Case Study: Health Benefits Program

Decent Essays
Informational Update Vol 7 #11

1. Health Benefits Program – If you are on Medicare, you have been bombarded by mail from various Medicare supplement programs, encouraging you to switch into their health plans. You also have received, or will receive, a letter from the Office of Labor Relations (OLR), explaining that you may now transfer out of your current health plan. This letter affects both Medicare and non-Medicare retirees.

Needless to say, all this activity has generated a barrage of calls and questions. “Why all this mail now?” “Should I switch my current plan?” Good questions causing confusion and uncertainty, which I will attempt to address.

You are receiving all this mail now because retiree private health plans and Medicare
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Perhaps, the one that really caught your attention was from Aetna. This plan does a line-by-line comparison with GHI/EBCBS Senior Care Plan (what most have) along with “Original Medicare.” On first blush, it looks like a much better plan than GHI as many of the costs are $0. However, understand that Aetna is a Medicare Advantage PPO Plan (all of the others you have received are either in the same category or are HMO’s), i.e. a health insurance program of managed health care that serves as a substitute for "Original Medicare" Parts A and B Medicare benefits. Under a PPO, you can go to doctors in or out of the network (HMO you must stay within the network). But if you go out of the network (and your current doctors may fall in that category) the co-pays can get to be quite …show more content…
That is a choice you must make. To help you make that decision, I have discussed the matter with the CSA Retiree Welfare Fund, which has recommended NOT transferring to an Advantage Plan. The belief is if you do, your medical costs will be more and you may not be able to use the doctors of your choice.

Must I do anything with the OLR letter if I choose NOT to transfer? NO. You may discard or keep the OLR letter for reference.

2. 2015 IRMAA – As I have said previously, you may now apply for 2015 IRMAA. You can download the application from the CSA Welfare Fund website, www.CSAwf.org. While the application is simple to fill out, you must enclose with it 2 documents: A copy of your and/or your eligible dependent’s Social Security Administration (SSA) letter issued to you and/or your eligible dependent at the end of CALENDAR YEAR 2014 showing what the income-related monthly adjustment amount will be in CALENDAR YEAR 2015 & a copy of your and/or your eligible dependent’s Form SSA-1099 issued to you by the SSA in January of CALENDAR YEAR 2016, as proof of the monthly Medicare Part B premium actually paid for CALENDAR YEAR 2015. If you cannot provide a Form SSA-1099 because you did not receive Social Security benefits in 2015 you must provide official documentation that you paid Medicare premiums in 2015 (a receipt from Social Security, cancelled checks for Medicare premium payment, or similar official documentation). REMEMBER

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