NEWS For Retirees Eligible for Premium Assistance Winter 2017

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1 Pennsylvania Public School Employees Retirement System (PSERS) NEWS For Retirees Eligible for Premium Assistance Winter 2017 Protect Your Family; Document Your Health History Have you considered starting a family health history that is, a written record of your family s health? If not, it s something you may want to consider because it can provide valuable information when it comes to protecting your family s health. Its purpose is to document potential genetic risk factors for certain diseases and conditions, which can help your doctors take better care of you and your loved ones. Though not all diseases and conditions can be completely prevented, early detection is important in the treatment and prognosis of many serious medical conditions. For example, a patient whose breast cancer is detected and treated at Stage 1 generally has a 100% survival rate. This drops to 93% if detection happens at Stage II, and to 72% at Stage III.* Creating Your Health History Your health history is for you and your family, so it needs to be in a format that you find easy to use and maintain. As a starting point, you may just want to handwrite a few notes in a journal about you and your parents. Then add to that information as things change and you learn more about your family s health. * Source: Breast cancer survival rates, by stage, American Cancer Society website last revised June Other than the information related to specific medical conditions, you may also want to consider including: A list of your current prescriptions and any known adverse reactions to medication. The names and phone numbers of all your doctors. Any allergies to food or materials (e.g. a latex allergy). If you prefer a keyboard over a pen and paper, the National Cancer Institute has an easy-to-use, online tool that allows you to create an electronic version of your health history and then share it with other family members. To learn more, visit: Whether you prefer paper or an electronic solution, be sure to keep your health history in a safe location and let other family members know where it is. What to include in a health history: Name, gender, date of birth, race, ethnicity of family members Family relationships and connections e.g., parents, siblings, adoption history Height, weight Past or current diseases and conditions along with age at diagnosis and any treatments or preventive measures taken Addictions and smoking habits, if any

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. If you remain enrolled in the HOP Medical Plan, you ll receive a discount on your premium each year until your 70th birthday. 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. 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 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. Our 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 HEALTH NOTES Protect Yourself It s Flu Season Flu season is here. If you haven t already, schedule your flu shot before the season is in full swing. The Center for Disease Control and Prevention (CDC) recommends annual flu shots because the flu virus is always changing and the vaccine is updated each year to better match circulating influenza viruses. The flu generally peaks in January or February and can still be around through May. Medicare Star Rating for the Health Options Program Each year, Medicare evaluates prescription drug plans and awards a star rating to each plan based on performance. This star rating can be used to help you determine which plans excel based on measured categories, including: customer service, the frequency of member complaints, overall member satisfaction and patient safety. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. For the third consecutive year, the Medicare Rx Options offered under the Health Options Program were awarded 4.5 out of a possible 5 stars. This rating puts the Health Options Program s prescription drug plan among the top 25% of all star rated drug plans, nationwide. SilverSneakers: Available Through the Health Options Program The SilverSneakers FLEX Program gives members convenient access to group exercise classes held right in your community at SilverSneakers fitness facilities and locations outside of a traditional gym. For example, Flex Program members participate in local walking groups, take dance classes at their recreational center and practice tai chi at a neighborhood location. To learn more, visit or follow SilverSneakers on Facebook to connect with other members. As a reminder, SilverSneakers is available to members enrolled in the HOP Medical Plan and the HOP Pre-65 Medical Plan. If you are enrolled in a Medicare Advantage plan, check with your plan to see if SilverSneakers is available to you. Dental Coverage Now Available Under the Health Options Program The MetLife 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 also available online at 3

4 2017 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 2017 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 including those who will enroll in Part B for the first time in 2017 will pay a Part B premium of $134 in If your annual income was less than $85,000 (or $170,000 for joint filers) in 2015, your Part B premium will be between $ and $ for 2017 the actual increase will depend upon your income and tax filing status. The Part B deductible is increasing to $183 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 2017 to The Health Options Program is designed to pay some or all of these deductibles and coinsurances. For example, 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 $1,288 $1,316 Coinsurance for days 1-60 of a hospital stay $0 $0 Coinsurance for days of a hospital stay $322/day $329/day Coinsurance for days 1-20 in a skilled nursing facility $0 $0 Coinsurance for days in a skilled nursing facility $161/day $164.50/day Part B Standard monthly premium for most Medicare beneficiaries $ $134 Standard monthly premium for new enrollees in 2017 and certain other Medicare beneficiaries $ (or more based on income) Deductible $166 $183 Coinsurance 20% 20% $134 4

5 In The Know... Health Care 101 We realize our members are not benefit experts and may have questions about how the plans work. For example, some members have asked about the different types of plan costs. The table below shows how the premium, deductible and coinsurance work together to make up your total out-of-pocket costs. BENEFIT TERM WHAT IT MEANS HOW IT WORKS Premium Deductible Cost Sharing/ Coinsurance The monthly amount you pay for your benefit plan whether you use benefits or not. The amount you must pay before your plan starts paying benefits for covered charges. The percentage of the cost of a covered health care service you pay, after you meet the deductible. The set amount deducted from your pension check or the amount you have to write a check for every month. Even if you don t use any medical care for the entire year, you will still be charged this amount. If your deductible is $1,000, your medical plan will not start paying for covered services that are subject to deductible until you have paid $1,000. There is no deductible under the HOP Medical Plan. If the coinsurance for an office visit is 20% and the total amount charged by the doctor for that visit is $100, you will pay $20 ($100 x 20%), after the deductible. The plan pays the remaining $80. The more you understand, the more you can get out of your benefits. If you have any questions, call the HOP Administration Unit at or visit From Health Options Program Members We love to hear from our members. Here are some recent questions members have asked that we d like to share. Can I use any doctor or hospital under the HOP Medical Plan and the Value Medical Plan? Members have the freedom to use virtually any health care provider (doctor or hospital) they want as long as the doctor or hospital accepts Medicare. Is Premium Assistance available with both the Medicare Supplement and Medicare Advantage plans? Yes, if you are eligible for Premium Assistance and enroll in either a Medicare Supplement plan or a Medicare Advantage plan through the Health Options Program, PSERS will pay up to $100 per month toward your monthly premium. (See Health Care 101 for more about the premium.) What is the difference between a Medicare Supplement and Medicare Advantage plan? The Health Options Program offers two Medicare Supplement plans the HOP Medical Plan and the Value Medical Plan. These plans are sometimes called Medigap policies. They pay all or part of the deductibles and/or coinsurance you would have to pay if you had just Original Medicare. We also offer Medicare Advantage plans which are provided by Highmark, Aetna, Capital Blue Cross, Independence Blue Cross or UPMC. These plans are also known as a Medicare Part C plans and they replace Original Medicare entirely. 5

6 Pennsylvania Public School Employees Retirement System (PSERS) Notice of Nondiscrimination The Pennsylvania Public School Employees Retirement System (PSERS) Health Options Program complies with applicable Federal civil rights laws and does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The PSERS Health Options Program: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Joseph E. Wasiak Jr., Assistant Executive Director. If you believe that the PSERS Health Options Program has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Joseph E. Wasiak Jr., Assistant Executive Director Public School Employees Retirement System 5 N 5th Street Harrisburg, PA Phone: (888) ; Fax: (717) ; jowasiak@pa.gov You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, Joseph Wasiak is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD). Complaint forms are available at

7 Attention: Free Language Assistance This chart displays, in various languages, the phone number to call for free language assistance services for individuals with limited English proficiency.

8 HOP Administration Unit P.O. Box 1764 Lancaster, PA Important Information for 2017 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