retiree readiness - tcuhr.tcu.edu/.../2016-tcu-oneexchange-presentation.pdf · 2016 - $0 to $360 ....

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Helping You Transition to Supplemental Medicare Insurance

Retiree Readiness

© 2013 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.

A Bit of Context

• TCU changed the way it provides medical

benefits to Medicare-primary retirees and their

Medicare-primary dependents.

• Retiree’s medical benefits are managed through a

Health Reimbursement Arrangement account

(HRA).

2


What we’ll cover today

• Why this approach? • How this affects you • Medicare 101 • Introducing OneExchange • Going forward • Questions & answers

3


Why This Approach? • Provides Medicare-eligible retirees with:

Greater flexibility in how to use health care dollars A broader range of plan options

• Enables TCU to continue supporting retirees during a time of uncertainty surrounding the rising cost of medical insurance and services

• Enables TCU to predict and budget for health care costs more accurately

4


How This Affects Medicare Eligible Retirees

• Medical premiums and out-of-pocket costs will vary depending on the coverage you choose.

• You will work with OneExchange to enroll in a plan that meets your medical and Rx needs.

• TCU will establish your Health Reimbursement Account. This account will be administered by OneExchange

• OneExchange Advisors will help you understand the costs associated with your coverage – premiums, co-payments, deductibles and all other costs.

What you pay

How to enroll

Your support


Medicare 101

• Everything you wanted to know about Medicare, but were afraid to ask!


CMS – Center for Medicare & Medicaid Services HHS agency that governs everything Medicare

1-800-MEDICARE


Original Medicare: • A Health insurance program for

– People 65 years of age and older

– Some people with disabilities

– People with End Stage Renal Disease (ESRD)

• Administered by CMS and the State Department of Insurance

• Enrollment handled by Social Security Administration or Railroad Retirement Board

Key Terms Medicare Part A = Hospital Coverage – administered by CMS Medicare Part B = Medical Coverage – administered by CMS Medicare Part C = Medicare Advantage Plans – private plans – group or individual market Medicare Part D = Prescription Drug Coverage – private plans – group or individual market Medicare Supplement (Medigap) – private plans – group or individual market

8


Original Medicare: Part A (Hospital) Premiums: • Most people do not pay a monthly Part A premium because they or a

spouse have 40 or more quarters of Medicare-covered employment. – $254.00 for 30-39 quarters of Medicare-covered employment.

– $461.00 for people who have less than 30 quarters of Medicare employment.

Foreign citizens and Americans who worked abroad Coverage: • Medicare Part A covers:

– Hospital Stays – Skilled Nursing Facility (SNF) – Home Health Care – Hospice Care – Pints of blood received at a hospital or skilled nursing

facility during a covered stay

9


Original Medicare: Part B (Medical)

Initial Enrollment Period:

o When turning 65. o 3 months before, the month of, and three months after 65th B-Day. (7 month window)

Coverage: • Doctors’ services (physician office and some hospital

settings) • Limited Chiropractic Services • Outpatient Services: • Diagnostic tests- clinical Lab

o (x-ray, MRI, CAT, EKT, nutritional therapy, etc…) • Other medical services

o Durable medical equipment (DME)- prosthetic, wheelchair etc. o Diabetic Supplies o Ambulance service

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A person that is eligible for Medicare but opts out of Part B may be subject to a 10% per year Part B penalty

• Penalty is waived if beneficiary has coverage through a group policy based on active employment

Medicare Part B - Late Enrollment Penalty


For employers with 20 or more employees, group coverage is primary for Medicare beneficiaries who are still active, and Medicare is secondary. Therefore, active beneficiaries don’t have to enroll in Part B and will not be penalized when they decide to retire. When they decide to retire, beneficiaries should enroll in Part B three months prior. This will insure that they can enroll in a Medicare Supplement plan and have it effective as soon as their group coverage ends.

Medicare Eligibility & Active Employment

• If active and covered under the group health plan, employee does not enroll in Medicare Part B or select a Medicare supplemental plan(s) until they retire or lose coverage.

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Post – 65 Coverage Options

Primary Coverage

Medicare A & B

Additional Coverage (your choice) Medicare Advantage with Prescription Drug (MAPD) OR Medigap + Prescription Drug


OPTION 1

Medicare Advantage Plan with Prescription Drug Coverage (MAPD)*

* Note that Medicare Advantage plans are generally network based plans.

MEDICARE ADVANTAGE HMO PPO


Note: You may need to pay your first premium when you enroll in coverage.

MEDIGAP PLAN

PART D PLAN

Medigap Plan + Part D Plan

OPTION 2


MediGap – Lettered Plans Medicare Supplement Insurance (Medigap) Plans

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 2015

$4,940 $2,470


Medicare Prescription Drug Coverage 2016

Catastrophic Coverage

Coverage Gap

Initial Coverage Deductible

You Pay Full Retail Until Deductible is Met 2016 - $0 to $360

You pay copays for your plan coverage for the first $3310 in actual costs of Medications

You pay 45% of Brand Name and 58% of Generics until your out of pocket costs reach $4850; Pharmaceutical contributions will count towards the $4850 TrOOP (True Out of Pocket)

You Pay $2.95 for Generics and $7.40 for Brand Name or 5% - whichever is greater

Only 25% reach Donut Hole

Only 4% reach Catastrophic


Aging Into Medicare – Turning 65 All Medicare beneficiaries receive a Medicare card when they become eligible. This will contain their full name, Medicare Claim number and the dates your Medicare Part A and B became effective. Beneficiaries may use this card with any medical provider in the country that accepts Medicare.

A beneficiary is automatically enrolled in Part B when enrolled in Medicare Part A. If you do not want Part B, you must opt out of that coverage. This card is generally sent three months before turning age 65.

Must Have Original Medicare A & B to be Able to Consider Any Supplemental Medicare Medical Insurance [either Advantage or Gap]


Helping You Prepare For Your Upcoming Medicare Enrollment

OneExchange

TOWERS WATSON


• Who We Are

• Transitions Can Be A Good Thing!

• OneExchange – For Your Benefit

• A Deeper Dive – Benefit Advisors, Private Exchange, Optimize Savings, Retiree Reimbursement Account for You

• Next Steps

• Questions and Answers


Transitioning from Employee to Retiree Healthcare Benefits

• OneExchange was chosen after an extensive evaluation of choices

• OneExchange will help you with total care in your transition over to more-effective individual Medicare health insurance

• The private exchange offers greater choice and flexibility; many affordable choices exist and in many cases provide more value at a lower cost than an employer group plan

• Ongoing support – at no cost to you

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Access to retiree health benefits for Medicare-eligible retirees and their Medicare-eligible dependents is

provided through OneExchange


About OneExchange Retiree

Towers Watson

over 100 years experience

First and Largest private Medicare Exchange

Personalized options with plans from a nationwide network of carriers

More Choice, More Flexibility – Better Value

Licensed advisor provides guidance and ongoing

advocacy Over 1-million

retirees served across 540+ employers

Our

10th annual enrollment season

Founded in 2004

No fees for our service


Simplified Selection

Consultative Process

Ongoing Advocacy

Effortless Enrollment

The Transition Process

towerswatson.com © 2014 Towers Watson. All rights reserved. Proprietary and Confidential. For Towers Watson and Towers Watson client use only.

Our Service Centers

Salt Lake City, UT

Dallas, TX

Operating hours: Monday – Friday, 7:00 a.m. until 8:00 p.m. Central Time

100% Domestic Workforce No Outsourcing!


All Medicare Plan Types

Plans and Partners

Multiple plans available to you from national/regional carriers

Prescription Drug (Part D)

Medicare Advantage Medicare Supplement (Medigap)

A few examples of the carriers on our Medicare exchange:

towerswatson.com 25


Simplified Selection

Consultative Process

Ongoing Advocacy

Effortless Enrollment

The Transition Process


1-888-429-8490

Education

Enrollment Guide: Prepare for Your Enrollment Consultation

• Review Medicare basics • What to expect on your

enrollment call • FAQs • Appointment confirmation

medicare.oneexchange.com/TCU

Toll Free


Decision Support Tools

• Help Me Choose

• Prescription Profiler

medicare.oneExchange.com/TCU

24/7 access to your information 28


Benefit Advisors

• Licensed / Certified / Appointed • OneExchange University™ • Average age 43 • Objective and unbiased • 100% domestic workforce

Benefit advisors are available: Monday – Friday, 7:00 a.m. until 8:00 p.m. Central Time


Enrollment Process

• Benefit Advisors can discuss coverage options with anyone

• Telephonic enrollment – 2 part process • 100% of calls are recorded

We’ve got your BAC: • Benefit Advisors • Application Data Processors • Customer Service Reps


You may review the plan(s) that you selected – will be sent shortly after you enroll.

Selection Confirmation Notice


Localized Slides Tarrant and Dallas County


Plans Available in Tarrant County

Plan Type Number of

Plans Offered (64)

2016 Monthly Premium Carriers

Medicare Advantage 22 $0 - $99

Coventry, Humana, AARP/UHC, Aetna,

Scott & White, CIGNA Health Spring, UHC,

Universal American, BCBS of TX

Medigap / Medicare Supplement 23 $75 - $339

AARP, Humana, BCBS of TX

Loyal American by CIGNA, Humana

Connect


19 $16 - $152

AARP, Aetna, CIGNA, Humana Express Scripts,

SilverScript, WellCare, Coventry,

BCBS of TX


Plans Available in Dallas County

Plan Type Number of

Plans Offered (68)

2016 Monthly Premium Carriers

Medicare Advantage 26 $0 - $196

Humana, UHC AARP/UHC, Aetna,

Scott & White, CIGNA Health

Spring, WellCare, BCBS of TX,

Universal American

Medigap / Medicare Supplement 23 $75 - $339

AARP, Humana, BCBS of TX,

Loyal American by CIGNA, Humana

Connect


19 $18 - $104

AARP, Aetna, CIGNA, Humana Express Scripts,

SilverScript, WellCare, Coventry,

BCBS of TX


Medicare Advantage Plan Benefit Cost Premium $0 Network HMO Deductible $0 Doctor Copay $0 Specialist Copay $30 Hospital Days 1 – 5 $150 copay per day Emergency Room $65 Deductible $0 Rx $2/ $10 / $45 / $95 / 33% 30-day supply

Mail Order $4 / $20 / $90 / $190 / 33% 90-day supply

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2016


Medigap Plan F + PDP (75 year old male) Benefit Cost Premium $252 ($229 Medical + $23 PDP) Network Any doctor who accepts Medicare Deductible $0 Doctor Copay $0 Specialist Copay $0 Hospital $0 Emergency Room $0 Deductible $0 Rx $3 / $15 / $46 / 48%/ 33% 30 day supply

Mail Order $7.50 / $37.50 / $115 / 48% 90 day supply

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2016


How This Affects You

• Depends on the plan you choose • Choose the right level of coverage for you

and your spouse individually

What you pay

How you enroll

Your support

• You enroll directly through OneExchange • You and your Medicare-eligible spouse enroll

in separate plans

• OneExchange will be your partner as you make this decision and enroll in plans

• OneExchange will provide ongoing support - at no cost to you

37


Health Reimbursement Arrangement (HRA)


• You may use HRA funds to reimburse yourself for eligible medical expenses which include premiums that you pay coverage for (including Medicare Part B) and certain out-of-pocket expenses

What is an HRA?

Tax-free account used to reimburse you for eligible health care expenses — you pay first and then get reimbursed

No Double-Dipping

Your HRA funding will be available and prorated from the effective date of your coverage.

January 1 of every year you will receive you annual allotment Unused funds DO roll over

If you are eligible, TCU will make an annual contribution to a Health Reimbursement Account (HRA)


Health Reimbursement Arrangement

You may be reimbursed up to the amount available in the HRA!


Health Reimbursement Arrangement

Reimbursement Options

Reimbursements are up to the amount

available in the HRA $ $

1 2 Automatic

Reimbursement (including recurring premiums)

Manual Reimbursement

Participant

OneExchange Insurance Carrier

Participant

OneExchange Insurance Carrier


Next Steps


What You Need To Do: Action Required!

Contact OneExchange 1-888-429-8490 • Call now to complete your profile and

schedule an enrollment appointment • You will need your Medicare card,

prescription list, and doctor and hospital information

We are Ready!


Personal Guidance

• 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


Questions and Answers


Call Now, We Are Ready! 1-888-429-8490

retiree readiness - tcuhr.tcu.edu/.../2016-tcu-oneexchange-presentation.pdf · 2016 - $0 to $360 ....

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