retiree medical benefits - grand valley state university · post-65 option - stipend to help ......

RETIREE MEDICAL BENEFITS – 2017

Presented By Kurt Swardenski, RHU, REBCAdvantage Benefits Group

Retiree Medical Options – Pre 651. GVSU Retiree Medical Plan

2. COBRA continuation coverage

3. Individual Coverage

4. Marketplace Coverage

PRESENTED BY ADVANTAGE BENEFITS GROUP 2

Pre-65

Retiree Medical Options

1. GVSU Retiree Medical Plan◦ See GVSU Health and Wellness Website for details

◦ www.gvsu.edu/healthwellness/benefits-in-retirement-446.htm

◦ “Official Retiree” Age and Service = 75

◦ Pre-65 Option - Coverage similar to GVSU Standard PPO but without prescription drug coverage (discount card available)◦ 2017 Monthly Cost (20 years of service) = $287.50

◦ 2017 Monthly Cost Spouse = $312.50

◦ Post-65 Option - Stipend to help pay for Medicare Advantage or Supplemental Plan◦ 2017 Monthly Stipend (20 years of service/age 65) = $52.50

◦ 2017 Monthly Stipend Spouse = $27.50


Pre-65

http://www.gvsu.edu/healthwellness/benefits-in-retirement-446.htm


2. COBRA Continuation Coverage◦ Up to 18 months or until entitled to Medicare,

whichever is less◦ Medical & Prescription Drugs◦ Dental

Cost (2017)◦ GVSU Standard Single

◦ $582.95 per month

◦ GVSU HDHP Single◦ $507.16 per month

◦ Dental Single ◦ $33.01 per month


Pre-65


3. Individual Plan◦ Available through a number of carriers:

◦ Priority Health

◦ Blue Cross Blue Shield

◦ Molina Healthcare

◦ Humana

◦ Cost varies based on smoker status, age, zip code and plan design


Pre-65


◦ Advance Premium Credits (subsidies) based on

household income and age

◦ Metal Tier Plans – Platinum, Gold, Silver, Bronze

◦ Multiple Carriers available (Blue Cross Blue Shield,

Priority Health, Blue Care Network)


Pre-65

Instructions to navigate the

www.healthcare.gov site: 1) Click “See Topics” from the top ribbon

on the homepage

2) Click “See plans and prices”

Open Enrollment Period: ◦ November 1, 2017 – December 15, 2017

◦ Average monthly cost (age 62, non-smoker, zip: 49401, effective 1/1/18)◦ Silver Plan for Single: $820 (23 plans available) - $403 after subsidy

◦ Gold Plan for Single: $1,235 (3 plans available) - $818 after subsidy

◦ Both plans have a subsidy of $417 per month based on single household income of $36,000

For Plan and Cost Estimates outside of Open Enrollment, go to: www.healthsherpa.com

4. Marketplace Plan (www.healthcare.gov)

http://www.healthcare.gov/

http://www.healthsherpa.com/

http://www.healthcare.gov/



Pre-65

2018

Will I Qualify for Lower Costs on Monthly Premiums? –Marketplace Plan


Savings Programs you may qualify for:

Estimated 2017 Household Income – based on number of people in your household *NOTE: Eligibility does vary based on age of

applicant.

1 2 3 4 5 6

Free or low-cost coverage through Medicaid based on

income alone

Below $16,394

Below $22,108

Below $27,821

Below $33,534

Below $39,247

Below $44,960

A Marketplace health plan with lower monthly premiums plus savings on out of pocket costs,

like deductibles and copayments

$16,394 -$29,700

$22,108 -$40,050

$27,821 -$50,400

$33,534 -$60,750

$39,247 -$71,100

$44,960 -$81,450

A Marketplace health plan with lower monthly premiums

$29,701 -$47,520

$40,051 -$64,080

$50,401 -$80,640

$60,751 -$97,200

$71,101 -$113,760

$81,451 -$130,320

You won’t qualify for savings on a Marketplace insurance plan. You can buy insurance through the Marketplace at full price, or

buy from other sources

Above $47,520

Above $64,080

Above $80,640

Above $97,200

Above$113,760

Above $130,320

Pre-65

What Does An Average (Silver) Plan Cost? Costs apply for Individual or Marketplace (if eligible for subsidy, it will reduce premium)

MyPriority HMO Holistic Silver 2500 (Priority Health)◦ Individual Premium (age 62, zip 49401) = $718 per month

◦ $2,500 Single Deductible, $6,750 Out of Pocket Maximum

◦ $30 Copay for first two Primary Care visits. Specialist $50 after deductible

◦ $5 Generic Drugs Before Deductible

◦ $60 preferred brand, $80 non-preferred brand, 20% specialty copays after deductible

◦ 30% member coinsurance after deductible for most other services

MyPriority POS HSA Silver 1500 (Priority Health)◦ Individual Premium (age 62, zip 49401) = $810 per month

◦ $1,500 Single Deductible, $5,250 Out of Pocket Maximum

◦ 30% coinsurance after deductible for most services

◦ $20 generic drugs after deductible

◦ $60 preferred brand, $80 non-preferred brand, 20% specialty copays after deductible


Pre-65

Retiree Medical Options – Post 65

1. Medicare

2. Medicare Advantage Plan

3. Medicare Supplemental Plan


Post-65

Retiree Medical Options - Medicare

Post-65 Option Medicare Supplemental/Gap – GVSU Retiree Plan◦ 2017 Monthly Stipend (20 years of service/age 65) = $52.50

◦ 2017 Monthly Stipend Spouse = $27.50

Who runs the Medicare Program?

◦ The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs Medicare. CMS is part of the U.S. Department of Health and Human Services

◦ Impact of recently enacted health reform on Medicare (2012)◦ Enhanced preventive care services

◦ Subsidy and discounts for drugs while in the donut hole

◦ Resource sites:◦ http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

◦ www.medicare.gov

◦ www.medicarerights.org – detailed timeline

◦ www.kff.org – Kaiser Family Foundation


Post-65

http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

http://www.medicare.gov/

http://www.medicarerights.org/

http://www.kff.org/

MedicareMedicare Benefits

Part A:

Hospital Coverage

Part B:

Medical Coverage

Part D:

Prescription Drug Insurance

Part C:

Combines Part A, B and D into one package


Post-65

Medicare Coverage Choices

Start

Original Medicare

Part A (Hospital Coverage)

Part D (Prescription Drug

Insurance)

Medigap (Medicare Supplement Insurance)

Policy

Part B (Medical Coverage)

Medicare Advantage Plan (like an HMO or PPO)

Part C (Includes BOTH Part A (Hospital Insurance) and Part

B (Medical Insurance) and usually Part D

Part D (Prescription Drug

Insurance)

END


Step 1: Decide how you want to get your coverage

Step 2: Decide if you want to add drug coverage

Step 3: Decide if you want to add supplemental coverage

If you join a Medicare Advantage Plan, you don’t need and can’t be sold a Medigap policy.

Post-65

Checklist: 5 Things to Do When You Get Medicare

1) Fill out an Authorization FormMedicare can’t give personal health information about you to anyone unless you give permission in writing first

2) Make a “Welcome to Medicare” Physical Exam AppointmentThis free, one-time comprehensive exam is offered during the first 12 months you have Medicare

3) Sign up for MyMedicare.govMyMedicare.gov is a secure online service where you can access you personal Medicare information 24 hours a day, every day

4) Choose and Join a Medicare Drug Plan (Part D)If you’re new to Medicare, you have 7 months to join a Medicare drug plan

5) Download a Copy of “Your Medicare Benefits”Medicare’s official “Your Medicare Benefits” publication explains the rules about which health care services and supplies Medicare covers


Post-65

Medicare Part A Helps Pay for:Hospital stays ($1,316 deductible, 1st 60 days/$329 per day – 61 to 90 days)

Skilled nursing facility (SNF) care

Long-term care hospitals

Home health care

Hospice care

Blood

For information, call 1-800-MEDICARE


Post-65

Paying for Medicare Part AMost people receive Part A premium free

People with less than 10 years of Medicare covered employment will pay a Part A premium

For information, call the Social Security Administration (SSA)◦ 1-800-772-1213

◦ 1-800-325-0778 for TTY users


Post-65

Part B Helps Pay for:

Doctors’ services

Outpatient medical and surgical services and supplies

Diagnostic tests

Outpatient therapy

Outpatient mental health services

Preventive health care services

Other medical services


Post-65

Paying for Medicare Part B:Most Medicare Part B beneficiaries will pay a premium amount of $134 (higher income earners may pay more) in 2016.

$183 per year deductible

20% coinsurance for most services

Some programs may help cover these costs

Addition of Preventive Care Services◦ Annual wellness exam

◦ Covers all wellness services/preventive care services as outlined by Health Care Reform


Post-65

Medicare Part D helps pay for:Prescription drugs provided by Medicare Approved Prescription Drug Plans (PDP) or Medicare Advantage Plans (MA-PD)

These plans offer negotiated discount prices based on a formulary with cost sharing

Health Care Reform filled some or all of the donut-hole◦ 50% manufacturers discount on brand name drugs

◦ Pay only 86% of plans cost for generic drugs


Post-65

Paying for Medicare Part D$0 or reduced premium, deductible and co-insurance if one qualifies for the Low Income Subsidy (LIS)

Must meet income and asset criteria

Eligibility determined by Social Security Administration (SSA)

PRESENTED BY ADVANTAGE BENEFITS GROUP

20

Post-65

The Affordable Care Act – Closing the Doughnut HoleBRAND NAME DRUGS

Health Care Reform closes the Part D Doughnut Hole (the gap in coverage during which people with Medicare must pay the full cost of their prescriptions out of pocket).

HCR phases this out by decreasing the beneficiary’s share of drug costs during the doughnut hole until it reaches 25% in 2020 for both brand name and generic drugs


YearPharmaceutical Manufacturer

DiscountPlan Responsibility (gov’t

contribution)*Consumer Responsibility

2010 0 0100% less the $250 rebate for brand

name and generic drugs

2011 50% 0 50%

2012 50% 0 50%

2013 50% 2.5% 47.5%

2014 50% 2.5% 47.5%

2015 50% 5% 45%

2016 50% 5% 45%

2017 50% 10% 40%

2018 50% 15% 35%

2019 50% 20% 30%

2020 50% 25% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Post-65

The Affordable Care Act – Closing the Doughnut HoleGENERIC DRUGS


YearPlan Responsibility (gov’t

contribution)*Consumer Responsibility

2010 0100% less the $250 rebate for brand

name and generic drugs

2011 7% 93%

2012 14% 86%

2013 21% 79%

2014 28% 72%

2015 35% 65%

2016 42% 58%

2017 49% 51%

2018 56% 44%

2019 63% 37%

2020 75% 25%

*Government subsidies to plans will account for the plan share of coverage for drugs.

Post-65

Medicare AdvantageMedicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan (Parts A, B, and D). This coverage can include prescription drug coverage. Medicare Advantage Plans include: ◦ Medicare Health Maintenance Organization (HMOs)

◦ Preferred Provider Organizations (PPO)

◦ Private Fee-for-Service Plans

◦ Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services


Post-65

Medicare Advantage

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigappolicy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.


Post-65

Medicare Advantage


Post-65

Shopping for Medicare Advantage Plans: www.Medicare.Gov


Post-65


Retiree Medical OptionsYour Personal Financial Advisor

Your Personal Home and Auto Insurance Agent

Advantage Benefits Group ◦ http://www.advantageben.com

Blue Cross Blue Shield of Michigan Medicare: 1-877-469-2583◦ http://www.bcbsm.com/medicare/

Priority Health Medicare: 1-888-389-6676◦ http://www.priorityhealth.com/medicare

Centers for Medicare and Medicaid Services ◦ www.cms.hhs.gov

The Official U.S. Government Site for People with Medicare◦ www.medicare.gov

“Medicare and You”◦ http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

AARP◦ http://www.aarp.org/health/medicare/

HealthCare.gov◦ https://www.healthcare.gov


http://www.advantageben.com/

http://www.bcbsm.com/medicare/

http://www.priorityhealth.com/medicare

http://www.cms.hhs.gov/


http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

http://www.aarp.org/health/medicare/

https://www.healthcare.gov/

retiree medical benefits - grand valley state university · post-65 option - stipend to help ......

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