Health care plans for MIT retirees

• MIT Traditional Plan
• About the MIT Choice Plan
• About the MIT High Deductible Health Plan (HDHP)
• About Blue Care Elect Preferred
• Medex
• Tufts Medicare Preferred
• Express Scripts
• Delta Dental

If you retire before age 65:

If you retire before turning 65, you can choose to stay on your current plan or select one of four options for medical coverage through MIT: the MIT Traditional Health Plan, the MIT Choice Plan, the MIT High Deductible Health Plan (HDHP) or Blue Care Elect Preferred. You can continue using one of these plans until the month before you turn 65. If you have a spouse under age 65, and/or eligible dependent children, they are eligible to be covered as well.

About the MIT Traditional Health Plan

With the MIT Traditional Health Plan, you and all of your covered family members will choose primary care providers (PCPs) at MIT Medical/Cambridge or MIT Medical/Lexington at Lincoln Laboratory in Lexington.

With the MIT Traditional Health Plan you:

• Must select a PCP at MIT Medical in Cambridge or Lexington.
• Must receive your care at MIT Medical (except in case of emergency).
• Will not owe copayments for most preventive care services.
• Will pay a $10 copayment for some outpatient services.
• Will pay a $100 copayment for each visit to the emergency room (waived if admitted).
• Will pay a $50 copayment for some high-tech imaging services.

Eligibility:

The MIT Traditional Health Plan is available to MIT retirees and/or eligible family members who:

• Are younger than 65.

For more information on the MIT Traditional Health Plan, see the MIT Traditional Health Plan Summary of Benefits and MIT Traditional Health Plan Summary of Benefits and Coverage.

About the MIT Choice Plan

The MIT Choice Plan offers flexibility if MIT Medical is not convenient for all family members. With the MIT Choice Plan, you can choose the convenience, lower copays, and quality of care that come with having a primary care provider (PCP) at MIT Medical, but one or more of your family members can choose PCPs from the multistate HMO Blue New England network or use out-of-network providers subject to deductible and coinsurance.

With the MIT Choice Plan you:

• Can select an MIT Medical PCP or any in-network PCP within New England.
• Will not owe copayments for most preventive care services when seeing a preferred provider.
• Will pay a $10 copayment for some outpatient services (with choice of MIT Medical PCP).
• Will pay a $20 copayment for some outpatients services outside of MIT Medical (with choice of in-network/non-MIT Medical PCP).
• Will pay a $100 copayment for each visit to the emergency room (waived if admitted).
• Will pay a $50 copayment for some high-tech imaging services.

Eligibility:

The MIT Choice Plan is available to MIT retirees and eligible family members who:

• Are younger than 65.

For more information on the MIT Choice Plan, see the MIT Choice Plan Summary of Benefits and MIT Choice Plan Summary of Benefits Coverage.

About the MIT High Deductible Health Plan

The MIT High Deductible Health Plan (HDHP), a Blue Cross Blue Shield plan, allows participants to use the nationwide PPO Blue Cross Blue Shield network. It offers lower premiums in exchange for a deductible ($1,500 for the individual plan, $3,000 for the family plan) and a tax-advantaged health savings account (HSA). The HDHP does not require patients to select a PCP.

With the MIT High Deductible Health Plan you:

• Are not required to select a PCP.
• Will not owe copayments for most preventive care services.
• Will owe a copayment for preventive prescriptions, but those medications are not subject to the deductible.
• Will pay the allowed amount for each non-preventive-care visit and prescription until you meet your annual deductible.
• Will need to manage an HSA, which you will use to pay for your qualified health care expenses.
• Will pay 10 percent of the allowed amount for the cost of non-preventive services (10% coinsurance), once you’ve met your deductible, unless those services are provided at IT Medical.
• Will have no out-of-pocket cost for visits at MIT Medical once you’ve met your deductible. 

Eligibility:

The MIT High Deductible Health Plan is available to MIT retirees and eligible family members who:

• Are younger than 65.

For more information on the MIT High Deductible Health Plan (HDHP), see the MIT HDHP Summary of Benefits and the MIT HDHP Plan Summary of Benefits Coverage.

About Blue Care Elect Preferred

Blue Care Elect Preferred, a PPO plan administered by Blue Cross Blue Shield of Massachusetts, allows you to receive care at MIT Medical or anywhere else in the United States. Unlike the Traditional or Choice plans, Blue Care Elect Preferred does not require that you have a primary care provider (PCP) in New England.

With Blue Care Elect Preferred you:

• Can select any in-network clinician (inside or outside of New England).
• Will not owe copayments for most preventive care services when seeing a preferred provider.
• Will pay a $25 copayment for some outpatient services.
• Will pay a $100 copayment for each visit to the emergency room (waived if admitted).
• Will pay a $50 copayment for some high-tech imaging services.

Eligibility:

Blue Care Elect Preferred is available to MIT retirees and eligible family members who:

• Are younger than 65.

For more information on Blue Care Elect Preferred, see the Blue Care Elect Preferred Summary of Benefits and Blue Care Elect Preferred Description of Benefits.

If you retire at age 65 or older:

If you retire at or after age 65, your primary health insurance will come from Medicare Parts A (hospital) and B (medical). However, MIT offers a Medicare supplemental plan and a Medicare HMO plan to help offset the healthcare costs that Medicare doesn’t fully reimburse.

For new enrollees: Medicare covers 80 percent of healthcare costs after your Part B (medical) deductible is paid. MIT offers a Medicare supplemental plan, Medex, to cover the remaining 20 percent. MIT also offers a Medicare HMO plan. However, the MIT plans cover only services allowed by Medicare. You will be fully responsible for the cost of any services that Medicare does not cover.

This table displays a comparison of MIT’s two plans.

For past enrollees: You may choose between the Medex and Tufts Medicare Preferred plans; however, you might already be signed up for one of MIT’s grandfathered plans: Managed Blue for Seniors or Tufts Medicare Complement Plan. Neither of these grandfathered plans are offered to new enrollees. To learn about these grandfathered plans, visit the MIT Human Resources MIT Medicare Supplemental Plans page.

About Medex

Medex is a supplemental insurance plan that provides additional coverage beyond the coverage provided by your Medicare hospital insurance (Part A) and Medicare medical insurance (Part B). It is administered by Blue Cross Blue Shield of Massachusetts.

Medex will provide supplemental coverage only for services covered by Medicare.

With Medex you:

• Don’t need to choose a primary care provider (PCP).
• Don’t need a referral to see a specialist.
• Will have no additional copayments (except for services received in a skilled nursing facility).

Eligibility:

Medex is available to MIT retirees and eligible spouses/partners who:

• Are age 65 or older.
• Have Medicare Parts A (hospital) and B (medical) as their primary insurance (Medex is secondary to Medicare).
• Live in the United States or its territories. (Medicare usually does not provide benefits for services received outside of the United States or its territories.)

For more information on Medex, see the Medex Summary of Benefits.

Your local Social Security Administration office or the Medicare website can provide answers to your Medicare questions.

About Tufts Medicare Preferred

The Tufts Medicare Preferred Plan is a Medicare HMO plan that provides your Medicare hospital insurance (Part A) and Medicare medical insurance (Part B). It is administered by the Tufts Health Plan and is available to residents of certain Massachusetts counties. It works much like a traditional HMO, meaning that you will need to select a PCP and pay a copayment for many outpatient services. 

With the Tufts Medicare Preferred Plan you:

• Must choose a primary care provider (PCP) to manage your care.
• Must obtain a referral from your PCP to see an in-network specialist.
• Will pay a copay when applicable. 
• Must live in the Tufts Health Plan service area, which includes the following Massachusetts counties: Barnstable, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester. Certain towns in Bristol and Plymouth counties are excluded; more information can be found in the Tufts Medicare Preferred Summary of Benefits. No coverage is available outside of the service area except in an emergency or urgent care situation. Patients cannot live outside of the service area for more than 90 consecutive days per year.

Eligibility:

Tufts Medicare Preferred Plan is available to MIT retirees and eligible spouses/partners who:

• Are age 65 or older.
• Live within the Tufts Health Plan service area. 

MIT Medical does not participate with the Tufts Medicare Preferred Plan or any other Medicare HMO plans. If you have selected a Medicare HMO for your coverage, you will be charged in full for any services you receive at MIT Medical.

For more information on the Tufts Medicare Preferred Plan, see the Tufts Medicare Preferred Summary of Benefits.

Your local Social Security Administration office or the Medicare website can provide answers to your Medicare questions.

About MIT-sponsored Medicare Part D through Express Scripts

All MIT retirees age 65 and older who are enrolled in one of MIT’s Medicare supplemental plans must also be enrolled in the Medicare Part D Prescription Drug Plan sponsored by MIT. When you enroll in an MIT Medicare supplemental plan, you will be automatically enrolled in the prescription drug plan. If you cancel this MIT-sponsored prescription drug plan, your MIT Medicare supplemental plan coverage will also be canceled.

Your MIT-sponsored prescription drug coverage is administered through Express Scripts. Unlike some other Part D plans, the MIT-sponsored plan does not have “donut hole” gaps (times when a Medicare Part D plan stops paying benefits and participants become responsible for the full cost of their prescriptions.)

Your MIT-sponsored Medicare Part D prescription drug coverage complements your supplemental medical plan, but it is separate. However, you must have MIT’s prescription drug coverage if you also receive supplemental Medicare coverage through MIT. Call MIT Benefits at 1-855-253-6151 if you are considering opting out of prescription coverage through MIT.

The cost for covered prescription drugs can be found on the MIT Human Resources Medicare Part D page.

Learn more about your Part D prescription drug coverage through Medicare.

About Delta Dental

Dental insurance for retirees is available through Delta Dental. Dental coverage is not subsidized by MIT; you will pay the full cost of this coverage.