Important information about Medicare Advantage Open Enrollment
The Open Enrollment period for State and University retirees on State of Illinois Medicare Advantage plans will take place from Oct. 15 to Nov. 15.
Here are some important points about the open enrollment period:
- If you are currently enrolled in a State of Illinois Medicare Advantage plan, you do not need to do anything unless you want to make a change to your health insurance coverage. If you do plan to make a change such as changing your insurance provider, opting out of your health insurance benefits, or adding a dependent you will need to complete and return the enrollment form sent to you by CMS.
- If you are new to the Medicare Advantage plans, you must select one of the state’s Medicare Advantage plans by completing the enrollment form sent to you by CMS. You will remain enrolled in your current state health plan until December 31, 2014, with your new Medicare Advantage plan starting January 1, 2015.
- The plan year for 2015 will begin on January 1, 2015.
Plan Changes
- Thanks to AFSCME’s legal challenge and the resulting Supreme Court ruling in the Kanerva case, premiums for retiree health care have been restored to their 2011 levels—i.e. no premium cost for all those who retired with 20 or more years of service—pending a final ruling in circuit court. Consistent with the past practice and with the collective bargaining agreement between AFSCME and the State, co-payments and deductibles for retirees (whether in a PPO or HMO) will increase on the same basis as for active employees in the group health plan.
- However, the annual maximum out-of-pocket (the most any retiree or employee will have to pay for co-pays and deductibles) in a given year remains unchanged.
- Many members were reporting problems obtaining a 90-day supply of drugs this past year. For the 2015 plan year, you will be able to receive a 90-day supply of both maintenance and non-maintenance drugs at retail pharmacies and through mail order.
- If you live in one of the 48 counties that only had the United Healthcare PPO to select from last year, you will now be able to also select a Health Alliance HMO plan this benefit choice period. The Health Alliance HMO is not the same as the Health Alliance plan you may have had before transitioning to Medicare Advantage. It will be almost identical to the HMOs currently offered in other parts of the state.
Comparing Plan Designs
Deciding which plan to select is an important decision and largely depends on your own preferences and medical situation.
Here is a chart to show the general differences between the plans:
|
United Healthcare PPO |
HMOs (Coventry, Humana, Health Alliance) |
|
You can see any Medical provider, anywhere in the country as long as they accept Medicare rate schedules. This means you do not have to deal with a “network” |
You are restricted to seeing providers in the plan’s network. You should check to make sure your doctor is included in the plan network otherwise the plan likely won’t pay for visiting that doctor. |
|
Due to the relatively low out-of-pocket maximum for medical costs, this plan keeps total costs low if you see a doctor a moderate amount or anticipate medium to high medical costs. |
You pay a set dollar amount for each service (instead of a percentage), this keeps medical costs predictable and relatively low- but the maximum out-of-pocket is also much higher. This means that if you experience major medical issues in a plan year you could potentially pay much more total for treatment. |
Here is an overview of the costs for each plan:
|
|
United Healthcare PPO |
HMOs |
|
Annual Deductible |
$110 |
0 |
|
Annual Out-of-Pocket Maximum |
$1300 per individual |
$3000 per individual |
|
Doctor Office Visit |
15% copay |
$20 |
|
Specialist Office Visit |
15% copay |
$30 |
|
Preventative Services |
Free |
Free |
|
Emergency |
$65 copay/waived if admitted within 24 hrs |
$65 copay/ waived if admitted within 24 hrs |
|
Inpatient Hospital |
15% copay |
$350 |
|
Outpatient Surgery |
15% copay |
$250 |
|
Diagnostic Tests (labs, x-rays, etc.) |
15% copay |
Free |
|
Prescription Drugs |
$125 deductible |
$100 deductible |
|
Generic drugs |
$10 copay |
$8 copay (30 day supply) |
|
Preferred brand drugs |
$30 copay |
$26 copay (30 day supply) |
|
Non-preferred brand and specialty |
$60 copay |
$50 copay (30 day supply) |
|
90 day supply |
2.5 x copayment |
2.5 x copayment |
|
Contribution for Dependents (1 Dependent) |
$110.00 |
$89.91 |
|
Contribution for Dependents (=>2 Dependents) |
$155 |
$126 |
