City of Houston Open Enrollment 2010

New Plays / Overview	Prescription highlights
Comparison of plans	Contribution
HMO	Dental
PPO and POS	Resources
Network-free

Network-free plans

Network-free plans at a glance

There are two Medicare plans that are network-free to choose from. These are key features of the network-free plans you can choose from:

Aetna Private Fee-For-Service: Live out of Texas? Do you spend the summers with your grandkids up north? With the Aetna PFFS, there’s no network to worry about. Just call your doctor, ask the questions in the box below to ensure the doctor will agree to participate in the plan, and schedule an appointment. The plan includes thousands of doctors. Remember: This plan will be discontinued on Dec. 31, 2010.	NEW! Medicare supplement (Medigap) plan F: Medicare is a good program. But it doesn’t cover all your expenses. The Medicare supplement insurance plan picks up a lot of that slack by paying many of those expenses that Original Medicare doesn’t pay.
Network-free plans service areas
Nationwide coverage. About 96 percent of doctors in the U.S. can become part of the Aetna PFFS plan – they must accept Medicare assignment and agree to Aetna’s terms and conditions.	Nationwide coverage. There’s no need to join a network. Just keep your same doctor.
Plan features and costs comparison
You do not need a primary-care physician, but it is recommended you have one. No referrals are needed for specialists. $15 copayment for most services. Precertification for certain services is recommended but not required. Worldwide emergency care is available.	You do not have to select a primary-care physician. Covers nearly everything that Original Medicare doesn’t with very little, if any, out-of-pocket charges at the time of service. It covers the Part A hospitalization deductible and coinsurance plus coverage for an additional 365 days of hospital care after regular Medicare coverage ends. Worldwide emergency care is available. There is a $50,000 lifetime maximum.
Prescription coverage
The same great prescription-drug copayments offered in our other Medicare plans. Medicare Part B drugs are covered at 100 percent.	The same great prescription-drug copayments offered in our other Medicare plans is offered through the Medicare supplement companion prescription plan.
Extra benefits
Extra benefits include free case management, free healthy-lifestyle coaching, one free routine eye exam per year, discounts on frames and lenses, one free routine hearing exam per year, $500 reimbursement on hearing aids every 36 months, and membership discounts in GlobalFit Health Clubs.	N/A

Questions for your doctor before you choose Aetna PFFS

Do you accept Aetna’s Medicare Advantage Private-Fee-for-Service plan?
Do you accept Medicare Assignment?
Do you balance-bill?
Will you read the terms and conditions of participation and agree to be a deemed provider through Aetna?

Reconfirm the doctor’s participation at the time of your appointment. If the doctor treats you, he/she has agreed to Aetna’s terms and is a deemed provider.

The Aetna PFFS plan will no longer be available as of Jan. 1, 2011. If you join this plan or are a member of it, you will need to select another plan in November, 2010, for coverage effective Jan. 1, 2011.

Medicare supplement plan F

Medicare supplement plans (also known as “Medigap”) are a totally different concept than the Medicare Advantage plans familiar to you. In a Medicare supplement plan, Original Medicare continues to be your primary provider of Medicare-covered medical services, and the supplement plan fills in most “gaps” not paid for by Original Medicare (Parts A and B).

Of the 12 Medicare supplement plans, A through L, available to all age 65 or older Medicare-covered individuals, the city selected Medicare supplement plan F for our retirees. You will have almost no out-of-pocket expenses for Medicare-approved services. This plan will pay most costs not covered by Original Medicare such as deductibles for Medicare parts A and B and the coinsurance for Part B, generally 20 percent, that is your share of Medicare-approved medical expenses.

Since Medicare supplement plans do not include prescription drugs, the city is providing anyone enrolling in Medicare supplement plan F with a Medicare Part D prescription plan. The plan has the same copayments as other city-sponsored Medicare plans. Medicare Part D also has a preferred drug listing, or formulary.

The best part is the cost is significantly less than the BCBSTX PPO plan, and the city will contribute 75 percent of the premiums for both Medicare supplement plan F and the Medicare Part D prescription drug plan. Instead of paying the monthly PPO premium of $807 for two Medicare-covered people, you could pay $183.48 per month for plan F. The annual savings in contributions is $624 per month, or $7,484 per year. Now that’s real savings!

UnitedHealthcare is the insurance company providing both Medicare supplement plan F and the Medicare Part D prescription drug plan to city retirees. All Medicare supplement insurance policies must follow federal and state laws designed to protect you, and the benefits in the plans are standard. We chose UnitedHealthcare because it offers group Medicare supplement plans. You can pay your monthly premiums through deductions from your pension check – that means the city can take care of all administrative details for retirees who elect this plan.

Enrollment in the Medicare supplement plan is slightly different than in the other retiree plans. The Medicare Part D Prescription Drug plan and Medicare supplement plan F are separate plans and are administered by two different UnitedHealthcare offices, so you will need to complete a total of four separate enrollment forms:

One for Medicare supplement plan F (medical)
One for Medicare Part D (prescription drugs)
A city of Houston disenrollment form if you are changing from a Medicare plan
The city’s Medicare plans election form

If your spouse or any other dependents will also be enrolling in Medicare supplement plan F, each of them will also have to complete the two UnitedHealthcare enrollment forms for medical and prescription drug benefits and a form to disenroll from an MA plan. However, only the retiree completes the city of Houston Medicare plans election form.

Network-free service areas

Both network-free options are available nationwide.

Time of service costs

Listed below are the copayments for certain services in the Medicare supplement and PFFS plans.

Network-free plan features and costs comparison
Plan feature	What you pay
	Medicare supplement plan F		Aetna PFFS
Deductible (Individual/Family)	Medicare supplement plan F pays most Medicare-covered medical expenses that Medicare does not.		N/A
PCP office visit copayment			$15
Specialist office visit copayment			$15
Routine physical copayment			$0
Well woman/man exam			$0
Inpatient copayment/coinsurance			$0
Emergency room			$50
Ambulance			$15
Outpatient surgery			$0
Prescriptions participating pharmacy	Medicare supplement companion drug plan		30-day supply	90-day supply
	31-day supply	90-day supply
Generic	$10	$20	$10	$20
Preferred brand	$30	$60	$30	$60
Non-preferred brand	$45	$90	$45	$90
Specialty drugs	$45	$90	$45	$90

If there exists a conflict between this Enrollment Guide Website and the official plan documents for each plan, the official plan documents will prevail. The city of Houston reserves the right to change, modify, increase or terminate any benefits.