Mzanyor@nco1921.org<\/a>><\/p>\nAll,<\/p>\n
I apologize in advance for the delay, but I was waiting on some clarification from Aetna and Pensions before sending this email out. \u00a0I will attempt to be as clear as possible, but if there are any questions please ask.<\/p>\n
First, a few main points you should know:<\/u><\/strong><\/p>\n <\/p>\n
\n- \u00a0Medicare Advantage (MA) Plans are also known as Medicare Part C plans and \u201cEggwhips\u201d (EGWP: employer group waiver plans) – it is a generic term that describes the type of plan but not extend of coverage, different MA plans have different coverage. \u00a0This MA plan is specifically for NJ public employees. \u00a0THIS DOES NOT PERTAIN TO MEMBERS COVERED UNDER THE EDUCATORS’ PLAN (SEHBP) – THAT MA IS SLIGHTLY DIFFERENT.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0The changeover will ONLY impact current medicare enrollees or members&spouses who become medicare eligible in 2019. \u00a0Medicare enrollment is mandatory at age 65.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0ALL medicare covered employees will be moved from their current plan into the Aetna MA PPO Extended Service Area plan on January 1, 2019 unless they \u201copt-out\u201d.<\/li>\n<\/ol>\n
<\/p>\n
\n- Referrals ARE NOT needed under this plan.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0There is no open enrollment period for any retiree (regardless of whenther medicare or non-medicare). \u00a0Instead, the following rule applies: any elective change is binding for one year from date of selection; an involutnary change can be changed at any time. \u00a0This is an important item to consider if opting out.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0The only plans available if a member opts out of MA and instead chooses medicare and a SHBP plan are Horizon products and they are:\u00a0NJ DIRECT1525,\u00a0NJ DIRECT2030,\u00a0Horizon HMOHorizon HMO1525Horizon HMO2030; Direct 15 is not an option. \u00a0Opt outs must be submitted before the end of December 2018. \u00a0REMEMBER THIS DECISION WILL BE BINDING FOR ONE YEAR. \u00a0However, if they are rolled over in January and don\u2019t like the coverage, they can then ELECT to go to different plan and then be locked-in for one year from the date of the elective change.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0In speaking to several retirees and other unions, going with MA or staying status quo is very much a personal decision that is truly case by case.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0The selling point of the MA plan is only one card is needed and Aetna handles all the paperwork.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0This doesn\u2019t affect prescription coverage. OptumRx is still handling that aspect.<\/li>\n<\/ol>\n
<\/p>\n
How Aetna MA works and covered services:<\/u><\/strong><\/p>\n <\/p>\n
\n- \u00a0There is no in-netowrk\/out-of-network issue. \u00a0If a provider accepts payment from Medicare, the plan will cover services from the provider. \u00a0HOWEVER, if the provider does not accept Medicare – even if in the Aetna network – services are not covered. \u00a0This was true even before MA was offered – you couldn\u2019t use Direct15 if you have medicare and the provider doesn\u2019t accept Medicare.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0The MA plan covers some things differently from the Direct15 and Aetna Freedom Plans. \u00a0For example, the MA copay is $15 for all doctors (regular and speciality), max out of pocket (OOP) is $1000 per person, ER visit is $75, and medical transportation and hospital are fully covered. \u00a0The non MA plans have higher max OOP\u2019s, $15 copay regular, $25 specialist, co-insurance (cost sharing) for hospitalization, medical transporation, and other items. \u00a0I\u2019ve attached PDF\u2019s with cost breakdowns.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0Some hospitals and providers will say they don\u2019t take Aetna MA even thought they take Medicare. \u00a0Per Aetna, if this happens, a member should call customer service and they will clarify it with the provider. \u00a0Sloan Kettering and Hospital For Specialized Surgery in NYC were identified by Aetna as examples that have told patients they don\u2019t take the plan but they do since they take Medicare. \u00a0Aetna also advised if a member is billed, the member should forward it to Aetna.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0Chriopractic visits covered under Medicare do not require a Prior Authorization (PA)-it is waived; non-medicare covered chriopractic visits are limited to 30 per year. \u00a0You may have heard or seen commercials and mailings say to not enroll in Aetna MA -some of these are sponsored by the Association of NJ Chiropractors. \u00a0I have a copy of a letter they have sent out – it is misleading propoganda.<\/li>\n<\/ol>\n
<\/p>\n
\n- \u00a0Preventitive OGBYN visitis covered at 100% go from once every 12 months to once every 24 months. \u00a0Any other visits subject to $15 copay.<\/li>\n<\/ol>\n
<\/p>\n
Summary:<\/u><\/strong><\/p>\n <\/p>\n
I personally see no benefit of opting out – the opt-out coverage is similar and the members\u2019 OOP is higher.<\/p>\n
<\/p>\n
THERE IS NO REASON TO SWITCH TO THE MA HMO – THE MA PPO IS BETTER AND CURRENT NJSP RETIREES AREN\u2019T SUBJECT TO PREMIUM COST SHARING. \u00a0THE PPO IS DEFAULT.<\/p>\n
<\/p>\n
Since it is a forced change, I would recommend trying the new coverage starting in January and then switching if unsatisified. \u00a0If a member opts-out, he or she can\u2019t return until a year from now. \u00a0However, I\u2019m sure there are individual circumtances in which opting-out is prudent.<\/p>\n
<\/p>\n
Finally, I have attached a comparison charts, a coverage summary sheet, a list of copays for the Aetna MA, a brochure from Aetna, and and change form for your reference. \u00a0I have also included a link to the NJ DOPB website and the Aetna NJ MA website.<\/p>\n
<\/p>\n
https:\/\/www.state.nj.us\/treasury\/pensions\/hb-retired-shbp.shtml<\/a><\/p>\n <\/p>\n
http:\/\/www.aetnastatenj.com\/state\/medical-retiree.php<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Mike Zanyor from the STFA\/NCO Associations is on the Plan Design Committee for the State Health Benefits and has been in regular contact with the FTA and me specifically as the Association Liaison regarding the changes in the Medicare Advantage … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/368"}],"collection":[{"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=368"}],"version-history":[{"count":2,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/368\/revisions"}],"predecessor-version":[{"id":374,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/368\/revisions\/374"}],"wp:attachment":[{"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=368"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=368"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ftanjsp.org\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=368"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}