2012 Health Meeting June 13-15, 2012

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1 2012 Health Meeting June 13-15, 2012 Session #5 PD: Retiree Health and Medicare Supplement Kristi M. Bohn, FSA, MAAA, EA Matthew James Hayes, FSA, MAAA David M. Hilko, EA, MAAA Moderator Susan E. Pierce, FSA, MAAA Primary Competency External Forces & Industry Knowledge

2 5/29/ Individual Options and Issues 2 1

3 California Oregon Washington Nevada Alaska Idaho Arizona Utah Montana Wyoming Colorado New Mexico North Dakota South Dakota Nebraska Kansas Texas Oklahoma Hawaii Minnesota Iowa Missouri Arkansas Louisiana Wisconsin Illinois Mississippi Indiana Michigan Tennessee Alabama (portability only) Kentucky Ohio Georgia West Virginia Pennsylvania Virginia North Carolina South Carolina Florida Vermont New York New Hampshire Maine Massachusetts Rhode Island Connecticut New Jersey Delaware Maryland 5/29/2012 Individual Options Prior to Medicare eligibility Individual market High Risk Pools and Pre-existing Condition Insurance Plans (PCIP) Exchange in 2014 High Risk Pools by State 3 Individual Options After Medicare Eligibility Parts A, B Medicare Supplement (Medigap) Medicare Advantage Medicare Cost Plans Medicare Part D Keep working. 4 2

4 5/29/2012 Individual Options Source: Society of Actuaries 2011 Retirement Risk Survey 5 Individual Options Source: 6 3

5 5/29/2012 Individual Issues Expensive even with Medicare Fidelity Investments expects at 65, a retired couple needs $250,000 for health care. Center for Retirement Research at Boston College: a 65-year-old married couple needs $197,000. Employee Benefit Research Institute (2011) a 65-year-old married couple needs $210,000 to have a 50 percent chance of affording their retirement health expenses. 7 Individual Issues 8 4

6 5/29/2012 Individual Issues Too many choices? search: 33 stand-alone PDPs 23 MA-PDs 9 MA choices Medicare Supplements not even counted above Medicare.gov now has a policy search function (but not an enroll function) Some of the non-cms websites may be culling the market down based on the size of commissions fiduciary concerns 9 Individual Issues Certain risks misunderstood and high Custodial care, specialty drugs, SNF days Formulary implications for Part D versus commercial formularies Benzodiazepines, barbiturates, cough suppressants, vitamins, certain urinary track infection drugs drugs under Medicare Part B like cancer oral chemotherapy, injectibles, test strips and lancets, DME supplies 10 5

7 5/29/2012 Individual Issues Adult children or nursing home making choices that effectively drop employer coverage Network access for certain MA plans Exchange plans may have very tight networks in order to compete on price 11 Are Retirees Less Healthy? Risk Scoring Method: retrospective ERGs 12 6

8 5/29/2012 Are Retirees Less Healthy? 13 7

9 Retiree Healthcare and Medicare Supplement Employer Group Options and Issues David Hilko Deloitte Consulting LLP June 2012 The Evolution of Retiree Medical The landscape of Retiree medical plans has undergone significant changes in the past 30 years. These changes are influenced by accounting and legislative changes, as well as population growth and cost increases. Wave 1 Paternalistic Wave 2 Cost-Share Wave 3 Limit Cost Wave 4 Defined Contribution 80s and early 90s Mid-to late 90s 00s 10s Traditional and Indemnity Plans Employersponsored retirement plans non-contributory Medicare FAS 106 implemented Managed Care Plans Medicare (Parts A & B) Medicare+Choice HMOs Employer/retiree cost-share approach Healthcare caps Elimination of retiree healthcare benefits for a subset of actives Retiree pay all Retiree Buyouts Medicare Coordinators Retiree Medical Savings Accounts Healthcare Exchanges beginning in 2014 HSA/HRA accounts -2-1

10 Future Vision Characteristic Current Future Employer Subsidy Annuity like payment based on healthcare costs Capped for many employers HRA Contribution Amounts not used can be rolled over Benefit Approach Group Plan typically with limited options for retirees Guaranteed Issue Individual Plans accessed through the exchanges Federal Subsidies Group healthcare plans that allow employers to maximize tax incentives Shift to MAPDs or EGWPs to maximize subsidy Administration Significant time and dollars spent on administering retiree healthcare plans Much of the administrative processes are eliminated through use of outside vendors Employee Savings for Retiree Healthcare No mechanism used to allow employees to save on a tax preferred basis for these costs -3- Employees will need to save for the cost of retiree healthcare as part of overall retirement planning Retiree Healthcare Hot Topics Change employer plans to MAPD or Employer Group Waiver Plan (EGWP) Replace Group Healthcare Plan with Employer Contribution to an HRA for Medicare eligible retirees Replace Group Healthcare Plan and provide employer subsidy to the State Exchanges for pre-medicare coverage Convert traditional retiree healthcare plan to an account balance plan (Retiree Medical Savings Account) that an employee earns over time -4-2

11 Employer Group Waiver Plans (EGWP) can generate significant savings for the employer Employer continues to provide a group healthcare plan Prescription drug coverage will now be provided by a Prescription Drug Plan (PDP) for Medicare eligible retirees Current plan provisions will be incorporated into PDP so from a design perspective the plan will have the same benefit levels Possible disruption for employees due to pharmacy network or exclusion of certain drugs High income retirees may need to pay a higher premium and low income retirees may pay reduced drug co-pays Savings can double the Medicare Part D subsidy payment for the Plan Can be up to $40-60 month per covered retiree Drug vendor should be able to quantify Employer may share a part of the savings with retirees through reduced contributions Case Study Large Plan Sponsor Plan Sponsor covers 13,000 Medicare eligible retirees Currently collects RDS subsidy for prescription drug coverage Total Accumulated Pension Benefit Obligation APBO is $3.9B with annual employer cash payment of $174M After implementation of HRA/MC model Plan Sponsor no longer collects RDS subsidy If employer elects to not share any savings with retirees, APBO is reduced by $230M, annual financial statement expense is reduced by $40M and cash costs are reduced by $8M a year. Earnings per share increases by 3 cents a share

12 Healthcare Exchanges are transforming Employer medical benefit design and delivery models Currently exist for individuals only Only economically efficient for Medicare eligible retirees Features of Medicare eligible retiree exchanges Defined contribution in nature Large number of choices in coverage types for individuals Aggregate lower cost than group healthcare plans Reduce administration for employers Guaranteed coverage for retirees More predictable cost pattern for employers Healthcare Reform will create more viable exchanges for active and pre-65 retiree coverage Eventually will include an employer exchange There is a built in subsidy for pre-65 retiree coverage in individual exchanges Still uncertain on how cost will compare to group healthcare plans The active and pre-65 retiree exchanges are subject to Healthcare Reform being upheld Medicare Exchanges reduce employer and participant cost in many different ways Eliminates over-insurance inherent in group healthcare plans An educated retiree selects the plan that is best for their current situation They can change their election each year at open enrollment HRA design provides incentives for retirees to become better consumers of healthcare benefits Maximize governmental subsidies in certain individual plans There are still Medicare Advantage plans that exist today at no cost to the retiree General health of covered population may be better than under group plan Pricing reflects overall health of covered population and not retiree s specific healthcare condition Employer and employees retain scale market pricing with large number of retirees in individually selected plans Plan priced not on individual underwritten basis but rather based on entire covered population (similar to group plan)

13 The change is made through a shift to a Defined Contribution design Employer still provides a subsidy but form of subsidy changes Provide a Health Reimbursement Account (HRA) to retirees HRA is typically a monthly or an annual contribution but can be in a lump sum form Spouse typically gets separate HRA HRA is used for retiree premiums and may be used for other out of pocket costs Any unused amounts are typically rolled over for future use Employers with collectively bargained populations need to consider: What incentives may need to be negotiated to address smaller portion of retirees that could be negatively impacted? Employer still retains retiree healthcare liability, however, the form of the promise is changed -9- Participants are given choices regarding individual plans This tailoring of the employer s group coverage to individual choices is enabled with communication, consultation and transparency Retiree selects individual plan Retiree or HRA pays premium HRA account builds to provide additional benefits Employer engages Medicare Coordinator to help retiree select plan Employer determines design and delivery mechanism on premium payment Employer may allow HRA to reimburse other costs -10-5

14 Individual plan marketplace provides numerous options Medicare Advantage Low premiums some have no cost Typically have market based out-of-pocket costs Medicare Supplement Supplements Medicare coverage Can provide rich level of benefits Higher premium cost Prescription Drug Plan Provides drug coverage Generally does not provide for full coverage in the donut hole but donut hole is to be filled in by Medicare Coordinators assist retirees in decision making Advocate for Retiree HRA Administrator Primary Retiree Contact A Medicare Coordinator becomes a key element of the employer s delivery model for medical benefits. They are the first contact for the retiree in open enrollment and HRA expense management

15 Most retirees experience lower cost and greater flexibility Typically employers design the plan so that 70-90% of retirees will pay less in out-of-pocket costs under an HRA design Out-of-pocket costs include both retiree contributions and deductibles and co-pays from health plan Healthy retirees who have less healthcare needs will pay less under HRA plan Retirees with high healthcare costs or who have drug costs in the donut hole may pay more If retirees make educated choices they typically do not pay more than $500-$1,000 more in a year Because of annual cycle retirees can tailor coverage to needs regularly As health status changes, can increase healthcare coverage Retirees should save HRA early in their retirement to be used as health status changes Case Study Large Plan Sponsor Plan Sponsor covers 13,000 Medicare eligible retirees Currently collects RDS subsidy for prescription drug coverage Total APBO is $3.9B with annual employer cash payment of $174M After implementation of HRA/MC model Plan Sponsor no longer collects RDS subsidy Plan sponsor makes contributions to an HRA only to the extent that retirees elect reimbursement from the HRA Employer s savings are based on level of employer credit to HRA APBO is reduced by $ M+, annual financial statement expense is reduced by $35-70M and cash costs are reduced by $7-14M a year Earnings per share increased by 3-6 cents a share -14-7

16 Retiree Medical Savings Account (RMSA) Plan sponsor creates a nominal account for each employee Account is credited each year with an employer contribution credit May contain an interest credit but somewhat unusual At retirement, employee can access account to pay for healthcare related expenses If employee leaves prior to retirement, employee forfeits account Employer may allow employee to purchase healthcare coverage through group plan but retiree must pay the full cost Retiree can also use account to pay for healthcare premiums purchased through another group plan or in the individual marketplace Some employers allow retirees to use account to pay for out-of-pocket costs as well Retiree Medical Savings Account (RMSA) Example Employers credit $1K per year to an active with no interest credits After 30 years, employee has $30K to use for retiree healthcare Employee still needs to meet retirement eligibility to be able to utilize account Generally between age 55 and 60 with between 10 to 20 years of service -16-8

17 Copyright 2011 Deloitte Development LLC. All rights reserved. 9

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