Health Options Program

Transcription

1 Pennsylvania Public School Employees Retirement System (PSERS) Health Options Program NEWS For Retirees Eligible for Premium Assistance Winter 2016 Getting Your Vitamins: Go To The Source If you re taking lots of vitamins, you may be wasting money. In 2015, Americans spent $21 billion on vitamins and mineral supplements and, according to many nutritionists, much of it was unnecessary. If you re concerned that you have a vitamin or mineral deficiency, you may need to simply change your diet. Most people can get 100% of the nutrients they need from the foods they eat. In fact, experts agree that supplements should be included only if a vitamin or mineral deficiency is causing a health concern and cannot be addressed with diet. Although the Academy of Nutrition and Dietetics suggests older adults should pay special attention to their intake of calcium, vitamin D, vitamin B-12, potassium and fiber, there is little scientific evidence that shows an increasing need for most vitamins or minerals as we age. In fact, too much of some nutrients can lead to difficulty sleeping or concentrating, nerve problems such as numbness or tingling, or feeling more irritable. Excesses of Vitamin C or zinc can cause nausea, diarrhea and stomach cramps. Too much selenium can lead to hair loss, gastrointestinal upset, fatigue and mild nerve damage. Talk to your doctor before making any changes to your diet or if you have questions about taking vitamins. He or she can assess your symptoms and run simple tests to determine whether or not your body is in balance. Eat smart. When you re planning your menus, consider trying some of the foods listed below: Sweet potatoes, spinach, fish, milk, eggs and carrots are good sources of vitamin A. Vitamin B12 occurs naturally in trout, salmon and tuna and is added to many breakfast cereals. Red peppers, oranges, kiwi fruit, broccoli, brussels sprouts and cantaloupe provide vitamin C. Yogurt, dairy products and leafy greens are natural sources of calcium. Calcium is often added to fruit juices and cereals. Natural sources of vitamin D include fatty fishes like salmon and mackerel. It can also be found in milk, breakfast cereals, yogurt and orange juice. Sunflower seeds and almonds contain vitamin E.

2 WHY JOIN THE HEALTH OPTIONS PROGRAM Age 65 Discount. If you enroll in the HOP Medical Plan within 180 days of your 65th birthday, you will pay a discounted premium. Substantial Premium Subsidy. If you are eligible for Premium Assistance and enroll in the Health Options Program, you can receive up to $100 per month in Premium Assistance from PSERS to help pay for health care coverage. Designed with You in Mind. The Health Options Program is sponsored by the Pennsylvania Public School Employees Retirement System (PSERS) for the exclusive benefit of our retirees and their families. It provides comprehensive medical, prescription drug and dental coverage at competitive rates. We work hard to provide you with health care coverage that meets your needs. Choice. The Program offers a choice of medical and prescription drug coverage options for both Medicareeligible and non-medicare-eligible participants. If you are Medicare-eligible, dental coverage can be included with either the HOP Medical Plan or Value Medical Plan. See page 3 for more information about the new options for Convenience. We make paying monthly premiums easy by deducting them automatically from your retirement benefit (as long as your benefit exceeds the premium cost). Flexibility. You can enroll, add dependents, or change your option at any time if you or one of your dependents experience a Qualifying Event (see examples below). Once you are enrolled in the Health Options Program, you can also change your option each year during the Option Selection Period with those changes becoming effective the first of the upcoming calendar year. SilverSneakers. If you enroll in the HOP Medical Plan or the HOP Pre-65 Medical Plan, you can join the SilverSneakers Fitness Program at no additional cost. SilverSneakers offers treadmills, weights, heated pools and fitness classes all included with your basic fitness membership. To find a location near you, go online to Access to Resources. You have access to health care information to help you make informed health care decisions and lead a healthier lifestyle. You will receive newsletters, booklets and a Personalized Statement to help you make the most of your participation. Customer service representatives are specially trained and dedicated to helping participants. You can reach one by calling weekdays from 8 a.m. to 7 p.m EST. A website ( is accessible 24 hours a day, 7 days a week. Examples of Qualifying Events You retire or lose health care coverage under your school employer s health plan. Coverage under your school employer s health plan includes any COBRA continuation coverage you may elect under that school employer s plan. You involuntarily lose health care coverage under a non-school employer s health plan (which includes any COBRA continuation coverage you may elect under that non-school employer s health plan). There is a change in your family status (including divorce, the death of a spouse, addition of a dependent through birth, adoption or marriage, or a dependent loses eligibility). You or your spouse reach age 65 or become eligible for Medicare. You become eligible for Premium Assistance due to a change in legislation. A plan approved for Premium Assistance terminates or you move out of a plan s service area. Depending on individual circumstances, Qualifying Events may apply independently to you, your spouse and/or your dependents. For example, if your spouse turns age 65 and becomes eligible for Medicare, he or she can choose to enroll in the Health Options Program, whether or not you also enroll. 2

3 INTRODUCING NEW OPTIONS FOR 2016 The Health Options Program introduced the Value Medical Plan, the Value Medicare Rx Option and the MetLife Dental Plan for The Value Medical Plan and Value Medicare Rx Option were designed to provide financial protection in the event of unexpected, high-cost hospital, medical and prescription drug expenses. The MetLife Dental Plan can be combined with either Medicare Supplement plan for those members who want to have preventive, basic and major dental services covered. An Overview of the New Options Value Medical Plan. This Plan is for members who are comfortable paying higher deductibles and copays for services in exchange for a lower monthly premium. If you are admitted to the hospital, the Plan pays 100% of Medicare s hospital deductible and daily copays but you must pay the first $500. When you have medical expenses, the Plan limits your share of the cost but only after you pay Medicare s annual deductible ($166 in 2016). If you are in a skilled nursing facility for more than 20 days, you and the Value Medical Plan share the cost; you pay $50 a day and the Plan pays the balance. Value Medicare Rx Option. The Value Medicare Rx Option is for retirees who are willing to pay Medicare s annual $360 prescription drug deductible in exchange for a lower monthly premium. It is designed to provide financial protection in the event of unexpected high-cost prescription drug expenses. After you meet the annual deductible, you pay 25% of the cost of any medication in Initial Coverage. This option is available to members who are enrolled in the HOP Medical Plan or the Value Medical Plan. The Metlife Dental Plan. The Dental Plan helps you maintain good oral health at a reasonable cost and offers a number of other important advantages. You can use any dentist you want but choosing one that s part of the MetLife network (in-network) saves you money. This Plan is available to members and their dependents enrolled in the HOP Medical Plan or the Value Medical Plan. The MetLife Dental Plan is not available on a standalone basis or with a Medicare Advantage plan. Additional information is available online at 3

4 QUICK REMINDERS Extended Hours for the HOP Administration Unit The HOP Administration Unit is now available to take calls Monday through Friday from 8:00 a.m. to 7:00 p.m. EST. Customer service representatives can help with questions about enrollment, premium payments and refunds as well as claim questions for the HOP Medical Plan or the Value Medical Plan. The phone number is PSERS25 ( ). It s Flu Season If you haven t had a flu shot, now s the time to get one. According to the Centers for Disease Control (CDC), it s not too late. The flu generally peaks in January or February and can still be around in March, April and May. High Scores Continue for the Rx Options Each year, Medicare evaluates prescription drug plans based on customer service, the frequency of member complaints, overall member satisfaction and patient safety and awards a star rating to each plan based on performance. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. For the second consecutive year, the Basic and Enhanced Medicare Rx Options offered under the Health Options Program were awarded 4.5 out of a possible 5 stars. Nationwide, only 51 of the nearly 500 plans included in Medicare s review ranked higher. PSERS Retirees Are Out and About with SilverSneakers Each month, more than 10,000 PSERS retirees are using Healthways SilverSneakers facilities in the Commonwealth and elsewhere to exercise and socialize and many are going six or more times. If you re enrolled in the HOP Medical Plan or the HOP Pre-65 Medical Plan, you can join SilverSneakers at absolutely no cost to you. If you re enrolled in a Medicare Advantage plan, you may also have access to SilverSneakers or another fitness program. Check with your plan. As a reminder, the Value Medical Plan does not include a SilverSneakers membership. Good Dental Health; Good Overall Health Good dental health delivers benefits beyond strong teeth and a nice smile it can help prevent other, more serious conditions too. Routine dental checkups can help detect early signs of gum disease and other dental issues that would allow the bacteria from your mouth to travel through your bloodstream to other parts of your body. The MetLife Dental Plan, available with the HOP Medical Plan and the Value Medical Plan, covers routine checkups and other preventive services at no cost when you go innetwork (see page 3 for more information). 4

5 2016 Medicare Highlights Each year, if needed, the Centers for Medicare and Medicaid Services (CMS) adjust Medicare s premiums, deductibles and copayments. As a reminder, Medicare Part A covers hospital expenses and Medicare Part B covers other types of medical expenses, including physician services, certain home health services and durable medical equipment. Medicare Part D covers prescription drugs. Part B Premium & Deductible For 2016 Most people do not pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working. However, to be covered under Medicare Part B, you must pay a monthly premium (in most cases deducted from your Social Security benefit). As required by law, the standard monthly premium is set each year at 25% of the cost for senior beneficiaries. The government pays the remaining 75%. Most Medicare beneficiaries will continue to pay the same Part B premium in 2016 as in If your annual income was less than $85,000 (or $170,000 for joint filers) in 2015, your Part B premium remains at $ About 30% of Medicare beneficiaries including those who will enroll in Part B for the first time in 2016 will pay a Part B premium of at least $ The premium varies depending upon income and tax filing status. The Part B deductible is increasing to $166 in This is the amount you must pay for health care before Medicare begins to pay for covered services and products. The chart below compares some of your costs in 2016 to Note that the HOP Medical Plan pays your Part A deductible and coinsurance for stays in hospitals and skilled nursing facilities, as well as the Part B deductible. The Value Medical Plan also pays 100% of Medicare s hospital deductible and daily copays but only after you pay the first $500. AMOUNT YOU PAY (Without Supplemental Insurance) Part A First-day hospital deductible $1,260 $1,288 Coinsurance for days 1-60 of a hospital stay $0 $0 Coinsurance for days of a hospital stay $315/day $322/day Coinsurance for days 1-20 in a skilled nursing facility $0 $0 Coinsurance for days in a skilled nursing facility $157.50/day $161/day Part B Standard monthly premium for most Medicare beneficiaries $ $ Standard monthly premium for new enrollees in 2016 and certain other Medicare beneficiaries $ $ (or more based on income) Deductible $147 $166 Coinsurance 20% 20% 5

6 HOP Administration Unit P.O. Box 1764 Lancaster, PA New Options for 2016 Have a Question? If You Have a Question About Please Call Or Go Online Enrollment in the Health Options Program Health Options Program in general HOP Administration Unit PSERS25 ( ) From outside the U.S.: a.m. to 7 p.m. eastern time, weekdays Health Options Program Website Premium Assistance Premium Assistance Office a.m. to 4:30 p.m. eastern time, weekdays Retirement PSERS PSERS4U ( ) 7:30 a.m. to 5 p.m. eastern time, weekdays PSERS Website Medicare Medicare MEDICARE ( ) Medicare Website