Author: sfrick

Categories
Benefits Health Options Program Medicare Supplement

Announcing the SilverSneakers 2025 Member of the Year Awards

Members of the Health Options Program who are enrolled in the HOP Medical Plan or HOP Pre-65 Medical Plan have access to SilverSneakers. We are pleased to announce the SilverSneakers 2025 Member of the Year awards, which recognize exemplary participants.

Anyone can nominate a SilverSneakers member by submitting their inspiring story online at SilverSneakers.com/MOYAwards.

This year, there will be two awards:

  • SilverSneakers Member of the Year Activity Award recognizing the gym warriors who are in class every day, setting goals and crushing them. They consistently set the bar and continue to raise it. Fitness is their passion, inside and outside the gym.
  • SilverSneakers Member of the Year Inspiration Award recognizing members with a spirit that cannot be stopped. They continue to rise above life’s challenges. They turn obstacles into opportunity and keep showing up. Their stories are a beacon of hope and perseverance.

Timeline:

  • June 25–July 6: Nominations accepted
  • July 7–29: Top 5 finalists selected for each award
  • August 1–11: Online voting
  • August 25: Winners announced on the Member of the Year awards site and SilverSneakers Facebook page

For more information and to nominate, go to SilverSneakers.com/MOYAwards. Think of a SilverSneakers member who inspires you, and nominate today!

Categories
Awareness Benefits Medicare Medicare Advantage

What You Should Know About Medicare Advantage If You Live in Multiple States

Whether you’re a snowbird escaping the harsh winter, or you spend a significant amount of time traveling in different states, it’s essential to review your specific Medicare Advantage plan’s details and speak with your plan provider to understand how your coverage works across different states.

In general, here are some key points to consider about Medicare Advantage coverage:

  1. Primary Residence: You must choose one location as your primary residence. This is where you will enroll in Medicare and where your plan will be based.
  2. Network Restrictions: Medicare Advantage plans often have networks of preferred providers. If you live in multiple states, you may need to ensure that your plan’s network includes providers in both locations. Otherwise, you might face higher out-of-pocket costs for out-of-network services.
  3. Plan Types:
    • PPO Plans: Preferred Provider Organization (PPO) plans offer more flexibility, allowing you to see out-of-network providers at a higher cost. This can be beneficial if you split your time between states.
    • HMO Plans: Health Maintenance Organization (HMO) plans typically have stricter network rules and may not cover out-of-network care except in emergencies.
  4. Emergency Coverage: Most Medicare Advantage plans provide emergency coverage nationwide, so you will be covered for urgent care needs regardless of your location.

If you find Medicare Advantage plans too restrictive, consider enrolling in a HOP Medical or HOP Value Medical Medicare Supplement plan. Medicare Supplement plans work with Original Medicare and are accepted nationwide, providing more flexibility for those living in multiple states.

Categories
Awareness Benefits Health

Walk your way to feeling better

Studies show that walking can help reduce feelings of depression—even adding a few more daily steps can improve mental health. For example, walking at least 5,000 steps a day has been associated with reduced depressive symptoms, and walking 7,000 steps a day can lower the risk of depression by 42%. For reference, one mile is approximately 2,000 steps.

How does it work? Walking helps release mood-boosting hormones like endorphins and serotonin, which can improve your mood and overall mental well-being.

Ideally, a stroll in nature provides the best benefits, but all walking counts toward your step goals.

Take your fitness one step further: Members enrolled in the HOP Medical Plan or HOP Pre-65 Medical Plan have no-cost access to the SilverSneakers® fitness program from Tivity Health, Inc. Learn more about SilverSneakers.

Categories
Awareness Benefits Health Options Program Medicare Medicare Supplement

Coordination of Benefits 101

Coordination of Benefits (COB) ensures that when you have multiple health insurance plans, they work together to pay your claims. The primary plan pays first, and the secondary plan covers any remaining eligible expenses.

COB comes into play when you are enrolled in Original Medicare—that is, Medicare Parts A and B—and in the HOP Medical Plan or HOP Value Medical Plan. In your case, Medicare pays first. Your HOP Medical Plan or HOP Value Medical Plan pays secondary.

Steps To Ensure Proper Coordination

  • Make sure you provide both your Medicare card and your HOP insurance information when you visit a doctor, provider, or hospital.
  • Review your Explanation of Benefits (EOB) and provider bills to make sure they have properly billed all your insurance plans.
  • Keep records of all communications and documents related to your insurance coverage.

Medicare Advantage Coverage

If you enroll in a Medicare Advantage plan, it essentially replaces your Original Medicare coverage. This means that you cannot be enrolled in both Original Medicare and a Medicare Advantage plan at the same time. The Medicare Advantage plan becomes your primary insurance, and you receive all your health care services through that plan.

School District Insurance Coverage

If you had medical insurance through your school district, it’s important that you get a letter of termination to confirm you are no longer covered by the district and submit it to the HOP Administration Unit. School districts sometimes forget to terminate coverage when you retire. This can affect your Medicare and Health Options Program coverage. However, if you are covered by your school district due to binding arbitration that mandates continued coverage, that is a separate matter. Questions? Contact the HOP Administration Unit toll-free at 1-800-773-7725.

Categories
Benefits Health Options Program Option Selection Period OSP

The Results Are In: Members Love HOP

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:

  • 90% rated the materials as 7 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.
  • 89% rated the personalized statement’s understandability as 7 or higher on a scale of 1 (not understandable) to 10 (very understandable).
  • 86% felt they had the right number of coverage options for medical, prescription drug, dental, and vision coverage.

Thank you to the more than 5,100 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.

Categories
Awareness Benefits Medicare Prescription Drugs PSERS Safety

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 5 being the highest score. The Health Options Program’s prescription drug plans received a 4.5-star rating for 2025, indicating that the program is highly rated in comparison to other prescription drug plans nationwide.

Categories
Awareness Benefits Health Options Program Materials Medicare Office Hours

Individual Phone Consultations: Spring 2025

You can schedule a 30-minute individual telephone consultation (not a group meeting) with a representative of the Health Options Program by following the steps below:

  • Call the HOP Administration Unit at 1-800-773-7725.
  • Let the representative know you want to schedule an individual telephone consultation.
  • After you make your appointment, you’ll receive a confirmation email with the date and time.
  • A few days before your appointment, you’ll receive a reminder email.

You can check our website for the schedule of live webinars. If you can’t attend a live session, don’t worry—you can watch a recorded one at your convenience.

Categories
Medicare Medicare Advantage Medicare Supplement

2025 Medicare Highlights

Each year, the Centers for Medicare & Medicaid Services (CMS) may adjust Medicare premiums, deductibles, and copays as needed. 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, which is typically deducted from your Social Security benefit. By law, the standard monthly premium is set each year at 25% of the cost for senior beneficiaries, with the government covering the remaining 75%.

The chart below compares the costs for 2024 and 2025. The Health Options Program is designed to cover some or all of these deductibles and coinsurances. For instance, the HOP Medical Plan covers your Part A deductible and coinsurance for hospital and skilled nursing facility stays, as well as your Part B deductible after you pay the first $50. The Value Medical Plan also covers 100% of Medicare’s hospital deductible and daily copays, after you pay the first $300.

 Amount You Pay (without supplemental insurance)
Part A20242025
First-day hospital deductible$1,632$1,676
Coinsurance for days 1–60 of a hospital stay$0$0
Coinsurance for days 61–90 of a hospital stay$408 per day$419 per day
Coinsurance for days 1–20 of a skilled nursing facility stay$0$0
Coinsurance for days 21–100 of a skilled nursing facility stay$204 per day$209.50 per day
Part B
Standard monthly premium for most new enrollees and Medicare beneficiaries$174.70$185
Deductible$240$257
Coinsurance20%20%

Categories
Health Options Program Office Hours Premium Assistance

Are You Almost 65?

If you’re a PSERS retiree nearing your 65th birthday, we want to ensure that you fully understand the benefits available to you through the Health Options Program.

We send out an information packet four to nine months before your 65th birthday. These packets are mailed twice a year—in the winter for those turning 65 in the first half of the following year, and in the spring for those turning 65 in the second half. The packet includes a detailed description of the medical and prescription drug benefits under the Health Options Program, along with a personalized statement that outlines your specific monthly premiums for all coverage options.

Additionally, we host webinars several times a year. These virtual group information sessions are a great way to learn more about the Health Options Program and to get your questions answered. You can check our website for the schedule of live webinars. If you can’t attend a live session, don’t worry—you can watch a recorded one at your convenience.

Another fantastic resource is our virtual benefits fair. This website provides more information about the Health Options Program from our partners and highlights all the great benefits available to you as a PSERS retiree. Visit discoverHOPbenefits.com to explore more. We look forward to helping you make the most of your retirement benefits!

Categories
Benefits Health Options Program

Unlock the Full Potential of Your Health Options Program Benefits 

The Health Options Program offers a range of resources to support your health and well-being. The HOP Administration Unit, customer service teams, program advocates, and case managers are all specially trained to assist you with your benefits. If you’re unsure where to begin, simply call 1-800-PSERS25 (1-800-773-7725). Here are some ways the Health Options Program can help you:

Facing a serious health condition or hospital admission? 

Reach out to the Luminare Health Care Management team at 1-800-480-6658. They may also contact you if you have a hospital stay or require skilled nursing care.

Looking to enhance your well-being? 

The Elder Care program can connect you with resources, such as local transportation options, answers to utility questions, prescription drug delivery services, discount programs, and nutritional support. For assistance, call 1-866-794-0685 and ask to speak with an advocate.

Want to stay active?  Try SilverSneakers for fitness and social connections. If you’re enrolled in the HOP Medical Plan or HOP Pre-65 Medical Plan, you have access to SilverSneakers instructors who lead specially designed group exercise classes. SilverSneakers also provides access to gyms for classes and fitness, as well as SilverSneakers FLEX®, SilverSneakers LIVE, SilverSneakers On-Demand™, and a mobile app for staying active outside of traditional gyms.

Not registered? Sign up today for personalized information.