Retirement insights from a Colorado PERA perspective

A distant view shows a mountainous landscape with sloping peaks, green trees in the foreground, and a cloudy sky above.

Recent changes to Medicare Advantage (MA) and Medicare Part D prescription drug coverage will affect the cost of <a href="https://copera.org/retirees/health-benefits-peracare" target="_blank" rel="noreferrer noopener">PERACare health benefits</a> in 2025.



<h4 class="wp-block-heading">What’s changing</h4>



The Centers for Medicare &amp; Medicaid Services (CMS) pays MA insurers a base payment for every enrollee in their plan, as well as additional money for enrollees that have more health issues. CMS will be reducing the base payment amount for 2025. In addition, in 2024 CMS started phasing in changes to how it calculates the additional health status payments. These actions are expected to reduce the amount CMS reimburses insurers.



For 2025, the Inflation Reduction Act adds an out-of-pocket maximum of $2,000 to costs MA enrollees pay for their Part D prescriptions. This means after that first $2,000, enrollees will not have to pay anything for their prescriptions. While this is a positive change for those who take multiple medications, this means more costs for the insurance companies.



While final rates and plan benefits for 2025 are not yet available, MA and Part D carriers have already noted that in response to these changes they are likely to increase MA premiums more significantly than in recent years and may also make benefit reductions. This will impact individual Medicare Advantage plans, individual Medicare Part D plans, and the Medicare plans offered by PERACare.



<h4 class="wp-block-heading">Other factors affecting cost</h4>



PERA’s insurance team uses a competitive bid process to identify carriers and plans that provide valuable health benefits to PERA retirees, and we negotiate the best rates we can. PERACare was able to negotiate a rate guarantee keeping MA premiums unchanged for several years, but that guarantee is now expiring.



PERACare plans offer generous benefits and broad networks of providers across the United States. The plans also cover only retirees, who tend to have more medical needs and use more services than the general population, resulting in higher plan costs. PERA offers a subsidy, based on years of service, to help offset some of the cost of PERACare premiums.



Everyone’s health care needs are different, and we encourage retirees to take a look at all their health insurance options to choose a plan that best fits their budget and needs.



<h4 class="wp-block-heading">What to know about open enrollment</h4>



PERACare staff are working to finalize plans and premiums for 2025, and we’ll be mailing information out in the coming months.



Here are some important dates to keep in mind:



<ul>
<li>October 1: 2025 PERACare information available online</li>



<li>Mid-October: PERACare open enrollment materials mailed to current PERACare enrollees</li>



<li>October 21 to November 21: PERACare open enrollment</li>



<li>October 15 to December 7: Medicare open enrollment</li>



<li>December 15: Last day for PERA to receive cancellation requests for January 1</li>
</ul>







For more information, visit <a href="https://copera.org/retirees/health-benefits-peracare" target="_blank" rel="noreferrer noopener">copera.org/peracare</a>.

What to Expect for Medicare Advantage in 2025

<h4 class="wp-block-heading"><a href="https://www.npr.org/sections/shots-health-news/2024/08/15/nx-s1-5075659/medicare-negotiated-drug-prices-for-the-first-time-heres-what-it-got" target="_blank" rel="noreferrer noopener">Medicare Negotiated Drug Prices for the First Time. Here’s What It Got. | NPR</a></h4>



Medicare has revealed the results of its first-ever negotiated drug prices. Officials have been negotiating with pharmaceutical companies for months, and that process just wrapped up, resulting in discounts on popular drugs for diabetes, cancer, arthritis, and other ailments. The new lower prices for the first batch of 10 prescription medications will take effect in 2026.



<h4 class="wp-block-heading"><a href="https://coloradosun.com/2024/08/15/colorado-special-session-property-taxes-election-2024/" target="_blank" rel="noreferrer noopener">Colorado Governor Calls Special Session on Property Taxes to Avoid Ballot Measure Fight in November</a></h4>



Gov. Jared Polis called for a special legislative session to tackle the issue of property taxes in Colorado. Various advocacy groups had been calling on the legislature to take action and pass a bill to lower taxes rather than allow two tax-related initiatives to appear on the November ballot.



<h4 class="wp-block-heading"><a href="https://www.reuters.com/markets/rates-bonds/size-looming-fed-rate-cuts-may-hinge-job-market-2024-08-02/" target="_blank" rel="noreferrer noopener">Fed Rate Cuts Loom Large as US Job Market Slows Sharply | Reuters</a></h4>



Prior to early August’s monthly jobs report, many analysts said the Federal Reserve would be likely to start lowering interest rates in September. That jobs report showed a noticeable increase in unemployment, signaling a weakening job market and all but guaranteeing a rate cut in the very near future.



<h4 class="wp-block-heading"><a href="https://www.plansponsor.com/milliman-reveals-health-care-costs-for-65-year-olds-retiring-in-2024/" target="_blank" rel="noreferrer noopener">Milliman Reveals Health Care Costs for 65-Year-Olds Retiring in 2024 | PLANSPONSOR</a></h4>



A new report highlights the rising cost of retiree health care. According to the Milliman Retiree Health Cost Index, the amount of savings needed to cover health care costs for a couple retiring in 2024 has increased by $7,000 in the past year if that couple is enrolled in original Medicare with supplemental coverage. On the other hand, retirees with Medicare Advantage plans need less money saved up in order to pay for care.



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News You Should Know is a digest of news from publications around the nation about finance, investing, and retirement.

News You Should Know: Medicare Wraps Up Drug Price Negotiations

<h4 class="wp-block-heading"><a href="https://coloradosun.com/2023/02/11/tabor-refund-checks-taxes-irs/" target="_blank" rel="noreferrer noopener">IRS Won&#8217;t Tax Most Relief Payments Made by Colorado, Other States Last Year | The Colorado Sun</a></h4>



Colorado residents who are getting ready to file their tax returns will not have to report last years $750 Taxpayers Bill of Rights refund checks as income. The IRS announced that taxpayers in Colorado and a slew of other states will not owe federal tax on payments from the state that were related to general welfare and disaster.



<h4 class="wp-block-heading"><a href="https://www.copera.org/news-you-should-know-irs-wont-tax-colorado-tabor-refunds" target="_blank" rel="noreferrer noopener" class="broken_link">Millions Could Lose Medicaid by April as Pandemic Rules Ease | U.S. News</a></h4>



Pandemic-related rules that allowed millions of people to sign up for Medicaid coverage are expiring, meaning many people could lose that health coverage. Loss of Medicaid coverage is a qualifying event to enroll in individual coverage through <a href="https://connectforhealthco.com/">Connect For Health Colorado</a> or <a href="https://www.healthcare.gov/">healthcare.gov</a>, or for PERA retirees to enroll in a <a href="https://www.copera.org/health-benefits-peracare">PERACare plan</a>.



<h4 class="wp-block-heading"><a href="https://www.bankrate.com/banking/federal-reserve/fomc-meeting-recap-february-2023/" target="_blank" rel="noreferrer noopener">Fed Raises Rates By Quarter Point, Signals More Increase Likely | Bankrate</a></h4>



The Federal Reserve continues to raise its key interest rate in an effort to rein in inflation. The most recent increase amounts to a quarter of a percentage point, which is smaller than other recent rate hikes. While more rate hikes could happen this year, theyre likely to be less aggressive as inflation shows signs of cooling down.



<h4 class="wp-block-heading"><a href="https://www.nerdwallet.com/article/finance/age-of-ai-chatgpt-bard-and-how-money-advice-might-evolve" target="_blank" rel="noreferrer noopener">Age of AI: ChatGPT, Bard and How Money Advice Might Evolve | NerdWallet</a></h4>



The field of artificial intelligence (AI) is rapidly advancing, with big implications for many industries, including finance. In this article, a financial planner discusses some of the shortcomings of current AI offerings and what the future might hold for AI-generated financial advice.



<hr class="wp-block-separator has-alpha-channel-opacity"/>



News You Should Know is a digest of news from publications around the nation about finance, investing, and retirement.

News You Should Know: IRS Won’t Tax Colorado TABOR Refunds

As enrollment in Medicare Advantage plans continues to grow, evidence is mounting that these comprehensive plans offer better outcomes and can even cost less for retirees than traditional Medicare.



In its annual <a href="https://bettermedicarealliance.org/wp-content/uploads/2022/07/BMA-State-of-MA-2022-FIN.pdf" target="_blank" rel="noreferrer noopener">“State of Medicare Advantage” report</a>, the Better Medicare Alliance states Medicare Advantage enrollees spend almost $2,000 less per year on plan premiums and out-of-pocket costs than those enrolled in original Medicare.



<h4 class="wp-block-heading">Medicare Advantage vs. Traditional Medicare</h4>



Medicare Advantage plans are offered by private insurers and serve as “all-in-one” or “package” plans. They combine the benefits of Medicare Parts A (hospital insurance) and B (medical insurance) with Part D (prescription coverage) into one comprehensive plan. These plans also usually cover extra services that aren’t covered by original Medicare, like dental and vision and even gym memberships. They also have yearly limits on out-of-pocket spending on services that Part A and Part B cover, while original Medicare doesn’t.



Over the past decade, enrollment in Medicare Advantage plans has doubled to more than 28 million people, which amounts to 45% of all Medicare beneficiaries. In Colorado, that number is nearly 48%.



With a focus on preventive and primary care, Medicare Advantage plans help ensure that enrollees receive regular screenings and care so that any medical problems can be addressed before they become more serious and costly. The report from Better Medicare Alliance finds Medicare Advantage plans cover all Medicare-covered services for 24% less than traditional Medicare.



In addition to cost savings, the report also found patients enrolled in Medicare Advantage plans often have better health outcomes, including higher rates of vaccination and cancer screenings, lower rates of hospitalization, and higher rates of follow-up care.



With regard to COVID-19, Medicare Advantage enrollees were hospitalized at a nearly 19% lower rate in 2020 and had a lower mortality rate, according to the report.



<h4 class="wp-block-heading">Medicare Advantage and PERACare</h4>



Colorado PERA offers Medicare Advantage plans through its health benefits program, <a href="https://www.copera.org/health-benefits-peracare" target="_blank" rel="noreferrer noopener">PERACare</a>. PERACare includes <a href="https://www.copera.org/over-age-65-medicare" target="_blank" rel="noreferrer noopener">three Medicare Advantage plans</a>: two national PPO plans with UnitedHealthcare and a regional HMO plan with Kaiser Permanente of Colorado.



PERACare also includes a subsidy, based on years of service, to help offset the cost of plan premiums. The maximum subsidy in 2021 was $115, which, depending on the plan chosen, could result in a $0 premium for PERACare coverage.



“We chose to offer Medicare Advantage plans because we could offer plans with lower premiums and a more coordinated approach that delivers better health outcomes,” said Jessica Linart, PERA’s director of insurance. “We’re glad to see the information in this report supports our efforts.”



The open enrollment period for PERACare begins on Oct. 17 and continues through Nov. 17.



To learn more about PERACare’s Medicare Advantage plans, visit <a href="https://www.copera.org/peracare" target="_blank" rel="noreferrer noopener">copera.org/peracare</a>.

Report: Medicare Advantage Plans Cost Less, Provide Better Outcomes Than Traditional Medicare

In this story:



<ul><li>Retirees enrolled in PERACare pre-Medicare plans will see higher monthly premiums in 2022</li><li>PERACare plans operate under different circumstances than plans on the individual marketplace</li><li>PERA is working to lower costs wherever possible</li></ul>



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Colorado Gov. Jared Polis announced last month that Colorado residents can expect to see <a href="https://stateofreform.com/featured/2021/10/colorado-reinsurance-savings/" target="_blank" rel="noreferrer noopener">big savings on individual insurance premiums in 2022</a> — about 24 percent, on average. That’s great news for people who don’t receive health insurance through an employer and have to purchase coverage on their own. For retirees enrolled in PERACare’s pre-Medicare plans, it likely came as a surprise that their premiums would instead be going up next year.



PERACare plans operate under slightly different circumstances than those on the individual marketplace, which in Colorado is called <a href="https://connectforhealthco.com/" target="_blank" rel="noreferrer noopener">Connect for Health Colorado</a>. While those differences can have an impact on a plan’s premium, there are a number of other important factors to consider when shopping for health insurance.



<h4 class="wp-block-heading">Connect for Health Colorado and PERACare</h4>



Insurance premiums — the amount insurance companies charge each month for coverage — are driven primarily by the cost of services and prescription drugs. Those costs have been rising across the country for years, and premiums have largely followed suit.



Colorado lawmakers have made multiple attempts to rein in premium increases in recent years, but they don’t always apply to all plans. In 2020, the legislature established the state’s <a href="https://doi.colorado.gov/insurance-products/health-insurance/health-insurance-initiatives/reinsurance-program" target="_blank" rel="noreferrer noopener">reinsurance program</a>, which helps cover the cost of expensive claims to keep plan costs down. That program is the key factor in reducing individual premiums for 2022, but it only applies to plans in the individual marketplace and not group plans like those offered by PERACare.



Demographics can also play a big role in the cost of health insurance — think of how a large number of younger people in a group brings down the average age of that group, for example. Insurance plans sold on Connect for Health Colorado are open to the general public and therefore cover people across a wide range of ages and circumstances. PERACare’s pre-Medicare plans, on the other hand, cover only retirees who aren’t yet eligible for Medicare — ages 50 to 64.



Older Americans are more likely to use more medical services than other sections of the population, so plans that only cover aging patients can be more expensive to administer. In addition, the prices for many services, in particular hospital and ER costs, are higher in Colorado than in other areas of the country.



<h4 class="wp-block-heading">What PERA is doing to lower costs</h4>



PERA’s Director of Insurance, Jessica Linart, said PERA understands the challenge of rising health care costs for retirees, and her team negotiates with PERACare insurance carriers to lower costs wherever possible. That can include administrative fees, which are a small portion of the overall cost of a plan. Other costs, like prescription drug prices, can be harder to control because carriers have already negotiated those prices with manufacturers and providers.



One area where PERA can help lower costs is by encouraging retirees to choose less expensive care options.



“PERACare plans have lower copays for higher quality doctors, lower copays for generic drugs versus brand names, and lower costs for outpatient surgeries versus surgeries performed at a hospital,” Linart said. “All of this can help bring down the overall claims costs, which can ultimately lead to lower premiums.”



PERACare plans also cover preventive care at 100 percent and include a fitness center benefit and weight loss programs to help retirees maintain their health, which can reduce overall costs long-term.



<h4 class="wp-block-heading">Other factors to consider</h4>



Premiums aren’t the only cost to consider when shopping for health insurance. Plans can have vastly different out-of-pocket costs like co-pays, coinsurance and deductibles. Then there’s a plan’s out-of-pocket maximum, which is the most a person will pay in a year. There can often be a trade-off with these costs: higher out-of-pocket costs in exchange for lower premiums.



It’s also important to check a plan’s network of providers and formulary, which is the list of covered drugs. Plans will sometimes opt for a small network and formulary to keep prices down. Linart said PERA usually opts for a broader network and formulary, which can be more expensive but provides retirees with more options.



“We encourage retirees to compare their options in PERACare and on the individual marketplace, to find the coverage that best suits their needs for provider and medication access, benefits and monthly premium,” Linart said.



Open enrollment for PERACare’s pre-Medicare and Medicare plans <a href="https://content.copera.org/peracare-working-to-cut-costs-as-medicare-advantage-enrollment-grows/" target="_blank" rel="noreferrer noopener">runs through Nov. 17</a>. Open enrollment for Connect for Health Colorado runs through Jan. 15.

What’s in a Health Insurance Premium? Comparing Retiree Health Care Costs

In this story:



<ul><li>Enrollment in Medicare Advantage plans has grown steadily in recent years</li><li>PERACare is changing providers for PPO Medicare Advantage plans in 2022</li><li>UnitedHealthcare will offer same plan benefits, lower premiums</li></ul>



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More people than ever are enrolled in Medicare Advantage plans, and PERACare is making some changes in 2022 to make its plans more affordable and convenient for retirees.



A <a href="https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/" target="_blank" rel="noreferrer noopener">data analysis by the Kaiser Family Foundation</a> found that enrollment in Medicare Advantage plans – like those offered by <a href="https://www.copera.org/peracare" target="_blank" rel="noreferrer noopener">PERACare</a> – has been steadily increasing since the early 2000s. In 2020, nearly 40 percent of all Medicare beneficiaries were enrolled in a Medicare Advantage plan rather than traditional Medicare, KFF found.



Colorado was one of 19 states where more than 40 percent of Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2020.



<h4 class="wp-block-heading">The advantages of Medicare Advantage</h4>



Medicare Advantage plans are offered by private insurers and serve as “all-in-one” or “package” plans. They combine the benefits of Medicare Parts A (hospital insurance) and B (medical insurance) with Part D (prescription coverage) into one comprehensive plan. These plans also usually cover extra services that aren’t covered by original Medicare, like dental and vision and even gym memberships.



While Medicare Advantage enrollees pay a premium on top of the Medicare Part B premium, Medicare Advantage plans may have lower out-of-pocket costs for some services. They also have yearly limits on out-of-pocket spending on services that Part A and Part B cover, while original Medicare doesn’t have any limits.



Medicare Advantage plans differ from Medicare Supplement Insurance, also known as Medigap, which supplements the coverage provided by original Medicare. Medigap plans typically don’t offer as much coverage as Medicare Advantage plans and they don’t include prescription drug coverage. A retiree cannot have both Medigap and Medicare Advantage.



PERACare offers three Medicare Advantage plans for PERA retirees, in addition to four pre-Medicare plans for retirees who aren’t yet eligible for Medicare.



<h4 class="wp-block-heading">Cost-saving changes coming to PERACare</h4>



In 2022, PERACare is making some changes to the providers who administer PERACare’s Medicare Advantage plans. UnitedHealthcare will replace Anthem Blue Cross Blue Shield and Silverscript.



One reason for the change is that UnitedHealthcare is able to offer lower plan premiums than Anthem. The new plans will also combine medical and prescription coverage under one company, making for a more streamlined process for enrollees and their providers.



“We have designed the new UnitedHealthcare plans to mirror the current plans as closely as possible; if there are changes to benefits, they are upgrades, not downgrades,” said PERA Director of Insurance Jessica Linart. “Plus, UnitedHealthcare brings an expanded fitness center benefit with access to more gyms, the Real Appeal weight loss program, and a commitment to delivering our retirees a high level of customer service.”



Retirees enrolled in an Anthem plan will be automatically enrolled in a corresponding UnitedHealthcare plan and recently received a letter in the mail with details on their new, lower premiums. Most copays for the new plans will be the same, though some copays will be lower with UnitedHealthcare. Like Anthem, UnitedHealthcare offers nationwide coverage.



Enrollees in PERACare’s Kaiser Permanente HMO plan will also see a reduction in their premiums for 2022.



PERACare open enrollment began Oct. 11 and retirees will be able to sign up for coverage for the first time, or make changes to their existing coverage through Nov. 17. For more information on the changes on open enrollment, including details on <a href="https://www.copera.org/peracare-working-to-cut-costs-as-medicare-advantage-enrollment-grows" target="_blank" rel="noreferrer noopener" class="broken_link">virtual meetings</a>, <a href="https://content.copera.org/peracare-working-to-cut-costs-as-medicare-advantage-enrollment-grows/" target="_blank" rel="noreferrer noopener">click here</a>.

PERACare Working to Cut Costs as Medicare Advantage Enrollment Grows

Prescription drug manufacturers continue to raise prices. Meanwhile, Colorado recently announced updated plans for a program that aims to bring lower-cost options to consumers.



You might think these sound like old headlines. You wouldn’t be entirely wrong. PERA On The Issues covered <a href="https://peraontheissues.com/multiple-approaches-to-keeping-prescription-drug-prices-down/" target="_blank" rel="noreferrer noopener">the rise of drug prices</a> in January 2020 and last summer looked into executive actions that <a href="https://peraontheissues.com/can-an-executive-order-bring-down-drug-prices/" target="_blank" rel="noreferrer noopener">aimed to keep prices down</a>.



So when GoodRX, which compiles data on medication costs, <a href="https://www.goodrx.com/blog/january-drug-price-hikes-2021/" target="_blank" rel="noreferrer noopener" class="broken_link">reported</a> that companies raised the price on 822 brand-name drugs by an average of 4.6% in January, it was news. But it wasn’t necessarily new.



“The rise in prescription drug prices is a trend we have been monitoring for years,” said Jessica Linart, PERA’s Director of Insurance. “When drug manufacturers raise prices insurers must pay those higher costs, which unfortunately get passed on to consumers in the form of higher premiums.”



This is an issue that affects every type of insurance: employer-based and retiree plans alike.



PERACare uses multiple strategies to keep drug prices down to the extent possible. Some are administrative, such as using competitive bid processes to get the best pharmacy pricing from insurance carriers. PERACare staff works with consultants and other industry groups to monitor legislation that can impact drug costs.



Another strategy is to give retirees choices to keep costs down where possible. Incentivizing the use of generic equivalents instead of name-brand drugs and filling prescriptions through the mail, when possible, can save retirees money and help reduce overall plan costs.



<h4 class="wp-block-heading">Colorado’s Plans to Address Rising Prices</h4>



In January, The Colorado Department of Health Care Policy and Financing <a href="https://content.copera.org/drug-prices-continue-multi-year-climb/" target="_blank" rel="noreferrer noopener">released an update</a> on a number of plans underway that address rising costs. These updates include:



<h5 class="wp-block-heading">Import Drugs From Canada</h5>



Colorado has been developing a program to import some drugs from Canada, where prices are often lower than equivalent drugs in the U.S. This program originated in a bill signed into law in 2019. However, Colorado must coordinate and comply with federal regulations. The report states: “The Department estimates that Colorado will have an operational importation program by 2023.”



<h5 class="wp-block-heading">Give Prescribers Useful Information Sooner</h5>



The Department has created a tool for people who prescribe prescription medication in Colorado. The first phase of the project helps prescribers assess opioid risks. The second phase, which the Department expects to be operational this summer, provides information like co-pays and drug prices so that prescribers can make cost-effective decisions for patients.



<h5 class="wp-block-heading">Target the Highest-cost Drugs</h5>



Not all drugs are created equal. Some specialty drugs — drugs that are often complex or treat rare diseases — cost so much that they can affect the entire system. The report states: “an analysis of fiscal year (FY) 2019-20 claims data from Colorado Medicaid revealed that 1.42% of the prescriptions written to care for Medicaid recipients were so expensive, they represented 48% of total pharmacy expenditures.” Colorado is analyzing the impact these drugs have. “These numbers are similar to what we see with the PERACare plans,” Linart said. “Anything that can be done to moderate the pricing on specialty medications will be a benefit to retirees on those PERACare plans.”



<h5 class="wp-block-heading">See What Other States are Doing</h5>



Every state across the country faces similar challenges related to rising prices. And every state is coming up with ideas to address them. The Department surveyed more than 431 bills it found in state legislatures nationwide and shared its findings for others to consider.

Drug Prices Continue Multi-year Climb

Editor&#8217;s note: Since publishing, Coloradans who are 65 or older and educators have gained eligibility for the COVID-19 vaccine. <a href="https://www.copera.org/covid-19-vaccines-for-coloradans-what-you-need-to-know" target="_blank" rel="noreferrer noopener" class="broken_link">Check here</a> for the latest information from the state of Colorado.



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Key points from this story:



<ul>
<li>Colorado is taking a phased approach to vaccinating residents</li>



<li>Coloradans who are 65 years old or older can receive the vaccine now</li>



<li>PERA is not a health care provider and does not have vaccines to distribute</li>



<li><a href="https://www.copera.org/covid-19-vaccines-for-coloradans-what-you-need-to-know" target="_blank" rel="noreferrer noopener" class="broken_link">Check here</a> for the latest information from the state of Colorado</li>
</ul>



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Efforts are underway to inoculate Americans against COVID-19, but only the most at-risk residents are currently eligible to receive their vaccinations.



Determining who can receive a COVID-19 vaccine and when involves a number of factors, including vaccine supplies and availability, location, occupation, and age. Jessica Linart, director of insurance at Colorado PERA, said the unprecedented nature of the coronavirus pandemic and the accelerated vaccine rollout have led to a process that isn’t as straightforward as many might expect.



“It’s different from a flu vaccine where it’s widely available and you can go to the pharmacy or to your doctor’s office,” because vaccine supplies are so limited, Linart said. “Eventually this will look more like a normal vaccine process…but it’s not there yet.”



Here are answers to some questions PERA has received from members, as well as links to more information.



<h5 class="wp-block-heading">Is PERA providing vaccines for retirees?</h5>



PERA itself is not part of the COVID-19 vaccine distribution process. Federal and state authorities are working with local health authorities and medical providers to vaccinate residents, Linart said, so your state or county health department should be the first place you look to for information.



The providers that PERACare enrollees use might be involved in that process, however.



Kaiser Permanente – one of the insurance carriers that provides coverage under PERACare – is also a medical provider and is providing COVID-19 vaccines to eligible residents. <a href="https://healthy.kaiserpermanente.org/colorado/health-wellness/coronavirus-information/covid-vaccine" target="_blank" rel="noreferrer noopener">Click here</a> for more information.



PERACare’s other carrier, Anthem, is solely an insurance carrier and is not administering vaccines. Those who are enrolled in Anthem’s PERACare plans can still get vaccinated—they can use the resources listed below to find a location.



<h5 class="wp-block-heading">How do I know if I’m eligible for the vaccine?</h5>



Colorado’s vaccine distribution plan is split into multiple phases, with the highest-risk groups in the first phase and the lowest-risk groups in the last phase. The state is currently in Phase 1, which contains several subgroups.



The groups Colorado currently is vaccinating include:



<ul>
<li>Phase 1A
<ul>
<li>Health care workers with direct contact with COVID-19 patients</li>



<li>Staff and residents of long-term care facilities</li>
</ul>
</li>



<li>Phase 1B.1
<ul>
<li>Coloradans who are 70+</li>



<li>Health care workers with less direct contact with COVID-19 patients</li>



<li>First responders</li>



<li>Correctional workers</li>



<li>Funeral service workers</li>
</ul>
</li>
</ul>



Beginning Feb. 8, Coloradans in Phase 1B.2 will be eligible for the vaccine. That includes:



<ul>
<li>Coloradans who are 65-69 years old</li>



<li>Educators (teachers and school staff)</li>



<li>Workers in licensed child care programs</li>



<li>Members of Judicial/Executive branches of state government</li>
</ul>



<figure class="wp-block-image size-large"><a href=""><img decoding="async" src="https://content.copera.org/covid-19-vaccines-for-coloradans-what-you-need-to-know/"" class="wp-image-4087"/></a></figure>



<h5 class="wp-block-heading">How do I know when and where I can be vaccinated?</h5>



This depends on the facility. Some allow you to reserve a spot while others ask you to wait to be contacted when it’s your turn.



To find a vaccine provider near you, head to <a href="https://www.copera.org/covid-19-vaccines-for-coloradans-what-you-need-to-know" target="_blank" rel="noreferrer noopener" class="broken_link">Colorado’s website</a>. There you’ll find a map of vaccine locations as well as a list of providers by county. If you’re outside Colorado, visit the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html" target="_blank" rel="noreferrer noopener" class="broken_link">CDC’s vaccine website</a> and choose your state/territory under “How do I get a vaccine?”



<h5 class="wp-block-heading">Do I have to pay for the vaccine?</h5>



No. The vaccine is available free of charge, with no copay, regardless of your insurance plan. A vaccine provider cannot turn someone away because they don’t have insurance.



Beware of scammers who are using the COVID-19 pandemic to take advantage of people. Don’t give out any personal information online or over the phone, beware of any advertisements that offer to move you ahead your place in line for a fee, and only use official providers listed on the state’s COVID-19 vaccine website. <a href="https://www.colorado.gov/pacific/cbi/identity-theft-fraud-and-cyber-crimes-victim-support" target="_blank" rel="noreferrer noopener">Click here</a> for more information from the Colorado Bureau of Investigation.



<h5 class="wp-block-heading">I have more questions about the vaccine; who can I ask?</h5>



Check <a href="https://www.copera.org/covid-19-vaccines-for-coloradans-what-you-need-to-know" target="_blank" rel="noreferrer noopener" class="broken_link">Colorado’s website</a> or your county health department for the most up-to-date information.



More information is also available over the phone by:



<ul>
<li>Calling the state’s 24-hour hotline at 1-877-CO-VAX-CO (1-877-268-2926)</li>



<li>Calling 211 or 866-760-6489 (available from 8 a.m. to 5 p.m. Monday through Friday)</li>



<li>Texting your ZIP code to 898-211</li>
</ul>



<hr class="wp-block-separator has-css-opacity"/>

COVID-19 Vaccines for Coloradans: What You Need to Know

For years, prescription drug prices have been rising at a dangerous rate—dangerous because high prices keep some people from buying or using the medication prescribed to them. 



Lack of awareness certainly isn&#8217;t an issue. Health care costs are at the top of mind for the American <a aria-label=" (opens in a new tab)" rel="noreferrer noopener" href="https://news.gallup.com/poll/276932/several-issues-tie-important-2020-election.aspx" target="_blank">voter</a> and leading <a aria-label=" (opens in a new tab)" rel="noreferrer noopener" href="https://www.cnbc.com/2019/03/06/amazon-jp-morgan-berkshire-hathaway-health-care-venture-named-haven.html" target="_blank">businesses</a>. 



Despite its prominence in the national discussion, addressing this nebulous issue hasn&#8217;t been easy. A single overarching solution remains elusive. Instead, multiple legislative proposals each seek to address specific cost drivers. Meanwhile, health care plans, including PERACare plans, have features that allow participants to keep costs down. 



Drug prices continue climbing



GoodRX <a label=" (opens in a new tab)" href="https://www.goodrx.com/blog/january-2020-drug-increases-recap/" target="_blank" rel="noreferrer noopener" class="broken_link">tracks the prices</a> of hundreds of brand drugs. They report that 601 brand drugs increased in price last year by an average of 5.8 percent. This was nearly three times larger than the overall <a aria-label=" (opens in a new tab)" href="https://www.usinflationcalculator.com/inflation/current-inflation-rates/" target="_blank" rel="noreferrer noopener">inflation</a> rate of 1.8 percent. 



Kaiser Family Foundation <a aria-label=" (opens in a new tab)" href="https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/" target="_blank" rel="noreferrer noopener">reports</a> that a quarter of those taking prescription drugs say they struggle to afford them, and nearly 30 percent say they didn’t take medications as prescribed in the past year because of cost. According to the research, “this includes about one in five who say they didn’t fill a prescription (19%) or took an over-the counter drug instead (18%), and about one in 10 (12%) who say they cut pills in half or skipped a dose.”



The reasons behind the seemingly endless increases amount to a tangled knot. Experts routinely <a label=" (opens in a new tab)" href="https://content.copera.org/multiple-approaches-to-keeping-prescription-drug-prices-down/" target="_blank" rel="noreferrer noopener">try</a> to <a aria-label=" (opens in a new tab)" href="https://www.nbcnews.com/health/health-care/no-end-sight-rising-drug-prices-study-finds-n1012181" target="_blank" rel="noreferrer noopener">untangle</a> the <a aria-label=" (opens in a new tab)" href="https://www.consumerreports.org/drug-prices/the-shocking-rise-of-prescription-drug-prices/" target="_blank" rel="noreferrer noopener">problem</a>, but it persists.



PERACare: Offering lower-cost options, passing along savings



Using generic drugs helps keep costs down. Generic drugs are chemically equivalent to their name-brand counterparts, but they typically cost much less. 



The pricing schedule in all PERACare plans is reflective of this. Generic drugs are available at a lower price than name-brand equivalents. Many people already take advantage of the option that costs less, but not everybody. In fact, a significant amount of savings goes unused every year. 



If everyone with an Anthem PERACare plan who currently uses one of just three common brand drugs—Synthroid, Lipitor, and Zoloft—started using the generic equivalent, not only would those members save money due to the lower copay, but the plan itself could save about $1 million per year. This, in turn, could reduce the plan’s overall expenses, which can help keep monthly premiums more affordable.



PERACare also helps keep prices down by passing rebates they receive from drug manufacturers on to PERACare enrollees in the form of lower monthly premiums. It’s a common practice for manufacturers of prescription drugs to send rebates to insurers or plan providers. Because PERACare is not designed to make a profit, rebate dollars PERA receives are used to lower premiums for everyone. 



“PERA is committed to keeping costs down in any way we can, whether that is negotiating for the best possible administrative costs and premiums or auditing carrier performance to assure financial accuracy,” said Jessica Linart PERA’s Director of Insurance. “However, we also encourage retirees to help each other by making smart health care decisions. When retirees use health care that costs less, by using generic medications or visiting their primary care doctor instead of going to the emergency department, that helps keep plan costs down which ultimately helps all enrollees in the PERACare program by helping to keep premiums down.”&nbsp; 



Prescription Drug Legislation
at the Capitol



Health care is taking a prominent role at the capitol this year. Bills that address prescription drugs are summarized below. Although the legislature temporarily adjourned due to concerns surrounding COVID-19, work on these bills may continue when work resumes. (Editor’s note: These summaries are for informational use and do not represent a PERA endorsement for or against the legislation.)



<a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="http://leg.colorado.gov/bills/hb20-1160" target="_blank">HB</a><a href="http://leg.colorado.gov/bills/hb20-1160" target="_blank" rel="noreferrer noopener" aria-label=" (opens in a new tab)"> </a><a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="http://leg.colorado.gov/bills/hb20-1160" target="_blank">20-1160</a> &#8211; Drug Price Transparency Insurance Premium Reductions



This bill would require health insurers, prescription drug manufacturers, pharmacy benefit management firms, and nonprofit organizations to send information about the costs of prescription drugs to the commissioner of insurance. This includes information on rebates and certain price increases. The commissioner is required to make the information available in an annual report. The bill also requires health insurers to pass rebate savings along to consumers by adjusting premiums based on rebate amounts.



<a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/hb20-1078" target="_blank">HB</a><a href="https://leg.colorado.gov/bills/hb20-1078" target="_blank" rel="noreferrer noopener" aria-label=" (opens in a new tab)"> </a><a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/hb20-1078" target="_blank">20-1078</a> &#8211; Pharmacy Benefit Management Firm Claims Payments



This bill would require pharmacy benefit managers to reimburse pharmacies at the same rates. It would also prohibit pharmacy benefit managers from retroactively reducing payments on a claim after a sale.



<a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/sb20-107" target="_blank">SB</a><a href="https://leg.colorado.gov/bills/sb20-107" target="_blank" rel="noreferrer noopener" aria-label=" (opens in a new tab)"> </a><a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/sb20-107" target="_blank">20-107</a> &#8211; Drug Production Costs Transparency Analysis Report



This bill would direct the Colorado Department of Health Care Policy and Financing (HCPF) to analyze drug production cost for the highest-cost prescription drugs by volume purchased by a number of state agencies. HCPF would then request from drug manufacturers a detailed basis of the costs to the manufacturer, including costs associated with research and development, clinical trials, and materials. Manufacturers who don’t provide this information would be subject to a fine. This data would be turned into an annual report.



<a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/sb20-119" target="_blank">SB</a><a href="https://leg.colorado.gov/bills/sb20-119" target="_blank" rel="noreferrer noopener" aria-label=" (opens in a new tab)"> </a><a rel="noreferrer noopener" aria-label=" (opens in a new tab)" href="https://leg.colorado.gov/bills/sb20-119" target="_blank">20-119</a> &#8211; Expand Canadian Prescription Drug Import Program



This bill would expand a program initiated in last year’s legislation that seeks federal approval to import prescription drugs from Canada. This bill would expand the request to include the import of prescription drugs into the state if certain conditions are met.

Multiple Approaches to Keep Prescription Drug Prices Down

<ul>
<li>Thinking about having a hip or knee replaced?</li>



<li>Are you under age 65?</li>
</ul>



Investigate <a href="https://www.copera.org/controlling-your-health-care-costs" target="_blank" rel="noreferrer noopener" class="broken_link">PERACare Select.</a>



In 2015, PERA partnered with skilled orthopedic surgeons at three metro-Denver area hospitals: <a href="http://northsuburban.com/" target="_blank" rel="noreferrer noopener">North Suburban Medical Center</a>, <a href="http://rosemed.com/" target="_blank" rel="noreferrer noopener">Rose Medical Center</a>, and <a href="http://swedishhospital.com/" target="_blank" rel="noreferrer noopener">Swedish Medical Center</a>, (all <a href="http://healthonecares.com/" target="_blank" rel="noreferrer noopener">HealthOne</a> medical centers) to provide PERA retirees under age 65 with fixed-cost hip or knee replacement surgeries.



This benefit waives the deductible (excluding members in the HDHP plan because federal law forbids PERA from waiving the deductible) and coinsurance for members who have their joint replacement at one of these hospitals.



Since April 1, 2015, when the program was launched, there have been 40 PERA members who have had either a hip or knee replaced, with ZERO out-of-pocket expense.



The PERACare Plan’s average cost for these procedures decreased by 40 percent over the prior year’s cost. This was an average savings of over $13,000 per procedure, saving PERA more than $500,000 and each participating member thousands of dollars, as well.



Donna Johnson, a PERA retiree, had both hips replaced as part of PERACare Select. &#8220;I had a very positive experience,” Donna said. “My doctor was very good and the hospital was excellent as well. Any questions I had were resolved quickly and courteously.&#8221;



If you and your doctor have talked about your need for a hip or knee replacement, you can get more information on our PERACare Select program by calling Anthem at 877-737-2258 or visit <a href="https://content.copera.org/the-results-are-in-500000-savings-for-peracare-select-hip-and-knee-replacement-surgery/">healthonecares.com/PERA</a>.



Learn more about <a href="https://www.copera.org/controlling-your-health-care-costs" target="_blank" rel="noreferrer noopener" class="broken_link">PERACare Select</a>.



Read more about PERACare Select on <a href="https://www.copera.org/a-voice-in-the-national-health-care-conversation" class="broken_link">PERA on the Issues</a>.



<blockquote class="wp-block-quote">
Why isn’t PERACare Select available for Medicare participants?
</blockquote>



The federal government negotiates pricing for procedures for Medicare-eligible retirees. In PERA’s self-funded Pre-Medicare plans, PERA has the ability to negotiate a fixed-price for hip or knee replacements.

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