The University Record, November 5, 1997

Attention Retirees: FAQs about Medicare HMO health insurance plans

From the Benefits Office

The Benefits Office has received numerous questions about the new Medicare HMO plans offered to U-M retirees for 1998. The information below will be of interest to retired faculty and staff, and anyone contemplating retirement in 1998. Open enrollment ended Oct. 31. However, the adjustment period is Nov. 10Ð26. Application forms will be accepted through Nov. 26.

1. I do not live in the M-CARE or Care Choices Medicare HMO service area. Can I still enroll in one of them?

Yes. The HMO of your choice will send you an out-of-area waiver. In signing the waiver, you acknowledge that you do not live in the service area, but are willing to travel to the service area for treatment.

2. What is the difference between the "Senior Plan" (as the HMOs call it) and the "Medicare HMO" (as the Benefits Office calls it)?

First, both M-CARE and Care Choices offer two Senior Plans. One is an individual plan that anyone can sign up for (individual Senior Plan), and the other is a group plan offered through employers who provide retiree benefits (group Senior Plan). The Medicare HMO and the group Senior Plan referred to by the insurance companies are exactly the same.

The University of Michigan's contract with Care Choices has always included a $10 copay on office visits. However, Care Choices Health Plan, in the past, made a business decision to waive the $10 copay. They have indicated they will collect the copayment at the time services are provided under the new Medicare HMO.

3. For prescriptions, M-CARE permits the filling of a 31-day supply and Care Choices permits a 34-day supply. What if I need a 90-day supply for my medication?

At this time, neither M-CARE nor Care Choices have any provision allowing refills beyond the 31-and 34-day supply, respectively.

4. I am retired from the University and cover my spouse on my U of M health insurance. My spouse is retired from another employer and is covered through that company for health insurance as well. In the past, my spouse's former employer's insurance paid for medical expenses before my U of M insurance. If I change my U of M health insurance to a Medicare HMO, how will this affect my spouse's health insurance through his/her former employer?

Since your Medicare card is virtually no longer any good (do not throw it away though!) and all you need to show is your Medicare HMO identification card, your University of Michigan health insurance is primary to any other health plan in which you or your spouse may be enrolled.

5. What happens if my doctor refers me to a specialist outside my Medicare HMO service area?

It is not likely that your doctor will refer you outside the Medicare HMO service area. The Medicare HMOs have a complete array of specialists as well as primary care physicians. In the rare instance that your Medicare HMO does not have a specialist for your situation, your Medicare HMO will provide coverage for the specialist you are referred to outside their network. For more information, contact your Medicare HMO directly.

6. I have an automatic deduction from my checking or savings account to pay for my HMO coverage each month. Now that I am enrolled in a Medicare HMO, do I have to notify my bank to stop the deduction, or will you stop it automatically?

The Benefits Office will notify the Payroll Office to cancel the automatic deductions that have been set up through the Automatic Clearing House system. You will not have to do anything to have this deduction stopped.

7. What if I sign up for one of the Medicare HMOs and I do not like it? Can I get out at any time? If I drop the coverage, what kind of health insurance will I have instead of the Medicare HMO?

Medicare rules allow you to drop the Medicare HMO at any time. That is why you do not want to throw away your Medicare card. If you find that you do not want to remain in the Medicare HMO, you will need to make that request to the Benefits Office in writing. The Benefits Office will then change your health insurance coverage to Blue Cross Blue Shield of Michigan and United of Omaha Major Medical, with an effective date of the first of the month after your request letter is received. Of course, you can always change your health insurance to any other plan U-M offers during the next open enrollment period.

8. Will I continue to receive Medicare Part B quarterly reimbursement checks?

You will continue to pay Medicare Part B premiums through deductions from your monthly Social Security checks. And, yes, you will continue to receive the Medicare Part B reimbursement benefit checks each quarter.

9. I am happy with the health insurance plan I have now. What do I do if I want to keep the same health insurance plan for 1998?

If you or one of your dependents on your health insurance plan are under age 65, you do not need to do anything. The coverage you have now will continue automatically.

If you are currently enrolled in (1) Blue Cross Blue Shield of Michigan with United of Omaha Major Medical, or (2) HealthPlus of Michigan, or (3) Health Alliance Plan (HAP), or (4) M-CARE Point of Service Plan, and you want to remain with the same plan for 1998Ñregardless of your ageÑyou do not need to do anything. The coverage you have now will continue automatically.

If you and all your dependents on your health insurance plan are age 65 or older and you are enrolled in M-CARE HMO or Care Choices Health Plan, you must complete an application. Your health insurance choices are (1) Blue Cross Blue Shield of Michigan with United of Omaha Major Medical, or (2) HealthPlus of Michigan, or (3) Health Alliance Plan (HAP), or (4) M-CARE Point of Service Plan, or (5) M-CARE Medicare HMO, or (6) Care Choices Medicare HMO.

If the Benefits Office does not receive your application by the end of open enrollment, you will receive a letter reminding you that you need to make a choice. You will then have another opportunity to decide which health insurance plan you wish to enroll in for 1998. If we do not receive a response from you after that mailing, you will be automatically enrolled in Blue Cross Blue Shield of Michigan with United of Omaha Major Medical, effective Jan. 1, 1998.

10. I am not eligible to enroll in a Medicare HMO because I do not meet the eligibility requirements listed in the retirees open enrollment book. What are my health insurance choices?

The Medicare HMO eligibility requirements are listed on page 9 in the retirees open enrollment book. If you do not meet the requirements, your health insurance choices are: (1) Blue Cross Blue Shield of Michigan with United of Omaha Major Medical, or (2) HealthPlus of Michigan, or (3) Health Alliance Plan (HAP), or (4) M-CARE Point of Service Plan, or (5) M-CARE HMO, or (6) Care Choices Health Plan HMO.

11. If I leave the Medicare HMO service area, can I use my Medicare card for services?

Your Medicare card cannot be used outside the HMO service area when you join a Medicare HMO. Both Care Choices and M-CARE cover worldwide urgent and emergency services, so no matter where you travel, you are covered. For more information on urgent and emergency coverage, contact the HMOs directly.

12. When do I need to turn in my application to change my coverage to one of the Medicare HMOs?

Open enrollment ended Oct. 31. However, you may still change your coverage to a Medicare HMO as long as your application is received in our office by Nov. 26.

For plan benefit information for Medicare HMOs, please contact:

M-CARE Medicare HMO at 1-800-228-8554

Care Choices Medicare HMO at 1-800-307-9226

For eligibility and enrollment information, contact the Benefits Office, 763-1214, Option 3.