Medica Group Medicare Solutions
2012 Plan Details
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Medica Group Medicare Solutions
At Medica, we believe in healthy living at all ages!
With that in mind, we created Medica Group Prime Solution to serve the needs of emploer group sponsors with Medicare-eligible retirees.
As a benefit administrator, you may not have the time or resources to deal with the complexities of Medicare. By partnering with Medica, the nation's leading Medicare cost plan, and let us administer your
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retiree health plan options. With more than 160 Group Medicare clients to date, Medica has partnered with employer group sponsors to help them maintain their committments and obligations to retirees.
Do you have a current retiree plan?
If so, is your current retiree strategy sustainable?
Minnesota’s Medicare population will rise sharply in the coming years and those persons 65 and older in an active insurance pool raise the overall group costs.
- Consider moving retirees from an active plan to a Group Medicare plan.
- Potential to reduce premium expenses.
- Potential to reduce FASB / GASB liability.
If not, there are good reasons to consider creating your own retiree plan
- It's better than a gold watch - reward your retireees with a comprehensive benefit plan.
- Employer contribution not required and minimal administrative burden.
- Enhances employee satisfaction and retention.
- Give your employees access to a "voluntary" Group Medicare plan that provides better benefits than the Individual Medicare market.
Who can form a group?
- Private employers
- Public entities (cities, counties, school districts)
- Labor unions
- Colleges and universities
How does a Group Medicare plan benefit a member?
Members will receive all the benefits of original Medicare plus additional benefits such as enhanced prescription drug coverage, lower out-of-pocket maximums and better eyewear and hearing aid coverage.
Medica plan highlights
- Lower out-of-pocket maximums than comparable plans
- Out-of-pocket maximum on drug cost unique to market
- Plans with no prescription Part D coverage gap or "donut hole"
- Richer drug benefits than comparabel plans
Group Medicare plan features:
- Out-of-pocket maximums as low as $1,000
- Prescription drug coverage through the coverage gap "donut hole"
- Coverage for Medicare-excluded drugs
- Standard plans offer a variety of coverage options
- Custom plan designs available depending on size of group
- Nationwide medical and prescription drug coverage when out of the Medica network
- Eyewear and hearing aid benefits
- Free health club membership
Employers choose Medica Group Medicare plans because...
- No employer contribution required
- Plans can be Group and/or Individually billed
- More plan design options to meet your needs
- Year-round implementation
- Dedicated account management
- Minimal administrative burden
- Local customer service with a market-leading reputation
- Retiree participation is voluntary
- No underwriting
- Uniform rating
- No tobacco rating
Group Medicare plans provide better coverage than Individual plans
- Prescription drug coverage through the coverage gap “donut hole”
- Lower out-of-pocket maximums
- Out-of-pocket maximums on prescription drugs
- Coverage for Medicare-excluded drugs
- Better eyewear and hearing aid benefits
Group Medicare Plans
Preferred Portfolio
- Four "off the shelf" plan designs
- $1,000, $2,000 or $3,000 max out-of-pocket expense
- Four tier Part D prescription benefit options with no "coverage gap"
- Individual or group billing options
|
Plan 1 |
Plan 2 |
Plan 3 |
Plan 4 |
| 2012 Monthly Rate |
$295 per member |
$235 per member |
$195 per member |
$95 per member |
| Medical Deductible |
None |
$150 |
$300 |
$300 |
| Doctor Visits |
100% coverage |
$15 copay |
$20 copay |
$20 copay |
| Inpatient Hospital |
100% coverage |
$100 copay |
$200 copay |
$200 copay |
Part D Prescription Drug Copays
No coverage gap |
Up to:
$10 copay
(generic)
$25 copay
(preferred brand)
$50 copay
(non-preferred brand)
$75 copay
(specialty) |
Up to:
$10 copay (generic)
$25 copay (preferred brand)
$50 copay
(non-preferred brand)
$75 copay (specialty) |
Up to:
$10 copay
(generic)
$25 copay (preferred brand)
$50 copay
(non-preferred brand)
$75 copay (specialty) |
Up to:
$10 copay
(generic)
$34 copay (preferred brand)
$74 copay
(non-preferred brand)
25% coinsurance (specialty)
Coverage gap applies
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| Out-of-Pocket Maximum per Calendar Year |
Medical - N/A, 100% coverage for all eligible medical services
Rx - $1,000 |
Medical -$1,000
Rx - $1,000 |
Medical -$2,000
Rx - $2,000 |
Medical - $2,000
Rx - Medicare catastrophic limits |
Public Employee Insurance Program (PEIP)
- Tailored plan options for cities, counties and school districts
- Three "off the shelf" plan designs
- No plan sponsorship is necessary
- Individual or group billing options
|
Plan 1 |
Plan 2 |
Plan 3 |
| 2012 Monthly Rate |
$255 per member |
$95 per member |
$135 per member |
| Medical Deductible |
None |
None |
None |
| Doctor Visits |
$15 copay |
$15 copay |
$15 copay |
| Inpatient Hospital |
$100 copay |
$100 copay |
$100 copay |
| Part D Prescription Drug Copays |
Up to:
$10 copay
(generic)
$25 copay
(preferred brand)
$50 copay
(non-preferred brand)
$75 copay (specialty)
No coverage gap
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No coverage |
Up to:
$10 copay
(generic)
$34 copay
(preferred brand)
$74 copay
(non-preferred brand)
25% coinsurance (specialty)
Coverage gap applies
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| Out-of-Pocket Maximum per Calendar Year |
Medical -$1,000
Rx - $1,000 |
Medical -$2,000 |
Medical - $2,000
Rx - Medicare castasrophic limits |
Next Steps
- Work with Medica to determine the best plan design:
- Retiree groups with 10 __ 50 members may choose from the Preferred Portfolio plans.
- Retiree groups with more than 50 members can collaborate with Medica to customize benefits.
- Public employers can use the PEIP benefit design.
- Minimal paperwork.
- Choose your start date; new groups can be created at anytime during the year.
- Schedule enrollment meetings and/or announcement letter mailing with support from Medica.
Additional Resources
Contact Us
Call us at 1-866-882-9973 or send us an email.
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