Subject:
Title
Approval of Retiree Medicare Advantage and Pharmacy Only Plan Design Changes
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Fiscal Impact:
No fiscal impact to the County's health insurance program.
Dept/Office:
Human Resources
Requested Action:
Recommendation
It is requested that the Board of County Commissioners approve plan design changes to the retiree Medicare Advantage and stand-alone Pharmacy plans for calendar year 2025 as recommended by the Employee Benefits Insurance Advisory Committee (EBIAC).
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Summary Explanation and Background:
There are numerous changes to the Medicare program which will be going into effect in 2025 including the following key changes which impact all Prescription Drug Plans (both Individual and Group plans):
1. CMS is implementing a $2,000 Out-of-Pocket Maximum
2. Removal of the coverage gap/donut hole
3. CMS is implementing a payment plan option for individuals with high-cost medications
Both the County's Medicare Advantage and stand-alone retiree pharmacy plan are affected by these changes.
The renewal rates for the County's Medicare Advantage and (Retiree) stand-alone pharmacy plans included options to accept some minimal plan design changes in order to reduce the premium increases.
This information was provided to the County's Employee Benefits Insurance Advisory Committee (EBIAC) by the Office of Human Resources for their consideration along with the County's benefits consultant's analysis of the options.
In summary, the proposed changes include:
UHC Medicare Advantage Plans:
Humana Pharmacy Only Plan:
o Alt 1 plan design mirrors your 2025 active plans (except for the OOPM):
* $100 DED / $2,000 OOPM / $12/$60/$100/$150 flat copays (removed the coinsurance up to X max)
o Alt 2 is the same as Alt 1 but with a $200 deductible:
* $200 DED / $2,000 OOPM / $12/$60/$100/$150 flat copays
After discussion of the various options, the EBIAC voted to recommend the following changes:
? Accept the plan design changes as proposed...
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