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Medicare & YouFor city of Phoenix Retirees

Presented by city of Phoenix

Personnel Department Benefits Office

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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.

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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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Medicare Part A

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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 B

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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!

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Your Medicare Card

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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.

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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 C: Private Insurance Option

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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?

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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

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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

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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

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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 and City Retiree Medical Coverage

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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

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With City Coverage …

NO MEDICAREPART D

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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.

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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:

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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.

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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.

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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.

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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.

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Retiree Dental Coverage

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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!

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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.

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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.

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Important Retiree Dental Dates

Information packets will be mailed in early January

Open Enrollment: January 11 – January 29

Coverage begins March 1, 2010

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Medicare & You

Questions?