Medicare Enrollment and Medicare Enrollment and Your UC Sponsored Your UC Sponsored

Medical Plan Coverage Medical Plan Coverage

UCSF HR/Benefits UCSF HR/Benefits

Health Care Facilitator Program, 2009Health Care Facilitator Program, 2009

Medicare BasicsMedicare Basics

What is Medicare?What is Medicare?• Medicare is a Federal Medical Insurance Medicare is a Federal Medical Insurance

Program for:Program for:– People 65 years of age and older regardless People 65 years of age and older regardless

of their income or medical historyof their income or medical history– In 1972 Medicare was expanded to include In 1972 Medicare was expanded to include

the following groups:the following groups:• Some people with disabilities under age 65Some people with disabilities under age 65• End-Stage Renal Disease (permanent kidney End-Stage Renal Disease (permanent kidney

failure requiring dialysis or transplant)failure requiring dialysis or transplant)

– In 2000, individuals with Lou Gehrig’s In 2000, individuals with Lou Gehrig’s Disease (amyotrophic lateral sclerosis) could Disease (amyotrophic lateral sclerosis) could enroll at time of diagnosis (rather than enroll at time of diagnosis (rather than having to satisfy the 24-month waiting periodhaving to satisfy the 24-month waiting period

Medicare CoverageMedicare Coverage

• Part APart A– Hospital CoverageHospital Coverage

• Part BPart B– Medical CoverageMedical Coverage

• Part CPart C– Medicare Advantage ProgramMedicare Advantage Program

• Part DPart D– Out-Patient Prescription Drug Coverage – Out-Patient Prescription Drug Coverage –

established in 2006established in 2006

Gaps in Medicare CoverageGaps in Medicare Coverage

• If you had If you had only only Medicare insurance you Medicare insurance you would experience large gaps in coverage would experience large gaps in coverage requiring significant out-of-pocket expensesrequiring significant out-of-pocket expenses

• Your UC medical plan coverage coordinates Your UC medical plan coverage coordinates with Medicare to reduce these gaps and with Medicare to reduce these gaps and decrease your out-of-pocket expensesdecrease your out-of-pocket expenses

See See www.medicare.govwww.medicare.gov for information on coverage for information on coverage and exclusionsand exclusions

Delaying Medicare Part B Delaying Medicare Part B enrollmentenrollment• Medicare allows you to delay Part B enrollment as Medicare allows you to delay Part B enrollment as

long as you are covered by an Employer Group long as you are covered by an Employer Group Health Plan (EGHP) either as an employee or the Health Plan (EGHP) either as an employee or the dependent of an employeedependent of an employee

• You will have a special enrollment period to enroll You will have a special enrollment period to enroll in Medicare if you are older than 65 when your in Medicare if you are older than 65 when your EGHP ends and you will not be subject to the late EGHP ends and you will not be subject to the late enrollment penaltyenrollment penalty

• SS will provide you with a form requiring SS will provide you with a form requiring documentation of EGHP enrollment and documentation of EGHP enrollment and terminationtermination

UC Medicare Enrollment UC Medicare Enrollment Policy for Policy for RetireesRetirees

UC’s Medicare Enrollment UC’s Medicare Enrollment Requirements for Requirements for Retirees Retirees

• UC requires that you/your dependents UC requires that you/your dependents enroll in Medicare Part B when you/your enroll in Medicare Part B when you/your dependents become eligible for dependents become eligible for premium premium freefree, Medicare Part A **, Medicare Part A **– You/your dependents are transferred into the You/your dependents are transferred into the

‘Medicare-coordinated’ version of the plan‘Medicare-coordinated’ version of the plan

• You/your dependents do not need to enroll You/your dependents do not need to enroll in a non-UC sponsored Medicare Part D in a non-UC sponsored Medicare Part D planplan– Your plan will enroll you in Medicare Part DYour plan will enroll you in Medicare Part D

** Adult Dependent Relatives that become eligible for Medicare ** Adult Dependent Relatives that become eligible for Medicare Part A may not continue their UC sponsored medical Part A may not continue their UC sponsored medical coverage.coverage.

UC’s Medicare Enrollment UC’s Medicare Enrollment Requirements for Requirements for RetireesRetirees

• Retirees and their dependents risk de-Retirees and their dependents risk de-enrollment from UC sponsored medical enrollment from UC sponsored medical coverage if they…. coverage if they….

– Do not enroll in Medicare Part B when eligible for Do not enroll in Medicare Part B when eligible for premium free Medicare Part Apremium free Medicare Part A

– Enroll in a non-UC sponsored Medicare Part D planEnroll in a non-UC sponsored Medicare Part D plan

– Are HMO members who do not assign/lock Are HMO members who do not assign/lock Medicare to the plan and/or uses Medicare outside Medicare to the plan and/or uses Medicare outside of the planof the plan

Why UC Mandates Medicare Why UC Mandates Medicare EnrollmentEnrollment• Retirees over age 65 without Medicare Retirees over age 65 without Medicare

cost at least twice as much to insure as cost at least twice as much to insure as those with Medicarethose with Medicare

• Enrollment in Medicare partially Enrollment in Medicare partially reduces the cost of the plan, which reduces the cost of the plan, which keeps the UC premiums affordable for keeps the UC premiums affordable for allall

• Allows UC to continue to fund health Allows UC to continue to fund health benefits for retireesbenefits for retirees– Many employers are dropping or reducing retiree Many employers are dropping or reducing retiree

health coveragehealth coverage

Exceptions to UC Medicare Exceptions to UC Medicare MandateMandate

• Retirees that didn’t pay Medicare Retirees that didn’t pay Medicare taxes may not be eligible for taxes may not be eligible for premium free Medicare Part Apremium free Medicare Part A

– UC UC does notdoes not require retirees require retirees ineligibleineligible for for premium free Medicare Part A, to enroll in premium free Medicare Part A, to enroll in Part B.Part B.• These retirees may continue with their current These retirees may continue with their current

non-Medicare medical plan.non-Medicare medical plan.

– Please note: You may qualify for premium Please note: You may qualify for premium free Medicare Part A through a spouse, free Medicare Part A through a spouse, former spouse or prior work history. former spouse or prior work history. Contact Social Security, 1-800-772-1213Contact Social Security, 1-800-772-1213

Exceptions to UC Medicare Exceptions to UC Medicare MandateMandate• UC does not require you to enroll in UC does not require you to enroll in

MedicareMedicarePart B if:Part B if:

– You reside outside the United StatesYou reside outside the United States• you must enroll in Medicare if you returnyou must enroll in Medicare if you return• You may incur a penalty from Medicare when you re-You may incur a penalty from Medicare when you re-

enroll enroll

– You are You are still workingstill working at UCSF and have health at UCSF and have health coverage as an employee (never retired from UC)coverage as an employee (never retired from UC)

– You have UC sponsored health coverage through your You have UC sponsored health coverage through your spouse or domestic partner who is spouse or domestic partner who is still working at UCstill working at UC

Medicare EnrollmentMedicare Enrollment

Medicare EnrollmentMedicare Enrollment

• To enroll in Medicare or determine if you are To enroll in Medicare or determine if you are eligible, contact Social Security eligible, contact Social Security 1-800-772-12131-800-772-1213

• Remember if you don’t qualify on your own, you Remember if you don’t qualify on your own, you may qualify through a current or former spouse may qualify through a current or former spouse

• If you don’t qualify now but continue to work you If you don’t qualify now but continue to work you may qualify in the futuremay qualify in the future

• You are required to enroll at age 65 unless You are required to enroll at age 65 unless covered by an employer group health plan covered by an employer group health plan (EGHP) or pay a penalty for late enrollment(EGHP) or pay a penalty for late enrollment

Tips for Enrolling in Tips for Enrolling in MedicareMedicare• If you are retired, when you reach age 65, you If you are retired, when you reach age 65, you

should apply for Medicare three months before should apply for Medicare three months before your reach age 65your reach age 65

• If you are receiving SS benefits at the time, you If you are receiving SS benefits at the time, you will automatically be enrolled in both Part A and will automatically be enrolled in both Part A and Part B and a Medicare card will be sent to you Part B and a Medicare card will be sent to you about 3 months before your birthdayabout 3 months before your birthday

• If you are not receiving SS benefits you will need If you are not receiving SS benefits you will need to initiate enrollment into Medicare yourselfto initiate enrollment into Medicare yourself

Coordinating Medicare with Coordinating Medicare with your Retiree Health Coverageyour Retiree Health Coverage• Approximately 3 months prior to your 65Approximately 3 months prior to your 65thth birthday UC will birthday UC will

send you the following documents (if you are retired):send you the following documents (if you are retired):– UC Medicare Declaration FormUC Medicare Declaration Form– Universal Medicare Advantage Form (to be completed by those Universal Medicare Advantage Form (to be completed by those

in an HMO plan: Health Net, Kaiser, WHA)in an HMO plan: Health Net, Kaiser, WHA)

• UCOP will transfer your medical plan enrollment to the UCOP will transfer your medical plan enrollment to the Medicare version of the plan once they receive your Medicare version of the plan once they receive your documents and adjust your plan premiums as indicateddocuments and adjust your plan premiums as indicated

• Your family members enrolled as dependents who are not Your family members enrolled as dependents who are not eligible for Medicare will remain in the basic non-Medicare eligible for Medicare will remain in the basic non-Medicare version of the planversion of the plan

““Period of Darkness”Period of Darkness”

• There is usually a three week period of There is usually a three week period of transition from a non-Medicare plan to the transition from a non-Medicare plan to the Medicare version of the planMedicare version of the plan

• During this time period it can During this time period it can appearappear that your that your coverage has been terminated. coverage has been terminated. It hasn’t!It hasn’t!

• If you experience problems obtaining medical If you experience problems obtaining medical care or accessing your pharmacy benefits care or accessing your pharmacy benefits during this time, call your Health Care during this time, call your Health Care FacilitatorFacilitator

How UC Sponsored Health How UC Sponsored Health Plans Coordinate with Plans Coordinate with

Medicare Medicare

Information based Information based on coverage for plan on coverage for plan

year, 2009year, 2009

Medicare vs. Non-Medicare Medicare vs. Non-Medicare PlansPlans • All the UC medical plans have a separate All the UC medical plans have a separate

“Medicare -coordinated” version“Medicare -coordinated” version

• When you become eligible for Medicare you When you become eligible for Medicare you coordinate your current medical plan with coordinate your current medical plan with MedicareMedicare

• The Medicare-coordinated version of a plan The Medicare-coordinated version of a plan may differ in:may differ in:– Plan benefits/drug formularyPlan benefits/drug formulary– CostsCosts– Service areaService area– Network providersNetwork providers– Enrollment/de-enrollment processEnrollment/de-enrollment process

Medicare Coordination withMedicare Coordination withHMO plans (Advantage Plans), HMO plans (Advantage Plans), 20092009

• If you are enrolled in a Health If you are enrolled in a Health Maintenance Organization plan (HMO) -- Maintenance Organization plan (HMO) -- Health Net, Kaiser, or WHA -- Medicare Health Net, Kaiser, or WHA -- Medicare Parts A, B and D must be Parts A, B and D must be ‘assigned/locked’ into the plan‘assigned/locked’ into the plan

– You cannot use Medicare outside the planYou cannot use Medicare outside the plan– You will need to complete a MAPD form assigning You will need to complete a MAPD form assigning

Medicare to your planMedicare to your plan– If you change plans you will need to “unlock” If you change plans you will need to “unlock”

Medicare from your planMedicare from your plan

Medicare Coordination withMedicare Coordination withHMO plans (Advantage Plans), HMO plans (Advantage Plans), 20092009

• You must live in the plan’s CA service You must live in the plan’s CA service areaarea

• Medicare pays a flat fee to the HMO Medicare pays a flat fee to the HMO each month - the HMO agrees to each month - the HMO agrees to accept full responsibility for your careaccept full responsibility for your care

• You pay a low monthly premiumYou pay a low monthly premium

**You cannot use Medicare outside the planYou cannot use Medicare outside the plan

Medicare Coordination withMedicare Coordination withHMO plans (Advantage Plans), HMO plans (Advantage Plans), 20092009

• You select a primary care provider You select a primary care provider (PCP) to coordinate your care (PCP) to coordinate your care through your medical groupthrough your medical group

• You pay a small co-pay when you You pay a small co-pay when you receive servicesreceive services

• No need to submit claim forms No need to submit claim forms

Medicare Coordination with Medicare Coordination with Blue Cross Plans, 2009Blue Cross Plans, 2009

• High Option Supplement to MedicareHigh Option Supplement to Medicare

• Blue Cross PPO (Preferred Provider Blue Cross PPO (Preferred Provider Organization)Organization)

• Blue Cross Plus POS (Point of Service Blue Cross Plus POS (Point of Service Plan)Plan)– Includes in-network (HMO), and out-of-Includes in-network (HMO), and out-of-

network coveragenetwork coverage– Must live in the CA service areaMust live in the CA service area

• Blue Cross CoreBlue Cross Core

Medicare Coordination withMedicare Coordination withBlue Cross Plans, 2009Blue Cross Plans, 2009• You may see any Medicare provider*You may see any Medicare provider*

– Find doctors using the Participating Physician Find doctors using the Participating Physician Directory online at: Directory online at: http://www.medicare.govhttp://www.medicare.gov

• Medicare pays as primary Medicare pays as primary

• Each plan has an annual deductible* - Each plan has an annual deductible* - Once the deductible is met, Blue Cross Once the deductible is met, Blue Cross coordinates their payment after coordinates their payment after Medicare pays, to cover a percentage Medicare pays, to cover a percentage of your expensesof your expenses

*Exceptions – Blue Cross Plus in-network

Medicare Coordination withMedicare Coordination withBlue Cross Plans – Medicare Blue Cross Plans – Medicare TermsTerms

• Provider Accepts AssignmentProvider Accepts Assignment– Provider will accept Medicare contracted rates for Provider will accept Medicare contracted rates for

servicesservices

• Provider Does not Accept AssignmentProvider Does not Accept Assignment– Provider can charge up to 15% above Medicare Provider can charge up to 15% above Medicare

contracted ratescontracted rates

• Provider Opts Out of Medicare or Does Not Have a Provider Opts Out of Medicare or Does Not Have a Medicare ContractMedicare Contract– Claims from a provider that has opted out of Claims from a provider that has opted out of

Medicare or from a provider without a Medicare Medicare or from a provider without a Medicare certificate number will not be paid by Medicare and certificate number will not be paid by Medicare and will not be paid by your UC sponsored health planwill not be paid by your UC sponsored health plan

Health Coverage CostsHealth Coverage Costs

How much will my medical How much will my medical plan cost when I retire?plan cost when I retire?• If you began work at UC prior to 1/1/90 and did not have a If you began work at UC prior to 1/1/90 and did not have a

break in covered service for more than 120 days, you will break in covered service for more than 120 days, you will receive 100% of UC’s maximum contribution toward the receive 100% of UC’s maximum contribution toward the medical monthly premium. You will still pay the medical monthly premium. You will still pay the employee/retiree portion of the costemployee/retiree portion of the cost

• If you began work on or after 1/1/90 you will be subject to If you began work on or after 1/1/90 you will be subject to graduated eligibility. You will receive a percentage of UC’s graduated eligibility. You will receive a percentage of UC’s maximum contribution. Your percentage corresponds to maximum contribution. Your percentage corresponds to your years of UC service credit. In addition, you will still your years of UC service credit. In addition, you will still pay the employee/retiree portion of the costpay the employee/retiree portion of the cost

• No “salary banding” – all retiree rates are equal to the No “salary banding” – all retiree rates are equal to the second band ($46, 001 - $92, 000) with the exception of second band ($46, 001 - $92, 000) with the exception of Medicare coordinated plansMedicare coordinated plans

Part B ReimbursementPart B Reimbursement

0

20

40

60

80

100

120

UC Contribution

Gross Premium

Gross Premium(+Medicare)

Part B reimbursement

Reimbursement for Part B may apply if UC’s contribution for a plan is Reimbursement for Part B may apply if UC’s contribution for a plan is greater than the gross premiumgreater than the gross premium

Maximum individual Part B reimbursement currently is $96.40 per person Maximum individual Part B reimbursement currently is $96.40 per person (2009)(2009)

Things to Consider in a Health Things to Consider in a Health PlanPlan

• Your total annual health plan Your total annual health plan costs:costs:– Services that are and are not coveredServices that are and are not covered– Medicare and UC Health Plan PremiumsMedicare and UC Health Plan Premiums– Deductibles and Co-insuranceDeductibles and Co-insurance

Include both medical, prescription drugs and Include both medical, prescription drugs and behavioral healthbehavioral health

– Factor in your Out-of-Pocket Maximum Factor in your Out-of-Pocket Maximum (OOPM) protection(OOPM) protection• If your co-pays, co-insurance and deductibles If your co-pays, co-insurance and deductibles

paid equal your OOPM, additional care in the plan paid equal your OOPM, additional care in the plan year for covered expenses is paid at 100% - year for covered expenses is paid at 100% - review the plan for excluded itemsreview the plan for excluded items

Additional Issues to Additional Issues to ConsiderConsider

Additional ConsiderationsAdditional ConsiderationsChanging Plans…..Changing Plans…..

• Open Enrollment (OE)Open Enrollment (OE)• When you retire you will continue to have the option to When you retire you will continue to have the option to

change plans during November Open Enrollment, the change plans during November Open Enrollment, the change will be effective the first of the following Januarychange will be effective the first of the following January

• Move Out of the Service Area/Out of the USMove Out of the Service Area/Out of the US• If you move out of your plan’s service area you will If you move out of your plan’s service area you will

have a ‘Period of Initial’ eligibility to switch plans have a ‘Period of Initial’ eligibility to switch plans outside of Open Enrollmentoutside of Open Enrollment

• Process: Call UCOP customer service, alert them of your Process: Call UCOP customer service, alert them of your new address. The rep will mail you a form so you can new address. The rep will mail you a form so you can select a new plan. If the form is returned to UCOP by select a new plan. If the form is returned to UCOP by the 15the 15thth of the month, typically the change is effective of the month, typically the change is effective the first of the following monththe first of the following month

– UCOP Customer Service 1-800-888-8267UCOP Customer Service 1-800-888-8267

• Plan options if you move outside Plan options if you move outside CaliforniaCalifornia– Blue Cross PPO, High Option Supplement Blue Cross PPO, High Option Supplement

to Medicare, and Coreto Medicare, and Core

• Plan options if you move outside the Plan options if you move outside the U.S. for longer than 6 monthsU.S. for longer than 6 months– Blue Cross PPO and CoreBlue Cross PPO and Core

•Will switch to Non-Medicare version of planWill switch to Non-Medicare version of plan

•Higher premiums, different coverage levels Higher premiums, different coverage levels

Additional ConsiderationsAdditional ConsiderationsChanging PlansChanging Plans

Additional ConsiderationsAdditional ConsiderationsChanging PlansChanging Plans

• Use the Medical Plan Wizard to find the Use the Medical Plan Wizard to find the medical plans available in your service medical plans available in your service areaarea– You will need a zip codeYou will need a zip code– Tool on At Your Service WebsiteTool on At Your Service Website– Always call the plan for the most current Always call the plan for the most current

information because service areas are information because service areas are subject to changesubject to change

Tips for Planning AheadTips for Planning Ahead

• Read Open Enrollment materials each year Read Open Enrollment materials each year to track changes in coverage to track changes in coverage

• Stay informed of general developments in Stay informed of general developments in Medicare and medical insuranceMedicare and medical insurance

• Use your UC online resources for retireesUse your UC online resources for retirees– UC ‘At Your Service’ WebsiteUC ‘At Your Service’ Website

• http://atyourservice.ucop.edu/http://atyourservice.ucop.edu/ – UCSF HCF WebsiteUCSF HCF Website

• http://ucsfhr.ucsf.edu/hcfhttp://ucsfhr.ucsf.edu/hcf

Tips for Planning AheadTips for Planning Ahead

• Use your Medicare resourcesUse your Medicare resources• www.medicare.govwww.medicare.gov - -• Medicare General Information – 1-800-633-4227Medicare General Information – 1-800-633-4227• Social Security – 1-800-772-1213Social Security – 1-800-772-1213• Health Insurance Counseling and Advocacy Program Health Insurance Counseling and Advocacy Program

(HICAP) – 1-800-434-0222(HICAP) – 1-800-434-0222

• Still have questions?Still have questions?– UC Retiree, Health and Welfare - 1-800-888-8267UC Retiree, Health and Welfare - 1-800-888-8267– Contact Your Health Plan Contact Your Health Plan – UCSF Health Care Facilitator (HCF) Pgrm – (415) 514-UCSF Health Care Facilitator (HCF) Pgrm – (415) 514-

33243324• sforstat@hr.ucsf.edusforstat@hr.ucsf.edu

The EndThe End

THANK YOU FOR PARTICIPATING!THANK YOU FOR PARTICIPATING!

Additional information about Medicare is Additional information about Medicare is available on the Health Care Facilitator available on the Health Care Facilitator

website at: website at: www.ucsfhr.ucsf.edu/hcfwww.ucsfhr.ucsf.edu/hcf