State of GA MAPD plans-Holy Cow

[agentjhc]

I turn 65 next year and have to stay on the state plan due to spouse needing coverage until she’s 65. I was shocked to find:

Anthem Standard plan $160+/-
Anthem Premium plan $350+/-

United Standard $0
United Premium $160+/-

based on online info and calling the state.

MOOP is $3500 for Standard. $2500 for Premium. The rest of the plan is middling compared to other options on the market. Drug coverage below average.

my original plan was to go Plan G. But circumstances changed.

 

[agentjhc]

I hope I am misinformed

 

[somarco]

For the most part, the SHBP retiree plans suck

https://shbp.georgia.gov/document/document/2024-shbp-retiree-decision-guide/download

SHBP for active employees
https://shbp.georgia.gov/document/document/2024-shbp-active-member-decision-guide/download

 

[agentjhc]

For the most part, the SHBP retiree plans suck

https://shbp.georgia.gov/document/document/2024-shbp-retiree-decision-guide/download

SHBP for active employees
https://shbp.georgia.gov/document/document/2024-shbp-active-member-decision-guide/download

yes. I was absolutely shocked. I’ll go with UHC $0 and ride out my time until my wife is 65. Then we will both leave the state. I can’t imagine many people taking out the plans with premiums. Probably what they want.

 

[somarco]

yes. I was absolutely shocked. I’ll go with UHC $0 and ride out my time until my wife is 65. Then we will both leave the state. I can’t imagine many people taking out the plans with premiums. Probably what they want.

Folks who have been covered by SHBP for years feel like they are entitled to the retiree benefit. They think the state is paying a portion of the premium . . . which I doubt. HR also scares them by saying if you reject it, or leave, you can never get back in.

The plans have lower OOP costs than "street" versions which can make them somewhat attractive but I can't see paying for the premium plan nor either of the BX plans.

 

[agentjhc]

I agree. I find the premiums odd when already paying the part B premium out of pocket. I understand the lower MOOP but you end up paying $2000-$3000 a year in premium so it might as well be $6-7k and you pay it whether you use it or not. So in low use years you’re are getting killed. Could easily get a plan G with PDP and be in better shape

UHC with $3500 MOOP and $0 premium isn’t a terrible plan and best I can tell, if a doc takes Medicare, they’ll likely take the plan.

Pharmacy benefits don’t seem optimal.

 

[BibH]

I agree. I find the premiums odd when already paying the part B premium out of pocket. I understand the lower MOOP but you end up paying $2000-$3000 a year in premium so it might as well be $6-7k and you pay it whether you use it or not. So in low use years you’re are getting killed. Could easily get a plan G with PDP and be in better shape

UHC with $3500 MOOP and $0 premium isn’t a terrible plan and best I can tell, if a doc takes Medicare, they’ll likely take the plan.

Pharmacy benefits don’t seem optimal.

I’ve run into tons of Ga state mapd the last few yrs . The premiums for uhc good plan were running $85 or so a month with great drug coverage . $0/$25 at drs . I never replaced any because drug coverage was awesome on high tier drugs . Maybe they changed for 2024 . I thought the state contributes $1500-$2500 a yr toward that ?

 

[somarco]

Pharmacy benefits don’t seem optimal.

PDP caps Rx OOP @ $3300 for 2024 & $2000 for 2025. That kind of deadens the combined health care/Rx max with SHBP.

 

[agentjhc]

Drug Plan Co Pays
Select Generic $0
Tier 1 $15
Tier 2 $45
Tier 3 $85
Tier 4 $85

 

[agentjhc]

PDP caps Rx OOP @ $3300 for 2024 & $2000 for 2025. That kind of deadens the combined health care/Rx max with SHBP.

True. Would be a combined max of $5500 in 2025 as it stands now.
Another positive,no in or out of network. Doc/Hospital just have to take Medicare. And I guess the take what the plan pays.