Medicare 101 Presentation
RESIG Medicare 101 Presentation Slides (PDF)
RESIG Medicare 101 Transcript
Welcome & Introductions
Good afternoon, everyone, and thank you for joining us. And the Medicare 101 session. It is 3:30 [PM], so we'll begin the program and start the recording. Thank you, Shauna. I would also like to thank Diego, a Kaiser Permanente Retiree Solutions Manager, and Shauna, Account Manager for SISC Self-insured Schools of California, for assisting RESIG in presenting this valuable information for Sonoma County retirees.
Just a word of caution. Please do not share any private health information in the chat feature or during this session. Instead, send Angela, Elizabeth, or Jodi an email. Their information is listed on this slide, and there will be another slide with their email and phone number listed at a later time in the presentation. It's actually, I think, the second to last page at that time.
You can easily take a picture of that slide and keep that information handy. Also, you might have noticed that their contact information was listed on the back of the flier that was sent out to you or your district. We will pause briefly at the end of each session for a limited number of questions. You can enter your general questions in the chat feature at the bottom right corner.
If that little chat with a with all circle with a little, I don't know what that's called, but it's right there in the lower right-hand corner. A recording of this presentation and the presentation deck will be posted online at npr.org. Once it has been declared through, read it department to our District Contact Benefit Individual. We will be sending out the presentation deck immediately following this presentation at the on the right side of the slide where it says Improve your viewing experience. If you need to enlarge or screen, please follow those directions.
If you need to shrink it, there's the information to do so there. So now I'm going to turn the presentation, I believe, over to Diego, correct?
That is correct.
Okay, Diego, take it away.
Kaiser Permanente Presentation
Thank you, Patty. And hello, everyone. And thank you, Patti and team, as well as for having me here today. It's a pleasure to collaborate and make sure you have the information that you need to go through this this very important process, which is Medicare. And so I welcome you to this presentation. So next, please.
So we're going to go over today is Medicare in general so that before, during, and after Medicare. On the next slide, you're going to see we're going to start talking about the basics of Medicare. So understanding who can join Medicare, probably the most common reason that you're familiar with is people that reach the age of 65 or older.
That's probably the most common reason why somebody will join Medicare. That's probably the case for most of you that are joining the call. But that's not the only reason why someone can join Medicare. Also, if someone has been disabled by Social Security, they can join Medicare after they meet a two-year waiting period. Also, if someone is diagnosed with ESRD, End-Stage Renal Disease, as well as Amyotrophic Lateral Sclerosis, also referred to as ALS, can also qualify to join Medicare as well as U.S. or permanent legal residents who have lived in the United States for at least five years.
So those, besides reaching the age of 65 or older, are different ways that one can join Medicare. Next slide, please. Now, it's also important to define what Medicare is. So Medicare, it's a federally funded health insurance plan that was actually designed to provide our disabled and aging folks a reliable way to get health coverage. It's it was founded in 1965 by President Lyndon Johnson, and the agency that administers Medicare is the Centers for Medicare and Medicaid Services, also referred to as CMS and Medicare is composed of four parts is made out of four different parts.
As you can see here on this slide, we're going to go dive deeper into each of the different parts. But here, for your reference there, all of them are name, and I'll just give you a brief overview of them here. So Part A it's often referred to as hospital insurance. It covers the inpatient hospitalizations, among other things.
Right beside is Part B, which is referred to as medical insurance and covers outpatient services such as your doctor's visits. Those two, Part A and Part B is, what is often referred to as â€œOriginal. Medicareâ€. Now, Part D is the part of Medicare that helps you cover prescribed medications, so your prescriptions.
Part C, also referred refers to as Medicare Advantage plans. It's a part of Medicare that includes or bundles all the parts of Medicare together. And next, please. So now let's talk a little bit more about each of the different parts that makes up Medicare starting with Part A. So as I mentioned before, Part A is often referred to as hospital insurance because it does cover hospitalizations, inpatient hospitalizations, but it covers more than that.
It also gives you coverage for inpatient hospice care. I'm sorry, for hospice care, it also covers home health care as well as skilled nursing care besides their inpatient hospitalizations. So what does Medicare Part A cost? Most of you will have. Excuse me, excuse me, premium Part A. No premium for Part A. So Medicare Part A is often referred to as an earned benefit.
And what I mean by that is that for people that have worked forty quarters or ten years, it doesn't have to be consecutively, and they are paying into Medicare taxes. They qualify for, or they earn the benefit of getting Part A at no cost. That's why it's often referred to as an earned benefit. Now, if someone works less than those forty quarters, less than those ten years, then there is a prorated formula that CMS has. But for someone that has not contributed to the Medicare tax, somebody that has not worked those years at all, the cost for Medicare Part A would be $506 a month.
For those of you and I, I'd say most of you here in the call would be a "no" Part A would be at no cost. It would be free of charge. Next [slide], please. Now let's talk about Part B. Part B it's often referred to as medical insurance because it does cover outpatient services such as those doctor visits. Those specialist visits, lab work, X-rays, [and] some preventative care services are also covered, or the preventative cares are also covered under Part B.
So what does Part B cost? Part B does have a cost associated with it. It's a monthly cost that is designated by Social Security, depending on on your income. And so they look back two years on your income, depending on that income, that that income two years back, they're going to assess a monthly premium which we're going to review in a couple of slides further ahead. Very important to keep in mind for Medicare Part B is that once you become eligible for Part B, you must sign up for Medicare Part B to avoid delayed enrollment penalty fees.
There is a very common misconception about Part B that is if you reach the age of 65, but if you decide that you want to continue to work. You don't have to enroll in Part B. You can delay that process. You can delay the enrollment into Part B, so you are able to postpone it and then enroll once you decide to once you decide to to retire.
It's common that CMS, in this case, that's Centers for Medicare Medical Services. Sends out communication as you age in into into Medicare. So even though if you decide to work, they will still send you information about enrolling in Medicare Part B, it is not required that you let Medicare or CMS know that you are continuing to work is not a requirement.
However, it is a best practice for you to let them know that you are delaying Part B and that you are not planning to enroll when you reach the age of 65. So again, it's not a requirement, but it is a best practice to let them know that that's what is happening. And then, once you retire, you provide them, you fill out the forms, and you provide them with the information about your coverage.
While, while you were working and we're going to go about over that window of opportunity that you have to enroll in Medicare, Medicare Part B, and Medicare in general. Next slide, please. Thank you, Shawna. Now, what you're looking at here is the Medicare Part B premiums. So as I mentioned before, CMS, Social Security looks back at two years of your income, and then they will assess that monthly cost of your Medicare Part B.
So if you're single and earning $97,000 a year or less, the monthly cost for Medicare Part B is $164.90. Now you file your taxes jointly with with your spouse. It is now $194,000 or less, or that $164 per year per member for your monthly Medicare Part B costs. These are changes subject to change every five years. [The] last couple of years, or this past year from 2022 to 2023, we had a decrease in the costs, and could it could change either way.
So just for you to keep in mind. Something else to keep in mind for Medicare Part B premiums is that since CMS and Social Security look at your income, your adjusted gross income two years prior, it's important to keep in mind as we age in, and, let's say you decide to cash in maybe a retirement account or maybe sell a property and things of those nature that, will look at your income differently [a higher income] than what it is usually. They will look at that. But if you feel that the assessment of of that premium of that monthly premium is not accurate, you can always call CMS and Social Security to explain why the income is not accurate, and they will make the assessments accordingly.
And next [slide], please. Now, what you're looking at now is a window of opportunity to enroll in Medicare. What you're looking at now it's called the initial enrollment period. This piece right here shows, generally speaking, about Medicare, when you can join Medicare, [unintelligible] ... to make sure you are you are promptly enrolling to your Kaiser Permanente Senior Advantage Plan.
It's important that you start the process three months prior to your birthday month. That way, when you birthday month hits, then you will be enrolled in in the plan that you desire to enroll. So again, three months prior, you want to start a process of contacting Social Security and CMS to let them know that you're choosing to enroll in Medicare because you are retiring and that it's, again, for those folks that are deciding to retire and enroll in, that are deciding to retire.
For those of you that reach the age reaching the age of 65 where you are continuing to work, just keep in mind, and you're probably going to hear me say this a couple of times, that you don't have to enroll in Medicare Part B if you are continuing to work. So that's that's not a requirement. And you can enroll different ways.
You can enroll by phone, you can enroll through the website that you see on the screen at SocialSecurity.Gov. Or you can also enroll on online. So there are these different ways that you can enroll, and you can right now, doing it in person might be a little there might be some delays because of what COVID caused, but you can enroll over the phone and also still make an appointment in person to go over any questions that you may have after the enrollment.
So that's something I've heard from some of the of the members that could be useful for you to enroll online is still make an appointment in person to to ask them questions if you have any. Next [slide], please. Now where you looking now? Now is the general enrollment period. So for those folks that didn't enroll when they were first eligible, meaning those folks that decided to retire at age 65 but they did not enroll in Medicare, they that's what the general enrollment period is for.
One thing that change this year is that that the effective date it would be it would be the first of the following month when you're enrolled. And so, the enrollment period, January 1st to March 31st. So let's say you enroll in January 15th. The effective date would be February 1st. Before, just so you guys know, of course, we have [had] to wait until July 1st for that effective date. But CMS decided to make the change of being effective the first of the following month, but you definitely don't want to be in the general enrollment period. You want to enroll when you're first eligible, when you're, deciding to retire, that's when you want to enroll to avoid those late enrollment penalties for Medicare Part B.
Now there is also the special enrollment period that that works for those folks that decided to work after age 65, and then a year goes by and then decide to retire. That's that's the special enrollment period. That is triggered by one of those special events, similar to what some of you are used to under your active plan. You know, those change of status that would allow you to make changes and mid-year. Next [slide], please. Thank you, Shawna. Now let's talk about Part D. Part D, as I mentioned before, cover your prescription drugs.
So there are different ways that you can get or enroll in Medicare Part D, different from Part A and B, Part D, you actually rule directly with the with the provider, with the insurance provider. And it's a standalone plan, but there are standalone plans that you can that you can get. However, it's important to note that when you enroll in Medicare in senior advantage with Kaiser Permanente, you Part D is included.
Something that happens sometimes, I don't want to say often, but it does happen sometimes is that, as you know, as we get older, people that our aging folks get bombarded with information. They might enroll in a stand-alone Part D, thinking that they are doing the right thing by saving money or maybe taking advantage of some sort of promotion.
What that does is sends a message to CMS saying that you don't want to be part of the Kaiser Permanente senior vantage point, that you want to be part of a standalone plan. So for those folks that are enrolling into the group Senior Advantage Plan through Kaiser Permanente, you don't have to enroll in a standalone plan for Part D. Part D would be part of using your advantage plan. Next [slide], please.
Now, for those of you that were asking yourself if Part D has a cost. It does have a cost; it does have a it does have a cost, depending on your income. If your income is $97,000 or less, you don't have an additional premium. It is referred to as an income-related monthly adjustment amount. So if your income is $97,000 or less as an individual, you wouldn't have an adjustment, an, a monthly adjustment amount to your Part D.
However, [if] your income is beyond that. There will be a monthly cost to add you Part D to your Medicare. Next [slide], please. So there are different options that you can get coverage for Medicare. So once you get your original Medicare, meaning your Part A and Part B through Social Security as well as your Part D, you have the option to enroll, and you're probably going to get some information about these through the mail, enroll in MediGap plans.
Kaiser Permanente Senior Advantage Plan. It's not a MediGap plan. MediGap plan is for those that choose to have only original Medicare to help them cover the out-of-pocket costs. Because when you have only original Medicare, there are deductibles and percentages associated with with the care that you that you receive. You can also get a Senior Advantage plan or Medicare Advantage plan known as Medicare Part C, which is where you get to through Kaiser Permanente.
So those are the two main ways that someone can get coverage through Medicare. And next [slide], please. So what does Medicare Advantage plans cover? So Medicare Advantage plans cover parts A, B, and C all together. So when you enroll in a Medicare Advantage plan, all those plans will be together in under one plan in a bundle, if you will, and all those services will be will be rendered through a network of providers.
So, in this case, when you choose to enroll in Kaiser Permanente Senior Advantage plan, you will get your services at Kaiser Permanente facilities through Kaiser Permanente doctors, much like you are used to now, for those are Kaiser Permanente members. Now with the exception of emergencies and urgent care. So if you have an emergency and urgent care and Kaiser is not you closest this option, you are able to go anywhere.
And what does Medicare Advantage cost? Just like like private plans or like, commercial plans, or active plans. If you will. They have those co-payments associated with it that we're going to also review as we as we move forward in the presentation. Next [slide], please. And they're different. Just for your knowledge, there are different types of Medicare Advantage plans. There is the Health Maintenance Organization plans, referred to as an HMO plan.
They're a point of service, also referred [to] as POS, which is kind of like a hybrid between an HMO and a PPO plan. There is also PPO plans as well as private fee-for-service plans, and medical savings account plans. The last two are not very common. The others you see them; definitely the most common are the Health Maintenance Organization plan, especially here in California, which is what the Kaiser Permanente plan is.
We also are staying true to our mission when made aware of different plans to help pay for premiums. And this, in this case, is specifically for Medicare Part D. So some of you may qualify for, or someone that you might know might qualify for Part D Premium Subsidy. This is done through Social Security. It will look at your income, and it will assess that, and then decide if you qualify for that subsidy.
It's something that is available for everybody that qualifies. Yes, there is a process, but it's definitely. If you think you qualify, it's definitely worth reaching out to Social Security, go through the process, and then they will let you know if you do qualify or not. Next [slide], please. See, there is a little delay, but we'll get there.
No worries. All right. So what you're looking at now, it's it's all this language I talk more about Kaiser Permanente. But very briefly, though, CMS has different ratings of the plans that are available to you as a member in all the different regions of the United States. So I'm I'm very proud to say that in California, as well as in other regions, we continue to maintain a five-star rating in California.
This is the tenth year in a row that we're able to maintain this high-quality rating. And this just shows our commitment to you, our members, by providing you the best quality services service that we can. And it's also a commitment to to continue to improve on what we are. We've been working on understanding our current challenges and challenges to come.
And if you want to know more about it, you can go to the website that you see on the screen, kp.org/medicarestars. Now what you're looking at now it's a Kaiser Permanente Medicare Helpline overview. Our support [unintelligible] Kaiser Permanente members. It is very little that you'll, you're going to notice a difference, and you do get a new card.
However, your medical record remains the same, but you get access to all your services through Kaiser Permanente, with the exception of emergencies and urgent care, in which you can access all the providers when you are traveling or when Kaiser Permanente is not the nearest optional option for you. And next [slide], please. Thank you. So Menow, what you looking at now is the different numbers and resources that you have as you go through this process.
We have our member services that is available seven days a week from 8 a.m. to 8 p.m.. You can call the 1-800-number to get to get guidance and information about it about what I just shared. You also can call Social Security or Medicare for questions maybe about premium for Part B premium Part D, maybe the low income subsidy if you qualify for the low income subsidy.
Also, information about enrollment periods also may be information about if Part A would be at no cost for you're doubting that. So all those things you can call Social Security and Medicare for for other questions you have you have SISC and you have Kaiser Permanente that we can we can assist and guide you through this process. Next [slide], please Now with that, we I want to conclude this presentation, the Kaiser Permanente section, and see if there are any, any questions.
I, I saw you coming through the, through the chat. Let's see here, are we doing questions at the end or apologies.
Kaiser Permanente Presentation Questions
We're doing the questions at the end of each segment. So if there are particular Medicare questions, that's what there's a good time to ask. You could unmute yourself and ask the question or put them in the chat. There is one in the chat that says,
"I worked for 42 years. I worked a good part time job, so it pays a little bit into Social Security. I'm trying to understand what I'm entitled to because of this. Are there benefits I'm not entitled to?"
And thank you for your question. In order to get the best information about what you qualify for and are entitled to is by calling Social Security. However, I can tell you that as we, when we work for an employer and we are what is referred to as a W-2, meaning that you get that slip at the end of the year and it shows you all your different deductions, some of those deductions that you see on that W-2, that paycheck slip, some of those some of those deductions will read Social Security and Medicare tax.
And as long as you have paid those for 40 quarters or have worked for at least 40 quarters, doesn't have to be consecutively, then you qualify for for Medicare Part A, at no cost. And then Part B, it is it depends on your income. And they look at two years prior to your retirement date to let you know what that monthly cost for Part B would be.
But if you are not sure if that was your case in terms of paying into Medicare and Social Security, it's best to contact Social Security as they would be able to look into into your record and see what you are entitled to or not.
There's a few more [questions] here also, it's one we get. It's,
"I have the RESIG teacher's retirement. Is there anything I need to do regarding moving on from that program or does my coverage end once I sign up for Medicare?"
and I can answer that and the answer is no, it's your choice whether you want to continue on with the Medicare programs under the RESIG/SISC umbrella or if you want to move on as an individual coverage, either through the Kaiser Individual or through another Medicare supplemental plan.
But you can definitely, anybody, whether it's classified or certificated, employees, once you sign up for Medicare, you can definitely continue your coverage under the SISC/RESIG umbrella. It's just a different, you have to sign up either under the group KPSA form Kaiser Permanente Senior Advantage group coverage or there are two Blue Shield plans and one that Blue Cross plan that you can sign up for. And it really depends on what what program you're in.
Another one, somebody says they have a hard time hearing the video, the conversation you might need to turn up the volume on your screen to hear. I don't think we can turn up our volume unless we talk louder. I think here is one [another question],
"If you begin to work again after retirement and after enrollment in Medicare and receive paid Medicaid medical benefits from your employer, can you defer Part B?"
So this sounds like they've accepted Part B and now they want to defer Part B, Can they do that after they've enrolled into it once.
Correct? Yes. So if you decide to retire, you're enrolled in Medicare, but then you go back to work and now they're offering you benefits. You can call Social Security to put a halt or a stop on your Medicare Part B. Probably a piece of advice. It is a personal decision, of course, but you want to look at what would be most beneficial for you in terms of of of benefit, benefit wise.
But to answer your question, yes, you can you can contact Social Security and let them know so they can put a hold per say on your Medicare Part B.
There's a question that says, I was told that once you retire, you no longer pay into Social Security. So it says. S.S. So I'm guessing that is Social Security and Social Security and Medicare are two different things that you pay in to when you're working or when you're not working when you retire. It depends on your pension check.
I don't believe you paying for Social Security, but I am not a Social Security employee, so I don't I don't know that answer.
Yeah, Unfortunately, it would be best to contact Social Security to to to get that answer on if it would be any deductions beyond retirement, Right.
That is about it that I'm seeing in the chat section. Shawna, do you see anything else?
I'm not seeing anything else. I think we can move on to the, SISC/RESIG portion about the plans and guidelines to follow. And then after that portion, we'll have another chance for everyone to ask any questions you guys might have.
Thank you, everyone. Thank you, Shawna.
Thank you so much, Diego, for that. Great information about Medicare. Very helpful. And I appreciate you being on this call with us.
RESIG/SISC Plans & Guidelines Presentation
So as Patty's stated, I am the SISC Account Manager here for RESIG at SISC, and I'm going to go over the different Medicare plan options that are available, as well as a little general overview on some guidelines. So before I get into too much information, I want to answer a question that most people have. And it is what happens to my dependents if they're under the age of 65, but I'm turning 65? So, they can stay enrolled in the under 65 plan.
As long as you, the retiree, continue to be enrolled with SISC. If you decide to term, then your dependents have to term as well. I want to point out that retiring and turning 65 are considered qualifying events that will allow both you and your dependent to change plans. But with that being said, something to keep in mind All subscribers and dependents must be enrolled on the same health carrier plan.
An example of that on the screen is a member, a retiree decides to enroll on Kaiser Permanente Senior Advantage, or is known as KPSA. Their family member. Their dependent must remain with Kaiser on the under 65 plan. So I think that comes up quite often. So I just wanted to touch on that right away, in case that's a question that is on your mind right now.
All right. So now let's look at the Medicare plans that are available to you, [unintelligible] offered to you, you have the Medicare Advantage plans, which is the Kaiser Senior Advantage. You're going to see. There's two of them. It's a $10 KPSA up plan or a $25. I also listed the premium amount for those plans on here.
You have a Medicare Supplement plan, which is companion care, and that's administered by Anthem Blue Cross, and the premium is below. And then you have a Medicare Coordination of Benefits plan, which is your Blue Shield 100-A EGWP plan. There are two of them. And we'll go in some details about what are the differences on those. And. Any enrollment forms and supporting documents to enroll into these plans,
as stated, we will need a 45 days in advance of the effective date. And the reason for that is it takes a while to process the enrollment forms once we receive them and get them in our system and send them, they have to go through CMS. And so that gives enough time to get the enrollment process in time to be effective on the effective date. On here, I want to make a note.
If you fail to maintain Medicare A and B, this may result into disenrollment and or a nonrefundable Medicare surcharge. This year it is a $625 per part per month, which can be up to $1,250 per month for each. So each part is $625 with if you're missing A and B it would be $1,250 per month. One other thing and a asterisks below I want to bring to your attention is that not all of these plans are available in all areas.
And if you have questions about that, you can contact your Benefit Specialist. That was the information on the first slide, which I will show again in a little while so you can reach out to them and talk to them about that. Okay. So now let's go into a little more information about those plans that I was just talking about.
As I said before, there are two Kaiser Permanente plan, a Senior Advantage plans available to you. You're going to see them listed next to them so you can see what the differences are. KPSA is a Medicare Advantage plan with Part D prescription drug coverage provided by Kaiser Permanente. For this plan, you must reside in the Kaiser Permanente Plan Service area. Members on these plans assign their Medicare to Kaiser Permanente and are unable to use their Medicare coverage with non Kaiser Permanente providers, except, as Diego noted in the case of emergency or urgent care, members do have access to emergency and urgent care worldwide while traveling.
The difference in the $10 plan and the $25 plan I have highlighted on the screen in red to bring those to your attention. First thing to be clear, there is no difference in what services and prescription drugs that are covered on the plan. The plans are exactly the same. The difference is pertaining to the cost share for certain services and prescriptions.
There is a $10 or $25 copay for office visits or outpatient procedures depending on the plan that you choose. On either plan, you've got a $1,500 annual out-of-pocket maximum. Emergency services are $50 co-pay on the $10 plan and a 25 on the $25 plan. You'll see that it is $50 as well. If you are, I'm sorry, $500 for the hospital.
If you do get admitted to the hospital, I would do want you to know that that amount is waived at that time. Also, there is a hearing aid benefit on here, a $500 allowance every 36 months that will be provided to you. And they also have a gym membership or discount program offered to you as well.
All right. We're going to now talk about the Companion Care. Companion Care is a Medicare Supplement plan, commonly known as a MediGap plan. That is what you might hear when this is talked about. This is administered by Anthem Blue Cross. You can reside anywhere in the United States while being enrolled on this plan. When you enroll onto a Medicare Supplement plan, you maintain your original Medicare.
What that means is you can self-refer to any provider that accepts Medicare assignment. Your cost share is zero. When the Medicare services are both approved by Medicare and the provider accepts Medicare assignment. You can determine if a provider accepts Medicare assignment by going to medicare.gov and selecting find care. Also, if you already have a doctor that you're seeing, you can just ask them if they accept Medicare assignment to see if they would accept you when you moved on to the Companion Care plan.
If a medical service is not covered by Medicare, then it will not be covered by this plan. You can reference this the section called what is not covered by Medicare A and B in the Medicare and You Guidebook. If you have that or you can look that up online and look in that section. This plan picks up the difference of the 20%.
that Medicare Part A and B did not cover. As you can see, this results in very few out of pocket cost to you. Like a $0 office visit, $0 cost share for emergency services. There is no annual out-of-pocket maximum on the supplement plan. Also on this plan, you do have a gym membership available to you through silver and fit at no charge to you as well.
Prescriptions for the Companion Care plan are through Navitas Health Solutions. For generic medications that would be $18 for up to a 90 day supply and for brand that would be 90 for a 90 day supply. Okay.
Can you go back? I think now two slides. I think it was the Kaiser Permanente. There is a question right there. Now. There's two color shades of what we view. They're all meant to be the same, correct?
The same yes, they should all be the same. And it is due to the different colors on the lines. I'm sorry.
Yeah, they're all there. Even though it may look orange to us. That really should be red. The red and the orange are the differences between the plans.
That is correct. Thank you. Any other question on this slide?
Not on the slide, but they're asking about the premiums regarding the plans. And I know it was on, I think, the first slide. Can we just review that one more time before we move on?
Definitely. Definitely. So this screen right here has your, I only put the premium for the single plan, for the plan, if it was just a retiree on the plan. And I'm sorry, I can't see the question that we have right now.
They were just asking about the cost of like the Companion Care and the Kaiser Permanente plan. So they're just right here and we can go over it again at the end also.
Yes, definitely Okay. So on this slide, it goes over a little bit of Silver & Fit. That is the exercise program that is available if you're on the Companion Care or KPSA, Kaiser Permanente Senior Advantage plan. There are over 14,000 locations and gyms that you can use. There's also a home fitness program as well as a healthy aging resource library with tons of information available to you.
So this is the program that's available for that. All right. So now we're going to talk about the Blue Shield 100-A $0 co-pay EGWP plan that is available. So this plan is a Coordination of Benefits with a Medicare Part D benefit attached to it, and it's administered by Navitas Health Solutions. The only difference in the Blue Shield plans we will I'll show a little more into it are the prescriptions, and we'll go in detail on the next slide.
With this plan, the member keeps their Medicare assignment, as I stated before on the other, and you can self-refer to any provider that accepts Medicare assignment and as long as they accept that you can use the plan, your share of cost is going to be $0. There is $1,000 individual yearly out-of-pocket max and a $3,000 for family per calendar year.
However, there is no deductible on the 100-A plan. Many services are at $0, with an exception you'll see below. Emergency services are $100 per visit, as well as ambulance services at $100 per transport. There are, there is a hearing aid benefit on here of $700, up to $700 for a hearing aids every 24 months. There is also a gym membership that is on here that will be a $25 a month.
And there is just a, you know, a $25 enrollment fee attached to that as well. Um, okay, let's see. This next slide is going to go over the two different prescriptions for the plan. As I said, this is a Coordination of Benefit plan with Medicare Part D prescription drug coverage. There is no coverage gap or a donut hole.
You probably have heard about the donut hole. All SISC Medicare plans do not have a coverage gap or a donut hole in them. And members can receive on this plan a $0 generic copay. I want to let you know and I should have said stated earlier on the Companion Care, there is not a $0 copay and you're not able to use Costco for $0 generics.
But on this plan you are able to it already has a $0 generics at any pharmacy that you go to. And the differences you're going to see the out-of-pocket max on the 0-25 EGWP for individual is $1,500. Whereas, on the 0-35, it's going to be $2,500 and family will be $2,500 and the next will be $3,500. Both of them give you $0 for the generic for a brand medication and specialty co-pays you're going to get.
It will be a $75 co-pay for the 0-25 and $105 for the 0-35. And the next one of it is for the mail order, it's $60 and then it would be $90. So the first ones are for the retail pharmacies. If you were to go in and get it and if you decide you want to do mail order, that would be the lower cost.
All right. This page right here is a brief overview of all of the plans that I just went over to you. I think it's a great snapshot of exactly what is covered and these are some questions right away for you. So on the top, it's going to tell you what are the plans called and then the providers who provides them.
So for the a Kaiser Permanente Senior Advantage, it's pretty easy because the name is in it, but with Companion Care is administered through Anthem and EGWP PPO is through Blue Shield. As I said, all of these plans are not available in all areas. So here lets you know if there is limitations to where you can live. And so the Kaiser plan does [limit locations], Companion Care
you do need to live in the U.S. where the PPO plan is open and there's no restrictions. All plans do not have a deductible on them. Any emergency services that let you know for Kaiser that there is Medicare A and B, all plans through SISC Medicare are going to require continuous enrollment in Medicare A and B or again, that will can terminate you from your plan or have you moved to a higher premium as well as get those surcharges.
And remember that $625 Per-Part Per-Month that would be put on top of your premium. So all Medicare, I was stating some of them, you actually assign it to the plan, as were the other ones you're actually using in your Medicare as your primary and you do not assigned to the plan. And the next one kind of goes with that.
If you retain your original Medicare, the next is travel coverage, it's letting you know outside of it [your coverage area] you have emergency and urgent care for Kaiser, emergency care for Companion Care, and same for Blue Shield you have emergency and urgent. Who administers the prescriptions? You'll see Kaiser provides for Kaiser, [while Anthem & Blue Shield go] through Navitas Health Solutions, which is the same with the active plans you currently are on.
If there are $0 generics, that would be your Blue Shield EGWP plans. And the very bottom one is going to show your gym memberships. The top two first two are â€œSilver & Fitâ€ as â€œFitness Your Wayâ€ is through Blue Shield. Okay, so a few things to keep in mind when you're making this decision on where what you want to do once you retire.
So when you're in or enrolling into one of these plans, these are things you should keep in mind. As I've already stated, I've said it over and over again, and I'm sorry to repeat it, but retired members must enroll in Medicare Parts A and B on the first day of eligibility. And that first day of eligibility, I'm going to go over in a few slides and go over a little more information about that.
But that's usually when you're turning 65. If you're already retired, if you're not retired, it's going to be when you retire, if you're already over the age 65. And here it states members working past age 65 must enroll Medicare Parts A and B for an effective date the first of the month following their retirement, retired Medicare eligible members must maintain continuous enrollment or, as I stated, a termination might happen or those surcharges be applied.
Those over 65 and retired are responsible for paying the Medicare Part B premium and any IRMAA if it's assessed and then your premium is separate. I get the question quite often is if I'm on this plan, do I still have to pay for part B? And the answer is yes, you have to pay part B and then through.
If you decide to stay on the plan, then you're going to be paying your premium through RESIG for the plan that you're enrolling on. Per CMS Rules members may only be enrolled in [one] Medicare Part D Prescription drug plan. One Medicare Part D plan, and if you enroll on another one, it will terminate the plan that you're currently on.
I know there's a lot of fliers and information that goes out that it is intriguing to enroll, but if you decide to be on one of these plans, if you enroll on another part D, since our plans already have you enrolled on Medicare Part D, it will terminate you and it becomes a hassle to try to get it fixed.
If you decided no, I didn't really want to term with the district. So, it becomes a lot of work on your side because unfortunately it's not something that we can do for you, contacting Social Security to get that corrected. So if you decide to enroll in a plan be very hesitant and please ask questions before enrolling onto anything else.
Okay, So how to enroll? Members may enroll in a RESIG/SISC Medicare plan if they are retired and have Medicare or they become newly Medicare eligible. You can make any changes to your plan to open enrollment. Those changes must be submitted to RESIG by August 15th. And again, that is because we need that advanced notice to make changes to these retiree plans.
It takes a while. One thing I want to point out, if your birthday is on the first of the month, you will really want to start four months in advance to start for Medicare because there is a possibility your Medicare is going to start the month prior to you turning 65 due to your birthday being on the first [of the month]. Contact your RESIG Benefit Specialist for the appropriate enrollment forms.
Depending on the plan, as she [Patty] stated that you would like to enroll on. We'll always need a copy of your Medicare card showing that you have A and B If you do not have A and B you're unable to enroll onto to one of these plans. Now, if you have Part A and you've already done the paperwork for part B, but you haven't received your card yet, we cannot enroll you until you at least have documentation showing that Part B is going to be effective and what day it's going to be effective.
I always recommend to people to go online and enroll on the Medicare website because sometimes you're able to do a screenshot of showing A and B as effective before you actually receive the card. So again, advance notice for these documents is very, very vital. Okay, As I stated, I'm going to go over a little information on guidelines on what to do depending on your scenario.
So on the top blue lines, you're going to see different scenarios. And then below that is going to tell you what you need to do with Social Security, and the bottom one of it is actually going to tell you what needs to happen with you and RESIG or SISC. So I'm turning 65 and you'll continue to work. So as Diego stated, you do not have to call a Social Security, but it's highly recommended that you call Social Security to defer your Medicare Part B enrollment until you're going to retire three months prior to retirement.
Then you will contact them back to enroll. And then what is going to happen after that? You're just going to continue on your active benefits and there's nothing else to do. Now, if you're over 65 and you're still working, but are you're planning to retire and say it's three months in advance, then you need to call social Security and start the process to get enrolled on your Medicare Part B or A if you have not done that already.
And then you need to. Speaking with RESIG on deciding on the Medicare plan that you are going to enroll in, as well as submit the enrollment forms and they're required documentation for enrollment. The next scenario is you're already retired and now you're turning 65. So three months before that, you 65, unless your birthday's on the first, you are going to call Social Security and start the process to get Medicare Part A and B, And I know Diego made. said some information about it, but there is a little bit of a delay and it's a long process.
So the earlier you get a hold of them, the better. So you'll contact them and start the process and then you're going to do the same thing. You're going to select the plan that you want to enroll on, get the correct enrollment form complete that, and then provide it back to RESIG within, before 45 days with a copy of your Medicare card.
And we will get you enrolled onto the plan. If you're already on a retiree plan and you want to switch plans, you are able to do that as long as you still have Medicare Part A and B and you're going to submit that enrollment by August 15th for an October 1st enrollment date, unless you have another qualifying event that happens throughout the year, then you would want to call and speak with your RESIG [Benefits] Specialist and they will let you know what is needed
so that you can make that change. Okay. Some things to keep in mind when making a plan change. Compare the plans carefully. Understand the Medicare Part D coverage gap or donut hole as most know it as on here. There is a link that you can go to, but excuse me to get some information on that gap. And what does that exactly mean?
So that when you're looking at other you know what to look for the coverage gap donut hole and individual Medicare Part D plans begins once you reach your Medicare D plan's initial coverage limit, which this year is $4,660. As you can see, I have to put the year because it does change. And so you always would have to look each year and ends when you spend a total of $7,400 out of pocket in 2023.
This amount may change each year. Not everyone will enter the coverage gap. And again, SISC plans do not have this coverage gap. But if you're looking outside of [or] at other plans, just please be careful and look for that. Okay? That is everything that I had to talk about in regards to SISC and the plans that are offered. And I think, Angela, you're going to speak on the billing, is that correct?
RESIG/SISC Plans & Guidelines Questions
Before Angela begins her session. Shawna, I have some questions for you from the audience. So let me ask some of those. And I believe Diego has answered partway in the chat feature, but I just want to conversation about it. Yeah, okay. And one question is
"How easy is it to change plans if you move? Like enroll Kaiser because they're here, but no Kaiser where you where you move?"
So the process is pretty easy. As soon as you know you're going to make that change and as soon as you move, we're going to need proof that you have a new address that's outside of the service area that is going to be your qualifying event to move. So we're going to need to show some documentation that shows you with your new address and you need to let us know when that change took place so that we can process it.
I will let you know. You need to let us know as soon as possible, because with these plans it's usually on a go forward basis. So you would just call your RESIG [Benefits] Specialist and they would get that documentation from you and get the new enrollment and that would be submitted over to us.
"What is Fitness Your Way?"
I'm sorry? What was the question?
Fitness your way? It's part, it's the activity program for.
Yes. So that's through your Blue Shield plan. And it is the same thing that you do have access to several different gyms that are available to you. And it just lowers the cost of the monthly premium that you would pay for that gym, which is at $25. And so you would go to their website and you would be able to see what gyms are qualified for that program.
And if currently don't and there's a gym you want to use, they are able to try to sign up for the program so you could still get a $25 monthly premium.
"Can I forgo Part D now and add it at next to year's enrollment period?"
So if you are a retiree already, then you need to get Medicare Part B. Now, if you are still actively working and you're 65, that is okay to not get part B and defer it until you retire and three months before you retire, then you're going to need to get Medicare.
I'm sorry, it was, can I forgo part D as in dog.
Okay, So with our plans, they already are bundled into the Part D and it's not something that you can decide to just not take that portion.
Okay. [Next Question]
"Can you sign up for Medicare earlier than three months time frame? Can you do it four months or five months?"
And Diego might want to answer that.
This is Diego and no. You have three months prior to your birthday month to start that process. Medicare wouldn't allow you to do it prior to that unfortunately.
And we have heard that many times from retirees that have tried to sign up for five or six months ahead of time, and they're essentially turned away at the door because they do they do limit to your set three-month timeframe.
"I just applied for A and B and turned 65, [on] March 6th. So should I not consider RESIG because [of] the 40-day, 45-day penalty?"
I would recommend that you give, if you are wanting to stay with your RESIG plan and you like one of the options that's available to you is to reach out to your [Benefits] Specialist, let them know that you started to enroll, and as soon as you have documentation showing that you have A and B and, you know, as soon as possible that you can get that information, we can look on enrolling you onto the plan.
But if you do not have it in time, I do want you just to be prepared and aware that there's [a] possibility that that surcharge would apply to you for a month until you get your enrollment.
And somebody has asked that, if we can add links in the chat, I'm not quite sure what links you're referring to.
Another question is that,
"Someone is retired, turning 65 in over six months. They have Covered California now, does RESIG or SISC apply to me?"
You have to be on a RESIG group plan to be able to enroll in their Medicare plans.
Shawna, do you have anything to add to that?
Nope, that's perfect.
Okay. Do we have any other questions before Angela takes over? Great questions you guys!
Very good questions.
Shawna, you provided the link on the previous slide. Can you? I'm not sure what which slide, but it is.
Okay, perfect. If you would like to take a picture of this, it will be up for a few more seconds. Then you can take a picture and we can go from this and then we can continue on with the presentation.
And I'm so sorry it's not letting me add it to the chat.
There. Somebody else was able to add it like, Oh, perfect. I could not copy paste. Thank you.
It's not letting me either. I'm so sorry. I'm glad somebody got it. All right, so do you want me to go back now to your slide, Angela All right.
RESIG Employee Benefits Department Presentation
There you go. All right, well, I know time is of the essence, so I'll make it short and sweet for all of you, but just to talk about direct billing. So business continuity ensures operations and core benefit functions are not impacted by a disaster on site and allows for seamless payments to carriers. So, it's the crazy world that we live in, who knows?
But we need prepare. We still need to pay for your health insurance.
[The] following things that I'll be talking about will allow us to be able to do [that]. So, RESIG staff members manage the monthly billing for the districts for medical, dental and vision plans. We also assist with monthly statements. enrollment in the automatic withdrawal for RESIG and the electronic credit card and check payments through RESIG's website. There is a fee for the credit card payments that is assessed and that is a 2.8 percentage [fee] of whatever you are going to charge. Upon enrolling in the automatic withdrawal or the ACH process once enrolled, funds are withdrawn on specific dates and that was given out during the retiree open enrollment booklet.
If you don't have that, certainly let your Benefit Specialist know and we can get you that. There is no charge to set up or to use the automatic withdrawal. There is a charge, however, if there is a return or something, as we used to say, "bounces", there is a $25 per occurrence charge on top of the monthly fee. Retirees receive a draft statement illustrating premium changes every September.
So this would be your open enrollment information if something is changing on your September bill, you will see that you do not have to send a check in, though. We go through every single automatic withdrawal member's information and make those changes automatically. For most districts medical, dental, vision plans will be administered entirely by RESIG Benefits by the Department and communication regarding the benefits and payments will be coming from and must be directed to RESIG or to your Benefits Specialist.
Next slide, please. So this is just information for you of which school district and who the Benefit Specialist is [for each district]. You can certainly take the picture if you want. As Patty had mentioned before, on the other side, or this will also be available and is available online as to who handles your district. So you would call them and ask any questions or send us an email. Next [slide].
So some really, really good resources and contact information for Social Security, Medicare, the "Medicare and You Handbook" and it sounds weird, but it's actually a really interesting book to read.
And Health Insurance Counseling or HiCAP, I can't say enough good about HiCAP. They are super informative and will sit down one on one with you and go over what your needs [are] and what works best for you. It's really a great plan to call them and look at the different items. Next [slide]. So I want to thank you all for attending.
Please feel free to ask any questions. Again, our names [are] Elizabeth, myself [Angela] and Jodi are your Benefits Specialists. Our phone numbers are there. And if you have any Medicare questions, the number is there or for HiCAP as I mentioned. And then if you have questions on a plan that you are currently on for Companion Care, Blue Shield, the EGWP two different plans, or the Kaiser Senior Advantage, those telephone numbers will get you to the proper place to ask your questions.
RESIG Employee Benefits Department Questions
All right. Did you have any other questions in the chat? The only question asked about is,
"Is vision and dental included any Medicare Part?"
So Medicare A and B is what I'm thinking they're asking about. And [Part] A is the hospitalization part and [Part] B is the medical part. So that would a Diego question to answer so Diego but before Diego answers. I want to say though, if your district if you had vision and dental when you're an active member in your district, then you carried on to retirement and your retiree benefits, you could still carry it on into your Medicare.
This is Diego, and just to make sure I understand the question, the question is if the Kaiser Permanente Senior Advantage plans offer vision as well as dental coverage?
It's just asking if vision and dental [are] included in any Medicare parts.
Got it. And the answer it is, is no. So dental is not part of your Medicare Part A, B or D, and then vision is whatever is included in your preventative care, which is your, your eye exams through Kaiser Permanente. But beyond that, there is no, no vision coverage per say. However, I do want to add that.
Let's say you have an eye infection and you need to be treated for that or need an eye surgery, a medical necessary eye surgery. Then you are a covered and [with] your Medicare Part A and B, as well as your Medicare Advantage plan.
Any other questions?
Okay. It doesn't it doesn't look like any more coming in. And I once again, I just want to thank you for joining RESIG and Diego from Kaiser Permanente and Shawna from SISC Self-Insured Schools of California in this Medicare 101 presentation. Remember that you can ask your Benefit Specialist assigned to your district [questions]. You can call them, send them an email and ask questions that way.
So I thank you for attending. And also, if you would like an individual recording of this, just send email to your Benefit Specialist to ask for that. Once we get, we get it and it goes through our I.T. department. Like I said previously, it will also be on our RESIG.org website along with the slide presentation.
So once again, thank you for attending, and thank you, Shawna and Diego.
Thank you for having me.
Thank you. Thank you.