Your Guide to Retiree Health Care Options Voiceover: Thanks for joining us today. We re glad that you re taking the opportunity to explore your retirement health care options. Over the next 20 minutes we ll tell you about some benefit options available to you as a federal retiree and show you ways to potentially save money! So what do say we get started? Whether you re already retired or soon to be retired, Aetna would like to thank you for your public service and congratulate you on your retirement from the federal government. You ve spent your entire career working hard and now life should be easier for you, especially when it comes to understanding your benefit options. Today, we ll help guide you through the health care choices for federal retirees and show you how to maximize these benefit options to potentially save you money. We ll begin by explaining the basic insurance terms used by most health care plans and give examples of how it impacts you when using specific plan benefits. Next, we ll help walk you through your Medicare options and explain some of the advantages for having Medicare parts A and B, while also having coverage through the Federal employee health benefits program or FEHBP. Then, we ll discuss some rules and guidelines for federal retirees, including the coordination of FEHB coverage with Medicare, the 5 year requirement for pre-retirees, and how open season works when you re retired. We ll also explain how retirement impacts your FEHB premiums and discuss the option of suspending your FEHB coverage. Next we ll review the federal employees dental and vision insurance program or FEDVIP and how this benefit program works in retirement. And lastly, we ll discuss a new low cost plan geared for federal retirees called Aetna Direct. This plan has great value and can save you significant money in monthly premiums. After today s presentation, we ll show you where you can go for more information if you still have questions.
Trying to navigate through the complex world of insurance terms can be very frustrating. Today we re going to help teach you some basic insurance terms that you should know. Many of you have probably heard these before but may not know what they mean. Deductible - A deductible is the amount you pay towards your medical services each year before your health plan starts paying toward your cost of care. For example, you may have to pay a deductible of $500 for self-only coverage or $1,000 for family coverage, before your plan pays benefits. Deductibles vary by plan and there may be a separate hospital deductible as well. PPO plans usually have deductibles. Co-Pay A copay is generally a set dollar amount that you pay for your covered health care expenses. The copay amount may be different for a PCP and a Specialist but is the same each time you see a provider. For example, you may pay a $20 copay for primary care or a $35 copay for a specialist visit. Coinsurance Coinsurance is the percentage of the charges that the plan or you will pay. For example, if the plan pays 85% for a service, you pay 15%. Referrals - Typically associated with HMO plans, a referral is an approval from your Primary Care Physician or (PCP) to see a specialist. Aetna s plans do not require referrals to see a network specialist (except our CA HMO). In-network vs. Out of network - In network providers are doctors, hospitals and other health care professionals that offer services at an agreed upon or contracted rate. Since an in-network provider has agreed to a contracted rate, you will generally save money when you visit an in-network provider vs. an out of network provider, who can charge as much as he/she wants for the same service. Now that we ve discussed some basic insurance terms, we ll walk you through the ins and outs of Medicare and what it means for federal retirees. Medicare is a government run and tax funded program designed to provide health insurance to people over 65 and the disabled.
You can enroll in Medicare without penalty at two times. The first is during your Initial Election Period or IEP. Your IEP occurs 3 months before the month of, and 3 months after your 65th birthday. If you are still working when you turn 65, you do not need to enroll right away since you will get a Special Election Period or SEP. Your SEP goes into effect when you retire and lasts 8 months. If you enroll outside of one of these periods, you must enroll during the Medicare General Enrollment between January 1 and March 31 each year and may be subject to late enrollment penalties. Part A Medicare Part A is part of Original Medicare and provides Hospital Insurance. Part A is free for those who have paid Medicare taxes while working, already receive Social Security benefits, or your spouse has Medicare covered employment. This coverage is going to help cover the costs of services like inpatient hospital, skilled nursing, home health care, and hospice. Part A does have some out of pocket costs, such as an annual deductible and copayments depending on the duration of your care. Part B Medicare Part B is also part of Original Medicare and provides Medical Insurance. Part B has a standard monthly premium. Part B also has a late enrollment penalty that will increase your monthly premium by 10% for every 12 months you do not enroll after your initial election period. Part B does have some out of pocket costs for coverage, such as and an annual deductible and coinsurance. Part C Medicare Part C, or Medicare Advantage, is an optional portion that is available for purchase for a monthly premium from private insurance companies. You must have Parts A and B to get a Part C plan. These plans can be any style, including a Health Maintenance Organization or HMO, Preferred Provider Organization or PPO, Fee for Service or Medical
Savings Account, and can vary in cost both for monthly premiums and out of pocket costs. These plans provide a complete level of coverage, but typically not as high value as employer coverage. Part D Medicare Part D is additional to Original Medicare and offers coverage for prescription drugs. You must have Medicare Parts A and B in order to get a Part D plan. Part D plans are one of several ways to satisfy Medicare s prescription drug coverage requirement. Like Medicare Advantage, there are different costs for Part D premiums and benefit coverage depending on what kind of plan you choose. If you do not enroll in a Part D plan but have another plan such as, Medicare Advantage, FEHB, etc., that satisfies this requirement. So now that you have a general understanding of what all of the Medicare plans are about, we ll now discuss how all of these play into your FEHB coverage. And most importantly, what parts of medicare you need to take to have proper coverage. Part A - If you receive Medicare Part A free, there is no financial downside to having it. It provides additional coverage and may help lower your out of pocket costs for hospitalization. Part B - Part B is optional. It is your choice whether or not to pick it up Part B and it can affect your coverage. If you do pick up Part B, you will have an additional monthly premium to pay, but it could result in much lower out of pocket costs, especially when you are retired and have an FEHB plan that waives copays and deductibles when you have Part B. If you do not pick up Part B, your FEHB plan will continue to cover you, but if you decide to pick it up later will pay penalty fees. There is a lot to consider when choosing whether or not to pick up Part B so be sure you do your research.
Parts C and D - If you decide to keep your FEHB coverage, then you will most likely not need any additional coverage through Medicare Parts C and D. Your FEHB plan satisfies your Part D prescription drug coverage and will, in most cases, provide better coverage than a Medicare Advantage plan. Now that you ve learned more about Medicare, we ll discuss how the coordination and enrollment process works for a federal retiree. When you have an FEHB plan and Medicare, you will have coordination of coverage. When you are an active employee, your FEHB plan is your primary coverage, but after retirement, Medicare becomes the primary payer when your doctor accepts Medicare once you reach age 65. Medicare will coordinate with ANY FEHB plan but some plans will automatically coordinate coverage. There are some plans that have reduced out of pocket costs for retirees that have Medicare Parts A and B. You also have the option to switch FEHBP plans when you become eligible for medicare. While there s no requirement to have an FEHB plan while you re an active employee, you must have an FEHB plan for 5 consecutive years before you retire in order to keep your coverage into retirement. During that 5 years you can switch plans, as long as your coverage is uninterrupted. Talk to your HR office to be sure that you have all of the requirements to carry your health insurance coverage into retirement. Once you retire, you still have the ability to switch plans annually at open season if you choose. You are not locked into a plan. Instead of switching through your agency, you will make your elections with the OPM retirement center. As a retiree, your FEHB premiums will become monthly and taken out of your annuity checks. You do have the option of suspending your FEHB coverage and picking up your own Medicare Advantage plans. However, in most situations, your FEHB coverage is going to be better than what is available on an individual basis. If you leave FEHB at any point after retirement, you will not be able to pick it back up unless you have suspended FEHB and
can provide documentation that you were enrolled under another Medicare Advantage plan. If you are considering dropping your FEHB coverage after retirement, please do thorough research. FEDVIP is a separate program available to federal employees for dental and vision coverage. When you retire you are still eligible to participate in the FEDVIP program. Your premiums become monthly and are taken from your annuity. Unlike FEHB coverage, there is no 5 year rule for the FEDVIP program, you can pick-up, drop, or make changes to your coverage every year. You can still make changes to your coverage during open enrollment through Benefeds.com In your retirement, you want to have peace of mind and not worry about your health coverage. Combining Medicare with your FEHB and FEDVIP plans will give you the complete coverage you need to have a safe, healthy retirement. Now that you have a better understanding of your retirement health care options, we ll discuss a FEHB plan called Aetna Direct and how it can be financially beneficial for federal retirees with Medicare parts A and B. Aetna Direct is whole new level of value offered to federal employees. So what are the experts saying about this plan? You may have heard of the Consumers checkbook guide to health plans. It s published by Walton Francis, who s considered an expert on the topic of benefits for federal employees and retirees. Here s what he had to say about the Aetna Direct plan: Aetna stepped up to the plate and hit what I think you could call a home run. They have a new plan called Aetna Direct. It s a good plan for anybody, but it s a spectacular plan for retirees with Medicare. You ve worked hard during your career as a federal employee, so you want to make sure you get the best value during retirement, but what does that look like? Today, we re going to discuss with you a plan that s unlike any plan you ve seen. It s called Aetna Direct. It has low monthly premiums - lower than the national average.
Much like other FEHB plans for retirees we waive deductibles and/or coinsurance for medical care. It covers prescription drugs at the pharmacy and by mail. But, what makes this plan stand out, is that it provides a fund money you can use to help you pay your Medicare Part B premiums or other health care costs. Plus, its easy to use. It works seamlessly with Medicare. You re covered nationwide. And it s a PPO plan which means that you don t need a referral to see a specialist. This plan is quite simple to understand and even easier to use. First, Aetna provides a fund. This is held for you until you use it for prescription drugs, to reimburse your Part B premiums, or other covered services. That s right, you can use that fund to help pay your Medicare Part B premiums. Simply submit proof of payment for your Part B premiums to Aetna and we will send you the reimbursement if funds are available. Then, get the medical services you need. You don t need to file a claim with us or with Medicare. We ll work that out with the doctor or other health care provider. Now, let s look a little closer at the benefits for Aetna Direct: The premium for Aetna Direct is one of the lowest available and well below the average premium in FEHB. Remember the fund I mentioned on the previous slide? This fund can be used in many ways. It will be applied to your medical expenses and prescriptions, but you can also use it to reimburse yourself for your Medicare Part B premiums. When Medicare Parts A & B are primary and your doctor accepts Medicare assignments, your deductible and coinsurance are waived. That lowers your out of pocket responsibility drastically. The only responsibility you have is for prescriptions. If you take advantage of our mail order system, you can save on those too!
When choosing a health plan, it s important to do the math to make sure you re getting the best value without compromising coverage. Take a look at this side-by-side comparison of the average FEHBP premium vs. Aetna Direct. You can clearly see that Aetna Direct helps save on your annual premium cost significantly. Give yourself the retirement you deserve. Get a health plan that gives you everything you need. Low premiums A fund to help you save money on your Part B Premiums Waived deductible and coinsurance for medical care (when the doctor accepts medicare assignments) Prescription coverage Seamless coordination of claims with Medicare and no claims forms Nationwide network and coverage And No referrals It s time to check out your options and see if Aetna Direct can save you money. We ve gone over a lot today. If you still need more information or have questions, it s easy to get help. Just call our customer service department at 855-277-4356. Or, visit us online at Aetnafeds.com/aetnadirect. Thanks for joining to learn about your retirement benefit options! We hope we ve helped you find the right combination of benefits, services and prices for you. 2015 Aetna, Inc. All rights reserved. All other names and (registered) Trademarks are the property of their respective owners. AetnaFeds.0100 (5/16)