【正文】 DC for Others Pure DC Full Cost High Low 47 Mercer Human Resource Consulting Medicare+Choice Health plan takes risk, receives “capitated” payment ? Medicare “Part C” (Medicare Advantage?) ? Health plan offered by private insurance panies, usually on an HMOlike basis ? Benefits broader than Original Medicare – Reduced out of pocket expenses for deductibles and copayments – May offer prescription drug coverage ? Medicare pays a set amount of money to private insurer ? May be additional premium cost over Part B premium (fully insured to employer) ? Available only in certain areas ? Recent private insurer profitability poor and insurers have curtailed availability and increased costs to retiree 48 Mercer Human Resource Consulting Medicare+Choice HMO Enrollment Enrollment declined for first time in 2023 Source: Medicare Managed Care Contract (MMCC) Plans Monthly Summary Reports from CMS Website () Dec 90 Dec 91 Dec 92 Dec 93 Dec 94 Dec 95 Dec 96 Dec 97 Dec 98 Dec 99 Dec 00 Dec 01 Dec 02 E nrol l ed 1, 26 3, 54 7 1, 38 9, 40 1 1, 56 5, 65 9 1, 81 1, 45 3 2, 26 8, 36 4 3, 08 9, 25 9 4, 11 5, 29 3 5, 21 1, 33 9 6, 05 5, 54 6 6, 34 7, 43 4 6, 26 0, 54 9 5, 48 0, 89 9 4, 92 9, 69 0% G r ow th n/ a 10% 13% 16% 25% 36% 33% 27% 16% 5% 1% 12 % 10 % P l an s 96 93 95 109 154 183 241 307 346 309 266 179 15501 , 0 0 0 , 0 0 02 , 0 0 0 , 0 0 03 , 0 0 0 , 0 0 04 , 0 0 0 , 0 0 05 , 0 0 0 , 0 0 06 , 0 0 0 , 0 0 07 , 0 0 0 , 0 0 08 , 0 0 0 , 0 0 0D e c 9 0 D e c 9 1 D e c 9 2 D e c 9 3 D e c 9 4 D e c 9 5 D e c 9 6 D e c 9 7 D e c 9 8 D e c 9 9 D e c 0 0 D e c 0 1 D e c 0 2Enrollment050100150200250300350400 of PlansT o t E n r H M O s49 Mercer Human Resource Consulting 2023 Medicare+Choice HMO Availability Even after pullbacks, slightly more than threequarters of Medicare Eligibles still live in counties which offer at least one M+C plan in 2023 PFFS Plan Locations Cover Approximately 35% of Medicare Eligibles Over 58% of Medicare Eligibles Live in M+C HMO Areas Source: CMS Medicare Plan Compare Data Sterling Life Insurance Company Coverage Data as of 3/31/023 50 Mercer Human Resource Consulting Medigap Overview Plans supplement “original Medicare” benefits ? Sold to individuals age 65+ (and certain other Medicare Eligibles under 65) ? Medigap carriers must accept all applicants for the first six months of eligibility ? The basic benefits included in every Medigap plan are – Part A coinsurance (for admissions of more than 60 days) – Coverage for 365 additional hospital days after Medicare benefits exhausted – Part B coinsurance – The first three pints of blood each year ? Product types – Standard products ? A through J sold from 1992 to present ? Only H, I and J cover prescription drug – Medicare Select ? Provides Medigap benefits with work discount and lower prices 51 Mercer Human Resource Consulting Medigap Policies Overview AARP and BCBS plans offer majority of products ? Only individual insurance plans permitted by law that can be issued to Medicare Eligible individuals ? Carriers cannot customize plans and must offer “standardized” plans ? Regulated by state insurance authorities within federal government guidelines ? Major providers include AARP, Blues plans, some insurers – AARP in all states with Plan A through J – Blues in all states but limited offering, particularly of plans H, I and J ? Most plans underwrite where allowed – Exception is AARP, with minimal underwriting requirements (only ESRD) except on plans H, I and J 52 Mercer Human Resource Consulting Medigap Policies Policy features Item Plan A Plan B Plan C Plan D Plan E Plan F Plan G Plan H Plan I Plan J Basic Benefits* Skilled Nursing Coinsurance Part A Deductible Part B Deductible Part B Excess Foreign Travel Emergency At Home Recovery Drugs** Preventive Care Approximate Monthly Premium Range $55$150 $90$190 $100$210 $90$200 $100$200 $110$210 $100$230 $150$230 $160$250 $200$290 *Basic Benefits = Part A coinsurance plus 365 extra days of hospital care plus Part B coinsurance plus three pints of blood/year **$250 deductible, 50% coinsurance to contract limit 53 Mercer Human Resource Consulting Medicare Select ? Same standardized plan designs (A through J) as other Med Supp policies – AARP offers it on Plan C only ? Works like a Preferred Provider Organization (PPO) – Full supplemental benefits available if work providers used – Reduction or loss of supplemental benefits if nonwork providers used – Always retain full Medicare benefits ? Most mon provider works are hospitals only – Hospital can waive Part A deductible via safe harbor from antikickback statutes – Limited ability to affect Part B cost – Negotiations with other vendors possible ? Lower cost than Medigap: typically 20% discount – AARP example: Ohio Plan C: $122。 DC for Others Employer pays X% of cost of one specified Plan A (“preferred” or “employer” plan). The amount of employer contribution for Plan A bees the defined dollar contribution for Plans B, C, …。 of uncapped plans ? Many caveats – Usually applied only to those retiring postannouncement – Evaluate separately for preMedicare eligible vs. Medicare eligible, or in aggregate – Evaluate per retiree or in aggregate – Definitions of “premiums” and “costs” ? cross subsidy of actives/retirees can cloud calculations ? Need clear definition of how costs and contributions are calculated before cap is hit ? Enrollees will understand concept, but likely won’t be prepared for eventual increases 42 Mercer Human Resource Consulting Employers Being Less Involved Summary ? Focusing on approaches that allow a