Your Retiree Health Plan Options for North Carolina Retired Governmental Employees Association Fall 2015 District Meetings

Transcription

1 Your Retiree Health Plan Options for 2016 North Carolina Retired Governmental Employees Association Fall 2015 District Meetings

2 Presentation Overview Medicare Advantage Refresher Plan Year 2016 Options Changes Preparing Income Related Monthly Adjustment Amount (IRMAA) Non-Medicare Retiree Options Annual Enrollment Question and Answer Session 2

3 What is Medicare Advantage? Medicare Advantage Overview A Medicare health plan choice. It may be an individual or group product. You are still considered to be in the Medicare program but you do not have Original/Traditional Medicare. Keep same rights and protections as Original Medicare. Must cover all services Original Medicare covers. Group Medicare Advantage Plans are different than Individual Medicare Advantage Plans. Must be an eligible member of the specific group to enroll. Customized for the State Health Plan. Private companies contract with Medicare to provide your Medicare Part A and Medicare Part B benefits. Most include Medicare Prescription Drug Coverage, Part D. Members must have and continue to pay Medicare Part A (if applicable) and Medicare Part B premiums. 3

4 Medicare Advantage & Other Insurance Medicare Advantage provides one ID card for medical services and prescription drugs. Remember: no longer under Original/Traditional Medicare Must use your Humana or UnitedHealthcare ID card not your red, white and blue Medicare card No need for additional coverage. Additional Medicare product coverage can cause you to be disenrolled from your State Health Plan Humana or UnitedHealthcare MAPDP. If enrolled in a MAPDP, agents cannot sell you a Medicare Supplement or Medigap plan without you terminating your MAPDP. If already enrolled in another Medicare Advantage or Part D prescription drug plan, your coverage with those plans will terminate unless you elect not to enroll in one of these Group Medicare Advantage plans. 4

5 TRICARE & Other Insurance TRICARE for Life (TFL) (TRICARE + Medicare) TFL beneficiaries can enroll in Medicare Advantage plans and TFL will reimburse your copayments for services covered by TFL. TFL pays secondary to the Medicare Advantage plan. In most pharmacies if you present both Medicare Advantage and TFL ID cards, online coordination of benefits will occur for prescriptions. Cannot utilize TFL mail-order prescription coverage if enrolled in Medicare Advantage plan. You cannot use Medicare or Medicare Advantage in a Military Treatment Facility, like a VA Hospital. Other Insurance If covered by a Federal Employee Health Benefit Plan or possibly another former employer s retiree group health plan, it is important to check with them to ensure enrollment into one of these Medicare Advantage plans will not disrupt coverage with them. 5

6 Automatic Enrollment Reminder The State Health Plan conducts auto-enrollments into a Group Medicare Advantage Base Plan as younger retired members age in to Medicare (typically when turning 65). Auto-enrollment letters are sent approximately days before a younger retiree becomes Medicare eligible. Retiree has opportunity to make a change in the autoenrollment. Auto-enrollment occurs even for those retirees living outside of North Carolina. State Health Plan members retiring when they are already 65 years or older are automatically enrolled into either a Group Medicare Advantage Base Plan or the Traditional 70/30 PPO. 6

7 2016 Benefit Plan Year Medicare Primary 7

8 2016 Plan Options for Medicare Retirees Your Plan options for 2016 will remain the same but the plans have changed. You will learn more about those changes today. Humana Group Medicare Advantage (PPO) Base Plan Humana Group Medicare Advantage (PPO) Enhanced Plan UnitedHealthcare Group Medicare Advantage (PPO) Base Plan UnitedHealthcare Group Medicare Advantage (PPO) Enhanced Plan Traditional 70/30 Plan Traditional 70/30 Plan premium free for Medicare Primary members Base Plan premium free for primary member Enhanced Plan monthly premium for primary member ($66) Each plan includes monthly premiums for spousal and dependent coverage. To be eligible for dependent coverage under the Medicare Advantage plans, dependent(s) must be Medicare eligible. 8

9 Preparing for 2016 All members who are enrolled in Group Medicare Advantage ENHANCED plans for 2015 are being automatically moved to their carrier s (Humana or UnitedHealthcare) BASE plan for During this Annual Enrollment Period, members may elect to return to their ENHANCED plan or elect any plan option that is available to them. It will be important for all members to carefully review their Annual Enrollment materials concerning plan choices for Review your medical needs in conjunction with benefit structures. Review pharmacy needs formularies (list of drugs covered) may vary between companies. Look at requirements such as prior authorizations, step therapy and quantity limits. 9

10 2016 Medicare Advantage PPO Benefits Both the Base and Enhanced PPO plans include: No deductibles. Maximum medical out-of-pocket limits $4,000 Base Plans $3,300 Enhanced Plans Predictable copayments. While there are no changes in Base plans copayments there are some changes in Enhanced plans copayments Medicare Part D prescription drug coverage No donut hole $2,500 maximum drug out-of-pocket limit Preventive care. Additional benefits like a nurse help line and SilverSneakers Vision, podiatry and hearing benefits. 10

11 Changes for 2016 Plan Year Group Medicare Advantage BASE plans have no changes to copays, coinsurance or maximum out-of-pocket limits but there are changes in the formularies (list of covered drugs). Prior Authorizations Step Therapy Group Medicare Advantage ENHANCED plans will have changes to some copays, increased medical maximum out-ofpocket limit and changes in formularies. Prior Authorizations Step Therapy Traditional 70/30 PPO plan will have changes across the board which include copays, deductible, and maximum out-of-pocket limits will be increasing for both medical and pharmacy benefits. 11

12 Traditional 70/30 Plan Members will still have the option to choose the Traditional 70/30 plan, which is administered by Blue Cross and Blue Shield of NC (BCBSNC). Original Medicare is primary, State Health Plan coverage is secondary. You would use your red, white and blue Medicare card along with your BCBSNC 70/30 ID card. Includes the Traditional prescription drug coverage. Not necessary to have a Medicare Part D plan as this is creditable drug coverage. Significant changes for 2016 Increased deductible, copays, maximum out-of-pocket limits Changes align with the State Health Plan s strategic plan that was adopted by the Plan s Board of Trustees in

13 2016 Plan Comparison (Medical) 2016 Traditional 70/30 BCBSNC 2016 Humana Enhanced Plan 2016 UHC Enhanced Plan Physician Services Primary Care Physician $39 copay * $15 copay $15 copay Preventive Care $39 copay * $0 copay $0 copay Specialist $92 copay * $35 copay $35 copay Urgent Care $98 copay * $35 copay $40 copay Deductible/Coinsuranc Outpatient Lab/X-ray e $25 copay $20/$25 copay Emergency Room $329 Copay/Ded/Coins $65 copay $65 copay Physical, Speech, Occupational Therapy $72 copay* $20 copay $20 copay Chiropractic Visits $72 copay* $20 copay $20 copay $0 copay (after PCP or Specialist copay) $0 copay (after PCP or Specialist copay) (depends on billing) $0 copay (after PCP or Specialist copay) (depends on billing) Labs/X-ray (conducted within Office Visit) Deductible/Coinsuranc Durable Medical Equipment e 20% coinsurance 20% coinsurance Annual Deductible $1,054/$3,162* $0 $0 Deductible/Coinsuranc Outpatient Hospital Services e $100 copay $100 copay Deductible/Coinsuranc Diagnostic (CT, MRI, PET scans) e $100 copay $100 copay Deductible/Coinsuranc Outpatient Surgery e $175 copay $250 copay $160/day (Days 1-10) Zero after that $150/day (Days 1-10) Zero after that $329 Copay/Ded/Coins Inpatient Hospital Confinement $4,282 Individual Max $3,300 OOP $3,300 OOP Coinsurance Max/OOP $12,846 Family Max (No Family Max) (No Family Max) 13 Fitness Not Covered SilverSneakers SilverSneakers

14 Income-Related Monthly Adjustment Amount (IRMAA) Members with higher income levels are required to pay an adjusted Medicare Part B premium plus an additional amount when enrolled in Medicare Part D prescription drug coverage. The additional amount is called Income-Related Monthly Adjustment Amount or IRMAA. Income level based on modified adjusted gross income, which is the total of your adjusted gross income and tax-exempt interest income. IRMAA is mandated by Federal law and each amount is deducted from your monthly Social Security payments. IRMAA will apply if individual income is over $85,000 or if married (filing joint tax return) income is over $170,000. If enrolled in the Group Medicare Advantage plans with Humana or UnitedHealthcare, higher income members may be subject to IRMAA. 14

15 2016 Non-Medicare Retiree Options 15

16 2016 Benefit Changes (Actives & Non-Medicare Retirees) Consumer-Directed Health Plan (CDHP) with HRA Enhanced 80/20 Plan Traditional 70/30 Plan Increase premium approximately $40 with the opportunity to earn it down to $0 Modify healthy activities to earn premium credits Increase HRA contribution by $100 to help offset member cost share Increase out-of-pocket max by $500 Establish Health Engagement Program to earn additional contributions to HRA: Increase credits for PCP visits and use of Blue Options Designated Providers Engage members with chronic conditions Healthy lifestyle program for all members Increase premium approximately $40 with the opportunity to earn it down to approximately $15 Modify healthy activities to earn premium credits Increase Tier 5 (non-preferred specialty medications) pharmacy coinsurance maximum Increase member cost share copays, deductible, coinsurance max, and pharmacy out-of-pocket max Premium amounts referenced on this slide are estimates and require legislation and Board approval 16

17 2016 Plan Design Changes (Actives & Non-Medicare Retirees) Current CDHP 2016 CDHP Current 2016/80/20 Current 70/ /30 Annual Contribution to Health Reimbursement Account (HRA) $500 Individual $1,500 Family $600 Individual $1,800 Family N/A N/A N/A Annual Deductible $1,500 Individual $4,500 Family $1,500 Individual $4,500 Family $700 Individual $2,100 Family $933 Individual $2,799 Family $1,054 Individual $3,162 Family Coinsurance Maximum N/A N/A $3,210 Individual $9,630 Family $3,793 Individual $11,379 Family $4,282 Individual $12,846 Family Out-of-Pocket (OOP) Maximum Pharmacy Out-of- Pocket Maximum $3,000 Individual $9,000 Family $3,500 Individual $10,500 Family N/A N/A N/A Included in OOP Included in OOP $2,500 $2,500 $3,294 Preventive Care $0 ACA Services $0 ACA Services $0 ACA Services PCP Visit Specialist Visit 15% after deductible; $15 added to HRA if you use PCP on ID 15% after deductible; $10 added to HRA if you use Blue Options Designated specialist 15% after deductible; $25 added to HRA if you use PCP on ID 15% after deductible; $20 added to HRA if you use Blue Options Designated specialist $30 for primary doctor; $15 if you use PCP on ID card $70 for specialist; $60 if you use Blue Options Designated specialist $35 PCP $81 Specialist $39 PCP $92 Specialist $35 $39 $81 $92 Urgent Care 15% after deductible 15% after deductible $87 $87 $98 Chiro/PT/OT 15% after deductible 15% after deductible $52 $64 $72 Emergency Care 15% after deductible 15% after deductible $233, then 20% after deductible $291, then 30% after deductible $329, then 30% after deductible Inpatient Hospital 15% after deductible; $50 added to HRA if you use Blue Options Designated hospital 15% after deductible; $200 added to HRA if you use Blue Options Designated hospital $233 copay, then 20% after deductible; copay not applied if you use Blue Options Designated hospital $291, then 30% after deductible $329, then 30% after deductible

18 2016 Plan Design Pharmacy Changes Pharmacy Benefit Current CDHP 2016 CDHP Current 80/ /20 Current 70/ /30 Tier 1 15% after 15% after $12 $12 $12 $15 Tier 2 deducible for in deducible for in $40 $40 $40 $46 Tier 3 network network benefits, 35% benefits, 35% $64 $64 $64 $72 Tier 4 after deductible after 25% up to 25% up to 25% up to $100 25% up to $100 out of network deductible out $100 $100 Tier 5 of network 25% up to 25% up to 25% up to 25% up to $125 $132 $125 $132 OOP Integrated with Medical Integrated with Medical $2,500 Rx Only $2,500 Rx Only $2,500 Rx Only $3,294 Rx Only ACA Preventive Medications Covered 100% Covered 100% Covered 100% Covered 100% No No CDHP Preventive Medications Waive deductible, 15% coinsurance only Waive deductible, 15% coinsurance only N/A N/A N/A N/A 18

19 Wellness Premium Credits N/A N/A 19

20 Wellness Premium Credits Wellness Activity How to Complete It When Members Can Take It Subscriber attests to being a non-tobacco user or commits to enroll in QuitlineNC s multi-call program and attests for spouse if applicable Subscriber updates or completes a confidential Health Assessment (HA) Subscriber selects a Primary Care Provider (PCP) and for each dependent covered on the State Health Plan. -AND- Subscriber watches a brief video on Patient Centered Medical Homes Log into eenroll, the attestation question will be included in the enrollment flow. Through the State Health Plan website ( click on Personal Health Portal. Health Assessments can also be completed by telephone at *Make sure all biometric numbers are included to receive a complete view of your health status. Log into eenroll system to select a PCP and watch the video. If members have trouble locating a provider, they can contact During Annual Enrollment, Oct. 15 Nov. 18, Even if members attested during last year s Annual Enrollment, they will need to reattest. If Subscribers have taken or updated their Health Assessment between Nov. 1, 2014, and Nov. 18, 2015, through the Personal Health Portal or by phone, it will count toward your premium credit, so encourage people to take it now! If members selected a PCP during the last Annual Enrollment or at some other time throughout this year, they will receive the premium credit. Video will be available beginning Oct. 1, 2015 in eenroll as part of the enrollment flow. 20

21 Consumer-Directed Health Plan (CDHP): Medical Benefits As a reminder, instead of copays, members will have to meet a deductible. After meeting the deductible members pay a 15% coinsurance on all in-network medical and pharmacy benefits except for ACA preventive services and ACA preventative medications, which are covered at 100%. The deductible and coinsurance are included in the out-of-pocket maximum. Medical and pharmacy expenses both apply to the out-of-pocket maximum. The CDHP is paired with a Health Reimbursement Account (HRA) to assist members with out-of-pocket expenses (deductible and coinsurance) The type of coverage (employee-only) determines the amount placed in the member s HRA account. 21

22 Consumer-Directed Health Plan (CDHP): Pharmacy Benefits For Prescription Drugs: You will pay in full for prescription drugs if your deductible has not been met. Pay in full means, you will pay the allowed amount for the drug Once your deductible has been met, you will pay a 15% coinsurance for prescriptions until your out-of-pocket maximum has been met. Once your out-of-pocket maximum has been met, your prescription will be covered at 100%. NEW in 2016: Rx Debit Card for CDHP members ACA and CDHP Preventive Medications ACA Medications covered at 100% Preventive Medications on the CDHP Preventive Medication list are subject to a 15% coinsurance with no deductible. Examples of medications include those used to treat heart disease, stroke, asthma, and diabetes. A list of these medications is available on the Plan s website at: When HRA funds are available, this card will work like a debit card and take funds out of your HRA. 22

23 2016 Annual Enrollment 23

24 Eligibility and When to Select During the Annual Enrollment Period, which will be held Oct. 15-Nov. 18 you can: Stay in the Base or Traditional 70/30 plan in which you are enrolled Switch to a different Base or elect an Enhanced Group Medicare Advantage Plan offered Switch to the Traditional 70/30 plan Drop or add dependents Disenroll from the Plan Medicare Primary dependents will stay together. If spouse/dependents are not Medicare eligible: They have same options available to active employees/non-medicare members. Enhanced 80/20 Traditional 70/30 Consumer-Directed Health Plan w/hra 24

25 Annual Enrollment Period Your opportunity to make changes: Change plans Opt in/out of the State Health Plan Add dependents Remove dependents If you opt out of the State Health Plan during an Annual Enrollment period, you may opt back into the State Health Plan during any following Annual Enrollment period or as a result of a Qualifying Life Event. Annual Enrollment will be from October 15-November 18,2015. REMEMBER: If you are in one of the Medicare Advantage ENHANCED plans for 2015, you will be enrolled into that carrier s Medicare Advantage Base plan for 2016 UNLESS you make a different selection during the Annual Enrollment Period. 25

26 How to Make a Change for 2016 You will be able to make changes either online or by phone: the ORBIT Online Retirement Benefits through Integrated Technology enrollment system Call , Monday-Friday from 8am-5pm Remember to make note of date, time and whom you spoke with in your records. Any plan changes during Annual Enrollment Period become effective January 1, Retired Medicare Primary members not wishing to enroll into one of the Group Medicare Advantage plans may elect to enroll into the Traditional 70/30 plan. If 70/30 elected for 2016, remember Medicare will be primary and 70/30 will be secondary coverage. 26

27 Effective July 1, 2015 A legislative change became effective July 1, 2015, which now allows retirees and surviving spouses to disenroll from the State Health Plan without a Qualifying Life Event. This mean they can drop entirely from the State Health Plan cannot make changes to coverage type. The legislative change also allows retirees and surviving spouses to disenroll their dependents from the State Health Plan during the Plan year without a Qualifying Life Event. Coverage under the Plan will end on the earliest of the following dates: Last day of the month in which the State Health Plan approves cancellation of coverage or as soon as administratively possible; or Last day of the month for which a premium is paid in full. All other changes must be made during an Annual Enrollment Period or with a Qualifying Life Event. 27

28 Humana and UnitedHealthcare Medicare Advantage Base Plans Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $0.00 N/A $0.00 Retiree + Child(ren) Retiree + Spouse Retiree + Family $0.00 $ $ $0.00 $ $ $0.00 $ $

29 Humana and UnitedHealthcare Medicare Advantage Enhanced Plans Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $66.00 N/A $66.00 Retiree + Child(ren) Retiree + Spouse $66.00 $ $ $66.00 $ $ Retiree + Family $66.00 $ $

30 Traditional 70/30 PPO Plan Coverage Type Retiree Premium Dependent Premium Total Monthly Premium Retiree Only $0.00 N/A $0.00 Retiree + Child(ren) Retiree + Spouse $0.00 $ $ $0.00 $ $ Retiree + Family $0.00 $ $

31 Thank You! Questions? Photo credits: Thinkstock Images