Health Care Open-Enrollment Materials Available in October
In late October, STRS Ohio will provide health care open-enrollment materials to benefit recipients who are currently enrolled in an STRS Ohio medical plan. Members who have requested the paperless delivery option will receive an email when the materials are available online, while the rest will be sent by mail. The materials will include personalized information about 2020 medical plan options and premiums, as well as details on a new feature that will enable benefit recipients to make enrollment changes online. STRS Ohio will also post open-enrollment information on our website.
Board Approves Health Care Premiums for 2020; More Than 90% of Enrollees Will See No Premium Increase
At its June meeting, the State Teachers Retirement Board approved health care plan premiums for the 2020 plan year along with several changes to the STRS Ohio Health Care Program for 2020. The approved premiums reflect favorable claims experience and result in little or no cost increase in most plans. In 2020, about 92% of enrollees will have premiums equal to or less than their current premium. The 2020 plan year will mark the fifth year in a row that board-approved premiums for the Aetna Medicare Plan have not increased. The Aetna Medicare Plan has the highest enrollment among plans offered by STRS Ohio.
2020 Health Care Premiums
A sampling of the approved 2020 premiums are shown below. A complete list of premiums is available on the STRS Ohio website.
Monthly Enrollee Premiums for 2020 — With Medicare
|Benefit Recipient Years of Service* (See requirements below.)||Aetna Medicare Plan (Medicare Advantage PPO)
Total Cost: $340
|Medical Mutual Basic (Indemnity or PPO)
Total Cost: $320
|AultCare PrimeTime Health Plan (Medicare Advantage HMO-POS) Total Cost $368||Paramount Elite (Medicare Advantage HMO)
Total Cost: $364
Monthly Enrollee Premiums for 2020 — Without Medicare
|Benefit Recipient Years of Service* (See requirements below.)||Aetna Basic/Medical Mutual Basic (Indemnity or PPO)
Total Cost: $986
Total Cost $894
|Paramount Health Care (HMO)
Total Cost: $936
Members who retired before Jan. 1, 2004, with less than 15 years of service credit have access to coverage but pay the full cost of their premium.
Members who retire on or after Jan. 1, 2004, and before Aug. 1, 2023, must have at least 15 years of qualifying service credit to access coverage.
IMPORTANT: Members who retire on or after Aug. 1, 2023, must have at least 20 years of qualifying service credit to access coverage.
Board Extends Medicare Part B Reimbursement for 2020
The Retirement Board approved a one-year extension of the current Medicare Part B Partial Reimbursement Program. Under this program, benefit recipients currently enrolled in the STRS Ohio Health Care Program and Medicare Part B receive $29.90 per month to reimburse a portion of the Medicare Part B premium. About 85,000 benefit recipients receive this reimbursement that was set to be reduced to $0 beginning Jan. 1, 2020. The reimbursement will continue through calendar year 2020.
Board-Approved Health Care Plan Changes for 2020
Approved health care plan changes include:
- Increasing the prescription drug maximum out-of-pocket limit to $6,350 from $5,100 for the Medicare plans to align with the 2020 standard Medicare prescription plan.
- Modifying the specialty drug coinsurance for Medicare and non-Medicare enrollees — changing the specialty drug coinsurance to the lesser of 13% or $450 per 31-day period from the lesser of 13% or $550 per fill. The cost for a 32–60 day fill will be the lesser of 13% or $900, and the cost for a 61–90 day fill will be the lesser of 13% or $1,350.
- Adding SaveonSP manufacturer copay assistance program for non-Medicare enrollees — the manufacturer pays a higher copay with a $0 balance to the participating enrollee.
- Adding a 24-hour nurse line to the Medical Mutual Basic Plan for non-Medicare enrollees.
- Requiring transplants to be performed at Organ Transplant Centers of Excellence for Medical Mutual Basic Plan non-Medicare enrollees.
- Moving Medicare Parts A & B enrollees in the regional AultCare PPO plan to AultCare’s PrimeTime Health Plan.
SaveonSP Manufacturer Copay Assistance Program
Non-Medicare enrollees currently taking a qualifying specialty medication will receive a letter inviting them to participate in the program. Enrollment in the SaveonSP program is completed during a phone call with trained representatives from both SaveonSP and Accredo, Express Scripts’ exclusive non-Medicare specialty medication provider. The enrollment call typically takes five to 10 minutes. Non-Medicare enrollees who are prescribed a qualifying specialty medication in the future will be enrolled in the program when they contact Accredo to schedule delivery of their specialty medication.