New Coverage & New Choices for Medicare-eligible Retirees
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1 New Coverage & New Choices for Medicare-eligible Retirees
2 What We Will Cover Today What is changing. How this affects Medicare eligible retirees. Extend Health and the services and health plans available to EBRPSS Medicare eligible retirees. A look at the Medicare marketplace. Going forward...what to expect. Questions and answers.
3 What s Changing? EBRPSS is proposing to change the way it provides health care benefits to Medicare-eligible retirees and dependents. Eligible retirees and dependents will have new choices for health care that may more closely match individual needs. Extend Health will help Medicare-eligible retirees select and enroll in the coverage that works best for them. Existing health care coverage under EBRPSS self-insured medical plan for Medicare eligible retirees and dependents will end on December 31, 2012 and be replaced with a Health Reimbursement Account to reimburse Medicareeligible retirees for their purchases through the Medicare exchange offered through Extend.
4 Benefits Of This Approach Leverages the expertise and market presence of Extend Health - the largest independent Medicare Market Coordinator and carrier exchange in the U.S. Provides retirees with better benefit choices, guidance and value. Personal, expert support for every retiree from licensed benefit advisors. Lower costs for EBRPSS to be shared with active employees and non-medicare eligible retirees Lowered GASB costs for EBRPSS
5 How This Affects You What s changing EBRPSS sponsored coverage will end for Medicare eligible retirees and dependents on December 31, Medicare eligible retirees will select and enroll in plans available through Extend Health. What you pay It may change depending on what coverage the Medicare eligible retiree chooses How you enroll Medicare eligible retirees will work with Extend Health to enroll in a plan that meets your medical and prescription needs. Your support Extend Health advisors will help Medicare eligible retirees understand the costs associated with your coverage premiums, copayments, deductibles and all other costs.
6 Introducing Extend Health The Industry s Largest Private Medicare Exchange
7 Who is Extend Health? Independent company, dedicated to serving Medicareeligible retirees. Partner with 70+ health plan carriers to provide you coverage to fit your individual needs and budget. Objective and Trusted U. S. based licensed benefit advisors. Focused on helping each participant make an informed and confident decision. 7
8 Why Extend Health? Extend is experienced in helping Medicare participants and their families Enrolled over hundreds of thousands of participants Extend s services are provided at no cost to EBRPSS Medicare eligible participants 8
9 9
10 Plans & Partners All Medicare Plan Types Medicare Advantage Medigap Prescription Drug (Part D) Vision Dental Select Carrier Partners
11 Currently Medicare & EBRPSS Medical and Rx Retiree pays EBRPSS premium contribution for coverage through deduction through payroll check 11
12 Future Coverage Plus HRA Primary Coverage Medicare Parts A & B Additional Coverage (Your Choice) Medigap + Prescription Drug (PDP) or Medicare Advantage with Prescription Drug (MAPD) Optional Coverage (Your Choice) Dental and Vision 12
13 OPTION 1: Medigap Plan + Part D Plan MEDIGAP PLAN PART D PLAN MEDIGAP (Medicare Supplement) A Medigap plan fills the gaps in original Medicare Part A and Part B coverage (i.e., helps pay the difference between your costs and the amount original Medicare pays). These plans provide additional coverage for your doctor visits and hospital stays as well as other expenses not covered by original Medicare. PART D PLAN A Part D plan supplements Medigap to provide prescription drug coverage. These plans help pay for your prescription drug expenses. You will need to pay your first premium when you enroll 13
14 OPTION 2: Medicare Advantage Plan with Prescription Drug Coverage (MAPD)* Medicare ADVANTAGE MAPD PLAN An MAPD plan provides an all-in-one plan which bundles your Part A, Part B and prescription drug coverage together with additional benefits. These plans provide coverage for your doctor visits, hospital stays, and prescription drug expenses. * Note that Medicare Advantage plans are generally network based plans 14
15 Health Reimbursement Account Medicare eligible retirees would receive a defined dollar contribution of $3,281 annually into a health reimbursement account If they had retiree and spouse Medicare coverage this would mean $3,281 for the retiree and $3,281 for the spouse for a total account funding of $6,562. The account can reimburse the retiree for: Premium selected Medicare advantage, Medigap and Medicare Part D plans and Dental and Vision Plans Copays, deductible and co-insurance if applicable for medical, dental and vision expenses EBRPSS allocates benefit dollars to each retiree s HRA Retirees are reimbursed for healthcare expenses Claims are paid daily Auto reimbursement Direct deposit option
16 Location Specific Plans
17 Extend Health Medicare Exchange Baton Rouge, LA Options Medicare Advantage MediGap Plans Male Age 75 Part D (Rx) 10 plan options $0 - $67 15 plan options $82 - $ plan options $15 - $108 Arcadian Community Care, Humana, Wellcare AARP, Blue Cross Blue Shield of Louisiana, Humana, United Healthcare AARP, Aetna, Cigna, Community CCRx, Coventry, CVS Caremark, Humana, WellCare *Based on Plans available January
18 Sample Plan Comparison for EBRPSS Benefits Medicare Advantage Plan Medicare Advantage Fee for Service Medigap Plan F + PDP (Male Age 75) Incumbent Plan (Retiree Only) Premium (monthly) $0 $45 $249 ($205 + $44) $409 Deductible $0 $0 $0 $600 Office Visits PCP: $5 co-pay PCP: $15 co-pay 100% covered PCP: $30 co-pay Specialist: $20 co- Specialist: $15 - $40 Specialist: $60 co-pay pay co-pay Hospital $50 copay per day, days 1 8; after 8 days: $0 $195 copay per day, days 1 8; after 8 days: $0 100% covered $600 per admission Prescription $3/$35/$/$60/33% $7/$41/$82/33% $6/$36/$78/33% $10/$25/$45 after $50 deductible Other $4,000 OOP Max for in- and out-ofnetwork services No Lifetime Max $5,000 OOP Max for in- Foreign Travel and out-of-network No medical plan services Proprietary copays/coinsurance and Confidential No Lifetime Max No Lifetime Max $3,500 OOP Max, exclusive of deductible No Lifetime Max
19 Medicare Prescription Drug Coverage For 2012 (Part D Plan) Initial Coverage You pay * Deductible and Co-payments for your plan * Coverage for the first $2,930 in Actual Cost of medications Coverage Gap Donut Hole You pay * 50% of Brand Drugs and 86% of Generics Until out of pocket costs reach $4,700 Catastrophic Coverage You pay * $2.60 for generics and $6.50 for brand Or 5% which ever is greater 19
20 2012 Average Plan Availability Plan Type Number of Plans Offered 2012 Monthly Premium Company Vision 1 $14 per person per month Annual eye exam: $15 Vision Service Plan (VSP) Dental 2 $16 - $43 $0 - $50 deductible $1,000 - $1,600 annual maximum Varied (i.e., Delta Dental, Humana Dental) 20
21 Enrollment Process and Communication Plan
22 The Process Educate Evaluate/Enroll Manage 22
23 Extend Retiree Communications Group Marketplace Personalized End to End Individuals Client announcement letter of program change Client communication educational piece Getting Started Guide Enrollment Guide Outbound/Inbound calls in pre-announced waves and appointments With benefit advisors Reminders: Postcards and certified letter Extend Health - Benefit selection confirmation HRA Guide 23 Do not copy or distribute without the express written consent of Extend Health, Inc Extend Health, Inc. 23
24 Pre-Season- 45-Days prior to enrollment Retiree Experience: 1. Client Announcement Letter alerts retiree to the change 2. Extend Health delivers the Getting Started Guide which includes: Welcome letter Frequently Asked Questions Workbook to complete before call 3. Retiree calls into Extend Health to: Verify profile information Provide Prescription drug information Schedule personalized enrollment appointment Ask questions 4. Retiree meetings at EBRPSS facilities 24 Do not copy or distribute without the express written consent of Extend Health, Inc Extend Health, Inc. 24
25 Enrollment- 90-Days prior to eligibility date Retiree Experience: 1. Extend Health delivers the Enrollment Guide which includes: Cover letter with appointment confirmation Medicare basics- plan education Frequently asked questions What to prepare for and expect on the call 2. Specially trained Benefit Advisors and the retiree partner to: Understand the unique medical and prescription need of the retiree Study the plans available that fit the retiree s needs Complete telephonic enrollment 3. Extend Health delivers reminder post-cards and certified mail to those retirees that have not responded 25 Do not copy or distribute without the express written consent of Extend Health, Inc Extend Health, Inc. 25
26 Post-Enrollment- Enrollment date and beyond Retiree Experience: 1. Extend Health delivers the Selection Confirmation which outlines the details of the plan selection 2. Insurance carrier(s) send out Welcome Guides which includes detailed plan information and new insurance cards 3. Extend Health delivers the Health Reimbursement Account packet 4. Extend Health remains an advocate free of charge, for the lifetime of the retiree to: Assist with carrier questions/challenges Help with future changes to medical and prescription drug changes Support HRA reimbursements and questions 26 Do not copy or distribute without the express written consent of Extend Health, Inc Extend Health, Inc. 26
27 Decision Support Tools Help Me Choose Prescription Profiler 27
28 Evaluate and Enroll Hours of Operation Monday Friday 7 a.m. 8 p.m. Central Standard Time Licensed Benefit Advisor 100% domestic workforce Objective advocacy Neutral compensation Extend University Licensed, certified, appointed Average age 43 Call Extend Health Toll-Free 28
29 Enrollment Process Benefit Advisors can discuss coverage options with anyone need to speak to the participant to complete the enrollment. Once Medicare eligible retiree have made a coverage selection, enrollment is conducted via telephone. 100% of calls are recorded. 29
30 Post-Enrollment- Enrollment date and beyond Retiree Experience: 1. Extend Health delivers the Selection Confirmation which outlines the details of the plan selection 2. Insurance carrier(s) send out Welcome Guides which includes detailed plan information and new insurance cards 3. Extend Health delivers the Health Reimbursement Account packet 4. Extend Health remains an advocate free of charge, for the lifetime of the retiree to: Assist with carrier questions/challenges Help with future changes to medical and prescription drug changes Support HRA reimbursements and questions 30 Do not copy or distribute without the express written consent of Extend Health, Inc Extend Health, Inc. 30
31 Questions & Answers
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