Medicare is health insurance for people age 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease (ESRD).
Whether you are an active or a retired City of Houston employee, you become eligible for Medicare on the first day of the month in which you turn age 65, or if your birthday is on the first of the month, on the first day of the prior month.
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What do I need to do?
If you, or a dependent, become Medicare eligible, you MUST apply for Medicare Part A and B. Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers certain doctor’s services, outpatient care, medical supplies, and preventative services.
- If you’re over age 65, or will be turning 65 in the next 3 months, AND are not already receiving benefits from Social Security, you will need to sign up with Social Security for coverage.
- If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part A and B and do not need to sign up with Social Security for coverage. Medicare will send you a “Welcome to Medicare” packet 3 months before you turn age 65.
Once you become covered by Medicare Part A and B, any medical coverage you carry with Cigna will end. Additionally, you will need to notify the City of Houston to enroll in any of the City of Houston’s supplemental Medicare Advantage plans.
- Cigna HealthSpring HMO
- TexanPlus HMO
- KelseyCare Advantage HMO
Low-cost, great care. These three plans offer you low premiums and copays – you can pay as little as $24 a month for coverage, and copays for primary-care services are between $0 and $10. But you have to stay within a network of services and must select a primary-care physician to coordinate your care.
These are high-quality doctors who will get to know you and your ailments well, and who are close by where you live. Service areas vary by plan. Available networks include Kelsey-Seybold, Renaissance, Memorial Clinical Associates, Heritage, and independent doctors. If you don’t mind having your coverage access limited to a local network of doctors, and you want to save money, these are the 3 plans to explore.
Aetna Steerage PPO
Room to stretch your wings. This plan gives you greater flexibility than the HMO plans. You select a network for coverage, but have the freedom to see doctors outside your network, for a higher cost.
This plan costs a little more than the HMO plans, but is still affordable at $100 a month. If you want to balance a little more freedom to choose a doctor within the Aetna network, this is the plan for you.
Medicare Supplement Plan F*
Unfettered freedom! But, freedom comes with a price. This plan allows you to go to doctors nationwide, but it has a slightly higher monthly contribution than the HMO plans. Plan F pays most out-of-pocket expenses for Medicare-approved services not paid by Original Medicare.
If freedom to choose any doctor who will accept traditional Medicare is more important than the price tag of the plan, this is the plan for you.
* Medicare Supplement Plan F is being discontinued for new enrollees that are eligible for Medicare on or after January 1, 2020. If you are currently Medicare-eligible, or will be Medicare-eligible prior to January 1, 2020, you can continue to keep this coverage or enroll in this plan for the first time. Please click here for more information regarding MACRA (the Medicare Access and CHIP Reauthorization Act of 2015).
All of the City of Houston’s Medicare plans offer prescription benefits more generous than Medicare Part D. The Medicare Supplement Plan F provides a companion drug plan that offers benefits equal to the other plans.
You’ll enjoy one of the richest prescription benefits around – fixed copays for most covered prescriptions.
Each plan has a different formulary list of covered drugs. The drug formulary established by Medicare for 2018 serves as a model for Medicare plan formularies. You received a formulary list when you enrolled in the plan. You can also find out how much your prescriptions will cost by calling the plan, visiting the plan’s website, or viewing the chart below.
Q: If my spouse or I am eligible to join a Medicare Advantage plan and one of us is not, will the non-Medicare-covered member still have insurance coverage?
A: Yes. You or your spouse who is not eligible to join a Medicare Advantage plan will keep your Cigna coverage.
Q: If I did not earn enough credits to be covered by Medicare, or I didn’t pay into the Social Security system for Medicare entitlement what coverage will I have after age 65?
A: You may retain coverage under a Cigna plan, but the coverage will be at a higher rate.
Q: I am comfortable with my PCP and receiving my care within a limited network. My spouse prefers freedom to see specialists of their choice, without restriction of a network. Can each of us have a different Medicare plan?
A: Yes, you may each have a separate plan.
Q: Which plan is best for me?
A: As you review the plan materials, you should consider your own medical situation, like your PCP, specialist, and the prescriptions you take. Check to see which networks your doctors are in and if your prescriptions are covered by that plan’s formulary and in which copayment tier they fall.
Q: I’m Medicare-eligible but do not have Medicare Part B. What are my options?
A: Retirees without Medicare Part B are able to remain on a Cigna plan provided they submit a copy of the letter from Medicare showing that they are not eligible for Part B.
Note: Retirees who do not have Medicare Part B will pay a higher contribution.
Apply for Medicare through the Social Security Administration by contacting them at 800.771.1213 or www.Medicare.gov.
If you are eligible for Part B but declined Part B, you must apply during the annual Medicare enrollment, January – March. Coverage will be effective July 1. If you don’t apply, you will become ineligible for a Cigna plan.
Q: Whom do I contact if I have a problem with billing, questions about what the plan covers, or claims and prescription concerns?
A: You should contact the plan in which you are enrolled at their customer-service phone number on the back of your insurance card.
Q: I’m in the Aetna Steerage PPO and live in the service area. How do I know if my doctors are in or out of network?
A: Go online to www.aetnamedicare.com to view a directory, or call 888.267.2637.
Q: I’m retired, and I turn 65 in November, making me Medicare eligible. Do I have to wait until spring Open Enrollment to switch to a Medicare plan?
A: No. Eligibility for Medicare Parts A and B starts on the first day of the month in which you turn 65, of if your birthday is on the first of the month, on the first day of the prior month. You should start the paperwork to enroll in Medicare two to three months in advance.
Q: If I am covered by a Medicare Advantage plan, and I will soon be moving out of state, will I be required to change to another Medicare Advantage plan?
A: If you are in the HMO, you will be required to change to one of the plans that offers nationwide coverage – the Aetna Steerage PPO plan or Supplement Plan F. If you’re already enrolled in one of these plans, you do not need to change.