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UM System Retiree Health Benefits Virtual Town Hall

UM System Retiree Health Benefits Virtual Town Hall

Friday, October 2, 2020  | 2 - 3 p.m.

Speakers

  • Mun Choi, President
  • Marshall Stewart, Chief Engagement Officer
  • Marsha Fischer, Chief Human Resources Officer
  • Carol Wilson, Director of Benefits, UM System
  • Kelley Stuck, Strategic Human Resources Consultant
  • Caroline Murphy, UHC Nurse Liaison
  • David Scinto, UHC Medicare Advantage Representative
  • Bob Eisele, Express Scripts Representative

Meeting archive

View the meeting video below, or click on a category header to expand a list of questions and responses related to each topic.

Trouble with the video? View the video on YouTube.

Enrollment

What does a retiree need to do to transition over to a Medicare-eligible plan and when?

In order to transition to the University Medicare Advantage Plan, apply for Medicare no earlier than three months before your eligibility date. The application process can be completed through your local Social Security office or online. University Medicare Advantage plans include enrollment in an eligible Part D prescription plan, so only enroll in Medicare Part A and Medicare Part B.

As you approach your enrollment date, the university will only send you information regarding Medicare Advantage plan enrollment. That packet will include an enrollment form you will need to return to us, along with a copy of your Medicare card. You can get more details on the Medicare website.

When I move to a Medicare-eligible plan from a non-Medicare eligible plan, will MU’s insurance still be able to cover my dependents who will not be eligible for Medicare?

Yes. Dependents may remain on UM-sponsored plans until no longer eligible. For example, child dependents may remain on the UM-sponsored plans until the age of 26. Please note, even if the primary subscriber transitions to a Medicare-eligible plan, non-Medicare eligible dependents will remain on pre-65 plans (Retiree Health Savings or Retiree Health PPO).

On death, can spouses and dependents continue with UM-sponsored retiree plans?

In the event of the retiree’s death, a spouse or sponsored adult dependent who is enrolled in a UM-sponsored retiree health plan at the time of the retiree’s death will have the option to continue with the same insurance.

If a dependent child is enrolled in a UM-sponsored retiree health plan at the time of the retiree’s death, coverage can only be continued if a spouse or a sponsored adult dependent is also enrolled in a retiree health plan and they choose to continue coverage.

Can life insurance be added for a dependent during the Annual Enrollment period?

No. Life insurance cannot be added for a dependent during Annual Enrollment.

Are Health Savings Accounts (HSAs) allowed for individuals after they qualify for Medicare?

When a retiree enrolls in a Medicare plan or collects Social Security, that person can no longer contribute to their HSA. However, those who have accumulated money in their HSA can continue to use those funds toward eligible medical expenses while being enrolled in a Medicare plan.

If I am working full time at another university and enroll in their health plan does that negatively impact my retirement coverage?

No, there is no negative impact on your university retiree health plan coverage if you are enrolled in another health plan. Your active group plan is your primary insurance coverage, which means medical claims will be sent to your active group plan first. Any claim balances that are left will require coordination of benefits to be processed by your UM retiree plan. Please keep in mind, if you become Medicare-eligible, you are still required to enroll in Medicare Part A and Part B in order to maintain enrollment in the university retiree plan.

 

Prescriptions

What safeguards are in place to protect medications and Durable Medical Equipment (DME) sent through the mail—particularly when mail service may be delayed?

Express Scripts takes many precautions to ensure medication is safe during shipping. Medications are packed appropriately and Express Scripts screens temperatures and uses temperature-controlled packaging to ensure medications are not affected by potential heat. As always, participants also have the option of using a local pharmacy for prescription medications.

The website indicates a change in prescription drug deductibles from $75 in 2020 to $250 in 2021. Currently, the deductible does not apply to prescriptions ordered through Express Scripts. Will this continue through 2021?

Yes. The deductible for 2021 will not apply to mail orders placed through Express Scripts.

Will retirees receive the reduced price for insulin that was mentioned in the Medicare Handbook?

This is not included in the UM plan at this point. The insulin cap was proposed in the Executive Order (EO) from President Trump in late July and primarily focuses on and benefits the Medicaid space. Information and regulations relating to the executive order and Medicare have not been provided or established by CMS or HHS at this point. Express Scripts will provide additional information as it becomes available.

Is using Express Scripts prescription mailing the only way to fill my prescription for three months at a time rather than month-by-month?

Retirees interested in receiving 90-day prescriptions can work with Express Scripts to receive their medications through home delivery. University hospitals and pharmacies also continue to offer 90-day prescriptions at the same cost as if they were purchase from the Express Scripts mail order service.

What controls or determines the cost of prescriptions?

The cost of prescriptions is typically determined by the manufacturer of the prescriptions. This means that prescription costs could potentially increase once or even multiple times a year. To help keep prescription prices as low as possible for the university and plan members, Express Scripts negotiates guaranteed discounts with retail pharmacies and provides discounts through their own mail order process.

Is it possible to guarantee a medication will be the same price throughout an entire year?

Unfortunately, no. The cost of prescriptions drugs is determined by the manufacturer. In cases where an insured person pays a percentage of a prescription’s cost (co-insurance), that co-insurance will be exposed to fluctuations.

 

Plan Design

What changes will Medicare-eligible retirees see to their coverage in 2021?

In 2021, the out-of-pocket maximum on prescription drug coverage will move from $3,250 to $4,130 and the deducible will increase from $75 to $200. These changes helped us lower the premium on both Medicare plans. This year, without the university subsidy, the base plan was $128/month and the enhanced plan was $208/month. In 2021, those premiums will go down to $120/month and $187/month respectively.

There are no other changes to the core benefit for either plan, but both plans will see the following changes in 2021:

  1. Renew Active will replace Silver Sneakers as the UHC fitness vendor.
  2. The United Healthcare Hearing benefit will be in-network only. Participants should make sure they purchase hearing aids from an in-network provider to take advantage of the allowance included in the plan.

How do current deductibles for the pre-65 medical plans compare to those in 2021?

In 2020, the annual in-network deductible for the Retiree Health PPO Plan was $350 for self-coverage and $850 for family coverage. In 2021 it will increase to $700 and $1,700 respectively. Similarly, the annual in-network deductible for both medical and prescription coverage through the Retiree Healthy Savings Plan was $1,500 for self-coverage and $3,000 for family coverage in 2020. Those deductibles will increase to $1,750 and $3,500 respectively in 2021.

How are premiums calculated for both Medicare-eligible and non-Medicare retirees?

UHC calculates Medicare-eligible premiums for both the Medicare base and enhanced plans each year. The performance of each plan is evaluated and it is underwritten accordingly. So, for example, there was no change in the way premiums were calculated for 2021, and due to the repeal of the Affordable Care Act and the positive performance of the enhanced plan, we actually saw a decrease in the premium for that plan.

For non-Medicare retirees, the university and UHC coordinate to review enrollee claims for the past three years. In addition, a review of changes in the market and collaboration with actuaries and other consultants helps us establish premiums moving forward.

Is the university considering a narrow-network option for retirees like the one that is provided for active employees?

The university is not exploring a narrow-network option for pre-65 retirees at this time. However, we’re always trying to innovate and leverage marketplace opportunities to provide the most cost-effective health care options for our university retiree community. If this option is considered during any future plan review, we’ll provide an update at that time.

 

Renew Active

When does the change from Silver Sneakers to Renew Active take effect?

The change will go into effect with the new plan year, on January 1 of 2021.

I have two Renew Active locations near me. Do I have to choose one or can I go to both?

Similar to the way the Silver Sneakers program worked, Medicare-eligible retirees enrolled in Renew Active are able to visit participating facilities interchangeably. Participants can choose between participating facilities and are not locked into a single facility.

Will Silver Sneakers instructors automatically be a part of Renew Active?

No. Silver Sneakers functions and personnel—including online presentations or courses—are specific to Silver Sneakers. Chances are these instructors are not also involved in the Renew Active program. However, Renew Active may offer similar options. Learn more at uhcrenewactive.com/home.

What if the gym(s) in my area doesn’t recognize Renew Active?

Renew Active has an extensive network of gyms and fitness locations across the country. If a gym or fitness center is not in the Renew Active network, let the program know. Renew Active will invite the gym to join. Check the facilities in your area at uhcrenewactive.com or call UHC customer service at 66-899-5903for additional support.

Are Renew Active locations only centered around university campuses or will there be resources in more rural areas?

Renew Active provides an extensive network of gyms and fitness locations across the United States. The program works to find opportunities that fit your style, including popular local and national gyms, fitness locations and community organizations. If your favorite location is not in the Renew Active network, you can reach out to Renew Active and the program will invite that location to join.

Does Renew Active have online videos like Silver Sneakers did?

Yes. To support retirees, the Renew Active Program rolled out online videos and virtual fitness classes to provide convenient options that help social distancing efforts. Learn more, register or access resources at uhcrenewactive.com beginning January 1, 2021.

 

Dental, Vision and Hearing Coverage

What is involved in adding dental, vision and/or hearing benefits to the current plan?

If you’d like to add or drop vision coverage, you can only do so during the Annual Enrollment period. Dental coverage must be elected at the time of retirement and cannot be elected later. However, if you elected it at retirement, you can choose to reduce your coverage or drop it at any time. If you choose to drop coverage, it cannot be reinstated at a later date.

Does the vision policy cover hearing, as well?

Yes, hearing coverage is included in the vision benefit. However, regardless of enrollment status, all retirees and their dependents have access to hearing aid discounts available through EyeMed and Amplifon. To learn more about the free discount program, you can visit the EyeMed website.

Can you use the three-year hearing benefit all in one year?

Yes. That benefit—which is a $500 hearing aid allowance once every three years—can be used all at once.

Are there cost-saving techniques for purchasing eyeglasses, especially frames?

EyeMed, our vision benefit administrator, allows participants to use their benefits at thousands of in-network store locations as well as several online stores. Using EyeMed, you can buy frames, prescription lenses, contacts and even sunglasses from home. There are many online network options, including LensCrafters, Target Optical, Glasses.com and more. Online eyewear stores can help you compare prices and choose frames that work for you.

 

Coverage for Specific Services and Care

What does retiree health insurance cover when traveling abroad?

If you are a non-Medicare eligible retiree, your plan will provide out-of-network coverage when you’re traveling abroad. The way you pay for your services maybe different depending on where you are or the type of care you receive, though. In some countries, health care providers may require you to pay up front before starting treatment. Keep careful records so you can submit them for reimbursement when you get home.

In 2020, foreign travel benefits were added to the Medicare Advantage plans. These plans now provide $200,000 lifetime maximum coverage for services received overseas. Retirees will need to pay for their services and submit for reimbursement from UHC. It’s important to note that the foreign travel allowance is specific to medical services and does not include prescription drug coverage. All plan-covered medical services are included under the foreign travel allowance.

Will medical evacuations be covered when traveling internationally?

Under the urgent care and emergency coverage provisions of the plan, a retiree would be eligible for medical evacuations if their diagnosis requires such an action. If the retiree is not in an emergency situation, the plan would reimburse for medical evacuation under the foreign travel benefit.

What is the cost of a virtual visit? Is it different from an in-person visit in terms of cost?

When you use one of the provider groups in our virtual visit network, your member cost share amount will vary depending on your plan. Non-Medicare eligible retirees on the Retiree PPO Plan or Healthy Savings Plan will pay the same co-insurance for a virtual or in-person visit.

Medicare-eligible retirees on the base or enhanced plan also have access to virtual visits at the same cost as an in-office visit. The copay for a primary care doctor visit for the Base Medicare Advantage plan is $10 and $0 for the Enhanced Medicare Advantage plan.

How should a retired person keep up with the changing information on COVID-19 testing if they think they may have been exposed but don't have symptoms?

If you’re concerned that you may have been exposed to COVID-19, or if you’re experiencing symptoms associated with COVID-19, it’s best to reach out to your primary care provider or a public health professional for guidance on when and how to get tested. If you are tested, the CDC notes that you should isolate at home pending test results.

Retirees who live in rural areas or have disabilities may find visiting doctors challenging. What solutions do our plans offer?

Virtual visits may be an option for retirees who live in rural areas or find accessing a doctor’s office difficult. UHC virtual visits let you see and talk—by phone or video—to a doctor from your mobile device or computer. They’re a great option that allows you to talk to a doctor about your health concerns, symptoms and treatment options. Doctors can write a prescription*, if needed.

Doctors can diagnose and treat a wide range of non-emergency medical conditions, but virtual visits are not appropriate for emergency situations, injuries like sprains or broken bones that require bandaging, complex or chronic conditions or anything requiring an exam or a test. Learn more at https://www.umsystem.edu/totalrewards/benefits/virtual_visits.

Do the Medicare plans cover any support for home health care or assisted living?

Home health care is included in the Medicare benefit, and Medicare Advantage plans cover support in a skilled nursing facility up to a 100-day limit. Medicare does not pay toward a permanent support in a long-term care facility like a nursing home—but if you are on Medicaid, or if you find yourself able to enroll, Medicaid does pay toward long-term care facilities.

Is cataract surgery covered under the Medicare Advantage Plans?

Yes. Cataract surgery is covered under the Medicare Advantage Base and Enhanced Plans. In addition, after you receive cataract surgery, Medicare covers one pair of lenses and frames, if you need any vision correction.

 

Reviewed 2020-10-13