SJUSD Retiree Transition Frequently Asked Questions
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- Barry Arnold
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1 SJUSDRetireeTransition FrequentlyAskedQuestions Q:WhatisaMedigapPlan? A:MedigapplansaredesignedtocovertheDeductiblesandCoinsurancenotcoveredbyOriginal MedicarePartAandB.Thereare10StandardMedigapPlansAvailable:PlansA N(varyinglevelsof benefitsfromrichtocatastrophic) Q:WhatisaMedicareSupplementPlan? A:MedicareSupplementplansandMedigapplansarethesame. Q:WhatisaMedicareAdvantagePlan? A:WhenapersonselectsaMedicareAdvantageplantheyTRADEMedicareentirelyforaMedicare AdvantagePlan.Featuresinclude: RegulatedbyCMS Benefitsmustbeequalto(orbetterthan)traditionalMedicarebenefits InsuranceCompaniesarecompensatedmonthlybyMedicareforeachbeneficiarywhoenrolls TypicallyincludePartDprescriptiondrugcoverage(PartD) Individualsarerestrictedtonetworksforthebestbenefits Q:WhatisaMAPDplan? A:AMedicareAdvantageplanthatalsooffersprescriptiondrugcoverage. Q:WhywouldIchooseaMedigapplanoveraMedicareAdvantagePlan?Orviceversa A:Personalchoicebasedoneachperson suniqueneedsandpreferences. MedigapAdvantages: Freedomtoseeanydoctor(inmostcases) Goodchoiceforindividualswholiketotravel(intheUSandabroad) Fortheindividualwhowouldratherpaymoreinmonthlypremiumandhavefewerout ofpocketexpenses MedicareAdvantageAdvantages: Lowerpremiumsbuthigherout of pocketcostsatpointofservice o MAenrolleesin2010willpayanaveragemonthlypremiumof$39,a$7.00increase over2009 saveragepremiumof$32 o In2010,nearly90%ofMedicarebeneficiarieswillhaveaccesstoanMAplanwith$0 premium o Only7%ofMAbeneficiarieswillhavetoswitchhealthplansbecauseofcarriers withdrawingfrommarkets.mostoftheseinsurersoperatedprivatefee for service (PFFS)plans. Mostaffordableoptionforbudget consciousbeneficiaries Broadaccesstoprivatehealthplansandchoiceofhealthcareoptions Broaderhealthbenefits 1
2 SJUSDRetireeTransition FrequentlyAskedQuestions Coordinationofcareforchronicillnessesincludingheartdisease,diabetes,lungdisease,and cancer Nutritional,wellness,andpreventivebenefits Q:Willwebeabletokeepthesamedoctorsweseenow? A:Weunderstandyourrelationshipwithyourdoctorisveryimportanttoyou.YourBenefitAdvisor willassistyouinverifyingthatyourdoctorcanparticipatewithaspecificplanbeforeyouenroll. Q:CanyourPrimaryCarePhysician(PCP)referyoutoaspecialist?Canyougetasecondopinion? A:MostHMOswillrequireyoutohaveaPCPtomakereferralsforyoutoseeaspecialist.PPO'sand Medigapstypicallydonotrequirereferralstoseeaspecialist. Medicaredoesallowyoutogetasecondopinion. Q:WillIberefusedcoverageduetoapre existingcondition?willipaymore?canmypolicybe cancelledonceiamenrolledbecauseofmycondition?canmyrateberaisedforthatreason? A:No.Duringtheinitialtransitionyoucannotbedeniedorbechargedmoreforyourspecificmedical conditions.additionally,theinsurancecompaniescannotraiseyourindividualratesbasedonyour healthcondition.infutureyears,youcanlookatnewplanoptionsduringtheannualenrollment Period.MedicareAdvantageandPartDprescriptiondrugplansdonothaveanyunderwritingcriteria, howeverachangetoamedigapplaninfutureyearsmaybeimpactedbyhealthcondition.your BenefitAdvisorwillassistyoutoensureyouareenrolledintheverybestplan. Q:Canwechangeplansasourhealthneedschange? A:EveryyearyouwillhaveanAnnualMedicareEnrollmentPeriodduringwhichyoumayinvestigate othermedicalanddrugplansandpotentiallyenrollinadifferentplan. However,duringfutureMedicareEnrollmentPeriods,yourcurrentmedicalconditionsmaylimitthe plansavailabletoyou.it'simportanttorememberthoughthatduringyourinitialenrollmentyouwill haveaccesstothefullrangeofplanssobethoughtfulinyourselection.youwillreceivenotification fromextendhealthoftheannualmedicareenrollmentperiod(october15throughdecember7).we encourageyoutocontactusshouldyouhaveanyquestions. Q:CanIobtainMedicalandPrescriptionDrug(Rx)fromonecarrierorwillIneedseparateplansfor each? A:MostMedicareAdvantageplansalsoincludePrescription(Rx)coverage.Ifyouchoosetoenrollin amedigapplan,thereisachancethesamecarriercouldprovideboth,howeverit snotrequired. Ultimately,thegoalistofindamedicalandRxplanthatisbestsuitedforyourspecificneeds, regardlessofcarrier.yourbenefitadvisorcanhelpyoufindthebestcombinationforyou. Q:IfIdon tliketheplanthatienrolledin,whencanichange? A:EveryyearyouwillhaveanAnnualMedicareEnrollmentPeriodduringwhichyoucaninvestigate othermedicalanddrugplansandpotentiallyenrollinadifferentplan.however,duringfuture MedicareAnnualEnrollmentPeriodyourcurrentmedicalconditionsmaylimittheplansavailableto 2
3 SJUSDRetireeTransition FrequentlyAskedQuestions you.youwillreceivenotificationfromextendhealthoftheannualmedicareenrollmentperiod (October15 December7);weencourageyoutocontactusshouldyouhaveanyquestions. Q:WhatifI m65oroverandmyspouseisunderage65? A:IfyouelecttochangeyourcurrentgroupcoveragethroughExtendHealth,thenyourspousemay continuecoverageunderoneofsjusd sretireemedicalplansuntils/hereachesage65. Q:Whatifmyspouseisage65orover,butI mnot? A:YourspousemayenrollwithExtendHealthindividually,andyoumaycontinueyourcoverageasan earlyretireewithsjusd. Q:Ire marriedafteriretired ismyspouseeligibleforextendhealth sservices? A:Yes,ExtendHealthcanassistyouwithindividualplancoverageforyourspousewhoisalso Medicareeligible. Q:Myspouseisonmyplan.Willsheneedtotransfertothenewinsurancealso? A.IfyourspouseisMedicareeligible,shewillalsohaveaccesstoExtendHealth'sservices. Q:Howdoweknowagenericisasgoodasabrandmedication? A:Youwillwanttoworkcloselywithyourdoctortoknowifthegenericwillworkaswellforyour needsasthebrandnamedrug. Q:Doescoverageincludechiropractor,physicaltherapy,andacupuncture? A:YourBenefitAdvisorwillassistyouinfindingtheplanthatbestcoverstheservicesyouarelooking for.planswillvary,butgenerally,allmedicareplansmustcoverthebasicservicesrequiredby Medicareataminimum. Q:Doesanyonewatchforchangesinthenumberofdoctorvisits,changesinprescriptionsand changesinoverallhealthofanindividual? A:TherearechecksinplacethatwatchforsuspicioustrendsincoverageforFraud,WasteorAbuse detection,tokeepcostsdownfortheplansotheywouldnotneedtoincreaserates.however,ifthere arelegitimateincreasesindoctorvisits,prescriptions,etc.,thereisnoneedtoworry,youwillbe covered.thereisnolimitonmedicallynecessaryservices. Q:Besidesatelephoneinterview,Iwouldlikeahardcopyof2 3plansthatIhavenarroweddown toduringthephoneconversation. A:ExtendHealthprovideswrittencopiesoftheplansonthewebsitewww.extendhealth.com Q:Doyouofferplansthatcovermeinmultiplestates Iamafrequenttravelerorhaveasecond homeinanotherstate(iama snowbird )? A:Yes.MedigapplansareacceptedbyeveryMedicare participatingproviderintheu.s.,withsome emergencybenefitsworldwide.ifyoutravelfrequentlyorlivepartoftheyearout of state,these plansmayberightforyou.partdprescriptiondrugplansprovidenationwidecoveragefrom 3
4 SJUSDRetireeTransition FrequentlyAskedQuestions participatingpharmacies.medicareadvantageplanscoverurgentandemergencyservices nationwide,butsomemaynotprovidenationwidecoveragefornon emergencyservices.ifyoulive partoftheyearout of state,theseplansmaynotberightforyou. Q:ArethereplansthatwillcovermewhenItraveldomesticallyorinternationally? A:Yes.MedigapplansareacceptedbyeveryMedicare participatingproviderintheu.s.,withsome emergencybenefitsworldwide.ifyoutravelfrequentlyorlivepartoftheyearout of state,these plansmayberightforyou.afewmedicareadvantageplansalsohaveworldwideemergency coverage. Q:HowoftenwillIbebilled?Bywhom?CanIpaybycheck? A:Whenyouenrollinanewplan,youwillneedtobeginmakingpremiumpaymentstotheinsurance companyinordertomaintainyourcoverage.someinsurancecompaniesmayrequirethefirst month spremiumpaymentduringtheapplicationprocess.inthiscase,youshouldexpecttomakea paymentwithinafewdaysofyourenrollment.pleasehaveyourbillinginformationreadywhenyou makeyourenrollmentcalltoextendhealth. Mostinsurancecompaniesgiveyouseveralbillingoptionsforongoingpayments:directbilling,paid bycheckeachmonth,electronicfundstransferfromyourcheckingaccount,orautomaticdeduction fromyoursocialsecuritycheck.youcanchoosetopaymonthly,quarterly,oryearly. IfyouareenrolledwithKaiser,KaiserwillbedirectbillingyoubeginningJuly1,2013.More informationaboutthetransitiontodirectbillingwillbeprovidedaswegetclosertojuly1,2013. Q:Howdoyouselectaprescriptiondrugplanwhenyoudon'tknowwhichdrugsyoumayneedin thefuture? A:YouareselectingaPartDprescriptiondrugplanonlyforoneyearatatime.Ifyourprescriptions changeduringthecourseoftheyear,youmaymakeanewselectionwithnopre existingconditions concern. Q:Willmynewplancoverpre existingconditions? A:Becauseyouarecomingoffofagroupplan,youwillhavewhatMedicarecallsGuaranteedIssue. Thisguaranteesyoutherighttoenrollintheplanofyourchoice.Theonlyexceptionswouldbea conditioncalledendstagerenaldisease(esrd),orifyouarepre 65. Q:Whyonly2MAplansinSanJose? A:Planavailability,aswellasrates,arebasedonzipcodeandvaryingfactorsimpacthowthatplays out,i.e.,population,competition,availableservices,etc.northerncaliforniahasalimitednumberof MedicareAdvantageplansavailable.Thisisnotnormallythecaseinotherareasaroundthecountry. Q:Willmypremiumratesincreaseeveryyear?Ifso,byhowmuch? A:Ingeneral,insurancepremiumsdoincreaseeveryyear.Theincreaseinplancostyear to yearcan varywidely.weadviseourenrolleestocontactusandcompareotherplansifyouexperiencerate increasesinthe10 15%range.Thenationalaverageis3 4%. 4
5 SJUSDRetireeTransition FrequentlyAskedQuestions Q:CananyoneuseExtendHealth?IsitdifferentforSJUSDretirees? A:Yes,anyonecanuseExtendHealth.ThedifferencetoyouisduringtheinitialtransitionSJUSDand ExtendHealthwillworktogethertoprovideallcommunicationmaterialsaswellasdatatomakethe enrollmentprocesssimple.allinformationprovidedtoextendhealthisconfidentialanditwillmakeit easierforyouusetheirservices. OnceyouareonindividualMedicareSupplementorAdvantageplan,youwillworkwithExtendHealth onanycoverageissuesorquestionsyoumayhavewithyourplan. Q:WhatisExtendHealth'sbusinessmodel? A:TheExtendHealthbusinessmodelisdesignedtoprovidechoiceandexperiencedguidancewhen selectingmedicalandprescriptiondrugcoverage.extendhealthhasbuiltthelargestmedicare exchangeinthenationwhichallowsretireestoselectplansbasedontheirspecificneedsversus limitedoptionsthatagroupenvironmentnormallyallows. Q:Dorealpeopleanswerthephones?Howavailablearetheadvisors? A:YouwillalwaysbeabletoreachalivepersonatExtendHealth.Whenyoufirstcall,ourautomated systemwillhelprouteyoutotheappropriatepersonwithinextendhealth. Q:DoIneedtocontactSJUSDorUASinthefuture? A:No.OnceyouelecttoenrollthroughExtendHealth,youneedtoupdateyourcontactinformation withextendhealthastheywillbeyourserviceadvocate,helpyouwithanyclaimsissues,andassist youannuallyduringsubsequentopenenrollments. Q:HowdoesExtendHealthmakeitsmoney?Willourservicesbefreenextyear? A:Onahighlevel,ExtendHealth,Inc.ispaidjustasanyagentwouldbe,bythecarrier.Theservices arealwaysfreetoyouandwhetheryouwent direct toacarrierwithoutanagent,thepremiumis stillthesameeitherway. Q:HowdoesExtendHealthmakeaprofitifthereisnochargetoretirees? A:Onahighlevel,ExtendHealthispaidbythecarrierswhenanenrollmentismade.Yourbenefit advisorisnotincentedtoenrollyouinanyparticularplanorcarrier,theironlyinterestiswhatis rightforyou.theservicesarealwaysfreetoyouandthepremiumratesyouwillpaywillbethesame asifyouenrolleddirectlywiththecarrier. Q:HowareExtendHealthBenefitAdvisorspaid?Whopaysforsupportservices? A:ExtendHealthbenefitadvisorsarenotincentedtoputyouintoaspecificplanorspecificcarrier. Theymakethesameamountofmoneyregardlessofwhattypeofplanaretireechooses. Q:Doyouhavealocaloffice?CanIgototheofficetodiscussmyoptionsinperson? A:ExtendHealth'sCorporateofficesarelocatedinSanMateo,howeverallserviceandenrollments facilitatedviaphone. 5
6 SJUSDRetireeTransition FrequentlyAskedQuestions Q:DoIpaymypremiumtotheinsurancecompaniesortoSJUSD? A:Allpremiumpaymentsaremadedirectlytothecarrier. Q:CanImeetwithaBenefitAdvisorpersonally? A:Allappointmentsaredoneoverthephoneandarerecordedforyourprotection.Thisprocess ensuresthattherewillneverbeanyquestionwhatyouweretoldduringyourdecision making process. Q:Howcanyoujustifyorclaimalowercostforindividualplanthanagroupplan? Inmostcases,individualplansarepricedmuchlowerthangroupplans.Duetothefactthatthese plansareguaranteedissue,thesheervolumeofpeopleinmedicaretoday,andotherlegislative factors,thecarriersareabletoprovideplansatalowercostthantraditionalgroup. Q:Whatothercompaniesdoyouofferyourservicesto? A:ExtendHealthisworkingwithover250employersrangingfromprivatecompaniestogroupsinthe publicsector.todatewehaveworkedwithhundredsofthousandsofretireestohelpimprovetheir planselectionsandrates. Q:Whatwillprotectusfromexorbitantyearlyraisesinpremiums? A:ExtendHealthwillbeyouradvocate.Whilesomeincreaseinhealthcarecostsisanunavoidablefact oflife,weareheretoassistyouifyourcostsareincreasedbeyondwhatisreasonable. Q:IfyougetaMedigapPlanF,willtherebeco paysandextracosts? A:APlanFMedigapplanisthemostcomprehensiveplanavailable.Enrolleesenjoythefreedomof payingtheirpremiumonly,andthetypicallynoadditionaloutofpocketexpenseonmedicarecovered services. Youwillneedtoenrollinastandaloneprescriptiondrugplantocoveryourmedications,unlessyou havecreditablecoverageelsewhere,i.e.,veteransbenefits,indianaffairs,etc. Q:WeneedaphonenumbertocontactExtendHealth. A.Thephonenumberwillbemadeavailableinthecommunicationmaterialsyouwillreceivefrom ExtendHealth. Q:HowdoesthisfitintoObamaCare? A:Itdoesn't.ExtendHealthisthenation'sleadingMedicareExchangeandourserviceshavebeenthe samesincebeforethehealthcarereformlawswerepassed.sofar,theonlychangeimpacting Medicareistheshrinkingofthedonuthole.Thecarrierswillberequiredtofollowanynewchanges thatmaycomeintolawin2014,whichmayinturn,affecttheplansweoffer. Q:KaiserDoctorscommunicatewitheachothersoyouhave3or4doctorsconferringonyour situation.wouldthatbetruewithanextendhealthplan? A:Yes,dependingontheplanyouareenrolledin,therewouldbethesamecoordinationofcareto varyingdegrees. 6
7 SJUSDRetireeTransition FrequentlyAskedQuestions Q:WhyistheDistrictrequiringustochange? A:Afterreviewingavailableretireemedicalplanoptions,theDistrictdecidedtoprovidenewoptions toimproveaccesstomorecarrieswithcustomizedplandesigns,reduceretireepaidpremium requirements,andprovidepersonalizedcustomerservicesupporttoaidretireeswiththeirmedical insurance. Q:WilltheDistrictstillpaythe$30amonthtowardtheretireemedicalpremium? A:Afinaldecisionregardinghowtobestaddressthe$30remainstobedetermined. Q:Isthisanoptiontocorrectretireeprogramorinlieuoftheprogram? A:Thenewretireemedicalplanoptionsaredesignedtoimproveretireeaccesstocareandreduce retireeout of pocketexpenses. Q:CanSanJoseretireesstaywiththeFoundationprogram?Whathappenstothebuyingpower thatcomeswithsanjoseunifiedschooldistrict? A:StayingontheFoundationplanisnolongeranoption.TheDistrictissignificantlyleveragingits buyingpowerbyjoiningmillionsofotherretireesfromothercompanies. Q:IsMedicaremyPrimaryinsurance?WouldtheDistrictcoveragebePrimaryorSecondary? A:MedicareiscurrentlyyourPrimaryinsurance.MedicarewillcontinuetobeyourPrimaryinsurance. Q:Willtherebeanychangestomylifeinsuranceordentalcoverage? A:No,notatthistime. Q:HowdoescreatinganotherentitytomanageretireebenefitssavetheDistrictmoney? A:ByusingExtendHealthtohelpretireespurchaseindividualcoverage,theDistrictsavesmoneyon recordkeepingexpensesandexpectstoreduceself fundedplanexpenses. Q:IsExtendHealthaffiliatedwithUAS? A:No.ExtendHealthisathirdpartyretainedbytheDistricttoassistretireeswithmedicalinsurance needs. Q:IfyougofromtheSJUSDKaiserplantoanIndividualKaiserplan,canyouswitchbacktoSJUSD s Kaiserplan? A:No.SJUSD sexistingretireeeligibilityrulesremainunchanged.onlynewlyretiredemployeesare eligiblefortheretireegroupplan,byelectingotherarrangementsordroppingthegroupplanretirees cannotreturntothegroupplan. Q:Ifyouopttochangeandarenothappy,canyoure enrollinthekaisersenioradvantage? A:No.Onceyouleavethegroupplan,SJUSDoffersservicesviaExtendHealthforyoutopurchase individualcoverage. 7
8 SJUSDRetireeTransition FrequentlyAskedQuestions Q:CanIeverrejointheKaiserGroupSeniorAdvantageplanforretirees? A:No.YouaretreatedthesamewayasifyouoriginallyelectednottoparticipateintheSJUSD s retirementplanoffering.onceyouelecttonotenroll,thenyoucannotre enrollatalaterdate. Q:IfI minkaiserandoverage65,caniutilizeextendhealthservices? A:Yes,insomecasescarrierswillpermityoutoenrollinMedigapand/orMedicareAdvantageplans withouthavingtoprovideevidenceofgoodhealth.talktoanextendhealthadvisor. Q.IfIamcurrentlyaFoundationsPPOretiree,canIswitchtotheSJUSDKaisergroupSenior Advantage? A.Yes,thiswillbetheonlyyearyouwillbeabletoswitchtotheKaiserSJUSDSeniorAdvantagegroup plan. Q.IfI mnothappywiththemedigapplanihavechosen,canimovebacktokaiserindividual SeniorAdvantage. A.Yes,theIndividualSeniorAdvantagewillremainanoptionforyou. Q.MyspouseandIhavedifferentmedicalneeds.Can,I,theretiredemployee,and/ormyspouse keepthekaisergroupsenioradvantageplanwhiletheothermovestoextendhealth? A.Yes,youoryourspousecanretaintheKaiserGroupSr.Advantageplanwhiletheothermovesto ExtendHealth. Q.WhatisthecurrentcostoftheKaiserSeniorAdvantageIndividualplananddoesithavethe samebenefitsthatsjusdhas? A.The2013,KaiserSeniorAdvantageIndividualplanhasacurrentrateof$72permonthintheSan Josearea.Eachareahasaslightlydifferentrate.Youcanresearchthisonlineatwww.kp.org,Senior Advantage.Theindividualplanhasadifferentplandesign,withhighercopaysfordifferentservices andrxtiers. 8
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