A message from the Coach (For Retirees)

Dear Retirees,

You worked for the residents of this city. I sincerely thank you for that. As you enjoy your retirement, we’re working hard to keep the health plans affordable in these dire economic times.

But health-care costs are going up every year, and at a faster rate than the city’s income. Maintaining comprehensive coverage for 68,000 employees, retirees and dependents and the quality you expect is important to me, and that requires we share the increased cost. That means that those who cost the plan the most will have to take on a bigger share of the costs.

Medical-claims costs for retirees who are under age 65 are 65 percent higher than the costs for active employees and retirees covered by Medicare. So this year, we’re increasing the contribution percentage that retirees under age 65 pay. Starting May 1, retirees under age 65 will pay 48 percent of the total premium for your coverage. (See the contributions chart)

Additionally, for members in the BCBSTX HMO and PPO plans, copayments for doctor visits and brand-name prescriptions are going up $5.

However, there is good news: We’re also introducing a money-saving option for retirees. The new Opt-out Opt-in feature allows you to dis-enroll from your city medical and dental coverage and re-enroll later – even years later. That way, if you find affordable insurance elsewhere, you can drop your city coverage for now, and then if you want to come back for whatever reason, you can re-join the city’s medical and dental plans.
And, for Medicare-covered retirees, we have more money-saving options than ever. This year, we introduced four new Medicare plans for retirees age 65 and older, giving you nine options from which to pick exactly the coverage that suits your needs. The new plans have great health-care coverage and doctors you expect, and all cost less than the BCBSTX HMO and PPO plans.

All seven of the Medicare plans cost you less than $100 a month per member – and one costs you just $3.50 a month per member.

I know the rising cost of health-care is a strain on your wallet just as it’s a strain on our budget. But by working together, we can keep your health coverage strong, and secure the future of our plans.

Respectfully,

Mayor Annise D. Parker

New Plays / Overview

What are your options during open enrollment?

• Change from HMO to PPO or PPO to HMO.
• Do nothing and remain in the plan you are in now.
• If you are covered by Medicare
  • Enroll in a Medicare plan for yourself only.
  • Enroll in a Medicare plan for yourself and your Medicare-covered dependents.
  • Enroll in a Medicare plan for a Medicare-covered family member and leave another Medicare- or non-Medicare-covered family member in the BCBSTX HMO or PPO plan.
  • Return to the BCBSTX HMO or PPO within 90 days of Medicare-plan enrollment if you are not satisfied.
  • After 90 days, your next opportunity to return to the BCBSTX HMO or PPO will be Jan. 1, 2011.

New Plays for 2010

• In January, we added four new fantastic plans for you to choose from:
  • NEW! KelseyCare Advantage HMO, with low copayments. Your contribution is just $3.50 a month.
  • NEW! KelseyCare Advantage Plus Choice POS, which has the same Kelsey-Seybold network as the KelseyCare HMO, but allows you to see out-of-network specialists.
  • NEW! Aetna PPO covers 24 counties in Texas, and allows you to see a doctor or specialist outside the network.
  • NEW! Medicare supplement plan F is a “medigap” plan that pays for most Medicare approved services not paid by original Medicare.
  • Plus - UnitedHealthcare Prescription Drug Plan is a companion plan for the Medicare supplement plan F. This Medicare prescription drug plan allows you to pay the same copayments as you now pay.
• New Opt-out Opt-in feature allows you to opt out of the city’s medical and dental plans upon retiring and opt back in at a future date.
• Monthly contributions in the BCBSTX HMO and PPO are increasing effective May 1.
• Copayments in the BCBSTX HMO, PPO and prescription drug plans are changing.
• Time limitations on mental-health and substance-abuse treatment are being removed.
• By mid-June, HMO and PPO members will receive new ID cards to show the new copayments for prescription drugs, PCP, and specialists.

A good strategy for victory over rising health-care costs

Medicare offers you different ways to get your Medicare benefits when you reach age 65 or become covered under Medicare before age 65. Original Medicare is the traditional form that underlies your retiree health coverage from the city.

One option is a Medicare Advantage plan, where Medicare contracts with private companies to provide the benefits. Another option is a Medicare supplement plan, which fills in some gaps that Medicare doesn’t pay.

If you are covered by Medicare, these Medicare plans are just a different way to have Medicare coverage at a lower premium.

The federal government is still responsible for making sure each Medicare beneficiary gets full Medicare benefits. With Medicare plans, employers can increase benefits and provide some that are better than Medicare alone.

You have the choice of six Medicare Advantage plans and one supplement plan for 2010.
In all, you and your dependents will be able to choose from nine health-benefit plans, including the BCBSTX HMO and PPO plans:

• Four HMO plans: BCBSTX HMO, KelseyCare Advantage HMO, TexanPlus and Texas HealthSpring.
• Two PPO plans: BCBSTX PPO and Aetna PPO
• A point-of-service plan: KelseyCare Advantage Plus Choice POS
• A private-fee-for-service plan: Aetna PFFS
• Medicare supplement plan F with prescription coverage
  

Savings? Show me the money!

Medicare plans offer you significant savings. Below are some examples of how:

• The contribution for health coverage in a Medicare plan for one retiree is only $3.50 to $91.74 per month. Compare that to $163.82 per month to enroll in the HMO and $600.20 in the PPO.
• Copayments are at least 40 percent lower for a visit to the PCP and specialist – and one plan has a zero copayment for PCP visits.
• Most other copayments are lower:
  • Save $200- $500 on hospital admissions
  • Save $100 on emergency-room visits
  • Save an extra 5-10 percent on durable medical equipment
  • 100 percent coverage for home health visits
• The prescription benefit is better than Medicare Part D benefits.
• There is no Medicare Part D premium.
• You can join a Medicare plan now, and your dependents can remain in the BCBSTX HMO or PPO.
• You can enroll in a city-sponsored Medicare plan on the first day of any month in 2010. If the plan does not meet your needs, you can re-enroll in the BCBSTX HMO or PPO within 90 days of your enrollment in the Medicare plan, or on Jan. 1, 2011.
• Free rides if you enroll in Texas HealthSpring, KelseyCare or TexanPlus. Up to 15 round trips to doctors, hospitals and pharmacies per year in Texas HealthSpring; up to 10 round trips per year to doctors and hospitals in KelseyCare and Texan Plus.

Who’s eligible for Medicare plans?

Here are the FIVE requirements to enroll in one of these Medicare plans. You must:

1. Be a city retiree, dependent or survivor covered under a city medical plan
2. Pay the required premium to the city
3. Be enrolled for coverage in Medicare Part A, hospital insurance, and Medicare Part B, medical insurance
4. Not have end-stage renal disease, except for the Aetna PFFS plan
5. If you opted out of a city plan, you must re-enroll

There are no waiting periods, and you cannot be turned down for coverage for a pre-existing health condition.

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