Retiree Health Retiree Health Benefits Program Benefits Program Medicare Part D Medicare Part D and Your State and Your State Benefits Benefits Your Benefits Choices Your Benefits Choices
Jan 20, 2016
Retiree Health Benefits Retiree Health Benefits ProgramProgram
Medicare Part D Medicare Part D
and Your State Benefitsand Your State Benefits
Your Benefits ChoicesYour Benefits Choices
We Will Look At…We Will Look At…
The good news!The good news! Basic Medicare Part D Basic Medicare Part D Your choices under the Your choices under the
Retiree Health Benefits Retiree Health Benefits ProgramProgram
Actions you need to take Actions you need to take and whenand when
The Good News
State program’s new State program’s new prescription drug option applies prescription drug option applies the value of Medicare Part Dthe value of Medicare Part D
Lower premiums and more Lower premiums and more flexibilityflexibility
Basic Medicare Part DBasic Medicare Part D
Passed Congress in 2003 and takes Passed Congress in 2003 and takes effect on Jan. 1, 2006effect on Jan. 1, 2006
Provided by Medicare-approved Provided by Medicare-approved Prescription Drug Plans (PDPs)Prescription Drug Plans (PDPs)
Enrollment period is November 15, Enrollment period is November 15, 2005 – May 15, 2006 2005 – May 15, 2006
You enroll in a PDP, can switch each You enroll in a PDP, can switch each yearyear
Basic Medicare Part DBasic Medicare Part D
Coverage includes a formulary, or list Coverage includes a formulary, or list of drugs covered by the plan of drugs covered by the plan
Some drug categories are not covered, Some drug categories are not covered, for examplefor example Drugs for symptomatic relief of Drugs for symptomatic relief of
cough and coldscough and colds Drugs used for cosmetic purposesDrugs used for cosmetic purposes Drugs for weight loss or weight gainDrugs for weight loss or weight gain BarbituratesBarbiturates
Basic Medicare Part D Basic Medicare Part D
Drug ExpenseDrug Expense You Pay (Covered You Pay (Covered Drugs)Drugs) Potential OOP Potential OOP
$0 - 250$0 - 250 DeductibleDeductible $250$250
$250 - 2,250$250 - 2,250 25% Coinsurance25% Coinsurance $500$500
$2,250 - 5,100$2,250 - 5,100 100% Coinsurance100% Coinsurance $2,850$2,850
$5,100+$5,100+ 5% Coinsurance/$2/$55% Coinsurance/$2/$5 5% of Unknown5% of Unknown
National Average Estimated Monthly Premium = $32.20 National Average Estimated Monthly Premium = $32.20
Adjusted Each Year for InflationAdjusted Each Year for Inflation
The State Program The State Program and Youand You
This Means….This Means…. Lower premiums and more flexibility!Lower premiums and more flexibility!
Retiree Health Benefits Program
State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit
Incorporates Part D value into state Incorporates Part D value into state programprogram
Enhances Part D benefit Enhances Part D benefit
Retiree Health Benefits Program
State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit
Broad formulary includes generic, preferred Broad formulary includes generic, preferred brand and non-preferred brand drugsbrand and non-preferred brand drugs
Low copayments for generic and preferred Low copayments for generic and preferred brand drugsbrand drugs
Protection through the“donut hole” ($2,250 Protection through the“donut hole” ($2,250 - $5,100) in Basic Part D - $5,100) in Basic Part D
Retiree Health Benefits Retiree Health Benefits ProgramProgram
State Enhanced Medicare Part State Enhanced Medicare Part D BenefitD Benefit
Administered by Medco Health Administered by Medco Health Solutions, Inc.Solutions, Inc.
Medco national prescription drug Medco national prescription drug networknetwork
No deductible for generic drugsNo deductible for generic drugsDrug tiers based on type and costDrug tiers based on type and cost
Retiree Health Benefits Retiree Health Benefits ProgramProgram
State Enhanced Medicare State Enhanced Medicare Part D BenefitPart D Benefit
Per Day SupplyPer Day Supply Generic Generic Drugs Drugs
Tier 1Tier 1
Preferred Preferred BrandBrand
Tier 2Tier 2
Non-Preferred Non-Preferred BrandBrand
Tier 3Tier 3
Specialty Specialty DrugsDrugs
Tier 5Tier 5
No No deductible deductible
**$250 deductible applies****$250 deductible applies**
30 days 30 days retailretail
You pay You pay
$4 $4
You payYou pay
$17 $17
You payYou pay
75% 75%
You pay You pay
25% 25%
90 days 90 days mail ordermail order
You payYou pay
$4 $4
You payYou pay
$34 $34
You payYou pay
75%75%
You payYou pay
25%25%
Retiree Health Benefits Program
State Plans with Enhanced Medicare Part D BenefitState Plans with Enhanced Medicare Part D Benefit Starting January 1Starting January 1
Advantage 65 Advantage 65 Advantage 65 + Dental/VisionAdvantage 65 + Dental/Vision Option IOption I Option II Option II Option II + Dental/VisionOption II + Dental/Vision
Same medical coverage as todaySame medical coverage as todayNew enhanced Part D coverageNew enhanced Part D coverage
Retiree Health Benefits Program
New Medical-Only Plans Starting New Medical-Only Plans Starting January 1January 1
Advantage 65 Medical-Only Advantage 65 Medical-Only Advantage 65 Medical-Only Plus Advantage 65 Medical-Only Plus
Dental/VisionDental/Vision Include same medical (and Include same medical (and
dental/vision) benefits as todaydental/vision) benefits as todayNo prescription drug coverageNo prescription drug coverage
Retiree Retiree Health Benefits ProgramHealth Benefits Program
PlanPlan 2005 2005 PremiumPremium
2006 2006 Premium Premium
Increase/Increase/DecreaseDecrease
Advantage 65 (includes drug)Advantage 65 (includes drug) $293$293 $220$220 ($73)($73)
Advantage 65 + Dental/Vision Advantage 65 + Dental/Vision (includes drug)(includes drug) $320$320 $249$249 ($71)($71)
Option I (includes drug)*Option I (includes drug)* $259$259 $183$183 ($76)($76)
Option II (includes drug)*Option II (includes drug)* $317$317 $259$259 ($58)($58)
Option II + Dental/Vision Option II + Dental/Vision (includes drug)*(includes drug)* $344$344 $288$288 ($56)($56)
Advantage 65 – Medical OnlyAdvantage 65 – Medical Only N/AN/A $117$117 ($176)($176)
Advantage 65 – Medical-Only + Advantage 65 – Medical-Only + Dental/VisionDental/Vision N/AN/A $146$146 ($174)($174)
Total Premiums
*No new enrollees*No new enrollees
Retiree Health Benefits Program
State Enhanced Medicare Part D Benefit Vs. State Enhanced Medicare Part D Benefit Vs. Other Drug Plan ChoicesOther Drug Plan ChoicesGather informationGather informationCompare costs Compare costs Check formulariesCheck formularies ConvenienceConveniencePeace of MindPeace of MindChoose the plan that is best for you!Choose the plan that is best for you!
Retiree Health Benefits Retiree Health Benefits ProgramProgram
What Do I Need to Do?What Do I Need to Do?Review the notification materials carefully, Review the notification materials carefully, then choose one:then choose one:
Do nothingDo nothing and remain in your current plan with and remain in your current plan with the Enhanced Part D Drug Benefit the Enhanced Part D Drug Benefit
Select a state medical-only planSelect a state medical-only plan and and re-enroll in a re-enroll in a separate Part D plan separate Part D plan (no return to state drug (no return to state drug coverage in the future)coverage in the future)
Cancel state program coverage Cancel state program coverage If you cancel state program coverage, you If you cancel state program coverage, you cannot cannot
returnreturn
Retiree Health Benefits Retiree Health Benefits ProgramProgram
What Do I Need to Do?What Do I Need to Do?Use the special enrollment form in your notification Use the special enrollment form in your notification
package to make a choice:package to make a choice: Enroll in a Medical-Only PlanEnroll in a Medical-Only Plan Cancel state program coverageCancel state program coverage Switch from Option I, Option II to Advantage 65 plansSwitch from Option I, Option II to Advantage 65 plans Take other permitted enrollment actionsTake other permitted enrollment actions
Retiree Health Benefits Retiree Health Benefits ProgramProgram
What Do I Need to Do?What Do I Need to Do?Return form by Return form by November 30, 2005November 30, 2005Provide Medicare Claim Number (if appropriate – Provide Medicare Claim Number (if appropriate –
see form)see form) If your form is If your form is not receivednot received by November 30, by November 30, you you
defaultdefault to your current plan with state Enhanced to your current plan with state Enhanced Medicare Part DMedicare Part D
Retiree Health Benefits Retiree Health Benefits ProgramProgram
Getting AssistanceGetting AssistanceState Medicare-coordinating prescription drug State Medicare-coordinating prescription drug
coverage coverage Medco:Medco:
1-800-572-40981-800-572-4098Medco Medicare Part D Plan quick link:Medco Medicare Part D Plan quick link:
www.dhrm.virginia.gov/hbenefits/retirees/medicareretireewww.dhrm.virginia.gov/hbenefits/retirees/medicareretiree.html.html
Retiree Health Benefits Retiree Health Benefits ProgramProgram
Getting AssistanceGetting AssistanceMedicare Part D plans (not associated with Medicare Part D plans (not associated with
the state program) the state program) Medicare:Medicare:
1-800-Medicare1-800-Medicarewww.medicare.govwww.medicare.gov
Medicare Part D Medicare Part D and Your Benefitsand Your Benefits
Thanks for Thanks for listening!listening!
Now’s the time Now’s the time to ask to ask questions questions
Make the right choice for you!Make the right choice for you!