Medicare 101 Presentation 2023

 RESIG Medicare 101 - 2024 Transcript

Elizabeth: [00:00:00] Use the chat if you have any questions, we'll get those addressed through the presentation. We also have posted a list of districts and the benefit specialist to whom they belong. So, if you retire from any of these districts, you'll find your district. Contact up here, so this will be the person you communicate with specifically.

If for any reason, one of us is out of the office, we can always get you some help. So try one of one of the other ones. And with all of that, I think we're good to go to turn it over to Diego to start the Kaiser session. Diego, are you ready?

Diego: Yes, thank you very much.

Hello, everyone. Thank you for joining today.

I'm going to jump in really quick. So you can see my face and introduce myself. So, as mentioned before, I am Diego Realpe, the resources manager for Kaiser Permanente. I want to thank Elisabeth, Shawna, RESIG and SISC to putting this together because as Elisabeth mentioned, It's it could be a very complex and very confusing.

So this, we're very confident that it's going to provide you with good answers, good [00:01:00] information, not only for Kaiser Permanente members, but for anybody that is going through the aging process and qualifying to for Medicare. So it's going to be a very useful presentation. So please make sure that if you have any questions, that's what we're here for, to provide you with the answers that, that you, that you seek.

So without further ado, I'm going to And continue with the presentation. So next, please. So, we're going to start with the basics of Medicare and starting with who can join Medicare and probably the answer that you're more that you're used to. It's people that are 65 years or older, but it's not the only reason 1 can join Medicare.

Also those folks that are 65. That are not 65 years old, but they have been deemed disabled, they can join so they can join Medicare, but they have to be deemed disabled by Social Security, which has a very strict definition of disability, which requires a two year waiting period. Also, those folks that [00:02:00] have been diagnosed with renal stage disease and stage renal kidney disease also refer as ESRD, they qualify for Medicare and also folks that have amyotrophic lateral scleroSISC often refer as ALS or Lou Gehrig's disease.

Also, US citizens or permanent residents that have been living in the United 5 years, they qualify for Medicare. That's probably the majority of you and also what you are most used to hearing. It's those folks that are 65 years or older that qualify for Medicare. Now, moving along. Next, please. And thank you.

It's it's important to define what Medicare is. So Medicare is a federally funded health insurance program that was created and designated to provide our aging and disabled folks a reliable way to cover their health care needs. It was established in 1965 by President Lyndon B. Johnson and actually President Truman was the first recipient of Medicare.

He was the first, was the first [00:03:00] beneficiary of Medicare and the agency that was that was designated to manage Medicare benefits is the Centers for Medicare and Medicaid Services, often referred as CMS. Medicare, as you can see in this slide, is made out of four different parts. And we're gonna go more in detail as we progress into this presentation about each of the different parts of Medicare, but this is a good reference for you to see all the different parts that Medicare is made out of.

Starting with Medicare Part A, which is often referred to as hospital insurance, because it mostly covers inpatient care. Now, Medicare Part B is the part of Medicare that covers outpatient care, and both Medicare Part A and Medicare Part B as in Boy, it's what is referred to as Original Medicare. Also, Medicare has a part that covers outpatient prescription drugs, and that's Medicare Part D as in Dog or Drugs.

And then, Medicare Part C as in Cat, it's referred to as Medicare Advantage. Which is the part of Medicare that often includes services that [00:04:00] are covered under Medicare Part A, as in Apple, B as in Boy, and in a lot of cases and usually benefits that are, that fall under Medicare Part D as in Drug. So now let's start, and next please, let's start talking about more in detail of all the different parts of Medicare, starting with Medicare Part A.

So, as I mentioned before, it's often referred to as hospital insurance because it covers mostly inpatient hospitalizations, but it's not the only thing that Medicare Part A as an Apple covers. It also covers skilled nursing care, hospice care, and home health care. Medicare Part A, it's often referred as an earned benefit, and the reason being is because we earned the right to be covered under Medicare Part A, once we have worked for at least 10 years or 40 quarters, and have contributed towards Social Security and Medicare taxes.

This doesn't have to be consecutively, so if you work for 5 years, take a break, then come back and work for 2 years, and then throughout your working age, you actually accumulate those [00:05:00] 40 quarters or 10 years. Paying into those taxes, then you will qualify to have Medicare Part A as an Apple at no cost.

Now, there might be folks out there that might have less than those 40 quarters, or maybe none of those quarters that they have paying to Medicare taxes. If that's the case, Medicare Medicare has a formula, a prorated formula, that will tell them how much they will be paying for Medicare Part A as an Apple, and the maximum they will pay for Medicare Part A is five hundred and five dollars a month.

Now it's important to know that if someone doesn't have those 40 quarters or 10 years, if they don't qualify for premium free Part A, there are other ways that they could actually qualify for that. One of them, probably the most common one, is qualifying through the spouse. So there is additional requirements for that to happen.

I'll give you a couple examples, probably the main ones. It's if your spouse has to be at least 62 years or older. And your [00:06:00] spouse has to you have to be married to for at least 2 years. So those, those will be the the requirements that, that you have in order to have to be able to qualify through your spouse.

Now, next, please. Now, let's talk about Medicare Part B. This is the part of Medicare that covers outpatient care. So, it's often referred to as medical insurance. So, Part B of Medicare covers those doctor's visits, specialist visits, radiology, dialysis, preventative care, just to give you an idea. A few examples and you might be asking yourself if Medicare Part B has a cost and it does have a cost and it depends on your income and we're going to look more in detail on the next slide.

What those what that table looks like and all the different thresholds depending again on your adjusted gross income as is being referred to. The one thing I do want to focus on this slide is the late enrollment penalty. The LEP as it is abbreviated there in the slide. So the late [00:07:00] enrollment penalty in this.

That's probably where most of the confusions about Medicare lands is the fact that once you are eligible for Medicare, you are required to enroll in Medicare Part B to avoid that late enrollment penalty. That late enrollment penalty is 10 percent for every year you fail to enroll, and it's in perpetuity, so it will stay with your premium for as long as you enroll in Medicare Part B.

But the confusion is about the exception, and the exception is if you decide to continue to work past age 65. So, let's say you reach the age of 65. Now, you are eligible for Medicare, but you are, you decide not to, not to retire. At that point, you don't have to enroll in Part B. You won't be penalized. And and in fact, you don't even have to let Social Security know that that's your intention.

But it is a best practice for you to reach out to Social Security and let them know that you are delaying retirement. Medicare Part B as an Enrollment. That way they will be aware. But you don't have to, it's not a requirement. But once you retire, [00:08:00] they will ask you if you were actually actively working and receiving your benefits through that employer so that way you won't be assessed that penalty.

So again, you don't have to enroll in Medicare Part B as in Boy if you are continuing to work past age 65.

Elizabeth: Are there questions about that? Because we do have that come up and it was a bit of a discussion in the last session.

Guest: So I have a question.

Elizabeth: Sure. Go ahead.

Guest: My question is my spouse who I cover on insurance is turning 65 before I am. Does he need. He's using my insurance still. Does he need to declare that?

Elizabeth: Are you an active member? Are you currently retired?

Guest: I am not retired. I am currently working.

Elizabeth: Okay. We should chat out that situation just to make sure we're capturing all the details with your benefits specialist directly.

Guest: Okay.

Elizabeth: What district are you with?[00:09:00]

Guest: I'm in Old Adobe. I have a message in to Jodi, so I should talk to her about that.

Elizabeth: Yeah. Perfect. All right. Thank you.

So, we do, we did have discussion about this, and we are seeing members retire at an older age. So we are seeing folks stay on and hang out in an active status after 65 and after Medicare eligibility.

In most cases, it is beneficial for members to accept part A of Medicare if it's premium free, like Diego just talked about. And if you are in an active status under group health plan, defer part B, it's not going to work, do much for you. And there's a monthly premium that goes along with it. So you can avoid paying that premium while you're not using it under legitimate circumstances.

When you transition from an active status into a retired status at that time, you would need to make sure that your Medicare eligibility aligns with the termination of your active coverage date. Does that make sense? All right, go ahead, Diego.

Diego: Thank you. So, the one thing that I will mention about that is that if your [00:10:00] spouse is, it's reaching the age of 65 prior to you, and if your spouse had already retired and receiving Social Security benefits, my chances are that your spouse could be enrolled automatically into Medicare.

So something to be mindful about if your spouse doesn't want to be enrolling to Medicare. Right? Thank you. Sure. And next, please. So now we're going to review the table for the cost of Medicare Part B as in Boy. So as I mentioned before, it has to do with your income. So if you earn $103,000 or more a year, or $206,000 or more or less, I'm sorry, a year when reporting or when filing jointly when married, then the premium for Medicare Part B per person will be $174.70. So that, what Social Security does is they, they have a two year look back period, meaning that if you are [00:11:00] retiring in 2024, they're going to look at the income that you reported in 2022. That way they will assess what the monthly premium would be for Medicare Part B. One thing that I do want to mention while talking about this is that as we retire, as we reach that retirement age, we might start making decisions or financial decisions about maybe a retirement account, maybe a property that you might want to sell or thinking about selling.

So if that affects your adjusted gross income, that income that you report to the to the government that could be that could affect your Medicare Part B premium. So if that's the case and that's not reflect your regular income. To put it in, in, in simple terms, you can always contact Social Security for them to reassess that, and they will actually automatically reassess premiums after two years you've been enrolled in Medicare, but but if you feel that the, the premium that was first assessed does not reflect your regular income, you can always contact Social Security for them to reassess and revise.[00:12:00]

Next, please.

Now, let's talk about the different windows of opportunity that you have to enroll in Medicare. So, as we mentioned at the beginning, this is referred to as Medicare 101. So, it is a general presentation about Medicare in general. There are things that might apply to most of the things that do apply to you, but there are certain things that we do want to call out and make you aware that are.

Slightly different for for you attending here today. One of them is the enrollment period. So as you can see, the initial enrollment period, it's made out of your birthday month, your birthday month, and after your birthday month, we do highly encourage you to start this process of enrollment into Medicare the first month that you are able to.

So the three months prior to your birthday month, because as you might understand, there is a process that is to follow to make sure you start. Your benefits start the day you want them to start and there is no potential lapse left in coverage. So [00:13:00] again, you want to enroll to Medicare as soon as soon as you're able to when you are retiring.

You can enroll through you're able to enroll through online through social security. gov also through medicare. gov you're able to do that. You can also contact Medicare by phone, or you can schedule an appointment in person. So you have different options to do that. It just depends on preference

Elizabeth: and I'll jump in and say, this is something that Shawna, and I will, we'll make sure it's addressed a couple of times in the presentation. We have members who do so. Technically, you have that 7 month initial enrollment period. Here at RESIG and SISC, if you want coverage through the group benefits, your Medicare needs to be assigned to you in that first 3 month period.

And it needs to be assigned to the 1st of the month in which you turn 65. so these technically. You can retroactively enroll to some products if you get your Medicare in that 7th month or 6th month. With our group, it's not how it works, and there [00:14:00] are very expensive surcharges that can occur if you are not signing up for your Medicare within that 1st, 3 month window.

So we'll address more of that further into the presentation, but signing up sooner rather than later for your Medicare is very important. And then if you are collecting Social Security income. When you turn 65, your Medicare card will be sent to you automatically in the mail. If you are not collecting Social Security income at the time that you turn 65, you do need to apply for Medicare.

Once you've applied for Medicare, like Diego said, you can go online or make an appointment. Once you apply for Medicare, it takes about a month to get your Medicare card. After the application process is finished, and we RESIG need a copy of that card to send along with your application if you're signing up for group health coverage.

So, even if you enroll in that 1st month, you still have a 1 month to wait for that card to get there. So it's, you know, we're telling you this because it's a, we don't want to charge you any more than we have to and we don't like those surcharges. Shawna and I have literally lost sleep over some of these [00:15:00] and we just want to make it.

As smooth a process for you as possible, so that's why we're calling this out a couple of times in the presentation.

Guest: Just to clarify. So your window opens. The 1st of the month, 3 months before coverage is started?

Elizabeth: Yeah, exactly. And then again, if you're so if my birthday is today, my Medicare eligibility would kick in the 1st of the month of this month, so 1st of February.

If my date of birth is March 1st, if I'm a 1st of the month baby, my Medicare is going to go into effect February 1st, the 1st of the month prior to your Medicare eligibility. So that's important. Very important, actually, because you lose one of these months in the window if you're a member whose date of birth is the 1st of the month.

Good question. Thanks, Diego.

Diego: Of course, of course. And now next, please. And now there are 2 other, as I, as we call it, windows of opportunity for you to enroll in Medicare. Next 1 that we're going to talk [00:16:00] about is the general enrollment period. This is something that happens every year from January 1st through March 31st.

The effective date will be the 1st of the month following that enrollment. And this is for folks to give you an example that let's say, failed to enroll in Medicare when they retired and we're first eligible. So that's the case. They will have to wait for that general enrollment period and then enrolled during any of those 3 months.

And again, the effective, they will be the 1st of the following month. Now, there is the, there is also the special enrollment period. And to give you an example, this is the period that folks will use those folks that actually. Decided to continue to work past age 65, will used. And for those of you that are actively working, maybe you might be familiar with the term with the term qualifying event to make changes throughout the year.

This is similar to it. So, if you are retiring or something changes, then you will be able to to enroll in Medicare and that period it's made out of 8 months and similar to the general enrollment period. [00:17:00] The effective date is the 1st of the month following that enrollment. Next, please. Now, let's talk about Part D as in drug, which covers outpatient prescription drugs.

There are two different ways that you can be covered for Medicare Part D as in drug. One is by enrolling into a Medicare Part D standalone plan. Those are offered by insurance companies, many of them. And there is also by enrolling. Another way that you can be covered by Medicare Part D as a drug is by getting coverage through Senior Advantage Plan Part C that covers Part D prescription drugs as well, which is what Kaiser Permanente offers, just to give you an example.

One thing that I do want to mention in this slide is that as you know, that. General enrollment period happens, that annual enrollment period happens. You will be inundated with information and maybe you might just be walking to [00:18:00] a place like maybe a Target or Walmart that offers a plan like these. And my thing, these plans might seem very appealing, very attractive and if you decide to enroll in a stand alone Part D plan while being enrolled in a, in a, Part C plan in a Senior Advantage plan the ones you're offered through, through, through RESIG, what that does is that it's going to send a message to CMS, the Centers for Medicare and Medicaid Services, that you no longer want to be part of of that plan, of that Medicare Advantage plan.

So you will be disenrolled and be left out with just the standalone Part D coverage, which could cause Potentially lapsing coverage. So it's something that happens more often that we wanted to see. So that's why it's important for us to make you aware that that could happen if you choose to enroll in a standalone Part D plan while being enrolled in a Senior Advantage plan.

So I'm going to pause there because I just dumped you a lot of information. So I just want to make sure that makes sense and see if you guys have [00:19:00] any questions.

Elizabeth: Okay, so any of the coverages that you purchase through the group, we're talking about RESIG, include credible coverage, meaning that the drug coverage offered through the Medicare programs are equal to or better than that of Medicare Part D. Yeah, perfect. So, one of so your prescription drug coverage is already included you.

Walgreens, lots of pharmacies offer drug discount programs, and they're actually a standalone prescription drug benefit. They can be very misleading because they can be labeled as a discount program versus a part D, but you can't overlap prescription drug benefits. So, whether it's a discount program, or a standalone Part D, or a secondary Medicare coverage, you can't have two.

So, if you are with Kaiser right now, and you go and get a discount program through Walgreens, [00:20:00] Walgreens is going to tell CMS that you have this new program, and you're going to get kicked off your senior advantage. So, yes, it can be, it can be disruptive. We literally had this happen 2 weeks ago. Somebody signed up for a program and they didn't exactly understand what it was.

And Shauna gave me a call and let me know, hey, they're getting kicked off. Let's let's let's up. So, it does happen and again. These programs aren't always labeled as specifically as I think they should be for people to understand. So, if you have coverage through RESIG, your prescription drug benefits are taken care of.

You should not purchase anything else in addition. Out there in the individual market, you might need to purchase a Part D standalone program if you're just purchasing a medical coverage. Through something like AARP you have the medical portion and then a separate Part D program. So we're talking about 2 different things, the group coverage, it's all included.

Don't purchase another one.

Guest: So I'm finding out in time.

Elizabeth: Okay. [00:21:00]

Guest: [distorted] Yeah, I'm starting July 1st.

Elizabeth: Yeah, we can we'll want to make sure that we check in with your district for the specifics of your date, but that sounds right.

Yeah. Any other questions about Part D right now?

Guest: If, in her case, which probably applies to a bunch of people here, why would she enroll in Medicare until she's no longer employed in June? Why wouldn't you just stay on the health care program that she's on?

Yeah, and I've got my effective date on.

Elizabeth: So, in this case, she's an active employee and will transition from active into a retired status at what point at which point we'll sign her up for one of these. Medicare products.

Okay. Any chat?

Okay. I think we're good to go.

Diego: Excellent. Now, next, please.

So now for those of you that were thinking about Or asking yourselves about Medicare Part D as a drug premium, it can have a, [00:22:00] it can have a cost. You have a monthly cost and it does depend on your income, just like Medicare Part B as a boy. So if you earn $103,000 or less as a single or $206,000 or less as filing a marriage jointly.

Married and jointly, there won't be an additional cost for Medicare Part D as a drug. However, if you earn more than those limits, then it will be a monthly amount. They call it an income related monthly adjustment amount, and it will be assessed in addition to your Part B premium. But again, if you earn less than those thresholds, there wouldn't be any additional cost for Medicare Part D as in drug.

Also, if you do fail to enroll in Part D as in drug, when you are first eligible and you're not covered by what it's referred to as creditable coverage, you will be assessed a penalty equal to 1 percent for every month that you fail to enroll. And similar to Part B Penalty, it is in [00:23:00] perpetuity, so it will stay in the premium for as long as you're covered for that plan.

I want to remind you about the exception, which is if you are continuing to work, if you are working past age 65, then you don't have to enroll for, for a premium. Medicare Part B or D because you're actively working and you're getting your benefits through your employer. Next, please.

Now, let's start talking about Medicare Part C, Senior Advantage plans and starting with the different ways that you can actually have medical coverage through Medicare. So you, there are Two main different ways that you can do that. You can actually enroll in Original Medicare for A & B as in Boy, and then get a Part D coverage all separate and be covered by Original Medicare.

By understanding that Original Medicare has coinsurance, has deductibles, and usually an 80/20 split there is a lot of folks that folks out [00:24:00] there that choose to enroll in a Medigap plan. So you might, this term might sound familiar to you, but what a Medigap plan is, is just a separate insurance policy, if you will, you can get to a, to an independent plan that will help you offset that out of pocket cost that original Medicare has.

And they do have that monthly cost each each company that offers it offer a slightly different plan. But just just to inform you that those plans are out there, I do have to say that Kaiser Permanente does not offer a Medigap plan. Also, the other way that you can get a Medigap plan. Coverage for Medicare is by joining or by enrolling in a Senior Advantage plan or Medicare Advantage plan, like the ones you're being offered through SISC and RESIG.

In those plans, you often include, or those plans include coverage for Medicare Part A as in Apple, B as in Boy, and D as in Drug. Next, please.[00:25:00]

Now, talking a little bit more about the Part C of Medicare, the Medicare Advantage Plans. Medicare Advantage Plans combine, as I mentioned before, benefits that fall under Part A as an Apple, B as in Boy, and D as in Drug, all together in a bundle, if you will. One thing that is important to keep in mind is that the services that are covered through these plans have to be provided by what is referred as an in-network provider.

So if, I'll give you an example, if you choose Kaiser Permanente, you will receive your services at a Kaiser Permanente facility or medical offices by a Kaiser Permanente physician. And if you choose any other plan, they will have doctors, hospitals, and offices that you, that are a part of their network.

There is also an exception to that, and the exception is emergencies and urgent care. So if you need it if you are having an emergency or need urgent care, and there is no network providers for you to access, you are able to go anywhere and sometimes you don't, you might not even have the choice. So you, for emergencies and urgent care, you're able to go anywhere [00:26:00] and still be covered.

Next, please. Now, it's also valuable to let you know what Medicare Advantage plans are out there in the market for informational purposes, starting with the Health and Maintenance Organization, often referred to as HMO plans. There are also point of service plans, often referred to as POS. There are preferred provider organizations, often known as PPO plans.

And the last two are not very common, but there are still markets out there that offer them. It's the Private Fee for Service and the Medical Savings Account Plans. So, these are the types of Medicare Part C or Medicare Advantage plans that are out there in the market. Next, please. Now, it's also important for us to make, you know, staying true to our mission in providing affordable and quality health care and to truly put out there all the tools and resources that you have that for those folks that you [00:27:00] qualify through social security, social security would be the one deeming someone eligible for this program is the it.

Low income subsidy for Medicare Part D as a drug. So, there are folks out there that due to their income, they could qualify to get help for paying for, to pay for prescriptions or to pay for that monthly Medicare Part D premium and again, you qualify through Social Security. Next, please.

Now, it's also important for you to know that Centers for Medicare and Medicaid Services, CMS, they have a star rating star rating star rating plan. So, they go out there and rate all the different Medicare Advantage plans, and according to many different measurements, they give them from 1 to 5 stars.

They measure quality of care, member satisfaction, they measure chronic condition management The accuracy of prescriptions, [00:28:00] so there is, there is multiple areas that they measure. So you can go to you can go to to learn more about that and see how the different plans that you have access to are, have been rated by CMS.

Next, please. Now, of course, we are here to answer any questions you might have, but if in, you know, we will always be a resource for you. There are also other numbers that you can reach out to help you answer your questions. You have the social security number that it would be a great resource if you're not quite sure whether you qualify for Medicare Part A as in Apple at no cost to maybe figure out how many quarters you have work if you're not sure about it.

You can, you also have the Medicare Medicare helpline that they can help you enroll in Medicare if you are going through that process. And of course, the Kaiser Permanente member services that is available to [00:29:00] you 7 days a week from 8 a. m. to 8 p. m. Now, next, please.

So now I'm reaching the end of my presentation, the part of my presentation. So I want to thank Liz and Shawna for, putting this together for bringing me in and allowing me to to provide this information to you all and and thank you to all of you that are attending for taking the time to learn about Medicare and your benefits.

Elizabeth: Thank you, Diego. Does anybody have questions about kind of the general Medicare section, Kaiser side of things? Okay, we'll touch on, we'll reiterate some of this in the 2nd section, and then we'll go into the individual plan options, Kaiser Blue Shield and Blue Cross. So, this now goes over to Shawna.

Shawna: Hi, everyone, let me see if my video will work for a 2nd.

If not, we're not going to mess up technology.[00:30:00]

Okay, perfect. Hi, everyone. I am Shawna Smith. I'm the SISC account manager for RESIG and have worked with RESIG for several years in different sections, eligibility, corporate direct bill, different things. So glad to be here. So this next part, I'm going to stop my video and we're going to go over the plans that you guys have available as retirees.

All right. All right. So one thing that I think we need to just talk about first is dependent coverage. It's probably the 1st thing we hear about when it's time to become Medicare eligible or retire. So, all plans allow non-Medicare eligible dependents to continue on their current under 65 plan. So, if you have dependents that are under 65, you can continue on.

The under 65 plan, you do still need to have Medicare for the [00:31:00] members that are 65 plus, but you can continue. Subscribers and their dependents must remain with the same health care carrier. And the reason of that is, if you decide if you're on a Kaiser plan. And your spouse is under 65, you both have to continue to be with Kaiser, but the subscriber or the retiree can be on the KPSA plan through Kaiser and the spouse can be on the under 65 Kaiser plan.

So, we can't have one with Kaiser and one with, say, Blue Shield. They need to be with the same carrier.

Elizabeth: And I'll jump in and just say, we get this question a lot, especially for people who are newly retired. You know, what am I going to do with my dependents? So we can't keep them on. You have to pay the premium for it.

But if there's. A family and 2 of you are Medicare eligible and 1 is not, there's a rate for that when 1 is over 65 and [00:32:00] 1 is not, there's a rate for that. So we can, you can continue coverage for your dependents. Additionally, dependent coverage dependents can come on and off during qualified points of the year as long as you, the subscriber to the policy maintains coverage.

So, if I take my spouse off because he got coverage elsewhere, and then he loses that coverage. He can come back on to mine during open enrollment as long as I provide all of the necessary documentation. So the subscriber to the policy has to maintain coverage, but dependents can come on and off as needed.

Shawna: As long as they have a qualifying event, open enrollment. Correct. So, Elizabeth, thank you. That's a very great point. And I think we'll answer a lot of people's questions.

So, I'm going to jump in to go over the actual plans that are available. So, the information on here is for this current plan year that started October 1st of 2023 and will end as of September [00:33:00] 30th.

The plans will stay the same unless RESIG adds a plan, or if there's a change, but these are the rates for this current year. So, currently, there are two Medicare Advantage plans that Diego was speaking of, and that is a, KPSA 10 and a KPSA 25. On the 10, you're going to see the single rate for that is 281 a month.

On the 25, the single rate is $231 a month. The next plan is a Medicare Supplement Plan, which is your companion care, which is administered by Anthem Blue Cross, and that premium each month is $406. There. You also have two Medicare coordination of benefit plans. These are a hundred percent plans. We call 'em Blue Shield Egg Whip, which is Employer Group Waiver Plan, which is a PPO plan with Med D wrapped in [00:34:00] it.

So the. You're going to see the medical portion is 100A on both. They are the exact same, where the prescription is different, which is 0-25 or 0-35. In a little bit, I will go into more detail of those. Single rate for the 0-35 is $596 and for the 0-35 prescription, it's $579. So, one point that I am going to say over and over in this presentation, and it is not to be annoying, but it's just very, very important.

And Elizabeth was not lying when she said we've missed some sleep over some of these things. So, enrollment forms and supporting documents are due to RESIG at least 45 calendar days advanced notice. The reason for that is not only do you need to get them to RESIG to make sure that they're complete with a copy of a Medicare card.

Once we get them and process them, we have to send them to the carrier, [00:35:00] then has to turn and send it to CMS. So the process takes a while, and a lot of things have to be verified. So that's why it takes 45 days. Also, you, need to make sure you have Medicare on time. Like stated three months in advance of turning 65 or if you work past the age 65, 3 months before retirement.

And you need to maintain Medicare parts A and B. So if you don't pay a premium for Part B and you part B drops, there are it can may result in disenrollment. And, or a non refundable $625 monthly surcharge. That $625 is actually per part, so that's up to $1,250 per month per person on the plan that has Medicare that lost a part.

So, really, really important, we do not want to charge the higher premium and we do not want [00:36:00] a surcharge to be a place placed on your account for losing it. So, really important to keep up with part of paying part B as well as not enrolling on another plan out of side of your RESIG plan, which I'll go into more detail and

Elizabeth: go ahead.

Guest: So looking at, say, Kaiser plans.

Elizabeth: Mm-Hmm.

Guest: Is this in a sense C?

Elizabeth: Yeah. So the Kaiser Senior Advantage is your Part C coverage. It's a Medicare Advantage product. Yes, exactly.

Guest: And so do you still pay the premium on the earlier page?

Elizabeth: Yes. Or a not A or B. So A is generally free. So A is, so these rates, I was just gonna say, these rates on this page are, in addition to that Medicare Part B, A or D. So standard Medicare Part B premium per month for most folks is $174.70. That changes every calendar year. So January 1st, it'll likely increase. And then if you are subject to those IRMA penalties, those income related monthly adjustment amounts, you may have a higher [00:37:00] premium for D and or.

Guest: So the $174 is rolled into this one.

Elizabeth: No. So you're going to pay $281 plus $174. The $281 comes to us. We send that to Kaiser. That's what you pay to have the senior advantage. And then the $174 goes to Social Security directly. That's just for having Part B of Medicare.

Guest: So it's $174 plus 281.

Elizabeth: Yeah, exactly.

Yeah. And that's the case with these other products too. The containing care benefit is the same. So is the coordination of Medicare coverage on the PPO options. I was going to mention also that effective 10/1 of. 2024, we are going to add on a new senior advantage option. So there will be a 0 dollar office visit option.

And then the 10 and 25 that we have currently, we don't have rates for that. Renewal is just starting. So more information to come out, but we'll have another option there. And then oh, Shauna, you did a great job. Again, we really are going to pound this home. The comments that Shauna had about those [00:38:00] non refundable surcharges link back to that image on slide 9, that 7 month enrollment period. So you're looking at that surcharge in that 4th, 5th, 6th, and 7th month that you haven't signed up. So, again, we don't want to charge you that. We hate it. It's horrible news to break to somebody. It's complicated to try and explain. We just want you to avoid it altogether.

Guest: So the $174 on the previous page, we're on social security would be the one deducted from your social security?

Elizabeth: Yeah. Good question. Yes, so those of you who are collecting Social Security at the time of Medicare eligibility, your Part B premium will be deducted straight off the top of your Social Security income. You'll get the remainder. For those of you who are not collecting Social Security, and this is common too, a lot of people are waiting.

CMS Social Security will bill you for 3 months at a time for your premium. This is a wonky billing cycle since it's quarterly and we have had more than 1 person forget [00:39:00] about the billing cycle or have a family member try and take over finances and that got lost. Part B didn't get paid, they got kicked off and then these surcharges and the whole mess happened.

So it's best. I like to say it's best to get your premium payment on some sort of auto payment program. If you are a PERS member, PERS has an option for you to have your Part B taken out of your pension and they can do that on a monthly basis. Or I believe there's a way to convert your Payment from a quarterly amount to a monthly amount electronically with CMS on the back of that statement you get.

So, it's important if you are not collecting Social Security income, keep an eye out for your bills from CMS in the mail. They will come and if you don't pay them, they will kick you off.

Guest: That's taking it out of your PERS.

Elizabeth: Yes, I'm sorry. She's right. STRS, not PERS. STRS. Sorry. They're too similar. Thank you.

Guest: B and D, and also this, fee here for the Kaiser $281. Those can both be taken out? [00:40:00]

Elizabeth: No, just your Social Security parts. Yeah, just part B.

Guest: And then the other is direct from RESIG.

Elizabeth: Exactly. And we will go over some billing and payment options for those premiums later. But, yeah, the $280, the premiums listed here come to RESIG, the amounts on the separate page go to Social Security.

And then to pull it out of your [unintelligible] it is PERS not STRS, right? Dang it. STRS has an authorization form. So they'll send you a packet and I think it's two or four pages, front and back, and then you could read through the directions. Again, don't listen to me, make sure you read it, but I think they ask you to send in your 1st state, a copy of your 1st statement, along with the authorization form unpaid, and then they'll pull it from your pension.

Guest: And we have to contact them to do that.

Elizabeth: I think they send that automatically, but don't trust me there. So, yeah, you might want to contact them if you're looking at this as an option.

Any other questions? Okay, all right, go ahead, Shawna.

Shawna: Yeah, I just [00:41:00] wanted to add one other part. So, if you lost part B, say, you forgot to make that payment that Elizabeth was just talking about.

Not only do you get a surcharge for it, but to be on these plans, you have to continuously be enrolled on A and B. so what happens at times as you get moved to an under 65 plan is what we call them and the premiums are higher on that and the surcharges assessed. So please do everything you can to, you know, take the steps Elizabeth just suggested. Thanks. You're welcome. All right. So, 1st, we're going to jump and talk about the KPSA plans or senior permanent. No, Kaiser Permanente Senior Advantage. We'd call them KPSAs and there are 2 plans side by side. The SISC $10 Senior advantage and the SISC $25 Senior advantage. And if you look down the rows they're going to tell you how [00:42:00] much those are gonna cost for the most like used services.

The ones that are in the bright yellow is really to catch your attention. 'cause those are gonna be the differences of the plans. So both of the plans have a $1,000 per calendar year out of pocket max with no lifetime max. Neither plan has a deductible. There's no charges for x rays. The other services like an office visit or outpatient surgery is going to be the dollar amount of what the plan is.

So either a $10 or $25 per visit. Visit or procedure. Hospitalization, there are differences. There's no charge if you're on the $10 and there is a $500 per stay on the $25 KPSA plan. Emergency services are $50 for both plans per visit. Ambulance services $50 per [00:43:00] transport on the $10 and $150 per transport on this $25.

Now, with the prescriptions that are built into these plans, they all cover the 100 day supply, but the amount that you would pay is differing. So on the $10, you're going to pay $10 for the generic up to 100, 100 day supply. I am sorry if I said stay. The brand is $20 for up to 100 day supply. On the $25 we're looking at $30 for generic and $75 for brand. For DME or durable medical equipment, there's no charge on the $10, where there is a 20 percent co-insurance that's assessed for on the $25 Senior Advantage plan. Eyewear, just so you know, both plans have a $150 allowance and hearing aids, both $500 allowance per aid. There's [00:44:00] also want to let, you know, for both of these plans, there are gym membership discount programs and those are at no charge for you and that we'll go over in a little bit.

That is through silver and fit any questions about the Kaiser plans?

Guest: I have a question, so let's say you have the, $231 dollar, the $25 dollar copay office visit one and you go to the hospital and it's 500 dollars to stay there. Does that count towards your out of pocket that 500 dollars? That you paid.

Shawna: Yes. Okay. So, yes. Yeah.

Guest: The 2nd part of so any of these, like, the 20 percent co insurance, any that all add to...

Elizabeth: All accumulates towards your deductible.

Guest: Who keeps track of that?

Elizabeth: Kaiser.

Guest: Like, when you pay out of pocket, they keep track of the money you've spent?

Elizabeth: Yeah, any other questions.

Shawna: [00:45:00] Okay.

So the next one is going to be that Anthem Blue Cross companion care plan. On this plan. one of the most important things is to make sure that you're seeing a provider that accepts Medicare assignment. And it's really important to Medicare assignment and not just Medicare. As long as you're seeing a provider that accepts medicare assignment, the companion care is going to pay that 20% that Diego was talking about earlier that original Medicare pays 80, and then members are stuck with the 20%. Well, that's where companion care comes in and pays the rest of it. And as long as the doctor accepts Medicare assignment, the member should not see any charges.

So if you look down the line, that's why on the maximums, deductibles, office visits and everything, it is at none or no charge. [00:46:00] For prescriptions, you're going to pay $18 for up to a 90 day supply and brand you're going to pay $90 for up to a 90 day supply and again DME and home care. There's no charges to those.

There is also, you have access to the same gym membership or discount program through Silver and Fit, which is at no charge for you. One other important thing that I think we always let our members active members know that you can get free generics at Costco. Unfortunately, on the companion care, we cannot do the $0 generics at Costco. So if you're currently using that when you move to this plan please know that it's $18 for the generic medication.

Elizabeth: And we had a question from our earlier session this morning, and one member asked, what did they ask? When they transition into a Medicare product, how do they make sure that they can keep their current providers? And that is an important [00:47:00] question. So with, since we're on companion care, I'll address it now.

Kaiser's all in one, right? So you're going to be able to see the same providers, whatever you have with Kaiser, whether you're on an under or over 65 plan. The blue shield plans that we're going to go into next are PPO.

So they function, they go on Medicare's primary, but they function off of the same PPO network that the non-Medicare PPO's do as well. So you can navigate that PPO network, just like you would as an active member. The companion care benefit is a really great coverage. As you can see, you're not going to pay a lot out of pocket as you utilize services, but it can be limiting in that you have to see a provider that accepts Medicare assignment, like Shauna said. Additionally, The services that you have have to be Medicare approved. If Medicare does not approve the service that you have, Medicare won't pay any of it, therefore, Blue Cross won't pay for any of it. Therefore, you are out of pocket for it.

So great plan, great coverage, as long as you know that your providers are going to accept the coverage and that you can continue with [00:48:00] your treatment and and that kind of thing. Seeing folks who are going to accept Medicare and who Where you're getting Medicare approved services.

Shawna: Okay. Alright, we so next one is going to go over the two Blue Shield plans. The 100-A $0 copay EGWP PPO plans on here, you're gonna see there's only one listed because as stated, the medical portion of the Blue Shield plans are the same. The only difference is the prescription. So on the next I'll go over the differences on prescription. So on this plan, like I said, it is a PPO plan. It is a full 100 percent PPO plan. So it's going to work like your normal, the normal active benefits on a PPO. There is an annual out of pocket max of a thousand dollars for individual and 3000 for family, [00:49:00] for a family per calendar year. There is not a deductible.

And as you look down the lines for your office visits, x rays, labs, there's no charge. Emergency services, there are, it is $100 per visit and ambulance services, it's $100 per transport. DME, there is no charge and hearing aids every 24 months up to $700 dollars combined maximum benefit. There is also a gym membership for this these plans.

It is through Fitness Your Way Tivity through Blue Shield. There is a fee to this. There is a enrollment fee of $28 and then a monthly fee anywhere from $10 to $29. And the reason that there is a range, there are different programs that you can choose through there. Whether it's you're going to go to a facility or if you're wanting more of a home based program.

So that's why there is differences [00:50:00] on the cost.

All right, so now we're going to go over the 2 drug benefits that are attached to it. The PPO plan is a coordination of benefits plan with Medicare Part D prescription drug coverage, and it's administered through Navitus Health Solutions. There is no coverage gap or donut hole on these plans. So please keep any of the plans.

I know that it's listed here, but any of the plans that we spoke about that are offered through RESIG and SISC there is no coverage gap, or most of us have heard of it as a donut hole. Members receive $0 generic copays on this plan. So, down below, you're going to see the 0-25 and the 0-35. Both have an out of pocket max for the 25.

it's $1, 500 for an individual and family $2,500, no deductible, [00:51:00] $0 generic copay again, and brand, you're going to see $75. If you would like to do mail order, which is 90 day supply, brand and specialty, copays will be $60. On the 0-35, the out of pocket max is $2,500 individual and $3,500 for a family. No deductible and zero for the generic medication.

For network retail pharmacies, for a brand, you're going to pay $105, but if you would like to do mail order, that would be $90 for a 90 day supply.

All right. Oh, sorry, any questions?

Elizabeth: No.

Okay. So, on this chart, I think it is very helpful. A lot of these charts are put together just to put each of the different plans side by side so that it can be [00:52:00] easier for you to decide what works best for you. So, the first one, or how it's listed is your Kaiser, your companion care, and then your Blue Shield.

Medical providers, as you know everything through Kaiser, you stay through Kaiser, you can continue with the same doctors and providers as Elizabeth stated. For the companion care, you do have to stay in the U. S., so U. S. providers who accept Medicare assignment. Again, I know that it's one of those things I'm just going to repeat.

Not accept Medicare, but accept Medicare assignment. On the Blue Shield. You're going to have the Blue Shield full PPO network available to you and U. S. providers who accept Medicare assignment is important. Anytime on one of these plans where you have choices is to ask the question. With on the Kaiser plan it is important that you lived in the service area. [00:53:00] So, if you're wanting to go on a KPSA plan, it is probably very beneficial for you to reach out to your. Benefit contact at RESIG to make sure that you live in the service area. Sometimes when people retire, they're in California, you know, working and then they decide to move out of state.

I do want you to know that it's only in California. That you can have this coverage and there are some spots of California that it is not accepted. So very important to talk with RESIG ahead of time before making that move. A lot of times we will get that call after the move has made and being asked why I cannot seek services or why am I being told I don't have coverage here?

For companion again there. You don't need to live in a service area. Per se, but you do have to be in the U. S. and Blue Shield, there is no [00:54:00] limitations. Deductible. None of the plans have a deductible. Must receive non emergency service and service area. Yes, for the KPSA plan and no for Companion Care or Blue Shield.

All plans, as I stated, require you to have Medicare A and B to be able to enroll in it and to stay enrolled on these plans. On the KPSA plan, your Medicare is assigned, assigned to Kaiser. On the other plans you keep your original Medicare and these are your supplement plans. The next travel coverage.

Emergency and urgent care you have through your KPSA plan and emergency care through companion care and emergency and urgent care through Blue Shield. Service is covered beyond Medicare? Kaiser, yes. No, for companion care, again, it's the Medicare assignment and yes, for your Blue [00:55:00] Shield.

Who administers the prescriptions?

Is Kaiser for the Kaiser plan and Navitus health solutions through the, for the companion care as well as the Blue Shield EGWP plans.

None of the plans again, I want to reiterate, do not and none of them have a donut hole. Nothing to be concerned about with that.

And each plan has a gym membership discount program that are listed here.

Elizabeth: I'll just mention the Medicare assignment piece of this, we did have a member a few years ago come in. They wanted, they needed a hip surgery. There was a hospital out in Napa that would do the hip surgery. I guess it was a new method or whatever. And they came in and wanted to, they were Kaiser with Medicare.

They wanted to go to this hospital and said that they would just take their Medicare to the hospital and pay the 20 percent after Medicare paid the 80%. Using original Medicare A and B. They [00:56:00] couldn't do it. When you sign, when you sign up for Kaiser, you take your original Medicare and you assign it to Kaiser.

They, they keep it. They retain it, which means that you can't go outside of Kaiser's network and facilities to utilize Medicare original Medicare on its own. So, With EPO, the companion care, you could, I mean, if you don't see a provider, you can go and just pay the 20 percent that Medicare won't and be done with it. But in this particular case, the member could not. So with Kaiser, it's a, it's an important distinction that you do not retain your Medicare.

Guest: What if you do move, say, you're with Kaiser in 4 or 5 years, and then you're going to move to, I don't know, wherever there's no Kaiser.

Elizabeth: Yeah. So our contract is here in Northern California. Specifically, if you move to Southern California, we can make it work with an inter-regional plan, but it gets a little wonky. If you move out of California, even to a state like Hawaii or Oregon or Washington with Kaiser, since our contract is not there, you can't go to Kaiser through the group [00:57:00] program. So, if you move outside of the Kaiser service area, and you are enrolled with RESIG, you would let us know. Moving outside the Kaiser service area is a qualifying event to make a mid year change. So we could offer you 1 of the Blue Shield options or the Blue Cross option if you wanted to stay with RESIG. Obviously you could search for something within the state that you've moved, or you'll find an individual product.

Guest: Because you're still going to have A & B through Social Security.

Elizabeth: Exactly. That won't change, but be sure to update your address with CMS. Okay. Yeah.

Good question. Anything else? Okay.

Shawna: All right, so important consideration. So these are just things to please keep in mind. You know, when making these changes, so when enrolling into the RESIG SISC Medicare plan, it's important to remember these things.

Retired members must enroll in Medicare Parts A and B on the 1st date of eligibility. And when we [00:58:00] say that saying it again, but 3 months before you turn 65, and bless your birthday's the 1st of the month. It's. It's truly 3 months before that, that you can truly start the process or if you're working past 65, that is fine. Just 3 months before you retired, you need to be preparing for retirement as well as Medicare.

Guest: Is this 3 months before you're eligible, like your Medicare coverage starts the 1st of the month of your birthday?

Elizabeth: Correct. So 90 days before the 1st of the month, 3 months before that, or on your birthday, 3 months before?

90 days in advance of your Medicare eligibility. So it's 90 days in advance of the 1st of the month of which you turn.


Perfect question, because if you had it, I know other people had the question.

Yeah, right!

Shawna: We do not mind talking about this. So, [00:59:00] again, you work past 65, that's fine. Just 3 months before and again, retired Medicare eligible members must maintain continuous enrollment in Medicare parts A and B or be subject to that to disenrollment. Or to a higher plan and be surcharge that $625 per missing part up to 120 or $1250.

And again, I just want to make sure that people are aware that this is per individual. So we've have ran into the situation where. Both retiree and spouse didn't make payment to Part B, and so they both got these surcharges. So it can become very expensive and it's a hard process to work through. I know the RESIG team really works with the members to get it fixed or figure out the problem. But if we can not have the problem at the beginning would be great. [01:00:00]

Those over 65 and retired are responsible for paying the Medicare Part B premium and any income related monthly adjustment amounts, which is IRMA. That is what that is the acronym for. If applicable in addition to monthly plan premiums. So, like, Elizabeth said, you're going to pay your Part B and if you have the IRMA, you're going to pay that as well to Social Security and then your medical plan is a different monthly premium that gets paid to RESIG.

And per CMS rules, members may only be enrolled in 1 Medicare Part D prescription drug plan. So, if you enroll in one of our plans, the Part D is already enrolled. Combined with each of these plans, we're not able to take that part out. It's just how the plans are set up. So you cannot enroll on any other plan, whether it's another medical plan or prescription [01:01:00] plan, or CMS notifies us that it terminated the plan that you're currently on. So very important and it comes in a lot of different forms. I mean, there's commercials about it and the flyers that are sent out when somebody turns 65 or like stated a discount card is sometimes how it's portrayed as. So, please, if you have any feeling that you're questioning it, please reach out to your team and question it first before enrolling on anything.

Alright. How to enroll members may enroll on the Medicare plan if they're retired. And again, have Medicare, Medicare A and B, or who become newly Medicare eligible. Members may change Medicare plans during open enrollment period, which is October 1st. Members making a change must submit their enrollment forms by August 15th, [01:02:00] again, for an October 1st effective date.

That is that 45 days advance notice for us to get the documents, make sure everything is complete, get it to the carriers and CMS, and also once we get it to CMS, there have been times that they have denied it or say that it's not in the service area, things of that nature. It gives us time to make those corrections before the effective date. So very important, but then we get those by August 15th.

Retired RESIG members will automatically receive a packet of information 3 months in advance of member's Medicare eligibility. The packet will contain information, timelines, premium cost, instructions. Members who wish to stay with RESIG benefits after Medicare eligibility should return the completed forms along with a copy of the Medicare Beneficiary Identifier card showing enrollment in Parts A and B to your benefits specialist.

One thing I [01:03:00] think is important is. I think Elizabeth already let you know that it takes at least 30 days to get that information. One thing that we hear quite often is that somebody is not able to get turned in an enrollment form yet, because they don't have the copy of the Medicare card and that's required.

I do want you to know that they do send out a letter to you. Ahead of time that will let, you know, what your Medicare ID number is going to be as well. If you look farther down in the letter, it will tell you part B is going to be effective on whatever date it will be. And then it will also talk about part B on there as long as you have that document that has those 3 pieces of information.

You can submit that with your enrollment form for your 65 plus plan. So we can start the process and then you can provide your. Medicare card after you receive it. If not, you can also log in to see your Medicare information and I've had people that have been able to screenshot the [01:04:00] information showing their name and the effective date for A and B and the Medicare number.

Anything that you can do to get us that information right away of proof, then you can get the card to us when you have a chance. We don't want to hold up enrollment over that. And again, requires that 45 day calendar, a day advance notice and active RESIG members who are still employed will automatically receive a letter with important information about active coverage in Medicare, explaining what to do at that time.

I also want to let, you know, this. SISC sends out a letter anytime our members, three months before they turn 65, we don't, it does not look to see if they're active, retiree, what the scenario is. It's just generated 3 months before somebody turning 65 to give them scenarios on what needs to be done. So, between RESIG and SISC you will receive a lot of information that will be helpful for you to know what to do at that [01:05:00] time.

On this slide here, you'll be able to see it somewhat of the chart that will show on the letter that comes from SISC and what it is is scenario based. On the top blue line, you're going to see different scenarios that you can look at to pick what scenario do you fall into.

So I'm turning 65 and I will continue to work. Okay, so in white, it's telling you what you need to do with Social Security. Contact Social Security to defer Medicare Part B enrollment until 3 months prior to the 1st of the month following your retirement, unless, you know, RESIG instructs you to do otherwise, then you won't want to do that. But that is usually what happens in that case. And then the next bottom one is what's happening with the SISC or RESIG plan, what needs to be taken care of. So, you continue on your current active employee plan, and you'll be good to go. And then so on, if you're over 65, still working, [01:06:00] here's the details of what you need to do for Social Security and with a RESIG.

So, very helpful chart, and again, on the letter that we send to you, it has more scenarios to it. You're just going to figure out which one explains what is your scenario falls into. Any questions on this?

Elizabeth: Nope.

Shawna: When changing plans, these are really important things to keep in mind, whether you're changing plans and deciding to leave the RESIG SISC plan, or just reviewing other plans. So compare plans carefully. Understand the Medicare Part D coverage gappers. Like I said, it's most of us know it as a donut hole.

If you haven't heard of donut hole, please search it. Put coverage Medicare Part D donut hole because don't put donut hole. You'll see. Donuts, but it'll give you details on what that [01:07:00] exactly means. And a lot of plans have this donut hole that members aren't prepared for. And they're enrolled on a plan that seems really good until they've hit their limit. And they have to pay a lot of money. So the coverage gap on an individual Medicare Part D plan begins once you reach your Medicare Part D plan's initial coverage limit, that $5,030, which is what it is in 2024, and ends when you spend a total of $8,000 out of pocket in 2024.

The amount may change each year. Not everyone will enter the coverage gap, but members that have a very high prescription costs could land into that. Again, none of the plans offered from RESIG have a coverage gap stage. So, you do not need to be concerned about this. This is if you look outside at another plan.

You must notify [01:08:00] your benefits specialist at RESIG if you plan to terminate coverage. Terminate coverage, only after you have a new plan in place. We've ran into a problem where members are looking, or they think that they're signing up for a plan and it's going to be effective, let's say, for one and they contact us now and say, let's terminate. I want to terminate. for your time. At the end of February, or I'm sorry, the end of March, and once they terminate, they find out that the plan never became effective April 1st. And it's really hard to get members reinstated. So, please make sure that you have confirmation that the other plan Is in place before you terminate and retired subscribers cannot return to the RESIG SISC benefits once you leave the RESIG SISC benefit program.

And this is in regards to the, if you decide I'm going to drop the medical coverage, then you cannot [01:09:00] continue. And this is subscribers as stated before that dependents are able to drop off the plan enroll onto the plan throughout the year with a mid year qualifying event or open enrollment, but only if the subscriber is still on the plan.

So, once a subscriber decides to drop, then they or dependents will not be able to re-enroll onto the plan.

Elizabeth: Thank you. Shana.


Guest: You say the present, but then move out.

Elizabeth: Mm hmm.

[ unintelligible]

Guest: So, it was, but then you come back. You still can't join back. Right?

Guest: In that case, I mean, that's unique. We could move you from your group senior advantage in California to blue shield or blue cross plan through the group while in Arizona and then moving back into Kaiser when you move back to the state. So, in that case, you wouldn't have to drop coverage, but if your preference is.. A lot of people [01:10:00] drop coverage to go to Kaiser's individual seniors advantage. If you make that kind of decision, you can't come back into the RESIG group program, even during an open enrollment. So, once you terminate that coverage, you're out as the subscriber.


Guest: The spouse of the subscriber could have done that and come back in?

Elizabeth: Yes, if you're the subscriber and your spouse left, but now needs to come back on, either during a qualifying event or during an open enrollment, your spouse could come on and off. Yeah. Okay, any other questions about that? Okay, next slide.

So just a couple of generic general information. Again, this is a lot of information, individual situations and scenarios. What we tell one person sitting next to another, even if you're within the same carrier, they're going to be very different based on individual details. So, if you have more questions, if you have concerns, talk to your benefits specialist, we'll get those individual [01:11:00] details and be able to give you a better picture of how we would recommend you move through the process.

This is something that's misunderstood. Retirement continuation can last indefinitely. We have a lot of people who retire, turn 65, and think that their Medicare coverage, that their group medical coverage is going to end. Just because you turn 65 doesn't mean that you lose access to the group health plan.

That's why we've been talking about all of this today. Additionally, Some districts are still issuing district contributions based on years of service in your contract. So, if you are a recipient of any kind of a district contribution against your premiums, those contributions may end at age 65, not all do.

So your contribution might end at 65, but as long as you pay the group premium, you can keep your coverage indefinitely as long as that premium is paid.

We already talked about this, but the premiums that you saw in here pertaining to the group products, those are paid to [01:12:00] RESIG directly. They do not include that Part A premium that pays to Social Security. Very different amounts. Members can pay RESIG directly. I'll check where we have currently the auto withdrawal program. It's free of charge. We did have an online payment portal for e-checks and credit and debit card payments. We had to disable it, but we're looking at bringing one back up. So we should have one by the end of the year.

We said it a lot. Pay your Part B premium and your penalties. It's just, you have to.

We really just want to try and make things as easy as possible. So, you know, an ounce of prevention.

For those of you who have dental and or BSP benefits through RESIG that are separate from your medical coverage. Ending your medical benefits or turning 65 and transitioning into a Medicare product does not affect your dental and revision benefits at all.

And I'm talking about your standalone benefits. This is Delta Dental or VSP. Kaiser's Senior [01:13:00] Advantage products. The KPSA products do include an optical benefit, so some folks do terminate their VSP coverage once they get the optical benefit with Kaiser, but some people also keep them.

So these are not a bundle benefit package you can keep, and choose which coverages you wish to keep individual, just know that when you terminate it, you can't bring it back later.


Guest: So once you leave RESIG medical coverage, let's say I decide, you know, it's really not worth it. I'm just going to go to Kaiser Senior Advantage Plus and all that, but I keep my foot in the door with the Delta Dental, does that mean I, could I reinstate my medical coverage at some time?

Elizabeth: Good question. No. So these are product specific. So your decision to leave medical is going to be separate from the decision to leave dental inclusion. Good question.

Unlike what we talked about earlier of not with the prescription, because you're on a plan, don't go for a different prescription. Therefore, the vision, you get the vision through Kaiser, and [01:14:00] there's not a problem with the VSP. As well, that doesn't.

Yes, it's things with dual coverage and it's the Medicare payer thing and coordination of benefits. So, because of all of that, how complicated it gets dual coverage with Medicare products is not great. It works fine with dental and vision. Yeah, thank you.

Let's see. I don't want to say all of that. I think it's on this slide. You know, I, again, just really want to reiterate, you can call us for any reason. If you have a quick question, if you heard a rumor, if you want to talk to a friend from a different district, we want to make sure that you understand your benefits.

We're here to provide you with that kind of an education so that you really can navigate the medical program and be your own advocate and get the most out of the coverage. It's expensive. We're all paying for it. We want to be able to use it and know how to use it and that's why we're here. So if any questions or concerns, please reach out to any of us here at RESIG.

Next slide. [01:15:00] So the value-added services for Medicare folks aren't quite as abundant as the non-Medicare people, but there are a couple of programs that you do have access to as a Medicare participant. The EAP, the Employee Assistance Program, is an invaluable tool. If there is something that you need help with, I guarantee the EAP can address it.

If you need help with finances, if you need help with pet sitters, grandchildren issues, child issues, anything, it doesn't matter. The EAP is a free resource. You can call them. We have somebody in the office just use it to set up a task. So there's 6 free therapy sessions per incident. So you can use this as a therapy tool if you need to, but the EAP is really, really just a big, robust program and we're really trying to push the value-added services out so that members know what resources they have access to.

In addition to the EAP, we also have the Teladoc. It's an expert medical opinion. I think this [01:16:00] one's particularly useful for people with Kaiser because it's not easy to get a second opinion if you are a Kaiser member. So, this particular product is something for real big diagnosis. If you have something life changing and you want somebody to review your case, doctor notes, recommendations, treatments. You can contact expert medical opinions who will review in coordination with your doctor and your doctor staff. All of your records and make either alternative recommendations for treatment or agree with the treatment that your provider has put through. And you just know that you piece of mind that you're doing the right thing for you.

So, this is another tool we've had a lot of people use it and actually get really good feedback. We hope you never find yourself needing to use it, but it's there if you do.

The next slide is just a quick slide on the gym discounts. Shawna kind of, you know, went through these through the presentation. We have great gym discount programs.

We do have some of the bigger gyms. There are [01:17:00] also at home options. So if you're like me, you hate the gym, you can get videos to do at home, get a little map. So this is really nice information to have. This is really good resources. Again, it's free, but no cost to you guys.

Next slide.

Here is again, just a snapshot of the districts and who the benefits specialist assigned to those districts is. So, based on where you retired from, you're going to contact the name at the top of that page. And again, if one of us is not here, out of the office, on vacation, one of us is always available to help.

So if you need anything, reach out to any of us. And then the last slide that we have, last one. Yep. So this is just resources and contact information. We have social security. You'll need to talk to them for your social security income and Medicare card is here as well. The "Medicare and You" handbook is a really nice [01:18:00] tool.

They started doing it electronically, so you can go to CMS. gov and pull the PDF of the "Medicare and You". It's a lot of real boring reading, but it actually is kind of interesting, so it tells you all about the basics of Medicare, what it costs, what it pays, what is covered, what's not covered. It's a good resource.

And then HICAP also, the Health Insurance Counseling and Advocacy Program. Great resource as you navigate through your Medicare journey, especially if you're looking at options outside of RESIG, where we might not be able to speak to the details of those plans. HICAP is a good resource for that. And then that's it.

We just have a couple of additional phone numbers, Anthem, Blue Shield, Kaiser, here for you. If you want to reach out to them directly, of course, you can always reach out to them at RESIG.

Guest: What's your experience on the day you're supposed to enroll? Does the online system work?

Elizabeth: Yeah, I actually funny you ask! So, you know, before I sat down with a member who was feeling very unsure about the [01:19:00] Medicare application process. I sat down with her. We've done step by step. It's very easy to put her mind. Yeah, you shouldn't, you shouldn't have any problems. Yeah. You don't like have to get up at three in the morning.

as far as I know, because I just, there is a funny question that we had questions from for years and have to sit down with her and look at it. There's a question that asks. Something about, are you currently in a retired status? And there's an informational bubble. You have to read that because the way the question is worded and the way you want to answer it, won't let you move through the application. So if you get stuck, there's a question mark bubble. It should help.

Okay. If you have questions, you can contact us.

Guest: HiCap, I find very interesting. So I retired a few years ago, and he's going to retire this year turning 65. And so. I just have a million questions about comparing, you know, the RESIG Kaiser plan to simply having the [01:20:00] advantage, senior advantage and the plus, like, what am I really paying that extra $143 dollars a month for beyond that?

Elizabeth: This is a very common question and it really comes down to personal practice. There is a significant difference between the premiums you would pay to RESIG for the group products versus Kaiser's individual senior advantage. So, Kaiser has 2 individual senior advantage products, the basic and the enhanced.

Right now, one is the $0 premium cost and the other is something like, yeah, so there's some big differences on that plan. One of them is the donut that Shauna referenced multiple times. So, Kaiser's individual prescription benefits do have the donut hole. So, if you're taking lots of prescriptions, or if you're taking any brand name drugs, especially infusions, things like that, The cost of the, the retail cost of those drugs could put you into that donut holder gap.

If you're taking a handful of [01:21:00] generics, probably not going to hit it. Another big difference is the annual out of pocket maximums. So our plans are set, they actually just reduced from $1500 to $1000 last year. Kaiser's individual out of pocket maximums are much higher. One is at $6200 and the other is 40 something.

So, that's a big difference. The annual out of pocket maximum is the literal cap or ceiling on your plan that prevents you from paying more out of your own pocket in a catastrophic situation. So, the lower the cap, [distorted]. Another big difference is in hospitalization. Kaiser charges you a certain amount per day, days one through five, one through seven, where the $10, you don't pay anything if you're hospitalized.

And on the $25, you would pay a hundred $500 per admission. So whether you stay one day or three months, if it's a single admission, it's just that $500 copayment. So there are some differences. If, [01:22:00] if you are somebody who needs to utilize services more often than somebody else, that would be maybe a reason to stay where it literally will save you money to pay a higher premium to not pay those out of pocket costs.

Some people like knowing that they have an attachment or some way back to their district or to RESIG. Some people just want to know that they have the peace of mind and the premium is something that they can handle and they just want a better coverage. So there are also folks who have family history of, you know, big illnesses that require a lot of service, so it really is an individualized personal decision. Our plan is more expensive because it is more robust. And offers lower out of pocket expenses as you incur services, and that works really well for a lot of people. Kaiser's individual plan also works really well for a lot of people.

So, again, we're not here to convince you to stay with the group, and we just want to make sure that when you make the decision. You [01:23:00] feel good and educated about making that decision and feel confident. You know, exactly what you're getting. So that's our job here.

Guest: Then your plan basically includes the Advantage plus also?

Elizabeth: There is the optical benefit. We do have chiropractic benefits built into the program. It does not and the gym discount. So, yeah, ours basically includes the plus the extra couple of bucks you pay plus also includes a Delta care benefit, which is a Delta dental HMO. The network is very limited and likely not going to find a provider here at all who will take it, but it does come along with the advantage plus.

Guest: Yeah, you know, I can see on the paper, you know, out of pocket, I can see the donut hole, which actually ends up being like, $3000 dollars is really the donut hole. I can see all that we've been lucky enough to [01:24:00] not know a lot about prescription drugs and or anything really, but I know that can change in a heartbeat or lack thereof.

Elizabeth: Yeah.

Guest: So I guess I just want to, I just want to know what things are hidden. Like, if I go in for care, I can see. Okay. I'm going to be, I'm going to be responsible for this much money or this much money. But I just want to know that the care ends up being the same.

Elizabeth: There can't be especially there are built in protections as a Medicare recipient. There are also built in protections as a group health coverage recipient. The quality and the type of care that you get from Kaiser being an individual member versus being a member enrolled in a group plan should not and will not differ.

Guest: Does it affect your ability to get those specialists?

Guest 2: My husband went on Medicare 5 years ago and stayed with Kaiser and I concur. There's been no [01:25:00] visible change that now he's got the Medicare Card versus the regular card.

Elizabeth: Yeah.

Yeah, you're going to notice the difference in the costs that you spend as you go through those services, but the type of care you get, it won't change.

Guest: Okay, between the RESIG and the.

And that's the same for Kaiser, Blue Shield, Blue Cross, I know the products, the same treatment, the same providers, the same access to care that you do on an individual basis.

But if I want to go through specific questions. About responsibilities that become mine outside of RESIG. High cap is the number too?

Elizabeth: Yeah, they can definitely talk about, they can give you some suggestions if you're looking at options outside of RESIG as well. So, yeah. Great resource. Yeah. Are there any other questions either from myself or any of the panelists that are still here?

Guest: Both of those cases, I heard a book where people left and went with Kaiser individually because they [01:26:00] were retiring 5 years before or when they reached age 65. Now, could they alter that decision and stay with RESIG because the spouse is now going to be making this RESIG versus individual decision?

Elizabeth: Are you talking about a couple or 2 individuals were employees of the district?

Guest: No, let's say only one was an employee of the district.

Elizabeth: So, if you're the subscriber to the policy, you can maintain coverage with RESIG. Even if you left. Assuming you're a couple, sorry. If you left, but she stayed on, you could come back and join RESIG during an open enrollment period or at a qualifying event.

So, again, the dependents can come on and off, but the subscribers have to maintain coverage with RESIG or you go outside and then you can't come back. Does that answer your question? Okay.

Guest: The 2nd question is is the Silver and Fit the same as the Silver Sneaker [01:27:00] program?

Elizabeth: Oh, Shawna, are you still on?

Shawna: Yes, I am. And no, they are.

Elizabeth: Is that the same change or was it a different program?

Shawna: It is a different program. I, I'm not well versed in what the differences are, but they are 2 different programs.

Elizabeth: Okay, yeah.

Guest: The silver sneaker one is the one that's offered through medicare.

Elizabeth: Right.

That's what's different in some way, I guess.

Yeah, it's a, it's a real cute name, but they're all basically similar to gym discount programs. But yes, the silver sneakers comes with Kaiser. Advantage Plus. Right.

Guest: And just fyi, at least in Sonoma County, the Y does not, does not take it. Yeah. At least silver sneaker. I dunno.

Elizabeth: And there might be a differentiation between the two programs since they are different.

But I'm gonna. Through Silver Sneakers. We'll look into that.

Anything else? Any panelists, someone [01:28:00] wanting to have any questions or want to Type a chat in?

Okay, well, I think that's it you guys.

This was great. Good, good conversation. Good questions. Thank you for joining us here today. If you have any questions, we're happy to stick around if you have questions. Or if you want to know if you need any assistance with any of the process.

Thank you so much.