COH Benefits

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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.

2025 Medicare Advantage Plan OPEN ENROLLMENT: October 28 - November 22, 2024

Open enrollment is a time for you to review your benefit elections and make changes as necessary.

What to know

For Kelsey Care Advantage, all members will receive new ID cards in December. All Aetna members will not receive new ID cards unless they switch from Basic to Premier, are new to Aetna or have a name change or change in Primary Care Physician.
Aetna and Kelsey Care Advantage have some new additional benefits, see inside for details.
Pharmacy Benefit Manager (PBM) with Kelsey Care Advantage will change from CVS Caremark to Optum Rx beginning January 1, 2025.

Open Enrollment Materials

Virtual Session
Date	Time	Meeting Number/Access Code	Meeting Password	Meeting Link

Nov. 14	10 a.m. - 11:30 a.m.	243 608 853 80	nRESkX	https://cohemployees.org/MA11-14-24
Nov. 20	1:00p - 2:30 p.m.	247 087 993 415	wxHTU6	https://cohemployees.org/MA11-20-24

In- Person Session
Date	Time	Location
Oct. 30	10 a.m. - 11:30 a.m.	E.B. Cape Center, 4501 Leeland St. Houston, TX 77023
Nov. 6	10 a.m. - 11:30 a.m.	E.B. Cape Center, 4501 Leeland St. Houston, TX 77023

Medicare Advantage Plan Options

aetna basic PPO

With the Aetna Basic PPO, you have access to in and out of network benefits with our National PPO plan. Use network doctors to avoid paying out-of-network cost sharing. Most in-network services have a set copay, providing you with certainty in your out- of-pocket costs.

Aetna Premier ESA PPO

With the Aetna Premier ESA PPO, you have access to in- and out-of-network providers. You pay the same cost share for any doctor or hospital, whether they are in- or out-o -network. Most services have a set copay, providing you with certainty in your out-of-pocket costs.

kelseycare advantage

With KelseyCare Advantage HMO, members have open access to Kelsey-Seybold Clinic’s premier multi-specialty physician group. This plan features low copays, same-day care and is a one-stop shop with access to all 29 KelseySeybold clinic locations.

2025 Monthly Medicare Advantage Plan Contributions

Monthly per person contributions
Aetna Basic PPO	$15.00
Aetna Premier PPO	$60.00
KelseyCare Advantage HMO	$42.00

Under all plans, you must pay a monthly premium to cover eligible family members. You also must pay the federal government for your premiums for Medicare Part A (if any) and Medicare Part B.

The premiums shown below apply to Medicare eligible retirees and their dependents, for whom the City of Houston pays 75% of the cost of monthly premiums. For monthly contributions for dependents under 65, see Monthly Medical Plan Rates for Retiree Under 65 Without Medicare.

Pharmacy Coverage

All of the City of Houston’s Medicare Advantage Plans include Part D, and offer comparable or better pharmacy benefits. The drug formularies established by Medicare for 2023 serves as the model for Medicare plan formularies.

If requested from your chosen provider*, you will receive a formulary list when you enroll in a plan. You can also find out how much your prescriptions will cost by calling the plan, visiting the plan’s website or viewing the prescriptions chart found in the Medicare Open Enrollment Guide.