Plans & Premiums for Enrollees With Medicare

Plans & Premiums for Enrollees With Medicare
If you are eligible for Medicare (Parts A & B or Part B only), this section is for you.

In this section you’ll find important information about Medicare. You’ll also find charts that provide a detailed look at the coverage features of the plans that may be available to you with Medicare. In addition, you’ll find charts that list monthly premiums for benefit recipients based on years of service, as well as premiums for spouses, children and other eligible dependents with Medicare.

Carefully review and compare the features and premiums of the plans that may be available to you, keeping in mind your health care and financial needs.

Individuals age 65 or older are eligible for Medicare, regardless of whether or not they contributed to Social Security. STRS Ohio requires all eligible health care plan participants to enroll in Medicare at age 65 or whenever eligible. If you do not enroll, you will pay a significantly higher premium for STRS Ohio health care coverage until you enroll in Medicare.

If you are enrolled in Medicare but you have a dependent who is not Medicare-eligible, review the section for your plan options and premiums with Medicare. Then go to the non-Medicare section to review your dependent’s plan options and premiums. Keep in mind that you and your dependents must enroll in a plan offered by the same plan administrator. In addition, if you’re enrolling in a Basic or Plus Plan, you and your dependents must enroll in the same plan level, Basic or Plus.

Members who have access to their personal account information online can use a “personalized” version of the health care plan options application, which uses the information STRS Ohio has on file for the member. To use this version, simply log in to the Personal Account Information area in the upper right-hand corner of the page and select “Health Care Options Wizard” from the drop-down menu.

If you have specific questions about plan features after reviewing this section, please contact the plan administrator directly. If you have questions about monthly premiums, please call STRS Ohio’s Member Services Center toll-free at 1-888-227-7877.

Prescription Drug Reference Guide
Express Scripts administers the prescription drug program for all Aetna, Medical Mutual and Paramount health care plans. When reviewing prescription drug coverage for these plans, it’s important to understand the following key terms.

Key Term	Description
Tier 1	Generic medications available for the lowest copayment.
Tier 2	Select brand-name medications available for a lower copayment than Tier 3 medications.
Tier 3	Other brand-name medications available for the highest copayment.
Prilosec OTC^®	Over-the-counter Prilosec, which is available for a $5 copayment with a prescription at participating retail pharmacies (up to a 28-day supply).
PPI	A proton pump inhibitor (PPI) class of medications primarily used to treat frequent heartburn and Gastroesophageal Reflux Disease (GERD). You will pay a higher copayment for Tier 1, Tier 2 and Tier 3 PPI medications. To save money, ask your doctor about Prilosec OTC^®.
Double-strength medications	The STRS Ohio Prescription Drug Program offers a voluntary tablet-splitting program that allows you to save money by using double-strength medications. Specific medications can be prescribed at double the strength and split in half by the recipient to get the prescribed lower strength. These medications, which are on a designated list, are available for half the applicable copayment, up to half the quantity of the maximum day supply. Your physician must write a prescription for twice the strength of the medication, up to a 15-day supply at retail and a 45-day supply through mail order.