Medicare Advantage Plan Highlights

What's new ... Medicare Advantage Plans.

Something you’ll really like. We’re introducing two new Medicare Advantage Plans for our Medicare-covered retirees and their Medicare-covered dependents that will save you some major money.

Your two new choices: TexanPlus and Texas HealthSpring.

Both are managed locally and are similar to the HMO-type benefits and prescription drug plan provided by the city – but with mighty attractive financial incentives. Such as:

	Lower monthly contributions: 85 to 92-percent savings on “retiree only” contributions.
	Lower copayments: 50 to 75-percent savings on standard PCP visits.
	Familiar plan design: similar to the HMO BlueTexas HMO plan.
	Prescription drug plan closely resembling the city’s HMO and PPO drug plan.
	Possibility for split-family elections.
	Try it ... you can return to the HMO or PPO.
	You can enroll in this plan, and your dependents can stay in the HMO or PPO.

What are my Medicare Advantage Plan Options?

Who is Eligible for the Medicare Advantage Plans?

Important Dates

Medicare Advantage Plan Highlights

What exactly are Medicare Advantage Plans

Medicare Advantage Plan Comparison

Medicare's Relationship to These New Plans

Things to Consider

Contribution Rates

Rules to Know for Medicare Advantage Plans

Prescription Drugs

Service Area

 

 

What are my Medicare Advantage Plan options?

They’re very similar to the HMO. In some areas the city’s plan offers a more generous benefit but in other areas, especially in out-of-pocket savings, the new plans are more generous. The plans recall the NYLCare65 plan offered until 2000. Click here for a description of benefits and the comparison chart for more plan features.

Both Medicare Advantage plans are based in Houston and offer quality health care, maintaining many of the doctor-patient relationships you already enjoy.

TexanPlus (866) 556-4607

Texas HealthSpring (800) 846-2098

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Who is Eligible for the Medicare Advantage Plans?

Possibly you. Here are the FIVE things you need to qualify:

1. Be a city retiree, dependent or survivor currently covered under a city medical plan.
2. Be a card-carrying member of Medicare enrolled for coverage in both Part A (hospital insurance) and Part B (medical insurance).
3. Live in the plan’s service area.
4. Pay the required premium to the city.
5. Not have end stage renal disease

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

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Medicare Advantage Plan Highlights

Here are some familiar features of these new plans.

	Familiar physician networks: Kelsey-Seybold’s 250 Houston-area physicians in TexanPlus; Renaissance physicians in Texas HealthSpring.
	Some new physicians who are not in the HMO Blue Texas network.
	Plan design is similar to the HMO Blue Texas HMO.
	The prescription benefits are similar to the HMO and PPO drug copayment structure, although there are differences in drug formularies and annual limits.
	Access to familiar retail pharmacies like CVS, Walgreens, HEB, Kroger, Randalls and others.
	Access to state-of-the-art medical facilities like St. Luke’s and Methodist hospitals.
	Urgent-care center locations so convenient they could almost be considered a house call.
	Both plans offer dramatic savings in monthly contributions and doctor-visit copayments.

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Savings? Okay, show me the money.

Lower monthly contributions: 85 to 92-percent savings on “retiree only” monthly contributions. Click here to see the contributions.

Lower out-of-pocket costs on many services including:

	50 to 75 percent savings on PCP visits;
	$100 savings on emergency room visits;
	Inpatient hospital care and mental health care;
	Durable medical equipment;
	No copayment for home health care visits.

How can such benefits be provided at a lower cost?

	All health care issues are managed locally.
	Plans have a smaller network of physicians and medical centers.
	The federal government is shouldering most of the financial responsibility.

What’s the downside?

	A smaller network of physicians, hospitals and urgent-care centers.
	Geographical considerations. You must reside in designated service areas to be able to participate. Service area maps.

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What exactly are Medicare Advantage Plans?

Medicare offers you different ways to get your Medicare benefits when you reach age 65. One option is called Original Medicare, and is the traditional form that underlies your retiree health coverage from the city.

Another option is called Medicare Advantage Plan where Medicare contracts with private companies to provide the benefits instead of Medicare. This kind of plan is similar to the NYLCare65 plan the city offered until 2000.

Medicare Advantage plans that are offered now are similar to HMOs. You must choose a PCP and use network providers. When you enroll in this type of plan, Medicare pays a monthly amount to TexanPlus and Texas HealthSpring for them to cover your Medicare benefits, instead of Medicare. That means these Medicare Advantage plans cover everything Medicare covers, and more. Medicare writes most of the rules that the vendor and retiree must follow.

These plans will replace your HMO or PPO plan and Medicare.

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Medicare Advantage Plan Comparison

The following plan features are effective May 1, 2005.

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Medicare's relationship to these two new plans

This is a lot of new and exciting information you should consider to make this important decision. We have provided the following information for you to use in making your decision:

	If you’re enrolled in the HMO or PPO, Medicare is primary; the HMO and PPO are secondary for your coordination of benefits.
	If you enroll in TexanPlus or Texas HealthSpring, then that plan becomes primary. All claims or inquiries are handled by the new plan in place of Medicare. These plans replace the HMO, PPO and Medicare.
	Medicare has turned over all responsibility for your care to these two plans. You still pay your Medicare premium, but it is the responsibility of the new plans to manage your care.
	TexanPlus and Texas HealthSpring are governed exclusively by Medicare, which writes all the rules for these plans. Medicare may mandate a benefits change in the future.
	Future retiree contributions are subject to change.
	If Medicare increases benefits, the city will determine if we will change the plan now offered to you. If additional costs are passed along to the city next year, we will determine if a cost is passed along to you.
	Medicare cannot decrease benefits in 2005.