1. How do I certify dependents, and how do I check for that? Everyone with a dependent needs to certify dependents regardless of age or Medicare status. Go to https://auditos.com/ and log in using the reference number on the letter from CMS dated September 25, 2013. The date for filing verification has been extended from October 25 to December 6.
2. Do any of the changes for retiree health insurance affect me?You will be affected ONLY if you are now on Medicare A+B for yourself and for all dependents (unless you live outside the USA).
3. How do I enroll in a state Medicare Advantage (MA) plan? What is the deadline for enrolling in state MA?
By now, you should have received the 8-page State Open Enrollment Form from CMS mailed in the week of November 11, and also the additional materials mailed directly from the insurance companies applicable for your residential address. December 13 is the CMS deadline for enrollment. Complete questions on ALL pages and return the entire form postmarked by December 13.
4. How do I opt out of the state MA?
You opt out on page one of the State Open Enrollment Form from CMS and can make other changes on page 3. You must return the entire form postmarked by December 13.
5. If opting out of state, how do I enroll in private Medigap and Part D (drugs)? What is the deadline?
To replace Cigna (or the new MA plan) you need to enroll in a Medicare supplement (Medigap) plan and Part D by the deadline of December 7; see www.Medicare.gov.
Unfortunately, the interpretation by the legal team from the Illinois Department of Insurance about the "guaranteed rights issue" is that changes in state plans do not constitute "loss of coverage" for purpose of guaranteed rights. This has major impact on what plans you can buy in the private insurance market because companies can deny coverage or raise prices because of your preexisting health conditions. Also, you need to register in the current open enrollment period by December 7 because we do NOT get the extension to the end of March, which would have been granted under "guarantee issue." There is still some ongoing discussion about this legal ruling, but it is risky to assume that it will be granted. Blue Cross/Blue Shield of Illinois waives the medical underwriting for preexisting health issues. We do not know what is available in other states.
6. How do I find Medigap and Part D policies for my dependents and myself?
You can use the Medicare link to find a policy but it is very complicated (http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx). Policies available vary depending on your home zip code, health status, age, gender, and more. We cannot advise you on what to do, but Medicare has excellent free personalized health insurance counseling (SHIP--State Health Insurance Assistance Program). To find the telephone number in Illinois and other states, go to:
http://www.medicare.gov/contacts/state-search-results.aspx?stateresult=ALL&stateabbr=IL|Illinois.
You can use the SUAA portal, which also lists a set of private insurance brokers. Note their disclaimer: "The information being provided is for general plan comparison only. While the companies strive to be accurate, we cannot guarantee the above information to be a perfect representation of benefits, nor can we guarantee the accuracy of the premium amount shown. Licensed Medicare Supplement Insurance Specialists should be consulted for a detailed description of benefits and limitations."
7. Will I continue to have dental coverage if sign up for state MA or opt out?
Yes. Every SURS retiree keeps dental.
8. Will I keep vision?
Yes, if you sign up for state MA, but not if you opt out.
9. What are the comparable costs for SURS retirees on the new MA plans?
You and your spouse continue to pay your Medicare Part B premium just as you do now. The actual amount is based on your taxable income and is typically $104.90.
The premium will be 1% of your pension per month until July 2014, when it becomes 2% per month.
The spouse/dependent premium is $89.91 (HMO) or $110 (PPO).
The deductible is $100 for the PPO and $0 for the HMO. The out-of-pocket maximum is $1,300 for the PPO and $3,000 for the HMO.
The % of costs covered is 90%; the participant pays 10%.
For drugs, the PPO has a $100 annual deductible and copays: generic ($10), preferred brand ($30), and non-preferred or specialty ($60).
For drugs, the HMO has a $75 annual deductible and copays: generic ($8), preferred brand ($26), and non-preferred or specialty ($50).
10. What are the costs for Medigap if I opt out of the state plan?
You and your spouse continue to pay your Medicare Part B premium just as you do now. The actual amount is based on your taxable income and is typically $104.90
You will pay nothing ($0) to CMS.
You will pay for private supplemental insurance. For a Plan F policy, you will pay a monthly premium that varies based upon your age and health (it starts under $100 a month per person for a healthy 65-year-old, but more with age and preexisting conditions).
For Part D drug coverage, you may expect to pay about $23 a month per person, but more based upon the drugs you need. Talk to your pharmacist or a qualified insurance agent, OR fill your shopping cart with your drugs to get a quote from Medicare at:
https://www.medicare.gov/find-a-plan/questions/home.aspx.
If you are opting out of the state plan, do so NOW because it takes 10-15 days after the application before everything is processed through the medical underwriters, since preexisting conditions are not exempt in Medicare supplementary plans. December 7 is less than 3 weeks away.
11. What are the other issues, such as access to my current doctor and hospital?
We cannot advise you on whether selecting a state MA or opting out is better because it is a balance of prices and your own health-care needs. MA will serve many people well. Opting out is more predictable, because almost all hospitals take the original Medicare A and B; most doctors take most of the Medigap private insurance policies; and Part D is widely accepted with the best rates at the preferred provider. You will need to check with your doctor and hospital and in the materials mailed by the MA companies to you to see whether they will accept the MA plan. You may lose universal acceptance, even with the PPO. We are getting very mixed information about denial of service, billing, and payment processes. You may have to self-pay and then be reimbursed by your new MA plan. The new MA plans will cover up to the same Medicare amounts.
If you believe your provider and/or hospital will not accept the United Healthcare PPO/MA, you may want to call the UHC number and ask to speak with a supervisor. Request that person to complete forms and mail them to your provider/hospital requesting a contract for service.
12. Can I switch back and forth between MA and Medigap?
SURS annuitants can try the MA for 2014 and then switch to Medicare plans in next fall's open enrollment for Medicare, or vice versa. (Note that teachers and community college annuitants cannot make the switch back to the MA).
For further information from CMS on FAQ, go to:
http://www2.illinois.gov/cms/Employees/benefits/trail/state/Documents/State_FAQ.pdf.
CMS phone lines (217-782-2548 and 800-442-1300) have been very busy during the open-enrollment period.
You may contact SURS via www.surs.org and submit a question via email. Dial toll free: 800-ASK-SURS (800-275-7877) or dial direct:
217-378-8800. Fax: 217-378-9800.
Title: Update: Health Insurance for SURS Retirees
Author: UIC Chapter of the State Universities Annuities Association
Date: Released November 18, 2013
Source: UIC United Voice: Fall 2013
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