MA Plans
Difference between the TCN and the MA plan:?
The main difference between the TCN plan and the MA plan is cost savings and programs available. The MA plan offers lower out of pocket costs and additional programs that the TCN plan does not offer.
My breakfast is pills. I'm not kidding, I eat them like cereal. How much is this going to cost me?
Great question! Every medication you take falls into a category. These categories are called Tiers. Depending on what Tier your medication falls into determines the cost. For 2024 the Tiers are: 1: $0 2: $33 3: $115.
How much do I get from OTC? What stores can I go to?
Each member will be getting $200 on a flex card. You have the entire year to use this benefit.
Nationwide stores: CVS, RiteAid, Walgreens, Family Dollar, Dollar General, Walmart
I am a retiree living in Kentucky with Humana how does that work with Optum Rx
All plans have Optum Rx. With this plan you will have an Optum RX medicare card and a Humana Medicare Card.
Why is my kid no longer covered on my insurance?!
All dependents must meet ALL 5 eligibility requirements: 1. age 26 OR legal guardians 18. 2. relationship. 3. marital status, 4. Dependency (taxes) 5. Live with you (exception of going to school or group home)
How many cards will I have in the BCBS MA plan? Do I need to keep my Medicare card?
1 card that has both your health plan information and your prescription drug information. You need to keep your Medicare Card in a safe place, but you will not need to present it at the doctor's office.
I am a protected member I swear. They have been telling me that I am. How come I'm not getting the protected member cost share? You guys are stealing my money!
Qualifying as a protected member depends on your retirement date. The protected class is for members that retired very early on. Can you tell me your retirement date? hmmm to be in the protected class you have to retire before 10/1/1990. After the meeting, come see me and lets look you up in the system.
If they are protected, take them over to their health plan to figure out the copay/deductible issue.
I got the card but how do I use it? How do I know which products I can buy?
You can use your OTC card online, in-store, or you can call to order over the phone.
You should have received a catalog in January giving you an overview of the list of items included. Unfortunately they are not sending new catalogs out due to cost but you can always call the number on the back of the card to inquire about certain items.
Most stores will have tags on their shelving that say OTC eligible, approved, FSA/HSA accepted. All of these are acceptable items.
will i be covered for international travel
Yes all of the health plans cover you for emergencies ONLY for international travel. Depending on where you travel, you may have to pay for services up front and get reimbursement from your plan. You may want to consider looking into travel insurance for the time you are gone.
WHY ON EARTH am I paying so much for drugs at the hospital?! Shouldn't Optum Rx be covering this? What is the purpose of my insurance if I am still paying $987?!?!?!?!!?!?!?!!?!?!?!?!
Self administered drugs in the hospital: must pay FULL balance and submit for reimbursement (note: ALL monies will not be returned) as self administered drugs do not correlate with part d. You will be reimbursed the allowed amount from your health plan provider, the drug portion of the plan does not pay this.
This is pretty crappy for members and there really is no way to avoid it. There is also a list of info needed to submit for reimbursement.
o Pharmacy Name
o Prescribing Physician's Name
o Drug Name, Strength, and Quantity
o Prescription Number
o National Drug Code (NDC) number
o Date of Service
o Amount Charged to Member
What is an ESA? You keep saying its an ESA, what does that mean?
ESA is an extended service area plan. This allows members on UHC MAPD to be able to see any doctor in the area as long as they accept original Medicare and are willing to bill UHC at the same in-network cost.
How does renew active fitness compare to silver sneakers ? My city has a fitness center and they accept silver sneakers will I loose that ability to use the fitness center ?
Good morning, UHC uses a program called Renew Active. You can find information about it online at www.UHCRenewActive.com. They offer many of the same locations as Silver Sneakers. You may use this benefit while traveling and are not limited to just one facility.
I tired to use my OTC card and it didn't work. Why isn't it working? What can I do?
If you went to use your OTC card and it didn't work, there are 3 things that could have happened. 1. Did you activate your OTC card? You need to turn it on before you can use it. 2. What type of products were you buying? were they on the list of eligible products? 3. were you at a participating retail location?
can i change anytime back to bc bs?
Hi Linda- According to Medicare rules, you can dis-enroll from a Medicare Advantage plan and re-enroll in the TCN plan at any time by calling RHCC. Dis-enrollments are generally effective the first day of the 2nd month following the request. It is important to note that any amount applied to deductible and out-of-pocket maximum under the original plan cannot be transferred or applied when switching back to the TCN plan mid-year.
why does ford get the SA 65 reimbursement but GM doesnt?????
The Medicare Part B reimbursement is for retired ford members. It applies to either the retiree or the surviving spouse (ONLY 1). This was given to them as Ford did not file bankruptcy and have certain extra perks for their members.
What are some of the additional perks of Medicare Advantage plans?
gym membership, weight loss programs, wellness coaching, 24-hour nurse line, smoking cessation
Hi. I am a diabetic and I need new test strips and lancets. Where do I need to go for that and how much is that going to cost me?
Hello! Diabetic test strips and lancets are covered by your health plan under durable medical equipment at 100%. You can call the number on the back of your health plan card and they will help find a provider/supplies shop near you.
How do I use the online portion of OTC?
Great question!
You will need to create an account at www.uawtrust.org/otcbenefit. Once you arrive on that screen, you will need to select "create an account" and put in your own email address. Following that you will fill out your personal information. When you get to the section for "Member ID" you need to write UAWTRUST all caps no spaces. Once you have done this you will have to click create an account and re-log in. Then you will be able to search products and have them sent directly to your home.
will my mental health be covered as a specialist if they are not on the platforms you listed for tele help
The best way to get an answer to these questions is to call the health plan that you are enrolled or considering enrolling in and ask if these specific services are covered under that health plan.
Why did my medicare part B go up so much? The Trust should be paying this!
Your Medicare Part B and D could have increased due to an IRMAA adjustment. This happens based on your tax return from two years prior. If you inherited some money, cashed in investments, or sold your home and included it as income on your tax return, you will experience an increase in your Medicare Premiums for 1 year.
What is UHC's Healthy At Home Program?
Healthy at home is a program by UHC where members, following a hospital or skilled nursing stay, have access to 28 meals delivered to their home, 24 one way trips via modivcare to dr. appts and 6 hours of in home personal care
Hi, I'm turning 65 in September. What do I need to do?
1st question: Are you collecting SS income?
If yes: Since you are collecting SSI, you will automatically enroll into Medicare Parts A and B. You will receive your Medicare RW&B card 3 months prior to your 65th birthday. Once you receive this card you can call RHCC to select your plan.
If no: You need to call the SSA and enroll in Medicare Part B starting the 1st day of the month you turn 65. Do this 3 months prior to your 65th birthday to avoid the late fees. Once you receive your Medicare RW&B card you can call RHCC to select your plan.
Why am I paying taxes this year? I never had to pay them last year. With these taxes I actually have less than $200.
Last year, the benefit bundled in taxes with the overall price of the object, sales tax was taken out, however it was not listed individually. With CVS, you will have to pay sales tax based on the state you live in. The good news is, you have the ability to shop around and use coupons with this new program to stretch your dollar.
Which is a better plan for me being retired from Chrysler, the Blue Cross or the United Health Care program ?
Tricky One!
This answer will depend on where the person lives (dual state) They may have 2 MA PPO plans (BCBS and UHC) OR they will have UHC and TCN.
For the Dual state, the cost share will be the same, the difference is the perks (healthy at home, rides to offices)
Between TCN and MA it will be the cost overall and the perks like fitness program.
Remember!!! We cannot tell the member what to enroll in, it goes by what meets their needs. Always provide a phone number and tell members to check if their doctors are in network and to call and ask further questions about the plan
WHY DO I NEED A PRIOR AUTHORIZATION? MY DOCTOR OBVIOUSLY PRESCRIBED IT AND HE KNOWS WHAT I NEED MORE THAN OPTUM
In the healthcare industry, prior authorization (PA) is a common practice in which the doctor is asked to confirm the diagnosis the medication will be used to treat. This is to ensure that medications are not subject to “off-label use” or being taken for any reason other than to treat conditions for which the medication was approved by the Food and Drug Administration (FDA). This is part of the formulary guidelines with OptumRx and those set forth by the FDA. These guidelines are put in place for patient safety and prescribing doctors are familiar with the need to submit a PA as this is common practice among all PBMs not just OptumRx.