Passing the Baton: Transitioning to Retiree Health Benefits
Presented bySusan 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 DependentsSame 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
2628
431
949
383
1930
1780
92
53 23733
COVA Care/Connect Basic - 2,628
CC w/Out of Network - 431
CC w/Expanded Dental - 949
CC w/Out of Net/Exp Dental - 383
CC w/Vision/Hearing/Exp Dental - 1,930
CC w/Out Net/Vision/Hearing/Exp Dental - 1,780
COVA HDHP - 92
Kaiser - 53
TRICARE Supplement - 23
Waived - 733
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
5,999
18,971
922
1,979
1,803
3,120Advantage 65 - 5,999
Advantage 65 w/DV - 18,971
Advantage 65 Med Only - 922
Advantage 65 Med Only w/DV - 1,979
Option 1 - 1,803
Option 2 - 3,120
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 ProgramHow does the State Retiree Health Benefits Program work with Medicare?
•Plan Provisions•Premium Cost
How Does Advantage 65 Work?2012 Medicare
BenefitA65 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 plan Can elect enhanced Med D benefit with A65
Routine Dental Not covered Optional
Routine Vision Not covered Optional
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 2013Plan Single Two-Person FamilyCC/CC Basic $491 $909 $1,328CC/CC + Out of Network $503 $925 $1,351CC/CC +Exp Dental $506 $939 $1,373CC/CC + Vision/Hrg/ED $519 $961 $1,402CC/CC + OON/Exp Dental $518 $955 $1,395CC/CC + OON/VH/ED $531 $977 $1,424COVA HDHP $392 $727 $1,062 Kaiser Regional HMO $516 $951 $1,386Tricare 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?
Resourceswww.dhrm.virginia.gov
– Retiree Fact Sheetswww.medicare.gov
– 800-MEDICAREwww.ssa.gov
– 800-772-1213Medicare COB
– 800-999-1118VICAP
– 800-552-3402
Questions
Thank you!