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1
Medicare & YouFor city of Phoenix Retirees
Presented by city of Phoenix
Personnel Department Benefits Office
2
Introduction Presenters
Kathy Bird, Benefits Analyst IICarol Dodd, Benefits Analyst II
TopicsAll the Medicare Parts (A, B, C & D)How Medicare works with the city’s retiree
coverage
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Purpose and Goals
Basic information about Medicare
How the city’s retiree coverage works with Medicare.
Representatives from CIGNA and BlueCross/BlueShield available after the meeting.
4
Medicare & You You are eligible for Medicare on the 1st day of
the month in which you are turning 65.
Example: 65th Birthday – March 23, 2010 Medicare eligible - March 1, 2010
You are also eligible for Medicare if you have qualified for Social Security Disability Income (SSDI) for the previous two years. Medicare enrollment is automatic when disabled.
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Your Choices at 65
BasicMedicare
Part A Part BPart D
Medicare Part CPart A Part BPart D
+ additional coverage
City Retiree Medical Coverage
Part APart B
+ coverage comparable to active employee coverage
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Medicare Part A Helps cover inpatient care in a hospital
You’re automatically enrolled at age 65
$1,068 annual deductible (increases to $1,100 in 2010) Can be co-insurance
Also covers skilled nursing care, hospice, and home health care, to a point, if eligible
Skilled Nursing facility limited to 20 days
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Medicare Part BHelps pay for outpatient medical care A monthly premium ($96.40 in 2009; $110.50 in 2010)
and an annual deductible are required.
80% of the Medicare approved amount is covered If a physician or hospital does not accept Medicare, you
are also liable for the charges above the Medicare approved amount (to a limit). These are called “excess charges.”
Does not cover most preventive care, vision or hearing expenses.
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Medicare Part B: Do I have to enroll?
Whether you have the city’s retiree medical coverage or you enroll in a Medicare Part C Advantage plan through private carrier, you must enroll in Medicare Part B!
YES!
12
Medicare Part BWhat if I’m eligible, but I didn’t enroll?
If you don’t enroll during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins the following July.
However, your monthly premium increases 10% for each 12-month period you were eligible for, but did not enroll in, Part B.
13
Medicare Part BWhat if I’m still working at 65?
If you are 65 or older and covered under a group health plan, you can delay enrolling in Medicare Part B without penalty. The rules allow you to:
Enroll in Medicare Part B any time while you are covered under the group health plan based on current employment; or
Enroll in Medicare Part B during the eight-month period that begins with the month your group health coverage ends, or the month employment ends—whichever comes first.
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Medicare Part CPrivate Insurance Option
If you have Medicare Parts A and B, you can join a Medicare Advantage plan.
Medicare Advantage Plans provide additional coverage and may include prescription drug coverage. If your Medicare Advantage Plan does not include
pharmacy coverage, you need to enroll in Medicare Part D.
Offers additional benefits such as hearing, vision and dental services, and health and wellness programs.
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Medicare Part CPrivate Insurance Option You can enroll in a Medicare Advantage plan during their
annual election period from November 15 – December 31.
Plan designs: HMO, PPO, Private Fee For Service
Carriers: CIGNA, Humana, SecureHorizons, SCAN, Health Net, Aetna, and more.
Sign over your Medicare benefits and (usually) pay an additional premium each month. Check each Medicare Advantage plan as some do not charge a monthly premium.
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Medicare Part CQuestions you should ask
Is there an additional premium (above and beyond the Medicare Part B premium)?
Are referrals needed? Is there a network of providers? Are your providers included?
What is the prescription drug coverage? Are your medications covered?
What are the deductibles and co-pays? Will the plan cover you out-of-state? How does coverage and cost compare to the city’s retiree
medical coverage?
18
Medicare Part C
Use the Plan Compare Tool at
www.medicare.gov
Here you can compare a variety of plan options and see who has the lowest out of pocket costs.
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Medicare Part D Prescription Drug Coverage
Helps cover the cost of prescription drugs.
May be offered on a stand-alone basis or in conjunction with a Medicare Advantage plan.
Do not sign up for a Medicare Part D plan if you have the city’s retiree medical coverage!
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Medicare Part D Prescription Drug Coverage
Major Out-of-Pocket Costs with Medicare Part D
Annual Deductible = $310.00
25% of the next $2,830 = $707.50
100% of the next $3,610
After that: $2.50/generic, $6.30/brand or 5% whichever is greater
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Medicare Part DPrescription Drug Coverage
Rx CostYou Pay
Medicare Pays
The first $310 $310.00 $0The next $2,830 $707.50 $2,122.50The next $3,610 $3,610.00 $0
Totals $4,627.50 $2,122.50Then: $2.50/generic, $6.30/brand or 5% whichever is more
23
Important Dates for Medicare
November 15 – December 31
Annual Enrollment Period This is when you can enroll in
or change your Medicare Advantage plan and/or Medicare Part D plan.
Changes are effective January 1
24
Important Dates for Medicare
January 1 – March 31 Open Enrollment Period This is when you can enroll
in Medicare Part B if you are a late enrollee. Coverage would begin July 1st.
Penalties may apply.
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Medicare Part D & City Coverage If you want to remain in the city’s
medical coverage, do NOT enroll in Medicare Part D.
When you are enrolled in Medicare Part A and B, your prescriptions continue to be covered through CVS/Caremark. You can use most pharmacies such as CVS,
Walgreens, Fry’s, Safeway, Wal-Mart, etc. Mail order available
28
Medicare & City CoverageCosts Medicare Part B premium is deducted
from your Social Security check.
You will see a reduction in the cost of your city retiree medical premium reflected in your pension check.
29
Medicare & City Coverage
Single Coverage, No Medicare Part B
Single Coverage, With Medicare Part B
CIGNA HMO $513.00/month $438.85/month
BCBS HMO $467.27/month $399.32/month
BCBS PPO $472.91/month $404.16/month
Signing up for Medicare Part B reduces your monthly premium for city medical coverage. Here’s one example:
30
Medicare & City Coverage
How does Medicare coordinate with CIGNA or BCBS?
You receive a Medicare Summary Notice (MSN) every 3 months from Noridian.
Retain the Medicare Summary Notices received for up to 2 years.
Your healthcare provider also receives this notice.
31
Medicare & City Coverage
Most Medicare providers don’t charge co-pays.
If you receive a bill from a provider, please contact CIGNA or BlueCross/BlueShield.
Remember, there are CIGNA, BCBS and CVS/Caremark reps on-site in the Benefits Office to assist you.
32
Medicare & City Coverage
CIGNA may send out a “Request for More Information” document. They are looking for the Medicare MSN. They can set up a “crossover” for claims.
BlueCrossBlueShield (BCBS) sets up a “crossover” for claims to transfer from Medicare to the providers.
33
Medicare & City CoverageCan I re-enroll in the city’s plan? Yes. If you want to re-enroll with the city at a future time, you
may do so during the city’s Open Enrollment or upon loss of other group coverage or during Medicare’s Annual Enrollment Period.
If you choose to waive and enroll in a Medicare product, this is not group coverage.
You will need to provide proof of continuous, comparable coverage, including prescription drug coverage.
35
Announcing Retiree Dental Choice!
Dental HMOMonthly Cost
Retiree $18.36Retiree +1 $33.17Family $58.46
Dental PPOMonthly Cost
Retiree $34.08
Retiree +1 $75.72Family $110.75
The monthly cost will be deducted from your pension check each month.
Informational fliers can be picked up in the back of the room!
36
General Information
Same network of dentists as the employee Dental PPO and the employee Dental HMO plans.
Must be enrolled for at least 12 months.
Dental plan year will become the same as the medical plan year.
37
Important Retiree Dental PPO Information
Tier 3 coverage (i.e., crowns, bridges, dentures, root canals) requires a 12-month waiting period.
This waiting period is waived IF YOU ENROLL as of March 1, 2010.
38
Important Retiree Dental Dates
Information packets will be mailed in early January
Open Enrollment: January 11 – January 29
Coverage begins March 1, 2010