Hari Arora (813) Jim Hughes (727)

Transcription

1 IBM Retiree Medicare Coverage 2015 Medicare Eligible Retiree Single Medicare Eligible Retiree with Medicare Eligible or Non-Medicare Eligible Spouse November 11 & 12, 2014 Hari Arora (813) Jim Hughes (727)

2 Agenda 2014 versus 2015 Medicare Changes Medicare Coverage Overview Part A, Part B & Part D Medicare Advantage Plans (Part C) PPO s & HMO s Medicare Supplement Plans Medigap + Prescription Plans IBM Medical Coverage Overhaul Who is OneExchange? All About Health Reimbursement Arrangement (HRA) IBM Subsidy for HRA Medicare Coverage Choices At-A-Glance Medicare Advantage Plans: HMO s At-A-Glance Medicare Advantage Plans: PPO s At-A-Glance Medigap Plans Prescription Plan Considerations Plan Selection based on Health Considerations Plan Options for Non-Medicare Eligible Spouse Dental Plans Vision Care Options Summary Q & A / Discussion 2

3 2014 VS 2015 Medicare Changes No changes to Part B annual deductible, Part B premium and income based surcharges Part A deductible increased from $1216 to $1260 Copayment for hospital stay from days increased from $304/day to $315/day. Days 91+ up to 60 days per lifetime increased from $608 to $630/day Copayment for skilled nursing facility from days increased from $152/day to $157.50/day Medicare Part D donut hole adjusted from $ $4550 to $ $4700. Income based surcharges adjusted upwards by small amounts. 3

4 Medicare Coverage Overview Medicare Part A Covers in-patient hospitalization No premium, automatically enrolled first month you turn 65 $1,260 deductible and no copayment for 1-60 days each benefit period, $315/day days,$630/day 91+ up to 60 days for lifetime Covers skilled nursing facility 1-20 days, you pay $157.50/day for 21 to 100 days, all costs after 100 days 4

5 Medicare Health Coverage Overview Medicare Part B Pays for doctor s services, outpatient care and other medical services Annual deductible: $147 Medicare pays: 80%, you pay: 20% Must enroll and pay monthly premium Minimum: $104.90/person modified AGI<85K for Single, 170K for Joint Adjusted upwards with your income 2015 adjustment will be based on 2013 modified gross income Deducted out of social security payment If retired before YE 1996, can recover 80% of premium up to $900 through IBM SHAP; must pay Part B premium to claim SHAP. Only one person can claim. 5

6 Medicare Health Coverage Overview Medicare Part D Medicare subsidized drug coverage offered through Medicare approved insurance companies Most street plans don t provide gap (donut hole) coverage from $2960 $4700 Gap starts when total drug costs reach $2960 and end when your total outof-pocket costs exceed $4700 and enter catastrophic level Catastrophic coverage co-pay: Greater of 5% or $2.65 for generics, 5% or $6.60 for all other drugs. However, gap is shrinking: 2014: 52.5% discount on brand names, 28% on generics 2015: 55% discount on brand names, 35% on generics 2020: Discounts increase till gap closed Part D income surcharge to go up by about 2% for all high income categories 6

7 Medicare Part B and Part D Premiums Modified Adjusted Gross Income* (MAGI) Monthly Premium/Person Single Joint Part B Part D $85K 170K $ None $ $ $ $ $ $51.30 >214K >428K $ $70.80 *Modified Adjusted Gross Income: Adjusted Gross Income Tax Exempt Interest

8 Medicare Advantage Plans Also called Medicare Part C All-In-One Plans Must enroll in Medicare Part A and Part B and assign your Medicare benefits to an insurance company Health Maintenance Organization (HMO) Must stay within the plan s network (except for emergency care) PCP required PCP referral required to see a specialist Preferred Provider Organization (PPO) PCP not required Generally have network of providers but can also use out-of-network providers, usually for a higher cost Local, Regional & Extended Service Area PPO s 8

9 Medicare Supplement Plans Also called Medigap Plans Supplement coverage not provided by Medicare Must enroll in Medicare Part A and Part B but no need to assign your Medicare benefits to an insurance company Will need to enroll in a separate Part D plan for drug coverage 9

10 IBM Medicare Coverage Overhaul IBM coverage for medical, dental & vision care was discontinued 12/31/2013 IBM subsidy continued through Health Reimbursement Arrangement (HRA) Must work with One Exchange Health and enroll in a medical plan or prescription drug plan to receive HRA No group plans - - retiree and spouse will enroll in individual plans Offers flexibility to sign up for a plan based on individual s health status However, adds to enrollment process Exception: Those currently enrolled in Aetna Medicare Plan A (HMO) and Aetna Medicare Plan B (PPO) can continue with these plans along with IBM offered dental and vision plans for one more year. Not eligible for HRA. Not need to return the Spousal Selection Form 10

11 Who is OneExchange? Largest private Medicare exchange serving over 500,000 Medicare retirees Acquired by Towers Watson in May 2012 OneExchange is now your primary contact for enrollment and ongoing support for your health care coverage for 2014 and beyond 11

12 All About Health Reimbursement Arrangement (HRA) A tax-free account which can be used to pay for eligible out-of-pocket health care costs: Premiums for medical, prescription, dental & vision care plans Deductibles, Co-Pays and Co-Insurance Medicare Part B Premiums IBM will contribute annually to your HRA if you were receiving subsidized group coverage If you and your spouse are both IBM retirees and Medicare-eligible, each of you are eligible for your own HRA. A joint account will be setup for the total amount unless otherwise requested HRA must be funded by IBM, you can not contribute to an HRA (IRS rules) If you don t use your annual HRA allocation, it will not roll over If you have an FHA account, it will be transferred into an HRA and will roll over year to year till all depleted OneExchange will serve as the administrator for your HRA account 12

13 All About Health Reimbursement Arrangement (HRA) (Continued) To receive your HRA contribution, you, the retiree (or surviving spouse), must enroll in medical and/or drug plan through OneExchange Exception: A U.S. Veteran enrolled in TRICARE or eligible to obtain services from the Veterans Administration. Call OneExchange to receive HRA Once you enroll in a medical plan through OneExchange, it s not necessary for your spouse to enroll in a medical plan through OneExchange. You and your spouse can enroll in prescription, dental and vision plans on your own and submit claims for premiums and other medical expenses for reimbursement Non-Medicare eligible spouse/dependent can not enroll through OneExchange but is eligible to draw upon retiree HRA for medical, dental, vision care premiums and expenses, same as the retiree Make sure your spouse/dependent is included in OneExchange database Reimbursements You will first pay all premiums and other out-of-pocket expenses Auto reimbursement for select medical plans and Part B premiums Manual process for all other expenses. Submit claims with valid receipts, etc. till HRA is depleted 13

14 IBM Subsidy for HRA IBM aggregate contribution to HRA s will be consistent with prior years Retirement Date Without Surviving Spouse Option With Surviving Spouse Option Retiree Already Deceased Now Surviving Spouse Now Surviving Spouse Medicareeligible Surviving Spouse Before Jan. 1, 1992 On or after Jan. 1, 1992 $3,500 0 $2,600 $1,300 $1,300 $3,000 0 $2,374 $1,187 $1,187 - You must make your selection on Survivor Selection Form and return to reach IBM vendor by due date - Default is Spousal Coverage meaning lower amount even if there is no spouse or dependent 14

15 Next Step Choose the best coverage while optimizing the use of available funds: Annual HRA (or FHA) Annual SHAP, if eligible 15

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17 Medicare Plan Types Option 1 Medigap + Part D Rx Option 2 Medicare Advantage Plan Name Plan F, N, C, etc. PPO, HMO, etc. Medicare Supplement to Original Medicare Pays instead of Medicare (You assign your Medicare benefits to the insurance provider) Costs Pay Up Front Pay As You Go Premiums Higher Monthly Premium Zero to Low Monthly Premium Co-Pays $0 Co-pays (Plan F) Co-pays, Co-insurance, Max out-of-pocket limits Doctors/Medical Facilities Any Doctor/Facility that Accepts Original Medicare Networks, PCP Portability Benefits Travel with You Only Emergency Coverage When Out of Network Area 17

18 Insert HMO Medicare Advantage Plans At-A-Glance 18

19 Insert PPO Medicare Advantage Plans At-A-Glance 19

20 Medigap Plans All policies are regulated by Federal and State laws and fall into 3 categories: Community Rated: Same monthly premium regardless of age Issue-Age-Rated: Premium is based on the age you are when you buy. Almost all policies (95%) fall in this category in Florida. Attained-Age-Rated: Premium is based on your current age and goes up as you get older. Not allowed in Florida. All policies are labeled by a letter. A policy with the same letter covers the same benefits no matter which insurance company sells AARP Medicare (United Healthcare) and Florida Blue are the two largest Medigap insurers in Florida. United Healthcare issues with providers do not apply here because your primary coverage continues to be through Medicare AARP Medicare and Florida Blue allow switching from one Medigap plan to another plan without going through underwriting requirements (Florida only) Must enroll in a Part D prescription plan Full coverage for domestic travel. Some plans provide emergency care coverage with limits for foreign travel: you pay first $250, 20% co-insurance for up to $50,000 lifetime limit 20

21 Medigap Plans (continued) Guaranteed Issue Rights (Medigap Protections) Entitle those coming off company group plans to enroll in a Medigap plan. Same is true for those just becoming Medicareeligible. If you decide not to enroll in a Medigap plan when first eligible, you lose the guaranteed issue status and may be subject to underwriting requirements Medicare Advantage plans are always guaranteed issue. 21

22 Medigap Plans Medigap Plans Medigap Benefits A B C D F* G K L M N Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Medicare Part B Coinsurance or Copayment 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%*** Blood (First 3 Pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A Hospice Care Coinsurance or Copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Skilled Nursing Facility Care Coinsurance 100% 100% 100% 100% 50% 75% 100% 100% Medicare Part A Deductible 100% 100% 100% 100% 100% 50% 75% 50% 100% Medicare Part B Deductible 100% 100% Medicare Part B Excess Charges 100% 100% Foreign Travel Emergency (Up to Plan Limits) 100% 100% 100% 100% 100% 100% Out-of-Pocket Limit** $4,940 $2,470 22

23 Medigap Plans (continued) *Plan F also offers a high deductible plan with annual deductible ($2,180 in 2015) **For Plans K & L, after you meet your out-of-pocket annual limit and your Part B annual deductible, Medigap Plan pays 100% ***Plan N pays 100% of Part B co-insurance except for: -Part B annual deductible $147 -Up to $20 for some office visits -Up to $50 co-pay for ER visits not resulting in inpatient admission 23

24 Medigap Plans Considerations OneExchange lists six plans but also offers AARP (United Healthcare) Medigap plans Consider your health status in selecting a Medigap plan Medigap Plans Comparison #1 (Age 73, ZIP: 33624) Florida Blue F $215.30/Month $ /Year Humana High Deductible F (Deductible $2180 for 2015) $110.22/Month $ /Year Best case savings: $ /year with high deductible F If your out-of-pocket expenses are less than $ , you will come out ahead Worst case delta cost if health condition worsens: $2180 $ = $ High deductible F is a viable alternative for healthy individuals desiring highest flexibility 24

25 Medigap Plans Considerations (continued) Medigap Plans Comparison #2 (Age 72, ZIP: 33624) AARP Plan F $221.75/Month $2661/Year AARP Plan N $160.25/Month $1923/Year Savings with Plan N: $738 Assuming no emergency visits, you will come out ahead if your doctor visits are less than 29 Medigap Plan N is a viable option for those with moderate health issues and requiring full flexibility AARP (United Healthcare) and Florida Blue allow switching without going through underwriting requirements 25

26 Prescription Plan Considerations If you are selecting a Medigap plan, you must enroll in a street Prescription Plan Your own prescription plan search using instructions on next chart is highly recommended May result in considerable savings compared to lowest cost plan offered through OneExchange Most street Prescription Plans and Medicare Advantage plans have coverage gap Premiums for most street plans have gone up. Enrollment period Oct. 15 Dec. 7 if you enroll yourself Formulary within a drug plan can make a significant difference in your overall drug costs Prescription offers from Publix, Sweetbay, Walgreens, etc. do not replace Medicare Part D plans but can be used to reduce your costs 26

27 Prescription Plan Search Go to Medicare.gov web site. Don t sign in even if you have ID Click on FIND HEALTH & DRUG PLANS Next Page enter ZIP code Step 1 of 4...Look at questions and just check ORIGINAL MEDICARE on first question. Answer second question as appropriate. Click on CONTINUE TO PLAN RESULTS (If you saved the drug list from last year, start with the previous Drug List ID) Step 2 of 4...Enter DRUGS. When done click on MY DRUG LIST IS COMPLETE Step 3 of 4 where you can look at eligible pharmacies in your area. Pick your favorite pharmacy. Click on CONTINUE TO PLAN RESULTS Step 4 of 4. Under REFINE YOUR SEARCH, check PRESCRIPTION DRUG PLANS only. Then click on CONTINUE TO PLAN RESULTS You have arrived at the list of Plans sorted by Cost. Pick up to three plans to compare. Print results using default options. You now have a detailed report to make your decision. Well done!! Note: To explore further, repeat above steps using different options. 27

28 Health Considerations Minor health issues / Low prescriptions Many choices HMO s are the lowest cost but offer limited flexibility Humana Gold Plus is a popular plan PPO s with zero premium offer good flexibility at low cost AARP Medicare Complete Choice Plan 2 used to be a popular plan but not anymore because of issues with providers in the Network. Humana Choice and Aetna Medicare Premier Plan are good alternatives If flexibility is a key consideration, your lowest cost option may be: Medigap Plan F with annual deductible ($2,180 for 2015) plus lowest premium Prescription Plan 28

29 Health Considerations (continued) Moderate health issues / Moderate prescriptions Consider HMO s only if cost is a major consideration PPO s offer better flexibility with as low as zero premium Humana Choice and Aetna Medicare PPO look most cost effective but should check the provider network (call your preferred providers) Should offer the best value for most in this category If full flexibility is key, a good option may be: Medigap Plan N AARP Medicare (United Healthcare) provides this policy. Can be upgraded to other AARP Medigap plans without going through underwriting terms. Plus a Prescription Plan with lowest annual cost 29

30 Health Considerations (continued) High health issues / Moderate to high prescriptions Medigap Plan C or Plan F, and the lowest annual cost prescription plan provide the best value Highest flexibility and may provide best cost in many cases 30

31 Plan Options for Non-Medicare Eligible Spouse Waiting for IBM Materials

32 Dental Options No monitoring by state or federal agencies Dental insurance plans Dental HMO s Many street plans Dental PPO s from OneExchange Humana One Preventive Plus MetLife Plan Option 1 MetLife Plan Option 2 Delta Dental Individual Plan III Dental Discount Plans Savings against normal dental charges Visit Check with your provider for actual discounts 32

33 Vision Options VSP plan offered through OneExchange looks expensive at $150/year Some Medicare Advantage plans offer vision care benefits AAA or AARP discount Your input? 33

34 Summary New to Medicare/One Exchange No need for retiree and spouse to enroll in the same plan. Each plan selection can be based on health profile Except for your medical or prescription Plan, you or your spouse don t have to enroll other plans with OneExchange to claim all of your HRA Prepare ahead of time before your enrollment appointment with OneExchange advisor to steer your discussion For a person with high health issues, a Medigap plan C or F plus the lowest annual cost prescription plan should provide the best value If you choose an HMO or PPO, check the provider database for network providers and drug formularies A good PCP is most critical if you choose an HMO Contact your preferred provider for confirmation 34

35 Summary Returning and already enrolled through OneExchange If you are satisfied with your current plans, no need for any further action If you are currently enrolled in a Medigap, your options to change medical plans are limited You can change within the family of United Healthcare and Florida Blue Underwriting requirements if changing across providers 35

36 Q & A Q: You are currently enrolled in the Aetna Medicare Plan A (HMO) or Aetna Medicare Plan B (PPO) and are planning to stay in that plan as per exception allowed by IBM. Do you have to respond back on Survivor Selection Form? A: No. You will receive a follow-up communication from IBM. Q: I am enrolled in a medical and prescription plan on my own, can I receive the HRA if I enroll in a dental or vision plan through OneExchange? A: No, you cannot. IBM is providing an HRA only if you enroll through OneExchange for medical or prescription drug coverage. Q: My spouse and I are both IBM retirees and Medicare-eligible, and are eligible for our own HRA. Can one of us use the other s HRA for reimbursing medical expenses? A: Yes, a joint account will be set up for the aggregate amount unless otherwise requested. Q: What s the prescription drug creditable coverage? A: Any drug coverage assessed as meeting Medicare coverage requirements. All plans previously offered by IBM which have drug coverage have been assessed as providing creditable coverage. Q: What happens if I don t sign up for a creditable coverage? A: You pay penalty of 1% of your annual premium for every month of delay. Q: What s SHAP? A: If you retired before the end of 1996, 80% of Medicare Part B premiums are covered up to a new maximum of $900/family. Q: If I have joined a Medicare Advantage Plan, can I also have a Medigap Policy to pay for copayments and deductibles? A: No. It is illegal for anyone to sell you a Medigap Policy if you are already in a Medicare Advantage 36 Plan.

37 SHAP and LPA Forms SHAP Special Health Assistance Provision Retired Dec. 31, 1990 or before - 80% of Medicare B premiums in excess of that which is included in your pension reimbursed Retired Dec. 31, 1996 or before - 80% of Medicare B premiums reimbursed Retiree or an eligible dependent enrolled in Medicare Annual maximum reimbursement per family $900 LPA Life Planning Account Retired Dec. 31, 2003 or before Health Club, gym etc. annual fee reimbursement Up to $250 per family per year Form must be submitted by April 30 following expense calendar year Forms are available at: Acclaris Reimbursement Center PO Box Lehigh Valley, PA (888) Forms can be printed from and can either be faxed or mailed to Acclaris. The link is also available at under Related Websites.