medicare supplement plan information session for priests · 2/11/2020 · • the archdiocese will...

©2020 ARTHUR J. GALLAGHER & CO.

Medicare Supplement Plan Information Session for PriestsFebruary 11, 2020 & February 19, 2020

2 ©2020 ARTHUR J. GALLAGHER & CO.

I. Medicare 101

II. About the Hartford Medicare Supplement Plan

III. Why is the Archdiocese Offering a Medicare Supplement Plan?

IV. Next Steps

Agenda


Medicare 101


What is Medicare?Medicare is the federal health insurance program available to qualified U.S. residents.

Who is Eligible for Medicare?U.S. residents who are:

• 65 or older,

• Are under 65 and have been receiving disability benefits for 24 months from Social Security or Railroad Retirement Board, or

• Have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)

Medicare 101


Medicare 101

Part A Part B

What’s Covered

• Inpatient hospital services• Skilled nursing facilities• Hospice care• Some home health care

• Outpatient hospital care• Doctor visits• Medical supplies• Lab work & imaging• Ambulance• Preventive services

Cost No premium cost to enroll for most people Premium is scaled based on income

Medicare Network• Medicare is the largest network of medical

providers in the country• Includes most hospitals and 95% of physicians• Medicare’s benefits are identical throughout

the U.S.• With few exceptions, there is no coverage

outside the U.S.


• Medicare Supplement Plans help fill-in gaps not paid by Medicare Parts A and B such as deductibles, copays, and coinsurance

• Provide access to the entire U.S. network of Medicare providers

• Provide coverage for providers that accept Medicare as well as providers who do not accept Medicare*

What is a Medicare Supplement Plan?

*Hartford Medicare Supplement Plan does not cover expenses for providers who are opted-out of Medicare.


About the Hartford Medicare Supplement Plan


Hartford Medicare Supplement Plan Premium Choice Medical Plan

Medical Services Benefit DescriptionLifetime Maximum Unlimited

Calendar Year Deductible Plan pays 100%

Part A Deductible (days 1-60)Hospital Confinement (days 61-150) Plan pays 100%

Part B Deductible Plan pays 100%

Physician and Specialist Benefit Plan pays 100%

Outpatient Services Plan pays 100%

Urgent Care and Emergency Care Plan pays 100%

Annual Physical (with blood work) $25 copay($500 calendar year maximum)

Acupuncture $25 copay($500 calendar year maximum)

Chiropractic Services $25 copay($500 calendar year maximum)

Foreign Travel Emergency $250 deductible, then plan pays 80% up to $50,000 lifetime maximum


Hartford Medicare Supplement Plan Premium Choice Medical Plan

Hearing Services Benefit DescriptionPer Exam $25 copay

Two hearing aids, including fitting and evaluation every 3 years $50 copay

Calendar Year Maximum (exam & hardware) $1,000

Vision Services Benefit DescriptionPer Exam $25 copay

One pair of eyeglasses per year, or a 12-month supply of contact lenses $50 copay

Calendar Year Maximum (exam & hardware) $500


Hartford Medicare Supplement Plan Express Scripts Prescription Drug Plan

Retail Pharmacy Member CostGeneric Drugs $0 copay

per 31-day supply

Preferred Brand Drugs $30 copayper 31-day supply

Non-Preferred Brand Drugs / Specialty $60 copayper 31-day supply

Home Delivery / 90-Day Retail (CVS) Benefit DescriptionGeneric Drugs $0 copay

per 90-day supply

Preferred Brand Drugs $60 copayper 90-day supply

Non-Preferred Brand Drugs / Specialty $120 copayper 90-day supply


Hartford Plan vs. Current AGH Priest PlanCovered Services AGH Priest Plan Hartford Supplement PlanAnnual Deductible $400 $0

Coinsurance Plan pays 90% after deductible Plan pays 100%

Annual Out-of-Pocket Maximum $1,500 N/A

Preventive Care Plan pays 100% Plan pays 100%($25 copay for annual physical w/blood work)

Physician Office VisitPrimary Care PhysicianSpecialist

$15 copay$25 copay

Plan pays 100%Plan pays 100%

Urgent Care $25 copay Plan pays 100%

Emergency Room $100 copay Plan pays 100%

Inpatient Hospital Care Plan pays 90% after deductible Plan pays 100%

Outpatient Surgery Plan pays 90% after deductible Plan pays 100%

Diagnostic Tests (x-ray, labs, blood work) Plan pays 100% Plan pays 100%

Imaging (MRI, CT Scan, PET) Plan pays 90% after deductible Plan pays 100%

Retail PharmacyGenericPreferred BrandNon-Preferred Brand

For a 30-day supply:$5 copay

$30 copay$55 copay


$30 copay$60 copay

Home Delivery/90-Day Retail (CVS)GenericPreferred BrandNon-Preferred Brand


$60 copay$110 copay


$60 copay$120 copay


How Does the Plan Work?ID Cards

At the Doctor’s Office:

Medicare ID Card

Hartford Supplement ID Card

At the Pharmacy:

Express Scripts ID Card


How Does the Plan Work?Participating vs. Non-Participating vs. Opt-Out Providers

Participating Providers Non-Participating Providers Opt-Out Providers

Do they acceptMedicare coverage? Yes Yes No

How much can they charge for services?

Only up to the Medicare-approved

amount

Up to 15% more thanthe Medicare-approved

amountUp to their discretion

What do you pay?

Medicare and the Hartford Supplement

Plan cover 100% of the charges


Plan cover 100% of the charges, including any

“excess” charges above the Medicare-

approved amount


Plan do NOT cover opt-out providers – you pay 100% of the cost out-

of-pocket


Why is the Archdiocese Offering a Medicare Supplement Plan?


Why Offer a Medicare Supplement Plan?• The Archdiocese of Galveston-Houston Medical/Rx Plan is a self-funded plan. This

means the Archdiocese pays the claims cost for all members covered on the Plan.

• In 2019, the total annual cost for the Priest Medical/Rx Plan was $15,120 per priest.

2019 AGH Priest Plan Hartford Supplement PlanAnnual Cost to AGH Per Priest $15,120 $6,027

Number of Eligible Retired Priests x 44 Priests x 44 Priests

Total Annual Cost to AGH $665,301 $265,188

• The Archdiocese will save an estimated $9,093 annually per priest by moving to the Hartford Medicare Supplement Plan.

• The benefits on the Hartford Medicare Supplement Plan are richer than the current AGH Priest Plan.

• A win-win: the Archdiocese can offer better benefits to our Priests while simultaneously reducing costs.


Next Steps


1. Remember – the Medicare Supplement Plan is completely voluntary. You may choose to enroll in this plan, but it is not mandatory.

2. You must be enrolled in Medicare Part A and Part B to participate in the Hartford Supplement Plan.

3. If you are currently enrolled in Medicare Part A only, you may enroll in Medicare Part B until March 31, 2020 – refer to the Medicare Part B Sign Up Packet for instructions.

4. Be on the lookout for enrollment forms later this Spring. The Plan will go into effect July 1, 2020.

Next Steps


Questions?

medicare supplement plan information session for priests · 2/11/2020 · • the archdiocese will...

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