Medicare and UC Medical Insurance

1
Medicare and UC Medical Insurance
2
Confused about Medicare and UC Medical Insurance?

• When does Medicare start? Do I lose my UC
  medical coverage? Do I have to enroll in Medicare
  when Im 65? What if Im still working? What if
  my spouse is 65 does he/she have to enroll in
  Medicare? Or lose UC coverage? What is meant by
  primary insurance? Secondary insurance?

Lets take a look
3
Medicare

• is the nations health care plan for senior
  citizens. Eligible beneficiaries are required to
  enroll in Medicare when they attain age 65. Some
  persons are eligible for Medicare prior to age 65
  due to specific health conditions such as end
  stage renal failure, permanent disability, etc.
  An eligible beneficiary can delay enrolling in
  Medicare past age 65 if that eligible beneficiary
  is covered by an active employer group health
  plan.

Medicare has 4 parts Part A, B, C and D.
4
Medicare tidbits

• Part A
• Covers Hospitalization
• Automatic at 65
• No monthly costs (already paid by payroll taxes)
• Annual Deductible currently 952/beneficiary
• Lifetime limits

• Part B
• Covers Physicians costs
• Must enroll at 65
• Monthly cost 2006 is 88.50/month/beneficiary
• Annual Deductible currently 124/beneficiary
• Lifetime limits

Late Medicare enrollment, without penalty, is
allowed if beneficiary is covered by Active
Employer Group Coverage.
This is for information purposes only. Medicare
Parts A, B, C D do not play a role while you
have active UC employer group insurance.
5
More Medicare tidbits

• Medicare Advantage Plans, formerly known as
  Medicare Part C or Choice Plans
• HMO Senior plan coordinates Medicare Parts A
  B with their plans benefits
• Note Medicare Fee For Service (FFS) Medicare
  stand-alone, can be supplemented by other
  Medicare supplement plans

• Part D - Drug Benefits
• Must enroll at 65 or with Medicare Part B
  enrollment
• Annual Liabilities per beneficiary
• 250 deductible
• 25 copay 251 - 2250
• 100 copay 2250 - 3600
• 5 copay after 3600/year
• Lifetime limits

This is for information purposes only. Medicare
Parts A, B, C D do not play a role while you
have active UC employer group insurance.
6
Medicare Secondary Payer Rule

• Medicare mandates that if a recipient is
  eligible for employer group health insurance,
  the employer group health insurance must be
  primary to Medicare.
• Generally, Medicare will not pay as a secondary
  when an employer group health plan has paid as a
  primary.
• Medicare may pay claims until COREs deductible
  is met. As the primary plan, CORE must first
  process the claims which will count towards its
  deductible. Medicare also has deductibles,
  co-insurances and some exclusions.

Providers must be Medicare Certified service
must be covered by Medicare.
7
Getting StartedPrimary vs. Secondary Insurance

• Primary insurance is the first insurance plan
  that will be billed for services.
• Secondary insurance is the second insurance plan
  that will be billed for services. A secondary
  insurance plan can pay an additional payment, in
  full or part, after the primary insurance plan
  has made payment or at least processed the claim.

Enrollment is not required in Part B if Medicare
is secondary insurance to an active employer
group health plan
8
What does this mean to me?
This means, in some cases, you will not be
required to enroll in Medicare Part B while
actively employed by UCLA
9
Medicare and UC Medical Insurance working
together

• If you are a UCLA employee who receives medical
  insurance from your active UCLA appointment and
  has attained the age of 65 or older,
• UCLA campus level coverage remains primary no
  change in coverage or usage
• Medicare Part A may start at age 65 and is free
• May postpone Medicare Part B enrollment until
  your UC retirement
• Do not have to enroll in Medicare Part B while
  your active UC group employer plan is your
  primary insurance

10
Medicare and UC Medical Insurance working
together

• If you are a UCLA employee who receives medical
  insurance from your active UCLA appointment and
  your spouse/domestic partner has attained the age
  of 65,
• UCLA campus level coverage remains primary no
  change in coverage or usage
• Medicare Part A may start at age 65 and is free
• May postpone spouses/domestic partners
  enrollment in Medicare Part B until your UC
  retirement
• Your spouse/domestic partner neednt enroll in
  Medicare Part B while your (UC employees) active
  UC group employer plan is your primary insurance

11
Medicare and UC Medical Insurance working
together

• If you are a rehired retiree (UC retiree/UCLA
  employee) who receives a monthly pension and
  medical insurance from UCOP, and you have
  attained the age of 65 or older,
• You are not eligible for campus level coverage
• You are required to apply for Medicare Parts A
  B. If eligible for Medicare, you are required to
  enroll in Medicare and coordinate your UC retiree
  coverage with Medicare
• Medicare Part A is free
• Medicare Part B has a monthly cost deducted from
  Social Security pension income

12
Medicare and UC Medical Insurance working
together

• If you are a rehired retiree (UC retiree/UCLA
  employee) who receives a monthly pension and
  medical insurance from UCOP, and your
  spouse/domestic partner has attained the age of
  65 or older, regardless of your age,
• He/she is not eligible for campus level coverage
• He/she is required to apply for Medicare Parts A
  B. If eligible for Medicare, he/she is required
  to enroll in Medicare and coordinate UC retiree
  coverage with Medicare
• Medicare Part A is free
• Medicare Part B has a monthly cost deducted from
  Social Security pension income

13
Medicare and UC Medical Insurance working
together

• If you are a rehired retiree (UC retiree/UCLA
  employee) who elected a Lump Sum Cashout (in lieu
  of a monthly UC pension and medical insurance) at
  the time of your UC retirement, and you have
  attained the age of 65 or older, or your
  spouse/domestic partner has attained the age of
  65 or older,
• You are eligible for campus level coverage if
  your recall appointment is
• At least 50 for 12 or more months or
• At least 100 for 3 months or longer
• You are not required to apply for Medicare Parts
  A B.

14
Employees retiring from UCLA

• your Benefits Office will
• Initiate transition of your campus level coverage
  to retiree level coverage with Office of the
  President, if eligible
• Complete the Special Enrollment Period (SEP) form
  for you and your spouse/domestic partner for
  enrollment in Medicare Part B
• the SEP form prevents a penalty for late Medicare
  enrollment
• Overview the UC retiree insurance coordination
  with Medicare and explain changes in coverage and
  usage, if any

15
Will I be eligible for UC insurance into
retirement?

• You may be eligible to continue your UC medical
  and dental coverage into retirement if ALL the
  following requirements are met
•  
• You are enrolled in your UC plan when you leave
  UC employment,
• You elect to continue coverage at the time of
  retirement,
• You retire within 120 days of terminating your UC
  employment,
• Your coverage is continuous and premiums are
  current,
• You meet UC service credit requirements.

Applies to a monthly UCRP benefit election, not a
lump sum cashout
16
UC Contributions The amount UC gives you for
health insurance costs

• You will receive 100 UC Contributions towards
  your medical and dental insurance if
• You have an UCRP entry date prior to January 1,
  1990, and
• You have at least 10 years of UCRP service
  credit, if retiring before age 55
• Otherwise, see Graduated Eligibility

Note Subject to conditions on slide 15.
17
UC Contributions100 Regents Contributions

• is the amount UC contributes to your medical
  and dental insurance plans costs into retirement
  and is based on the second tier of the Medical
  Contribution (salary) Band. It may not cover the
  entire premium thereby requiring retiree
  subsidies. Example, Retiree is eligible for 100
  UC contributions, has Health Net and Delta
  Dental, UC Retiree plus Adult coverage
• UC Contribution 479.66 Health Net
• UC Contribution 62.08 Delta Dental
• Retiree Contribution 66.21 Health Net
  (premium
• subsidy Just like active employees)

18
If I started after 1990, will I be eligible for
health benefits into retirement?
Yes, however Regents Contributions will be
subject to Graduated Eligibility.
19
UC Contributions The amount UC gives you for
health insurance costs

• You will be subject to Graduated Eligibility if
• You have an UCRP entry date January 1, 1990 or
  later, and
• You have a minimum of 10 years of UCRP service
  credit
• -OR-
• Your service credit years plus your age equals at
  least 75

Note Subject to conditions on slide 15.
20
Graduated Eligibility How its measured

Unless Rule of 75 (age plus service credit 75
or more) is met, then 50
21
UC ContributionsGraduated Eligibility
Contributions

• is the prorated amount UC contributes to your
  medical and dental insurance plans costs. It too
  may not cover the entire premium and may require
  premium subsidies paid by the retiree. Example,
  retiree (with 17 years) is eligible for 85 UC
  contributions, has Health Net and Delta Dental,
  UC Retiree plus Adult coverage
• UC Contribution 407.71 Health Net (85 x
  479.66)
• UC Contribution 52.77 Delta Dental (85
  x 62.08)
• Retiree Contribution 66.21 Health Net
  (premium subsidy)
• plus 15 x 479.66 71.95 (balance of
  Health Net premium)
• plus 15 x 62.08 9.31 (balance of Delta
  Dental premium)
• Total Retiree Cost 147.47 (Medical and
  dental costs)

22
FAQs

• I am still actively working at UCLA and have
  Health Net medical insurance. Next month I turn
  65. Do I need to sign up with Medicare? The
  Medicare website says I must enroll in Medicare
  at age 65. What will happen with my UC coverage?
• As long as your UC health insurance is active
  employer group health insurance (medical
  insurance from your UCLA appointment, not UC
  retirement plan), you can delay your enrollment
  into Medicare parts A B and your UCLA health
  insurance will continue uninterrupted. Upon your
  UC retirement, you will receive a Special
  Enrollment Period (SEP) for Medicare which
  allows you to enroll in Medicare parts A B
  without penalty.

23
FAQs

• Q I am 57 and plan to retire from UCLA in 3
  years. My husband is on my medical insurance and
  will turn 65 next year. Does he have to enroll in
  Medicare?
• No, as long as your UC medical insurance is
  active employer group health plan insurance
  (medical insurance from your UCLA appointment,
  not UC retirement plan), your husband can delay
  enrollment into Medicare part B without penalty.
  When you retire from UCLA, your husband will
  receive a Special Enrollment Period (SEP) for
  Medicare which allows enrollment into Medicare
  without penalty.

Also applies to Same Sex Domestic Partners.
24
FAQs

• Q I am a rehired retiree who has returned to work
  at UCLA 60. I want to keep my retiree health
  insurance which is coordinated with Medicare.
  What can I do?
• If you continue to work at UCLA 60 time, you
  must change from your UC retiree medical plan to
  the campus level medical plan, offered to you
  from your appointment. NO EXCEPTIONS ALLOWED.
• -OR-
• You can reduce your appointment to 43 or lower
  and keep your retiree medical insurance
  coordinated with Medicare.

25
Resources

• Medicare Website at www.medicare.gov
• Campus Human Resources, 310.794.0830
• Healthcare Human Resources, 310.794.0500
• www.chr.ucla.edu, Health Plans, UC Regents and
  Employee Health Plan Contributions
• Returning to UC Employment After Retirement
  Factsheet and Waiver

26
Medicare and UC Medical Insurance

• The End