your 2019 guide - kaiser permanente · this guide will help you understand your options so you can...

INCREASE YOUR COVERAGE without increasing your FEHB monthly premium

Your 2019 guide to choosing Kaiser Permanente MEDICARE health plans for Federal members

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What’s inside this guide

The 4 parts of Medicare — and what they cover p. 4

Why choose a Kaiser Permanente Medicare health plan? p. 6

Choosing the right Kaiser Permanente FEHB option p. 7

Changing FEHB options p. 8

Compare your options for 2019 p. 10

Your Kaiser Permanente Medicare health plan sign-up checklist p. 12

Get the most out of your FEHB coverageDid you know you can enhance your benefits by adding a Kaiser Permanente Medicare health plan specifically designed for Federal employees?

For better benefits than your Federal Employees Health Benefits (FEHB) coverage alone, consider a Kaiser Permanente Medicare health plan. With a Medicare health plan for Federal members, you’ll have lower copays for covered services and additional benefits.

This guide will help you understand your options so you can choose the Medicare health plan that’s right for you. You’ll also find tools and tips to make your transition easier.

If you have questions or are ready to enroll in a Medicare health plan, we are here for you.

Call a Kaiser Permanente Medicare Specialist at 1-800-581-8252 (TTY 711), 8 a.m. to 5 p.m., Monday through Friday.

Current FEHB Medicare members can call Member Services at 1-888-901-4600 (TTY 711) 8 a.m. to 8 p.m., 7 days a week.

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Trust a plan with a high ratingHighly rated quality and service

The Centers for Medicare & Medicaid Services (CMS) rates the excellence of certain Medicare health and prescription drug plans based on major categories that include:

• Preventive care

• Chronic care

• Prescription drug services

• Customer service

• Member satisfaction

To learn more about Kaiser Permanente’s high Medicare plan ratings, visit wa-medicare.kaiserpermanente.org.1

1Every year, Medicare evaluates plans based on a 5-star rating system.

http://wa-medicare.kaiserpermanente.org

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The 4 parts of Medicare — and what they cover

PART A

Covers services and supplies considered medically necessary, including:

• Inpatient hospital care• Skilled nursing facility care• Hospice care

When can you sign up for Part A?

• When you turn 65. Depending on your situation, you will either automatically get Part A or you’ll need to sign up for Medicare.

• You can contact Social Security 4–6 months before you turn 65 to confirm that you are eligible and ask for your Medicare card.

What does Part A cost?

• If you or your spouse paid Medicare taxes while working, you usually won’t pay a monthly premium for Medicare Part A. (You automatically qualify if you were a Federal employee on January 1, 1983.)

• Otherwise, if you are 65 or older, you may be able to buy Part A.

PART B

Covers many services that aren’t covered by Part A, including:

• Doctor services• Outpatient care

When can you sign up for Part B?

• Your initial sign-up period begins 3 months before you turn 65 and ends 3 months after your 65th birthday month.

What does Part B cost?

• You must pay a monthly premium for Part B.

• Your premium is usually paid out of your Social Security check or your retirement check.

• Members with higher incomes may have higher premiums. This is called Part B Income Related Monthly Adjustment Amount (IRMAA).

• Contact Social Security Administration at 1-800-772-1213 for more information on Part B premiums.

If you can get Part A at no cost, you should take it, even if you’re still working.

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PART C

Includes both Part A and Part B.

• It’s also known as Medicare Advantage.

• It’s offered by private insurance companies that are approved by Medicare.

PART D

Covers prescription drugs.

• Covers outpatient prescription drugs.

• If you enroll in Kaiser Permanente Medicare Advantage for Federal Employees, prescription drug coverage that meets or exceeds Part D standards is included.

Is there a penalty for not enrolling in Medicare Part A or B as soon as possible?

• Part A: If you qualify for premium-free Part A, there is no penalty. Generally, if you choose not to sign up for Part A when you’re first able to enroll in Medicare, you won’t pay a penalty.

• Part B: If you choose not to enroll in Part B when you’re first able to, your Part B payments could go up by 10% for each year that you delay signing up for Part B. This is due to the Part B penalty applied by CMS. This penalty is subject to change.

– If you or your spouse keeps working, you may be able to delay your Part B enrollment without a penalty. Contact Social Security Administration at 1-800-772-1213 to delay your Part B enrollment.

Kaiser Permanente’s FEHB prescription drug coverage is, on average, as good as or better than standard Medicare prescription drug coverage and is considered Creditable Coverage. As long as you’ve had continuous FEHB coverage while you were eligible to enroll in Part D, you won’t have to pay a Part D late enrollment penalty. Medicare Advantage for Federal Members includes Part D, which in some cases means you will pay a lower amount for prescription drugs than with your FEHB coverage alone.

You need to be enrolled in Part A and B in order to enroll in a Part C Medicare Advantage plan.

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What’s the advantage to enrolling in a Kaiser Permanente Medicare health plan?Consider joining to get richer benefits than with your FEHB coverage alone. You’ll get all your FEHB benefits plus:

High Option Medicare Advantage 1

• No copays for primary and specialty care office visits, lab, X-ray, diagnostic tests, outpatient surgery, inpatient hospital care, urgent care, and ambulance

• Lower copay for emergency services

• Lower out-of-pocket maximum

• $100 allowance for eyewear

• $250 allowance for hearing aids

• Silver&Fit® fitness benefit

High Option Medicare Advantage 2

• Lower copays for primary and specialty care, outpatient surgery, inpatient hospital and emergency services

• No cost shares for lab and X-ray



• $1,200 total annual HRA contribution to be used to pay your Medicare Part B premium

High Option Medicare Choice

• Low copays for primary and specialty care, outpatient surgery, inpatient hospital and emergency services

• Low out-of-pocket maximum

• $600 total annual HRA contribution to be used to pay your Medicare Part B premium

Standard Option Medicare Advantage 1

• Low copays for primary and specialty care office visits, outpatient surgery, inpatient hospital care, emergency care, urgent care, ambulance, and generic and brand-name prescription drugs

• $100 allowance for eyewear

• $250 allowance for hearing aids

• Low out-of-pocket maximum


Standard Option Medicare Advantage 2

• Low copays for primary and specialty care, outpatient surgery, inpatient hospital and emergency services

• No cost shares for lab and X-ray



• $750 total annual HRA contribution to be used to pay your Medicare Part B premium

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Which Medicare health plan can I choose?Medicare Advantage

You may choose one of the Medicare Advantage plans if you have Medicare Part A and Part B and live in our plan’s Medicare Advantage service area. Our service area includes the counties of Island, King, Kitsap, Lewis, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom in Western Washington, as well as Spokane in Eastern Washington. Also, our service area includes the following ZIP codes in parts of these Western Washington counties: Grays Harbor: 98541, 98557, 98559, and 98568. Mason: 98524, 98528, 98546, 98548, 98555, 98584, 98588, and 98592. To remain a member of our plan, you must continue to reside in the plan service area.

You can enroll in Kaiser Permanente Medicare Advantage for Federal Members if you have Medicare Part A and Part B and are an FEHB Kaiser Permanente member.

We’ll enroll you in the Medicare health plan that matches the Kaiser Permanente FEHB option you have now. For example, if you’re a Kaiser Permanente Standard Option member, you’ll be enrolled in Standard Option Medicare Advantage 1 for Federal Members. If you’re a Kaiser Permanente High Option member, you’ll be enrolled in High Option Medicare Advantage 1 for Federal Members.

Medicare Choice

If you are a High Option member, have Medicare Parts A and B and are not enrolled in our Medicare Advantage health plan, you will get Medicare Choice. You will pay lower cost-sharing than with FEHB coverage alone, plus we will reimburse you for up to $600 annually ($50 each month) for the Medicare Part B premium you pay.

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Changing FEHB optionsWhen you become eligible for Medicare, you may be able to change your current FEHB option. To learn more about making enrollment changes outside of Open Season:

• Go to opm.gov or

• Contact your employing agency or retirement office

Your FEHB premium does not change when you enroll in Medicare Advantage. The FEHB premium share you currently pay is listed in the table below.

YOUR PREMIUM SHARE2 HIGH OPTION (Code) STANDARD

OPTION (Code)

Self Only

Biweekly Non-Postal $146.16 (541) $67.52 (544)

Biweekly Postal Category 1 $142.96 (541) $64.82 (544)


Monthly Non-Postal $316.68 (541) $146.29 (544)

Self Plus One





Self and Family





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2 You must pay the Medicare Part B premium to join a Kaiser Permanente Medicare health plan. The above FEHB rates do not apply to all enrollees. If you are in a special enrollment category, please contact the agency or Tribal Employer which maintains your health benefits enrollment.

You can enroll in Kaiser Permanente Medicare Advantage for Federal Members if you have Medicare Part A and Part B and are an FEHB Kaiser Permanente member.

http://opm.gov

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Enjoy healthy extras. With Kaiser Permanente Medicare Advantage for Federal Members, you will be able to enjoy the benefits of the Silver&Fit® exercise and healthy aging program, which includes a membership at a participating fitness center at no additional cost cost to you. For more information, call Silver&Fit’s customer service at 1-877-750-2746 (TTY 711) or visit silverandfit.com.

The Silver&Fit program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver&Fit is a registered trademark of ASH and used with permission herein.

http://silverandfit.com

High Option Standard Option

FEHB Only MA 1 MA 2 Medicare Choice FEHB Only MA 1 MA 2

Monthly Medicare Part B premium reimbursement $0 $0 $100 $50 $0 $0 $62.50

2019 Benefits and Services

Primary care $25 $0 $15 $15 $25, $0 for children $10, $0 for children $20, $0 for children

Specialty care $25 $0 $15 $15 $35 $10 $25

Most lab tests $0 $0 $0 $0 $0 $0 $0

Most X-rays $0 $0 $0 $0 $0 Specialty scans $100 $0 $0

Outpatient surgery $75 $0 $75 $75 $150 $50 $100

Inpatient hospital care $350/admit $0 $100/admit $100/admit $750/admit $100/admit $250/admit

Emergency care $100 $50 $65 $65 $150 $50 $65

Urgent care $25 $0 $10 $10 $25 / $30 $10 $20

Ambulance 20% $0 10% 10% $100 per trip $0 10%

Prescription drug supply at Plan pharmacies3

Value Tier 1-month supply / 90-day mail order supply

N/A N/A N/A N/A $5 / $10 N/A $5 / $10

Tier 1: Formulary generic 1-month supply / 90-day mail order supply $20 / $40 $20 / $40 $20 / $40 $20 / $40 $20 / $40 $3 / $6 $20 / $40

Tier 2: Formulary and preferred brand 1-month supply / 90-day mail order supply $40 / $80 $40 / $80 $40 / $80 $40 / $80 $40 / $80 $30 / $60 $40 / $80

Tier 3: Non-formulary / non-preferred 1-month supply / 90-day mail order supply $60 / $120 $60 / $120 $60 / $120 $60 / $120 $60 / $120 $40 / $80 $60 / $120

Tier 4: Preferred specialty 1-month supply 25% up to $200 25% up to $200 25% up to $200 25% up to $200 25% up to $200 25% up to $200 25% up to $200

Tier 5: Non-preferred specialty 1-month supply 50% up to $500 50% up to $500 50% up to $500 50% up to $500 50% up to $500 50% up to $500 50% up to $500

Eyewear (every 24 months) Not covered $100 allowance Not covered Not covered Not covered $100 allowance Not covered

Hearing aids (every 24 months) Not covered $250 allowance Not covered Not covered Not covered $250 allowance Not covered

Silver&Fit® Fitness Benefit Not covered $0 $0 Not covered Not covered $0 $0

Out-of-pocket maximum per person (2x per family) $3,000 $1,000 $2,000 $2,000 $5,000 $1,000 $3,000

Compare your optionsThis 2019 benefit summary lets you review your choices side by side.

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Please note that the above information is only a summary of the Kaiser Foundation Health Plan of Washington benefits. Before making a final decision, please read the Plan’s Federal brochure (RI 73-012). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure and the Kaiser Permanente Medicare Advantage for Federal Members Evidence of Coverage.

3 Plan providers determine the drug that is medically necessary. If you request another drug, you pay prices charged to members for non-covered drugs.

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Your Kaiser Permanente Medicare health plan sign-up checklistIf you’re an FEHB member and have already signed up for Medicare, you’re ready to enroll in a Kaiser Permanente Medicare health plans.

If you’re a Kaiser Permanente FEHB member, use the checklist below to see your next steps.

4–6 months before turning 65 2–3 months before turning 65 Your birthday month

LEARN ABOUT MEDICARE TIME TO ENROLL IN A MEDICARE HEALTH PLAN

TIME’S RUNNING OUT TO JOIN A MEDICARE HEALTH PLAN

• Learn about Medicare basics and the importance of Medicare Star Quality Ratings online at wa-medicare.kaiserpermanente.org.

• Call Social Security to confirm that you’re eligible and ask for your Medicare card.

• Look for your Kaiser Permanente Medicare health plan enrollment kit in the mail.

• Enroll

– To enroll in Medicare Advantage, you must fill out the enrollment form and mail it back to Kaiser Permanente.

– To enroll in Medicare Choice, you don’t need to submit anything to Kaiser Permanente. You just need to enroll in Medicare Parts A and B.

• Have questions? Talk to a Kaiser Permanente Medicare specialist at 1-800-581-8252 (TTY 711) 8 a.m. to 5 p.m., Monday through Friday.

Timing is everything. To enhance your FEHB coverage and sign up for Kaiser Permanente Medicare Advantage, return your enrollment form as soon as possible.



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What’s next?To learn more about Medicare benefits and eligibility:

• Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 7 a.m. to 7 p.m.

If you’re ready to enroll in a Kaiser Permanente Medicare health plan for Federal members, or have questions:

• Call a Kaiser Permanente Medicare specialist at 1-800-581-8252 (TTY 711), 8 a.m. to 5 p.m., Monday through Friday. We’ll be happy to answer your questions and walk you through the enrollment process. Current FEHB Medicare members can call Member Services at 1-888-901-4600 (TTY 711) 8 a.m. to 8 p.m., 7 days a week.

• After we have your enrollment form and confirm your status, you’ll receive a letter of confirmation and a new Kaiser Permanente ID card.

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For more information on our Kaiser Permanente Medicare health plans, please visit kp.org/feds/wa-core/medicare.

Medicare EnrollmentKaiser Foundation Health Plan of WashingtonPO Box 34255Seattle, WA 98124

Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal. To join a Kaiser Permanente Medicare Health Plan, you must reside in the Kaiser Permanente Medicare Advantage service area in which you enroll. This information is not a complete description of benefits. Call 1-888-901-4600 (TTY 711) for more information. Enrolling in Medicare Advantage for Federal Members will not affect the benefits you receive through the Federal Employees Health Benefits (FEHB) Program, although the network and other rules of Medicare may apply. FEHB Program coverage is described in FEHB brochure RI 73-012.

©2018 Kaiser Foundation Health Plan of WashingtonPlease recycle.MA0001972-52-18

http://kp.org/feds/wa-core/medicare

your 2019 guide - kaiser permanente · this guide will help you understand your options so you can...

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