MEDICAL: MEDICARE SUPPLEMENT BENEFIT ... - Home - …



69850312420005181600-15430502018 Labor FirstHealthcare Enrollment GuideBaltimore County GovernmentMedicare Eligible Retirees and/or DependentsADDITIONAL MEDICARE SUPPLEMENTAND PART D PLAN CHOICES AVAILABLEDear Medicare Eligible Retiree and/or Dependent, The accompanying enrollment and educational guide is a follow up to Baltimore County’s announcement of offering additional Medicare Medical Supplement and Part D Prescription Drug Plan choices beginning January 1, 2018. The County has partnered with Labor First, a Retiree Benefit Administrator and Advocacy Company that specializes in retiree healthcare, to help the County’s Medicare eligible retirees and their Medicare eligible dependents evaluate additional choices on an individual retiree basis to see if they are right for you. THE COUNTY’S CURRENT MEDICARE AND NON-MEDICARE PLANS WILL CONTINUE TO BE AVAILABLE TO ALL ELIGIBLE RETIREES AND THEIR DEPENDENTS. Your Selection is Annual- If you choose to enroll in a Labor First plan and are dissatisfied, you may return to a County sponsored Medicare Supplemental and/or Part D Prescription Plan during the next Open Enrollment.As previously announced, credits are being offered to offset the plan cost. Please refer to the rate information provided in your packet from Baltimore County to determine the amount of the credit available to you. If you decide to enroll in a plan through Labor First, the County will credit your monthly Pension Check up to $130 (member)/ $65 (Spouse) toward the premium of the Medicare Supplemental plan of your choice and up to $30 (member)/ $15 (Spouse) toward the Part D Prescription Drug Plan of your choice. Credits are based on your date of retirement and years of service. This means that depending on the plan(s) that you select and the amount of your Pension Check credit(s), your premiums may be covered by more than 100%. In the following pages, you will find abbreviated benefit summaries. There are two (2) Medicare Medical Supplement alternatives, insured by United American Insurance Company (UA). UA has been in business since 1947 and specializing in Medicare since 1966. In addition, there are five (5) alternative Medicare Prescription Drug Plans (PDP) at various price points and benefit coverage levels. Three (3) of the plans are AARP? MedicareRx insured by UnitedHealthcare? and two (2) of the plans are being offered through Express Scripts, Inc (ESI).We encourage you to speak with a Labor First Advocate as there could be annual savings (premium + co-pays) for many of you. Sincerely, Labor FirstMEDICAL: MEDICARE SUPPLEMENT BENEFIT SUMMARYHealth Benefits SummaryBaltimore County Government CignaPlan Pays:Labor First High Option Plan Pays:Labor First Low Option Plan Pays:2018 Plan Premium (PMPM)$200.53$168.00$115.00County Contribution or Pension Credit *($150.40)($130.00)($130.00)Retiree Net Cost with Maximum Credit$50.13$38.00($15.00)DeductiblePart A: Covered at 100% Part B: Covered at 100%Part A: $0 Part B: $183Part A: $0 Part B $1,500Inpatient Hospital / Facility Services100% of inpatient deductible days 1-60. 80% after day 60 until new benefit period100% of inpatient hospital and deductible cost for days 1-365 or until new benefit period100% of inpatient hospital and deductible cost for days 1-365 or until new benefit periodInpatient Professional / Practitioner Services100% of balance due including deductible100% of balance due after deductible100% of balance due after deductibleOrgan Transplants100% of balance due including deductible100% of balance due after deductible100% of balance due after deductibleEmergency Care100% of balance due including deductible80% of balance due after deductible. Waived if admitted.Balance after $50-member copay. Waived if admittedOffice Visit80% of balance due including deductible80% of balance due after deductibleRemainder of 80% balance after $20 copayOutpatient Hospital / Facility Services100% of balance due including deductible80% of balance due after deductible100% of balance due after deductibleOutpatient / Office Professional Services100% of balance due including deductible80% of balance due after deductiblePlan pays balance due after$20-member copayPreventative: Well Care / Diagnostic Testing / Mammogram & PSA TestingCovered in Full by MedicareCovered in Full by MedicareCovered in Full by MedicareRadiation Chemo Therapy & Renal Dialysis100% of balance due including deductible80% of balance due after deductible100% of balance due after deductibleAcupuncture80% of the usual and customary rateNot CoveredNot CoveredChiropractic80% of balance due including deductible80% of balance due after deductible100% of balance due after deductibleDurable Medical Equipment /Prosthetic Devices & Ortho Braces80% of balance due including deductible80% of balance due after deductible100% of balance due after deductibleMental Health100% of balance due including deductible80% of balance due after deductible100% of balance due after deductibleHome Health CareCovered in Full by MedicareCovered in Full by MedicareCovered in Full by MedicareSkilled NursingDays 1-20: Covered by full by Medicare, Days 21-100: 100% of the per day deductibleDays 1-20: Covered by full by Medicare, Days 21-100: 100% of the per day deductibleDays 1-20: Covered by full by Medicare, Days 21-100: 100% of the per day deductibleOut-of-Pocket Maximum (OOPM)$2,000$2,000$1,500 on Part B Services only. Not including office copays.Ancillary Benefit CoverageHearing BenefitsNot Covered30%-60% savings provided off MSRP30%-60% savings provided off MSRPVision BenefitsNot Covered100% balance for eye exam (1) per calendar year; Discounted Frames, Lenses, Contacts andLasik100% balance for eye exam (1) per calendar year; Discounted Frames, Lenses, Contacts andLasikDental BenefitsNot CoveredNot CoveredNot Covered*Example based on Maximum Retiree CreditFOREIGN TRAVEL EMERGENCY COVERAGE: Emergency care outside U.S.: Covered at 80% coinsurance of the billed charges after a $250 deductible annually. Maximum $50K LifetimeMEDICAL NETWORK: PLAN ACCEPTED NATIONALLY AT ANY PROVIDER / FACILITY THAT ACCEPTS MEDICAREPHARMACY: PRESCRIPTION DRUG BENEFIT SUMMARYBaltimore County Government Cigna Rx AARP?MedicareRx Walgreens (PDP) **AARP?MedicareRx Saver Plus (PDP) **AARP?MedicareRx Preferred (PDP) **ESI Low OptionESI High Option2018 Plan Premium (PMPM)$202.01$26.80$28.90$76.50$66.90$90.80County Contribution or Pension Credit *($150.77)($30.00)($30.00)($30.00)($30.00)($30.00)Retiree Net Cost with Maximum Credit$50.25($3.20)($1.10)$46.50$36.90$60.80Annual Deductible$100$0 for Generic,$405 for Brand$405$0$405$150Preferred Retail30 Day30 Day30 Day30 Day30 Day30 DayPreferred Generic20%$0$1$7$5$5Generic20%$6$5$12$5$5Preferred Brand30%$31$34$3730%$65Non-Preferred Brand30%32%41%40%30%$80Specialty30%25%25%33%25%25%Mail Order90 Day90 Day90 Day90 Day90 Day90 DayPreferred Generic20%$0$0$0$12.50$12.50Generic20%$18$0$0$12.50$12.50Preferred Brand30%$93$97$9630%$162.50Non-Preferred Brand30%32%41%40%30%$200Specialty30%25%25%33%N/AN/ACoverage GapFull CoverageCMSMinimumCMSMinimumCMSMinimumFull CoverageFull CoverageCatastrophic CoverageStandardStandardStandardStandardCustomCustomThis is a summary overview of benefits. For more detailed information on AARP? plans please refer to included booklets. For ESI please refer to ESI Handout.*Example Based on Maximum Retiree Credit**Rates vary by state of residence. All rates listed below above based on Maryland residence. If you reside in a different state, please call Labor First for accurate pricing.COVERGE GAP:CMS MINIMUM: After $3,750 of drug spend, you will pay 35% of the plan cost for Brand Drugs and 44% of the plan cost for Generic DrugsFULL COVERAGE: You pay the same copay as the initial coverage phase.CATASTROPHIC COVERAGE:STANDARD: After True Out-Of-Pocket reaches $5,000, you will pay the greater of 5% or $3.35 for generics or $8.35 for all other medications.CUSTOM: After True Out-Of-Pocket reaches $5,000, you will pay the greater of 5% or $3.35 for generics or $8.35 for all other medications not to exceed the copay in the initial coverage phase.FREQUENTLY ASKED QUESTIONS685800116840Who is Labor Fist?Labor First is a Retiree Benefits Administrator and Advocacy Company that specializes in retiree healthcare. Our dedicated Member Advocates are here to not only assist members with enrollment, but to provide ongoing retiree support to Baltimore County Retirees throughout their enrollment in any of our plans.00Who is Labor Fist?Labor First is a Retiree Benefits Administrator and Advocacy Company that specializes in retiree healthcare. Our dedicated Member Advocates are here to not only assist members with enrollment, but to provide ongoing retiree support to Baltimore County Retirees throughout their enrollment in any of our plans.What to have with you when speaking with a Member Advocate, in person or over the phone:Medicare CardList of MedicationsFull Enrollment guide and applicationsDo the Medicare Supplemental plans offered by Labor First have a special Physician/Provider Network?No. The Medicare Supplemental plans offered by Labor First are accepted by any facility or physician that accepts the Medicare assignment. Additionally, referrals are not required under the United American (UA) Plans.Do I still need my Medicare Card?Yes, Medicare will continue to be your Primary Insurance. You will need to show your provider your Medicare card and your UA card at the hospital and doctor’s visits. The claim will automatically be processed by Medicare and UA. You will receive an Explanation of Benefits (EOB) from both.How do I know which Medical plan to choose?Based on your Doctor utilization one of the two plan options may be more suited to your needs. It will be beneficial to speak with a Retiree Advocate to go over both plan options, please call 410-431-2226 (TTY 711) to discuss plan options or to schedule an Individual Appointment. Are my drugs covered?Most likely yes. Please have your current list of medications available. Our Retiree Advocates can review your information and provide prescription plan options that best meet your needs and budget.Can I go to the same Pharmacy?Most likely yes. There should be little to no pharmacy disruption. You do NOT need new prescriptions for retail pharmacy fills. However, you will see the most cost savings using the preferred retail pharmacies for the prescription plan that you choose. Is there a Mail Order Pharmacy?Yes, but you will need new prescriptions if you prefer to use the Mail Order Service.I am a Veteran and I purchase my prescriptions from the VA, can I still go to the VA for my drugs?Yes.Will my mail order prescriptions transfer from the old plan?No, you will need to obtain all new scripts from your Provider if you are using Mail Order. If you use a retail Pharmacy you do not need new prescriptions.Do I need Prior Authorizations for certain prescription medicines?Yes. Some drugs require Prior Authorizations or may have quantity limits. This is standard in all Medicare type part D plans. Please contact Labor First if you have questions at (410) 431-2226 or Toll Free (855) 499-2656 (TTY 711).When will I receive my card/ Welcome Kit?Cards and Welcome Kits should be received around Mid-Late December based on your enrollment date. Members and covered Spouses/Medicare Eligible Dependents will each receive separate welcome kit and ID cards. UA Medicare supplement packets, AARP? MedicareRx packets and ESI Rx packets are mailed separately and at different times.Will my premium change?Yes. Premiums change on a yearly basis every January. Since the two UA Medicare Supplement Plans and the two ESI Rx plans are group rated plans the increases tend to be smaller than seen in individual plans. The three AARP options are individual plans and subject to the annual CMS regulated changes for 2019.Is this information available online?Yes, for additional information and enrollment instructions visit baltimorecounty.May I elect to enroll in a Medicare Supplemental plan from Baltimore County and a Prescription plan offered by Labor First, and vice versa?Yes, you may mix and match the coverage to best meet your needs and budget.?If I choose a plan offered by Labor First, can my spouse remain on the Baltimore County Plans, and vice versa?Yes, you and your spouse/dependents can mix and match the coverage that best meets your needs.GROUP INFORMATION SESSIONSAND INDIVIDUAL APPOINTMENTS Individual Appointments will be held on the following dates from 10 am- 4 pm:DateLocationWednesday, October 18Historic Courthouse, 1st FloorThursday, October 19Fire Union HallFriday, October 20Oregon Ridge LodgeWednesday, October 25Historic Courthouse, 1st FloorFriday, November 3Historic Courthouse, 1st FloorWednesday, November 8Oregon Ridge LodgeWednesday, November 15Oregon Ridge LodgeSchedule Your Individual Appointment Today (RSVP ONLY)Call 410-431-2226 or 1-855-499-2656 to speak to a Labor First Retiree Advocate dedicated to Baltimore County Government and schedule your individual appointment today.Group PresentationsIn addition to individual appointments, Labor First will also be holding group presentations at 10am, 11am and 1pm on the dates listed above (No presentation at Fire Union Hall). These presentations will provide you with a brief overview of the plans offered through Labor First. No appointment necessary. Meeting Location AddressesHistoric Courthouse: 400 Washington Ave, 1st Floor, Towson, MD 21204Oregon Ridge Lodge: 13401 Beaver Dam Road, Cockeysville, Maryland 21030Fire Union Hall: 52 Scott Adam Road, Cockeysville, MD 21030FOR MORE INFORMATION ABOUT MEETINGS OR TO SCHEDULE A FACE TO FACE APPOINTMENT DURING ONE OF THESE MEETINGS PLEASE CALL LABOR FIRST AT (410) 431-2226 OR TOLL FREE (855) 499- 2656 (TTY 711) ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download