Gary L. Harbin, CPAExecutive Secretary

Teachers’ Retirement System of the State of Kentucky

Turning 65

2017

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Happy

65th

Birthday

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Insurance companies bombard you by

phone and mail with policies from the

open market as early as six months

before you turn 65.

Remember, it is not necessary to review these materials unless you expect to

pay a premium at TRS and would just like to compare policies.

About 3 Months

Before You

Turn 65

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TRS does not endorse

any vendor.

TRS Medicare Eligible

Health Plan

(MEHP)

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What Happens to Your TRS

Insurance Upon Turning Age

65?

If you are currently on TRS insurance

If you are not currently on TRS insurance

You will receive a turning 65 booklet explaining the TRS

Medicare Eligible Health Plan (MEHP) which is composed of

a Medicare Advantage PPO plan and a Medicare Part D

prescription drug plan.

You must request a turning 65 booklet explaining the TRS

Medicare Eligible Health Plan (MEHP) or download materials

from https://trs.ky.gov.

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The Turning 65 BookletT

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The Turning 65 Booklet

▪ Quick Step Guide

▪ Introduction & MEHP description

▪ Transitioning from KEHP

▪ Medical Summary of Benefits

▪ Prescription flyer

▪ Currently covered by a family, couple or parent plus plan?

▪ MEHP Enrollment Form (blue)

▪ Return to TRS envelope

Getting to Know ...

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Administered by Centers for Medicare & Medicaid Services (CMS)

Health insurance for

people age 65 and older

or anyone

Social Security disabled

for over 24 months.

Enroll by contacting Social Security Administration (SSA)

or

Railroad Retirement Board (RRB)

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Medicare

Original Medicare (1965)

• Part A – Hospital coverage

• Part B – Medical coverage

• Run by the federal government

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Medicare Advantage Plan

(Balanced Budget Act of 1997)

• Part C

• Run by private companies

There are 2 main ways to

receive medical coverage when on Medicare ...

#1

#2

Claims go to Medicare

first & you should

purchase additional

supplemental/secondary

coverage

Original Medicare Medicare Advantage

Medicare Advantage

claims go to private company (like

UnitedHealthcare) to pay and process as

primary & secondary. No need to

purchase supplemental coverage

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The medical portion of the TRS MEHP is a

Medicare Advantage plan administered by UnitedHealthcare.

▪ Result of the Medicare Modernization

Act 2003

▪ Also known as

Medicare Part D

▪ Run by private companies

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The prescription portion of the TRS MEHP is a Medicare Part D

prescription drug plan administered by Express Scripts.

What about Medicare RX coverage?

Express Scripts

Medicare Part D prescription drug

plan covers

prescription claims

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Do not enroll in another Medicare Advantage plan

or Medicare Part D plan outside of TRS.

UnitedHealthcare

Medicare Advantage plan

covers

medical claims

The TRS

Quick Step

Guide

14

on

how to enroll

in the MEHP

~~

• Apply for Medicare 3 months BEFOREyour 65th birthday

You MUST …

• You will automatically be enrolled in Medicare Parts A & B.

• Your Medicare card will be mailed to you.

If you are receiving Social Security

or Railroad Retirement benefits …

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Enroll In Medicare

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More About Enrolling in Medicare

You must enroll in Medicare to be

eligible to enroll in the TRS MEHP!

Not eligible to receive Social Security Benefits?

You will NOT receive Medicare

automatically. You must apply!

The ways to apply for Medicare are

Call or visit your

local Social Security

office

Apply

online at

www.ssa.gov/medicare/

Take original documents such as Drivers License, Social Security Card, Birth Certificate, Marriage License, Proof of Income

ORIf you worked for a

railroad, call the RRB at

877-772-5772

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What Parts of Medicare Do I Need?

• You must enroll in Medicare Part B.

• Only enroll in Part A if it’s FREE. You could possibly qualify for free Part A through a spouse, ex-spouse or deceased spouse who paid into Social Security.

• Not eligible for free Part A? The TRS plan will pay as Medicare would have paid on Part A expenses, excluding the MEHP deductibles and copayments.

Retirees

• Enroll in Medicare Part A.

• Enroll in Medicare Part B.Spouses

• Do not enroll in Medicare Part D.

You will have a Medicare Part D plan through Express

Scripts when you enroll in the TRS MEHP.

Retirees & Spouses

www.medicare.gov

• Everyone must enroll in Part B and pay the standard Part

B monthly premium ($134 for those new to Medicare in

2017).

• If you don’t enroll or fail to pay the Part B premium,

your TRS MEHP will be terminated.

• Ways to pay Part B premium

• Auto deduct from your monthly Social Security

benefit check

• Billed quarterly by Social Security if no Social

Security Benefit check

• If billed quarterly, contact Medicare to enroll in

Medicare Easy Pay for monthly auto deduction

from a checking account.

• Or, sign up for your bank’s online bill payment

service, if available to you.

Additional Medicare Part B information

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Page 1

Complete

MEHP

Enrollment

Form

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Complete the blue MEHP

enrollment form by copying your

Medicare claim number from

your Medicare Card.

Page 2

Always keep your address

current with TRS, Medicare

& Social Security.

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Submit Your MEHP

Enrollment Form to TRS

If available, include a copy of your

red, white and blue Medicare card

with the blue MEHP enrollment

form. Otherwise, fax or mail a copy

upon receipt.

▪ Form should be submitted to TRS two months before your 65th

birth month, but no later than the last day of the month before you

turn 65.

For example:

Birthday is Oct. 16, submit by Sept. 30

Born on the first day of the month?

(Sept. 1, Oct 1., Nov. 1)

Submit one month early

For example:

Birthday is Oct. 1, submit by Aug. 31

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What About Covered

Dependents?

On a KEHP Couple or

Family plan?

▪ May need to complete and return

the KEHP Qualifying Event Form

to continue or waive coverage for

remaining dependents. See page

26 of the Turning 65 booklet.

▪ KEHP rates are shown on the rate

chart included in the booklet.

On a Parent Plus plan?

▪ You will receive a separate

COBRA packet from

WageWorks before the

termination date to continue

coverage for the child, if needed.

▪ If the child is disabled and has

Medicare Parts A & B, you can

enroll them in the TRS MEHP.

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TRS MEHP Medical Coverage Overview

Medical Deductible

-$150 per calendar year, then

- Member pays 4%, plan pays 96% of

covered expenses

Other copayments:

- $200 Inpatient Hospital Copayment

- $35 Urgently Needed Services

Member’s maximum out-of-pocket is

$1,200 per calendar year

- Once met, plan pays 100% of covered

expenses

The deductible, copayments and

coinsurance apply toward $1,200 out-of-

pocket annual maximum.

Medicare covered preventive care paid at 100% with no deductible to meet.

Receive a gift card for completing your Annual Wellness Visit by June 30

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Additional features of the MEHP

• A routine hearing exam every 12 months, $0 copay

• A $500 hearing aid allowance every 36 months

• hi HealthInnovations Hearing Aids Discount Program

• 6 routine podiatry visits per plan year, $0 copay

• HouseCalls, in home assessment program, $0 copay, Target

gift card reward

• Solutions for Caregivers –resources to help in caregiving

• Dedicated UHC Retiree Advocate to help with escalated

issues and meet face to face with TRS retirees, if necessary

• SilverSneakers fitness program provided at no cost. Find

participating facilities at www.silversneakers.com or call

888-423-4632

• Edumedics provides personalized care to those with chronic

diseases like diabetes, high cholesterol and high blood

pressure. For more information, call 855-210-8514

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TRS MEHP Part D Prescription Coverage Overview

Retail Program – designed for short-

term 30 day medications

Deductible -$150 per calendar year

Coinsurance after deductible is met

- Tier 1: 20% Generic

- Tier 2: 20% Preferred brand

- Tier 3: 50% Non-preferred drugs

(generics & brands)

Mail Program – designed for maintenance

90 day medications

Deductible -$0 per calendar year

Copayment

- Tier 1: $10 Generic

- Tier 2: $20 Preferred brand

- Tier 3: 50% Non-preferred drugs

(generics & brands)

In the coverage gap stage (donut hole),

you pay the same as shown above.

Confidential and Proprietary Information© 2014 Express Scripts Holding Company. All Rights Reserved. 26

Know Your Rx Coalition

855-218-5979

Clinical Director

Lucy Wells

Dedicated Clinical

Pharmacists

Travis Albrecht

Marissa Boelhauf

Lea Goggin

Amy Griesser

Charla Katz

Matt McMahan

April Prather

Allison Russell

Know Your Rx Coalition Pharm-Assist Offering

Monday-Friday 8 a.m. – 6 p.m. ET

• Free counseling service via live pharmacists

• Identification of lower-cost prescription

alternatives

• Contacting physician to facilitate seeking

authorization for lower-cost alternative therapies

• Liaison for retirees/physicians for issues with

Rx benefit including prior authorization, step

therapy and other programs

• Educational resources for retirees – adverse

effects, drug interactions and general medication

information

• All major chain pharmacies included in the

retail pharmacy network.

• Show your Express Scripts ID card at the

retail pharmacy.

• To avoid any possible lapse in your

medication with the TRS MEHP, obtain a

refill through your current plan by the

last day of the month prior to your birth

month.

TRS MEHP Overview

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• This Medicare Advantage plan allows you the

same in- and out-of-network cost-share;

therefore, you can see any licensed provider

who accepts Medicare patients and Medicare

assignment and agrees to bill UHC directly.

• Show providers your UHC Medicare Advantage

ID card and have them file claims directly with

UHC instead of Medicare.

• Providers submit claims directly to UHC &

provider will bill you after claims have been

processed by UHC. Do not pay the provider

anything up front.

Please note: If you enroll in another Medicare Advantage plan or Medicare Part

D plan outside of TRS, your TRS MEHP terminates immediately.

Benefit Booklets and Identification Cards

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Present at doctor or

hospital

Present at retail

pharmacy

DO NOT present your Original Medicare card to your providers.

On the effective date of coverage, if you have not received your ID cards, you can print

a temporary ID card by registering at www.uhcretiree.com/trs and www.express-

scripts.com.

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What else should you expect?

Within the first 90 days

of enrollment you should

expect:

Welcome Call

AND

Health Assessment Call

Introduction Call

OR

Email

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What will the MEHP cost?

How much does the MEHP cost for 2017?

Listed below is the monthly cost of the 2017 MEHP (you also must continue to pay

your Medicare Part B premium and any additional Part B and Part D income-adjusted

premium billed by Social Security).

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Recommend contacting TRS to verify your premium.

Reciprocity retirees must contact TRS for premium calculation.

Years of

Service

TRS Entry Date

Before

July 1, 2002

TRS Entry Date on or

After

July 1, 2002

TRS Entry Date on or

After

July 1, 2008 Medicare-Eligible

Spouses/Children

Pay

Full Monthly

Premium

of

$252

and

the monthly

Medicare Part B

premium

5-9.99 $189 $226.80 Not Eligible

10-14.99 $126 $189 Not Eligible

15-19.99 $63 $138.60 $138.60

20-24.99 $0 $88.20 $88.20

25-25.99 $0 $25.20 $25.20

26-26.99 $0 $12.60 $12.60

27 or more $0 $0 $0

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What Additional Premiums Can You Expect?

Above amounts are in addition to the standard Part B premium

amount paid to Social Security ($134 for those new to Medicare in

2017) and the MEHP premium paid to TRS (if any).

Late enrollment penalty from Social Security

• Penalty for failing to enroll in Medicare Part B or a

Medicare Part D plan when first eligible

• This is a monthly premium paid to Social Security.

High income earner premium from Social Security

• Additional monthly premium if your income, as reported

on your IRS tax return from 2 years prior, is greater than

$85,000 for individuals or $170,000 for those filing joint

tax returns

• This is a monthly premium paid to Social Security.

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What Happens if You

MEHP Coverage?

W A I V E

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▪ Open enrollment not an

option

▪ You must experience a

qualifying event to enroll.

▪ Spouse loses other

employer/ retirement

system sponsored coverage,

spouse’s COBRA expires,

tag-along with retiree or

death of retiree

W A I V E

Retiree Waives

MEHP upon

turning 65

Spouse Waives

MEHP upon

turning 65

▪ Open enrollment effective

Jan. 1

▪ Outside of open enrollment

you must experience a

valid qualifying event.

▪ Loss of other coverage,

COBRA expires, gaining

Medicare Part B or moving

back to U.S.

If you are retired and

employed by an agency

that does not participate

in the KEHP, but you

are eligible for health

insurance through that

employment, you must

terminate TRS

coverage unless that

coverage is not as good

as TRS coverage. You

may be asked to certify

this information.

If you are retired

and employed by

an agency that

participates in the

Kentucky

Employees’ Health

Plan (KEHP) and

you are eligible for

health insurance,

you must terminate

coverage through

TRS.

Additionally, once

you terminate that

employment or lose

eligibility for active

insurance, it is your

responsibility to

contact TRS within

the qualifying event

period (usually 30

days) to re-enroll and

provide the required

documentation.

1 2 3

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livingwell.ky.gov

Also,if you have a Consumer Driven

Health Plan (CDHP) you will want to use any remaining HRA funds before moving to the MEHP.

Don’t forget you may have

unspent bucks left with

Go365. You will need to

spend all your bucks in the

Go365 Mall before your

Kentucky Employees’ Health

Plan terminates.

MALL

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With the TRS MEHP

Good news!

Let’s Have a Big “Shout-Out” to

TRS Retirees LIVING LONGER!

Age 100 years old or more 48

Age 95-99 years old 211

Age 90-94 years old 780

Age 80-89 years old 5,03338

4,800

5,000

5,200

5,400

5,600

5,800

6,000

6,200

2010 2011 2012 2013 2014 2015 2016

5,107

5,2765,297

5, 535

5,692

5,864

6,072

Retirees Over 80

As of Dec. 31

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REMINDER!

Benefits & Costs Can Change on an

Annual Basis

✓ Deductibles

✓ Coinsurance/copayments

✓ List of covered drugs

✓ Premiums

Always watch TRS newsletters for changes and

notices.

TRS Keeping In Touch

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Online

Special mailings and newsletters

Information Center

TRS News & Information

https://trs.ky.gov https://mss.trs.ky.gov/

TRS

facebook.com/KyTeachersRS @KyTeachersRS

Our Members

Come First!

As always, you may contact

TRS if you have any

questions or concerns.

Monday through Friday,

8 a.m. – 5 p.m. ET

800-618-1687

502-848-8500https://trs.ky.gov

Protecting & Preserving Teachers’ Retirement Benefits 42