Passing the Baton: Transitioning to Retiree Health Benefits Presented by Susan Jones

For discussion… Eligibility Plan Choices Program Provisions Medicare – Overview – Enrollment – Coordination with the State Program – Prescription Drug Coverage

Eligibility Must be a retiring state employee receiving an immediate (not deferred) VRS retirement benefit or periodic benefit from an ORP Must have been eligible for state coverage as an active employee at the time of retirement (not Extended Coverage) Must enroll within 31 days of retirement date

… and Not Eligible Coverage is declined at retirement (except waiver) Enrollment is not completed within 31 days of retirement Retirement benefit is deferred Coverage is cancelled

Coverage Begins… The first day of the first full month of retirement

Eligible Dependents Same as active employees Legal spouse Children

Plan Choices Non-Medicare Plans Medicare Plans

Current Non-Medicare Plans COVA Care/COVA Connect COVA Care/COVA Connect with optional benefits – Out-of-Network – Expanded Dental – Out-of-Network and Expanded Dental – Vision, Hearing and Expanded Dental – Out-of-Network, Vision, Hearing and Expanded Dental Regional Plan – Kaiser Permanente COVA HDHP TRICARE Supplement

Non-Medicare Retiree Group

Medicare Supplemental Plan Options Advantage 65 Advantage 65 with Dental/Vision Advantage 65 Medical Only Advantage 65 Medical Only with Dental/Vision

Medicare Retiree Group

Changes Allowed at Retirement Enroll from active waive into single coverage Decrease membership Waive to active/retiree coverage as dependent (and return in the future per plan provisions) Plan change Decline/cancel coverage – no return to program

NOT Allowed at Retirement Increase in membership

Allowable Changes After Retirement Changes Consistent with Qualifying Midyear Events Membership Reduction (prospective) Cancellation (prospective ) Open Enrollment (non- Medicare only) Certain Medicare- Coordinating Plan Changes (prospective)

Required Change To a Medicare- coordinating plan immediately upon Medicare eligibility

NOTE: Active Employees If covered based on current employment, Part B can be declined without penalty (no break in creditable coverage for 63 or more days)

Medicare 101 What is it? How do I get it? What do I need? How much does it cost?

What is it? Medicare Eligibility At age 65 Before age 65 – Disability – End Stage Renal Disease

What is it? Original Medicare Plan Medicare Part A – Hospital Insurance – Inpatient care – Skilled nursing facility – Hospice Medicare Part B – Medical Insurance – Doctors’ services – Preventive care

What is it? Medicare Part D Outpatient Prescription Drug Coverage

What is it? Medicare Part C NOT ORIGINAL MEDICARE Medicare Advantage Plans Medicare PPO Plans Medicare HMO Plans Medicare Private Fee- for-Service Plans Medicare Special Needs Plans

How do I get it? Enrollment – A, B If no SSA/RRB benefits, you must actively enroll in A and B Automatic enrollment if you are already getting SSA/RRB benefits Declining Part B – Special Enrollment Period – General Enrollment Period – Late Enrollment Penalty

How do I get it? Enrollment – D Initial Enrollment Special Enrollment Annual Coordinated Election Period Late Enrollment Penalty

What do I need? To Summarize: You must have Medicare Parts A and B (Original Medicare)when your retirement begins if you enroll in the State Retiree Health Benefits Program to avoid a gap in coverage! You can get Part D through or outside of the state program.

How much does it cost? Cost for Medicare Only Part A – usually no cost Part B - $99.90 for 2012 (unless IRMA) Part D – cost based on elected plan ($38 average premium— IRMA/LIS)

The State Program How does the State Retiree Health Benefits Program work with Medicare? Plan Provisions Premium Cost

How Does Advantage 65 Work? 2012Medicare Benefit A65 Benefit Hospital Inpatient (Part A) You pay Deductible/Copay $1,156, $289, $578 A65 pays all but $100 +Additional AC for 365 Days Physician and Other Services (Part B) Generally, 80% coverage Pays 20% after $140 deductible Outpatient Prescription Drug (Part D) Based on chosen planCan elect enhanced Med D benefit with A65 Routine DentalNot coveredOptional Routine VisionNot coveredOptional

Enhanced Part D Provisions Formulary – Exceptions/appeals Tiers Excluded Drugs Coverage Stages – Deductible – Initial – Coverage Gap/Medicare Coverage Gap Discount Program – Catastrophic

Medicare Must Approve Part D: Enrollment Disenrollment – Only one plan Penalties

Premium Cost Retiree pays the full cost of coverage Health Insurance Credit (VRS) if eligible

How is Premium Paid? VRS Benefit Deduction Direct Bill – Automatic Bank Draft – Online payments

July 2012 through June 2013 PlanSingleTwo-PersonFamily CC/CC Basic $491$909$1,328 CC/CC + Out of Network $503$925$1,351 CC/CC +Exp Dental $506$939$1,373 CC/CC + Vision/Hrg/ED $519$961$1,402 CC/CC + OON/Exp Dental $518$955$1,395 CC/CC + OON/VH/ED $531$977$1,424 COVA HDHP $392$727$1,062 Kaiser Regional HMO $516$951$1,386 Tricare Supplement $60$119$160

2013 Premium Cost Advantage 65$237 Advantage 65 with Dental/Vision $271 Advantage 65 – Medical Only$139 Advantage 65 – Medical Only with Dental/Vision $173

Your Decision at Retirement… Is the state program the best choice for me?

Resources – Retiree Fact Sheets – 800-MEDICARE – Medicare COB – VICAP –

Questions Thank you!