The Board of Pensions will offer enhanced medical coverage to retired members through the Humana Group Medicare Advantage PPO plan, starting January 1, 2024. Retired members pay no monthly subscription rate to participate in the new plan, which replaces the Medicare Supplement Plan.
The Humana Group Medicare Advantage PPO plan for retired members replaces the Medicare Supplement Plan effective January 1, 2024. The new plan demonstrates the Board of Pensions’ commitment to member health and well-being at every stage of life, including the transition from active work into and throughout retirement.
While you will continue to be responsible for the Medicare Part B premium, there is no additional cost for you to participate in the Humana Group Medicare Advantage PPO plan. With a large national provider network, this plan provides all the benefits of Original Medicare (Parts A and B), prescription drug coverage, plus extras like dental, vision, and hearing aid benefits and a variety of wellness, clinical, and fitness programs.
The new plan is a Medicare Part C plan that
covers medically necessary items and services from a large national network of hospitals and physicians, as well as any doctor, specialist, or hospital who accepts Medicare and agrees to bill Humana;
requires you to keep Medicare Parts A and B;
includes Medicare Part D prescription drug coverage to help pay for medications your provider prescribes; and
allows you continued access to a range of medical care and services, including behavioral healthcare and prescription drugs, covered by the plan, along with other benefits (see Added value for retirees, below).
Taking advantage of Humana’s expertise in the Medicare Advantage marketplace allows us to increase services while decreasing costs to you. The Humana Group Medicare Advantage PPO plan is a fully insured plan, which allows us to offer this coverage with no monthly subscription rate.
You pay nothing to participate in the Humana Group Medicare Advantage PPO plan and your out-of-pocket cost in some instances is $0 or minimal:
Your annual deductible for services is $0, and you pay $0 for primary care physician office visits and just a $5 copayment for Tier 1 — Generic or Preferred Generic prescription drugs at participating retail pharmacies in Humana’s network.
While there is no deductible for services, you pay a $320 copayment for each hospital admission, after which the plan pays 100 percent.
For other types of services, the plan pays 96 percent of the cost, and you pay 4 percent; your share is called coinsurance. Examples of services that require you to pay coinsurance include specialist care; outpatient hospital services; urgent care; occupational, physical, and speech therapy; and durable medical equipment.
You also pay $0 for many other types of healthcare services, including preventive care; in-person and virtual visits with a primary care physician; lab services when performed in a primary care physician’s office or in a free-standing laboratory; and home healthcare.
Out-of-pocket costs for all medical expenses are capped at $2,590 per year; prescription drugs have a separate out-of-pocket maximum of $2,500 per year.
The Humana Group Medicare Advantage PPO plan offers dental, vision, and hearing aid benefits, SilverSneakers membership, and more.
dental coverage for exams, teeth cleanings, X-rays, fillings, anesthesia, dentures, and crowns
annual routine eye exams, eyeglasses (lenses and frames), and contacts
part of your cost for hearing aids prescribed by an audiologist and one routine hearing exam
SilverSneakers health and fitness program
Go365 wellness program by Humana
Humana Care Management
Humana Well Dine meal program
advance care planning with MyDirectives
Humana Neighborhood Center
Your eligibility for the Humana Group Medicare Advantage PPO plan depends on your situation.
You will automatically be enrolled in the new plan beginning January 1, 2024. At that time, the current Medicare Supplement Plan, and your coverage under it, will end. If you do not want to be enrolled in the Humana Group Medicare Advantage PPO plan, you will have the opportunity to opt out. If you do opt out, you will need to obtain either supplemental or other Medicare Advantage coverage on your own.
Enrolled as of December 31, 2022, and opted out for 2023
You may enroll in the new plan during fall 2023 annual enrollment for coverage effective January 1, 2024. You will receive enrollment instructions in the fall.
If you were actively employed at the start of 2023 and retire(d) or plan to retire in 2023, you will have the opportunity to enroll in the new plan during fall 2023 annual enrollment for coverage effective January 1, 2024. You will receive enrollment instructions in the fall.
If you retire on or after January 1, 2024, you and your eligible spouse may enroll in the new plan when you retire, if you are age 65 or older and are enrolled in Medicare Parts A and B.
Eligibility for this coverage will be expanded to include additional members, effective January 1, 2025. The Board and Humana are working together and will provide more details in the coming months.
Humana representatives are prepared to address any questions about the new plan, providers, and the formulary during this transition from the Medicare Supplement Plan.
You can contact the Humana Customer Care team at 855-273-0021 (TTY: 711) Monday through Friday, 8 a.m. to 9 p.m. ET, to learn more.
Once enrolled in the new plan, Humana will be your primary source of information about your healthcare benefits.
Instead of calling Highmark Blue Cross Blue Shield with questions about your medical benefits, you will now call Humana. Your provider will also contact Humana to preauthorize medical care and services, when needed.
Instead of calling Express Scripts or logging on to express-scripts.com with prescription drug questions or to order or refill home delivery prescriptions, you will contact Humana.
The Board of Pensions is still here for retirees who prefer to reach out to us and continues to be the primary point of contact for questions about pension, disability, and death benefits.
Answers to frequently asked questions about the new plan
Do I have to use a network doctor, specialist, or hospital to receive benefits under the plan?
Having a relationship with your primary care provider is important. While Humana offers a large national network of contracted providers, under the new plan you can use any provider who accepts Medicare and agrees to bill Humana. Your plan coverage remains the same, even if you receive care from an out-of-network provider.
What if my physician accepts Medicare but isn’t in the Humana network?
If your physician accepts Medicare but isn’t in the Humana network, you should ask that they bill Humana directly. The reimbursement will be no less than what Medicare allows.
Does Humana have to approve care or services from my doctor before I receive benefits?
Certain services and procedures may need advance approval from Humana — called prior authorization. Your provider typically handles the prior authorization process on your behalf; however, you are responsible for making sure it gets done.
What if I have one or more chronic medical conditions and need ongoing outpatient treatment or frequent hospital stays?
The designated Customer Care Team at Humana can help you navigate complex care issues and treatment.
How can I find out if my medications are covered under the plan?
The formulary is the list of drugs covered by the plan. The plan formulary includes four tiers: Tier 1 — Generic or Preferred Generic; Tier 2 — Preferred Brand; Tier 3 — Non-Preferred; and Tier 4 — Specialty. The 2024 Humana Medicare Employer Plan Formulary will be available when members enroll in the fall.
Are diabetic monitoring supplies covered under the plan?
The plan helps cover the cost for a variety of diabetic glucose testing supplies. The following meters, along with their test strips and lancets, are the preferred meters covered with $0 copayment for you through CenterWell Pharmacy: CenterWell TRUE METRIX AIR, by Trividia Health; Accu-Chek Guide Me, by Roche Diabetes Care; and Accu-Chek Guide, by Roche Diabetes Care.
Will I have separate ID cards for medical and prescription coverage?
You will have one Humana ID card, which you will receive 10-14 days after you enroll in the plan.
Will I have coverage during international travel?
The Humana Group Medicare Advantage PPO plan includes worldwide benefits for emergencies, and, for 2024, you will continue to have access to International SOS services when traveling abroad.
Humana is a national Medicare Advantage insurance carrier dedicated to retiree healthcare and whole-person health. With about 8.6 million Medicare members, Humana has served Medicare beneficiaries for nearly 40 years. Approximately 5.7 million of their Medicare members are enrolled in a Medicare Advantage plan, including retirees of other faith-based groups.