Medicare and Your UC Medical Benefits

UC Retiree Health Benefits
UCSB Health Care Facilitator Program
Laura Morgan
893-4201
UC Retirement Administration Service Center
(RASC)
800-888-8267
4/30/14
http://ucnet.universityofcalifornia.edu
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This presentation is intended for communication
purposes only, it is not a guarantee of benefits.
Details about the UC policies and health plans are
available on UCnet.
http://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html
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Agenda
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Future of retiree health benefits
Eligibility for retiree health benefits
Transition to retiree health plans
Health plan premiums
Overview of Medicare (Bill Batty, HICAP)
Enrolling in Medicare
Coordination with Medicare
How UC Medicare plans work
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Future of Retiree Health
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Committed to ongoing health benefit
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Retiree plan designs are likely to change
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Retiree share of premium will increase
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UC may reduce the overall level of
contribution to retiree health programs by
3% per year, to a floor of 70%.
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Health Benefit – “fine print”
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UC's contribution toward the monthly cost
of medical and dental coverage is
determined by UC and may change
Not a guaranteed benefit
Subject to California's annual budget
appropriation
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Eligibility for Health Benefits
Medical and dental benefits continue if:
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You were enrolled when you left UC
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You elect to continue coverage when you retire
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Your coverage is continuous until the date your
retirement benefit begins
Your monthly retirement income begins within
120 days of your separation from UC
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You meet UC service credit requirements
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Benefits end if you select “lump sum cashout”
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3 Eligibility Groups
1. UCRP entry prior to 1/1/1990
2. UCRP entry/reentry on or after 1/1/1990
3. NEW 2013 eligibility rules
 Hired on or after 7/1/2013
 Hired before 7/1/2013 and not “grandfathered”
Each group has specific service
credit and/or age requirements.
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1. UCRP entry prior to 1/1/90
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Retire before 55 w/ 10 years service credit*
Retire at 55 or later w/ 5 years service credit
* Five years for Safety members
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2. UCRP entry/reentry on or after 1/1/1990
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Retire at age 50 or later w/ 10 years
service credit
OR
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“Age + service credit = 75”
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3. Hired on/after 7/1/2013
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Also current employees not “grandfathered”
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Retire at 56 or later w/ 10 years service credit
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2013 “Grandfathering” Provision
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Remain under current retiree health
eligibility rules if by June 30, 2013:
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five years of UCRP service credit and
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age plus years of service credit is 50 or greater
Example:
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Age 45 with 5 years = 50 (grandfathered)
Age 40 with 5 years = 45 (new eligibility rules)
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Transition to Retiree Health
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At retirement, you and your enrolled family
members transfer from the “employee” to
the “retiree” insurance program
Employee insurance ends the month
following your separation date – example:
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Separate on June 27
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Employee insurance ends July 31
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Retiree insurance starts August 1
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Transition cont’d
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Must enroll in Medicare, if eligible, and
transfer to Medicare coordinated plan
May change plans during Open Enrollment
or if you move out of your plan’s service
area
RASC counselor will help you with the
transition and paperwork
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Dental
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Delta PPO or DeltaCare USA
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Coverage remains the same
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Premium paid in full by UC
OR subject to “graduated eligibility”
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Vision
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Retiree Vision Services Plan (VSP)
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Enroll in Retiree VSP to continue coverage
Pay full premium to VSP – see rate chart
Same coverage as employee plan
Routine eye exam and eye wear
Health Net Seniority Plus
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Medicare version of Health Net
Vision benefit similar to VSP
No additional monthly premium
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Medical Plans
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Non-Medicare Plans
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Retirees and family members who are not
65 or are not eligible for Medicare
Same plans as employees
Medicare Coordinated Plans
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Retirees or family members who are 65 or
older, or disabled
Must enroll in Medicare A & B, if eligible
UC Medicare plans
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Medical Plans
Non-Medicare
Medicare
Health Net Blue & Gold HMO
Health Net Seniority Plus HMO
Kaiser HMO
Kaiser Senior Advantage HMO
UC Care (PPO)
Blue Shield Medicare PPO
Blue Shield Health Savings
Blue Shield Medicare PPO
without Rx
Core (Catastrophic)
Same as employee plans
High Option Supplement
Coordinated with Medicare
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Split Families – Partner Plans
When a family has both
non-Medicare & Medicare members
Non-Medicare Members
Medicare Members
Health Net Blue & Gold HMO
Health Net Seniority Plus HMO
Kaiser HMO
Kaiser Senior Advantage HMO
UC Care (PPO)
Blue Shield Medicare PPO
Core (Catastrophic)
Blue Shield Medicare PPO
Blue Shield Health Savings is not available to split family
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Behavioral Health
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All plans cover mental health care and
substance abuse treatment
Provider networks may change when
enrolled in Medicare
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Behavioral Health Providers
Medical Plan
Non-Medicare
Medicare
Health Net/
Seniority Plus
Optum
MHN with Medicare
Kaiser/
Senior Advantage
Optum & Kaiser
Kaiser
Blue Shield HSP
Optum &
non-Optum
N/A
Core
Blue Shield
N/A
N/A
Medicare & Blue Shield
UC Care (PPO)
Blue Shield PPO
High Option
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Are you moving in 2014?
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Must live in California
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Available in US
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Health Net, Kaiser
UC Care
Blue Shield Health Savings Plan
Core
Blue Shield Medicare PPO (see Exchange One)
High Option (see Exchange One)
Available when LIVING out of US
 UC Care, Core (without Medicare)
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Exchange One – Out of CA
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Retiree living out of California
ALL family members are enrolled in Medicare
UC makes annual contribution to a Health
Reimbursement Account (HRA) for retiree and
each family member
Retiree uses HRA funds to purchase individual
Medicare supplement plan through Exchange One
UC contribution is subject to graduated eligibility
Can use extra HRA funds to pay medical expenses
and Part B premium
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Retiree Health Premiums
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Each year UC determines the maximum amount
that UC will pay toward a retiree’s medical and
dental insurance
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Some retirees receive the “maximum UC contribution”
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Some retirees have “graduated eligibility” and receive a
% of the maximum amount
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The amount of the UC contribution depends on:
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Retiree health eligibility rules
Years of UCRP service credit
Age – factor added in 7/1/2013 rules
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Maximum UC Contribution
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Hired prior to 1/1/90 (UCRP entry date)
Hired on/after 1/1/90 with 20 years of
UCRP service credit
See rate chart
http://ucnet.universityofcalifornia.edu/compensation-andbenefits/health-plans/medical/retiree-plan-costs.html
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Maximum UC Contribution – Rate Chart
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All family members in Medicare
One or more are not in Medicare
Non-Medicare Plans
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All family members under 65
Non-Medicare Age 65 and Over
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UC Retiree did not coordinate with Social
Security when employed
No one in family eligible for Medicare
Rates are same as employees in category 2
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Medicare Part B Reimbursement
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If your UC medical plan premium is zero,
you may receive a full or partial
"reimbursement" of your Medicare Part B
premium – example:
$0.00
$44.49 > added to UC pension
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The amount of the reimbursement depends
on the premium UC is charged by the
insurance carrier for your plan
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Graduated Eligibility
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Hired on/after 1/1/90 (UCRP entry/reentry date)
with less than 20 years of UCRP service credit
UC contributes 50% of the maximum contribution
at 10 years of service credit
UC contribution increases 5% per year of service
credit
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“Age + service credit = 75” -- 50% of max
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Find rate on UCnet using “Medical Plan Chooser”
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Graduated Eligibility
Years
Service
Credit
5-9
% of
Maximum
Contribution
Age+years = 75
Years
Service
Credit
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% of
Maximum
Contribution
75%
10
50%
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80%
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55%
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85%
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60%
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90%
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65%
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95%
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70%
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100%
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Graduated Eligibility – Example
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Service credit = 15 years
UC pays 75% of “Maximum UC Contribution”
$436
$327
Maximum UC Contribution (single/non-MC)
75% of Maximum UC Contribution
$611 Gross premium (single/HN Blue & Gold)
- $327 75% of Maximum UC Contribution
$284 = Monthly premium paid by retiree
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https://uc2014.chooser2.pbgh.org
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New 2013 Graduated Eligibility
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Hired on/after 7/1/2013
Also current employees not grandfathered
UC Contribution calculated using age and
service credit;
100% at age 65 w/ 20 years of service credit
Graduated eligibility chart is posted on Future
of UCRP website – see Fast Facts
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Monthly Premiums
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Medicare Part B
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Deducted from Social Security check or
you pay directly
UC Medical and Dental
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$104.90 – standard rate in 2014
Deducted from UC pension check
Part B Reimbursement added to check
UC Retiree Vision – paid to VSP
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“Income Related Adjustment”
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Medicare Part B and D premiums may be
higher for retirees with incomes over:
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$85,000 – single
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$170,000 – married
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What is Medicare?
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Federal program that provides health
insurance to:
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People 65 or older
People with disabilities
Covers most medical services
Does not pay total cost of care
Foundation for all UC Medicare plans
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Medicare Eligibility
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Your own work history
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Work history of spouse or ex-spouse
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Contact Social Security to clarify your
eligibility
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Three Parts of Medicare
Part A - Hospital
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In-patient hospital
Home health care
Skilled nursing facility
Hospice care
Part B - Medical
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Office visits
Lab tests
Physical therapy
Medical equipment
Some preventive care
Part D – Prescription Drugs
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Medicare Premiums in 2013
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Medicare Part A – No monthly premium
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Medicare Part B - $104.90 per month
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May cost more for retirees with higher incomes
Deducted from Social Security check or
you pay directly
Medicare Part D – No monthly premium
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May cost more for retirees with higher incomes
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When to enroll in Medicare?
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Employees
Eligible at retirement
Eligible after retirement
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Employees
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Do not enroll in Medicare Part B or D
Spouse enrolled in your UC employee
medical plan does not need to enroll *
“Special enrollment period” when UC
employee retires
You may enroll in Part A when first
eligible at age 65 – not required *
See special considerations
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Employees – Special considerations
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Same-sex spouses have the right to delay
enrollment in Medicare if enrolled in a UC
medical plan
Domestic partners should consult Social
Security about when to apply
Blue Shield Health Savings Plan members
may NOT be enrolled in Medicare A, B or D per
IRS rules
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Eligible at Retirement
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You and your family members who are
eligible for Medicare must enroll in Parts A
&B
Go to Social Security office one month
before UC employee retires
Complete UC forms to enroll in UC plan
You may also receive a follow-up
“Coordination of Benefits” form from
Medicare
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Eligible after Retirement
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You and your family members who are eligible
for Medicare must enroll for Parts A & B
Go to Social Security office or www.ssa.gov
about three months before turning 65
OR
 If receiving a Social Security pension, you will
get a Medicare card in the mail
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UCOP will mail UC enrollment forms to you
and family member
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Coordination with Medicare
HMO Advantage
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Health Net Seniority Plus
Kaiser Senior Advantage
Blue Shield PPO
High Option Supplement
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You assign your Medicare
to the insurance plan
Cannot use Medicare
outside the plan
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Medicare is primary payer
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Blue Shield is secondary
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Choice of Physician
HMO Advantage
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Health Net Seniority Plus
Kaiser Senior Advantage
Blue Shield PPO
High Option Supplement
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You
selectClinic
PCP is only HNSP
Sansum
provider
in Santacare
Barbara
PCP
coordinates
PCP
refers
specialists
Change
to to
Sansum
PCP
Specialists
to plan
Change to limited
Blue Shield
physicians in medical group
Any Medicare physician
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HMOs have copays for care
Health Net Seniority Plus
Kaiser Senior Advantage
Service
Copay
Deductible
$0
Office Visit
$20
Urgent Care
$20
Emergency Room
$65
Outpatient Surgical Center
$100
Inpatient Hospital
$250
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Blue Shield - Deductibles
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Deductibles paid by Blue Shield
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Medicare Part A (Hospital) = $1216
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Medicare Part B (Medical) = $147
Deductible paid by you
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Plan deductible for services not covered by
Medicare
Blue Shield PPO = $100 per individual
High Option = $50 per individual
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Blue Shield – Office Visit Example
Medicare Allowable = $150
Who pays?
Medicare pays 80%
Blue Shield pays
You pay for services
PPO
$120
High
Option
$120
$24
$30
$6
$0
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Blue Shield – Hospital Example
Stay of 1-60 days
Medicare Part A Deductible = $1,216
High
Option
Who pays?
PPO
Blue Shield pays
$1,216
$1,216
$0
$0
You pay for services
Medicare pays balance of bill
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Blue Shield – Skilled Nursing
1st to 21st day
Paid in full by Medicare
21st to 100th day
Daily rate = $152
Who pays?
Blue Shield pays
You pay for services
PPO
High
Option
80%
$122
100%
$152
$30/day
$0
Medicare pays all but $152 per day
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Are you traveling out of US?
HMO
Emergency & Urgent Care only
Blue Shield PPO
Plan pays 80%
High Option
Plan pays 80%
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Prescription Drugs - Part D
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All plans have Medicare Part D
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NO additional premium for Part D, for most
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Copays – NO “donut hole”
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Some formulary (drug list) changes
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ID cards with Part D logo
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HMO members receive 1 card
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Blue Shield members receive 2 cards
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1 medical card and 1 drug card
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Prescription Drug Costs
Health Net
Kaiser
Blue Shield
Retail (30 day)
• Generic
• Brand
• Non-formulary
$5
$25
$40
$10
$30
$45
Mail Order (90 day)
• Generic
• Brand
• Non-formulary
$10
$50
$80
$20
$60
$90
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Can’t stay away???
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Review the Rehired Retiree policy
Returning to work can impact how your
medical plan coordinates with Medicare
Contact Benefits Office at 893-2489
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Web Resources
http://ucnet.universityofcalifornia.edu
 Health plan information and rates
 Medical Plan Chooser
 Complete Guide to Retirement Benefits
 Retirement Handbook
http://www.ssa.gov
 Apply for Medicare Benefits
http://www.medicare.gov
 “Original” Medicare coverage and publications
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Resources
RASC – Retirement Administration Services Center
 Process retirements for UC employees
 UC retiree health plans
 1-800-888-8267
HICAP - Health Insurance Counseling and Advocacy
Program
 Medicare information and assistance
 1-800-434-0222
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