Frequently Asked Questions
1. I’ve heard you're going to move me to the Coventry Advantra Freedom MAPD plan. What is MAPD?
MAPD is a Medicare Advantage/Prescription Drug plan. PEIA has selected Coventry Health Care's Advantra Freedom Plan for Medicare eligible retired PEIA members, and Medicare-eligible dependents of retired employess. This plan is licensed by the federal government through the Centers for Medicare and Medicaid Services (CMS). These plans provide both medical and prescription drug benefits to Medicare-eligible retirees through a fee-for-service plan. CMS pays the MAPD plan to provide coverage for Medicare members, and the MAPD takes full responsibility for paying for benefits for the member.
You should have received a welcome packet from Coventry detailing the the Advantra Freedom Plan.
2. I’m a Medicare retiree with PEIA coverage, what will happen to me when we go to the Coventry Advantra Freedom Plan?
The Coventry Advantra Freedom MAPD plan is nearly identicle to the PEIA PPB Plan. It includes the following:
A. Comprehensive medical plan with no deductible and an out-of-pocket maximum of $500 per person per year that includes both copayments and coinsurance. That means that a Medicare retiree would pay no more than $500 in a plan year for medical care. After the retiree meets the $500 out-of-pocket maximum, then the plan will pay 100% of that retiree’s medical costs for the rest of the plan year.
B. A prescription drug plan that’s the same as the one offered to the active employees. The deductible on prescriptions will be $75 per individual, and when that’s met, the member will pay $5 for generic drugs, $15 for preferred brand name drugs, and $50 for non-preferred brand name drugs. There will be an out-of-pocket maximum on prescription drug copayments of $1750 per member. After the retiree meets the $1750 out-of-pocket maximum on drugs, then the plan will pay 100% of that retiree’s drug costs for the rest of the plan year. This is the same benefit we offer active employees.
PEIA will transfer the eligibility and responsibility for all of these retirees to the Advantra Freedom MAPD plan on July 1, 2007. You will receive a new medical/prescription drug ID card from Coventry to use after July 1. When you go to the doctor after July 1, you will present that new ID card, and the doctor will bill Advantra Freedom for the services. You will pay your office visit copayment to the doctor’s office. You will also be responsible for 20% coinsurance on any lab work, imaging and other services. You will receive an Explanation of Benefits (EOB) from Advantra Freedom that tells you exactly how much you owe for the services you received.
This change means that you will have coverage through the Coventry MAPD plan, just as some active employees now have managed care coverage through a plan offered by PEIA. There will still be an association with PEIA. You will still have your life insurancethrough PEIA.
3. Do I have to enroll in a Medicare Part D Plan o:p>
NO. In fact, if you apply for a Medicare Part D Plan, you will be disenrolled from all medical benefits PEIA provides. You will have drug coverage from Advantra Freedom.
4. Will the $500 that I have to pay first on Medicare count toward my PEIA out-of-pocket maximum?
Because of the way the new plan is designed, you will not pay a Medicare deductible. See the answer to question #2 above.
5. If the Advantra Freedom Plan ends, does that mean I won’t have PEIA anymore?
No. In that case, PEIA will continue to provide medical benefits to retirees, either through the PEIA PPB Plan or through some other plan for which we contract.
6. Do I have to keep Medicare Part A and Part B?
Yes. In order for you to have coverage from Advantra Freedom, you will continue to pay your Medicare Part B premium through Social Security.
7. What if I live outside West Virginia for part or all of the year? How will this change affect me?
Since Advantra Freedom provides coverage throughout the country, it should have little or no effect on retirees who live out of state.
8. What if a retiree cannot afford these changes? Will they lose coverage?
If a retiree truly cannot afford these changes, PEIA offers a Retiree Assistance Program that provides premium and benefit relief to retirees who are at or below 250% of the Federal Poverty Level. The program reduces premiums and out-of-pocket costs for these retirees based on their income and their years of public service.
Since PEIA does not have income information for retirees, the only way we can administer the program is by requiring retirees to apply for this assistance. The application form is not complicated, but it does require the retiree to submit a copy of his/her most recent tax return so that we can determine what level of assistance the retiree qualifies for. Applications were mailed in April. A copy of the application is available by clicking here.
9. I am a Medicare retiree, but my spouse doesn’t have Medicare yet. What will happen to me and my spouse?
YOUR coverage will move to the Advantra Freedom plan, but your spouse will continue to have coverage through the PEIA PPB Plan until he or she reaches Medicare age, at which point he or she will also move to the MAPD plan. PEIA has designed benefits to keep costs for these “split” coverages at approximately the level they were before this change.
10. What about my lifetime maximum benefit? Will the amount I’ve used of it follow me to the Advantra Freedom Plan?
No. There is no lifetime maximum benefit for Advantra Freedom members. If for some reason the retiree had to come back to the PEIA PPB plan in the future, he or she would come back with the same lifetime maximum that existed when he/she left the PEIA PPB Plan.