprocessed back to Medicare eligibility date.
• The State Health Plan will reduce your claims by the amount that
would have been paid under Medicare, paying the remaining
claim amount under the terms of the health benefit plan.
• As a result, if you do not enroll in Medicare Part B, you will be
responsible for the amount that would have been paid by
Medicare Part B.
9
Medicare Advantage & Other Insurance
• Enrollment in other insurance coverage may result in
disenrollment from our group Medicare Advantage
Prescription Drug plans. If disenrollment occurs subscriber or
dependent (if applicable) would be placed automatically in the
Traditional 70/30 plan.
• Enrollment in another Part D prescription drug plan (PDP) or
Medicare Advantage plan can also cause you to be disenrolled
from your SHP plan.
• When enrolled in a MAPDP, you can not purchase a Medicare
Supplement or Medigap plan without terminating the MAPDP.
• If already enrolled in an individual Medicare Advantage or Part D
prescription drug plan, your coverage will terminate when autoenrolled unless you opt out of these Group Medicare Advantage
plans.
10
TRICARE & Other Insurance
• TRICARE® for Life (TRICARE ® + Medicare)
• TRICARE for Life beneficiaries can enroll in Medicare Advantage plans
and TRICARE will reimburse your copayments for services covered by
TRICARE . TRICARE pays secondary to the Medicare Advantage plan.
• You cannot use Medicare or Medicare Advantage in a Military Treatment
Facility, like a VA Hospital.
• TRICARE beneficiaries have a robust pharmacy benefit and typically
don’t need additional prescription drug coverage.
• If covered by another Employer Group Health Plan, it is
important to check with them before enrolling in one of these
Medicare Advantage plans.
• Federal Employee Health Benefit Plans (FEHBP)
• Other former employer retiree group health plans
11
Re-employment and State Health Plan
• General Assembly passed legislation to create a new eligibility category for
non-permanent full-time employees to comply with the Affordable Care Act
(ACA).
• Directed State Health Plan to offer a health benefit for “newly eligible” employees
that is not greater than the “bronze level” as defined under ACA.
• High Deductible Health Plan (HDHP) created which meets the bronze level
requirements.
• Employing units are responsible for determining eligibility for this plan.
• Includes non-permanent employees who work at least 30 hours per week.
• Employing units are required to cover re-hired State retirees as active
employees if they are determined to meet definition of full-time employee.
• Eligible re-hired retirees are NOT eligible for retiree health benefit coverage.
• Retiree are not required to enroll in HDHP but no longer eligible for State Health
Plan under Retirement Systems.
• State Health Plan will terminate the retiree from retiree group coverage under
Retirement Systems.
12
2016 Benefit Changes (Actives & Non-Medicare Retirees)
Consumer-Directed Health Plan
(CDHP) with HRA
• Increase premium
approximately $40 with the
opportunity to earn it down to $0
• Modify healthy activities to earn
premium credits
• Increase HRA contribution by
$100 to help offset member cost
share
• Increase out-of-pocket max by
$500
• Establish Health Engagement
Program to earn additional
contributions to HRA:
• Increase credits for PCP visits
and use of Blue Options
Designated Providers
• Engage members with
chronic conditions
• Healthy lifestyle program for
all members
Enhanced 80/20 Plan
• Increase premium
approximately $40 with the
opportunity to earn it down to
approximately $15
• Modify healthy activities to earn
premium credits
• Increase Tier 5 (non-preferred
specialty medications)
pharmacy coinsurance
maximum
Traditional 70/30 Plan
Active Employees Only
• Establish a $40 premium with
the opportunity to earn it down
to $0
• Establish healthy activity to
earn premium credit:
• Tobacco attestation
Active Employees and Retirees
• Increase member cost share
• copays, deductible,
coinsurance max, and
pharmacy out-of-pocket max
Premium amounts referenced on this slide are
estimates and requires legislation and Board approval
13
2016 Plan Design Changes (Actives & Non-Medicare Retirees)
Current CDHP
2016 CDHP
Current 2016/80/20
Current 70/30
2016 70/30
$500 Individual
$1,500 Family
$600 Individual
$1,800 Family
N/A
N/A
N/A
$1,500 Individual
$4,500 Family
$1,500 Individual
$4,500 Family
$700 Individual
$2,100 Family
$933 Individual
$2,799 Family
$1,054 Individual
$3,162 Family
N/A
N/A
$3,210 Individual
$9,630 Family
$3,793 Individual
$11,379 Family
$4,282 Individual
$12,846 Family
Out-of-Pocket (OOP)
Maximum
$3,000 Individual
$9,000 Family
$3,500 Individual
$10,500 Family
N/A
N/A
N/A
Pharmacy Out-ofPocket Maximum
Included in OOP
Included in OOP
$2,500
$2,500
$3,294
Preventive Care
$0 ACA Services
$0 ACA Services
$0 ACA Services
$35 PCP
$81 Specialist
$39 PCP
$92 Specialist
$35
$39
$70 for specialist;
$60 if you use Blue
Options Designated
specialist
$81
$92
Annual Contribution
to Health
Reimbursement
Account (HRA)
Annual Deductible
Coinsurance
Maximum
PCP Visit
15% after deductible;
$15 added to HRA if
you use PCP on ID
15% after deductible; $30 for primary doctor;
$25 added to HRA if $15 if you use PCP on
you use PCP on ID
ID card
Specialist Visit
15% after deductible; 15% after deductible;
$10 added to HRA if $20 added to HRA if
you use Blue Options you use Blue Options
Designated specialist Designated specialist
Urgent Care
15% after deductible
15% after deductible
$87
$87
$98
Chiro/PT/OT
15% after deductible
15% after deductible
Emergency Care
15% after deductible
15% after deductible
$52
$233, then 20% after
deductible
$64
$291, then 30% after
deductible
$72
$329, then 30% after
deductible
Inpatient Hospital
$233 copay, then 20%
15% after deductible; 15% after deductible;
after deductible; copay
$50 added to HRA if $200 added to HRA if
$291, then 30% after
not applied if you use
you use Blue Options you use Blue Options
deductible
Blue Options
Designated hospital Designated hospital
Designated hospital
$329, then 30% after
deductible
2016 Plan Design Pharmacy Changes
Pharmacy
Benefit
Tier 1
Tier 2
Tier 3
Tier 4
Current CDHP
2016 CDHP
15% after
deducible for in
network
benefits, 35%
after deductible
out of network
15% after
deducible for
in network
benefits, 35%
after
deductible out
of network
Tier 5
Current 80/20
2016 80/20
Current 70/30
2016 70/30
$12
$12
$12
$15
$40
$40
$40
$46
$64
$64
$64
$72
25% up to $100
25% up to $100
25% up to $100
25% up to $100
25% up to $125 25% up to $132
25% up to $125 25% up to $132
OOP
Integrated with
Medical
Integrated
with Medical
$2,500 Rx Only
$2,500 Rx Only
$2,500 Rx Only
$3,294 Rx Only
ACA Preventive
Medications
Covered 100%
Covered
100%
Covered 100%
Covered 100%
No
No
CDHP Preventive
Medications
Waive
deductible,
15%
coinsurance
only
Waive
deductible,
15%
coinsurance
only
N/A
N/A
N/A
N/A
15
2015 Transition to Aon Hewitt
• Effective June 1, 2015, services currently performed
by BenefitFocus will transition to Aon Hewitt.
• This transition will be seamless to members.
• Same phone number for support
• Access enrollment system via ORBIT
• System name will remain eEnroll
• Online enrollment will have a new look and feel for
retirees that will hopefully be easier to navigate.
Telephonic enrollment and navigational support
remains available by calling 855-859-0966.
16
2015 Outreach
• Pre-retiree/Pre-65 meetings - explains State Health Plan
Options when retiring - will be held in April and May
• Retiree Annual Enrollment Meetings – review of the
Medicare eligible plan options available to Medicare
eligible retirees – will be held in September and October.
• Annual Enrollment mailings will occur in August and
September.
• The Annual Enrollment Period for 2016 plan year will be
during the month of October 2015
• READ all mail from the State Health Plan completely.
17
Important Numbers
• ELIGIBILITY AND ENROLLMENT SUPPORT CENTER
855-859-0966
• HUMANA
800-944-9442
• UNITEDHEALTHCARE
866-747-1014
• BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and
HRA)
888-234-2416
• EXPRESS SCRIPTS (PHARMACY QUESTIONS for Active/NonMedicare Retirees)
800-336-5933
• If you have questions about Medicare enrollment, you may contact
the Seniors’ Health Insurance Information Program (SHIIP) at 855408-1212.
18
Thank You!
Questions?
www.shpnc.org
www.nctreasurer.com