Your UC Medical Plan Coverage Post Retirement

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1 Your UC Medical Plan Coverage Post Retirement Sue Forstat UCSF Health Care Facilitator Manager, UCSF Health Care Facilitator Program 2015

2 Retiree Health Care Eligibility

3 Retiree Health Care Eligibility: Current rules/requirements Benefits always subject to change/not guaranteed Must be eligible for health insurance at the time of retirement Elect Monthly Retirement Income within 120 days of separation May be subject to graduated eligibility May continue for eligible survivors

4 Retiree Health Plan Options/Changes/Costs Non-Medicare plan options do not change but health plan service areas based on home address Medicare versions of all plans/partner plans some service area changes Move out of state all members Medicare eligible Extend Health Medicare Coordinator Suspend coverage

5 Retiree Medical Plan Options Commercial: Health Net Blue & Gold Kaiser UC Care Blue Shield HSA plan only if enrolled at time of retirement Medicare: Health Net Seniority Plus Kaiser Senior Advantage Blue Shield Medicare PPO High Option Supplement to Medicare

6 Retiree Insurance Costs UC currently pays, on average 77% of cost of retiree health premiums for Medicare eligible retirees and 70% for non-medicare eligible retirees <65; will reduce to 70% for each category over time Not eligible for premium-free Medicare Part A (premiums same as employee pay band 2 No salary banding for retirees at this time

7 Retire Insurance Costs Retiree Medical and Dental Eligibility Group 3: Post July 2013 Graduated Eligibility * Group 2: UCRP Entry Post Jan 1990 Graduated Eligibility Group 1: UCRP Entry Pre-Jan 1990 *On 7/1/13, if you were vested and age + service = 50+, then Group 1 or Group 2 rules apply If not eligible for health benefits at retirement, COBRA may apply Use the Medical Plan Chooser to determine your rates: https://uc2015.chooser2.pbgh.org/default.aspx

8 Part B Reimbursement Reimbursement for Part B may apply if UC s contribution for a plan is greater than the gross premium Maximum individual Part B reimbursement currently is $99.90 per person (2014) Part B reimbursement UC Contribution Gross Premium Gross Premium (+Medicare)

9 Additional Considerations Plan Service Areas Use the Medical Plan Chooser to find the medical plans available in your service area You will need a zip code Tool available on UCNet Always call the plan for the most current information because service areas are subject to change

10 Medicare Enrollment

11 What is Medicare? Medicare is a Federal Medical Insurance Program for: People 65 years of age and older regardless of their income or medical history In 1972 Medicare was expanded to include the following groups: Some people with disabilities under age 65 (24 month waiting period) End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) In 2000, individuals with Lou Gehrig s Disease (amyotrophic lateral sclerosis) could enroll at time of diagnosis (rather than having to satisfy the 24- month waiting period

12 Medicare Coverage Part A Hospital Coverage Part B Medical Coverage Part C Medicare Advantage Program Part D Out-Patient Prescription Drug Coverage established in 2006

13 Delaying Medicare Part B enrollment Medicare allows you to delay Part B enrollment as long as you are covered by an Employer Group Health Plan (EGHP) either as an employee or the dependent of an employee You will have a special enrollment period (SEP) to enroll in Medicare if you are older than 65 when your EGHP ends and you will not be subject to the late enrollment penalty

14 UC s Medicare Enrollment Requirements for Retirees and their dependents UC requires that you/your dependents enroll in Medicare Part A & Part B when you/your dependents become eligible for premium free, Medicare Part A Retirees and their dependents risk a financial penalty/de-enrollment from UC sponsored medical coverage if they don t comply with the requirements You/your dependents do not enroll in a non-uc sponsored Medicare Part D plan; Medicare Part D coverage is integrated with your medical plan coverage

15 Why UC Mandates Medicare Enrollment Retirees over age 65 without Medicare cost at least twice as much to insure as those with Medicare Enrollment in Medicare partially reduces the cost of the plan, which keeps the UC premiums affordable for all Allows UC to continue to fund health benefits for retirees Many employers are dropping or reducing retiree health coverage

16 Exceptions to UC Medicare Mandate UC does not require retirees ineligible for premium free Medicare Part A to enroll in Part B You reside outside the United States you must enroll if you return you may incur a Medicare late enrollment penalty You have UC-sponsored health coverage through your spouse who is still working at UC

17 Medicare Enrollment Initiate Medicare enrollment Medicare Part A (if not enrolled) and Medicare Part B. Do NOT enroll in a Medicare Part D plan (prescription coverage) Online at OR By phone at OR Schedule an appointment at your local Social Security Office

18 Medicare Enrollment Remember if you don t qualify on your own, you may qualify through a current or former spouse If you don t qualify now but continue to work you may qualify in the future You are required to enroll at age 65 unless covered by an employer group health plan (EGHP) or pay a penalty for late enrollment

19 Medicare Enrollment If you are retired, when you reach age 65, you should apply for Medicare two months before your reach age 65 If you are receiving SS benefits at the time, you will automatically be enrolled in both Part A and Part B and a Medicare card will be sent to you about 3 months before your birthday If you are 65 or older at the time of retirement you will need to provide an employment verification form

20 Medicare Costs Part A Free if meet the 40 quarter requirements Part B based on modified gross income from IRS returns two years prior to enrollment date Part D also based on income (higher income = pay more) Important Part B and Part D costs are paid directly to Social Security and separate from your retiree insurance premiums IRMAA Income Related Monthly Adjustment Amounts

21 Medicare Part B costs 2015 If your yearly income in 2013 (for what you pay in 2015) was File individual tax return File joint tax return File married & separate tax return You pay (in 2015) $85,000 or less above $85,000 up to $107,000 above $107,000 up to $160,000 above $160,000 up to $214,000 $170,000 or less above $170,000 up to $214,000 above $214,000 up to $320,000 above $320,000 up to $428,000 $85,000 or less $ Not applicable $ Not applicable $ above $85,000 and up to $129,000 $ above $214,000 above $428,000 above $129,000 $335.70

22 Medicare Part D costs 2015 File individual tax return File joint tax return $170,000 or $85,000 or less less above above $85,000 $170,000 up to up to $107,000 $214,000 above above $107,000 up to $214,000 up to $160,000 $320,000 above $160,000 up to $214,000 above $214,000 above $320,000 up to $428,000 above $428,000 File married & separate tax return $85,000 or less You pay (in 2015) not applicable $12.30 not applicable $31.80 above $85,000 up to $129,000 above $129,000 $50.30 $70.80

23 How UC Sponsored Health Plans Coordinate with Medicare Information based on coverage for plan year, 2015

24 Medicare vs. Non-Medicare Plans All the UC medical plans have a separate Medicare - coordinated version/partner plan When you become eligible for Medicare you coordinate your current medical plan with Medicare; must use Medicare providers for Medicare covered services The Medicare-coordinated version of a plan may differ in: Plan benefits/drug formulary Costs Service area Network providers Enrollment/de-enrollment process

25 Provider Medicare Status Provider Accepts Assignment Provider will accept Medicare contracted rates for services Provider Does not Accept Assignment Provider can charge up to 15% above Medicare contracted rates Provider Opts Out of Medicare or Does Not Have a Medicare Contract Claims from a provider that has opted out of Medicare or from a provider without a Medicare certificate number will not be paid by Medicare and will not be paid by your UC sponsored health plan

26 Medicare Coordination with HMO plans (Advantage Plans), 2015 If you are enrolled in a Health Maintenance Organization plan (HMO) -- Health Net Blue & Gold, or Kaiser-- Medicare Parts A, B and D must be assigned/locked to the plan You cannot use Medicare outside the plan You will need to complete a MAPD form assigning Medicare to your plan

27 Medicare Coordination with HMO plans (Advantage Plans), 2015 You must live in the plan s CA service area Health Net Seniority Plus is the full HN provider network Medicare pays a flat fee to the HMO each month - the HMO agrees to accept full responsibility for your care

28 Medicare Coordination with Blue Shield Plans, 2015 High Option Supplement to Medicare Blue Shield Medicare PPO (Preferred Provider Organization)

29 Medicare Coordination with Blue Shield Plan, 2015 You may see any Medicare provider Find doctors using the Participating Physician Directory online at: Medicare pays as primary Each plan has an annual deductible - Once the deductible is met, Blue Shield coordinates their payment after Medicare pays, to cover a percentage of your expenses

30 Coordinating Medicare with your Retiree Health Coverage Complete the UC required Medicare coordination forms and submit to UC Retiree insurance and/or the insurance plan, along with a copy of the Medicare card. Each individual coordinating with Medicare completes their own form UC Retiree insurance will enroll you in the Medicare plan/transfer your medical plan enrollment to the Medicare plan once they receive your completed Medicare coordination forms and adjust your plan premiums as indicated Your family members enrolled as dependents who are not eligible for Medicare will remain in the a non- Medicare plan

31 Tips for Planning Ahead Review Open Enrollment materials each year - you can make plan changes at that time (plan changes not allowed at the time of retirement/medicare enrollment) Stay informed of general developments with Medicare and health insurance Use your UC online resources UC Net Website: UCSF HCF Website:

32 Tips for Planning Ahead Use your Medicare resources Medicare General Information Social Security Health Insurance Counseling and Advocacy Program (HICAP) Still have questions? UCSF Health Care Facilitator (HCF) Program

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