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Overview

1. Who is eligible for the It's Your Choice (IYC) Medicare Advantage Plan?

Individuals who are enrolled in both Medicare Part A and Part B and are insured under a retiree contract are eligible to enroll in IYC Medicare Advantage.

2. Who administers the IYC Medicare Advantage plan?

The Group Insurance Board selected UnitedHealthcare to administer the IYC Medicare Advantage plan under the Wisconsin Public Employers (WPE) Group Health Insurance Program.

3. What is the difference between the IYC Medicare Advantage plan and an individual Medicare Advantage plan (that I can get somewhere else on my own)?

The IYC Medicare Advantage Plan is a group insurance plan; most plans that are advertised on TV or in magazines are individual plans. Group insurance plans are purchased by an organization on behalf of a group. Individual plans are purchased by individuals for themselves or their family, either through an insurance company or a broker.

With a group Medicare Advantage plan, the state can negotiate plan enhancements that are not available via individual Medicare Advantage plans. For example, the group IYC Medicare Advantage plan is not subject to the prescription drug coverage gap, otherwise known as the “donut hole.” The IYC Medicare Advantage plan provides Uniform Benefits, set by the Group Insurance Board each year. The prescription drug benefits will continue to be offered through Navitus.

Medical Benefits

4. How is the IYC Medicare Advantage plan different from the other options offered through the Group Health Insurance Program?

The IYC Medicare Advantage plan covers the same uniform set of benefits as most of the other Medicare-coordinated plans ETF offers. However, UnitedHealthcare offers some specialized services such as optional in-home preventive visits and Renew Active, a gym membership program.

5. How do the medical benefits work?

The medical benefits are a lot like the other Medicare-coordinated benefits offered by the program, but with IYC Medicare Advantage, you can see any doctor nationwide who accepts Medicare and is willing to treat you and bill UnitedHealthcare. 

6. If my family is covered under a Medicare Some contract with two health plans, how will medical out-of-pocket limits (OOPLs) and deductible work?

Medical claims for Medicare members and non-Medicare members add up separately. That means, when a non-Medicare member pays for a medical service, it will count towards the non-Medicare deductible and out-of-pocket limit. It will not count towards the Medicare out-of-pocket limit.

Prescription drug costs for Medicare and Non-Medicare members will add up to one family out-of-pocket limit.

7. How can I determine if my health care provider is covered by this plan?

The IYC Medicare Advantage plan is a “passive” Preferred Provider Organization, or PPO, meaning you are not restricted to using network doctors, hospitals and other health care providers. You can see any provider that accepts Medicare and is willing to treat you and bill UnitedHealthcare. For services covered by the group health insurance program, you can continue to see your doctors if they have not opted out of Medicare and agree to see you. Both nationally and in Wisconsin, less than 1% of providers have opted out of Medicare.

8. Is this a Medicare Advantage Health Maintenance Organization (HMO) plan with a limited network?

No. This is a national plan that allows you to see doctors and hospitals around the nation, whether they are in-network or out-of-network. This plan will travel with you and your covered dependents throughout the United States. The service area is all counties in all 50 U.S. states, the District of Columbia and all U.S. territories.

9. What happens if I travel outside the U.S. and need medical coverage?

You will have worldwide coverage for emergency and urgently needed care. You may need to pay the entire claim when receiving care and then submit the claim to UnitedHealthcare for reimbursement after returning to the U.S.

10. Do I still need to use my red, white and blue Medicare card?

No. You will only use the UnitedHealthcare Group IYC Medicare Advantage ID card for all covered medical services. You should put your Medicare card somewhere for safe keeping. It is important that you use your UnitedHealthcare ID card each time you receive medical services. Because UnitedHealthcare pays all claims directly, the claims no longer go to Medicare first. By always showing your UnitedHealthcare ID card, you will ensure your claims get processed correctly, timely and accurately.

You will continue to use your Navitus card when you fill your prescriptions.

Pharmacy

11. Does the IYC Medicare Advantage plan include prescription drug coverage?

Your prescription drug coverage will continue to be provided by Navitus.

12. Will my medications be covered at the same level under the IYC Medicare Advantage Plan as they were when I was an active employee?

There are some drugs that are covered at a different level or require prior authorization under the IYC Medicare Advantage Plan that did not have these requirements under ETF's Commercial Pharmacy Benefit.  Please check the IYC Medicare Advantage Plan Formulary at https://etf.benefits.navitus.com/ to see if there are changes in coverage to your current medications.

13. Will the pharmacy benefits for the IYC Medicare Advantage plan be different from the other Medicare plan options offered through the group health insurance program?

No. All Medicare-coordinated plan options through the group health insurance program offer the same pharmacy benefit administered by Navitus. The plans have the same formulary, in-network pharmacies, mail-order program and cost sharing. There is no coverage gap, or “donut hole” to worry about.

Enrollment

14. Can I or my Medicare-enrolled dependent choose to be insured by IYC Medicare Advantage or IYC Medicare Plus, and the non-Medicare individual choose a non-Medicare IYC Health Plan under my family coverage? 

Yes, if you are insured under a retiree contract where one or more family participants have Medicare and one or more do not, your family may select up to two health plans. This is called a Medicare Some contract. You may select from the following:

  1.  Either IYC Medicare Advantage or IYC Medicare Plus for the Medicare enrolled participants.
  2.  One other IYC Health Plan for the non-Medicare individuals. 

Complete a Health Insurance Application/Change For Retirees & COBRA Continuants (ET-2331) form to enroll.

Note: ETF members are only eligible for the IYC Medicare Advantage plan if they are enrolled in Medicare Parts A and B.

15. If I’m covered by two health plans under a Medicare Some contract, and me or my dependent newly gain Medicare, what happens to my coverage? 

Individuals within the family who gain Medicare will automatically be enrolled in the Medicare plan in place for the Medicare individual(s) that is, either IYC Medicare Advantage or IYC Medicare Plus. The effective date will be the same as the Medicare effective date. 

16. If I choose the IYC Medicare Advantage plan, can I choose one of the other plan options in subsequent years?

Yes. You have an opportunity to change plans each fall during the annual open enrollment period.

Medicare

17. Do I need to enroll in Medicare if I want IYC Medicare Advantage?

Yes. As is the case today, when retirees or their dependents turn age 65 or first become eligible for Medicare, they must enroll in Medicare Parts A and B. Under the IYC Medicare Advantage Plan, individuals eligible for Medicare and enrolled under a retiree contract must pay or continue to pay their monthly Part B premium. Individuals who stop paying their Part B monthly premium will be moved from the IYC Medicare Advantage plan to the IYC Medicare Plus plan. See Question: Can I change health plans, cancel my insurance or change coverage levels when I or my dependent enroll in Medicare?

18. Will I still have Medicare if I enroll in IYC Medicare Advantage?

Yes. You will retain all the rights and privileges of traditional Medicare. Under the IYC Medicare Advantage plan, your medical claims will be paid directly by UnitedHealthcare.

Member Costs

19. How can I pay for the IYC Medicare Advantage plan through ETF?

There will be no difference in how premiums are paid. It is most common that monthly premiums are deducted from your annuity check if it is large enough to cover the monthly health insurance premium. If the annuity payment is not large enough to cover the monthly health insurance premium, the health plan can be paid directly. 

20. The IYC Medicare Advantage plan sounds too good to be true. How can the premium rates be that low?

The answer lies in how the federal government reimburses for Medicare-covered services. Under the current structure, traditional Medicare pays pre-set amounts for specific services, regardless of the patient involved. Under a Medicare Advantage plan, the federal government recognizes that some individuals have health risk factors that make them likely to need additional services. Medicare reimburses more for those patients and enhances payments to the Medicare Advantage plan based on how well it meets standards for quality and member satisfaction. Medicare Advantage plans have an incentive to make sure all members get the care they need. By optimizing federal reimbursement through the Medicare Advantage plan, the state can achieve savings while maintaining the same level of covered services for its retirees.

Other

21. Is this the Medicare Advantage plan that’s advertised on TV?

No. This is a custom Group Medicare Advantage PPO plan designed exclusively for ETF. This plan is different and should not to be confused with individual UnitedHealthcare Medicare Advantage plans that might be available in the area.