Things to Consider for Medicare-covered Retirees

These are important things you need to consider before making your enrollment decisions.

Which plan is right for me?
	Comparison of network physicians
	Comparison of network hospitals
	Comparison of network pharmacies
Extra services
Tools to help you make your decision
Eligibility
How to enroll or disenroll
City of Houston Health Fair

Which plan is right for me?

To help you make that decision, the following charts present several considerations in choosing a new plan. The MA plans are compared to the HMO Blue Texas HMO.

1. Comparison of network physicians

You must select a PCP for all primary care. To see if your physicians are in a one of these networks, use the contact information in the contact box to the right. All questions regarding physicians, facilities, drugs and benefits should be directed to the customer service departments at the phone numbers listed to the right.

2. Comparison of network hospitals

Listed below are just some of the hospitals in the TexanPlus, Texas HealthSpring and HMO Blue Texas networks. For a complete list, check the Web sites or call one of the numbers in the contact box on page 12. If a hospital accepts Medicare and Aetna terms and conditions, it will be in the Aetna Private-Fee-for-Service plan.

In an emergency, you may seek treatment at any hospital, under any plan; however, you may be transferred to a network facility as soon as your condition is stabilized.

3. Comparison of network pharmacies

Below is a list of many familiar network pharmacies. Others are available, so check online or call customer service for a complete listing of all pharmacies and their locations.

4. Extra services

Listed below are value-added services for all MA plans. When making your health care decision, take into account these unique bonus features.

Medicare Advantage Plans: Tools to help you make your decision

By now you should be curious to know if one of the MA plans will work for you. Here are some questions to help you make that decision.

	Are you interested in joining an MA Plan? Do you live in the Houston area or another city in Southeast Texas more than 6 months in the year? Or, do you live outside of Texas? If so, TexanPlus, Texas HealthSpring or the Aetna PFFS might be for you! See the Service area maps.
	Are your doctors in Kelsey Seybold, Renaissance or another group? You might consider TexanPlus, Texas HealthSpring, or the Aetna PFFS.
	Is there a hospital that meets your needs in TexanPlus and Texas HealthSpring? The Aetna PFFS plan also includes any hospital that accepts Medicare.
	Are your prescriptions available on one of the formularies in a lower-tier (meaning lower copayment?)
	Is there a conveniently located pharmacy?
	Are the medical services you use most often available for a lower cost in one of the MA plans?
	Are there extra services offered by these plans that you like?
	Do you ever need help getting to the doctor or drugstore?

If you answer yes to most of these questions, Aetna, TexanPlus or Texas HealthSpring could be right for you. However, if you live outside of the TexanPlus or Texas HealthSpring service area, the Aetna Private-Fee-for-Service plan is a great option for you to consider. All three plans offer considerable monthly premium savings of 82% - 95%, wallet-stuffing savings for point-of-service costs, and all three are backed by Medicare and the City of Houston. If you try one, you might just like it; and if not, you have 90 days to re-enroll in the HMO Blue Texas HMO or PPO plans, or you can enroll again on May 1, 2008.

Eligibility

You are eligible for coverage as a retiree under the benefits plans if you were covered when you retired and have been continuously covered after retirement. If both you and your spouse retired from the city, you may be covered as a retiree or as a dependent — but not both. Dependents may be enrolled under only one parent or guardian.

The eligibility criteria remain the same. Your eligible dependents are your:

• Legal spouse,
• Unmarried natural or adopted children up to age 25, if they qualify as dependents for federal income tax purposes,
• Children up to age 25 over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income tax purposes,
• Grandchildren under age 25 if they qualify as your dependents for federal income tax purposes,
• Disabled dependents over age 25 who are incapable of self-sustaining employment because of mental or physical handicap. The dependent must be primarily dependent on you for more than 50 percent of financial support and covered before age 25.

How to enroll or disenroll

Keeping the HMO or PPO

If you or your Medicare-covered dependent does not want to join Aetna, TexanPlus or Texas HealthSpring, you do not need to do anything. You will keep your HMO or PPO. If you or your Medicare-covered dependent wish to remain in an MA plan, you do not need to do anything.

You may change plans during the MA plan annual enrollment in December for (Jan. 1), annual open enrollment in the spring (for May 1), or you may elect to join an MA plan on the first of any month. For coverage to be effective on the first of the next month, the Benefits Division must receive your application before the end of the previous month.

• Request an enrollment packet from Aetna, TexanPlus or Texas HealthSpring.
  
• Enrollment forms will be in the packet.
  
• Each person must complete, sign, date, and return all copies of an “Enrollment Application and Statement of Understanding” for the plan you elected.
  
• You must also complete the “City of Houston MA plans Enrollment Form.”
• This form will keep your dependents’ coverage in the HMO or PPO in place, and it will help ensure that you pay the correct health-care premium. Keep the last page for your records.
  
• Use the City of Houston return, postage-paid envelope to return all of your forms to the Benefits Division.

How to enroll

Complete the forms and return postmarked no later than December 31, 2007. Changes will be effective January 1, 2008. Use the postage-paid envelope in your packet. If you don’t use the envelope, the address is:

City of Houston
Human Resources Department, Benefits Division
P.O. Box 248
Houston, TX 77001

You may enroll in an MA plan on the first of any month. Forms postmarked after December 31, 2007, will be effective the first day of the following month.

Disenrolling from a Medicare Advantage Plan

You may choose to enroll or disenroll from an MA plan at the first of any month. This includes changing from one MA plan to the other. To disenroll from an MA plan:

• Decide if your dependent or you want to elect a different city-sponsored MA plan, or if you want to re-enroll in the HMO or PPO plan, you can do so on Jan. 1, 2008 or within 90 days of MA plan enrollment.
  
• Each person who wants to disenroll from an MA plan must complete a “City of Houston Medicare Advantage Disenrollment Form.” The retiree must complete a “City of Houston Retiree Medical Election Form.” Request these forms from the Benefits Division, (888) 205-9266 or
  (713) 837-9400. If a person wants to elect another MA plan, request the enrollment application from the benefits division.
  
• As the retiree, you must complete the “City of Houston Retiree Medical Election Form” to reinstate HMO or PPO coverage for any dependents and/or yourself. You must also complete the form to change your dependents’ or your coverage to another MA plan.
  
• Send all completed forms to the Human Resources Department, Benefits Division, P.O. Box 248, Houston, TX 77001. The Benefits Division must receive your forms by the end of the month for coverage to be effective on the first of the next month.