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Medicare Enrollment and Your UC Sponsored Medical Plan Coverage UCSF HR/Benefits Health Care Facilitator Program, 2009.

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Presentation on theme: "Medicare Enrollment and Your UC Sponsored Medical Plan Coverage UCSF HR/Benefits Health Care Facilitator Program, 2009."— Presentation transcript:

1 Medicare Enrollment and Your UC Sponsored Medical Plan Coverage UCSF HR/Benefits Health Care Facilitator Program, 2009

2 Medicare Basics

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

4 Medicare Coverage Part A Part A –Hospital Coverage Part B Part B –Medical Coverage Part C Part C –Medicare Advantage Program Part D Part D –Out-Patient Prescription Drug Coverage – established in 2006

5 Gaps in Medicare Coverage If you had only Medicare insurance you would experience large gaps in coverage requiring significant out-of-pocket expenses If you had only Medicare insurance you would experience large gaps in coverage requiring significant out-of-pocket expenses Your UC medical plan coverage coordinates with Medicare to reduce these gaps and decrease your out-of-pocket expenses Your UC medical plan coverage coordinates with Medicare to reduce these gaps and decrease your out-of-pocket expenses See for information on coverage and exclusions

6 Delaying Medicare Part B enrollment Medicare allows you to delay Part B enrollment as long as you are covered by an Employer Group Health Plan (EGHP) either as an employee or the dependent of an employee Medicare allows you to delay Part B enrollment as long as you are covered by an Employer Group Health Plan (EGHP) either as an employee or the dependent of an employee You will have a special enrollment period to enroll in Medicare if you are older than 65 when your EGHP ends and you will not be subject to the late enrollment penalty You will have a special enrollment period to enroll in Medicare if you are older than 65 when your EGHP ends and you will not be subject to the late enrollment penalty SS will provide you with a form requiring documentation of EGHP enrollment and termination SS will provide you with a form requiring documentation of EGHP enrollment and termination

7 UC Medicare Enrollment Policy for Retirees

8 UCs Medicare Enrollment Requirements for Retirees UC requires that you/your dependents enroll in Medicare Part B when you/your dependents become eligible for premium free, Medicare Part A ** UC requires that you/your dependents enroll in Medicare Part B when you/your dependents become eligible for premium free, Medicare Part A ** –You/your dependents are transferred into the Medicare- coordinated version of the plan You/your dependents do not need to enroll in a non-UC sponsored Medicare Part D plan You/your dependents do not need to enroll in a non-UC sponsored Medicare Part D plan –Your plan will enroll you in Medicare Part D ** Adult Dependent Relatives that become eligible for Medicare Part A may not continue their UC sponsored medical coverage.

9 UCs Medicare Enrollment Requirements for Retirees Retirees and their dependents risk de- enrollment from UC sponsored medical coverage if they…. Retirees and their dependents risk de- enrollment from UC sponsored medical coverage if they…. –Do not enroll in Medicare Part B when eligible for premium free Medicare Part A –Enroll in a non-UC sponsored Medicare Part D plan –Are HMO members who do not assign/lock Medicare to the plan and/or uses Medicare outside of the plan

10 Why UC Mandates Medicare Enrollment Retirees over age 65 without Medicare cost at least twice as much to insure as those with Medicare 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 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 Allows UC to continue to fund health benefits for retirees –Many employers are dropping or reducing retiree health coverage

11 Exceptions to UC Medicare Mandate Retirees that didnt pay Medicare taxes may not be eligible for premium free Medicare Part A Retirees that didnt pay Medicare taxes may not be eligible for premium free Medicare Part A –UC does not require retirees ineligible for premium free Medicare Part A, to enroll in Part B. These retirees may continue with their current non- Medicare medical plan. These retirees may continue with their current non- Medicare medical plan. –Please note: You may qualify for premium free Medicare Part A through a spouse, former spouse or prior work history. Contact Social Security,

12 Exceptions to UC Medicare Mandate UC does not require you to enroll in Medicare UC does not require you to enroll in Medicare Part B if: –You reside outside the United States you must enroll in Medicare if you return you must enroll in Medicare if you return You may incur a penalty from Medicare when you re-enroll You may incur a penalty from Medicare when you re-enroll –You are still working at UCSF and have health coverage as an employee (never retired from UC) –You have UC sponsored health coverage through your spouse or domestic partner who is still working at UC

13 Medicare Enrollment

14 To enroll in Medicare or determine if you are eligible, contact Social Security To enroll in Medicare or determine if you are eligible, contact Social Security Remember if you dont qualify on your own, you may qualify through a current or former spouse Remember if you dont qualify on your own, you may qualify through a current or former spouse If you dont qualify now but continue to work you may qualify in the future If you dont qualify now but continue to work you may qualify in the future You are required to enroll at age 65 unless covered by an employer group health plan (EGHP) or pay a penalty for late enrollment You are required to enroll at age 65 unless covered by an employer group health plan (EGHP) or pay a penalty for late enrollment

15 Tips for Enrolling in Medicare If you are retired, when you reach age 65, you should apply for Medicare three months before your reach age 65 If you are retired, when you reach age 65, you should apply for Medicare three 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 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 not receiving SS benefits you will need to initiate enrollment into Medicare yourself If you are not receiving SS benefits you will need to initiate enrollment into Medicare yourself

16 Coordinating Medicare with your Retiree Health Coverage Approximately 3 months prior to your 65 th birthday UC will send you the following documents (if you are retired): Approximately 3 months prior to your 65 th birthday UC will send you the following documents (if you are retired): –UC Medicare Declaration Form –Universal Medicare Advantage Form (to be completed by those in an HMO plan: Health Net, Kaiser, WHA) UCOP will transfer your medical plan enrollment to the Medicare version of the plan once they receive your documents and adjust your plan premiums as indicated UCOP will transfer your medical plan enrollment to the Medicare version of the plan once they receive your documents and adjust your plan premiums as indicated Your family members enrolled as dependents who are not eligible for Medicare will remain in the basic non-Medicare version of the plan Your family members enrolled as dependents who are not eligible for Medicare will remain in the basic non-Medicare version of the plan

17 Period of Darkness There is usually a three week period of transition from a non-Medicare plan to the Medicare version of the plan There is usually a three week period of transition from a non-Medicare plan to the Medicare version of the plan During this time period it can appear that your coverage has been terminated. It hasnt! During this time period it can appear that your coverage has been terminated. It hasnt! If you experience problems obtaining medical care or accessing your pharmacy benefits during this time, call your Health Care Facilitator If you experience problems obtaining medical care or accessing your pharmacy benefits during this time, call your Health Care Facilitator

18 How UC Sponsored Health Plans Coordinate with Medicare Information based on coverage for plan year, 2009

19 Medicare vs. Non-Medicare Plans All the UC medical plans have a separate Medicare - coordinated version All the UC medical plans have a separate Medicare - coordinated version When you become eligible for Medicare you coordinate your current medical plan with Medicare When you become eligible for Medicare you coordinate your current medical plan with Medicare The Medicare-coordinated version of a plan may differ in: The Medicare-coordinated version of a plan may differ in: –Plan benefits/drug formulary –Costs –Service area –Network providers –Enrollment/de-enrollment process

20 Medicare Coordination with HMO plans (Advantage Plans), 2009 If you are enrolled in a Health Maintenance Organization plan (HMO) -- Health Net, Kaiser, or WHA -- Medicare Parts A, B and D must be assigned/locked into the plan If you are enrolled in a Health Maintenance Organization plan (HMO) -- Health Net, Kaiser, or WHA -- Medicare Parts A, B and D must be assigned/locked into the plan –You cannot use Medicare outside the plan –You will need to complete a MAPD form assigning Medicare to your plan –If you change plans you will need to unlock Medicare from your plan

21 Medicare Coordination with HMO plans (Advantage Plans), 2009 You must live in the plans CA service area You must live in the plans CA service area Medicare pays a flat fee to the HMO each month - the HMO agrees to accept full responsibility for your care Medicare pays a flat fee to the HMO each month - the HMO agrees to accept full responsibility for your care You pay a low monthly premium You pay a low monthly premium *You cannot use Medicare outside the plan

22 Medicare Coordination with HMO plans (Advantage Plans), 2009 You select a primary care provider (PCP) to coordinate your care through your medical group You select a primary care provider (PCP) to coordinate your care through your medical group You pay a small co-pay when you receive services You pay a small co-pay when you receive services No need to submit claim forms No need to submit claim forms

23 Medicare Coordination with Blue Cross Plans, 2009 High Option Supplement to Medicare High Option Supplement to Medicare Blue Cross PPO (Preferred Provider Organization) Blue Cross PPO (Preferred Provider Organization) Blue Cross Plus POS (Point of Service Plan) Blue Cross Plus POS (Point of Service Plan) –Includes in-network (HMO), and out-of- network coverage –Must live in the CA service area Blue Cross Core Blue Cross Core

24 Medicare Coordination with Blue Cross Plans, 2009 You may see any Medicare provider* You may see any Medicare provider* –Find doctors using the Participating Physician Directory online at: Medicare pays as primary Medicare pays as primary Each plan has an annual deductible* - Once the deductible is met, Blue Cross coordinates their payment after Medicare pays, to cover a percentage of your expenses Each plan has an annual deductible* - Once the deductible is met, Blue Cross coordinates their payment after Medicare pays, to cover a percentage of your expenses *Exceptions – Blue Cross Plus in-network

25 Medicare Coordination with Blue Cross Plans – Medicare Terms Provider Accepts Assignment Provider Accepts Assignment –Provider will accept Medicare contracted rates for services Provider Does not Accept Assignment 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 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

26 Health Coverage Costs

27 How much will my medical plan cost when I retire? If you began work at UC prior to 1/1/90 and did not have a break in covered service for more than 120 days, you will receive 100% of UCs maximum contribution toward the medical monthly premium. You will still pay the employee/retiree portion of the cost If you began work at UC prior to 1/1/90 and did not have a break in covered service for more than 120 days, you will receive 100% of UCs maximum contribution toward the medical monthly premium. You will still pay the employee/retiree portion of the cost If you began work on or after 1/1/90 you will be subject to graduated eligibility. You will receive a percentage of UCs maximum contribution. Your percentage corresponds to your years of UC service credit. In addition, you will still pay the employee/retiree portion of the cost If you began work on or after 1/1/90 you will be subject to graduated eligibility. You will receive a percentage of UCs maximum contribution. Your percentage corresponds to your years of UC service credit. In addition, you will still pay the employee/retiree portion of the cost No salary banding – all retiree rates are equal to the second band ($46, $92, 000) with the exception of Medicare coordinated plans No salary banding – all retiree rates are equal to the second band ($46, $92, 000) with the exception of Medicare coordinated plans

28 Part B Reimbursement Part B reimbursement Reimbursement for Part B may apply if UCs contribution for a plan is greater than the gross premium Maximum individual Part B reimbursement currently is $96.40 per person (2009)

29 Things to Consider in a Health Plan Your total annual health plan costs: Your total annual health plan costs: –Services that are and are not covered –Medicare and UC Health Plan Premiums –Deductibles and Co-insurance Include both medical, prescription drugs and behavioral health Include both medical, prescription drugs and behavioral health –Factor in your Out-of-Pocket Maximum (OOPM) protection If your co-pays, co-insurance and deductibles paid equal your OOPM, additional care in the plan year for covered expenses is paid at 100% - review the plan for excluded items If your co-pays, co-insurance and deductibles paid equal your OOPM, additional care in the plan year for covered expenses is paid at 100% - review the plan for excluded items

30 Additional Issues to Consider

31 Additional Considerations Changing Plans….. Open Enrollment (OE) Open Enrollment (OE) When you retire you will continue to have the option to change plans during November Open Enrollment, the change will be effective the first of the following January When you retire you will continue to have the option to change plans during November Open Enrollment, the change will be effective the first of the following January Move Out of the Service Area/Out of the US Move Out of the Service Area/Out of the US If you move out of your plans service area you will have a Period of Initial eligibility to switch plans outside of Open Enrollment If you move out of your plans service area you will have a Period of Initial eligibility to switch plans outside of Open Enrollment Process: Call UCOP customer service, alert them of your new address. The rep will mail you a form so you can select a new plan. If the form is returned to UCOP by the 15 th of the month, typically the change is effective the first of the following month Process: Call UCOP customer service, alert them of your new address. The rep will mail you a form so you can select a new plan. If the form is returned to UCOP by the 15 th of the month, typically the change is effective the first of the following month –UCOP Customer Service

32 Plan options if you move outside California Plan options if you move outside California –Blue Cross PPO, High Option Supplement to Medicare, and Core Plan options if you move outside the U.S. for longer than 6 months Plan options if you move outside the U.S. for longer than 6 months –Blue Cross PPO and Core Will switch to Non-Medicare version of plan Will switch to Non-Medicare version of plan Higher premiums, different coverage levels Higher premiums, different coverage levels Additional Considerations Changing Plans

33 Use the Medical Plan Wizard to find the medical plans available in your service area Use the Medical Plan Wizard to find the medical plans available in your service area –You will need a zip code –Tool on At Your Service Website –Always call the plan for the most current information because service areas are subject to change

34 Tips for Planning Ahead Read Open Enrollment materials each year to track changes in coverage Read Open Enrollment materials each year to track changes in coverage Stay informed of general developments in Medicare and medical insurance Stay informed of general developments in Medicare and medical insurance Use your UC online resources for retirees Use your UC online resources for retirees –UC At Your Service Website –UCSF HCF Website

35 Tips for Planning Ahead Use your Medicare resources Use your Medicare resources -www.medicare.gov -www.medicare.gov Medicare General Information – Medicare General Information – Social Security – Social Security – Health Insurance Counseling and Advocacy Program (HICAP) – Health Insurance Counseling and Advocacy Program (HICAP) – Still have questions? Still have questions? –UC Retiree, Health and Welfare –Contact Your Health Plan –UCSF Health Care Facilitator (HCF) Pgrm – (415)

36 The End THANK YOU FOR PARTICIPATING! Additional information about Medicare is available on the Health Care Facilitator website at:


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