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Meet the New 2027 Health Plan Carriers

Earlier this year, PERA completed a Request for Proposal (RFP) process to review non-Kaiser health carriers for PERACare. As announced in the summer issue of PERACare Insights, we selected new carriers for 2027, and we’d like to take this opportunity to introduce them to you.

In addition to the information in this newsletter and in the Open Enrollment packet, we highly encourage you to visit our Open Enrollment website where you can:

  • Visit each carrier’s PERA-specific web page which includes links to provider directories and covered drug lists as well as the schedule for each carrier’s virtual Open Enrollment meetings 
  • Review the PERACare 2027 materials, download forms, and view the schedule for PERA’s virtual Open Enrollment meetings.

Anthem Plans for those Under 65 (Pre-Medicare)

Anthem will replace UMR and OptumRx in administering the two PERACare Pre-Medicare PPO plans in 2027. If you are currently enrolled in UMR, you will automatically be enrolled in the corresponding Anthem PPO plan January 1, 2027, unless you choose a different option during open enrollment. No action is required to maintain coverage.

The deductibles and out-of-pocket maximums for the new Anthem plans will remain the same as the current UMR plans, but there will be some changes to doctor visit copays on both plans. You’ll continue to have integrated medical and pharmacy benefits, as Anthem’s pharmacy benefit manager, CarelonRx, will administer prescription drug coverage for both plans.

Below are some highlights of the plans and things to consider:

Anthem National PPO

  • This plan uses a broad nationwide network of providers and allows for out-of-network coverage, though at additional member cost. More than 98% of the providers currently used by PERA members participate in Anthem’s BlueCard PPO network. You can review the provider directory on the PERACare carriers page or call Anthem for assistance.

Anthem Pathway PPO

  • This plan will replace the UMR Select Colorado plan as the narrow-network, lower cost plan option and is available to anyone who lives in Colorado.
  • The Pathway PPO uses Anthem’s Pathway PPO/EPO network in Colorado. If you are traveling out of state, you’ll have access to Anthem’s national BlueCard PPO network.
  • Aside from emergency and urgent care, there is no coverage for out-of-network care.
  • If your preferred providers do not participate in the Pathway PPO/EPO network, you’ll need to choose new providers or move to the National PPO. You can review the provider directory on the PERACare carriers page or call Anthem for assistance.

Prescription Drug Coverage

  • CarelonRx will administer the prescription benefits for both Anthem PPO plans. There will be some changes to the covered drug list (formulary). If you are taking a medication that will no longer be covered, or will change copay tiers in 2027, you will receive a notification from CarelonRx later this year. If you’d like to check your medications now, you can view the covered drug list on the PERACare carriers page or call Anthem for assistance.

Additional Benefits with Anthem

  • SilverSneakers Fitness Center Program: You’ll have access to a nationwide network for gyms and fitness locations as well as on-demand workout videos.
  • Virta Health: An online nutrition program that can help you lose weight or manage conditions like diabetes.
  • Virtual Care (Telehealth): Access to Anthem’s virtual care provider LiveHealthOnline for video medical care or therapy.

Review your open enrollment booklet for more details.

Humana Medicare Advantage PPO Plan

Humana will replace UnitedHealthcare as the administrator of the Medicare Advantage PPO plans effective January 1, 2027. If you are currently enrolled in UnitedHealthcare, you will automatically be enrolled in the Humana Medicare Advantage plan effective January 1, 2027, unless you choose a different option during open enrollment. No action is required to maintain coverage.

Plan Highlights

  • You can see any in-network provider or any out-of-network provider who accepts Medicare and agrees to bill Humana. Your cost is the same for in-network and out-of-network services.
  • Plan premiums will decrease for most enrollees for 2027.
  • You’ll continue to have access to a fitness benefit offered by SilverSneakers for Humana enrollees, and other benefits such as wellness incentives and medical transportation.

What’s Next?

In addition to the open enrollment packet you’ll receive from PERA, you’ll also receive a mailing from Humana which will include:

  • Information about Humana’s coverage and additional benefits
  • Tools and resources to help you determine if your providers are in Humana’s network and if your prescription medications are on the covered drug list (formulary)

Moda Health Medicare Companion

In response to retiree feedback, we’re pleased to offer access to Medicare Supplement-style coverage through a new partnership with Moda Health. The plan offered through Moda Health is a Medicare Companion plan designed exclusively for Colorado PERA retirees and works alongside Original Medicare. Like a Medicare Supplement (Medigap) Plan G, it helps pay many of the costs that Medicare does not cover.

With this plan you don’t have to worry about a network of providers; you can see any provider who accepts Medicare. This may be a good option for retirees who prefer not to enroll in a Medicare Advantage plan or whose providers do not accept Medicare Advantage.

The Moda Medicare Companion plan includes Medicare Part D prescription drug coverage administered by Humana and is available nationwide. If you would like to enroll in the Moda Medicare Companion plan you must submit a PERACare Enrollment/Change form to PERA by November 19.