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Retiree Medicare Options

Update

We do not expect any plan design changes for 2012. We are waiting for final pricing and will post it on our Website once it is available.

Further down:

Medical Plans

We understand the difficulty of the choice you are making and offer plans to fit a variety of needs.  All of our medical plans are available with or without a creditable drug coverage plan.  If your situation changes, you may elect to add drug coverage at a later date in compliance with Centers for Medicare & Medicaid Services (CMS) guidelines.  The School District of Philadelphia (SDP) plans include traditional Medicare Supplements, Medicare Advantage, and Fee-For-Service plans.  

All polices are written as single coverage; therefore, you and a spouse may elect different plans.  For those eligible for Medicare based on their age (typically 65), we offer a rolling enrollment; coverage starts the first of the month after your dated application is received by the carrier.  Some plans may limit disability enrollment to the initial qualifying event.  

You enroll directly with the provider.  Our plans are offered by Independence Blue Cross (IBC) (877) 393-6731 and Aetna - a Medicare Advantage Organization [Contact Allen Heffler, CLU, at (215) 658-1555].  You may contact them for literature and information on these plans.

When you become eligible for Medicare, you may be eligible to elect coverage through PSERS Health Options Program (HOP).

The following chart summarizes our offerings.  Unless noted, rates adjust annual on Janaury 1. 

    

Medicare Advantage  - HMO Plans

Plan

Co pay

Monthly Premium

Aetna 25 HMO - No Prescription

Includes Free Gym Membership - membership details

$25 for Doctor,

$30 for  Specialist

2011-$166.70

2012 $TBD

 

IBC - Keystone 65 - No Prescription (4) (5)

Includes SilverSneakers Fitness Program - program details

 

$10 for Doctor,

$15 for  Specialist

2011-$270.40

 2012 $324.50

 

IBC - Keystone 65 with Select Drug - generic coverage in gap (1) (5)

Includes SilverSneakers Fitness Program - program details

 

$10 for Doctor, $15 for  Specialist

Formulary $ 5 / $20 / $ 40

90 day mail order for 1 co-pay

2011-$368.40

2012-$427.40

   
   

Medicare Advantage  - PPO Plans

IBC - Personal Choice 65 - No Prescription (4) (5)

Includes SilverSneakers Fitness Program - program details

$15 for Doctor,

$25 for  Specialist

2011-$445.70

2012 -$445.70

 

IBC - Personal Choice 65 with Select Drug - generic coverage in gap (1) (5)

Includes SilverSneakers Fitness Program - program details

$15 for Doctor, $25 for  Specialist

Formulary $ 5 / $20 / $ 40

90 day mail order for 1 co-pay

2011-$551.30

Aetna Medicare Custom PA Golden Choice PPO - No Prescription

Includes Free Gym Membership - membership details

$ 15 Regular and Specialist

2011

$188.80 for Phila County

$212.60 for Surrounding Counties

 

Aetna Medicare Custom PA Golden Choice PPO - Rx: generic coverage in gap(1)

Includes Free Gym Membership - membership details

 

$ 15 Regular and Specialist

Formulary $5 / $20 / $40

90 day mail order for 2 co-pays

 2011

$306.00 for Phila County

$338.20 for Surrounding Counties
 

Aetna Medicare Custom PA Golden Choice PPO - Rx: no gap

Includes Free Gym Membership - membership details

(1)

 

$ 15 Regular and Specialist

Formulary $5 / $20 / $40

90 day mail order for 2 co-pays

     2011

$426.50 for Phila County

$450.30 for Surrounding Counties
   
   

Medicare Supplements

IBC - Medigap Security C- No Prescription

No co pay

$222.96 **

Aetna Medicare Plan F
        No co pay

     2011

Starting at $188 per month based on age, gender and zip code

   
   

Health Options Program (HOP)

The Pennsylvania Public School Employees' Retirement System (PSERS) sponsors plans for PSERS retirees, their spouses or surviving spouses, and their dependents. Contact HOP at 1-800-773-7725 or www.hopbenefits.com  for plans and eligibility.

 
 

Free Standing Medicare D Drug Plan

IBC - Select Drug Option (No gap) (1)

OPEN Formulary $10 / $25 / $50

90 day mail order for 2 co-pays

Mail Order Form

2011- $449.10

2012- $506.90

 Aetna PDP Rx Option 08
 

Formulary $5 / $20 / $40

90 day mail order for 2 co-pays

 $171.40
 Aetna PDP Rx Option 013 (No gap)
 

Formulary $5 / $20 / $40

90 day mail order for 2 co-pays

 $292.20

(5) Available in the 5 County Philadelphia Area only

(6) Available to add to Medicare Supplements and Fee for Service Plans


A comparison of our plans can be viewed and printed from here.

Prescription Help

 

Rx Assist

Many pharmaceutical companies have income based programs to help defray costs for retirees who need help with prescription costs. To learn more about these programs, you can log on to Rx Assist  Patient Assistance Program Center. This is a central website that you can enter the prescription name and it will give you information on any available program.

 

Other Pharmaceutical Programs For Pennsylvania

          If you do not qualify for PACE or PACENET and do not have some other type of benefits to cover the cost of your prescription medications, there are programs that may be able to assist you. To learn more visit PA Rx Assitance.

 

Lipitor

Lipitor is running a promotion that will give a rebate of co-pays, up to $180 a year. If your insurance co-pay is:

  • Less than $35, you will instantly receive $10 or the amount of your co-pay (whichever is less), up to 12 times per year (up to $120 in savings).
  • $35 or greater, you will instantly receive $15 toward your co-pay, up to 12 times per year ($180 in savings).

 
To learn more, call Customer Service at 1-877-234-3050 and ask about the "Lipitor Copay Card" or visit www.lipitor.com/offers.

Help for Those on Medicare


Medicare     www.medicare.gov  1-800-633-4227

      Pennsylvania 

Apprise health insurance counseling (Department of Aging)

1-800-783-7067

Bucks County 

215-348-0510

Chester County 

610-344-5004

Delaware County

610-237-6222

Montgomery County

610-278-3601

 

CARIE  (Center for Advocacy for the Rights and Interests of the Elderly)

Philadelphia:
215-545-5728;
Outside Philadelphia: 1-800-356-3606

 

     New Jersey

  Burlington County

  609-265-5069

  Camden County

  1-877-222-3737

  Gloucester County

  856-384-6900

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Optional Retiree Dental and Vision

 

Retirees who join PASR may enroll in their sponsored benefits. This include Dental and vision as well as other benefits:

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Other Information & Resources

 

Pennsylvania’s “MOM” Medicare Over Charge Measure

The law’s technical name is The Health Care Practitioner’s Medicare Free Control Act, but it is commonly called “the MOM legislation”, for its original name, Medicare Overcharge Measure. The law was enacted on September 8, 1990. It protects people on Medicare from being overcharged by doctors and other health care practitioners by making it illegal in Pennsylvania to charge a higher fee than that approved by Medicare.

Answers To Your Questions About The "MOM" Law

Pennsylvania Department on Aging

www.aging.state.pa.us

"Enhancing the quality of life of all older Pennsylvanians by empowering diverse communities, the family and the individual."

Medicare’s Website

www.medicare.gov

Medicare and You 2011 Booklet

Medicare and You 2010 Booklet

IBC Medicare Resource Guide

When do I need coverage in the Donut Hole (or Coverage Gap)?

www.medicare-partd.com

Medicare Prescription Drug Finder

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