Medicare Advantage Enrollment for 2013 FOR RETIREES WITH MEDICARE PART A & PART B

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1 Office of Group Benefits Medicare Advantage Enrollment for 2013 FOR RETIREES WITH MEDICARE PART A & PART B Welcome... This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan, read the plan documents carefully and consult other OGB and plan administrators publications. 1

2 Presentation Agenda This presentation will cover Enrollment information Key points Overview of plans Life insurance Medicare Advantage Enrollment Timeline Enrollment starts Enrollment ends October 1 November 26 January 1 December 31 OGB must receive enrollment form to ensure correct deductions on January retirement check Effective date of coverage 2

3 Enrollment Guidelines TRANSFER NOT ALLOWED These health plan changes can ONLY be made during OGB Annual Enrollment OGB Standard Plan PPO HMO Medical Home HMO OGB Standard Plan PPO HMO Medical Home HMO Important Reminders If your current plan will no longer be offered in 2013, you must choose a new plan or OGB will choose a plan for you You can change health plans once each year during OGB Annual Enrollment and Medicare Advantage Enrollment Compare costs, benefits and restrictions and in-network providers when choosing a plan 3

4 What happens if you drop coverage? If you drop OGB coverage without transferring to an OGB standard plan or a Medicare-type plan You lose OGB coverage forever!! You lose OGB coverage forever EXCEPT if You joined an individual (non-ogb) Medicare Advantage plan and it is no longer available or you withdrew, OR You joined Tricare for Life and it was discontinued or had a significant reduction in benefits, OR You lost other creditable continuous coverage and meet all requirements in your health plan s Plan Document Call OGB Customer Service for more information 4

5 Enrollment Procedures 1 If you are not changing from one plan to another, you DO NOT need to do anything. 2 You and your covered spouse, if applicable, must both join the same plan unless you each join an individual Medicare Advantage plan through the Extend Health exchange. 3 To enroll in an OGB-sponsored Medicare Advantage plan, complete an enrollment form (available at meetings, on OGB s website or at any OGB office). Medicare requires a street address (not a post office box). Sign and date the form and mail it to: OGB Eligibility Division P. O. Box Baton Rouge, LA To enroll in a Medicare plan through the Extend Health exchange, call toll-free. Change Notification If the following information changes at any time, report it immediately to OGB Mailing address Address Working status Working status Eligible dependents Eligible ibl dependents d Eligibility for Medicare Medicare status 5

6 Change Notification To report changes Go to the Human Resources office at the agency from which you retired or Send a letter to OGB OGB Medicare Advantage Plans Key Points & Decision Questions 6

7 Key Point # 1 YOU DO NOT HAVE TO JOIN a Medicare Advantage plan sponsored by OGB or through the Extend Health exchange. You can choose to keep your OGB standard plan (PPO, HMO or Medical Home HMO) Key Point # 1 (continued) or you can select from these options OGB-sponsored group Medicare Advantage plans Peoples Health HMO-POS Vantage HMO-POS Vantage Zero-Premium HMO-POS Extend Health exchange Extend Health exchange Individual Medicare Advantage plans Medigap plans Medicare Part D plans 7

8 Key Point # 2 The Medicare program allows each person to enroll in only ONE medical or prescription drug Medicare-type plan. Key Point # 2 (continued) Once you enroll in an OGB-sponsored Medicare Advantage plan or a plan through the Extend Health exchange, DO NOT purchase or enroll in any other Medicare-type plan such as A Medicare supplemental plan; A Medicare Advantage plan that includes Medicare Part D prescription drug coverage; A group Medicare Advantage plan (such as your spouse s group plan); or A Medicare Part D plan for drug coverage only. 8

9 Key Point # 3 If you do join an OGB-sponsored Medicare Advantage If you DO plan join or an a OGB plan through Medicare the Extend Health Advantage exchange, plan, it will you replace will get whatever ALL of Medicare your health and OGB benefits standard through coverage that you currently have. plan, including your prescription drug coverage. You will continue to pay that your plan; and Medicare Part B premium. You will get ALL of your health benefits through You MUST continue to pay your Medicare Part B premium. Key Point # 4 Both you and your dependent must have Medicare Part A and Part B to join a Medicare Advantage plan. You and your spouse must enroll in the same plan if you choose an OGB-sponsored Medicare Advantage plan. You and your dependent(s) can enroll in different individual plans through the Extend Health exchange. 9

10 Key Point # 5 Even though h Medicare Advantage plans replace traditional Medicare coverage, plan members still retain all rights and protections provided by traditional Medicare. ALL companies that offer Medicare Advantage plans are regulated by the federal Centers for Medicare and Medicaid Services (CMS). Key Point # 6 You must stay in the plan you select until December 31,

11 Decision Questions Is the plan available in my area or parish? Are my hospitals and doctors in the plan s provider network? Does the plan have out-of-state coverage if I need it? Does the plan have an open or closed (restricted) drug formulary? Are my prescription drugs covered? Does the plan have drug coverage in the coverage gap or donut hole? How much is the plan s monthly premium? How much will I pay in yearly out-of-pocket costs? How do the costs and benefits of the plan compare to my current plan? Overview of Plans 11

12 Medicare Advantage Options HMO-POS Plans Extend Health Exchange Peoples Health Vantage Health (2 plans) Multiple plans OGB Medicare Advantage Plans Coverage Areas Peoples Health HMO-POS Ascension Assumption East Baton Rouge East Feliciana Iberville Jefferson Lafourche Livingston Orleans Plaquemines Pointe Coupee St. Bernard St. Charles St. James St. John St. Helena St. Mary St. Tammany Tangipahoa Terrebonne Washington West Baton Rouge West Feliciana Vantage HMO-POS Vantage Zero- Premium HMO-POS Extend Health Exchange E t B t R Statewide Statewide Regional Statewide Nationwide (multiple plans; varies by plan) 12

13 Extend Health Exchange This year, OGB is partnering with Extend Health in offering a variety of Medicare plans. Extend Health benefit advisors will contact retirees to explain plans and answer questions. To enroll in a Medicare plan through the Extend Health exchange, call toll-free. Monthly premiums can be paid to the Medicare plan in one of 3 ways: Personal check or money order; Automatic bank account deduction; or Personal credit card. A Health Reimbursement Arrangement (HRA) will be established for each OGB plan member who enrolls in a Medicare plan through Extend Health. Health Reimbursement Arrangement (HRA) After Extend Health establishes your HRA, the state credits your HRA each month $200 per month for you only (a maximum of $2,400 per year), or $300 per month for you and any Medicare-eligible dependents (up to $3,600 per year). You can be reimbursed from your HRA up to the available balance for expenses such as: Premiums for your individual Medicare Advantage plan, Medicare Part B, Medicare Part D prescription drug plan, Medigap plans and dental and vision plans; Out-of-pocket expenses, such as deductibles and co-pays, for drugs and medical, dental and vision care; and Other eligible expenses incurred by you and your Medicare-eligible dependents (according to Internal Revenue Service rules). Under current IRS regulations, reimbursements from your HRA are not taxable. 13

14 HMO Plan Overview Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2013) Peoples Health HMO-POS Vantage HMO-POS Vantage Zero- Premium HMO-POS Lifetime Maximum Unlimited Unlimited Unlimited Deductible (Calendar Year) Out-of-Pocket Maximum Inpatient Hospital Care Per Day 1, 2 Outpatient $0 $2500 $0 co-pay $0; $325 drug deductible tiers 3 & 4 $5900 in-network $250 co-pay per day (days 1-5) $0, $325 drug deductible tiers 2, 3 & 4 $6700 in-network $300 co-pay per day (days 1-5) Hospital Care $0 co-pay $100 co-pay (facility) 2 $100 co-pay (facility) 2 Surgery/Anesthesia/ $0 co-pay $0 co-pay (physician) 2 $0 co-pay (physician) 2 X-ray Ambulatory Surgical Facility Doctor Visit Primary/Specialist $0 co-pay $250 co-pay 2 $300 co-pay 2 $5/$10 co-pay $5/$45 co-pay $10/$50 co-pay 1 Semi-private room, ancillary services and doctor visits 2 Some services may require pre-certification HMO Prescription Drug Coverage Plan Member Out-of-Pocket Expenses (Jan. 1 Dec. 31, 2013) Formulary Retail (30-day supply) 1 Peoples Health HMO-POS Vantage HMO-POS Vantage Zero- Premium HMO-POS Closed with Closed with Closed with exceptions exceptions exceptions Level 1 - Generic Drugs $0 co-pay $5 co-pay $5 co-pay 2 Level 2 - Preferred Brands $20 co-pay $45 co-pay $45 co-pay 2, 3 Level 3 - Non-Preferred Brands $40 co-pay $85 co-pay 2, 3 $85 co-pay 2, 3 Level 4 - Specialty Drugs 20% co-insurance 25% co-insurance 2, 3 25% co-insurance 2, 3 Mail Order (90-day supply) Level 1 - Generic Drugs $0 co-pay $15 co-pay $15 co-pay 2 Level 2 - Preferred Brands $40 co-pay $135 co-pay $135 co-pay 2, 3 Level 3 - Non-Preferred Brands $80 co-pay $255 co-pay 2, 3 $255 co-pay 2, 3 Level 4 - Specialty Drugs 20% co-insurance 30-day limit 25% co-insurance 2, 3 Limited to 31-day supply 25% co-insurance 2, 3 Limited to 31-day supply 1 Vantage covers 31-day supply at retail 2 No coverage through the gap (donut hole) 3 After $325 drug deductible 14

15 Explanation of Coverage Gap What is the coverage gap (donut hole)? Member pays applicable deductible and co-pays for your plan up to $2,970. Member pays 47.5% of brand drugs and 79% of generic drugs until out-of-pocket costs reach $4,750. After $4,750, co-pays are $6.60 for brand name drugs and $2.65 for generic drugs or 5% co-insurance, whichever is greater. Applies to some tiers of Vantage Medicare Advantage plans and to individual plans available through Extend Health Peoples Health HMO-POS Key Features 100% hospitalization coverage 0% co-pay! $0 co-pay for X-rays, MRIs, CT scans & labs Vision benefit free glasses or contacts each year Dental coverage including dentures up to $2,000 per year Free health club membership Full prescription drug gap coverage in all tiers 15

16 Peoples Health HMO-POS Advantages Largest Louisiana-based Medicare Advantage company Coverage for services from any provider you choose Personalized service from representatives based in southeast Louisiana Stability and experience we have continuously served dlouisiana i Medicare beneficiaries i i since Medicare Advantage was introduced Peoples Health received the 2013 Senior Choice Gold Award for Excellence in Medicare Benefits Value in Baton Rouge and New Orleans markets Vantage HMO-POS Key Features Great customer service from a Louisiana-based member service call center Plan offered statewide Access to out-of-network providers through point-of-service i (POS) option 16

17 Vantage HMO-POS Advantages Low monthly premium with no medical deductible Smoking cessation and wellness programs available No separate bills from pathologists, radiologists and anesthesiologists Speak with a live person every time you call Vantage Member Services Free SilverSneakers membership Vantage Zero-Premium HMO-POS Key Features Great customer service from a Louisiana-based member service call center Plan offered statewide Access to out-of-network providers through point-of-service i (POS) option 17

18 Vantage Zero-Premium HMO-POS Advantages No monthly premium with no medical deductible Smoking cessation and wellness programs available No separate bills from pathologists, radiologists and anesthesiologists Speak with a live person every time you call Vantage Member Services Free SilverSneakers membership Extend Health Exchange Key Features Largest Medicare exchange in United States Provides access to a wide variety of Medicare Advantage, Medicare supplement ( Medigap ), Medicare Part D prescription drug plans and dental and vision plans from leading companies Plans share a larger risk pool of plan members than employer group plans, so they often cost the same or significantly less than a group plan and some have no monthly premium Personalized service and assistance from licensed Extend Health benefit advisors to help you and your spouse choose the best health plan for you at no additional cost 18

19 Extend Health Exchange Advantages Extend Health s knowledgeable, objective benefit advisors provide: Individualized telephone support and online tools to help you make an informed, confident decision when choosing your health plan for 2013; Education about the differences between various plans and the costs of each of those plans; Advice and decision-making support based on your current health coverage and your individual medical needs and financial situation; and Assistance to help you enroll in an individual Medicare Advantage plan or Medicare supplement plan if you choose to do so. Extend Health benefit advisors remain objective because their pay is not tied to which Medicare supplement or Medicare Advantage plan you choose. If you enroll in a Medicare Advantage plan through the Extend Health exchange for 2013, you will have an opportunity to choose a different OGB health plan or OGB Medicare Advantage plan each year during OGB Annual Enrollment or Medicare Advantage Enrollment. Life Insurance 19

20 Life Insurance Now administered by Prudential Life Insurance Contract ends December 31, 2012 Contracting process underway; may be administered by a different company effective January 1, 2013 Premiums may change Visit OGB website ( for information and forms Life Insurance Group term life insurance Retiree pays half of monthly premium for retiree coverage Retiree pays full monthly premium for dependent coverage 25% reduction in coverage with appropriate 25% reduction in coverage with appropriate reduction in premiums on July 1 after reaching age 65 and age 70 20

21 Life Insurance Accidental death and dismemberment (AD&D) benefits available to all active and retired employees covered under Basic or Basic Plus plan Retirees over age 70 not eligible for AD&D All inquiries and changes in life insurance must be made through your agency HR office Life Insurance Basic Plan Option I Option II Employee $5,000 $5,000 Spouse $1,000 $2,000 Each Child $ 500 $1,000 Employee Schedule in Premiums Helpful Information Book 21

22 Life Insurance Basic Plus Supplemental Plan Option I Option II Employee Schedule to maximum of $50,000 (amount based on employee s annual salary) Same Same Spouse $2,000 $4,000 Each Child $1,000 $2,000 Employee Premiums Schedule in Helpful Information Book For More Information OGB Customer Service TDD (hearing impaired) Blue Cross Extend Health Medicare Exchange Peoples Health Vantage Express Scripts (formerly Medco) TTY/TDD Catamaran (formerly Catalyst Rx) Diabetic Sense Program (PPO & HMO)

23 Sources of Information The OGB website has links to each health plan s current provider directory and plan information Go to OGB s home page Click on the Medicare Advantage Annual Enrollment for 2013 box (through December 31, 2012) or the Health Plans link in the Quick Links list (after January 1, 2013) Look at the list of available plan options for links to websites and other information for each OGB-sponsored Medicare Advantage plan and the Extend Health Medicare exchange Questions? 23