medicare and uc medical insurance

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Medicare and UC Medical Insurance

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Confused about Medicare and UC Medical Insurance?

When does Medicare start? Do I lose my UC medical coverage? Do I have to enroll in Medicare when I’m 65? What if I’m still working? What if my spouse is 65; does he/she have to enroll in Medicare? Or lose UC coverage? What is meant by primary insurance? Secondary insurance?

Let’s take a look…Let’s take a look…

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Medicare

…is the nation’s health care plan for senior citizens. Eligible beneficiaries are required to enroll in Medicare when they attain age 65. Some persons are eligible for Medicare prior to age 65 due to specific health conditions such as end stage renal failure, permanent disability, etc. An eligible beneficiary can delay enrolling in Medicare past age 65 if that eligible beneficiary is covered by an active employer group health plan.

Medicare has 4 parts: Part A, B, “C” and D.Medicare has 4 parts: Part A, B, “C” and D.

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Medicare tidbits

Part A– Covers Hospitalization– Automatic at 65– No monthly costs (pre-

paid by active payroll taxes)

– Annual Deductible– Lifetime limits

Part B– Covers Physicians’ costs– Must enroll at 65*– Monthly cost – 2009 is

$96.40/month/beneficiary minimum

– Annual Deductibles– Lifetime limits

* Late Medicare enrollment, without penalty, is allowed if beneficiary is covered by Active Employer Group Coverage.

This is for information purposes only. Medicare Parts A, B, “C” & D do not play a role while you have active UC employer group insurance.


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More Medicare tidbits

Medicare Advantage Plans, formerly known as Medicare Part C or “Choice” Plans

– HMO “Senior” plan coordinates Medicare Parts A & B with their plan’s benefits

Note: Medicare Fee For Service (FFS) “Medicare stand-alone”, can be supplemented by other Medicare supplement plans

Part D - Drug Benefits– Must enroll at 65 or with

Medicare Part B enrollment– Annual Liabilities per

beneficiaryThe “donut hole”

$275 deductible25% copay; $275 - $2510100% copay on $3216.255% copay after $4050/year

– Lifetime limits



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Medicare Secondary Payer Rule

Medicare mandates that if a recipient is “eligible” for employer group health insurance, the employer group health insurance must be primary to Medicare.

Generally, Medicare* will not pay as a secondary when an employer group health plan has paid as a primary.

Medicare* may pay claims until COREs deductible is met. As the primary plan, CORE must first process the claims which will count towards it’s deductible. Medicare also has deductibles, co-insurances and some exclusions.

*Providers must be Medicare Certified; service must be covered by Medicare.*Providers must be Medicare Certified; service must be covered by Medicare.

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Getting Started:Primary vs. Secondary Insurance

Primary insurance is the first insurance plan that will be billed for services.

Secondary insurance is the second insurance plan that will be billed for services. A secondary insurance plan can pay an additional payment, in full or part, after the primary insurance plan has made payment or at least processed the claim.

Enrollment is not required in Part B if Medicare is secondary insurance to an active employer group health plan

Enrollment is not required in Part B if Medicare is secondary insurance to an active employer group health plan

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What does this mean to me?

This means, in some cases, you will not be required to enroll in Medicare Part B while actively employed by UCLA

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Medicare and UC Medical Insurance working together…

If you are a UCLA employee who receives medical insurance from your active UCLA appointment and has attained the age of 65 or older,

UCLA campus level coverage remains primary – no change in coverage or usage

Medicare Part A may start at age 65 and is “free” May postpone Medicare Part B enrollment until your UC

retirement Do not have to enroll in Medicare Part B while your active

UC group employer plan is your primary insurance

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If you are a UCLA employee who receives medical insurance from your active UCLA appointment and your spouse/domestic partner has attained the age of 65,

UCLA campus level coverage remains primary – no change in coverage or usage

Medicare Part A may start at age 65 and is “free” May postpone spouse’s/domestic partner’s enrollment in

Medicare Part B until your UC retirement Your spouse/domestic partner needn’t enroll in Medicare

Part B while your (UC employee’s) active UC group employer plan is your primary insurance

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If you are a rehired retiree (UC retiree/UCLA employee) who receives a monthly pension and medical insurance from UCOP, and you have attained the age of 65 or older,

You are not eligible for campus level coverage You are required to apply for Medicare Parts A & B. If

eligible for Medicare, you are required to enroll in Medicare and coordinate your UC retiree coverage with Medicare

Medicare Part A is “free” Medicare Part B has a monthly cost deducted from Social

Security pension income

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If you are a rehired retiree (UC retiree/UCLA employee) who receives a monthly pension and medical insurance from UCOP, and your spouse/domestic partner has attained the age of 65 or older, regardless of your age,

He/she is not eligible for campus level coverage He/she is required to apply for Medicare Parts A & B. If

eligible for Medicare, he/she is required to enroll in Medicare and coordinate UC retiree coverage with Medicare

Medicare Part A is “free” Medicare Part B has a monthly cost deducted from Social

Security pension income

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If you are a rehired retiree (UC retiree/UCLA employee) who elected a Lump Sum Cashout (in lieu of a monthly UC pension and medical insurance) at the time of your UC retirement, and you have attained the age of 65 or older, or your spouse/domestic partner has attained the age of 65 or older,

You are eligible for campus level coverage if your recall appointment is:

– At least 50% for 12 or more months or– At least 100% for 3 months or longer

You are not required to apply for Medicare Parts A & B.

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Employees retiring from UCLA…

… your Benefits Office willInitiate transition of your campus level coverage

to retiree level coverage with Office of the President, if eligible

Complete the Employer’s Statement for you and your spouse/domestic partner for enrollment in Medicare Part B

– the Employer’s Statement prevents a penalty for late Medicare enrollment

Overview the UC retiree insurance coordination with Medicare and explain changes in coverage and usage, if any

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Will I be eligible for UC insurance into retirement?

You may be eligible to continue your UC medical and dental coverage into retirement if ALL the following requirements are met:

You are enrolled in your UC plan when you leave UC employment,

You elect to continue coverage at the time of retirement, You retire within 120 days of terminating your UC

employment, Your coverage is continuous and premiums are current, You meet UC service credit requirements.

Applies to a monthly UCRP benefit election, not a lump sum cashout Applies to a monthly UCRP benefit election, not a lump sum cashout

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UC Contributions – The amount UC gives you for health insurance costs

You will receive 100% UC Contributions towards your medical and dental insurance if:

You have an UCRP entry date prior to January 1, 1990, and

You have at least 10 years of UCRP service credit, if retiring before age 55

Otherwise, see Graduated Eligibility

Note: Subject to conditions on slide 15.

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UC Contributions:100% Regents’ Contributions

…is the amount UC contributes to your medical and dental insurance plans costs into retirement and is based on the second tier of the Medical Contribution (salary) Band. It may not cover the entire premium thereby requiring retiree subsidies. Example, Retiree is eligible for 100% UC contributions, has Health Net and Delta Dental, UC Retiree plus Adult coverage:

UC Contribution = $770.87 Health Net

UC Contribution = $77.94 Delta Dental

Retiree Contribution = $136.16 Health Net (premium

subsidy – Just like active employees)

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If I started after 1990, will I be eligible for health benefits into retirement?

Yes, however Regents’ Contributions will be subject to Graduated Eligibility.

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UC Contributions – The amount UC gives you for health insurance costs

You will be subject to Graduated Eligibility if:

You have an UCRP entry date January 1, 1990 or later, and

You have a minimum of 10 years of UCRP service credit

-OR- Your service credit years plus your age equals at

least 75*

Note: Subject to conditions on slide 15.

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Graduated Eligibility – How it’s measured

UC Contribution is prorated based on UCRP service credit at retirement. The UC contribution will be multiplied by the designated percentage; the retiree is responsible for the balance.

UCRP Service Credit UC Contribution

(0-9)*10111213141516171819

20 or more

050%55%60%65%70%75%80%85%90%95%

100%

* Unless Rule of 75 (age plus service credit = 75 or more) is met, then 50%

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UC ContributionsGraduated Eligibility Contributions

…is the prorated amount UC contributes to your medical and dental insurance plans costs. It too may not cover the entire premium and may require premium subsidies paid by the retiree. Example, retiree (with 17 years) is eligible for 85% UC contributions, has Health Net and Delta Dental, UC Retiree plus Adult coverage:

UC Contribution = $655.24 Health Net (85% x $770.87)UC Contribution = $66.25 Delta Dental (85% x $77.94)

Retiree Contribution = $136.16 Health Net (premium subsidy)

plus 15% x $770.87 = $115.63 (balance of Health Net premium)plus 15% x $77.94 = $11.69 (balance of Delta Dental premium)Total Retiree Cost = $263.48 (2009 Medical & Dental costs)

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FAQs…

Q I am still actively working at UCLA and have Health Net medical insurance. Next month I turn 65. Do I need to sign up with Medicare? The Medicare website says I must enroll in Medicare at age 65. What will happen with my UC coverage?

A As long as your UC health insurance is active employer group health insurance (medical insurance from your UCLA appointment, not UC retirement plan), you can delay your enrollment into Medicare parts A & B and your UCLA health insurance will continue uninterrupted. Upon your UC retirement, you will receive an Employer’s Statement for Medicare which allows you to enroll in Medicare parts A & B without penalty.

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FAQs…

Q I am 57 and plan to retire from UCLA in 3 years. My husband* is on my medical insurance and will turn 65 next year. Does he have to enroll in Medicare?

A No, as long as your UC medical insurance is active employer group health plan insurance (medical insurance from your UCLA appointment, not UC retirement plan), your husband can delay enrollment into Medicare part B without penalty. When you retire from UCLA, your husband will receive an Employer’s Statement for Medicare which allows enrollment into Medicare without penalty.

*Also applies to Same Sex Domestic Partners.*Also applies to Same Sex Domestic Partners.

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FAQs…

Q I am a rehired retiree who has returned to work at UCLA 60%. I want to keep my retiree health insurance which is coordinated with Medicare. What can I do?

A If you continue to work at UCLA 60% time, you must change from your UC retiree medical plan to the campus level medical plan, offered to you from your appointment. NO EXCEPTIONS ALLOWED.

-OR-

You can reduce your appointment to 43% or lower and keep your retiree medical insurance coordinated with Medicare.

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Resources

Medicare Website at www.medicare.gov Campus Human Resources, 310.794.0830 Healthcare Human Resources, 310.794.0500 www.chr.ucla.edu, Health Plans, UC Regents

and Employee Health Plan Contributions Returning to UC Employment After

Retirement Factsheet and Waiver

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Medicare and UC Medical Insurance

The End

medicare and uc medical insurance

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