TITLE
Title
MEDICARE ADVANTAGE PLAN FOR 2025
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SPONSOR
Sponsor
Jaime Joyner (Mirna Simaan)
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BACKGROUND
Background
Medicare-eligible retirees who meet the required criteria are currently covered by a Medicare Advantage plan. The Inflation Reduction Act (IRA) includes a redesign of the Medicare Part D benefit in 2025. Two major changes that are part of this redesign are:
1-Medicare is eliminating the Coverage Gap in Part D plans effective 1/1/2025
2-Medicare Part D is implementing a $2,000 out-of-pocket max effective 1/1/2025
In addition to the design changes, the Centers for Medicaid and Medicare Services (CMS) are providing less subsidies to insurance carriers which is causing an increase in insurance premium rates for Medicare Advantage plans.
When initially notified of the plan changes, the quote included a potential 25.3% increase over current costs for the county’s Medicare Advantage plan. We asked our broker to market the plan for better rates and redesign the plan’s offerings to ensure coverage that is consistent with our active employee plan.
The proposed plan design changes for retirees would be a $20 co-pay for primary care visits, $35 co-pay for specialist visits, $125 co-pay for emergency room visits, $50 co-pay for urgent care visits, $100 co-pay for physical, speech and occupational therapy visits, and a $10 co-pay for chiropractic visits. Additionally, the annual deductible amount would increase from $200 to $500 and the amount of out of pocket maximum would increase from $2,200 to $5,000.
The plan currently costs a total of $237.59 monthly for Medicare-eligible retirees. The County contributes $203.12 on behalf of 30-year retirees. For 2025, the total monthly premium will increase to $242.89. This is a change of $5.30 per month or 2.2%.
The County's contribution will increase to $208.28, with the retiree paying the balance. The retiree's contribution will increase by $0.14 from $34.47 per month for the current year to $34.61 per month for 2025 to be consistent with the Health Care Coverage for Retired Guilford County Employees Resolution.
As of October 2024, we have 1,197 participants that are enrolled in our Medicare Advantage plan. The County's estimated total annual contribution based on current membership is $2,511,231.96 and the total estimated retiree contribution based on current membership is $977,640 for a total annual estimated expense amount of $3,488,871.96.
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BUDGET IMPACT
Budget Impact
NO ADDITIONAL COUNTY FUNDS REQUIRED
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REQUESTED ACTION
Requested Action
Approve price only contract, in substantial form, with United Healthcare (UHC) to provide Medicare eligible qualified retirees with the current Medicare Advantage plan, with minimal plan design changes, with a total rate of $242.89 and the County's contribution at $208.28 per eligible retiree to be effective January 1, 2025. (The anticipated total expense is $3,488,871.96 including $977,640 in retiree premium contributions and $2,511,231.96 in County premium contributions.)
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