Gary L. Harbin, CPAExecutive Secretary
Teachers’ Retirement System of the State of Kentucky
Turning 65
2017
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Happy
65th
Birthday
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Insurance companies bombard you by
phone and mail with policies from the
open market as early as six months
before you turn 65.
Remember, it is not necessary to review these materials unless you expect to
pay a premium at TRS and would just like to compare policies.
About 3 Months
Before You
Turn 65
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TRS does not endorse
any vendor.
TRS Medicare Eligible
Health Plan
(MEHP)
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What Happens to Your TRS
Insurance Upon Turning Age
65?
If you are currently on TRS insurance
If you are not currently on TRS insurance
You will receive a turning 65 booklet explaining the TRS
Medicare Eligible Health Plan (MEHP) which is composed of
a Medicare Advantage PPO plan and a Medicare Part D
prescription drug plan.
You must request a turning 65 booklet explaining the TRS
Medicare Eligible Health Plan (MEHP) or download materials
from https://trs.ky.gov.
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The Turning 65 BookletT
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The Turning 65 Booklet
▪ Quick Step Guide
▪ Introduction & MEHP description
▪ Transitioning from KEHP
▪ Medical Summary of Benefits
▪ Prescription flyer
▪ Currently covered by a family, couple or parent plus plan?
▪ MEHP Enrollment Form (blue)
▪ Return to TRS envelope
Getting to Know ...
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Administered by Centers for Medicare & Medicaid Services (CMS)
Health insurance for
people age 65 and older
or anyone
Social Security disabled
for over 24 months.
Enroll by contacting Social Security Administration (SSA)
or
Railroad Retirement Board (RRB)
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Medicare
Original Medicare (1965)
• Part A – Hospital coverage
• Part B – Medical coverage
• Run by the federal government
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Medicare Advantage Plan
(Balanced Budget Act of 1997)
• Part C
• Run by private companies
There are 2 main ways to
receive medical coverage when on Medicare ...
#1
#2
Claims go to Medicare
first & you should
purchase additional
supplemental/secondary
coverage
Original Medicare Medicare Advantage
Medicare Advantage
claims go to private company (like
UnitedHealthcare) to pay and process as
primary & secondary. No need to
purchase supplemental coverage
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The medical portion of the TRS MEHP is a
Medicare Advantage plan administered by UnitedHealthcare.
▪ Result of the Medicare Modernization
Act 2003
▪ Also known as
Medicare Part D
▪ Run by private companies
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The prescription portion of the TRS MEHP is a Medicare Part D
prescription drug plan administered by Express Scripts.
What about Medicare RX coverage?
Express Scripts
Medicare Part D prescription drug
plan covers
prescription claims
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Do not enroll in another Medicare Advantage plan
or Medicare Part D plan outside of TRS.
UnitedHealthcare
Medicare Advantage plan
covers
medical claims
The TRS
Quick Step
Guide
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on
how to enroll
in the MEHP
~~
• Apply for Medicare 3 months BEFOREyour 65th birthday
You MUST …
• You will automatically be enrolled in Medicare Parts A & B.
• Your Medicare card will be mailed to you.
If you are receiving Social Security
or Railroad Retirement benefits …
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Enroll In Medicare
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More About Enrolling in Medicare
You must enroll in Medicare to be
eligible to enroll in the TRS MEHP!
Not eligible to receive Social Security Benefits?
You will NOT receive Medicare
automatically. You must apply!
The ways to apply for Medicare are
Call or visit your
local Social Security
office
Apply
online at
www.ssa.gov/medicare/
Take original documents such as Drivers License, Social Security Card, Birth Certificate, Marriage License, Proof of Income
ORIf you worked for a
railroad, call the RRB at
877-772-5772
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What Parts of Medicare Do I Need?
• You must enroll in Medicare Part B.
• Only enroll in Part A if it’s FREE. You could possibly qualify for free Part A through a spouse, ex-spouse or deceased spouse who paid into Social Security.
• Not eligible for free Part A? The TRS plan will pay as Medicare would have paid on Part A expenses, excluding the MEHP deductibles and copayments.
Retirees
• Enroll in Medicare Part A.
• Enroll in Medicare Part B.Spouses
• Do not enroll in Medicare Part D.
You will have a Medicare Part D plan through Express
Scripts when you enroll in the TRS MEHP.
Retirees & Spouses
www.medicare.gov
• Everyone must enroll in Part B and pay the standard Part
B monthly premium ($134 for those new to Medicare in
2017).
• If you don’t enroll or fail to pay the Part B premium,
your TRS MEHP will be terminated.
• Ways to pay Part B premium
• Auto deduct from your monthly Social Security
benefit check
• Billed quarterly by Social Security if no Social
Security Benefit check
• If billed quarterly, contact Medicare to enroll in
Medicare Easy Pay for monthly auto deduction
from a checking account.
• Or, sign up for your bank’s online bill payment
service, if available to you.
Additional Medicare Part B information
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Page 1
Complete
MEHP
Enrollment
Form
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Complete the blue MEHP
enrollment form by copying your
Medicare claim number from
your Medicare Card.
Page 2
Always keep your address
current with TRS, Medicare
& Social Security.
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Submit Your MEHP
Enrollment Form to TRS
If available, include a copy of your
red, white and blue Medicare card
with the blue MEHP enrollment
form. Otherwise, fax or mail a copy
upon receipt.
▪ Form should be submitted to TRS two months before your 65th
birth month, but no later than the last day of the month before you
turn 65.
For example:
Birthday is Oct. 16, submit by Sept. 30
Born on the first day of the month?
(Sept. 1, Oct 1., Nov. 1)
Submit one month early
For example:
Birthday is Oct. 1, submit by Aug. 31
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What About Covered
Dependents?
On a KEHP Couple or
Family plan?
▪ May need to complete and return
the KEHP Qualifying Event Form
to continue or waive coverage for
remaining dependents. See page
26 of the Turning 65 booklet.
▪ KEHP rates are shown on the rate
chart included in the booklet.
On a Parent Plus plan?
▪ You will receive a separate
COBRA packet from
WageWorks before the
termination date to continue
coverage for the child, if needed.
▪ If the child is disabled and has
Medicare Parts A & B, you can
enroll them in the TRS MEHP.
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TRS MEHP Medical Coverage Overview
Medical Deductible
-$150 per calendar year, then
- Member pays 4%, plan pays 96% of
covered expenses
Other copayments:
- $200 Inpatient Hospital Copayment
- $35 Urgently Needed Services
Member’s maximum out-of-pocket is
$1,200 per calendar year
- Once met, plan pays 100% of covered
expenses
The deductible, copayments and
coinsurance apply toward $1,200 out-of-
pocket annual maximum.
Medicare covered preventive care paid at 100% with no deductible to meet.
Receive a gift card for completing your Annual Wellness Visit by June 30
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Additional features of the MEHP
• A routine hearing exam every 12 months, $0 copay
• A $500 hearing aid allowance every 36 months
• hi HealthInnovations Hearing Aids Discount Program
• 6 routine podiatry visits per plan year, $0 copay
• HouseCalls, in home assessment program, $0 copay, Target
gift card reward
• Solutions for Caregivers –resources to help in caregiving
• Dedicated UHC Retiree Advocate to help with escalated
issues and meet face to face with TRS retirees, if necessary
• SilverSneakers fitness program provided at no cost. Find
participating facilities at www.silversneakers.com or call
888-423-4632
• Edumedics provides personalized care to those with chronic
diseases like diabetes, high cholesterol and high blood
pressure. For more information, call 855-210-8514
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TRS MEHP Part D Prescription Coverage Overview
Retail Program – designed for short-
term 30 day medications
Deductible -$150 per calendar year
Coinsurance after deductible is met
- Tier 1: 20% Generic
- Tier 2: 20% Preferred brand
- Tier 3: 50% Non-preferred drugs
(generics & brands)
Mail Program – designed for maintenance
90 day medications
Deductible -$0 per calendar year
Copayment
- Tier 1: $10 Generic
- Tier 2: $20 Preferred brand
- Tier 3: 50% Non-preferred drugs
(generics & brands)
In the coverage gap stage (donut hole),
you pay the same as shown above.
Confidential and Proprietary Information© 2014 Express Scripts Holding Company. All Rights Reserved. 26
Know Your Rx Coalition
855-218-5979
Clinical Director
Lucy Wells
Dedicated Clinical
Pharmacists
Travis Albrecht
Marissa Boelhauf
Lea Goggin
Amy Griesser
Charla Katz
Matt McMahan
April Prather
Allison Russell
Know Your Rx Coalition Pharm-Assist Offering
Monday-Friday 8 a.m. – 6 p.m. ET
• Free counseling service via live pharmacists
• Identification of lower-cost prescription
alternatives
• Contacting physician to facilitate seeking
authorization for lower-cost alternative therapies
• Liaison for retirees/physicians for issues with
Rx benefit including prior authorization, step
therapy and other programs
• Educational resources for retirees – adverse
effects, drug interactions and general medication
information
• All major chain pharmacies included in the
retail pharmacy network.
• Show your Express Scripts ID card at the
retail pharmacy.
• To avoid any possible lapse in your
medication with the TRS MEHP, obtain a
refill through your current plan by the
last day of the month prior to your birth
month.
TRS MEHP Overview
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• This Medicare Advantage plan allows you the
same in- and out-of-network cost-share;
therefore, you can see any licensed provider
who accepts Medicare patients and Medicare
assignment and agrees to bill UHC directly.
• Show providers your UHC Medicare Advantage
ID card and have them file claims directly with
UHC instead of Medicare.
• Providers submit claims directly to UHC &
provider will bill you after claims have been
processed by UHC. Do not pay the provider
anything up front.
Please note: If you enroll in another Medicare Advantage plan or Medicare Part
D plan outside of TRS, your TRS MEHP terminates immediately.
Benefit Booklets and Identification Cards
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Present at doctor or
hospital
Present at retail
pharmacy
DO NOT present your Original Medicare card to your providers.
On the effective date of coverage, if you have not received your ID cards, you can print
a temporary ID card by registering at www.uhcretiree.com/trs and www.express-
scripts.com.
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What else should you expect?
Within the first 90 days
of enrollment you should
expect:
Welcome Call
AND
Health Assessment Call
Introduction Call
OR
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What will the MEHP cost?
How much does the MEHP cost for 2017?
Listed below is the monthly cost of the 2017 MEHP (you also must continue to pay
your Medicare Part B premium and any additional Part B and Part D income-adjusted
premium billed by Social Security).
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Recommend contacting TRS to verify your premium.
Reciprocity retirees must contact TRS for premium calculation.
Years of
Service
TRS Entry Date
Before
July 1, 2002
TRS Entry Date on or
After
July 1, 2002
TRS Entry Date on or
After
July 1, 2008 Medicare-Eligible
Spouses/Children
Pay
Full Monthly
Premium
of
$252
and
the monthly
Medicare Part B
premium
5-9.99 $189 $226.80 Not Eligible
10-14.99 $126 $189 Not Eligible
15-19.99 $63 $138.60 $138.60
20-24.99 $0 $88.20 $88.20
25-25.99 $0 $25.20 $25.20
26-26.99 $0 $12.60 $12.60
27 or more $0 $0 $0
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What Additional Premiums Can You Expect?
Above amounts are in addition to the standard Part B premium
amount paid to Social Security ($134 for those new to Medicare in
2017) and the MEHP premium paid to TRS (if any).
Late enrollment penalty from Social Security
• Penalty for failing to enroll in Medicare Part B or a
Medicare Part D plan when first eligible
• This is a monthly premium paid to Social Security.
High income earner premium from Social Security
• Additional monthly premium if your income, as reported
on your IRS tax return from 2 years prior, is greater than
$85,000 for individuals or $170,000 for those filing joint
tax returns
• This is a monthly premium paid to Social Security.
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What Happens if You
MEHP Coverage?
W A I V E
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▪ Open enrollment not an
option
▪ You must experience a
qualifying event to enroll.
▪ Spouse loses other
employer/ retirement
system sponsored coverage,
spouse’s COBRA expires,
tag-along with retiree or
death of retiree
W A I V E
Retiree Waives
MEHP upon
turning 65
Spouse Waives
MEHP upon
turning 65
▪ Open enrollment effective
Jan. 1
▪ Outside of open enrollment
you must experience a
valid qualifying event.
▪ Loss of other coverage,
COBRA expires, gaining
Medicare Part B or moving
back to U.S.
If you are retired and
employed by an agency
that does not participate
in the KEHP, but you
are eligible for health
insurance through that
employment, you must
terminate TRS
coverage unless that
coverage is not as good
as TRS coverage. You
may be asked to certify
this information.
If you are retired
and employed by
an agency that
participates in the
Kentucky
Employees’ Health
Plan (KEHP) and
you are eligible for
health insurance,
you must terminate
coverage through
TRS.
Additionally, once
you terminate that
employment or lose
eligibility for active
insurance, it is your
responsibility to
contact TRS within
the qualifying event
period (usually 30
days) to re-enroll and
provide the required
documentation.
1 2 3
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livingwell.ky.gov
Also,if you have a Consumer Driven
Health Plan (CDHP) you will want to use any remaining HRA funds before moving to the MEHP.
Don’t forget you may have
unspent bucks left with
Go365. You will need to
spend all your bucks in the
Go365 Mall before your
Kentucky Employees’ Health
Plan terminates.
MALL
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With the TRS MEHP
Good news!
Let’s Have a Big “Shout-Out” to
TRS Retirees LIVING LONGER!
Age 100 years old or more 48
Age 95-99 years old 211
Age 90-94 years old 780
Age 80-89 years old 5,03338
4,800
5,000
5,200
5,400
5,600
5,800
6,000
6,200
2010 2011 2012 2013 2014 2015 2016
5,107
5,2765,297
5, 535
5,692
5,864
6,072
Retirees Over 80
As of Dec. 31
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REMINDER!
Benefits & Costs Can Change on an
Annual Basis
✓ Deductibles
✓ Coinsurance/copayments
✓ List of covered drugs
✓ Premiums
Always watch TRS newsletters for changes and
notices.
TRS Keeping In Touch
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Online
Special mailings and newsletters
Information Center
TRS News & Information
https://trs.ky.gov https://mss.trs.ky.gov/
TRS
facebook.com/KyTeachersRS @KyTeachersRS
Our Members
Come First!
As always, you may contact
TRS if you have any
questions or concerns.
Monday through Friday,
8 a.m. – 5 p.m. ET
800-618-1687
502-848-8500https://trs.ky.gov
Protecting & Preserving Teachers’ Retirement Benefits 42