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Awareness Benefits Health Options Program Medicare Prescription Drugs PSERS

End of the Federal Public Health Emergency for COVID-19

Recently, the Department of Health and Human Services (HHS) announced the end of the federal Public Health Emergency for COVID-19, effective May 11, 2023. As a member enrolled in a Health Options Program Medicare Rx Option, we want to help you understand what this means for your benefits coverage and answer any questions you may have.

What this means starting May 12, 2023

Between now and May 12, 2023, there is no change to how COVID-19-related services are covered.

OptumRx, the administrator for the Health Options Program Medicare Prescription Drug Options, will be ending certain operating flexibilities that were put in place during the Public Health Emergency. Your prescription drug benefit will resume all normal operating policies and coverages as outlined in the Evidence of Coverage (EOC) and the Utilization Management (UM) criteria for formulary medications. This includes, but is not limited to the resuming of:

  • Quantity limits on some medications
  • Refill too soon edits as per normal operating policy
  • Transition fills to the normal 30-day supply

You can find a copy of the 2023 Evidence of Coverage on the Medicare-Eligible Resources page. If you have questions regarding your prescription benefits, contact OptumRx at 1-888-239-1301 (TTY/TDD: 1-800-498-5428) 24 hours a day, 7 days a week.

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Benefits Health Options Program Option Selection Period OSP

The Results Are In: Members Love HOP

Last fall, we included a survey in the materials our members received for the Option Selection Period. The survey asked members to rate the materials on a scale from 1 to 10. The results are in and were similar to past years’:

  • Ninety percent rated the materials as 7 or higher on a scale of 1 (not satisfied) to 10 (very satisfied).
  • Eighty-six percent felt they received the right amount of information—not too much or too little.
  • About 88% rated the personalized statement’s understandability as 7 or higher on a scale of 1 (not understandable) to 10 (very understandable).
  • Over 88% of members felt they had the right number of coverage options for medical, prescription drug, dental, and vision coverage.

Thank you to the more than 6,100 members who responded. We work hard to meet your needs and provide useful and relevant materials. We hope you continue to find the materials informative and helpful.

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Benefits Health Options Program Medicare PSERS

Medicare Star Rating for the Health Options Program

Each year, Medicare evaluates prescription drug plans and awards a star rating to each plan based on performance. This star rating can be used to help you determine which plans excel based on measured categories, including customer service, overall member satisfaction, and patient safety. Ratings range from 1 to 5 stars, with five being the highest score. The Health Options Program’s prescription drug plans received a 4.5-star rating for 2023, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.

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Benefits Office Hours

Individual Phone Consultations: Spring 2023

You can schedule a 30-minute individual telephone consultation (not a group meeting) with a staff member of the Health Options Program by following the steps below:

  • Call the HOP Administration Unit at 1-800-773-7725.
  • Let the representative know you want to schedule an individual telephone consultation.
  • After you make your appointment, you’ll receive a confirmation email with the date and time.

As it gets closer to your appointment, you’ll receive a reminder email.

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Awareness Benefits Health Options Program Medical Medicare

2023 Medicare Highlights

Each year, if needed, the Centers for Medicare & Medicaid Services (CMS) adjust Medicare’s premiums, deductibles, and copays. Most people do not pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working. However, to be covered under Medicare Part B, you must pay a monthly premium, which is deducted from the Social Security benefit for most people. As required by law, the standard monthly premium is set each year at 25% of the cost for senior beneficiaries. The government pays the remaining 75%.

The chart below compares 2022 to 2023 costs. The Health Options Program is designed to pay some or all of these deductibles and coinsurances. For example, the HOP Medical Plan pays your Part A deductible and coinsurance for stays in the hospital and skilled nursing facilities, as well as the Part B deductible. The Value Medical Plan also pays 100% of Medicare’s hospital deductible and daily copays but only after you pay the first $300.

Amount You Pay (without supplemental insurance)

2022 2023
Part A
First-day hospital deductible $1,556 $1,600
Coinsurance for days 1-60 of a hospital stay $0 $0
Coinsurance for days 61-90 of a hospital stay $389/day $400/day
Coinsurance for days 1-20 of a skilled nursing facility $0 $0
Coinsurance for days 21-100 of a skilled nursing facility $194.50/day $200/day
Part B
Standard monthly premium for most new enrollees and Medicare beneficiaries $170.10 $164.90
Deductible $233 $226
Coinsurance 20% 20%
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Awareness Benefits Health Options Program Medicare Advantage Medicare Supplement PSERS

Are You Almost 65?

If you’re a PSERS retiree about to turn age 65, we’re eager to tell you about the benefits of joining the Health Options Program. We take a number of steps to make sure you understand how the program works.

First, we’ll send you a package of information from four to nine months before your 65th birthday. We mail these twice a year—in the winter for people turning age 65 during the first six months of the following year and in the spring for people turning age 65 in the second half of the year. The package contains a description of the medical and prescription drug benefits available under the Health Options Program—plus a personalized statement that has information specific to you—including your monthly premiums for all your coverage options.

In addition, we conduct virtual group meetings multiple times a year, where you can learn about the Health Options Program and ask questions. If you’re unable to attend a live virtual group meeting, you can watch one of the recorded sessions. The live meeting schedule is posted to our website.

Also, if you register on this website, you’ll find an online version of the personalized statement. Plus, if you misplace or want another copy of your statement, a printer-friendly version is available.

Interested in learning more about the Health Options Program? Visit our virtual benefits fair at discoverhopbenefits.com. You’ll find a ton of information from Health Options Program partners and all the great benefits available to you as a PSERS retiree.

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Awareness Benefits Medicare

You Need to Know: 2023 Updates for the Medicare Rx Options

Increases to Coverage Gap and Catastrophic Coverage Thresholds

Medicare requires that all Medicare prescription drug plans (including those provided by a Medicare Advantage plan) make certain changes each year. For 2023, the dollar thresholds for certain coverages are increasing:

  • The coverage gap dollar threshold increased to $4,660.
  • The catastrophic coverage dollar threshold increased to $7,400.

What this means for you:

If you meet the catastrophic coverage threshold, you will then pay:

  • Generic drugs: the greater of 5% or $4.15, up to the maximum
  • Brand-name drugs: the greater of 5% or $10.35, up to the maximum

Enhanced, Basic, and Value Medicare Rx Options

There are no changes to the copay or coinsurance that you pay for medication in the Initial Coverage stage under the Basic or Value Medicare Rx Options.

2023 updates for the Enhanced and Value Medicare Rx Options are:

  • Value Medicare Rx Option: The annual deductible increased to $505.
  • Enhanced Medicare Rx Option: The coinsurance for specialty drugs in the Initial Coverage stage reduced to 25%.

Need more info? Refer to the benefit tables for specific copay amounts.

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Awareness Benefits Health Options Program Medicare Supplement Prevention

Take Full Advantage of Health Options Program Resources—Here’s How.

The HOP Administration Unit, customer service teams, program advocates, and case managers are especially trained on Health Options Program benefits. Not sure where to start? Call 1-800-PSERS25 (1-800-773-7725). In the meantime, here are certain ways the Health Options Program can help.

Experiencing a serious health condition or treatment, or have a hospital admission?

Call the Trustmark Health Care Management team at 1-800-480-6658. Note that they may reach out to you if you have a hospital stay or need skilled nursing care.

Looking for ways to enhance your well-being?

Call the Elder Care Program at 1-866-794-0685, and ask to speak to an advocate. They can help you find resources, such as local transportation options, getting answers to utility questions, help with finding prescription drug delivery, discount programs, and support for improving nutrition.

Want to be more active?

Give SilverSneakers a try for fitness and social connections. If you are enrolled in the HOP Medical Plan or HOP Pre-65 Medical Plan, you have access to SilverSneakers instructors who lead specially designed group exercise classes. SilverSneakers features access to gyms for classes and fitness. Plus, SilverSneakers FLEX®, SilverSneakers LIVE, SilverSneakers On-DemandTM, and the mobile app all provide options to get active outside of traditional gyms. Find out how to enroll in SilverSneakers, or find a SilverSneakers location.

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Awareness Benefits Health Options Program

If Your New Year’s Goal Is to Simplify Your Life, Read This!

Did you know that the Health Options Program features online access to important information for you and/or your authorized representative? Here’s how to access it:

  • Log in to the secure Member Area of the website for personalized information, such as copies of your claims, Explanation of Benefits, and ID cards. If you are already registered, just sign in with your username and password. You can reset them if you’ve forgotten them.
  • Register for the secure Member Area if you haven’t already. To create an account, click on the For Members button on the top right corner of the home page.
  • Visit the Forms & Resources page for HOP Medical Plan, Value Medical Plan, and Pre-65 Medical Plan documents and forms—no need to log in to view these.

We take the security of our members’ information seriously. Our website uses industry-standard security to protect our members’ information. It also meets the stringent data security requirements of HIPAA (the Health Insurance Portability and Accountability Act of 1996). Note: If you are enrolled in a Medicare Advantage plan, ask your insurance provider about the online resources available to you.

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Awareness Benefits Health Options Program

Make 2023 Your Healthiest, Happiest Year Ever — with SilverSneakers!

The new year is just around the corner, and the senior fitness experts at SilverSneakers are excited to ring it in with the all-new Strong Body, Strong Mind, Strong You! Challenge.

What do you see for yourself in 2023?

Is your wish to have more energy so you can travel or pick up a new hobby? Or maybe your goal is to get stronger or more mobile so everyday activities are easier. Or perhaps you simply want to take a little time out of your day to invest in your health and peace of mind.

No matter where you are on your fitness journey or what you want to achieve, the SilverSneakers Strong Body, Strong Mind, Strong You! Challenge can help get you moving in the right direction with fun videos and great tips.

About the challenge: During the month of January, SilverSneakers LIVE trainer Shannon Thigpen will be your guide. You’ll find:

  • New follow-along workouts for cardio, strength, and flexibility
  • Moves to build balance and coordination, and ease aching joints
  • Simple strategies to start your own mindfulness practice
  • Quick tasks to help you exercise smarter, eat better, and find more joy
  • Foolproof ways to set goals and stay motivated

Everyone is invited to visit the SilverSneakers blog and Facebook page beginning January 1 to make 2023 your healthiest, happiest year yet!

Not registered? Sign up today for personalized information.