Your UC Medical Plan Coverage Post Retirement. Sue Forstat Manager, UCSF Health Care Facilitator Program

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1 Your UC Medical Plan Coverage Post Retirement Sue Forstat Manager, UCSF Health Care Facilitator Program

2 Tell me and I forget. Teach me and I remember. Involve me and I learn. Benjamin Franklin

3 Retiree Health Insurance Eligibility

4 Will I be eligible for UC Retiree Health insurance when I retire? To be eligible for retiree health benefits, employees must meet the following general criteria at the time of retirement: Be enrolled in or eligible to enroll in UC employee benefits on the day they retire Continue coverage at the time they retire Have a retirement date that is within 120 days of the date they end UC employment Continue coverage until the date retirement income begins

5 Will I be eligible for UC Retiree Health insurance when I retire? Additional eligibility rules based on date of membership in UCRP: ELIGIBILITY RULES FOR EMPLOYEES HIRED PRIOR TO JAN. 1, 1990 ELIGIBILITY RULES FOR EMPLOYEES HIRED OR REHIRED FROM JAN. 1, 1990 TO JUNE 30, 2013 ELIGIBILITY RULES FOR EMPLOYEES HIRED OR REHIRED ON OR AFTER JULY 1, 2013 Details for each group outlined in Fact Sheet: UC Retiree Health Eligibility Rules

6 Will my dependents be eligible for coverage under my retiree health insurance? Same rules/requirements for dependents of retirees as dependents of employees Survivors eligible if enrolled in plan and will receive monthly survivor benefits from UCRP

7 Retiree Health Insurance Costs

8 How Much will my Retiree Health Insurance Cost? Everyone has some cost responsibility for retiree health insurance Two types of cost insurance premium and cost for services; Insurance premium costs are different than when you are an employees; UC contributes less towards the total cost Insurance premium costs impacted if subject to graduated eligibility Insurance premium cost changes over time because the full plan premiums will change (usually increase)

9 Retiree Health Premiums Retiree Contribution UC contribution

10 Retiree Health Insurance Premium with Graduated Eligibility Retiree Share Retiree premium UC Contribution

11 Medical Plan Chooser

12 Medical Plan Chooser

13 Medical Plan Chooser

14 Retiree Health Insurance Coverage

15 Are the plan offerings for retirees the same as for employees? Non-Medicare plans are the same for retirees as employees Medicare versions of all plans/partner plans For HMO plans, will use your home zip for service area UC does offer a different health insurance program for retirees who move out of California and they/all covered dependents are enrolled in Medicare

16 Retiree Medical Plan Options 2017 Commercial: Health Net Blue & Gold Kaiser UC Care UC HSA plan only if enrolled at time of retirement Medicare: Health Net Seniority Plus Kaiser Senior Advantage UC Medicare PPO UC High Option Supplement to Medicare

17 Can I select a different health insurance plan when I retire or become eligible for Medicare? Neither retirement nor Medicare enrollment provide an opportunity to change plans at that specific time in general Retirees have the same options to make health insurance changes during Open Enrollment each year When you become eligible and enroll in Medicare, you will be transitioned to the Medicare version of the plan you are currently enrolled in Exceptions: Plan not offered based on your home zip code Move out of California and are currently enrolled in an HMO Move out of the US

18 Retiree Health Insurance & Medicare

19 What is Medicare? Medicare is a Federal Medical Insurance Program for: People 65 years of age and older regardless of their income or medical history Medicare expanded in 1972 to include the following groups: Some people with disabilities under age 65 (24 month waiting period) End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) In 2000, individuals with Lou Gehrig s Disease (amyotrophic lateral sclerosis) could enroll at time of diagnosis (rather than having to satisfy the 24-month waiting period

20 Parts of Medicare Coverage Part A Hospital Coverage Part B Medical Coverage Part C Medicare Advantage Program Part D Out-Patient Prescription Drug Coverage established in 2006

21 What happens to my retiree health insurance when I am eligible for Medicare? UC requires all retirees and their eligible dependents to enroll in both Medicare Part A and Medicare Part B when they become eligible and coordinate their Medicare with their retiree health insurance Retirees and their dependents risk financial penalty/de-enrollment from UC sponsored medical coverage for lack of compliance In most cases your health insurance premium cost will decrease, but you will also start paying a Part B premium

22 Why UC Mandates Medicare Enrollment Retirees over age 65 without Medicare cost at least twice as much to insure as those with Medicare Enrollment in Medicare partially reduces the cost of the plan, which keeps the UC premiums affordable for all Allows UC to continue to fund health benefits for retirees

23 Exceptions to UC Medicare Mandate UC does not require retirees ineligible for premium free Medicare Part A to enroll in Part B You reside outside the United States you must enroll if you return you may incur a Medicare late enrollment penalty You have UC-sponsored health coverage through your spouse who is still working at UC and you are covered under their medical plan at the time of retirement

24 How do I enroll in Medicare? Initiate Medicare enrollment Medicare Part A (if not enrolled) and Medicare Part B. Do NOT enroll in a Medicare Part D plan (prescription coverage) Online at OR By phone at OR Schedule an appointment at your local Social Security Office

25 How do I enroll in Medicare Part A Enroll online:

26 Timing of Medicare Enrollment If you are retired, when you reach age 65, you should apply for Medicare two months before your reach age 65 If you are receiving SS benefits at the time, you will automatically be enrolled in both Part A and Part B and a Medicare card will be sent to you about 3 months before your birthday If you are 65 or older at the time of retirement you will need to provide an employment verification form (provided by your retirement counselor)

27 How much does Medicare cost? Part A Free if meet the 40 quarter requirements Part B based on modified gross income from IRS returns two years prior to enrollment date Part D IRMAA also based on income (higher income = pay more) Important Part B and Part D IRMAA costs are paid directly to Social Security and separate from your retiree insurance premiums IRMAA Income Related Monthly Adjustment Amounts

28 Medicare Part B Premiums 2017 If your yearly income in 2015 (for what you pay in 2017) was File individual tax return File joint tax return File married & separate tax return You pay each month (in 2017) $85,000 or less $170,000 or less $85,000 or less $134 above $85,000 up to $107,000 above $107,000 up to $160,000 above $160,000 up to $214,000 above $170,000 up to $214,000 above $214,000 up to $320,000 above $320,000 up to $428,000 Not applicable $ Not applicable $ above $85,000 and up to $129,000 $ above $214,000 above $428,000 above $129,000 $428.60

29 Medicare Part D IRMAA If your filing status and yearly income in 2015 was File individual tax return File joint tax return File married & separate tax return You pay (in 2017) $85,000 or less $170,000 or less $85,000 or less your plan premium above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $ your plan premium above $107,000 up to $160,000 above $214,000 up to $320,000 not applicable $ your plan premium above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 up to $129,000 $ your plan premium above $214,000 above $428,000 above $129,000 $ your plan premium

30 Medicare Coordination with UC Retiree Insurance

31 How Will My Plan Change When I Am Enrolled in a Medicare Coordinated Plan? Must use Medicare providers for Medicare covered services The Medicare-coordinated version/partner plan may differ in: Costs Service area Plan benefits/drug formulary Enrollment/de-enrollment process

32 Do all providers accept Medicare? Provider Accepts Assignment Provider will accept Medicare contracted rates for services Provider Does not Accept Assignment Provider can charge up to 15% above Medicare contracted rates Provider Opts Out of Medicare or Does Not Have a Medicare Contract Claims from a provider that has opted out of Medicare or from a provider without a Medicare certificate number will not be paid by Medicare and will not be paid by your UC sponsored health plan

33 How does Medicare Coordinate with HMO plans (2017)? If you are enrolled in a Health Maintenance Organization plan (HMO) -- Health Net Blue & Gold, or Kaiser-- Medicare Parts A, B and D must be assigned/locked to the plan You must live in the plan s CA service area Health Net Seniority Plus is the full HN provider network You will need to complete a MAPD form assigning Medicare to your plan

34 How does Medicare Coordinate with PPO plans (2017)? High Option Supplement to Medicare Blue Shield Medicare PPO (Preferred Provider Organization) You may see any Medicare provider Medicare pays as primary Blue Shield coordinates their payment after Medicare pays on the claim Plans provide coverage for services not covered by Medicare or partially covered by Medicare if medically necessary deductible will apply

35 How Do I Coordinate My Medicare With My UC Retiree Coverage Complete the UC required Medicare coordination forms and submit to UC Retiree insurance and/or the insurance plan. Each individual coordinating with Medicare completes their own form UC Retiree insurance will enroll you in the Medicare plan/transfer your medical plan enrollment to the Medicare plan once they receive your completed Medicare coordination forms and adjust your plan premiums as indicated Your family members enrolled as dependents who are not eligible for Medicare will remain in the a non-medicare plan

36 Resources

37 Where can I get more information? Group Insurance Eligibility Fact Sheet for Retirees: A New Approach to Your Retiree Medical Benefits: (Retirees and their family members enrolled in Medicare and living outside of California) Fact Sheet: UC Retiree Health Eligibility Rules: Medicare Fact Sheet: Medical Plan Chooser: Medicare General Information and Resources: Medicare premium information for 2017:

38 Tips For Planning Ahead Review Open Enrollment materials each year Stay informed of general developments with Medicare and health insurance Use your UC online resources UC Net Website: UCSF HCF Website: Use your Medicare resources Health Insurance Counseling and Advocacy Program (HICAP) UCSF Health Care Facilitator (HCF) Program - Sue.Forstat@ucsf.edu

39 Health Care Program Having a hassle with your health plan? Your health care facilitator can help.

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