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Frequently Asked Questions

 


What is the difference between Original Medicare, Medicare Advantage plans, Medicare Supplement plans, and Senior Supplement plans?

Medicare Part A and Part B are usually referred to as "Original Medicare". Part A offers coverage for your hospital stays, while Part B offers coverage for doctor visits and outpatient care. You receive your benefits directly from the government. Medicare then pays fees for your care directly to the doctors and hospitals you visit.

Medicare Part C plans are usually referred to as Medicare Advantage plans. All Medicare Advantage plans are provided by private insurance companies, like UnitedHealthcare Insurance Company, and they all combine coverage for hospital stays (Medicare Part A) with coverage for doctor visits and other outpatient care (Medicare Part B) into one plan. Some plans include prescription drug coverage (Medicare Part D), plus extra benefits and features like vision, hearing and dental coverage. Under Medicare Part C, the Medicare Advantage plan pays the fees for your care directly to the doctors and hospitals that you visit.

Medicare Supplement plans act as a supplement to "Original Medicare" (Parts A and B). Medicare Supplement plans help to pay for some of the costs, like coinsurance and deductibles that Original Medicare does not cover. If you enroll in a Medicare Supplement plan and need prescription drug coverage, you will need to enroll in a Medicare Part D prescription drug plan also.

Senior Supplement plans also act as a supplement to Original Medicare, but are only offered through an employer group or plan sponsor. They may have similar benefits as the Federal Medicare Supplement plans, but may also cover state-mandated benefits. If you enroll in a Senior Supplement plan and need prescription drug coverage, you will need to enroll in a Part D prescription drug plan also. Employer groups and plan sponsors commonly offer both a Senior Supplement plan and a separate Medicare Part D prescription drug plan.

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When enrolled in a UnitedHealthcare plan, do I have to continue paying my Medicare Part B monthly premiums?

Yes. You must be enrolled in Medicare Part A and Part B to be eligible for our retiree plans and you also must pay or continue to pay your monthly Part B premium If you stop paying your Part B monthly premium, you risk losing your Connecticut State Retiree Health Plan medical and prescription drug coverage.

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Is my doctor or hospital included in the UnitedHealthcare Medicare Advantage Network?

The UnitedHealthcare® Group Medicare Advantage (PPO) plan is a Preferred Provider Organization (PPO) plan and does not have restrictions on in and out-of-network coverage. You have access to our national network and can see any provider as long as the provider has not opted out of the Medicare program and agrees to see you.  The provider does not have to be in the UnitedHealthcare network. When you go out-of-network for care, the PPO plan pays providers just as much as Medicare would have paid, and you pay the same out-of-pocket copayment as if you had stayed in the network.  If you have any questions, please give UnitedHealthcare a call.  We will be happy to help and if desired, we will be happy to call your doctor and explain how the plan works to your doctor (and office staff) so that they are comfortable accepting this plan.

To find doctors or hospitals in our network, see the online Provider Directory. This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service.

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Where can I learn more about the appeals process?

Navigate to the Find and Learn tab in the menu at the top of your screen and click on the File Appeals & Grievances option in the sub-navigation. This page provides detailed information about the appeals process.

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Where do I find out if I have met my deductible or out-of-pocket costs?

This information is accessible within the member portion of the site. Once logged in, click the "Coverage & Benefits" link in the menu at the top of your screen. This page will provide your annual deductible and out-of-pocket costs for your health and prescription drug plan, as applicable.

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Where can I see my latest claims information?

This information is accessible within the member portion of the site. Once logged in, click the "Claims" link in the menu at the top of your screen. The Claims page will enable you to search for medical and/or drug claims by date range and will provide an overview of each claim searched.

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Can I change my group-sponsored coverage at any time?

The Connecticut State Retiree Health plan has specific rules that tell you when you can change or disenroll from your plan. Usually there is a defined "open enrollment" period during which those changes can occur. It's important to understand your group's rules and timing. If you have any questions, please contact the State of Connecticut Retiree Health Insurance Unit at 860-702-3533.

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How do I know what changes there will be to my plan for the next year?

Each year that you are a member of a UnitedHealthcare Medicare Advantage or Medicare Part D Prescription Drug plan, you will receive an Annual Notice of Changes (ANOC) about six weeks before your plan's effective date. The ANOC explains any changes in coverage, costs, and benefits that will be effective for the upcoming year. You may also call the customer service number listed on the back for your member ID card with any questions.

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What do I do if I have lost my member ID card?

This information is accessible within the member portion of the site. Once logged in, navigate to the bottom of any page and click on the "Print temporary ID card" link. You can also navigate to the "My Plans" tab in the menu at the top of your screen and select the "Order Materials" option in the sub-navigation. The Order Plan Materials page enables you to request a replacement ID card be mailed to you.

If you are unable to find the links noted above, please call customer service using the number listed on your plan materials or the number noted for Plan Members on the Contact Us page.

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Why did the state move to a Group Medicare Advantage plan for retirees?

The Group Medicare Advantage plan allows the State of Connecticut to retain services that are consistent with the previous plan, expand preventive care and add new programs and services while at the same time reducing overall state costs.

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Do retirees need to enroll in Medicare?

Yes!  When retirees turn age 65 or first become eligible for Medicare, they must enroll in Medicare Parts A and B.  Retirees also must pay or continue to pay their monthly Part B premium.  If a retiree stops paying his or her Part B monthly premium, the retiree risks losing his or her Connecticut State Retiree Health plan medical and prescription drug coverage.  

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Do retirees still have Medicare?

Yes.  With the Group Medicare Advantage plan, retirees will have all the rights and privileges of traditional Medicare.  Only the administrator will change.  Instead of the federal government administering retirees’ Medicare Part A and Part B benefits like it does under traditional Medicare, UnitedHealthcare will become the administrator through the Group Medicare Advantage plan.

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What is a PPO plan?

PPO stands for Preferred Provider Organization.  The UnitedHealthcare® Group Medicare Advantage (PPO) plan is a “passive” PPO, meaning retirees are not restricted to using a network of doctors, hospitals and other health care providers.  In addition, there is no financial preference given to network health care providers.  Retirees pay the same cost share whether they see providers in or out of network, anywhere in the country.

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What happens when a retiree turns 65 and becomes eligible for Medicare but dependent(s) remain under age 65?

When a retiree turns 65 and becomes eligible for Medicare, he or she will be enrolled in the UnitedHealthcare Group Medicare Advantage plan.  Your dependent’s coverage will not change until the dependent becomes eligible for Medicare.

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What happens if an individual retires but is not age 65 or otherwise eligible for Medicare?

A retiring individual who is not eligible for Medicare will stay on his or her current plan. When the retiree turns 65 or otherwise becomes eligible for Medicare, he or she will move to the Medicare Advantage Plan.

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When retirees become eligible for Medicare, will this plan change or reduce retirees’ health care benefits?

This plan will not reduce benefit levels to state retirees. The UnitedHealthcare Group Medicare Advantage plan includes all of the current Connecticut State Retiree Health Plan covered services, including Medicare Part A and Medicare Part B.  In addition, it includes Medicare Part D prescription drug coverage, expanded preventive care and new features like SilverSneakers® and a health rewards program.  The plan also includes expanded support and services for retirees who have more complicated health care needs like diabetes and heart disease. Except for these enhancements, all health benefits otherwise will remain consistent.

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This sounds too good to be true.  How can this change possibly save money?

The answer lies in how the federal government reimburses for Medicare-covered services. Under the current structure, traditional Medicare pays pre-set amounts for specific services, regardless of the particular patient involved. Under a Medicare Advantage plan, the federal government recognizes that some individuals have health risk factors that make them likely to need additional services. Medicare reimburses more for those patients and enhances payments to the Medicare Advantage plan based on how well it meets standards for quality and member satisfaction. Medicare Advantage plans have an incentive to make sure all members get the care they need. By optimizing federal reimbursement through the Medicare Advantage plan, the State is able to achieve savings while maintaining the same level of covered services for its retirees.

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Does this plan include prescription drug coverage?

Yes, as of January 1, 2018, prescription drugs will be covered by UnitedHealthcare, not SilverScripts. Retirees will use the same UnitedHealthcare ID card for all their medical and prescription drug needs.

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Do retirees still need to use their red, white and blue Medicare card?

No, retirees will use the UnitedHealthcare Group Medicare Advantage ID card for all covered medical and prescription drug needs.  Retirees will want to put their Original Medicare card somewhere for safe keeping.  It is important retirees use their UnitedHealthcare ID card each time they receive medical services or fill a prescription because UnitedHealthcare pays all claims directly.  The claims no longer go to Medicare first.  By always showing their UnitedHealthcare ID card, retirees make sure their claims get processed correctly, timely and accurately. 

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Is this plan the same as the UnitedHealthcare Oxford plan?  

No. This plan is different. The UnitedHealthcare Group Medicare Advantage plan is just for Medicare-eligible State of Connecticut retirees and eligible dependents. The changes in your covered services include the enhancements noted above.

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Does the plan include any benefit enhancements?

Yes, the UnitedHealthcare® Group Medicare Advantage (PPO) plan provides retirees with access to expanded preventive care as well as new programs and services.   Here are just a few examples:

  • SilverSneakers® – A basic fitness membership at thousands of participating gym locations across the country.
  • Renew Rewards – Is a health and wellness reward program.  Retirees can receive gift cards for completing screenings and preventive care such as getting an annual wellness visit and flu shot.
  • NurseLine –   Registered nurses answer retirees’ calls 24 hours a day/7 days a week.
  • HouseCalls – Once a year, retirees have the option to have a health care clinician visit them in the comfort and convenience of their home. The clinician will review the retiree’s health history and medication(s), perform a physical exam, identify health risks and provide educational information. A gift card is available for completing a HouseCalls visit.
  • Solutions for Caregivers – Support and resources for retirees when caring for a loved one.

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Is this the Medicare Advantage plan that’s advertised on TV?

Absolutely not! This is a custom Group Medicare Advantage PPO plan designed at the direction of the Health Care Cost Containment Committee exclusively for Medicare-eligible State of Connecticut retirees and eligible dependents based on our current benefit design. These plans are different and should not to be confused with other UnitedHealthcare Medicare Advantage plans that might be seen or heard about in the area.

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Are retirees required to join the Group Medicare Advantage plan?

In order to maintain state retiree health care and prescription drug coverage, all Medicare-eligible members must enroll in Medicare Parts A and B and will automatically be enrolled in the Group Medicare Advantage plan.  The Group Medicare Advantage plan is the platform that is used to administer your retiree health benefits.

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Is the Group Medicare Advantage plan available nationwide?

Yes. This is a national plan that allows retirees to see doctors and hospitals anywhere in the United States, as long as they take Medicare and accept the plan. Retirees are not limited to seeing providers only in Connecticut. This plan will travel with retirees throughout the United States. The service area is all counties in all 50 U.S. states, the District of Columbia and also includes all U.S. territories.

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Is this a Medicare Advantage HMO plan with a limited network?

No. This is a national plan that allows retirees to see doctors and hospitals anywhere in the United States, whether they are in-network or not. Retirees are not limited to seeing providers only in Connecticut. This plan will travel with retirees throughout the United States. The service area is all counties in all 50 U.S. states, the District of Columbia and also includes all U.S. territories.

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What happens if retirees travel outside the U.S. and need medical coverage?

Retirees will have worldwide coverage for emergency and urgently needed care.  Retirees may need to pay the entire claim when receiving care and then submit the claim to UnitedHealthcare for reimbursement after returning to the U.S.

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IMPORTANT INFORMATION

2019 Open Enrollment Period

Began: 09/27/2018
Ended: 10/31/2018


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Last updated: 09.28.2018 at 12:01 AM CT   H2001_180920_015826_M