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Health Options Program Prescription Drugs

Prescription Drug Options Recognized Again

The prescription drug options under the Health Options Program are being recognized by the Pharmacy Quality Alliance for maintaining high standards in medication quality measures. These categories are part of the overall CMS star rating. The Program received an overall rating of 4.5 stars out of 5 for 2021. The Program also received a 4.5 star rating in 2020. CMS awards a star rating to prescription drug plans based on performance in categories such as customer service, overall member satisfaction, and patient safety. The Pharmacy Quality Alliance works with CMS on these measures and recognizes plans with an Excellence in Quality Award and the Quality Improvement Award. The Health Options Program is pleased to share this recognition.

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Health Options Program OSP

The Results are In: Option Selection Period Materials

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':

  • 88% rated the materials as 8 or higher on a scale of 1 (not satisfied) to 10 (very satisfied).
  • 86% felt they received the right amount of information—not too much or too little.
  • About 89% rated the personalized statement’s understandability as 8 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 5,000 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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Awareness Health Options Program Prescription Drugs PSERS

Price Your Medications Online

When your doctor prescribes a new medication, how do you know how much it will cost? You can use the OptumRx® Drug Pricing Tool. This online tool is easy to use and provides the information you need to compare local pharmacies and home delivery costs. This tool is available to members enrolled in a Medicare Rx Option under the Health Options Program. You must be registered on the OptumRx website. When you register or sign in on optumrx.com for the first time, you will be asked to create a HealthSafe ID. This ID helps protect the security of your personal health information.

How to Use the Tool

  1. Visit optumrx.com and log in or register to get started.
  2. Select the Price a Drug option from the main menu.
  3. Enter the name of your medication, and click the search icon.
  4. Review the results. As a registered member, the tool will know which Medicare Rx Option you are enrolled in and what stage of coverage you are in (e.g., Initial Coverage, the Coverage Gap, or Catastrophic Coverage).
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Awareness Benefits Eyesight Health Options Program

Have You Scheduled Your Annual Eye Exam?

If you are enrolled in the HOP Medical or the Value Medical Plan and have dental coverage, you have a new vision benefit in 2021. Your new EyeMed vision coverage includes an eye examination, frame, and prescription lenses or medically necessary contact lenses once every other calendar year.

It’s important to get an eye exam every year—even if you don’t need glasses. Your eyes can change gradually over time and they might be under more strain if you use digital devices. Also, health problems such as diabetes, high blood pressure, high cholesterol, thyroid disease, cancer, tumors and autoimmune disorder can be detected through a comprehensive eye exam.

To find an in-network provider, visit the EyeMed website and select the Insight network. If you haven’t received your ID card in the mail, you can print one by logging in to the member website or download the EyeMed member app though the Apple App Store or Google Play.

Visit the EyeMed Vision Option page for more information.

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Awareness Benefits Health Medicare

When You Need A Little Extra Support

Whether you are facing a serious health issue, hospital admission, or want to quit smoking, the Health Options Program has you covered. Our plan options provide financial protection from the high cost of health care—and programs, such as Elder Care and Health Care Management, to help with everything else.

The advocates and case managers are trained on the Health Options Program benefit plans. They can support you while you focus on your well-being. Each program is designed to focus on a specific type and level of care, as shown below.

  Elder Care Program (general wellness resources) Health Care Management (medically necessary services)
Program description

A service that connects members with resources for their overall well-being.

A program that supports members (or their authorized representative) through a serious health condition and related treatment.
How it works

Members can call the Elder Care Program at 1-866-794-0685 to speak to a social and human services advocate.

In certain cases, such as a hospital admission, an advocate may reach out directly to the member.

Advocates also work with Health Care Management case managers.

In most cases, a representative will reach out to members based on their claims experience. However, members can call the Health Care Management Program at 1-800-480-6658.

A representative will take your information and send it to a case manager, who will contact you at a later time. All case managers are registered nurses.
Examples of when to use these programs
  • If you need help navigating Medicare resources, such as the State Health Insurance Program (SHIP).
  • If you need to find local meal delivery, transportation, utility assistance, or prescription drug delivery and discount programs.
  • If you need general wellness, specific condition care, or nutrition resources (e.g., smoking cessation tips).
  • When you need help planning for recovery or looking for alternative methods of medical care or treatment, equipment, or supplies.
  • When you need skilled nursing care at home, a skilled nursing facility, or home intravenous infusion therapy.

Services are available only when they are medically necessary and covered under the Health Options Program.

 

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Benefits Health Options Program Prevention

Stay Fit From the Comfort of Your Home

If going to the gym is not an option, SilverSneakers offers virtual solutions so maintain a healthy lifestyle, without leaving your home. If you are enrolled in the HOP Medical Plan or HOP Pre-65 Medical Plan, you have access to these programs at no additional cost.

SilverSneakers LIVE offers online, full-length classes and workshops multiple times every day, including weekends. Pick the class you want to attend, and log on at class time.

You also have access to a videos anytime, anyplace through SilverSneakers On-Demand. The video library has hundreds of videos on popular topics such as workouts, fall-prevention classes, and stress management.

To get started, download the SilverSneakersGO mobile app or visit www.silversneakers.com to learn more about your benefit.

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Awareness 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 and one being the lowest score. The Health Options Program’s prescription drug plans received a 4.5 star for 2021, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.

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Health Options Program PSERS

You Can Pay Your Bill Online!

If you currently pay your premium via payment coupons, you can now make payments online by logging in to your Health Options Program account.

To get started, sign in and click Pay My Bill to go to the new payment portal. Once you are in the payment portal, you will also be able to view your statement, payment history, and balance due, or set reminders about payments.

If you are not registered, click New User Registration.

Note: The option to pay your premium online is only available if your premium is larger than your pension. Otherwise, your premium is deducted automatically from your pension.

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Benefits Health Options Program Medicare Newsletter

2021 Medicare Highlights

Each year, if needed, the Centers for Medicare & Medicaid Services (CMS) adjust Medicare’s premiums, deductibles, and copays. As a reminder, Medicare Part A covers hospital expenses, and Medicare Part B covers other types of medical expenses, including physician services, certain home health services, and durable medical equipment. Medicare Part D covers prescription drugs.

Part B premium and deductible for 2021

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 (in most cases, deducted from your Social Security benefit). 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%.

Most Medicare beneficiaries—including those who will enroll in Part B for the first time in 2021—will pay a Part B premium of $148.50. However, some people who get Social Security benefits pay less ($130 on average), and others may pay more if their 2019 modified adjusted gross income is above a certain amount. More about Part B premium amounts can be found on the Part B Costs page on www.medicare.gov.

The Part B deductible is $203 for 2021. This is the amount you must pay for health care before Medicare begins to pay for covered services and products.

The chart below compares some of your costs in 2020 to 2021. 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 hospitals 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) – Part A
What you pay for 2020 2021
First-day hospital deductible $1,408 $1,484
Coinsurance for days 1-60 of a hospital stay $0 $0
Coinsurance for days 61-90 of a hospital stay $352/day $371/day
Coinsurance for days 1-20 in a skilled nursing facility $0 $0
Coinsurance for days 21-100 in a skilled nursing facility $176/day $185.50/day
Amount YOU Pay (without supplemental insurance) – Part B
What you pay for 2020 2021
Standard monthly premium for most Medicare beneficiaries $144.60 $148.50
Standard monthly premium for new enrollees in 2021 and certain other Medicare beneficiaries $144.60 $148.50
Deductible $198 $203
Coinsurance 20% 20%

 

Categories
Benefits Health Options Program Medicare Supplement

New: MetLife Dental and EyeMed Vision Option

If you are enrolled in the MetLife dental plan, you have a new vision benefit in 2021. One election provides you with both dental and vision coverage. Your new EyeMed vision coverage includes an eye examination, frame, and prescription lenses or medically necessary contact lenses once every other calendar year.

Each time you need vision care, you decide whether to use an in-network or out-of-network provider; however, you’ll always pay less with an in-network provider. For most in-network services, including eye exams, most lenses and frames, you pay nothing—a $0 copay—when you need care. To find an in-network provider, visit eyedoclocator.eyemedvisioncare.com and select the Insight network. If you haven’t received your ID card in the mail, you can print one by logging in to member.eyemedvisioncare.com or download the EyeMed member app though the Apple App Store or Google Play.

Visit the MetLife Dental and EyeMed Vision Option page for more information.

Reminder: You must be enrolled in the HOP Medical or the Value Medical Plan to be eligible for the EyeMed vision option. It is not available on a stand-alone basis or with a Medicare Advantage plan.

Not registered? Sign up today for personalized information.