2017 Verizon Retiree Health Care Benefits Info & Updates
(For full PDF of August 1, 2016 mailout with changes to Verizon retiree medical benefits: click here)
WHAT IS MEDICARE ADVANTAGE?
(scroll below this description for bargaining report and MOU)
The following information is taken directly from the Medicare.gov website. Because it is general information about Medicare Advantage, some of it may not apply to our situation.
How do Medicare Advantage Plans work?
Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare . You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare .
Medicare Advantage Plans cover all Medicare services
Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care . Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care .
The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.
Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D) . In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.
In 2016, most people pay the Part B premium of $104.90 each month.
If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service, but you have the right to appeal the decision.
You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won't pay for a service you think you need, you'll have to pay all of the costs if you didn't ask for an advance coverage decision.
Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year.
Costs for Medicare Advantage Plans
What you pay in a Medicare Advantage Plan depends on several factors.
Your out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:
- Whether the plan charges a monthly premium.
- Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.
- Whether the plan has a yearly deductible or any additional deductibles.
- How much you pay for each visit or service (copayment or coinsurance ). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.
- The type of health care services you need and how often you get them.
- Whether you go to a doctor or supplier who accepts assignment (if you're in a PPO, PFFS, or MSA plan and you go out-of-network ).
- Whether you follow the plan's rules, like using network providers.
- Whether you need extra benefits and if the plan charges for it.
- The plan's yearly limit on your out-of-pocket costs for all medical services.
- Whether you have Medicaid or get help from your state.
Each year, plans establish the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.
Drug coverage in Medicare Advantage Plans
You usually get prescription drug coverage (Part D) through the plan. In some types of plans that don't offer drug coverage, you can join a Medicare Prescription Drug Plan.
You can't have prescription drug coverage through both a Medicare Advantage Plan and a Medicare Prescription Drug Plan. If you're in a Medicare Advantage Plan that includes drug coverage and you join a Medicare Prescription Drug Plan, you'll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans
Medigap policies can't work with Medicare Advantage Plans.
13 things to know about Medicare Advantage Plans
- You're still in the Medicare Program.
- You still have Medicare rights and protections.
- You still get complete Part A and Part B coverage through the plan.
- You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.
- You can join a Medicare Advantage Plan even if you have a pre-existing condition , except for End-Stage Renal Disease (ESRD) .
- You can check with the plan before you get a service to find out if it's covered and what your costs may be.
- You must follow plan rules, like getting a referral to see a specialist to avoid higher costs if your plan requires it. The specialist you're referred to must also be in the plan's network. Check with the plan.
- If you go to a doctor, other health care provider, facility, or supplier that doesn't belong to the plan's network, your services may not be covered, or your costs could be higher. In most cases, this applies to Medicare Advantage HMOs and PPOs.
- Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
- If you join a clinical research study, some costs may be covered by your plan. Call your plan for more information..
- Medicare Advantage Plans can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
- Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.
- If the plan decides to stop participating in Medicare, you'll have to join another Medicare health plan or return to Original Medicare.
From Bargaining Report:
a. Retirees with a Net Credited Service Date on or after August 3, 2008. Annual benefit towards coverage in retirement will continue at $480 for each year of Net Credited Service (up to 30 years).
b. Retirees with Net Credited Service before August 3, 2008
i. Medicare-eligible Retirees
Beginning 2017, Medicare-eligible retirees currently covered by the MEP PPO or HCN plans will be enrolled into new Medicare Advantage plans.
Unlike traditional Medicare and the Verizon supplemental plan, the Medicare Advantage plan will provide full coverage under one card and one administrator.
Deductibles under Medicare Advantage MEP/PPO plan will decrease between $4 and $33 annually depending on retirement date. There will be no deductible for the Medicare Advantage HCN plan.
Plan designs are the same as the current Medicare Plans except the carryover deductible will not apply and a $15 specialist copay in the MEP plan.
All doctors that accept Medicare will be covered as in-network.
The Company and Union will work together to educate retirees about this change and ensure a smooth transition with a communications and outreach program funded by the company.
There will be no premium contributions for covered retirees enrolled in Medicare Advantage programs.
ii. Pre-Medicare Retirees
Post January 1, 2013 Pre-Medicare retirees will have their premium contributions frozen at the 2016 level for the life of this contract and are subject to any additional contributions as a result of piercing the caps on the company’s contribution for retiree health care. Over the term of the contract the following terms will apply to Pre-Medicare retirees enrolled in the MEP PPO plan or HCN plan: 2016
Pre-Medicare retirees enrolled in the MEP plan who are currently paying premium contributions as a result of piercing the caps on the company’s contribution for retiree health care will not be required to pay premium contributions when the new plan goes into effect. 2017 8
Pre-Medicare retirees who enroll in either the MEP plan or the HCN plan will be required to pay contributions in excess of the caps on the company’s contributions towards retiree health care, if any.
The HCN plan is currently projected not to exceed the caps on the company’s contributions towards retiree health care. The Union and the Company will negotiate a “new” plan option that will not exceed the caps on the company’s contributions for retiree health care. 2018
Pre-Medicare retirees will have three options:
(1) Enroll in the MEP and be required to pay premium contributions equal to the amount in excess of the caps on the company’s contributions toward retiree health care
(2) Enroll in the “new” plan that will be negotiated in 2017 that will not exceed the caps on the company’s contribution toward retiree health care which replaces the HCN option.
(3) Elect to receive an HRA in the amount of the caps on the company’s contribution to health care which will be $15,447 for retiree coverage, $30,893 for retiree + 1 coverage, and $38,639 for family coverage. The retiree then will purchase health insurance on the open market. Any excess funds in the HRA after purchasing a plan can be used for health care expenses incurred during that calendar year (ex. copays, deductible, etc.). 2019
Pre-Medicare retirees will have the same options that were available in 2018 except that the union has the right to bargain the “new” plan design on a yearly basis to keep the cost of the plan below the caps on the company’s contribution toward retiree health care. When you become eligible for Medicare you will be transitioned back into Verizon’s Medicare Advantage plans
CLICK HERE to read the complete Memorandum of Understanding (MOU) PDF from 2017 Verizon strike settlement. It's about 100 pages. Retiree health care section is from page 25 to page 35