RESIG Medicare 101 Transcript
Patty Baumunk: Please do not share any private health information. You are welcome to take a snapshot of that page. That I was just mentioning the third to last. So, you can see the district and the benefits specialist assigned to that district. So, you have easy access by phone or email to contact them. Today's presenters.
One is Cassidy Clifton. Cassidy is RESIG's Account Manager for Self Insured Schools of California or SISC, the largest public-school pool in the United States. She is a classified employee of the Kern County superintendent of schools and has five years of experience working with Medicare health plans and the public sector.
The other presenter today is Maria Harlan. She is a senior retiree solutions manager, Medicare consultant from Kaiser Permanente. Maria joined Kaiser Permanente in November of 2004 and has been in the health insurance industry for over 20 years. Maria has supported SISC for well over 10 years and has been the go-to person when it comes to understanding the complexity of Medicare. Maria has also helped school districts understand the advantages of offering group retiree benefits and has conducted hundreds of Medicare seminars in her career.
This is today's agenda. What you will learn. You'll learn the basics of Medicare, Medicare health insurance plans administered by SISC, Self Insured Schools of California. Important things to consider: How to Enroll, we'll discuss RESIG's Retiree Direct Billing, and you'll be given additional resources and contact information.
Now I am going to give Maria the control so that she can discuss Medicare with you, Maria.
Maria Harlan: [00:02:14] Thank you, Patty, and welcome everyone to a Medicare 101 virtual presentation. And what we're going to do is talk about the basics of Medicare help you understand the ABCDs of Medicare, understand the enrollment periods, the late enrollment penalty associated with Medicare, the premiums under the Part B, and just help you understand when to enroll into the Medicare program.
So let's get started. When you work for the school district, you have health insurance as an employee, and then the word retirement comes around and you start to think about when should I retire? Should I retire before the age of 65? Some of you may decide to retire at age 65. And then there's some of you that may postpone retirement till after the age of 65.
So there is a milestone in your life, which is as your 65th birthday and understanding what Medicare is all about. So let's start off by defining what Medicare is. Medicare is our federally funded national insurance program that was established back in 1965 under President Lyndon Johnson and Medicare is administered by CMS, known as centers for Medicare and Medicaid Services.
Medicare today includes four parts. There's Part A, which is the hospital insurance, Part B, medical insurance, Part C, which is known as the Medicare Advantage Plan, and Part D, prescription drug coverage. So I'm going to walk you through each of these parts under the Medicare program.
So who can join the Medicare program who's eligible for Medicare? Most of you on the call will probably be eligible under the first check Mark here, which is age 65 or older. So the magic number in terms of eligibility for Medicare is age 65, but then there are people under the age of 65 because of a disability. And after collecting social security disability for two years, they can also be eligible for Medicare.
To the right here. It also indicates that at any age, if someone is diagnosed with end-stage renal disease, also known as kidney failure at any age can be eligible for Medicare and also Amyotrophic Lateral Sclerosis, ALS, also known as the Lou Gehrig Disease. So those are the four eligibilities in terms of Medicare.
So let's talk about the first part of Medicare Part A, when you hear Part A under Medicare, it means hospital insurance. It gives you coverage for in-patient hospital care, skilled nursing care, hospice care, and home health care. Now you're probably wondering, well, is direct cost affiliated with Part A, do I need to pay for Part A? Most of you will not have to pay for Part A as long as you have 40 credits or 40 quarters into the social security system, meaning you paid into Medicare taxes for 10 years, which is equivalent to 40 quarters.
And so the government. Marks that as premium-free Part A, when you start to enroll in Medicare Part A, they look at the, your record and shows that you have enough quarters in the system. There is no premium that you have to pay the federal government for Part A. Now, if you work less than 10 years and you're turning 65 as a retiree and you're enrolling in Part A, and they find that you don't have enough quarters in the system. Medicare does have a formula to determine how much someone would have to pay for Part A right now, anyone below 30 quarters has a premium of $471 per member per month. But again there's other ways to be eligible for this premium-free Part A. Some of you, if you are falling under that, not enough quarters by the time you turned 65, you could qualify based on your spouse's work history.
For example, if you were married and you're married for at least one year and your spouse qualifies for the premium-free Part A. You too can qualify for a premium-free Part A under your spouse's record, or maybe some of you were divorced. As long as you were married for 10 years, you could also qualify for the premium-free Part A under your spouse's record. Those that are widowed, married for at least nine months, and you have to be single, you can also qualify under that umbrella. So it's between you and social security to determine if you are under a premium-free Part A or not. And there's other ways to qualify for that. So you don't have to pay for the Part A.
Then there's part B under Medicare, which is considered medical insurance. So, A, is hospital, B, is medical. Part B helps pay for doctor's visits, other healthcare provider services. Your labs, your radiology, durable medical equipment, such as wheelchairs, dialysis, and some preventive services are also covered. For Part B there is a monthly premium, and it's usually deducted from one's social security check or retirement check, but there's other ways to pay for this Part B premium. So Part A, if you have 40 quarters, it's free, but unfortunately, there is a Part B premium that you have to pay and the way Medicare beneficiaries pay for their Part B, if they are not collecting social security benefits, they can pay online through a secure service that Medicare provides. You can either pay directly from your checking or savings account through your bank's online bill payment service. Some of you may sign up for Medicare Easy-Pay. Where Medicare provides a free service that you automatically deduct get from your savings or checking account.
And then some of you may want to pay by check and so there's a coupon that social security will mail to you every three months. They bill you quarterly for your Part B premium, and you can pay for it that way. When we get through the next few slides, we'll talk about the enrollment periods into the Medicare program.
If you don't enroll timely within that enrollment period, there is a late enrollment penalty and the premium, which I'm about to go through in the next few slides here. Your premium goes up 10% for every 12-month period that a retiree declines to rolling into the Medicare program. For those that are given a late enrollment penalty, it continues through your enrollment, into the Medicare program. It doesn't go away. It's not just a one-time late enrollment penalty. It continues throughout your enrollment, but that late enrollment penalty does not apply or it's not imposed for anyone that are continuing to work past the age of 65, as long as you have group health insurance through your school district, that has more than 20 employees. You can defer enrolling in Part B until you decide to retire. Because if you're actively working and you have group insurance, you can delay enrolling in Medicare until you decide to retire and they give you up to eight months after your employment ends to enroll to avoid that late enrollment penalty.
So now you're all probably wondering what does that part B premium looks like? So every year the government releases what they call a Part B premium table. And this is what the Part B premium table looks like for this year 2021. And for those of you that might retire later on and in the next few years you can Google the Part B premiums like in 2022, 23, or the year 2024.
But let's look at the way the government determines how much you pay for Part B. So basically the IRS feeds social security, your income tax return, and they usually feed the information based with a two-year lag. So the way the government determines how much you paid for your Part B, they look at your 2019 income tax return. If you were enrolling in Medicare Part B this year 2021, they're looking at your 2019 yearly income and they base it on your modified, adjusted, gross income. So if I was enrolling in Medicare this year and my income tax return two years ago, as a single filer, was reported below $88,000 a year then my Part B premium this year is $148 and 50 cents. Now, if you have a spouse and you're both enrolling into the Medicare program and you filed jointly, for example, reporting below $176,000 on your modified, adjusted, gross income, you each have to pay $148 and 50 cents. For this year, 2021. So once you're enrolled in Medicare, around the end of the year, around December of each year, you'll get a letter from social security telling you what your new Part B will be for 2022. Now they're looking at the year 2020 in terms of your income tax return to determine how much you're going to pay for Part B. Not only do you have to look at the new table for 2022. You also want to remember that they're referring back to your two-year look-back on your income. To determined. And I've worked with retirees in the past and they would call me and say, you know why I've been enrolling I've been enrolled in Medicare for many years. And why did my part B premium go up to let's say $386? And I remind them that it's a two-year look back. What did you do two years ago that elevated your income? That social security, all of a sudden [is] billing you at a higher Part B premium. Some of them will say, well, I cashed in my stocks and bonds, I sold my house, and I made a lot of money. And it's between you and social security. If you disagree in terms of what they're billing you for your part B, it's not RESIG, it's not SISC or Kaiser for you to determine why your Part B premium is the way their billing needs between you and social security to determine why your Part B premium is being billed at a certain rate.
Now, for those of you that are filing separately from your spouse, as you can see here, anyone reporting above $88,000 will go straight to $475 and 20 cents. For your Part B premium.
Okay. So Part A is hospital insurance, usually at no cost to you. Part B, there is a Part B premium that you have to pay directly to the federal government. So where do you enroll in Medicare Parts A and B, and when do you enroll? Medicare has several different enrollment periods. There's three, there's an initial enrollment period, there's a general enrollment period, and then there's a special enrollment period. So let's look at the first one, which is the initial enrollment period.
Some of you may have retired before the age of 65 and your spouse or yourself may be collecting social security benefits early. So you'll be automatically enrolled in both Parts A and B starting the first day of the month that you turn 65. That's the ones that are automatically enrolled.
A lot of people have this idea that. I'm turning 65. I'm going to be automatically enrolled in Medicare. It's only for those that are collecting social security benefits before, or right at age 65. But if you don't receive social security benefits, you need to contact social security to enroll in Medicare Parts A and B.
Now, this initial enrollment period starts three, two to three months. Three months before your 65th birthday, your 65th birthday month, and after three months after your 65th birthday. So you're given this seven-month window to enroll in Medicare Parts A and B to avoid that famous 10% late enrollment penalty.
So let's pretend your birthday's in June. So. March April, May, June. March you want to start the process of enrolling in Medicare Parts, A and B by contacting social security. Now because of COVID some social security offices are closed, so you can do it online by going to social security dot gov I've heard some retirees are able to walk up to a social security office and they take enrollments through the door or faxing it to social security, but you want to start the process three months before your 65th birthday.
Now, even though they give you up to three months after your 65th birthday to enroll, you'll learn later on. When Cassidy comes on, that it is required that you have your Medicare Parts A and B by your 65th birthday month as a retiree.
Now, if you decide to enroll in Medicare Parts, A and B during your 65th birthday month, your effective date will be moved forward a couple [of] months. And if you enroll after your 65th birthday, the effective date of your Medicare will be moved two more months forward. So you really want to do it three months before [your] 65th birthday.
Now, let's say you miss that seven-month window. The only time the government is going to allow you to enroll in Medicare again is through their general enrollment period. So if you're not signing up when you were first eligible at age 65, as a retiree, you can sign up between January 1st and March 31st of each year. But it won't be effective until July 1st of that year. We are basically under the general enrollment period under the Medicare program right now because it's February. So we're in that period at this moment for those retirees that have missed their seven-month window to enroll. This is the time that Medicare opens up the enrollment opportunities, but they won't make it effective until July 1st of the year.
On the bottom of the slide, it says special enrollment periods. For those of you that will continually continue to work past the age of 65. And you decide to retire, maybe let's say age 68 or age 70, it's called the qualifying event that Medicare will allow you to enroll under the special enrollment period.
This is triggered by events such as maybe you lost your employment or maybe you're retiring later on after age 65, that Medicare allows you to enroll under the special enrollment period. For those of you that will be retiring past age 65. Social security will ask you to fill out two forms. It's a Part B enrollment form and also an employment verification form that you'll take back to RESIG so that they can acknowledge that you were still working and you had group insurance to avoid that famous late enrollment penalty.
So now we're going to go over Part C once you receive your Medicare card, it's going to be [a] red, white, and blue card. It's going to have an 11 digit Medicare beneficiary indicator number assigned to you. And it'll show you when you enrolled in Part A and when you enrolled in Part B, but then there's another step that you need to take.
How do I want to receive my Medicare benefits now that I've enrolled in Medicare and I'm paying that Part B premium, what are my options? First options to get, you know, your Medicare coverage is what they call original Medicare. And that means that you can take your red, white, and blue card and go anywhere in the United States and seek services through a provider that accepts Medicare patients.
But there are deductibles and co-insurance is under original Medicare that you've paid before Medicare pays. So you can supplement original Medicare by enrolling in what they call Medigap plans. And that's why you're going to become a commodity at age 65. There's going to be so much mail coming to you. There's going to be Medigap, Medicare Supplement plans, Medicare Advantage plans. And that's the other option that you have, you can sign up for what they call a Medicare Advantage plan. And that is known as Part C under the Medicare program. And those Medicare Advantage plans are offered by private insurance companies, such as Kaiser Permanente.
Kaiser Permanente offers Medicare Advantage plans. We do not offer any Medigap plans. And what you'll learn when Cassidy goes through her presentation from SISC is that SISC provides you different Medicare plans that you can enroll in. But I wanted to just point out to you what Part C of Medicare is, which is considered Medicare Advantage plan.
Now, in some other parts of the country, there are what they call Medicare Cost plans, which allows you to seek services under original Medicare and through the private insurance company plan. But it's not available in California. So right now we're, we're just focusing on. The Medicare Advantage and Medigap plans that are available to you.
So again, Part C equals Medicare Advantage. It combines your benefits from Part A and Part B. And in most cases, most Medicare Advantage plans of your choice includes Part D, which is prescription drug coverage. You have to seek services under the network of providers under that Medicare Advantage plan.
And what happens when you lock in your Medicare with a private insurance company, such as Kaiser or Blue Shield, or Blue Cross? Medicare pays that health insurance, a capitation to take care of you because we're now going to take on the risk to make sure we cover your Part A hospital insurance and Part B medical insurance, and some Medicare Advantage plans have additional monthly premiums.
So when you're budgeting retirement health insurance, you got to remember not only Part B. Premium, but how much is it going to cost? If I sign up for this Medicare plan through SISC, or if I go on my own, you have to always remember there's potentially additional monthly premiums associated with the plan of your choice.
And if you're enrolled in the Medicare Advantage plans and you choose to go out of network you'll be financially responsible, responsible for those claims. Except for any emergency or urgent care.
These are just the different types of Medicare Advantage plans that are out there. Again, you're going to become a commodity. They're going to be so much coming to you in the mail. There are HMO plans. There are PPO plans, HMO POS, private fee for service plans, medical savings plans, and you have the right to review those plans that are given to you, but you've always have to remember that you're under RESIG-SISC plans that offer you group insurance plans for Medicare. That Cassidy will be going over with you. So as you plan on retirement, I would encourage you to have, you know, bins for, do not throw mail that comes from Medicare, from social security, from RESIG, from SISC for those of you that are Kaiser members from Kaiser that do not throw away mail and then you're going to have a lot more other mail[ers] coming to you that you want to have a separate bin for those.
The last part of Medicare is Part D. So if you can imagine Medicare was signed into law in 1965, and only in 2006, did they add Part D under the Medicare program? So when you hear Part D it means prescription drug coverage covers outpatient prescription drugs.
So now you're thinking, well, how do I enroll in Part D. Well, you have a couple options again. When Cassidy goes over the Medicare plans under SISC with you today, most of those include Part D coverage. It all includes prescription drug coverage. You don't need to enroll in a Part D plan outside SISC, for those of you that want to stay under the SISC umbrella.
But if you do enroll in a Medicare Advantage plan, that usually includes prescription drug coverage. But if you decide to drop your plan through RESIG through SISC and you're on your own, you want to make sure that if you're on a Medigap plan, you find a standalone prescription drug plan so that you have prescription drug coverage.
Under Medicare, there's another table that you need to be aware of. It's called a Part D income-related monthly adjustment amount, Part D Irma.
This additional premium paid directly to the federal government is only assessed for those Medicare beneficiaries reporting their income above $88,000 as a single and above $176,000 as a couple. Remember that two-year look back. So if they find that you are above $88,000 filing as an individual tax return there is another $12 and 30 cents that you have to pay directly to the federal government up to $77 and 10 cents.
And the question I always get is, "do I have to still pay this Part D Irma premium if I'm already enrolled in a Medicare plan through SISC?" And the answer is yes, this is between you and the federal government. This Part D Irma. But again, most of you should not be billed a Part D Irma premium if [you're] below $88,000 as a single and below $176,000 as a couple.
But just in case you get that famous bill or maybe your social security check will say minus Part B premium as in Bravo. And then there's a Part D as in drug Irma of $12 and 30 cents. It's telling you that you also have to pay that. And same as the Part B as in Bravo premium that we talked about earlier, it's usually deducted from your social security check, or you can pay it directly through the different types of payment options that you have as a Medicare beneficiary.
Now, for those of you that may need help to pay for your prescription drugs. There's what we call the Medicare extra help program, low-income subsidy. You have to have very limited resources and income to qualify for the subsidy under the federal government. And it provides you extra help with your Part D prescription drug premiums or outpatient drug co-pays. So the way you would apply for this subsidy is go through Social Security or your local state or Medicaid office. And you must be enrolled in a Part D plan to be able to qualify for this low-income subsidy. So as you can see, if you make a lot of money, the government's going to bill you an extra Part D Irma premium. If you need help to pay for your prescription drug, they're there to help you by providing you a low-income subsidy.
The last part of Medicare is about the quality rating that's now in place provided by CMS. All Medicare Advantage plans and Part D plans are now being audited every year, based on the quality of care that's given to the Medicare beneficiaries. This is an example of Kaiser Permanente. Again is a Medicare advantage plan. So we're being audited every year and they base it on a five-star rating, five being the highest, and they go through 40 measures of quality care. Like, are you providing the preventive services to your Medicare beneficiaries? The way you're supposed to? How are you managing their chronic illnesses? Are you prescribing the right prescription drugs? How fast are you answering phone calls when they call your company? And they survey our members? So, this is showing you that Kaiser Permanente has a five-star rating. We're going 10 years in a row based in California. And those are the other regions that Kaiser Permanente is available just in case you're you wanted to move to those areas. There are Medicare plans available to you on an individual basis through those other regions. So basically. You have now the right to ask questions about the Medicare advantage plan of your choice. For example, before you signed the dotted line, you want to know the ratings, you have the right to ask what their Medicare star ratings,
Some important numbers for those of you that are Kaiser members. You know that there is that. (800) 443-0815 number that's open seven days a week, 8:00 AM to 8:00 PM. Social Security Number. You might want to put on your refrigerator or the Medicare number, just to have access to those that, so that you have these resources.
So with that, why don't I turn it over to our panelists to read me some of the questions that people might have.
Elizabeth Matheny: Hi, Maria, it looks like we only had two questions come up in. I feel like those were addressed in your presentation. The first one was how much is the premium and the second is timing for signing up.
Maria Harlan: Okay. And we did cover that. So any other questions at this time, under the basics of Medicare before I turn it over to Cassidy? And feel free. You can always type in more questions as Cassidy goes through her presentation. So, Cassidy, I'm going to pass it over to you.
Cassady Clifton: Thank you so much for that valuable insight into the world of Medicare Maria, SISC appreciates Kaiser Permanente's partnership in educating our members. My name is Cassady Clifton, and I am your specific account manager.
I work very closely with Patty, Angela, and Elizabeth to support medical insurance. Today I'll be highlighting SISC enrollment guidelines, plan benefits, and some things to keep in mind when considering insurance options outside of SISC, so that you can make an informed decision on your medical options in retirement.
And before we dive into the nitty-gritty, I want to address probably the number one question I get, which is. Can I cover my dependents and the answer is yes, all of our plans allow non-Medicare eligible dependents to continue on with their current under 65 plans? However, all subscribers and their dependents must remain with the same health plan carrier.
For example, if you're on Kaiser Permanente Senior Advantage, then your dependents need to be on a corresponding under age 65, Kaiser Permanente plan. Same thing. If you're on your Blue Shield with EGWP PPO plan, then your dependents also need to be on that Blue Shield plan. Fortunately, retirement ease or aging into Medicare is a qualifying event, which will allow you and your dependents to change plans if needed.
SISC offers several different Medicare plans for retirees through RESIG, including to Kaiser Permanente, Medicare advantage plans, a Medicare supplement plan through Anthem Blue Cross, and to Medicare coordination of benefit plans administered through Blue Shield of California. All of these plans require continuous enrollment in Medicare Parts, A and B, and failure to maintain Medicare coverage may result in termination from your plan and or a non-refundable $550 monthly surcharge per missing part up to a total of $1,100 per month. Also, please keep in mind that not all plans are available in all areas. This specifically applies to that Kaiser Permanente senior advantage plan, where you must reside in their service area. Please contact RESIG directly with any questions on plan availability and costs. The costs in the plans shown on the slide are currently effective through September 30th of this year  and are subject to change effective October 1st.
Now let's dive into the plan options. Our first plan up is Kaiser Permanente Senior Advantage. It's a Medicare Advantage plan with Medicare Part D prescription drug coverage provided through Kaiser Permanente. So to confirm, you've got your medical and your prescription drug coverage through Kaiser Permanente.
To enroll in Kaiser Permanente, senior advantage. You must maintain continuous enrollment in Medicare Parts, A and B and reside in the plan service areas within the state of California. I know Kaiser is in Oregon and some of these other really great States, but unfortunately you're not able to enroll in Kaiser Permanente if you're outside of California. Members covered on this plan are unable to use their Medicare coverage with non-Kaiser Permanente providers. You are assigning your Medicare to Kaiser Permanente. You do have coverage for emergency and urgent care coverage worldwide, and there's either a $10 or $25 office visit copay and members receive either $10 generics and 20 or $25 brand name on specialty prescription drug coverage on these plans, depending on which plan you enroll on. And there is no coverage gap also known as the donut hole on either of these prescription drug plans. You still have access to mail order pharmacy through Kaiser, which is a great feature and you save one copay when you do so, and you get a 100 day supply. And as with all of our SISC retiree Medicare plans, if you are over 65 and without Medicare, you will remain on your previous Kaiser Permanente plan with a non-refundable monthly Medicare surcharge rate, each part of Medicare you're missing and for every month you're missing it.
So it's very important that you enroll when you're first eligible and instructed to do so.
And here's a brief rundown of the plan benefits available to those on the Kaiser Permanente Senior Advantage plans. Both plans have a $1,500 annual out-of-pocket maximum that out-of-pocket maximum is the most you'll pay for medical care in a calendar year. As a reminder, out-of-pocket maximums on all SISC plans, exclude drug costs and monthly plan, and Medicare premiums.
So if you have an annual out-of-pocket maximum, the most you'll pay for medical care, that year is that annual out-of-pocket maximum, plus your monthly premiums and Medicare Part B charges, and Irma. If you have that and any prescription drug costs that, that there is out-of-pocket maximums there to protect you.
Neither plan have a deductible and office visits and outpatient procedures are only $10 or $25, depending on your plan. Emergency services are a $50 copay, which will be waived if you're then admitted to the hospital. Ambulance and air evacuation services are also $50 on the $10 plan or $150. Okay. On the $25 plan per trip.
Those on the $25 plan, we'll also have a $500 charge for a hospital stay. Those on the $10 plans don't have that $500 charge. All members receive a 100 day supply for generic and brand medication through the mail order pharmacy each at $10 and 20 or $25 respectively. And as a reminder, there's no drug gap or donut hole on either plan.
Members also receive a $150 eyewear allowance every 24 months for use at Kaiser Permanente and a $500 allowance per-ear, every 36 months, the silver and fit exercise and healthy aging program is also included at no additional cost. And I do see a question here on the difference between the $10 and $25 plans.
Again, the biggest difference between the two plans is your office visits and services are either $10 on the $10 plan or $25 on the $25 plan. There's a $500 charge on the $25 for the hospital stay, there is $150 on the $25 plan for an emergency or air evac, as opposed to the $50 on the $10 plan. And then the differences in the drug copays for those brand and specialty names.
It's $20 on the $10 plan and $25 on the $25 plan.
Our next plan up is our Companion Care plan, which is a Medicare Supplement through Anthem Blue Cross. Again, this is Anthem Blue Cross, not the Blue Shield that you currently have. So there is a difference, but the networks should be very similar. It's administered through Anthem Blue Cross and Medicare Part D prescription drug plan coverage is provided through Navitas health solutions.
That's the same. If you're on the PPO plan, that's the same drug prescription drug provider you have currently this plans just like Kaiser Permanente Senior Advantage requires continuous enrollment in Medicare Parts A and B. Unlike Kaiser Permanente, senior advantage, you can reside anywhere within the United States.
When enrolling into a Medicare Supplement sometimes called a Medigap plan, you maintain your original Medicare. This means you can self-refer to any us provider that accepts Medicare assignment. Your cost-share is zero. When the medical service is both approved by Medicare and the provider accepts Medicare assignment, and it's part of our plan's network. You can determine if a provider accepts Medicare assignment by visiting medicare.gov and selecting "find care", and then validating that within the Anthem website to confirm it's in your network. Alternatively, if you already have a physician, ask them if they accept Medicare assignment.
However, if the medical service is not covered by Medicare, then it will not be covered by the plan, excluding some very limited travel coverage. So you should definitely reference the section titled what's not covered by Medicare Parts A and part B in the "Medicare and You" guidebook. Prescription copays on this plan are $9 for generics and $35 for brand.
This plan includes [a] Medicare prescription Part D drug plan through Navitus. But one important thing to remember, even though it's through Navitas on this plan, you are ineligible for generic drugs. Again, that you are ineligible for the Costco $0 generic drug program. However, there is no coverage gap or donut hole on this plan.
So, as I mentioned before, Companion Care is a Medicare Supplement plan, by and large, if a service or procedure is not covered by Medicare, then it will not be covered on this plan, but you should refer to the evidence of coverage for more detailed information. This plan essentially picks up the difference of that remaining 20% that Medicare does not cover between Medicare Parts A and B however, As you can see this results in a very few out of pocket cost for you as evidenced by the $0 office visit copays and the lack of cost-share for emergency services. Just like Senior Advantage, there's no deductible on this plan. However, because it is limited to what Medicare covers, just like Medicare Parts A, B, and D, which have no out-of-pocket maximum. There's no, out-of-pocket maximum on this plan. The prescription drug plan itself features that $18 copay for generic drugs and [a] $90 copay for brand name drugs, through mail order services.
And as another final reminder, this plan is ineligible for Costco's $0 generic drug co-pays. However, if you enroll in this plan, you do have access to a larger pharmacy network, which includes Walgreens. So that's a big change from your current Blue Shield plans and just like Kaiser Permanente, senior advantage companion care members also get access to the silver and fit exercise program at no cost.
Speaking of the silver and fit exercise program at no cost members receive access to this gym membership program and can choose from a network of 14,000 plus fitness centers, or they can exercise in the comfort and convenience of their own home by choosing up to two home fitness kits per benefit year.
Each kit may have a DVD, a guide book, and or other products members also receive access to healthy aging classes, four times a year, the silver slate newsletter at the silver and fit connected program, which is a fun and easy way to track your exercise through a wearable fitness device or app and other online tools like a fitness center search, challenges, and classes. So it's a great program and it's included at no cost. I think the Kaiser Permanente senior advantage program might also have some other bells and whistles and Maria can chime in if that's the case.
Maria Harlan: I'm sorry, Cassidy. What was the question?
Cassady Clifton: I believe there was a change that allows those on the Kaiser Permanente plan to have the healthy aging kit and the gym membership. Is that correct?
Maria Harlan: That is correct. It was a change based on the situation with COVID that instead of picking a gym. Versus getting DVDs, mailed to their homes. The retiree can now have both attend a gym, or also have DVDs mailed to their home. So both are now available, starting in 2021.
Cassady Clifton: Which is a great feature again, that applies to Kaiser. If you're getting it through companion care, it's just one or the other. So you'll have to choose. But Kaiser Permanente, senior advantage members can have both for the 2021 plan year.
Thank you, Maria. Moving along. We've got your blue shield, 100 $8,000 and $120 coordination of benefits plans, and they also have Medicare Part D prescription drug coverage provided through Novitas health solutions. If you're enrolled on one of these plans, again, just like all of our other retiree plans.
You must maintain continuous enrollment in Medicare Parts A and B when enrolling into a Medicare coordination of benefits plan, you maintain your original Medicare, which means you can self refer to any us provider that accepts Medicare assignment on the 100-A and 100-G plans. Your medical cost share is zero, $20, or the defined co-pay such as ambulance once deductibles and there is a $500 deductible on that 100-G plan are met. And when the medical service is approved by Medicare, the provider accepts Medicare assignment and it's a covered benefit under the PPO plan. If a medical service is not covered by Medicare on the coordination of benefit plan, it may be covered by this PPO plan, a benefit like that is acupuncture. It's not covered under Medicare, but it is covered on this plan. That's the 100-A and 100-G EGWP PPO plans have prescription drug coverage through Navitus copays, vary by plan, but none of the prescription drug plans include a coverage gap. One important thing to remember when enrolled in this plan is that medications such as diabetes supplies are ineligible for Costco's zero co-pay program. But unlike companion care, this plan does allow for $0 generics through Costco and retail and mail-order pharmacy, and also includes access to a larger pharmacy network, which includes Walgreens.
So there's two different prescription drug plan designs for the 100-A $0 and the 100-G $20 plans. And which prescription plan option available to you is dependent upon your plan. Neither of the prescription drug plans include that coverage gap. Both plans have $0 generics through Costco, retail, and mail-order pharmacy.
As a quick reminder, you don't have to be a Costco member to take advantage of $0 generics. Those on the 100-A plan have $25 copays for brand name and specialty drugs. While those on the 100-G plan have a $35 copay is for brand name and specialty drugs. And as you can see, you'll save $15 on brand and specialty drugs when using the mail-order pharmacy.
And here's a brief summary of the major differences between the 100-A ...100-A $0 plan and the 100-G a $20 EGWP PPO plans through Blue Shield. An important distinction between the two plans is that the 100-A plan does not have a deductible while there is a $500 medical deductible on the 100-G plan.
Other than that, the major differences between the two plans out of the office visit copays $0 on the 100-A $0 plan and $20 on the 100-G $20 plan and the differences in the prescription drug plans. With the $25 plans for brand and specialty on the 100-A and the $35 on the 100-G plan. Both EGWP PPO plans also feature access to a gym membership discount program through Tivity health.
So it's not Silver And Fit. It's too Tivity health. Moving along here, we've got a side-by-side view of the major differences between the SISC Medicare plans available to you. As a reminder, Kaiser Permanente is a Medicare Advantage plan. Companion Care is a Medicare Supplement plan and the EGWP PPO plans through Blue Shield are Medicare coordination of benefit plans.
As a reminder with companion care in the EGWP PPO plans your medical providers will be any U S providers that accept Medicare assignment and are in-network. While Kaiser Permanente Senior Advantage must see Kaiser Permanente physicians. Medicare is also assigned to Kaiser Permanente while enrolled on the senior advantage plan and members receive their prescription drug coverage through Kaiser Permanente.
Companion care and the Blue Shield EGWP PPO plan members receive prescription drug coverage through Navitus health solutions. With Kaiser Permanente, senior advantage. You must reside in the plan service area within the state of California and receive non-emergency services at Kaiser Permanente facilities, Companion Care, and EGWP PPO members must reside in the US.
But they're not limited to the state of California or specific plans, service area like Senior Advantage. Unlike Companion Care, Kaiser Permanente Senior Advantage, and the Blue Shield PPO plans cover additional services beyond Medicare, such as acupuncture. And as a big reminder, none of the retiree health plans have a prescription drug coverage gap also known as the donut hole, but [a] vital reminder. Maybe, no promises there.
Cassady Clifton: [00:47:32] All plans require continuous enrollment in Medicare Parts A and B again, if you don't enroll or you lose one part or the other, you may be subject to disenrollment and or higher surcharged premiums. Again, that's $550 per part missing for every month. You're missing it. So make sure you keep your Medicare, you pay your Medicare Part B premium.
You pay any income-related monthly adjustment amounts, and you stay on top of that. Yes. If you leave the state of California and you're on Kaiser Permanente, senior advantage, or any of these other plans, honestly, moving is considered a qualifying event, so you can change plans. And now that we've talked about your plan options, let's talk about one to enroll.
Maria touched upon it earlier, but really if you're retiring and are over the age of 65. You want to get your Medicare set up as soon as possible. Those have continued you continuing to work. Past age 65 will remain on your current active SISC plan. You should contact social security to defer your Medicare Part B enrollment unless instructed otherwise by RESIG those already 65 and older looking to retire should first contact social security to enroll into Medicare Part B for an effective date.
The first of the month in which you retire. Unless RESIG instructs you otherwise. Ensure your Medicare Part A as in Apple is also in effect and then select a SISC retiree health plan and submit a SISC enrollment form to RESIG. If you've already retired and are just now turning 65, you'll want to enroll in Medicare Parts A and B three months prior to your 65th birthday, then you'll select a SISC retiree health plan and submit an enrollment form to RESIG.
As a final reminder.
All enrollment forms must be accompanied with a copy of your Medicare beneficiary identifier card, and must be received by RESIG no later than 60 days prior to your Medicare Part B as in boy effective date and Part A if you're just now turning 65. Those of you who are already enrolled in a SISC retirement health benefit plan can switch plans by submitting an enrollment form by August 27th of this year for an October 1st effective date. That date changes every year and is announced in RESIG's open enrollment booklet, which is sent every year in July. In order to enroll outside of this yearly enrollment period or to switch plans, you'll need a qualifying event such as a change of address.
So as we wrap up here, I just like to summarize some requirements in regards to enrolling in SISC Medicare plans. Regardless of the plan you select, it's vitally important that you enroll into Medicare Parts A and B when you're first eligible. Provided that you're already retired. If you decide to work past age 65, you must enroll in some Medicare Parts A and B for an effective date the first [day of the month] following your retirement. You could be subject to disenrollment from the plan and, or higher surcharge premiums if you failed to maintain that continuous enrollment in Medicare Parts A and B. In addition to the monthly premium for medical and prescription coverage, you must also pay for your Medicare Part B premium.
And depending on your income level, you may also be subject to income-related monthly adjustment amounts. I'd also like to remind you that members can only be enrolled in one Medicare Part D prescription drug plan per CMS regulations. If you attempt to enroll in a second prescription drug plan, you will be disenrolled from both your SISC medical and SISC prescription drug plans.
So be very careful.
And when you're considering other coverage options outside of SISC first and foremost, it's important that you plan ahead so that you maintain continuous coverage. You do not want a coverage gap. You don't want to terminate coverage with SISC until you have a new plan in place. You'll have to notify RESIG or SISC if you're enrolled in direct bill to terminate your coverage and be sure to sign up on time, to avoid Medicare late-enrollment penalties and higher surcharge premiums. You'll want to compare the plans very carefully and ensure you fully understand the prescription drug coverage gap. It's also important to remember that most retirees that leave SISC coverage will not be allowed to rejoin us in the future.
So be careful to make this decision.
Finally, members can enroll in a SISC Medicare retiree health plan if they're already retired and either have Medicare or have become newly Medicare eligible, typically during the month of their 65th birthday. Members can change Medicare plans during their open enrollment period. Again, that's August 27th of this year.
Please contact RESIG for the appropriate enrollment forms and return the forms and a copy of your Medicare beneficiary identifier card at least 60 days prior to your desired SISC Medicare retiree health plan, effective date. Thank you all for your attention. I'm now going to turn this over to Patty, to close out this webinar, and then we'll open it up to questions.
Patty Baumunk: So once again, I'm Patty Baumbach and I am Director of Employee Benefits for RESIG. RESIG has 33 districts in Sonoma County and one in Marin that we supply the health benefits for. How that works is that RESIG purchases the Kaiser and Blue Shield plans from SISC Self-Insured Schools of California, and that is over $4 million a month. For all of the districts that we administer the benefits for the active members, the retiree members, and Cobra members, there is over 1,200 retirees within Sonoma County.
That RESIG administered benefits for whether it's medical, dental, or vision. How we for this 4 million, basically it's a cash in cash out or a charge and transfer in an ACH-in and then we do a wire to SISC but for the past three to four years you know, our County has seen a disruption in life, whether it be fires two, three, four years in a row there's been floods. Currently, there is the pandemic going on that has disrupted our life and how we work our business. For our districts, we do a charge and transfer for the active members and also if your district has a contribution to the retirees' premiums. We also do a charge and transfer to get those funds to pay for your healthcare benefits.
Another way that the RESIG team manages the billing on a monthly basis is with the automatic withdraw ACH through RESIG. Like I said, we have over 1,200 retirees and this morning I was looking at our spreadsheets and we have 893 retirees that do automatic withdrawal for their healthcare benefits. That allows that retiree to not worry about their benefit payments, because RESIG will go in between the 5th and the 10th on a monthly basis and pull those funds, then it gets applied to their count, and then we have the funds to pay SISC on that $4 million a month. We also send out monthly statements to retirees, but that kind of limits the retiree that they need to be around towards the end of the month, every month. Around the 20th, because that's when our statements go out to non-ACH retirees so that they get their statement and then physically write a check to us. So what we try and encourage all our retirees to do is sign up for the ACH process.
It's an automatic withdrawal and ACH stands for Automatic Clearing House. So that the funds are withdrawn between the 5th and the 10th on a monthly basis. There's no charge to set up the ACH process. The retiree that is on the ACH process will receive a draft statement, illustrating the new premium charges every September, because remember our enrollment cycle is October 1 through September 30th.
So rates go up or down, depending on what plan you're in [on] October 1st. All the payment questions and statements and everything, whether it's medical, dental, and vision can go to your benefits specialist, who is in charge of your district. This is the districts here that are under Elizabeth and the districts that are under Angela.
If you want, you know just take a snapshot of this frame right here so you can easily contact either of those benefits specialists. We strongly encourage you for any question to contact them, whether it's premium costs, whether you're going to continue to work past 65, so you can get clear guidelines on how to proceed.
If you are going to be living in two States while you're retired, which is the best plan for you, the best plan for one retiree is not going to be the same plan for another retiree in our retirement lives, which someday I hope to do. It's going to be different from one person to the next.
Here are some additional resources and contact information. I believe Maria had supplied this information pre previously on another slide. There's social security, there's the Medicare and in Sonoma County and Santa Rosa, the social security and Medicare offices on Range Avenue, but as was stated earlier, Due to COVID you may not be able to go in just as a walk-in. You might have to make an appointment, but you can do your Medicare enrollment online. There's also the handbook, "Medicare and You", it's published annually. If you are signed up for Medicare, you can get this mailed to you annually. But what I find is, is easy to do is you can go onto the Medicare website, download that "Medicare and You" handbook, and then you can do a control find and just search for any topic that you might need to know about, like, what is my Medicare Part B premium this year? Then it'll take you through that. There's also HICAP, which is Health Insurance Counseling and Advocacy Program that many retirees have utilized and they can guide you through this process. Also, it's just another resource for you.
Angela Zimmerman: There is a question, Patty on the chat here that is asking, can you explain the advantage of signing up for Part C?
Maria Harlan: I can take that question. It's really up to the Medicare beneficiary to decide what Medicare plan is best for them. You know, the there's. So it all depends on your personal situation. Many of our Kaiser members are very familiar with the integrated model where everything is mostly under one roof and it helps them navigate their prescriptions or lab work. Their doctors visits all in one visit and in some cases but you are covered worldwide for any emergency or urgent care as a Kaiser Permanente member. But It all depends. We cannot advise you that this is the best plan or that's the best plan. As, as Cassidy explained in some of the summary of each of the plans available through SISC, you can look at it with your budget situation.
You know, how much am I paying for my Part B how much would it be if I enrolled in the Kaiser $25 plan versus a $10 plan, and then what are my out-of-pocket copays? Let me look at my prescription drugs. How many prescription drugs am I taking? What is my co-pays every 30 days, every hundred days? And you start to realize budget may be a concern for you.
So the only thing I can say about Kaiser is we are a five-star Medicare plan. So that's the advantage of being affiliated with Kaiser Permanente being rated as a highest Medicare advantage plan. So hopefully that helps.
Cassady Clifton: I've got a question here. What if you live part-time in California and part-time in Arizona.
Well, on the companion care and EGWP PPO plan through Blue Shield, that's not a concern where you may encounter issues with the Kaiser Permanente senior advantage plan. So long as you're in the service area, it's fine. But if you're visiting Arizona and spending time in Arizona, you'll be limited to urgent care and emergency services.
Maria Harlan: If I could add to Cassidy's point, you also have to be careful because if you have two homes, it all depends on the address that you're reporting to Medicare and social security. Let's say you're on a Kaiser plan in California and all of a sudden you update social security and say my new address is in Arizona. Social security is going to pass that onto Medicare. Medicare is going to pass on that Arizona address to Kaiser saying. Hey, this person now lives in Arizona. Can you please verify? Cause now they're out of area. We need to disenroll them from Senior Advantage. Cause you have to be within the service area for Kaiser, for example.
So just be aware about how you update the federal government in terms of your addresses. It may affect on what plan you're at currently enrolled in.
Cassady Clifton: I've got a question here. Can you choose the Companion Care supplement plan? If you have always been a Kaiser Permanente member? Yes, that is true. You can choose to join Companion Care. You can switch between all three of them. Blue Shield, Anthem, and Kaiser so long as you do so with a qualifying event or every year during the open enrollment period.
I have a question here. If I retire. 62, how do I proceed? Stay in the district plan until 65 and then transition into Medicare, but keep my membership in SISC?
Yes, that is correct. That is one of your options. If you retire at 62, you'll remain on your current plan unless you choose to switch it until age 65. Three months prior to your 65th birthday, you're going to go ahead and sign up for Medicare Parts A and B you'll contact RESIG to get the appropriate enrollment form for your plan and any questions you may have. And then you'll go into that plan at age 65.
Elizabeth Matheny: Patty, do you or Cassidy, want to address the question that we have about the relationship or difference between RESIG and SISC?
Patty Baumunk: Sure. I can do that. RESIG purchases the or enlists the plans from SISC Self-Insured Schools of California. They are selected by the districts. Each district can have different plans that they can choose, but RESIG does purchase those plans or healthcare plans from SISC. That is kind of our basic relationship there. Then SISC updates the plans on an annual basis and they relay the information to us then we relay it to the districts. RESIG is your local entity for all things health benefits, dental, and vision. Our benefits specialists Elizabeth and Angela, are your individual contact between the retiree and their health plan so that they can explain it to you on a clear basis. And like I was saying, everybody's retirement plan is going to be different from the next person. Did that help in the explanation?
Angela Zimmerman: There's a question here you're asking, can I be on one plan and my husband be on another or what's the method of him being covered under my plan?
Cassady Clifton: Great question. So the caveats going to be if your husband or you are under 65 and the spouse is older. If that's the case, the person under 65 will remain on the under 65 plan. And the person who's 65 and older would go on to a 65 and older plan. You have to remain with that same provider. So, unfortunately, if you've got an under over situation, companion care is out since you don't have Anthem as your provider, but you could be on an under 65 Blue Shield plan or an under 65 Kaiser plan and then have that Kaiser senior advantage with the Kaiser Permanente under 65 plans or the Blue Shield PPO plan with the under 65 Blue Shield PPO plan.
Patty Baumunk: And if you're both over 65, the dependent follows or actually it doesn't matter if you're over 65 or you're under 65, but the dependent follows the employee, or the retiree. That was the employee at the school district. So if the employee, the retired employee is on Kaiser, then the dependent has to be on Kaiser.
Cassady Clifton: And I noticed it says you're both over 65. So if that's the case, you would both either need to be on companion care, both on Kaiser Permanente, senior advantage, or both on the 100-A $0 or the 100-G $20, and you cannot mix and match.
Elizabeth Matheny: We also have a question about information about Covered California. If you retire before 65. If you do retire before 65, you'll be offered group continuation through Cobra or retirement benefits through the group through RESIG. I don't know if anybody else wants to chime in on that Covered California is a separate entity.
Cassady Clifton: I will add that if you choose to leave and go to Covered California, barring some unusual circumstances, you will not be allowed to rejoin SISC in the future. So if you leave at 62, unfortunately, you'll be continuing your benefits elsewhere and will not be allowed to rejoin RESIG or SISC.
Patty Baumunk: That is the same policy with RESIG, except for some extenuating circumstances.
Cassady Clifton: Do we have any additional questions?
Patty Baumunk: It doesn't look like we do, I just want to thank everybody in attendance during this, Medicare 101 Workshop. I thank you for attending. If you have any questions, please address them to either Angela or Elizabeth. If it needs to go to Maria, we will forward that question to Maria or to Cassidy.
Patty Baumunk: I thank you for attending and I thank our panelists, Cassidy, Maria, Angela Elizabeth, Chloe, for helping out in this presentation.
Patty Baumunk: Thank you very much.