Medicare Advantage Plan

Will I get Part A and Part B automatically?

 

If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B starts the first day of the prior month.)

If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after getting 24 months of disability benefits, either from Social Security or certain disability benefits from the RRB.

Will I have to sign up for Part A and/or Part B?

If you’re close to 65, but NOT getting Social Security or RRB benefits, you’ll need to sign up for Medicare. Visit SSA.gov/medicare to apply for Part A and Part B. You can also contact Social Security 3 months before you turn 65 to set up an appointment. If you worked for a railroad, contact the RRB.

In most cases, if you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare Part B coverage in the future because you can only sign up at certain times. You may also have to pay a late enrollment penalty for as long as you have Part B. Call Social Security at 1-800-772-1213

Anthm High Plan and Aetna Low Plan

Rockwood did a price check on our Medicare Advantage plan and found one we think will be a better price for our retirees.  You will be able to enroll in the Anthem Medicare Advantage Plan effective January 1, 2026. 

You will receive a Medicare Advantage Enrollment Guide in the mail if you are currently enrolled in the Aetna plan.  This guide will describe the new medical and prescription drug plan.  Please review this information carefully.  The Rockwood group Aetna Medicare Advantage Plan will not be offered after December 31, 2025.  You will probably still be able to get an individual plan with Aetna if you want to stay with them.  The price they offer Rockwood retirees as a group will probably be different that what they offer an individual plan.

Rockwood will be hosting a meeting with Anthem so you can learn what they have to offer and ask questions.  The meeting is September 3, 2025 at Crestview Middle School from 9-10am.  Bring your Anthem Enrollment Guide with you to the meeting.

To be enrolled in the Anthem Medicare Advantage plan, you must be enrolled in Medicare Parts A & B.  Since this plan offers a Prescription plan, you should not enroll in Part D. 

The Anthem plan uses a network of healthcare providers but gives you the freedom to see providers outside of the network.  No referrals are required.  However, some benefits or services may need prior authorization.  Prior authorization is approval that providers and pharmacies request and receive from your plan to provide you with certain services, drugs, treatments, or therapies.

This plan pays the same benefit for in-network providers and out-of-network providers who accept both Medicare and the Anthem Medicare Advantage Plan.   Higher costs may apply for out-of-network services.  Using our network of providers can help keep your medical costs lower. This plan provides reimbursement for all covered services regardless of whether they are received in-network or out-of-network and are a Medicare-covered benefit. 

Coverage you can count on:

 The Anthem plan coverage includes:

• Doctor office visits
• Video provider visits
• Inpatient and outpatient hospital services
• Emergency care services
• Ambulance services
• Diagnostic tests such as X-rays and laboratory services
• Prescription Drug Coverage
• Large Network of Pharmacies - More than 64,000 pharmacies in the network, including most national chains, and many local pharmacies.  Additional information on pharmacies is included in the Enrollment Guide.
• Dental, Vision, Hearing, Footcare
• Dedicated customer service unit specially trained to handle the needs of our retirees
• NurseLine – Registered nurses answer your call 24 hours a day, 7 days a week
• Voluntary HouseCalls – Personalized visit to your home once a year that can lead to a care plan tailored just for you (program is completely voluntary)
• SilverSneakers® – Fitness and lifestyle benefit, with access to thousands of participating locations
• Medicare Community Resource Support – a social worker will get you in touch with community services such as getting nutritious food, non-emergency transportation, assistance with pharmacy copayments and utility bills, and much more
• Nationwide Access - You can see any provider who participates in Medicare and accepts your group PPO plan either as an in-network or out-of-network provider

Added benefits without additional cost:

The Anthem plan also offers wellness programs at no extra cost.  These programs include access to discounts on fitness club memberships, weight loss programs, nutritional supplements and more.  You will also enjoy the flexibility of using just one card whenever you seek medical or prescription benefits.

What you need to do

Review the Medicare Advantage Enrollment Guide you receive.  If you decide you want to enroll in the Anthem plan, please complete the enrollment election form in the Medicare Advantage Enrollment Guide and return to the address listed in your Enrollment Guide by November 30, 2025.

The following information is required to complete your enrollment in the Anthem plan.

• Physical street address, if your mailing address is a P.O. Box
• Medicare Beneficiary Identifier (MBI) - the number on your red, white, and blue Medicare card

If you do not want to enroll in the Anthem Medicare Advantage Plan, please complete the opt-out instructions in the Medicare Advantage Enrollment Guide.

Once your enrollment is complete, a membership card and welcome guide will be mailed prior to January 1, 2026.   After receiving your membership card, you may register with the QR code on the sticker, or online at the website on the back of the card. This will ensure you receive updates on claims status, urgent notifications, information on new programs, and benefit reminders.  Additionally, you can view details of your plan, manage prescriptions, chat with customer service, search for providers, and much more. 

Please review the welcome guide for information regarding what you need to do to ensure your prescription refills occur timely.

PLEASE NOTE:  You may receive correspondence from your current plan stating your coverage will be terminated upon enrollment into the new plan.  No action is required; please keep this information for your records.

If you have questions or concerns, please contact the Anthem plan First Impressions Welcome Center at 1-833-848-8729 and reference Rockwood School District, Monday through Friday, 8:00 AM to 9:00 PM ET, except holidays.  TTY users should call 711.

Important information for retirees who choose not to take this coverage

 If you choose not to enroll, you may be eligible to enroll in an individual Medicare Advantage plan in your service area.  You can also get information about the Medicare Program and Medicare health plans by visiting www.medicare.gov on the web or by calling 1-800-MEDICARE (1-800-633-4227).  TTY users should call 1-877-486-2048. Medicare customer service representatives are available, 24 hours a day, seven days a week, to answer questions about Medicare.

Plan Options

The below table represents the 2026 plan that starts January 1, 2026.  Both plan options provide benefits and care in every state.  Retirees can visit any doctor who accept Medicare, in or out of the Plan's network, anywhere in the nation.  For more details, refer to the Summary Plan Description on the Anthem website.

2026 Plan Name	Anthem PPO High Plan (15PH)	Anthem PPO Low Plan (20PD)
2026 Plan Monthly Cost	$221.74	$118.08
Annual Medical Deductible (does not apply to the PPO deductible)	$0	$500
Out of Pocket Max-does not include copays or pharmacy copays	$4,150	$4,150
Inpatient Hospital (1-5 days per admission)	$150 copay per admission	$200 copay per admission
Outpatient Services/Surgery	$200 copay per visit	$150 copay per visit
PCP/Specialist Visits	$15/$25 Copay	$20/$30 Copay
Diagnostic Radiology	20%	$120 Copay
Ambulance	$100 copay per one-way trip	$120 copay per one-way trip
Video Dr Visits (LiveHealth Online)	$0 copay for video doctor visits using LiveHealth Online (LHO)	$0 copay for video doctor visits using LiveHealth Online (LHO)
Lab	$0 copay	$0 copay
X-Ray	$0 copay	$0 copay
Urgent Care	$25 copay per visit	$50 copay per visit
ER	$50 copay per visit	$120 copay per visit
Annual Wellness Visit	$0 copay per visit	$0 copay per visit

Prescriptions (standard)	$10/$35/$55/25%	$10/$35/$55/25%
Retail 90-Day Supply	2x Copay Tier (except Tier 4)	2x Copay Tier (except Tier 4)
Gap Coverage	There is no Gap, only copays listed in the two boxes above.  You will pay copays until you have paid $2,100.  The rest will be covered at 100%.	There is no Gap, only copays listed in the two boxes above.  You will pay copays until you have paid $2,100.  The rest will be covered at 100%.
Vision Eyewear reimbursement	$100 every calendar year         Blue View Vision	$200 every calendar year       Blue View Vision
Hearing aid reimbursement	$500 every calendar year    Hearing Care Solutions	$2,500 every calendar year Hearing Care Solutions
Medicare Community Resource	$0 cost to member EAP (Employee Assistance Program)	$0 cost to member EAP (Employee Assistance Program)
Silver Sneakers	Free Fitness Program	Free Fitness Program
Meals	Covered up to 14 meals per qualifying event, allows up to four events each year (56 meals in total)	Covered up to 14 meals per qualifying event, allows up to four events each year (56 meals in total)
Dental (In-Network)	$1,000 max each year Preventative Services $0 deductible/0% coinsurance Basic Services $0 deductible/20% coinsurance Major Services $0 deductible/50% coinsurance	$1,000 max each year Preventative Services $0 deductible/0% coinsurance Basic Services $0 deductible/20% coinsurance Major Services $0 deductible/50% coinsurance
Dental (Out-of-Network)	$1,000 max each year Preventative Services $0 deductible/20% coinsurance Basic Services $0 deductible/40% coinsurance Major Services $0 deductible/50% coinsurance	$1,000 max each year Preventative Services $0 deductible/20% coinsurance Basic Services $0 deductible/40% coinsurance Major Services $0 deductible/50% coinsurance
Annual 2026 Cost	$2,660.88	$1,416.96