Health Options in Retirement
I. Prior to Age 65
1. COBRA (typically available for 18 months of eligibility; could be 24 or 36 months
depending on the circumstances)
Sample Rates (COBRA)
Employee +1 $1,454.78
2. Spousal Employer Plans
3. Individually Medical Underwritten Plans – various deductibles and coinsurance
available through Highmark(www.highmarkbcbs.com), HealthAmerica (Med One)
and Geisinger Health Plan
Sample Monthly Rates (Highmark PPO/Direct Blue)
Direct Blue PPO Blue
($250 ded.– 90/10 coinsurance) ($1,200 ded. – 90/10
Age Male Female Male Female
50 $298.35 $343.65 $184.45 $211.45
55 $397.15 $395.10 $243.30 $242.10
60– $541.00 $466.70 $329.05 $284.75
4. Guaranteed Issue Plans (If you don’t qualify for medically underwritten)
Preferred Blue, HIPPA compliant. **Definitions attached.
a. Guaranteed Issue Plan may have pre-existing clause, will not pay for
conditions treated in the past 5 years for the first 12 months of coverage
b. HIPPA has basic qualifications of having prior coverage, but does pay for all
Sample Monthly Rates (Preferred Blue – Highmark)
Age Male Female
50- $590.05 $590.05
5. PCIP (PA pre-existing condition plan) (www.healthcare.gov)
a. no prior coverage for 6 months
b. declined from commercial carrier
c. $283.20/month ($1,000 deductible)
Health Options in Retirement (cont.)
II. Age 65 and above Medicare Eligible (www.medicare.gov)- Parts A & B. The 2011
Part B premium is $115.40 per month (income based formula). There is a scale of
income ranges and “what ifs” located at www.socialsecurity.gov/pubs/10536/html
1. Medicare Advantage programs from Freedom Blue, Geisinger Gold, Advantra,
a. Rates/benefits: $0 premium (High deductible options) to $226+ for
comprehensive no deductible, low co-pay programs.
b. Combines medical (Part A and B) and prescription (Part D) benefits into one
2. PDP Plans: stand alone prescription plans available from numerous carriers
a. deductibles, co-pays, co-insurance vary. The “donut hole” for 2011 is
expenses from $2840 to $4550.
b. premiums from low $20’s to $100+
**See attachment at end.
3. Medigap Plans – supplement original Medicare parts A & B
a. standardized plans A, B, C, D, F, G, K, L, M, N
Sample Rates (New Era Life--Medigap Plan C)
Age Male Female
65 $ 97.49 $ 90.27
70 $110.15 $101.99
75 $132.50 $122.69
80 $161.42 $149.47
4. Juniata sponsored Medigap plan through Hartford, employee eligible if hired
before January 1, 1997.
If you have any questions after reviewing this document or would like more information
about Retiree Health Options please contact the Juniata Human Resource Department.
For HIPAA eligible individuals: Health care coverage options that cover pre-existing
conditions are available to individuals who meet the eligibility requirements of the Health
Insurance Portability and Accountability Act (HIPAA) of 1996. If you live in the 29
counties of western Pennsylvania served by Highmark Blue Cross Blue Shield and meet
the following guidelines, you may be eligible to purchase either PreferredBlue, An
Individual Comprehensive Major Medical Preferred-Provider Health Plan; $1,000
Deductible or PreferredBlue An Individual Comprehensive Major Medical Preferred-
Provider Health Plan; $500 Deductible. Parents of HIPAA Eligible children who do not
elect HIPAA Coverage for themselves may still enroll their children in one of these
To be HIPAA eligible:
You must have a minimum of 18 months of prior creditable health care coverage
(with no breaks in coverage of more than 63 days each) and your last coverage
was provided through a group, governmental, or church plan.
You must submit your substantially completed application to Highmark Blue
Cross Blue Shield within 63 days from the date that your most recent insurance
You must have used all of the “COBRA” benefits available to you through your
You are not eligible for or enrolled in Medicare, Medicaid , or any other group,
governmental or church health insurance plan.
You do not have any other health insurance coverage.
PPOBlue-Medically Underwritten: This program is available to individuals who
wish to purchase a qualified high deductible health plan for use with a Health
Savings Account as defined by the Internal Revenue Service. This Preferred-
Provider program utilizes the Keystone Health Plan West network of providers.
Acceptance for PPOBlue coverage is determined by an evaluation of your medical
history and other health infromation, as well as that of each dependent you wish to
enroll. As a result, we cannot guarantee acceptance for PPOBlue. PPOBlue includes
a pre-existing condition clause for any member age 19 or older. For the first 12 months
of your coverage, the PPOBlue Agreement will not pay for expenses related to a
condition for which you or your enrolled dependents age 19 or older received medical
attention during the five years before you enrolled.
PPOBlue-Guaranteed Issue: This program is available to individuals who wish to
purchase a qualified high deductible health plan for use with a Health Savings
Account as defined by the Internal Revenue Service. This Preferred-Provider
program utilizes the Keystone Health Plan West network of providers. PPOBlue
includes a pre-existing condition clause for any member age 19 or older. For the first
12 months of your coverage, the PPOBlue Agreement will not pay for expenses related
to a condition for which you or your enrolled dependents age 19 or older received
medical attention during the five years before you enrolled.
How Part D works for you.
You may have heard a lot about the gap in Part D Prescription Drug coverage. And you
may wonder how that gap can cost you money. Although there will be positive changes
in 2011, here’s how Part D payments work:
You pay this every month, unless you receive Part D coverage through a Medicare
Advantage plan. Then, you pay only the Medicare Advantatge premium.
Deductible up to $310
If your plan has a deductible, you pay your yearly deductible until it is met. (It is
important to note that many Part D plans do not have deductibles.)
Cost sharing from $310 to $2,840
Once you’ve paid your deductible, you’ll pay a share of your expenses until total
medication costs reach $2,840. This cost-sharing is called a copay or co-insurance.
Your plan pays the rest.
The coverage gap
Under Medicare Part D, when your total costs reach $2,840, you’ll become responsible
for all expenses until they reach $4,550. This is the coverage gap, where the discounts
and coverage discussed on page 7 start to work for you.
When you’ve reached $4,550 in total prescription drug expenses for the year, your
coverage begins again and you pay a set copayment of $2.50 for generic and $6.30 for
brand-name prescription drugs. Your plan pays the rest.
More good news about Part D.
The Part D Doughnut Hole Will Eventually be Filled
Starting with the new discounts, the health care legislation will eliminate the Part D
Coverage gap over the next 10 years. Between 2011 and 2020, the coverage gap will
gradually be eliminated. While this may sound like a long time, the savings will start now
and continue to grow. The average savings while in the coverage gap is estimated to
be $700 in 2011, and this savings will grow annually to $3,000 by 2020.