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Welcome
Current Retiree Health Plan
Tufts University currently offers the following group-sponsored
plans: BCBS Medex Silver Medigap Plan
Fallon Senior Advantage Plan
Harvard Pilgrim Health Medicare Enhance Medigap Plan
Tufts Health Plan Medicare Complement Medigap Plan
Tufts Health Plan Medicare Preferred Advantage Plan
Trending Issues General costs of health insurance is escalating
Retirees experience challenges paying for their health insurance
Retirees are electing for more affordable plan options through the private insurance market,
waiving university group sponsored plans.
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OneExchange
• Effective January 1, 2018, Tufts University will transition to
plans offered on the OneExchange platform.
• Retirees will have access to comparable plans which will
result in lower costs for a significant number of retirees.
• Based on the lower premium rates for plans through
OneExchange, the university will reduce its annual
contribution to retiree health for those receiving partial
subsidies.
As was outlined in the August 15, 2017 letter
Retiree Dental Benefit
• The Retiree Dental Plan will remain a group sponsored plan choice through Tufts University.
• We are transitioning our third party administrator from Crosby/Wage Works to EPBA.
• EPBA will send you a 2018 Open Enrollment communication during the month of October.
• Your current Dental insurance election will continue in 2018 unless you change it during the annual Open Enrollment Period--November 1 – 15
© 2016 Willis Towers Watson. All rights reserved.
September 2017
Helping You Prepare For Your Upcoming
Medicare Enrollment
OneExchange
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Who We Are
Your Future Coverage
OneExchange – For Your Benefit
A Deeper Dive – Benefit Advisors, Private Exchange & Optimize Savings
Health Reimbursement for You
Next Steps
Questions and Answers
OneExchange Medicare Insurance Marketplace
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Willis Towers Watson
over
100 years experience
First & Largest
private Medicare Exchange
Personalized options with plans from a nationwide network of carriers
More Choice, More Flexibility
– Better Value
Licensed Benefit Advisor
provides guidance &
ongoing advocacy
Over 1.7-million retirees served across
600+ employers
Our
13th annual enrollment season
Founded in 2004
No fees
for our
service
OneExchange Service Centers
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Operating hours:
Monday – Friday, 8:00 a.m. until 9:00 p.m. Eastern Time
100% Domestic Workforce No Outsourcing!
Salt Lake City,
UT
Dallas, TX
Phoenix, AZ
Plans and Insurers
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Medicare
Advantage
Medicare Supplement
(Medigap)
Prescription Drug
(Part D)
Your Future Coverage
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How Medicare coverage works
Primary Coverage
Medicare A and B
Additional Coverage (your choice)
*Medicare Advantage with
Prescription Drug (MAPD) or
*Medigap + Prescription Drug
Your Medicare Options
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Option 1: MAPD: Medicare Advantage + Part D Prescription Drug plan
* Note that Medicare Advantage plans are generally network based plans.
MAPD HMO PPO
MEDIGAP
PLAN
Your Medicare Options
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Option 2: Medicare Supplement Insurance (Medigap) and
Part D Prescription Drug plan
Part D
Prescription
Drug Plan
Note: You may need to pay your first premium
when you enroll in coverage.
PART D
PLAN
MEDIGAP
PLAN
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Medicare Supplement Insurance (Medigap) – Lettered Policies
Medicare Supplement Insurance (Medigap) Policies
Benefits A B C D F G K L M N
Medicare Part A coinsurance
and hospital costs (up to an
additional 365 days after
Medicare benefits are used)
100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Medicare Part B coinsurance
or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care
coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care
coinsurance 100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible 100% 100%
Part B excess charges 100% 100%
Foreign travel emergency
(up to plan limits) 80% 80% 80% 80% 80% 80%
Source: CMS Out-of-Pocket
limit in 2017
$5,120 $2,560
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Medigap in Massachusetts
Core Supplement 1
Part A: Coinsurance and hospital costs (up to an additional 365 days
after Medicare benefits are used) 100% 100%
Part B Coinsurance or copayment 100% 100%
Blood (first three pints) 100% 100%
Part A Hospice care coinsurance and copayment 100% 100%
Skilled nursing facility coinsurance 100%
Part A deductible 100%
Part B deductible 100%
Part B excess charges 100%
Foreign travel emergency (up to plan limits) 100%
Medigap Benefits Medigap Plans
Part D Plans – 5 Tiers of Co-Pays
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A prescription drug plan will typically
break the formulary into “tiers.”
The tiers correspond to the copayment or
coinsurance the beneficiary will pay.
Cost-sharing increases with the tier
number.
Tier 1 is the least expensive, tier 4 or 5 is
the most expensive.
Tier descriptions:
Tier 1 preferred generic
Tier 2 non-preferred generic
Tier 3 preferred brand
Tier 4 non-preferred brand
Tier 5 specialty drugs or
injectable medicine
Medicare Prescription Drug Coverage 2018
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Catastrophic Coverage
Coverage Gap
Initial
Coverage Deductible
You Pay Full Retail
Until Deductible is Met
2018 - $0 to $405
You pay copays for
your plan coverage
for the first $3,750
in actual costs of
Medications
You pay 35% of Brand Name
and 44% of Generics until
your out of pocket costs
reach $5,000; Pharmaceutical
contributions will count
towards the $5,000 TrOOP
You Pay $3.35 for
Generics and $8.35 for
Brand Name or 5% -
whichever is greater
Only 25% reach
Donut Hole
Only 4% reach
Catastrophic
The OneExchange Process
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Consultative
Process
Simplified
Selection
Effortless
Enrollment
Ongoing
Advocacy
Education
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Getting Started Guide:
Prepare for your enrollment
Pre-existing conditions will not
limit your plan selection*
Make an appointment to enroll
Call Toll Free
1-844-353-0772
Or go online to create an account, review
your plan options and schedule an appt.
medicare.oneexchange.com/tuftsuniversity
Education
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Enrollment Guide:
Understand your options
Review Medicare basics
What to expect during your
enrollment call
FAQs
Appointment confirmation
Make an appointment to enroll
Call Toll Free
1-844-353-0772
Or go online, create a profile, review your
plan options and schedule an appt.
medicare.oneexchange.com/tuftsuniversity
Licensed Benefit Advisors
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Licensed / Certified / Appointed
OneExchange University™
Average age 43
Objective & unbiased
100% domestic workforce
Licensed Benefit Advisors are available:
Monday – Friday, 8:00 AM. until 9:00 PM Eastern Time
Decision Support Tools
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Prescription Profiler
medicare.oneexchange.com/tuftsuniversity 24/7 access to your information
Load in your prescriptions
Shorten your time on the phone with us!
Decision Support Tools
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Help Me Choose
comparison tool
Enrollment Process
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Two Step Process:
1. Licensed Benefit Advisors
Benefit Advisors can discuss
coverage options with anyone
2. Application Data Processors
Telephonic enrollment
100% of calls are recorded
Enrollment Process
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• Review the plan(s) that you
selected
• The selection confirmation
letter will be sent shortly after
you enroll.
• This letter confirms that your
applications have been
submitted.
Selection Confirmation Letter
Personal Guidance
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Navigation
Enrollment
Prescription
changes
Affordability concerns
Reimbursement issues
Late enrollment
HRA
Annual plan review
The plans you select continue on year
to year. No need to re-enroll in the fall
unless you want to make a plan change.
An Ongoing Advocate
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Health Reimbursement Arrangement (HRA)
Health Reimbursement Arrangement
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Your HRA funding will
be
available
January 1st, 2018
Unused funds DO roll
over
If you are eligible, Tufts University will make an
annual contribution
to a Health Reimbursement Arrangement (HRA)
You may use HRA funding to reimburse
yourself for eligible medical, prescription
drug, dental, vision, Long Term Care & Medicare
Part B premiums, as well as eligible out-of-pocket
medical expenses
Tax-free account used to reimburse you
for eligible health care expenses — you pay first
and then get reimbursed
Qualify for your Health Reimbursement Arrangement
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Enroll in a medical plan through OneExchange before your enrollment
period ends on December 29th, 2017 to have access to your HRA.
Must remain enrolled through OneExchange each year to continue to
have access to your HRA or forfeit the rights to your HRA.
We recommend you schedule a call to enroll.
You can also go online to investigate your options.
Health Reimbursement Arrangement
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You may be reimbursed up to the amount
available in your HRA!
Health Reimbursement Arrangement
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Options for Reimbursement
$ $
Option 1
Automatic
Reimbursement
Participant
OneExchange Insurance
Carrier
Participant
OneExchange Insurance
Carrier
Option 2
Manual
Reimbursement
Up to the
amount
available in
your HRA
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Local Examples – Middlesex County
Plans for Middlesex County
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Plan Type Number of
Plans Offered
2017
Monthly Premium
Insurers
(subject to change)
Medicare Advantage 12 $0 - $159
Fallon, Tufts
Health Plan, Harvard
Pilgrim, United
Healthcare, AARP/United
Healthcare
Medicare Supplement
Insurance (Medigap) 6 $112 - $260
Humana, AARP/United
Healthcare,
Harvard Pilgrim
Part D 15 $17 - $95
AARP/United
Healthcare, Aetna,
SilverScript, Express
Scripts, Coventry,
WellCare, Humana
2018 plan information will be available mid-October
Medicare Advantage Plan
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Benefit Cost 2017
Premium $0
Network HMO
Deductible $0
Doctor Copay $15
Specialist Copay $40
Hospital Days 1 - 4 $395 per day
Emergency Room $75
Rx – Deductible
Retail Co-Pay Tiers
$210 (excludes Tiers 1 and 2)
$3 / $11 / $45 / $95 / 28% 30 days
Preferred
Mail Order Co-Pay Tiers $0 / $0 / $125 / $275 / 28% 90 days
2018 plan information will be available in mid-October
MA Supplement 1 + Prescription Drug Plan
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Based on a 75 year old male
Benefit Cost 2017
Premium $244.30 ($212 Medical + $32.30 PDP)
Network Not Applicable
Deductible $0
Doctor Copay $0
Specialist Copay $0
Hospital $0
Emergency Room $0
Rx – Deductible
Retail Co-Pay Tiers
$0
$3 / $13 / $42 / 44% / 33% 30 days
Preferred
Mail Order Co-Pay Tiers $7.50 / $32.50 / $105 / 44% 90 days
2018 plan information will be available in mid-October
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Next Steps
What You Need To Do: Action Required!
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Find your Medicare Card!
Contact OneExchange
1-844-353-0772
Call now to complete your profile
and schedule an enrollment
appointment
You will need your Medicare card,
prescription list, and doctor and
hospital information
Schedule your enrollment call
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Call Now, We Are Ready!
1-844-353-0772
Or go online and create a profile, review your
plan options and schedule an appt. today!
medicare.oneexchange.com/tuftsuniversity
Thank you!