Medicare Medical Savings Account (MSA)

2021

Y0117_MC-778-2826-C-09-20_M accepted

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Want to save money on your health coverage?

Let Security Health Plan show you how.

Secure Saver MSA

2 3Compare plans and apply online at www.securityhealth.org/medicare21 Want help? Ask your agent or call our Sales Department – 1-844-679-9733 3

Manage your costs and budget Secure Saver MSA is a Medicare medical savings account for people with high-deductible health plans.

Security Health Plan deposits funds from Medicare

into the account each year for you to use in paying for

qualified medical expenses, like doctor’s visits and

monthly prescriptions.

Make the right choice for your peace of mind.Pair the medical benefits of Medicare with the financial savings of a medical savings account when you enroll in the Secure Saver MSA* plan. Coverage is available to all Medicare beneficiaries with primary residency in Wisconsin. It combines the coverage of Medicare Parts A and B (Original Medicare) with a savings account fund that you can use to pay for your qualified medical expenses, tax-free!

* Plan does not include Medicare Part D for prescription drug coverage – please enroll in a separate Medicare prescription drug plan.

Who can apply for Secure Saver MSA?You may apply for membership in Secure Saver MSA if you have both Medicare Part A and Part B and your in primary residency is in Wisconsin.

$

$0 monthly plan

premium

$1,920 2021 tax-free

deposit to use in paying for qualified medical expenses

Save money on your out-of-pocket costs. Secure Saver MSA offers health care coverage and financial security that saves you money on your yearly deductible or maximum out-of-pocket costs.

Secure Saver MSA is a “high-deductible” health plan with an annual deductible for 2021 of $5,600 for Medicare-covered services. But you actually pay much less! Medicare, through Security Health Plan, deposits $1,920 into your MSA account to be applied toward the deductible. This leaves you responsible for $3,680 of Medicare-covered expenses until you satisfy the deductible. Once satisfied, Security Health Plan pays all your Medicare-covered health costs for the rest of 2021.

Here’s how you save $1,920 on your $5,600 deductible*:

1. After enrolling in Secure Saver MSA, you receive a debit card and the option to receive a checkbook to access the funds Security Health Plan has deposited in your MSA account. You pay the additional costs up to $3,680 out of your own pocket until you reach the $5,600 annual deductible.

2. You see your doctors for your health care needs. You can use the money in your MSA to pay for all your qualified medical expenses, including those covered by Medicare and not covered by Medicare. Only Medicare-covered Part A (hospital) and Part B (medical) services count toward your $5,600 deductible. You will pay Medicare-approved charges for your services.

3. If you use all the money in your MSA but have not yet reached the deductible, you are responsible for covering additional expenses until you meet the $5,600 deductible.

4. After you reach your deductible, you will have no more out-of-pocket expenses for your Medicare Part A and Part B covered services. Security Health Plan pays these costs for the rest of the year.

Remember, you must continue to pay your Medicare Part B Premium.

Members will need to retain records on qualified medical expenses paid from their MSA and submit details to the IRS when filing taxes. If you use the money in your MSA to pay for medical expenses that are not qualified or to pay for non-medical expenses, these payments will be taxed as part of your income and will be subject to an additional tax penalty.

Secure Saver MSA deductible

$5,600

Security Health Plan deposit

$1,920

Member’s out-of-pocket

maximum

$3,680

* Figures represent 12-month costs

4 5Compare plans and apply online at www.securityhealth.org/medicare21 Want help? Ask your agent or call our Sales Department – 1-844-679-97334 5

Life happens. Get security. Secure Saver MSA offers flexible, high-quality benefits and services. Here are some more good reasons to choose this plan for your health care coverage:

Use any doctor or hospital you chooseYou can choose any Medicare-certified doctor, hospital or health care provider of your choice in the United States who has not opted out of Medicare. Secure Saver MSA has no provider network, so there are no in-network and out-of-network decisions to make.

Find convenient care with the 24-Hour Nurse Line and Care My Way® Use our 24-hour Nurse Line, available 7 days a week including holidays, to talk to a registered nurse who can help answer your health care questions. And for many common health ailments, you have 100% coverage for free, unlimited use of Care My Way® to talk to a nurse practitioner without leaving home. They can verify your symptoms over the phone through a virtual visit and, if needed, call a prescription into the pharmacy of your choice – saving you time, money and hassle.

Get help staying healthyOur team of health professionals will work with you to assess your specific needs and then help you and your doctor determine the services and care you need. Plain and simple, we’re here to help you make life a little easier. We can help you:

• schedule your medical appointments • quit nicotine • lose weight • manage your chronic health conditions • manage your medications

Get your questions answered on the first callWhen you have questions or concerns you get the help you need from our award-winning customer service located in Wisconsin. Our World Class* team welcomes your calls and is recognized as one of the best in health care for resolving issues on the first call.* SQM World Class Customer Service designation, 2016, 2017, 2018 and 2019.

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When can I enroll?The Secure Saver MSA plan is generally for the full calendar year, effective Jan. 1 through Dec. 31. It is prefunded each year on the first day of the calendar year.

If you join after Jan. 1, Security Health Plan’s deposit and your deductible are prorated to cover just the months remaining in the year.

For example, if you join in July, your coverage period would be for one-half of the year and the Secure Saver MSA plan would reflect this.

How can I enroll? 1. Enroll online at www.securityhealth.org/medicare21 or

2. Complete paper enrollment forms found in the Secure Saver MSA enrollment kit. To get this kit:

• Contact your trusted agent or • Call our Sales Department at 1-844-679-9733 from 8 a.m. to 5 p.m.

Monday through Friday

Please note that MSA enrollment is not available at www.medicare.gov.

Ready to enroll?

What happens after I enroll?Once you’ve enrolled in Secure Saver MSA, you will receive a confirmation letter in the mail. Security Health Plan partners with Optum Bank, member FDIC, to administer the financial and custodial activities.

Optum Bank sets up a dedicated MSA savings account for you. Optum Bank will send you a welcome kit followed by a debit card. You may also request a checkbook if you prefer.

Setting up your online account

Total deductible $2,800 ($5,600 x 1/2 year)

Security Health Plan contribution - $960 ($1,920 x 1/2 year)

Your out-of-pocket expenditure $1,840 ($3,680 x 1/2 year)

6 7Compare plans and apply online at www.securityhealth.org/medicare21 Want help? Ask your agent or call our Sales Department – 1-844-679-9733

Besides my annual deductible, are there any banking fees?Secure Saver MSA is a $0 premium plan. Security Health Plan also does not charge an account setup fee or monthly service charges while you are enrolled in Secure Saver MSA. In short, you will not pay anything to Security Health Plan.

Optum Bank may deduct fees directly from your MSA account for ATM fees, investment fees (if applicable) and mailed statements (online statements are free). You will have no monthly service fees deducted from your account as long as you are a Secure Saver MSA member.

Here’s what you’ll pay

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$0 premium $0 setup fee $0 monthly service fees

How do I make payments from my Secure Saver MSA?After Security Health Plan sets up your medical savings account, you will be able to pay for qualified medical services, like doctor visits and lab tests, using a debit card or a check from your MSA checkbook, if requested.

What medical expenses count toward my deductible?Secure Saver MSA covers only what is covered by Original Medicare, and these services count toward your annual deductible. These include qualified Medicare Part A and B expenses, hospital stays, doctor visits and lab tests.

How do I use Secure Saver MSA to pay for my annual exam?Medicare Part B covers a Welcome to Medicare preventive visit, available to new Medicare enrollees in the first 12 months, and an annual wellness visit. At either of these visits, your health care provider measures your height, weight, body mass and blood pressure, listens to your heart, discusses your concerns and issues, and establishes or reviews your care plan.

Any expenses will count toward your annual deductible and you may use your MSA bank account dollars to pay for these costs. The expenses are tax-free and applied to the $5,600 deductible.

Medicare Part B does NOT cover a comprehensive annual physical exam. This exam includes a full-body examination and tests to screen for disease and assess your potential risk factors for future medical problems.

You may use your MSA bank account dollars to pay for costs associated with a physical exam. They will be tax-free, but they will not count toward your annual $5,600 deductible.

Managing your Secure Saver MSA costs

8 9Compare plans and apply online at www.securityhealth.org/medicare21

Does the Secure Saver MSA plan include Medicare Part D Prescription Drug coverage?No, prescription drugs are not covered by Original Medicare. If you join Secure Saver MSA and need drug coverage, you need to join a Medicare prescription drug plan or a prescription drug assistance program such as Wisconsin SeniorCare.

Can I use my Secure Saver MSA to pay for prescription drugs?Yes. You can use Secure Saver MSA for this type of expense. Since this is a qualified medical expense, the money will not be taxed. However, prescription drug expenses do not count toward your deductible.

What about dental and vision care and other qualified medical expenses?Most dental care, dentures, routine eye exams and hearing aids are not covered by Original Medicare and do not count toward your annual deductible. However, you can pay for these expenses using your MSA bank account.

For a full list of qualified medical expenses, contact the IRS at 1-800-829-3679 or visit www.irs.gov for publication 969, “Health Savings Accounts and Other Tax-Favored Health Plans.”

Can I use my Secure Saver MSA to pay insurance premiums, such as Medicare Part B?No. These are considered non-qualified expenses and cannot be paid with tax-free funds. These expenses would be treated as taxable income and may be subject to penalties when filing annual taxes. Please contact your tax advisor for additional information.

Using your dollars - Secure Saver MSA

Want help? Ask your agent or call our Sales Department – 1-844-679-9733

Medical expense examplesMSA funds can be used without penalty?

Count toward MSA deductible?

Medicare-covered doctor visits, lab tests Yes Yes

Excess charges on Medicare-covered services (provider does NOT accept assignment)

Yes Yes

Prescription drugs (copays, deductible) Yes No

Insurance premiums (including Medicare Part B, Part D)

No No

Defined by and subject to Internal Revenue Service (IRS) regulations. These may change from year to year.

Can I use my Secure Saver MSA to pay providers who don’t accept Medicare? Providers who do not accept Medicare assignment (non-participating providers) can charge up to 115% of approved Medicare Fee for Service (FFS) rates. When you receive covered medical services from these providers, you are responsible for the amount in excess of approved Medicare FFS rates (up to the allowable 15% excess charge) until your deductible is met. You can pay this “excess” charge with funds from your Secure Saver MSA and it will count toward the deductible.

Once the annual deductible is reached, Security Health Plan pays the entire cost for Medicare-covered services received from participating and non-participating providers.

Some providers have opted out of Medicare entirely. If you receive services from these providers, you may use your MSA funds to pay for these services as long as they are considered qualified medical expenses by the IRS. Payments to these providers do not count toward your deductible.

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Notice of NondiscriminationSecurity Health Plan of Wisconsin, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations. Security Health Plan does not exclude people or treat them differently because of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status.

Security Health Plan of Wisconsin, Inc.:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:• Qualified sign language interpreters

• Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

• Qualified interpreters

• Information written in other languages

If you need these services, contact Customer Service at 1-877-998-0998 (TTY 711). If you believe that Security Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status, you can file a grievance with:

Security Health Plan Attn: Grievances 1515 North Saint Joseph Avenue | Marshfield, WI 54449-8000

Phone: 715-221-9596 (TTY 711) Fax: 715-221-9424 Email: shp.appeals.grievance@securityhealth.org

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Security Health Plan can help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue SW. | Room 509F, HHH Building | Washington, DC 20201

Phone: 1–800–368–1019 or 800–537–7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Limited English Proficiency Language ServicesATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-998-0998 (TTY 711).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-998-0998 (TTY 711).

LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-877-998-0998 (TTY 711).

Large print: If you require materials in large print, please call 1-877-998-0998 (TTY 711).

10 Compare plans and apply online at www.securityhealth.org/medicare21

Can I add funds to my Secure Saver MSA? No, you cannot deposit your own money. Only Security Health Plan can make deposits into your account.

What happens to money left over at the end of the year? If you have money remaining in your MSA savings account at the end of the year, it will carry over to the next year. At the start of a new year, a new allowance is deposited into your account. Your funds will accumulate tax-free.

Can I leave Secure Saver MSA? You may disenroll during the Annual Enrollment Period between Oct. 15 and Dec. 7 and during other limited periods. If you disenroll during the calendar year, you will need to repay a prorated portion of Security Health Plan’s deposit and you will still be responsible for the full deductible amount.

Member’s eligible expenses for ¾ year $3,200

Applied annual contribution to deductible - $1,440

Member’s out-of-pocket expenditure $1,760

For example, a member is disenrolling from Secure Saver MSA as of Sept. 30 due to relocation to another state. A move out of state makes the member ineligible for Secure Saver MSA since it is open only to Wisconsin residents.

Security Health Plan deposited $1,920 in the member’s account for the calendar year on Jan. 1. Since the member is disenrolling after nine months (January to September), the deposit is prorated to nine months, or $1,440. The member must repay Security Health Plan $480.

Since the beginning of this year, this member has incurred $3,200 in eligible expenses prior to disenrollment. The member has not met the $5,600 deductible, which remains $5,600 and is not prorated.

The member can apply the prorated $1,440 deposited by Security Health Plan to these expenses. The member is left with $1,760 to pay out of pocket.

What happens when you disenroll?

Using your dollars - Secure Saver MSA

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Annual contribution paid Jan. 1 $1,920

Member’s eligibility ¾ year - $1,440

3 months of deposited deductible to be repaid $480

Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract. Enrollment in Security Health Plan depends on contract renewal.

MSA Plans combine a high-deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally must pay out of pocket before your coverage begins.

Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate Medicare Prescription Drug Plan. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact Security Health Plan, 1-877-998-0998 (TTY 711), for additional information. We are open 7 days a week, 8 a.m. to 8 p.m., Oct. 1-March 31; and Monday through Friday, 8 a.m. to 8 p.m., April 1-Sept. 30.

About Security Health Plan

Security Health Plan of Wisconsin, Inc., part of the Marshfield Clinic Health System, is helping its 205,000 members in Wisconsin and beyond achieve their best health. Accredited by the National Committee for Quality Assurance (NCQA), Security Health Plan offers health insurance coverage for employees of large and small businesses, individuals and families. It also provides full-service third-party administration for self-funded employee benefit plans through Security Administrative Services.

(09/20) 18740-003

©2020 Security Health Plan of Wisconsin, Inc. All rights reserved. Written permission to reproduce or transmit this document in any form or by any means must be obtained from Security Health Plan of Wisconsin, Inc.

1515 North Saint Joseph AvenuePO Box 8000Marshfield, WI 54449-8000

Sales Department1-844-679-9733 (TTY 711)Monday-Friday, 8 a.m. to 5 p.m.

www.securityhealth.org/Medicare21

In addition to our Medicare health plans,

we offer health insurance coverage for all stages in life.

If you know someone looking for individual and family

coverage or small or large business health insurance,

please tell them to call us at 1-800-622-7790.