Medicare Advantage Plan Options
The State Health Benefit Plan (SHBP) offers Medicare-eligible members Medicaid Advantage (MA) Plan Options (Standard and Premium) from two different vendors:
- Anthem Blue Cross and Blue Shield Medicare Advantage Standard
- Anthem Blue Cross and Blue Shield Medicare Advantage Premium
- UnitedHealthcare Medicare Advantage Standard
- UnitedHealthcare Medicare Advantage Premium
No Coordination with Medicare: The benefits paid under the MA Plan Options reflect what Medicare would have paid (except for some plan enhancements); therefore, it does not coordinate benefits with Medicare.
Medicare Parts A, B, and D Included: MA Plan Options include Medicare Parts A, B, and D. You must have Medicare Parts A and B to enroll in a MA Option. MA Plan Options include Medicare Part D drug benefits. Individuals who have lived at least five years in the United States may purchase Medicare Part B coverage even if they did not contribute to Social Security or work the number of required quarters.
Loss of Eligibility For SHBP Coverage if You Enroll in a MA Part D Plan or Medicare Supplement: If you and/or your dependent are enrolled in a SHBP MA Option and enroll in an individual MA Part D Plan or Medicare Supplement, you and/or your dependent may lose eligibility for SHBP coverage. If coverage is terminated by the Centers for Medicare and Medicaid Services (CMS) due to enrollment in another plan or failure to pay Medicare Part B premiums, the SHBP Member Services will enroll you and/or your dependent in the “default” commercial Non-MA option or the commercial Non-MA option in which you or your dependent are enrolled in (if you have a split contract).
Members and/or Their Dependent(s) Age 65 and Older Must Be Enrolled in Medicare Part B To Avoid Paying the Unsubsidized Premium for Health Coverage (i.e., Full Costs of Coverage):
- Retired: You are required to provide documentation confirming enrollment in Medicare Part B one month prior to you and/or your dependent turning age 65.
- Currently Employed: If you are currently employed with an employing entity, you are required to provide documentation confirming enrollment in Medicare Part B one month prior to your retirement date (if you or your Dependent are age 65 or older, or will be age 65 upon retirement).
Note: If Medicare Part B is not provided, you will be required to pay the total cost of the premium for the coverage, and will not receive any subsidy.
Physical Address Required: If your mailing address is a P.O. Box, CMS will not approve your enrollment into a MA Plan. You will remain in your current Plan Option and be required to pay the full cost of coverage (without any subsidy) until you provide a physical street address to CMS and CMS approves your enrollment into a MA Plan.
Split Eligibility – One Person Under Age 65 and One Person 65 or Older With Medicare Part B
- If an annuitant maintains Medicare Part B and enrolls in a MA option, and the annuitant’s dependent is not eligible for Medicare Part B, the dependent may be enrolled in any non-MA option.
- If any annuitant 65 or older enrolls in a non-MA option, the annuitant will be charged for the full cost of all coverage elected. There is no subsidized coverage for Persons age 65 or older.
- If SHBP Member Services has received and processed your Medicare Part B information, your coverage will be rolled over into the MA Standard option.
- If you have dependents not eligible for the MA option, their coverage option will stay the same as it was at the time you became covered by the MA option or, if your covered dependent is age 65 and elects to enroll in a non-MA option, you will be charged the full premium cost of coverage.
- Individuals with Medicare are not eligible for TRICARE Supplement option.
- SHBP will continue to pay primary benefits for annuitants and their dependents not enrolled in a MA option at age 65 or older if there is no Medicare information on file with SHBP.