State of Wisconsin
It's Your Choice 2017
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
For Retirees with Medicare: How to Choose Your Group Health Insurance Plan
As a retiree participating in Group Health Insurance you have many options to consider whether you are a new retiree, you have experienced a life event that may allow for a change, or it's the annual It's Your Choice open enrollment period. Consider the following:
- Is your health plan still available next year? Sometimes health plans merge with others or change their service areas. See important changes and check your service area in the Health Plan Provider Map.
- Have your premiums changed?
- Is your doctor, clinic and hospital still affiliated with your health plan?
- Have benefits changed? Changes are summarized in the important changes.
- How satisfied are participants with their health plans? Review and compare health plan report cards.
- How do health plans compare for wellness and health management programs? Check out health plan features.
If you are happy with your current plan and do not want to decline Uniform Dental Benefits coverage, you do not need to do anything unless you want to enroll in an optional plan.
Health insurance Marketplaces, also known as the Exchanges, are also available. These are separate from the group health insurance program, but may be of interest to you, especially if you are a retiree who is paying health insurance premiums through annuity deduction or directly to your health plan. For more information, visit HealthCare.gov, or call 1-800-318-2596. Also see the ACA: Marketplace Notice.
Let’s walk through some of the steps you should take to decide on a plan design and health plan.
Note: If you have experienced a life event, such as a change in marital status or move to a new county, you should review the Changes and Coverage Changes chart to see what your options are and how long you have to enroll or make a change.
Do you have any dependents who are not enrolled in Medicare? Click here for important information.
For additional information, see the It's Your Choice FAQs.
Medicare Step 1 – Choose a Plan Design that works with your Medicare coverage
First, decide which plan design you would like by reading the summaries below and by going to the Plan Designs for Medicare page found under the Compare Plans tab in the navigation bar above. It is important to remember that if you are retired and are eligible to participate in Medicare that you must do the following:
- Enroll in Medicare Parts A and B. You will automatically be enrolled in the Medicare Part D program that is part of the State Group Health Insurance Program.
- Notify ETF. It is important that you contact us immediately or your Medicare coordinated coverage may be delayed.
- Understand that Medicare will be the primary payer of your covered medical services and prescription drugs.
The following is a summary of the three primary health insurance plan designs of the State Group Health Insurance Program. These plan designs all work a little differently and are coordinated with Medicare.
- IYC Health Plan - Medicare:
The majority of state retirees are enrolled in this plan. This plan offers uniform benefits and is coordinated with your Medicare coverage, allowing you to choose from a variety of health plan providers.
If you were enrolled in the IYC Health Plan plan prior to enrolling in Medicare Parts A and B, you will automatically be moved into this plan design.
While these plans all offer the same uniform benefits package, this does not mean that they will treat all illnesses or injuries in an identical manner. Treatment will vary depending on patient needs, the physicians’ preferred practices, and the health plan’s managed care policies and procedures.
- IYC Medicare Advantage:
This plan is offered by Humana and allows members to use any health care provider in the United States that accepts Medicare. Benefits are the same in- and out-of-network. If you do decide to seek care from an out-of-network provider, your share of the costs may be slightly higher for medical equipment or supplies.
- IYC Medicare Plus:
This is a fee-for-service Medicare supplement plan administered by WPS. This plan is available to eligible retirees enrolled in Medicare Part A and B and generally only pays Medicare deductibles and coinsurance. It's Your Choice Medicare Plus permits you and your eligible dependents to receive care from any qualified health care provider nationwide, or during worldwide travel, for treatment covered by the plan.
Compare medical and pharmacy benefits by plan design type.
Monthly Premium Rates:
You will also need to pick a health plan provider, consider the cost of each health plan provider, both with dental and without dental coverage. (See Step 2, below).
Made a Decision?
If you chose the IYC Health Plan - Medicare option, move to Step 2 to select a health plan provider.
If you chose IYC Medicare Advantage or IYC Medicare Plus, move to Step 4, below.
Medicare Step 2 – Choose a Geographic Coverage Area
Check out the Health Plan Coverage Map. This interactive map shows you which health plan providers are available in your area. You do not have to choose a plan in your county, but keep in mind how far you are willing to travel for services.
The map also shows whether the available health plan providers are considered “qualified”. A qualified health plan provider meets certain medical provider access requirements (has the minimum allowable number of clinics, hospitals and providers available in that county). Some health plans may be listed, but have limited availability.
Medicare Step 3 – Choose a Health Plan Provider
Ok, now you know what health plan providers you have to choose from. Next, you will want to check out the specific health plan features and plan descriptions to learn about their quality ratings and medical provider networks (including specialists and hospitals), as well as other features, which may include:
- referral and prior authorization requirements,
- whether they require you to select a primary care provider (PCP) and other administrative requirements, and
- whether they offer a member web portal, a 24-hour nurse line, and wellness and health management programs.
You will also want to consider the cost of choosing each health plan provider. Note the monthly premium cost for single or family coverage. You will find these total rates both with dental and without dental coverage found under the Rates tab in the navigation bar above.
Medicare Step 4 – Enroll or Make a Change
Now that you have chosen a plan design and health plan provider, you will need to either enroll or make a change to your current enrollment. Make changes or enroll online using myETF Benefits, or a paper application may be completed and submitted to ETF.
If you do not want to change plan design or health plan provider, or decline dental coverage for 2017, you do not need to do anything and your coverage will continue for the next year.
Step 5 – Stay Up To Date
Sign up for It's Your Choice e-alerts on health and wellness benefits, and related topics of interest.
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.
This page was last modified on: 11/1/2016 1:08:30 PM