ROCHESTER INSTITUTE OF TECHNOLOGY

Transcription

1 ROCHESTER INSTITUTE OF TECHNOLOGY 2017 Information on Medical and Rx Plan Changes Due to Medicare Eligibility This information is designed to help you understand the differences between the employee and retiree pre- Medicare coverage and the RIT retiree Medicare plans coverage. In addition, we outline the steps you will need to take if you need to make a plan change due to Medicare eligibility as a retiree or retirement when you are Medicare eligible. What is Medicare? Medicare is a federal insurance program and is administered by the Centers for Medicare and Medicaid Services (CMS). Medicare is generally available at age 65 for those who are retired. Those who continue to work past age 65 can continue to be covered under the active employee plan. Medicare has several parts: 1) Part A (hospitalization), 2) Part B (medical), 3) Part D (prescription drug). There is no premium for the Part A coverage (premiums for Part A are paid through a portion of the FICA tax deduction from the paycheck of those who are working). There is a premium for the Part B coverage; this premium (generally $134 per month in 2017, but it could be higher based on income) is deducted from your Social Security check. You will have Part D prescription drug coverage with your RIT retiree coverage. Like Part B, there is also an income threshold for Part D so there could be an additional premium for Medicare Part D deducted from your Social Security check depending on your income. For more information about Medicare, contact the Social Security Administration at (800) /v and (800) /TTY; or, go to the Medicare web page at Becoming Eligible for Medicare If you are retired and you or your spouse/partner will soon turn age 65, you should receive information from CMS about enrolling in Medicare. If you don t receive anything (it is usually sent about 3 months prior to your 65 th birthday), you should contact your local Social Security office and enroll in Medicare Part A (hospitalization) and Part B (medical). You may also receive information from Excellus BlueCross BlueShield. You can disregard the information from Excellus BCBS because you should complete the form(s) that RIT provides (outlined below). Please return the completed form(s) to RIT Human Resources. If you are Medicare-eligible at retirement, you will need to enroll in Medicare Part B (Medicare Part A should have gone into effect when you turned age 65). In order to continue RIT medical coverage as a retiree when you are eligible for Medicare, you must enroll in Medicare Part A and Part B. You do NOT need to enroll in a Medicare prescription drug plan because the coverage that RIT offers along with each retiree medical plan is considered Part D creditable coverage. Rev March 2017 Page 1 of 5

2 RIT Coverage Change-Medical Plan If you are retired, when you (and/or your spouse/partner) become eligible for Medicare (generally, the first of the month in which you attain age 65; if your birthday is the 1 st, it would be the 1 st of the prior month), you will need to change plans because the RIT Medicare plans are different than the pre-medicare plans. If you and/or your spouse/partner are over age 65 when you retire, you will need to choose a Medicare plan. There are Medicare rules regarding geographic access as outlined below: If you live permanently in the Rochester area at least six months of the year Medicare Blue Choice Plan 4 (without Rx Coverage Gap) Medicare Blue Choice Plan 5 (with Rx Coverage Gap) Preferred Gold HMO POS Option 1 (without Rx Coverage Gap) Preferred Gold HMO POS Option 2 (with Rx Coverage Gap) If you live permanently outside the Rochester area, you would enroll in one of the following plans Medicare Advantage Blue PPO without Rx coverage gap Medicare Advantage Blue PPO with Rx coverage gap The Medicare Advantage Blue PPO plans are available in most geographic areas. If they are not available in your area, you would enroll in either the Medicare Blue PPO without Rx coverage gap or the Medicare Blue PPO with Rx coverage gap. If You Your Spouse/Partner is Eligible for Medicare But the Other is NOT If either you your spouse/partner is eligible for Medicare (one of you is under age 65 and the other is/will soon be age 65 or older), the person who is not eligible for Medicare will continue to participate in one of the pre- Medicare plans and the one who is eligible for Medicare will participate in one of the RIT plans for Medicare eligible individuals as described below. You need to participate in the same plan, as follows: Pre-Medicare (Under 65) Person Blue Point2 POS A, B, B No Drug, or POS D Blue PPO Medicare Eligible (Over 65) Person Medicare Blue Choice 4 or 5 or Preferred Gold Option 1 or 2 Applicable Medicare Blue PPO plan with or without Rx coverage gap Medicare Prescription Drug Coverage Information Please note that the prescription drug coverage will be provided as part of the retiree medical plan, but it is different than your employee pre-medicare prescription drug coverage. You will no longer have RIT prescription drug coverage through OptumRx. In addition, there is not a lower copay at Wegmans pharmacies compared to other retail pharmacies. If you are using OptumRx home delivery pharmacy with RIT s prescription drug coverage, you will no longer be able to do so. You will need to obtain new prescriptions from your physician for any prescription you have had filled through mail order. If you have your prescriptions filled at a retail pharmacy, you may continue to do so. However, you will need to let the pharmacy know that your coverage is changing and you will need to provide your new identification card to them. Rev March 2017 Page 2 of 5

3 Important Note About the Medicare Prescription Drug Coverage for Rochester Area Plans Similar to the employee pre-medicare prescription drug coverage, the Medicare Blue Choice plans have 3 tiers (generic, preferred brand, non-preferred brand); the two Preferred Gold plans separate their tiers a bit more; there are six (6) tiers. This does not mean that the Medicare Blue Choice plans don t cover medications in these additional tiers. It simply means that the medications are covered under one of the other tiers. For example, the Preferred Gold plans have two tiers for generic medication; the Medicare Blue Choice plans cover generics in one tier. Description of how the Rx Coverage Gap Plans Work The plans that do not have the Rx Coverage Gap have prescription drug coverage similar to the employee pre- Medicare coverage; you pay copays for your medications, regardless of the cost of the medication. The plans with the Rx Coverage Gap are different. Depending on the cost of your medications, you could pay a percentage of the total drug cost. There are three separate parts to the Rx benefit, with each administered on a calendar-year basis as described below: 1. Limit - You pay the applicable copay and the insurance plan pays the remaining cost for each covered drug until the combined total amount that you and the plan pay reaches $3,700. Once you reach this amount, you move into the Coverage Gap. 2. Coverage Gap - Once you and your insurance plan have spent $3,700 for covered drugs in the Initial Coverage, you are in the Coverage Gap, also known as the donut hole. In the Coverage Gap, the costs are as follows Generic drugs - you pay 51% of the cost, the plan pays 42% of the cost Brand name drugs - you pay 40% of the cost, the plan pays 10%, and the pharmaceutical manufacturers provide a 50% discount You are in the Coverage Gap until the following total $4,950 Your copays in the stage, plus Your cost for the generic and brand name drugs in the Coverage Gap, plus The 50% pharmaceutical manufacturer s discount in the Coverage Gap 3. Catastrophic Coverage - Once you have reached the $4,950 threshold in the Coverage Gap, you move into the Catastrophic Coverage for the remainder of the calendar year. In this part, your payment will be as follows Generic drugs - you will pay copays of $3.30 or 5% of the cost, greater Brand name drugs you will pay copays of $8.25 or 5%, greater. The insurance plan will cover the remainder of the cost. You will find a summary of the prescription drug coverage for the Rochester area plans on the next page. For those outside the Rochester area, the prescription drug coverage is as follows: Medicare Advantage Blue PPO Without Rx Coverage Gap and the Medicare Blue PPO Without Rx Coverage Gap is the same as the Medicare Blue Choice Plan 4 prescription drug coverage. Medicare Advantage Blue PPO With Rx Coverage Gap and the Medicare Blue PPO With Rx Coverage Gap is the same as the Medicare Blue Choice Plan 5 prescription drug coverage. Rev March 2017 Page 3 of 5

4 Important Notes 1. Medicare Blue Choice only has 3 tiers (generic, preferred brand, non-preferred brand); where it says N/A, the medication is covered under one of the other tiers. 2. Copays listed in this order: 30-day retail/90-day retail/90-day mail order. 3. OptumRx does not administer the prescription drug coverage or mail order medications. LOCAL RETAIL PHARMACY-Coverage for 30-Day Supply Tier Medicare Blue Choice Plan 4 Medicare Blue Choice Plan 5 Preferred Gold HMO POS Option 1 Preferred Gold HMO POS Option 2 1. Preferred Generics $10* $5* $0 $0 2. Generics $10 $5 $10 $10 3. Preferred Brand $30 $30 $30 $35 4. Non-Preferred Brand $50 $75 $60 50% 5. Specialty Drugs $50* $75* $60 33% 6. Select Vaccines $0** $0** $0 $0 Coverage Gap (Donut Hole) After (plan plus retiree cost) = $3,310 Catastrophic Coverage Reach this level when member copays in Initial Coverage + total member payments in Coverage Gap + Rx manufacturer 50% brand discount in Coverage Gap = $4,850 Part B Drugs (do not count toward or Coverage Gap limits) N/A-continue to pay copays listed above greater. You will never pay more than the copay amount in the stage. 51% generic 40% brand greater N/A-continue to pay copays listed above greater. You will never pay more than the copay amount in the stage. 51% generic 40% brand ($0 for Tier 1 and Tier 6) greater You pay 20% You pay 20% You pay 20% You pay 20% Applications to Complete to Make the Change in Your RIT Coverage In addition to your Medicare enrollment, you will need to complete an application(s) for your RIT coverage. The number of applications to enroll and the number of ID cards you receive varies by plan as follows: Medicare Blue Choice 4 or 5 complete one application; you will receive one ID card, a Medicare Blue Choice ID card that you use for both medical services and prescription drugs. Preferred Gold Option 1 or Option 2 -- complete one application; you will receive one ID card, a Preferred Gold ID card that you use for both medical services and prescription drugs. Medicare Advantage Blue PPO with or without Rx coverage gap -- complete one application; you will receive one ID card, a Medicare Advantage Blue PPO ID card that you use for both medical services and prescription drugs. Rev March 2017 Page 4 of 5

5 Medicare Blue PPO with or without Rx coverage gap -- complete two applications (BCBS application and Simply P application); you will receive two ID cards, a BCBS ID card that you use for medical services and a Simply P ID card that you use for prescription drugs. What You Need to Do at a Glance Enroll in Medicare Part A and Part B directly with Medicare Do not enroll in a separate Medicare prescription drug plan Complete the medical insurance application for the plan you want to join Complete the Simply Prescriptions application if you are enrolling in one of the Medicare Blue PPO plans Return your RIT medical application (and Simple P application, if applicable) to your benefits representative in the RIT Human Resources Department. If you have any questions, feel free to contact your benefits representative in the Human Resources Department based on the first letter of your last name as follows: YOUR LAST NAME CONTACT TELEPHONE ADDRESS A-L Valerie Liegey (585) /V valpsn@rit.edu M-Z Brett Lagoe (585) /V bllpsn@rit.edu The information is for a retiree and the spouse/partner when becoming eligible for Medicare. The information in this document is based on the current benefits and they can be changed at any time in the future. If there is any confusion or conflict regarding plan features, the plan document/contract will be the final authority. RIT reserves the right to change, modify, discontinue, or terminate benefits at any time for any reason. Rev March 2017 Page 5 of 5