Material for: Commission on Government Forecasting and Accountability Hearing
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1 Material for: Commission on Government Forecasting and Accountability Hearing May 20, 2013 Room C-1, Stratton ffice Bldg. 10:30 a.m.
2 A Primer on, Advantage and Medigap plans is a federal health insurance program specifically for individuals who are 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). is broken out into four specific parts: A, B, C, and D. Part A of refers to hospital insurance. By this, Part A covers inpatient hospital care, skilled nursing facility care, hospice care and some home health care. Part B of refers to general medical insurance. By this, Part B covers certain doctors services, outpatient care, medical supplies, and preventative services. Part C (explained later) Part D of refers to Prescription Drug Coverage. This part adds prescription drug coverage to original, some Cost Plans, some private FFS plans, and MSAs. Individuals may be automatically enrolled in depending on certain conditions: 1. If they are getting Social Security (SS) or Railroad Retirement Board (RRB) benefits 2. If they are under 65 years of age and disabled 3. If they have Amyotrophic Lateral Sclerosis (ALS) 4. If they live in Puerto Rico and receive SS or RRB benefits If these conditions do not apply, individuals must apply for Parts A and B of online, in person or via a toll-free telephone number. premiums are automatically deducted from an individual s Social Security, Railroad Retirement, or Civil Service Retirement check. If an individual does not receive the aforementioned payments, will send a bill for the insurance premium quarterly. Advantage Advantage plans are typically classified under Part C of the traditional sections. In comparison to traditional coverage for types A and B (and also D, in some cases), Advantage is primarily a type of plan that is offered by private companies that contract with to provide Parts A and B benefits. In addition, Advantage plans may also contain prescription drug coverage. Generally, Advantage plans include HM, PP, FFS, Special Needs and Medical Savings Account plans. Medigap Plans Medigap plans refer to a supplemental insurance policy sold by private companies to help pay for certain health care costs that original does not cover, such as co-payments, co-insurance and deductibles. In addition, certain Medigap policies also offer coverage for services that original does not cover, including foreign health care while traveling outside the United States. A Medigap plan differs from a Advantage plan as Medigap coverage only supplements original benefits. Medigap plans cannot be used to pay Advantage plan co-payments, deductibles or premiums.
3 ption Comparison Component Comparison What does it cover? Premiums Deductibles Traditional covers various hospital and general medical expenses. Part D of covers prescription drugs. Part A = up to $441/month if you do not already receive it for free Part B = $104.90/month PART A Hospital - $1,184/benefit period, $0 for the first 60 days of the benefit period, $296/day or higher after that point Skilled Nursing Facility - $0 for the first 20 days of the benefit period, $148/day or higher after that point Advantage Advantage covers traditional Part A and B benefits, along with Part D coverage in some cases. Approximately $300/month Varies by plan may range from $500 to several thousand dollars (.com) Medigap Plans (Medigap) Medigap covers remaining expenses from traditional Part A and B coverage. If covers 80% of an individual s health care costs, Medigap would cover the remaining portion. Approximately $147/month ($182/month if combined with a Part D drug plan) None, depending on the optional Part D plan. Co-payments Network ptions Estimated savings to the State Part B $147/year Participants pay the annual deductibles and 20% coinsurance. Part D participants pay a co-pay for their prescriptions % of all providers accept This option keeps the status quo (includes retiree options to participate in state-sponsored health insurance plans as a supplement to ). Vary by plan Limited to the provider choosing to accept the HM/PP/etc. that is offering coverage under Advantage CMS estimates savings of $100 million/year to the State of Illinois. None, depending on the optional part D plan. Works in conjunction with and is accepted by all providers who accept Various Medigap providers estimate savings to the State of Illinois of approximately $200 million/year or greater.
4 Company Responding Responses to CMS RFI for Retiree Health Insurance ptions Issued November 7, 2012 Response to Question 4 of RFI What option/strategy would you suggest the State pursue and why? Aetna Enroll retirees and dependents in a Advantage PP with a Prescription Drug Plan AN Hewitt Information Not Provided by CMS N/A Buck Consultants Use a Advantage PP and/or EGWP* Rx program to save money CIGNA In a 2-part plan, move from the current plan, ME, MA administered by CIGNA to a Supplement plan (Medigap) along with a Prescription Drug Plan. The next step would be to move towards a Advantage HM plan including an integrated Part-D (Prescription Drug) plan. Conexis Coventry Use a Exchange for retirees and dependents combined with a Health Reimbursement Arrangement** to convert retirees and dependents to individual plans Use an EGWP* Advantage Prescription Drug Plan for Illinois service area residents and a defined contribution Supplement wrap*** with a Part D plan for residents out of the Illinois service area Extend Health, Inc. Use a private Exchange for retirees., ME, MA Gallagher Public Implement a Group Supplement and ME Entity & Scholastic Group prescription drug plan Health Alliance Use a Advantage/Part-D plan in MA conjunction with multiple carriers for Illinois and nationwide HealthLink Use a Health Insurance Exchange, allowing retirees to pick and choose from Advantage, Medigap and other plans Recommendation: MA = Advantage ME = Medigap = ther/combination of Both N/A = Not Applicable MA
5 Responses to CMS RFI for Retiree Health Insurance ptions Issued November 7, 2012 (Continued) Company Responding Humana Insuraprise My CustomHealth SilverScript Transamerica United Healthcare Response to Question 4 of RFI What option/strategy would you suggest the State pursue and why? Use a Advantage PP/HM plan. Also, the State should explore a passive (same benefits for in and out-of-network services) EGWP* Advantage PP/HM with medical only and integrated medical/prescription drug Use a Supplement (Medigap ) F plan with an independent Part-D Drug Plan Use Individual Plan options for Retirees (possibly through a Exchange) Use an EGWP* or an EGWP* with an ptional Health Insurance wrap-around coverage plan for Part-D Prescription Drug benefits Allow multiple plan options for retirees, including Supplement Plans, Advantage Plans, and No Coverage. Also, the state should use an EGWP* for prescription drug benefits Choose one of three options: 1) Integrate retirees into a Advantage PP with a Part-D plan; 2) Set up a defined contribution model with a health insurance exchange; 3) ffer a fully insured EGWP* Recommendation: MA = Advantage ME = Medigap = ther/combination of Both N/A = Not Applicable MA ME, MA, ME * An Employee Group Waiver Plan, or EGWP, is a usually self-insured product that is designed to allow employers to save money on prescription drug costs, similar to the traditional Retiree Drug Subsidy. An EGWP Rx is the same thing, at least in this context. ** A Health Reimbursement Arrangement is an employer health benefit plan that reimburses employees for out-of-pocket medical expenses. *** A Supplement Wrap is Medigap insurance, insurance meant to supplement and pay for expenses not covered under, along with an additional wrap-around insurance option (the wrap) to cover any expenses such as the Donut Hole coverage gap in Part D prescription drug insurance.
6 AFSCME Contract Retiree Health Section Retiree Health The Bargaining Committee fought to minimize the impact of the newly-enacted Public Act (riginally SB 1313) by limiting the premium costs that could be imposed on retirees. Under the CMS implementation plan, many retirees would have paid more than 20% of their pension income for health care premiums. Now retirees will pay only a fraction of that. Plan Design All changes to co-pays, deductibles and co-insurance made to the MCHP and QCHP plans for active employees will also apply to retirees. Premiums -- Eligible Retirees Effective , Eligible retirees will have 1% of their pension annuity deducted to pay for their share of the health care premium. Effective , an additional 1% will be deducted. Effective , all Eligible Retirees will be enrolled in a Advantage plan that provides a comparable level of services and a comparable range of providers as the current health plans. According to the U.S. website: A Advantage Plan is a type of health plan offered by a private company that contracts with to provide you with all your Part A and Part B benefits. Advantage Plans include Health Maintenance rganizations, Preferred Provider rganizations, Private Fee-for- Service Plans, Special Needs Plans, and Medical Savings Account Plans. Eligible dependents enrolled in a MCHP plan will pay no more than $89.91/month and dependents in a QCHP plan will pay no more than $142/month through the same rates they are currently paying. Premiums Pre-65 Non- Eligible Retirees Effective , Pre-65 Non- Eligible retirees will be offered a $500/month subsidy if they opt out of the state s group health insurance plan to be covered in another health insurance plan. Effective , Pre-65 Non- Eligible retirees will have 2% of their pension annuity deducted to pay for their share of the health care premium. Effective , an additional 2% will be deducted. QCHP: Effective , premium monthly rates for dependents in the Retiree +1 Dependent plan option will increase $53, from $196 to $249. Effective 7-1-3, premium monthly rates for dependents in the Retiree +2 or More Dependent plan option will increase $61, from $226 to $287. MCHP: Effective , premium monthly rates for dependents in the Retiree +1 Dependent plan option will increase $19. The current monthly rate of $94 will increase to $113. Effective , premium monthly rates for dependents in the Retiree +2 or More Dependent plan option will increase $ The current monthly rate of $ will increase to $159. Labor-Management Health Care Committee The tentative agreement includes a provision for the Union and Management to work together to implement a Wellness Program by The goal of the Wellness Program is to control health costs and improve the health and wellness of employees. The Wellness Program will be guided by a Joint Labor/Management Advisory Committee on Health. The Committee will also explore other innovations in health care coverage that can contain costs for employees, retirees and the employer, while maintaining or improving the quality of services provided.
7 AFSCME Contract Summary FY13: CLA 0% Step Increases: $22 Sub Steps: ($2) FY13 Total: $20 FY14: Pay Parity $74 CLA 2% $49 Step Increases: $22 Sub Steps: ($10) Longevity pay $25 increase $5 Wages Total $140 Plan Design Changes ($52) Employee Contributions ($111) Retiree Contributions ($64) Max. Rem. Charge ($10) Coordination ($34) Advantage ($58) SERS pt ut ($25) Health Care Savings ($354) FY14 Total ($214) FY15: CLA 2% $50 Step Increases: $22 Sub Steps: ($10) Wages Total $62 Plan Design Changes ($86) Employee Contributions ($124) Retiree Contributions ($64) Advantage ($116) + FY16 rollover ($58) SERS pt ut ($13) Wellness ($53) Insurance Comm. Initiatives ($35) Health Care Savings ($491) FY15 Total ($429) Total Savings By Agreement $681 million All Figures in Millions
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