State Teachers Retirement System of Ohio Medicare Enrollment and STRS Ohio

Transcription

1 Welcome to the Webinar. All STRS Ohio health care plan enrollees are required to enroll in Medicare at age 65 or whenever eligible. Medicare is a federal health insurance program for people age 65 and older, some people with disabilities under age 65 and people with end-stage renal disease or amyotrophic lateral sclerosis (ALS). This webinar will explain the parts of Medicare as well as the steps you need to take to become enrolled.

2 Today we are going to cover the five main steps for easy Medicare enrollment: Relax. Sign up. Send STRS Ohio proof of enrollment. Pay Medicare. Select an STRS Ohio health care plan. After we ve reviewed these simple steps in more detail, we will review some questions commonly asked by new Medicare enrollees.

3 Step one: Relax! You are not in this alone. STRS Ohio will mail you a packet about enrolling in Medicare three months before you turn age 65. It is an easy process that does not require any special assistance or an STRS Ohio counseling appointment to complete.

4 Step two: Sign up. You have a seven-month window which surrounds your birthday month in which to enroll in Medicare. This period begins three months before you turn age 65, includes the month you turn age 65 and ends three months after the month of your birthday. To avoid a delay in the start of your Medicare coverage, we recommend you enroll before your 65 th birthday. You can enroll at your local Social Security office; however, some of you may be eligible to enroll online at If enrolling at a Social Security office, you can call Social Security at the number shown here to locate the nearest office and to find out what documents you ll need to take with you.

5 STRS Ohio requires that you enroll in Medicare Parts A & B or Part B-only. Part A is hospital coverage and you only need to enroll if it is free to you. If it is not free, you do not need to enroll and pay for it. All STRS Ohio health care plans cover hospitalization. Part A is free to those who are getting a Social Security benefit, have a spouse who is at least age 62 and is entitled to Social Security, or those who paid the Medicare tax (while working) for 10 years. Social Security will tell you if you are entitled to the benefit free or at a cost.

6 Medicare Part B is medical coverage and enrollment is mandatory when you are eligible. Everyone pays a premium for it. Social Security knows your Medicare status. If you or your spouse are already receiving a Social Security benefit, Social Security will automatically sign you up. It is those of you who do not currently receive a Social Security benefit who need to go online, call or visit a Social Security office to sign up for Medicare.

7 We ve discussed Parts A and B of Medicare, but what are Parts C and D that you hear so much about? Part C is a type of health insurance plan approved by Medicare and administered by private companies. You may be more familiar with the term Medicare Advantage Plan. STRS Ohio offers two Medicare Advantage Plans the Aetna Medicare Plan and the Paramount Elite HMO. You must not enroll in any other Medicare Advantage plan if you want to keep your coverage under STRS Ohio s Aetna and Paramount advantage plans. Part D is the prescription drug plan. It is mandatory to carry a Part D plan. If you want to remain enrolled in an STRS Ohio plan, you should not enroll in any other Part D plan all of the health care plans we offer for enrollees with Medicare Parts A & B or Part B-only already include Medicare Part D prescription drug coverage. Enrollment in any other Part D plan will cancel your STRS Ohio health care enrollment.

8 Step 3: Send proof of Medicare enrollment to STRS Ohio. You will want to do this immediately upon receiving your Medicare card. Postponement in sending proof of enrollment will delay your enrollment in a health care plan for Medicare enrollees and paying the lower premium for that plan. The majority of retirees send STRS Ohio a copy of their Medicare card as proof of Medicare enrollment. Instead of a Medicare card, you can also send a copy of any of these Social Security Administration forms: Retirement, Survivors and Disability Insurance Notice of Award; Report of Confidential Social Security Benefit Information; or Notice of Health Insurance Entitlement. Write your STRS Ohio account number on any documents you submit.

9 Step four: Pay your Medicare premium. For those enrolling in Part B for the first time in 2016, the standard rate is $ per month. You will pay this to Medicare, not STRS Ohio. You may have Medicare deduct the payment from your Social Security check, if you receive one, or have the payment deducted from your savings or checking if you are enrolled in the Medicare Easy Pay Plan. Or, Medicare can bill you quarterly. The Part B premium must be paid to be eligible for all the benefits afforded with a Medicare Advantage Plan such as STRS Ohio s Aetna Medicare Plan or the Paramount Elite HMO.

10 Step five: Select your STRS Ohio health care plan. If you are in Medical Mutual or HealthSpan prior to turning age 65, you will be enrolled in the Aetna Medicare Plan after STRS Ohio receives a copy of your Medicare card and Medicare approves your enrollment request. If you are in HealthSpan, you will be ineligible for HealthSpan upon turning age 65. If you do not want the Aetna plan, you must submit your request to be enrolled in the Medical Mutual Basic Plan (or a regional plan, if available) when you submit proof of Medicare enrollment to STRS Ohio. If you are enrolled in the Paramount or AultCare regional plans before age 65, you may remain in that plan, or enroll in the Aetna plan or the Basic Plan. If you select the Paramount Elite plan, you will also need to request an enrollment application from Paramount and return it to the plan. This is required even if you had coverage with Paramount prior to Medicare enrollment.

11 What about your family members who are not yet Medicare-eligible? STRS Ohio offers an individual enrollment option. In other words, those individuals in your family who are Medicareeligible can choose the Aetna Medicare Plan while non-medicare family members can remain in the Medical Mutual Basic Plan. Please note that all non-medicare enrollees must enroll in the same plan. Those in HealthSpan turning age 65 with family members still under age 65, must move them to the Medical Mutual Basic Plan.

12 Let s take a look at some of the more common questions we get about the Medicare enrollment process.

13 What happens if I don t sign up for Medicare? Medicare has a penalty for not signing up at the appropriate time. For Part B, there is a 10% late enrollment penalty. This percentage would be added to your monthly premium for each year you delay enrollment and would be paid for the duration of your Part B enrollment. For example, if your monthly Part B premium would have been $ if you had signed up during your initial enrollment period, every year you delay adds another $12 late enrollment penalty to your monthly cost. If you go 63 days or more without Part D or creditable coverage and later enroll in a plan, you ll be assessed a penalty for letting your drug coverage lapse. (Creditable coverage means prescription drug coverage that is as good or better than the standard Medicare Part D prescription drug coverage.) If you have one of the STRS Ohio health care plans, you have a creditable Part D plan. The penalty would be charged for as long as you have Part D coverage and could increase if another 63-day lapse in creditable coverage occurs in the future.

14 If you do not send STRS Ohio proof of Medicare coverage by the end of your Medicare enrollment period, you will be enrolled in the Medical Mutual Basic Plan. Also, your claims will be processed as if you were enrolled in Medicare. This means you will be responsible for 80% of all allowed claim expenses, including physician claims.

15 What if I am still employed at age 65? We have many retirees who work well beyond age 60 and many who work after they turn age 65. While you are working and receiving health care coverage through your employer, you do not need to sign up for Part B. You do need to sign up as soon as employer health coverage or employment ends, whichever comes first. You have eight months in which to do this without a penalty. The eight-month period begins with the month your coverage or employment ends. If for some reason you miss that special enrollment period, general enrollment guidelines will apply. The general enrollment period is January 1 through March 31 and your coverage would not begin until July 1 of that year. If enrolling during the general enrollment period, a late enrollment penalty will apply.

16 What are surcharges? Part B and Part D enrollees with higher annual incomes are subject to monthly Medicare surcharges. Surcharges vary by income levels set by Medicare (currently $85,000 or more for individuals and $170,000 or more for married couples). Your drug plan with STRS Ohio is a Part D plan that is bundled into your health care package. You do not pay a separate amount for drug coverage as some people do. Nonetheless, Medicare assesses this surcharge to you anyway since you do have a Part D plan. If you qualify for the Part B surcharge, you will also qualify for the Part D surcharge. For more information, go to

17 What if I am not eligible for Part A? We touched on this earlier, but it is something that bears repeating. All STRS Ohio health care plans cover hospitalization. Do not enroll in Part A if you will be required to pay a premium. Without Part A, you still have the same coverage and rates as other STRS Ohio Health Care Program enrollees.

18 What is the Part B premium reimbursement? Service retirement and disability benefit recipients who are enrolled in Part B are eligible to receive a partial Part B premium reimbursement from STRS Ohio. The reimbursement is on the Part B standard monthly premium charged by Medicare. You must be enrolled in an STRS Ohio health care plan to receive this reimbursement. The 2016 reimbursement amounts are shown here. These rates are based on years of service and are set by the State Teachers Retirement Board.

19 What are the key similarities among the health care plans offered to Medicare enrollees? Key similarities among all of the plans are as follows: Once you have met the out-of-pocket maximum all covered expenses are paid at 100% for the remainder of the year. The lifetime benefits maximum per enrollee is unlimited. There is no cost for preventive services. The emergency room copayment is waived if you are admitted. Now, let s look at the features of each plan individually.

20 With the Aetna Medicare Plan, the annual deductible is $150 in-network, and $500 out-ofnetwork. The out-of-pocket maximum is $1,500 in-network and $2,500 out-of-network and includes the deductible, copayments and coinsurance. If you change plan administrators, your medical deductible and out-of-pocket maximums will transfer to the new plan administrator only if you move between the Aetna Medicare Plan and the Medical Mutual Basic Plan. For hospital inpatient expenses, the enrollee pays 4% in-network and 8% out-of-network up to the out-of-pocket maximum. Primary care physician office visits are $15 in-network and $40 out-of-network. Specialist physician office visits are $25 in-network and $55 out-ofnetwork. An enrollee will pay $65 for an emergency room visit and $35 for an urgent care visit. You will pay this even if you have met your out-of-pocket maximum for the year.

21 For Medical Mutual Basic Plan enrollees who are also enrolled in Medicare, the annual deductible is $2,500 in-network and $5,000 out-of-network. The out-of-pocket maximum is $6,500 in-network and $13,000 out-of-network. These amounts include the deductible and coinsurance and in-network also includes primary care physician copayments. For hospital inpatient expenses, once the deductible is met, the enrollee pays 20% innetwork and 50% out-of-network up to the out-of-pocket maximum. For a primary care physician office visit, an enrollee pays $20 per visit for the first two visits per year. For visits thereafter, the deductible has to be met and then the enrollee pays 20% up to the out-of-pocket maximum. For a specialist physician office visit, an enrollee pays 20%. An enrollee pays $150 for an emergency room visit and $35 for an urgent care visit.

22 For AultCare PPO enrollees who are also enrolled in Medicare, the annual deductible is $150 in-network and $500 out-of-network. The out-of-pocket maximum is $1,500 innetwork and $2,500 out-of-network. The deductible, copayments and coinsurance apply to these amounts. The hospital coinsurance is 4% in-network and 8% out-of-network. A primary care physician office visit is $15 in-network and $40 out-of-network. A specialist physician office visit is $25 in-network and $55 out-of-network. An enrollee pays $65 for an emergency room visit and $35 for an urgent care visit. These coverage levels match the coverage levels offered under the Aetna Medicare Plan. The AultCare PPO plan is only available in select northeastern Ohio area ZIP codes.

23 For Paramount Elite HMO enrollees who are also enrolled in Medicare, there is a $150 deductible and a $1,500 out-of-pocket maximum. The out-of-pocket maximum includes the deductible, copayments and coinsurance. The coinsurance for hospital inpatient services is 4%. Enrollees pay $15 for a primary care physician office visit and $25 for a specialist physician office visit. The coinsurance for an emergency room visit is 4% and the copayment for an urgent care visit is $35. Like the Aetna Medicare Plan, this is a Medicare Advantage Plan and you must have Medicare Parts A & B or Part B-only to enroll in this plan. The plan requires that you use Paramount Elite physicians and hospitals. Coverage of services out of the plan s network is on an emergency basis only. Paramount Elite is available in select northwestern Ohio and southern Michigan area ZIP codes.

24 What are the monthly premiums? This 2016 monthly premium chart allows you to compare the monthly premiums of the Aetna Medicare Plan and Medical Mutual Basic Plan with the regional plans: AultCare and Paramount. Premiums will vary depending on years of service. Shown here is the premium for a benefit recipient with 30 years of service credit and the premium for the spouse. As you can see, the regional plans have the higher monthly premiums in comparison to the Aetna Medicare Plan and Medical Mutual Basic Plan. A full list of monthly premiums for all plans, based on years of service, is available on the STRS Ohio website.

25 Are there alternatives to STRS Ohio coverage? Yes. There are a number of individual Medicare Advantage plan options offered in Ohio in the general marketplace. These plans may be more advantageous and have a lower cost for the spouse of an STRS Ohio benefit recipient than the group STRS Ohio Medicare Advantage plans, especially if you are agreeable to a limited provider network. It is important to note that not every Medicare Advantage plan includes prescription drug coverage. Medicare requires all eligible recipients to enroll in a Part D plan.

26 How should I evaluate health care coverage options? When evaluating health care plans, it is important to understand the differences in costs and plan features. For instance, the monthly premium the plan charges may be low, but the deductible and out-of-pocket maximum may be high. What does the out-of-pocket maximum amount include? Some plans may include the deductible in that maximum while other plans may not. Are your favorite doctors within the provider network? And, what is the prescription drug coverage offered by the plan? Knowing this information puts you in a better position to make an apples to apples comparison of health care plans and hopefully prevents any surprises when medical bills arrive.

27 This concludes our agenda. Now that we have covered the details of signing up for Medicare, as well as what happens after, all you have to do is celebrate your birthday.

28 If you have any questions after the conclusion of this webinar, here are a few informational resources. You can obtain STRS Ohio health care plan information on our website or by calling toll-free For Medicare information, go to or call toll-free Another resource for Medicarerelated information is the Ohio Senior Health Insurance Information Program. Further information is available on the Ohio Department of Insurance website at or by calling We hope this webinar has been helpful for you. Thank you for your attention.