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Employee Benefits Employee Benefits

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Eligibility/Open Enrollment Eligibility / Open Enrollment

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Claim Resolution Claim Resolution

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Important Notices Important Notices

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Self-Pay Retirees/Medicare Self-Pay Retirees / Medicare

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Coverage Continuation Coverage Continuation

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Self-Pay Retirees/Medicare



SELF-PAY RETIREES

Retirees that are not eligible for health benefit coverage through the School Employees Health Benefit Plan (SEHBP) may continue coverage through the district at their own cost.  Please contact the Business Office prior to retirement if you are interested in obtaining this coverage.

Plan Choices

Self-Pay Retirees have the following plans to choose from:

Aetna HMO $10 Copay with Prescription

Aetna Managed Choice Open Access $10 Copay with Prescription

Aetna Managed Choice Open Access $15 Copay with Prescription

Medicare Eligible

Self-Pay Retirees that are Medicare Eligible must enroll in Medicare Part A and Part B.  Please send in proof of Medicare coverage with your enrollment form in order to qualify for the premium rates for retirees with Medicare coverage.

Cost of Benefits

Self-Pay Retirees must pay the full monthly premium cost of the benefits.  Click on the link below for the current monthly premium rates.

Monthly Premium Rates 7/1/2017 to 7/1/2018.

Enrollment Form

Click Here for a copy of the enrollment form.  Completed forms must be turned into the Business Office.

MEDICARE

Medicare is health insurance coverage that typically becomes available to an individual when:

  • A person turns 65 years old
  • A person is under the age of 65 with certain disabilities
  • A person of any age has End Stage Renal Disease (ESRD). (Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.)

There are four parts to Medicare-

Hospital Insurance (Part A)

Medicare Part A helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care. There is no cost for part A and most Americans get this albeit you have to enroll at age 65 (hope and presume you did).

Medical Insurance (Part B)

Medicare Part B covers doctors’ services and many other medical services and supplies that are not covered by the hospital insurance under part A. There is a monthly premium for part B. The monthly part B premium is an estimated $105 a month per person over 65 for 2016. This changes annually.

Medicare Advantage (Part C)

Medicare Part C provides private products administered by insurers that bundle together medical and pharmacy coverage more like an HO or PPO style plan. The government pays insurers fee to manage these plans and Medicare participants can choose these type plans over part A and part B. In many instances, the coverages for Medicare Advantage plans are very good.

Medicare Prescriptions (Part D)

Medicare Part D is the pharmacy plan. This is so-so coverage and has a large deductible or donut hole in the middle. This is available when one has part A and part B. If one buys a private part C plan, the pharmacy is embedded in that Medicare Advantage plan. For part D, one enrolls with Medicare for pharmacy but the pharmacy plans are through a private company unless again you choose a part C plan which has the pharmacy included. Below is the 2016 part D pharmacy premium costs. Note there is a cost to government and then usually a premium to the pharmacy company. When you enroll for this part, Medicare usually provides a list of the part D pharmacy companies.

A Medicare chart shows the estimated prescription drug plan monthly premium based on income as reported on an individual’s tax return. If  income is above a certain limit, an income-related monthly adjustment amount is paid in addition to the plan premium.You can see the chart here: https://www.medicare.gov/part-d/costs/premiums/drug-plan-premiums.html.

Medicare Options

There are a few options for Medicare eligible members. First, one needed to have enrolled in part A at age 65. One would have received a notification from the government when they turned 65. There is generally no cost for part A. If retiring, one must call to buy part B. The options for Medicare are:

  • Use part A, part B and part D which is “traditional Medicare”.Under these plans you have deductibles and coinsurances and again, there are premium costs for part B and part D.
  • Use part A, part B and part D which is “traditional Medicare” and buy a private Medicare Gap or supplemental plan to cover the costs not paid under part A, B and D. These policies come from private insurers and come with monthly premiums. The premium is dependent upon the level of coverage you buy. You can buy a plan that covers nearly all of the deductibles and coinsurance or a plan that covers some of it. The better the coverage the higher the premium. These plans are sold by places like Blue Cross, AARP, etc. With these plans you use any doctor that takes Medicare and you submit balances you have to the “gap policy” that makes up the differences.
  • Enroll with a Medicare Part C plan which are one of the Medicare Advantage plans.These plans most closely resemble plans like one has as an active employee. They generally have in and out of network coverage; copays for doctor visits, covers pharmacy, etc. These Medicare Advantage plans in essence bundle together parts A, B and D into a cohesive plan. If one buys this type plan, they make an election for a year at a time and can later opt out and go to the traditional style plan. With this type plan one must still pay their part b premium, plus any premium to the private insurer. The premiums vary pending the level of coverage you buy.

Key Actions

Once one is close to retiring and in need of Medicare as their primary coverage, a key step is to sign up for part B. This can be done via phone at 1-800-772-1213. One should establish an account with Medicare to see some of the options. One can enroll here: https://www.ssa.gov/myaccount/. See the Medicare Guidebook which is also helpful.

Using Medicare While Actively at Work

One can continue to be actively working at Medicare age. If they do so, their employer plan will remain primary and Medicare shall be secondary. Employers cannot “force” a worker at Medicare age to elect Medicare as primary. A worker at Medicare age can, if they chose, elect Medicare to be primary (perhaps for cost sharing purposes, etc.) Click Here for a Medicare Guidebook that outlines one’s rights under Medicare when they are still working.

*This general overview of Medicare is being provided as a convenient reference tool. To speak with a Medicare representative, visit medicare.gov*

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