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Retiree health insurance questions & answers

Another all-day retirement seminar will be held Tuesday, March 12, at the Faculty Club from 9:30 am-4 pm. Presentations will include topics such as Social Security and Medicare, MIT retiree health insurance, the MIT Retirement Plans and Prudential tax-deferred annuity income options.

Seating is limited so reservations are required. Prospective retirees may bring a guest. Reservations may be made by calling x3-4276 and leaving your name, department and telephone number.

This is the third in a series of articles designed to give the MIT community answers to frequently asked questions about the Special Retirement Incentive Program. Today's article focuses on retiree health insurance.

Q: Who is eligible for retiree health insurance?

A: An employee must have 10 years of benefits-eligible service after age 45 in order to be eligible for retiree health benefits. If you meet the criteria, then you and your spouse qualify for health coverage through the Institute.

Q: How does retirement affect my health coverage?

A: If you retire before age 65, there is no change to your current coverage; you are entitled to maintain your individual or family health coverage at the subsidized rate until you reach age 65. As a retiree under age 65, you will still have an opportunity to change your health plan or your coverage during the annual open enrollment period which takes place in November and becomes effective January 1.

If you retire at age 65 or later, you will no longer be covered by your current MIT health insurance plan because you become eligible for Medicare, the federal health insurance program under Social Security.

Since Medicare does not provide comprehensive health insurance coverage, MIT currently offers several Medicare supplement plans through four carriers: Blue Cross and Blue Shield, Harvard Community Health Plan, Tufts Associated Health Plan, and Bay State Health Care. You and your spouse or eligible spousal equivalent will each be offered enrollment in one of these plans. If your spouse/spousal equivalent is under age 65 when you retire, s/he will remain on your current MIT health insurance plan until age 65 and then will enroll in a Medicare supplement plan. If you are covering other dependents on your current health plan, they may remain in the plan until they no longer satisfy the plan's definition of a dependent. Retirees age 65 and over have an annual open enrollment period each spring with changes effective May 1.

Q: How much do I pay for Medicare and a Medicare supplement plan?

A: Medicare insurance is divided into two parts, known as Part A and Part B. Part A, which covers hospital services, is free. Part B covers physician's fees and many outpatient hospital services. In 1996, the monthly premium for part B is $42.50; this amount is generally deducted each month from your Social Security check.

The Institute currently subsidizes the cost of the supplement plans up to the cost of the Medex 3 plan. MIT reserves the right to change the subsidy, health care benefits or carriers, which could affect employees and retirees in the future.

Q: Can you explain the different Medicare supplement plan options?

A: MIT offers six supplement plan options which fall into three categories: an indemnity supplement plan, three HMO supplement plans, and two Medicare HMO plans. These three types of plans differ in where you can receive care and how you share in the cost of your care.

With the indemnity supplement plan (Blue Cross and Blue Shield Medex 3, no cost):

  • you are free to choose your own health care provider
  • you may be responsible for paying part of the cost of your care through the plan's deductibles and copayments
  • most preventive and routine types of care are not covered

With HMO supplement plans (Harvard Community Health Plan 65, no cost; Tufts Medicare Supplement Plan, monthly cost $19.64; Bay State for Seniors, monthly cost $40.44):

  • your medical services must be provided or arranged by your plan physician
  • you make small copayments; there are no deductibles
  • coverage is provided for preventive and routine services
  • you may choose to receive medical care that is not arranged by your physician, but claims will only be paid to the extent they are covered by Medicare

With Medicare HMO Plans (Harvard Community Health Plan First Seniority, no cost or Tufts Associated Health Plan Secure Horizons, no cost):

  • your medical services must be provided or arranged by your plan physician
  • you make small copayments; there are no deductibles
  • coverage is provided for preventive and routine services
  • dental care, free or low-cost eyewear, or hearing aids may included (varies by plan)
  • these plans contract with Medicare to provide all your health care; you will not be covered for any care not arranged by the plan.

Please refer to page 28 of the Highlights Brochure for other information.

Q: If I retire at age 65 or later, is my choice of a Medicare supplement plan restricted at the time I retire?

A: That will depend on your plan coverage at the time you retire. You may enroll in Secure Horizons, First Seniority, Plan 65, Bay State for Seniors or Medex 3, regardless of the plan in which you are enrolled at the time you retire. However, if you are not a Tufts subscriber at that time, you would not be eligible to enroll in the Tufts Medicare Supplement until the retiree open enrollment period.

Q: What happens if I don't qualify for retiree health coverage?

A: If you are under age 65, you are eligible for up to 18 months of coverage through COBRA by paying 102 percent of the group rate for your plan. If you are over age 65, you are eligible for Medicare insurance, and you may want to consider purchasing a supplement plan. There are several non-group coverage options you can consider. Although the Benefits Office has some information about non-group Medicare supplement plans, it is best to call your current plan and request this information directly.

Q: When should I contact Social Security about enrolling in Medicare?

A: If you are over age 65, you should contact the Social Security Office three months prior to your retirement. Otherwise, you should do so three months prior to your 65th birthday. The telephone number is 1-(800) 882-1312.

Q: May I continue to use the MIT Medical Department for services after I retire?

A: Yes. If you retire between the ages of 55 and 65, are eligible for retiree health benefits, and are a member of the Traditional or Flexible MIT Health plan, your services will be paid according to the respective plan provisions until age 65. If you belong to one of the health maintenance organizations that MIT offers such as Harvard Community Health Plan, you may still use the Medical Department, but you will be charged for the services unless the visit is authorized by your HMO plan's primary care physician.

If you are retired and over age 65, you may continue to use the Medical Department; however, at this time, Medicare is your primary coverage and you may enroll in one of the Medicare supplement plans through MIT. If you want to continue using the services of the Medical department for lab tests and examinations, for instance, then Medex 3 would be the appropriate plan for you. Any services rendered would be paid according to Medicare and Medex guidelines. If you are enrolled in one of the HMO Medicare supplement plans, then you would be expected to go to your HMO provider.

Q: If I retire with health insurance benefits and am single, then subsequently marry, could my spouse or other dependents be covered through MIT?

A: Yes. Call the Benefits Office for forms to initiate the change. Be aware that for this or any other status change, you have 31 days to make the change in your health insurance coverage.

Q: Do the Medicare supplement plans provide coverage if I travel?

A: Medex 3 provides coverage while you are traveling in the United States or abroad, although the procedure for filing claims is different for services received overseas. The HMOs provide coverage only for emergency services when you are traveling within the United States or abroad.

Q: I live in Massachusetts for most of the year but live in Florida during the winter months. Does this affect my health insurance coverage?

A: If you have a temporary residence outside of your HMO's enrollment area, you have coverage only for emergency care up to 90 days. If you reside outside of your HMO's enrollment area for more than 90 consecutive days, you are no longer eligible for coverage with your plan. In that case, you would have to transfer to Medex 3 which provides coverage throughout the United States and its territories without enrollment area constraints. If you later relocate to the enrollment area, you may transfer back to your HMO. A permanent residence outside of the United States makes you ineligible for coverage with any of MIT's Medicare supplement plans.

Q: If I was eligible to retire on January 1, 1994, but didn't, will I be subject to MIT's cap on Medex 3 health insurance premium payments?

A: No. The changes in retiree health insurance cost sharing do not affect those employees who, by January 1, 1994, had satisfied the eligibility criteria to retire. For more information, please see page 29 of the Highlights Brochure.

Q: What happens to my dental coverage when I retire?

A: MIT does not offer retiree dental coverage, but you are eligible for up to 18 months of coverage through COBRA by paying 102 percent of the group rate for Delta Dental. Since Delta Dental does not offer non-group coverage, your Delta Dental coverage will end when your COBRA coverage expires. However, Harvard Community Health Plan's First Seniority provides some routine dental coverage for plan members.


Retiree health insurance open enrollment announced

The 1996 Medicare supplement plan open enrollment for retiree health insurance will be held from March 1-29. Changes made during this period will take effect on May 1.

An information package has been sent to all current participants. If you did not receive a package and think you should have, please call the Benefits Office at x3-6151 to request one.

The Benefits Office has also announced the addition of Tufts' Secure Horizons as an MIT Medicare supplement plan effective May 1. This plan is currently available at no cost and includes fitness benefits and a free pair of eyeglasses annually.

Prospective retirees, retirees and their guests are invited to attend one of the Retiree Medical Benefits Seminars sponsored by the Benefits Office.

The seminars will provide information on Medicare, Medex and the senior plans now available. Plan representatives will be available for individual consultation.

All five sessions will be held in the Bartos Theater (Bldg E15). The schedule is: Monday, March 4, and Tuesday, March 5, 9:30am-12:30pm and 1:30-4:30pm, and Wednesday, March 6, 9:30am-12:30pm. Because of space limitations, reservations are required. To reserve a space, please call x3-5000 and press 2-7-3 when the recording begins.

A retiree Medical Benefits Seminar will be held on Thursday, March 14, from 9:30am-12:30pm in Rm S2-180 at Lincoln Laboratory. Reservations are not necessary for the Lincoln Laboratory seminar.

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