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Answering your questions about the ERS HealthSelect Medicare Advantage Plan

HealthSelect Medicare Advantage is a health insurance plan offered to retirees, survivors, and their dependents who are covered by Medicare and have health insurance benefits through ERS. The plan began covering members with ERS benefits on January 1, 2012.

General information

1. Who is eligible for the HealthSelect Medicare Advantage Plan?

You must be enrolled in Medicare Part A and Part B to be eligible for the Medicare Advantage Plan, also known as Medicare Part C. Only retirees, their dependents, and survivors enrolled in Medicare Parts A & B can enroll in the HealthSelect Medicare Advantage Plan.

2. When am I eligible for Medicare?

You become eligible for Medicare once you are age 65. You may also be eligible for Medicare before age 65 if you are determined to be disabled by the Social Security Administration.

3. Is the HealthSelect Medicare Advantage Plan supplementary insurance? Do I still have my Medicare?

The HealthSelect Medicare Advantage plan is not supplementary insurance. The Medicare Advantage plan takes the place of Original Medicare plus Supplemental insurance, such as HealthSelectsm of Texas. With a Medicare Advantage Plan, you remain a member of Medicare and continue to pay Medicare Part B premiums, but all claims are filed through HealthSelect Medicare Advantage.

4. What prescription drug coverage do I have with HealthSelect Medicare Advantage?

HealthSelect Medicare Advantage members have prescription drug coverage managed by a third-party administrator.

5. Do I still have my HealthSelect/GBP HMO coverage?

No, you no longer have HealthSelect or GBP HMO coverage. Your health insurance coverage is now through HealthSelect Medicare Advantage, and Humana handles all of your paperwork and claims. This means no more coordination of benefits between Original Medicare and a secondary insurance. Covered services will be paid for by Humana.

6. What ID card do I give to my doctor?

Show your HealthSelect Medicare Advantage medical ID card for all medical services. Leave your red, white and blue Medicare card at home. Anytime you are asked for your health insurance card or for a Medicare card, present the HealthSelect Medicare Advantage card.

If you need a replacement card at any time, please contact the Medicare Advantage Customer Care Team at (855) 377-0001.

7. What ID card do I give my pharmacist?

For prescription drugs, show your pharmacist your HealthSelect Medicare Rx prescription drug ID card or the prescription drug ID care you received when you joined HealthSelect Medicare Advantage for prescription drugs.

Some drugs are covered under Medicare Part B and are included in your medical coverage. If the drug is covered under Medicare Part B your pharmacist will typically ask you for your Medicare card. In this case, you only need to show your HealthSelect Medicare Advantage card. If you’re unsure, give both HealthSelect Medicare Rx and HealthSelect Medicare Advantage cards to the pharmacist.

8. Where can I obtain the HealthSelect Medicare Advantage Plan’s Evidence of Coverage Document or check my claims?

Download the Summary of Benefits, Evidence of Coverage, Welcome Kit materials, and other plan information documents. You may also read about the extra benefits and services offered by Humana from the HealthSelect Medicare Advantage Website.

Register and log into MyHumana on the HealthSelect Medicare Advantage website in order to check claims online, request an ID card, and access wellness and health tips.

You can also call Medicare Advantage Customer Care at (855) 377-0001 to check the status of claims or to request a copy of plan materials by mail. View full contact details for HealthSelect MA amd schedule an appointment at a Guidance Center.

Enrollment

9. Can my spouse and I enroll in different health plans?

This depends on whether you and your spouse are enrolled in Medicare Parts A and B. All Medicare-enrolled household members must enroll in the same plan. Household members not enrolled in Medicare continue with their current GBP coverage, either HealthSelect or an HMO.

Example: 

Mary is a state retiree, aged 65 and enrolled in Medicare. Mary’s spouse Nathanial is also retired, but only age 64, so he is not enrolled in Medicare. Only Mary is eligible for the HealthSelect Medicare Advantage plan because she is the only one enrolled in Medicare. Mary will be enrolled in the HealthSelect Medicare Advantage plan unless she opts out. Mary can stay enrolled in the HealthSelect Medicare Advantage Plan while Nathanial stays enrolled in HealthSelectSM of Texas, or Mary can contact ERS to opt out of HealthSelect Medicare Advantage Plan and enroll in HealthSelectSM of Texas.

10. When can I change my enrollment in the HealthSelect Medicare Advantage Plan?

You can contact ERS at anytime. The change will be effective the first of the next month. Current premiums for the coverage will apply. You can switch between the HealthSelect Medicare Advantage Plan and your previous GBP coverage, either HealthSelect or a GBP HMO. If you live in Brazoria, Chambers, Liberty, Waller, Harris, Fort Bend, Montgomery, or Galveston counties, you also have the option of coverage with the KelseyCare Medicare Advantage HMO Plan. See the ERS website for details.

When you disenroll from a Medicare Advantage plan, it can take up to 30 days to update your Medicare records. However, it usually does not take that long. If you have difficulty accessing services during this time, please contact Medicare Advantage Customer Care toll-free at (855) 377-0001. Humana will contact your doctor and explain that Medicare is denying the claim only because Medicare’s records have not completed updating. Humana will work with your doctor so that you may still receive the necessary care.

11. I called ERS to opt out of the HealthSelect Medicare Advantage Plan. Then I called Humana to verify that I will be disenrolled next month. Humana shows that I am active in their system for next month. How can I verify my next month’s coverage?

ERS cannot notify Humana of your disenrollment for next month until the first day of that next month. After notification, the Centers for Medicare and Medicaid Services (CMS) must approve your disenrollment, so you will continue to show active in Humana’s system until this occurs. Please verify your coverage with ERS, not Humana. You may do so by phone toll-free at (877) 275-4377 or by logging into your ERS Online account (upper left corner) and checking your next month’s coverage on the Benefits Summary page.

12. Do I need to enroll in an additional Medicare Advantage Plan or Prescription Drug Plan? If I enroll in an additional plan, what happens to my enrollment in the HealthSelect Medicare Advantage?

If you are enrolled in the HealthSelect Medicare Advantage Plan, you shouldn’t need additional medical or prescription drug coverage. If you sign up for another Medicare Advantage (MA) or Prescription Drug Plan (PDP), the new enrollment cancels your current HealthSelect Medicare Advantage coverage. The Centers for Medicare and Medicaid Services (CMS) only accept one enrollment, the most recent.

If you enroll in another MA or PDP plan, you will revert to your previous non-Medicare Advantage GBP coverage, but you may see a delay in this process. ERS retroactively enrolls you in prior GBP coverage, but you may not be able to access services until ERS finishes processing the change. If you intend to disenroll from the HealthSelect Medicare Advantage Plan, please contact ERS at (877) 275-4377 so we that we can minimize any coverage reduction

Benefits

13. Do I still have a Medicare deductible?

No. The HealthSelect Medicare Advantage Plan covers the Medicare deductible. In addition, the Plan has no additional deductibles for medical services. You will pay any applicable copays or coinsurance. You still have a $50 annual deductible for prescription drugs at the beginning of each plan year.

14. Do I need to select a primary care physician (PCP)?

No you do not need to choose a PCP, but it is always a good idea to have one primary doctor who is coordinating your medical care.

15. Do I need to get referrals in order to see specialists?

No. You do not need a referral to see a specialist. Be sure to check that all of your doctors accept Medicare and are willing to bill Humana.

16. How does the HealthSelect Medicare Advantage Plan coordinate with TRICARE?

Members can keep TRICARE while enrolled in the HealthSelect Medicare Advantage Plan. The Plan will pay primary for Medicare-covered services, and then TRICARE may pay secondary. TRICARE will pay for services from a military hospital or any other federal provider. In addition, Tricare will pay any Medicare coinsurance amounts and for any non-Medicare covered service that is a covered service with TRICARE.

You may have received a letter from TRICARE stating that your prescription drug benefit will change due to your enrollment in a Medicare Part D plan. Be assured that your prescription drug coverage with the State of Texas is not a Medicare Part D plan.

ERS has learned of a problem in the Defense Enrollment Eligibility Reporting System (DEERS), which TRICARE uses for eligibility purposes through the Social Security Administration (SSA). DEERS has incorrectly identified our HealthSelect Medicare Advantage members as having Medicare Part D drug coverage. Due to this error, your pharmacy experience may possibly be different.

To correct this problem with your account, you must take action. Please contact DEERS at (800) 538-9552 and give them permission to verify your Medicare coverage with SSA. You should state that you do not have a Medicare Part D plan. This will prompt DEERS to open a Medicare case and verify with SSA that you do not have a Medicare Part D plan.

This is a TRICARE and DEERS issue. Unfortunately ERS, Caremark, and Humana cannot correct this problem for you; you must take action with DEERS.

17. Does the plan cover durable medical equipment and related supplies?

Yes, many items are covered at 100% including wheelchairs, walkers, crutches, and more. However, prior authorization is typically required. To obtain prior authorization and/or a full list of the covered equipment/services, please call Medicare Advantage Customer Care at (855) 377-0001.

The State’s role

18. The HealthSelect Medicare Advantage Plan seems too good to be true. Where did this plan come from? Am I losing anything?

ERS worked with the Legislature this session to preserve health insurance benefits for retirees. The legislative initiative driving the implementation of a Medicare Advantage program comes from HB 1 from the 82nd Legislative Session. Offering this type of Medicare plan allows the State to continue providing quality health insurance coverage to retirees, because the Federal Government partially subsidizes Medicare Advantage plans. This allows lower premiums for dependents than other GBP coverage and still represents a cost savings for the State.

Under the HealthSelect Medicare Advantage Plan most Medicare-eligible services are covered at 100% in the United States.

19. Why is the HealthSelect Medicare Advantage Plan the default medical insurance? Why is enrollment of Medicare-covered retirees in this plan automatic?

The HealthSelect Medicare Advantage Plan saves money for retirees and their family members, and the plan. If the cost to provide retiree health care is too high for the State, retirees risk losing health insurance coverage or having significant cuts to their health insurance benefits.

Provider Acceptance

20. My doctor says that he or she is not in the Humana network. Can I still see my doctor?

The HealthSelect Medicare Advantage Plan has the same benefits in and out of network, so your doctor does not need to be a Humana network doctor in order for you to see him or her. As long as the doctor accepts Medicare, you may see that doctor. However, if your doctor refuses to file claims with Humana, you may have to pay up front and file a claim for reimbursement with Humana.

21. My doctor will not take the HealthSelect Medicare Advantage Plan. Can I still see my doctor?

As long as your doctor accepts Medicare, you may see the doctor. However, if the doctor will not bill Humana, you may have to pay up front and file a claim with Humana for reimbursement. Have your doctor contact Medicare Advantage Customer Care toll-free at (855) 377-0001 so that Humana can explain the plan and its benefits directly to your doctor. You may also call Medicare Advantage Customer Care yourself and request that Humana reach out to your doctor. Either way, have Humana speak with your doctor. The Humana representatives have experience with the physician and Medicare billing processes and can explain how the HealthSelect Medicare Advantage Plan works within that system.

22. Humana has contacted my doctor; he or she understands the HealthSelect Medicare Advantage Plan, and still refuses to take my HealthSelect Medicare Advantage insurance. Can I still see my doctor?

Yes, but you may have to pay up front and request reimbursement from Humana. As long as your doctor accepts Medicare, you may still see the doctor. However, if the doctor refuses to bill Humana, you will have to pay out-of-pocket and file a claim with Humana for reimbursement. For more information about how to file a claim with Humana, please call Medicare Advantage Customer Care toll-free at (855) 377-0001.

23. My doctor does not participate in the Medicare program. Can I still see my doctor?

Yes, but you will have to pay the full cost for your care, and you will not be reimbursed. If your doctor does not participate in the Medicare program, he or she should inform you of this upfront. If the doctor does not participate in Medicare and you receive services, you will have to pay all charges 100% out-of-pocket and Humana will deny your claim. Humana cannot pay a doctor who does not accept Medicare, and they will not reimburse you for services you receive from a doctor who does not accept Medicare.

24. My doctor does not wish to accept the HealthSelect Medicare Advantage plan because he or she says that Medicare Advantage plans do not pay doctors as much as Original Medicare does. What can I tell my doctor to change his or her mind?

There is no financial penalty to the doctor for accepting the HealthSelect Medicare Advantage Plan. Humana will pay your doctor the same Medicare reimbursement that he or she would have previously received from your previous insurance carriers. Remember, before you enrolled in the HealthSelect Medicare Advantage Plan, Medicare (the primary payer) paid 80% of your services and your GBP plan (HealthSelect or HMO) paid 20% of your services. Now all payment comes from one source: Humana. Please have your doctor contact Medicare Advantage Customer Care at (855) 377-0001 so that the experts there can discuss physician billing and payment terms with him or her, and explain to your doctor that he or she will still be receiving full compensation for services rendered.

25. What are ERS and/or Humana doing to educate providers about the HealthSelect Medicare Advantage Plan?

Humana has been contacting providers since early Fall 2011 to educate them about the HealthSelect Medicare Advantage Plan’s benefits. Many providers used by ERS members were in Humana’s network already, and more are being added as Humana’s provider education outreach continues. Humana is also contacting providers who are not contracted with Humana in order to obtain verbal agreement that they accept the plan. Remember, if your doctor is unclear about the plan, please have your doctor reach out to Medicare Advantage Customer Care at (855) 377-0001. You may also call Humana to nominate providers whom you wish Humana to add to their network.

26. Do I have to go to a doctor listed in the provider directory?

The provider directory you received lists the HealthSelect Medicare Advantage network doctors in your area. If you are searching for a new doctor/specialist in your area, you may wish to use the provider directory to locate one. If you already have a doctor, but he or she is not listed in your provider directory, you may still see the doctor as long as he or she accepts Medicare.

27. I am trying to find a doctor/specialist in my area who accepts the HealthSelect Medicare Advantage Plan but I am having difficulty doing so. What can I do?

Contact Medicare Advantage Customer Care at (855) 377-0001. They will work with you to help find a doctor/specialist in your area who accepts the plan. You may also use your provider directory to find doctors and specialists who are guaranteed to accept the HealthSelect Medicare Advantage Plan.

Return-to-work

28. What happens if I return to work? Am I still eligible for the HealthSelect Medicare Advantage Plan?

If you come back to work for the State of Texas in a benefits eligible position after retiring, you become ineligible for the HealthSelect Medicare Advantage Plan while working, regardless of whether you elect active or retiree benefits. Your GBP coverage will default to your last non-Medicare Advantage Plan, either HealthSelect or a GBP HMO. When you leave employment, ERS will automatically re-enroll you in the HealthSelect Medicare Advantage Plan.

Working for employers other than the State of Texas will not affect your eligibility for the HealthSelect Medicare Advantage Plan. However, if you are receiving employer insurance benefits elsewhere, then the HealthSelect Medicare Advantage Plan is your secondary coverage while the employer insurance is primary.

29. I opted out previously. Why am I being enrolled in the HealthSelect Medicare Advantage Plan now that I’m leaving employment with the State?

The HealthSelect Medicare Advantage Plan is the default medical insurance for all Medicare-enrolled retirees. You will be enrolled in this plan anytime you become eligible, such as leaving State employment as a return-to-work retiree. If you want to opt out of HealthSelect Medicare Advantage, you may contact ERS at (877) 275-4377 to opt out after leaving employment.