Your UC Medical Benefits When You Retire

1
Your UC Medical Benefits When You Retire

• Presented by
• Deborah Lloyd,
• Health Care Facilitator

2
Goals for Today

• Clarify what you need to do
• Determine eligibility
• Assess your personal situation
• Explain how Medicare coordinates with your UC
  plan
• Overview of the UC Medicare-coordinated plans

3
Eligibility to Continue Medical Coverage as a UC
Retiree

• Retirees may be eligible for medical and dental
  coverage (vision not offered)
• If hired before 1/1/90, may be eligible for full
  UC contribution toward premiums after 5 years
  service
• Hired after 1/1/90 qualify for annuitant health
  insurance only after 10 years service
• Graduated eligibility--- you will receive a of
  UCs maximum contribution
• See handout When You Retire

4
UCs Medicare Enrollment Requirements

• UC requires that retirees and/or enrolled family
  members enroll in Medicare Part B when they
  become eligible for Part A
• Part A no cost Part B 66.60/month in 2004
• You transfer into the Medicare-coordinated
  version of your UC medical plan
• UCOP Annuitant Insurance unit will contact you a
  few months before your 65th birthday
• See handout Enrollment Details

5
UCs Medicare Enrollment Requirements

• Retired faculty/staff and family members who
  become eligible for premium free Medicare Part A
  but do not enroll in Part B will permanently lose
  UC-sponsored retiree medical coverage.
• Enrollment must be continuous.
• If member cancels Part B at any time they will be
  deenrolled from UC retiree medical coverage.

6
Why UC Mandates 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
  to the plan, which keeps the UC premiums
  affordable for all.
• Allows UC to continue to fund health benefits for
  retirees.
• Many employers are dropping retiree health
  coverage.

7
Dependents and Medicare

• Dependents are also required to enroll in
  Medicare when they are eligible
• Remember your dependents must be in the same
  medical plan as you
• If they dont have Medicare yet they will remain
  in the regular version of the plan
• RememberMedicare version of the plan may differ
  from regular plan

8
Exceptions to UC Medicare Mandate

• UC does not require you to enroll in Medicare
  Part B if
• You are still working and have health coverage as
  an employee
• You reside outside the United States
• You must enroll if you return
• NOTE Medicare late penalties may apply

9
Medicare vs. Non-Medicare Plans

• All the UC medical plans have a separate
  Medicare-coordinated version
• The Medicare-coordinated version of a plan may
  differ in
• Plan benefits
• Costs
• Service area
• Network providers
• Enrollment/de-enrollment process

10
UC Medical Plans for Annuitants

• A range of choices at a range of costs
• Plans with more flexibility cost more
• May self-refer for care
• Access to non-network providers
• Less expensive plans have less flexibility
• Must use network provider
• Networks are shrinking in size
• Networks differ between plans
• Provider may drop out of a plan mid-year
• Remember the HMO Transfer Program

11
High Option Supplement
Blue Cross PPO
Blue Cross PLUS
Health Net, PacifiCare, Kaiser
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UC Medicare-Coordinated Plans

• Medicare Choice plans (HMOs)
• Health Net/Seniority Plus
• Kaiser/Sr. Advantage
• Pacificare/Secure Horizons
• Western Health Advantage/WHA Care
• The Blue plans
• Blue Cross Plus
• Blue Cross PPO
• High Option Supplement to Medicare
• Core/Medicare

13
Medicare Choice Plans(HMOs)

• You assign your Medicare benefits to the plan
• Must complete forms with UC and your plan
• Plan agrees to assume full responsibility for
  your medical care
• Medicare pays the plan a flat fee each month
• UC plans provide extra benefits
• Prescription drugs
• You must receive all services through the plan
• Cannot use Medicare outside the plan

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Medicare Choice Plans(HMOs)

• You must live in the plans service area
• You must receive services from network providers
• You select a Primary Care Physician (PCP) who
  coordinates your care
• Preauthorization required for services
• Out-of-area covered for emergency services only
• You pay a small copayment when you receive
  services
• No claim forms no annual deductible

15
The Blue Plans

• Blue Cross PLUS
• Blue Cross PPO
• High Option Supplement to Medicare
• Core / Medicare

16
The Blue Plans

• You do not assign your Medicare to the plan
• Medicare is primary payer, BC is secondary
• You have an annual deductible
• Then, Medicare coordinates with BC to pay a
  percentage of the cost, you pay the rest
• After you reach maximum out-of-pocket, plan pays
  100 of covered charges

17
Physicians and Medicare

• Physician accepts assignment
• Provider will accept the Medicare allowable for
  services
• Find doctors online at http//www.medicare.gov
• Physician does not accept assignment
• Provider can charge up to 15 above Medicare
  allowable
• Physician opts out of Medicare (private
  contract)
• Provider does not participate in Medicare
• Neither Medicare nor Blue Cross will pay

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Blue Cross PLUS

• Must live in plan service area
• Two level plan design
• Network and out-of-network
• Network benefits through chosen PCP/medical group
• Out-of-network benefits through any Medicare
  physician
• You do not assign your Medicare to the plan

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Blue Cross PLUS Network

• You select a PCP who authorizes your care (works
  like an HMO)
• You pay a copayment for most services
• 20 for most doctors office visits
• Medicare and the plan pay everything else
• No deductible or claim forms

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Blue Cross PLUS Out-of-Network

• You may use any doctor who is a Medicare provider
  (no PCP authorization required)
• Neither Medicare nor BC will pay if you see a
  private contract provider
• Medicare pays 80 of Medicare allowable
• Blue Cross does not pay any additional benefit
• You pay total remaining balance up to annual
  out-of-pocket maximum of 5,000
• After you have paid out-of-pocket max, plan pays
  100 of covered charges

21
Blue Cross PPO

• Higher monthly premium than BC or HMOs
• You may use any doctor who is a Medicare provider
  (no PCP authorization required)
• Neither Medicare nor BC will pay if you see a
  private contract provider
• Annual deductible 100
• Coverage (after deductible)
• Medicare pays 80 of Medicare allowable
• Plan pays 80 of amount between Medicare payment
  and Medicare allowable
• You pay remainder

22
High Option Supplement to Medicare

• Highest monthly premium
• You may use any doctor who is a Medicare provider
  (no PCP authorization required)
• Neither Medicare nor BC will pay if you see a
  private contract provider
• Medicare pays first then plan pays the full
  remaining balance up to Medicare allowable
• Limited preventative benefits, no eye exams or
  hearing aids, limited behavioral health
• Annual deductible 50
• Maximum out-of-pocket 1,050

23
Core / Medicare

• Monthly premium fully paid by UC
• You may use any doctor who is a Medicare provider
  (no PCP authorization required)
• Annual deductible 150
• Medicare pays 80 of allowable, Core plan does
  not pay any additional
• Annual out-of-pocket max 2,260/member
• Limited preventative benefits, no behavioral
  health benefits, no hearing aids
• Plan pays 80 of UCR for prescriptions
• No formulary

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How much do the plans pay?

• See handout Payment Examples for UC Plans
• Plans coordinate with Medicare in different ways
• Some plans cover more of the cost
• Premiums reflect this
• Blue plans have annual out-of-pocket maximum
• Once you have met that, the plan will pay 100 of
  covered charges

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Out-of-Pocket Maximums

• Per Individual/ Per Calendar Year
• Review EOC for Limitations

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Which Blue plan is best for you?

• Look at the total annual premium cost, including
  the cost of Medicare Part B (deduct your Part B
  reimbursement if any)
• Compare this to the maximum out-of-pocket to
  choose the plan that best meets your needs

27
Prescription Drug Benefits for all plans except
Core

• Three tier copayment structure
• Generic on formulary 10 HMOs, 15 BC
• Brand name on formulary 20 HMOs, 25 BC
• Off-formulary 35 HMOs, 40 BC
• Formularies vary by plan
• Check plan website or call plan for latest list
• Mail order available
• Save by receiving three months worth of
  medications for two copayments
• See handout UC Medicare-coordinated Plans
  Prescription Drug Benefits 2004

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Things to Consider

• What will your total cost be?
• Your monthly premium cost
• Part B premium (66.60 in 2004)
• Deduct your Part B reimbursement (if any)
• Copays, deductibles, the balance you must pay
  after the plan pays its share
• Out-of-pocket maximum
• Cost to you for services not covered by plan
• See handout 2004 Plan Costs for UC Annuitants

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Things to Consider

• Which plans cover your location?
• Call plans for latest info on service areas
• HMO service areas subject to change
• Call UCOP Customer Service
• 1-800-888-8267 or customer.service_at_ucop.edu
• Check Medical Plan Wizard
• http//www.webifyyourinfo.com/01291/index.php?loc
  UC
• Shows all plans available in a zip code area

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Coverage in Other Locations

• If you move within California
• Check to see if plan covers your new location
• If you move outside California
• Blue Cross PPO, High Option Supplement, Core
• If you move outside USA
• Blue Cross PPO, High Option Supplement, Core
• Will switch to Non-Medicare version of plan
• Higher premiums, different coverage levels
• NOTE High Option members may switch to PPO or
  Core to lower premiums

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Coverage in Other States

• Washington D.C., Maryland or Virginia
• Blue Cross PPO, Core, Kaiser Permanente
  Mid-Atlantic
• NEW! UHC Select EPO
• Nevada
• Blue Cross PPO, Core, Pacificare of Nevada
• NEW! UHC Select EPO
• New Mexico
• Blue Cross PPO, Core, Pacificare of Nevada
• NEW! UHC Select EPO

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Tips for Planning Ahead

• Handout Medicare Flow Chart
• Think about your age in the coming year.
• You might want to switch to the desired plan
  during the Open Enrollment before you turn 65.
• Read Open Enrollment materials each year to track
  changes in coverage.
• Remember that you may have to change plans if you
  move out of area.
• Stay informed of general developments in Medicare
  and medical insurance.

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Resources

• UCB Health Care Facilitator Program
• UCB Retirement Center
• UCOP Customer Service for Annuitants
• Social Security/Medicare
• Your medical plan
• Your doctors office
• See handout Resources for UCB Annuitants

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Handouts

• 1. When You Retire
• 2. Enrollment Details
• 3. Medicare Coordination Payment Examples for UC
  Medical Plans
• 4. Prescription Drug Benefits 2004
• 5. 2004 Plan Costs
• 6. Medicare Flow Chart
• 7. Resources