The move to Medicare Advantage. The good, the bad and the ugly.

There wouldn’t be as big a problem if the timeline wasn’t so short. Illinois state retirees feel pressed and pressured to make decisions that have a major impact on their health and health care.

I have been deluged with phone calls and emails and comments.

Trust me. If people are turning to me to get advice on what to do about health insurance, that is a bad sign.

It is simply too short a time frame for people to wrap their heads around such a significant change.

We do know a couple of things.

The cost of the premiums for the new Medicare Advantage plan is relatively low.

We know that for those in TRIP, if you choose to leave, short of a life changing situation, you cannot get back in.

So the choice you make now is the choice you live with.

We know that if you leave, costs in the private insurance market, whether as part of a group or as an individual, will go up as we get older simply because we are getting older.

We don’t yet know what the coverage will look like. The state is claiming savings from the change to Medicare Advantage. But savings are often costs shifted to somebody else. Or in the extent of coverage.

That will be revealed in meetings that Central Management Services will be holding in November.

One point of contention is whether our doctor will take Medicare Advantage. What I have been told is that if our doctor takes Medicare they will take this state retiree specific Medicare Advantage. This is supported by Janice Bonneville, deputy director of benefits for Central Management Services.

In a lengthy story in the Springfield State Journal Republican it is reported that Bonneville assured retirees who are Medicare eligible and presently covered by the Teachers Retirement Insurance Program,  that “of the options available — UnitedHealthcare PPO — allows members to see any doctor in the country who accepts Medicare. That’s different from most PPO plans that limit the doctors a person can see to a specific network with whom the company has a contract.”

This has been a sore subject for many who are concerned about doctor choice.

Bonneville offered this advice. “I know the original reaction from a lot of people is ‘I don’t want to do this. I’m just going to stay in (federal) Medicare. I’m going to buy my own plan. Everyone has the right to do that. The request I make to every group I’ve spoken to is at least take a moment to look at what we are sending you.”

I think that is good advice.

Other important points in the Journal story:

  • “There’s no doughnut hole in the state plan,” Bonneville said. “We’ve covered the doughnut hole so you will pay your normal pharmacy co-payment from zero to $4,500.”
  • The state is moving to Medicare Advantage plans for Medicare-eligible retirees and their dependents. Medicare Advantage is essentially Medicare coverage provided by private health insurance rather than the federal government. The state believes it will save more than $200 million from the switch. But the change has sparked confusion and fear among retirees because it is different from the insurance coverage they’ve known for years.
  • A move to Medicare Advantage was part of the latest labor agreement between the state and the American Federation of State, County and Municipal Employees, although it covers retired state workers and teachers who were not part of the union.
  • Will Lovett, who handles pension and insurance issues for the Illinois Education Association, said a lack of information about the plans earlier created confusion for retirees. He said they need to “take a deep breath and wait and see what the information looks like when we receive it from CMS. I think as information comes out about premium levels and benefit design, I think they will breathe a sigh of relief to some extent.”
  • Bruce Strom, president of the Retired State Employee Association, also said a lack of information about the plans as the state was putting them in place left a lot of retirees confused and frightened. “For the average retiree, the process is viewed as very complicated and having a major effect on their lives,” Strom said. “There have been and continue to be concerns of retirees regarding what is happening to them.”

29 thoughts on “The move to Medicare Advantage. The good, the bad and the ugly.

  1. While Bonneville is correct that the plan will pay in-network and out-of-network doctors the same, and that any provider that accepts Medicare is included, what she is NOT saying is that all providers who accept Medicare will accept this plan. Just because a provider accepts Medicare does not mandate them to accept this plan. Each provider can decide for themselves. They have three options:

    1. Accept the plan and bill for the 90% coverage, letting you pay the remaining 10% up front (your co-pay).
    2. Accept the plan for the 60% out of network coverage and make you pay the other 40%. You would then need to request reimbursement from the plan for the 30% owed back to you.
    3. Not accept the plan at all.

    Part of our due diligence before making a decision must be to contact our providers and see which of these 3 categories they will fall into. This is critical to the decision making process.

    The rub there is that you can’t really approach your provider until you (and they) know the details of the plan. Since we aren’t promised that will be known until November 12th or so, that only leaves 4 weeks to get all of our ducks in a row. What, you say? I thought the deadline had been moved back. It has, unless you want to opt out, in which case your deadline is still the federal deadline of December 7th to pick up another plan.

    What we CAN be doing now is weighing all of our options based on the information we do have. We can shop for an alternative plan in case the specs for our plan come back not to our liking. Then when we get the specs, we’ll have something to compare to and then we can check with our providers to see which above the above options they will choose. But we have to be ready to hit the ground running, so I wouldn’t recommend waiting to begin the process until CMS sends out the specs.

  2. Clarification to my previous comment: I’m only talking here about the United Healthcare PPO plan, which is nationwide, and not any of the other plans that are offered. Bonneville has said that it will include 90% coverage for all providers, in or out of network. That plus the “no donut hole” referenced by Fred are really the only details we have thus far about the plan.

  3. According to the letter I received, the premium for the PPO plan is $47.56 while the current premium for PPO Cigna is $198.93. (How is that possible? Will coverage be the same?) Since I will be out of town for the month of November, I will not be able to attend a meeting. I plan to choose the PPO to stay in a TRS plan and then hope for the best. This is truly a rush job.

  4. Fred,
    Thank you for this wonderful website. Since I am retired but live out of state, the information that you provide is very valuable to me. I cannot attend any meeting sponsored by the State, nor can I talk to anyone. Please keep the information flowing, it will help me make the correct decision, which especially now is very important since I am under a Doctor’s care for recent and potentially serious problems that I have been having. Again, thank you for this very important information.

  5. This is not the equal to what we were receiving from TRIP concerning the drug plan. The copay for medicine could be $4500 per year? That is NOT what we have now.

  6. Thank you for the info… We also to need to wait until the medical providers are more informed. Loyola said to call every day or so as it could change and the news would be good,Loyola might recognize United at Loyola in Network!

    Sent from my iPad Mca

  7. I find it disturbing that not much is said about us retired teachers eligible for Medicare LOSING our supplemental TRIP insurance and NOT being allowed to purchase another if we decide to accept/join this state-subsidized Medicare Advantage plan.
    Sure, the premiums will be lower but there’ll be plenty of other expenses that the TRIP supplement took care of (very similar to the Medigap plan F).
    The question that we’ll have to decide is if the costs of this Advantage plan will truly be to our ‘advantage’, or perhaps it’ll be better to go with the original Medicare A + B plus Medicare D, and a Medigap plan.

    1. I have the same concern that misha1035 has.
      Seems scary not to have supplemental insurance as we currently have
      with TRIP
      What to do???

  8. I find it interesting that this change is the result of a new contract with State workers. No one else had any input or impact other than to learn about it after the fact, The other four pension systems were out of the discussions. Is my information wrong?

  9. I am wondering if , given the “can’t get back in” restriction: would it be wise to take this for one year, then understand it better, and stay in or opt out at the next enrollment period?

  10. No one has yet commented on the COGFA hearing last Wednesday. It seemed to me that a large amount of time was spent in discussing the mess CMS has once again made with Health Alliance in central Illinois. While I am sympathetic to those affected by this blunder I think the bigger question that no one asked is this. WHY wasn’t a medigap supplement policy included in the choices for retirees? I think the answer is obvious. If a standard medigap policy had been included probably at least 90% of retirees would have chosen that option and “the state” obviously is using this move to Medicare Advantage as one of the mechanisms to “scrub it’s rolls” of retirees.

    I am also very apprehensive about the language that Janice Bonneville from CMS uses at these COGFA hearings. She says things like “any doctor who takes Medicare “should be “willing” to take this Medicare Advantage program”. There is a huge difference between that statement and saying any doctor who takes original Medicare “must” take this Medicare Advantage program. Yes, we are told that this “group state sponsored Medicare Advantage program” is different from an individual Medicare Advantage policy one might purchase, but, that still doesn’t mean providers must accept it. I think it’s quite possible that especially in the beginning if one tries to make an appointment with a physician’s office (most of whom, for good reason will not accept Medicare Advantage) their receptionist will not have been educated in “how this state plan is different from individual Medicare Advantage and only hear those dreaded words “Medicare Advantage” and tell you repeatedly that their practice doesn’t accept any Medicare Advantage programs period. I feel that we who unfortunately are 65 with any dependent also 65 are now going to be the “canaries going into the mine”on this since we are the first group under this new plan and any “kinks in the system” will be worked out (or not worked out!) at our expense. At least for those say like 62, 63 or so, they will have a few years before they are forced into this and by then we should know all the pitfalls of this option. Yes, it may eventually work out (for those choosing this option I truly hope that it does, and, even for me, if it turns out to not be that bad I can reconsider next year) but as of now it seems like there are three “negatives” in this all rolled into one. First, State of Illinois – a lot of providers have had long standing problems with CIGNA payments, Second, just the designation of this plan using the title “Medicare Advantage” in any way and third, the bad reputation that United Health Care seems to have. These are concerns to me.

    I know for those in TRIP and CIP the choice is more difficult because of the inability to “opt in or opt out” on an annual basis. I am in SURS so we do have the opt in and opt out option once a year. SURS has tried to be proactive with this and even put a Medigap insurance portal on their website. This has been extremely useful for me and I have been working with an agent regarding purchasing a private Blue Cross/Blue Shield Plan F with drug coverage. While this is a bit more expensive for me it’s not horrible at this point since I am only 65,and I calculated after getting my 1% (next year 2% and after that who only knows what CMS will be charging for premiums) back and putting that money towards my monthly BC/BS premium it’s not really that much more and certainly to have the piece of mind that when I go to the doctor or hospital that I won’t have to argue with them to, as Janice Bonneville suggested, have the doctor or hospital call United Health Care and try and get them to accept my insurance.

    1. @Ronnie, It appears SURS changed policy. It looks like we no longer have the option of opting in and out of this Medicare (dis)advantage. Look at the SURS website. Obviously they are trying to force all 65 and over retirees with Medicare into this plan. The state saying they are “saving” 200 Million on this plan sounds a lot like the various schemes to “save” on pensions. United Healthcare has a horrible reputation and many doctors who have taken UHC in the past are dropping them. We should all ask our state reps and senators to have a law to require a payment to the retiree that ops out of the plan. The amount should be the same as what CMS would otherwise have paid to UHC. That money could then be used towards a private Medicare supplement policy.

      1. Are you referring to the College Insurance Plan (CIP), or the regular state employee plan? My understanding was that CIP cannot re-enter the program, while state employees can. I couldn’t find anything on the SURS website that said otherwise. Can you provide a link?

      2. Anon,
        Apparently there are two groups under SURS, the SURS (University retirees) and the CIP (College Insurance Program (I think these are community college retirees). For some reason, and I think Janice Bonneville touched on this at the COGFA meeting last Wednesday, that because of the way the original plans were set up with the state both CIP (which is a group under SURS) and TRIP (the Teacher’s Retirement Program) cannot opt in or out. I just checked both the SURS and SUAA websites and both still have the same sample letters to retirees posted as before. There are two letters, both letters are similar but in the CIP letter it states that participants cannot opt in and out while in the SURS letter it states that the next time we can access this program, if we opt out now, is next fall during the open enrollment period for coverage beginning January 1, 2015. I think the confusion may have arisen because there are actually two programs under SURS or am I missing something?

  11. We are being asked to choose between the Fed., not for profit, program and a private program that is for profit. We are being asked to accept insurance from a state that is trying to cut our pensions and has proposed to cut our insurance if we did not accept a cola cut. I don’t know?? Didn’t the western states have the Advantage program and over time, wasn’t shown to be wanting?

  12. Just wanted to make a correction to my above post. It is our retirees association SUAA, who has been proactive in this and the Medigap insurance portal is on the SUAA (not SURS) website.

  13. The CMS letter stated, “The advantage of having coverage under (Medicare Advantage) is that you will have all the….coverage you need in one plan, with one ID card.” Wow, just one card, what a great improvement. Do they think we’re idiots?

  14. Problem is that the literature talks about “willing providers”. I wrote to Janice B asking if she had been misquoted. Any Medicare provider can accept UHC and UHC claims it will pay even if out of network. But there is no way of forcing a medicare provider to accept UHC. The written documents refer to “willing provider” and not all providers are willing.

  15. @Ronnie from Anon 8:27, Yes I think you are right, there are 2 similar but not identical SURS insurance plans one for State and one for community college retirees (CIP). Previously CIP members were able to opt in and out during open enrolment. I saw a letter to SURS-CIP Medicare eligible retirees that said if you don’t enroll in this enrollment period you are out permanently. I got confused thinking that applied to SURS-State as well. (I hope it is not an oversight, at least you will a year to get feedback from retirees who do go in this year).

    1. My letter (SURS, state employee, not CIP) says this:

      “If you miss the December 13, 2013, enrollment deadline, medical, prescription drug, vision, and dental coverage for you and your enrolled dependents will end January 31, 2014. The next time you will be able to enroll in one of the State-sponsored MA-PD healthcare plans will be in the fall of 2014 for coverage effective January 1, 2015”

      I believe that this paragraph is different for those on CIP. This is pretty explicit that you CAN come back into the program if you’re not on TRIPS or CIP. Maybe someone on CIP who got the letter can quote the verbage here so we can see the difference. The quotation above is under the heading “Failure to Enroll.”

  16. I noticed your coverage of changes that the State if Illinois has made that affect retirees. Please note our story below: Please pass this information along to anyone you know who would cover the outcome of the switch to United Medicare Advantage plan on Jacob Brody, MD, formerly Dean of the School of Public Health at UIC. http://www.linkedin.com/in/jacobabrody I am his wife and available for comment if you are interested.

    I’d like to report that the Bermuda Triangle for healthcare is located in Miami. Who swiped our Medicare?

    We are caught in a horrific situation. We live in Miami and the reputable hospitals in this area refuse to even bill United Healthcare for this plan that SURS is providing to its retirees. I have contacted the Provider Outreach office at United which tried to get U of Miami Hospital and Baptist Hospital to bill them for treatments for my husband, age 82, with Stage 4 lung cancer. The hospitals refuse to bill (and refuse to treat) him now. United will only provide the name of a totally unacceptable hospital somewhere in Florida that no one has heard of. My husband is also a 30 year military retiree, but Tricare (military health plan) will only pay after they receive a denial of benefits statement from the primary insurer. Since the Miami hospitals won’t treat or bill, United can’t deny, so Tricare won’t pay. We are out of luck for February. I have applied to opt-out of this United Plan, which is the only way to get back into “old Medicare.” That cannot happen until March 1. I hope my husband does not need hospitalization before then. By the way, my husband was formerly the Dean of the School of Public Health at UIC . It is a cruel irony that someone who has devoted his life to public health cannot access decent healthcare under this dreadful plan that we unwittingly slipped into. United may say that they will pay any willing provider, but there are many who are not willing to deal with United.

    Here is the plan Jacob enrolled in, thinking that it was replacing the previous supplementary Medicare plan.

    Insurance changes for Illinois State Retiree Health Insurance
    The following is information regarding recent changes to Illinois State Retiree Health Insurance. These changes only apply to those who are enrolled in Medicare. If you are affected by this change, you should be receiving a letter from CMS regarding the proposed changes to the SURS health insurance plan this week. Note: if you are covering a dependent, you must both be enrolled in Medicare for this change to affect you. If only one of you is enrolled in Medicare, then you will keep your existing coverage and May benefit choice period.
    Here is a summary of what we know:
    Important! You must make a decision and enroll (postmarked) by December 13, 2013. There is no default choice. If you do not enroll, you will only have Medicare Parts A and B coverage which is very limited and does not include prescription drug coverage. New state coverage will start February 1stand run through December 31st of 2014. In future years, your open enrollment period for health insurance will be the same as the Medicare Fall enrollment period. You will note this has changed from May, as in past years, to fall enrollment for this year and future years. This is also the time to add or drop dependents, add, drop or change Optional life insurance coverage, and add or drop dental coverage.
    Coverage Summary
    Every county in the state has different choices of plan. Consult the map in the materials you receive, or follow this link and view page 8
    In Champaign County, you have two choices of plans: UnitedHealthcare (UHC) PPO and Coventry Advantra HMO.
    With the UHC plan, you can see any willing provider as long as the provider is in the Medicare program. You should note there is no difference for in-network and out-of-network coverage levels, as with most PPO plans. After a $100 deductible, you pay 10% of charges for services up to the $1,300 annual out-of-pocket maximum, then the plan covers 100%.
    With the Coventry Advantra HMO plan, you must choose a primary care physician from within their network of providers, and use only in-network providers except for emergency care. There are copays, and the annual out-of-pocket maximum is $3000. There is a chart on page 11 of the Trail booklet comparing the costs for the two plans.
    All SURS annuitants who are enrolled in Medicare Parts A&B (and SURS annuitants with Medicare enrolled dependents) will be required to enroll in a Medicare Advantage plan if they want to be covered by the SURS health insurance. These plans include prescription drug coverage (MA-PD plans; MA equals Medicare Advantage, including Part A and Part B coverage; PD equals Prescription Drug), so you do NOT have to enroll in a Medicare Part D plan.
    Caution! Be careful when enrolling as you may also be receiving mailed offers from private Medigap insurance companies. These options do not qualify for State coverage. To enroll in the state plan, your forms must have the “Total Retiree Advantage Illinois” logo (Your TRAIL to Better Health). Here is the logo:

    1. I think this is an unfortunate illustration of Herb’s comment above, where he speaks to “willing” providers. Personally, I bailed from the state plan and bought my own Plan F from USAA (for veterans). I bought an additional Plan D (drug benefit) from Humana. I am 66, with no major health problems, and the out-of-pocket cost to me is less than $30 per month more than I would be paying as of July 1, 2014, when the state was set to increase the premium to 2%. I more than get that back if I have much in the way of doctor visits, as I pay no co-pays or deductibles. And I can use any provider who takes Medicare, as the provider just submits all bills to Medicare and Medicare copies the bill to USAA, who then pays the provider the difference between the bill and what Medicare pays.

  17. One of my doctors offices had a big sign at their front desk “We don’t take United Health Care at all, and we do not fill out their forms. We also no longer take State of Illinois Cigna, or TRS Cigna.”
    I asked why not Cigna, they said they had bills over a year old still unpaid.

  18. My questions is: what are the benefits of having TRAIL over just Original Medicare? Are there services that TRAIL pays that Medicare Original does not?

    Thank you,

    1. My best suggestion to you is to call the Teacher Retirement System (TRS) in Springfield at 217 753 0964. They will answer all your questions.

    2. Dear Elizabeth,
      Trail PPO pays exactly what Medicare Original pays, plus (after deductible) the 20% Medicare Original does not pay. It pays ANY doctor who accepts Medicare the same as Medicare does. It also has a “part D” pharmacy included. Also, Trail pays bills promptly, without the long Cigna delay. Also, part of the Trail payment is covered by TRS, SURS, or SERS. That being said, I don’t like that we have all been FORCED to go on Trail or we are on our own. STAY AWAY from the HMO unless you are exceptionally healthy and, well that’s just my opinion. You can quit Trail and go back to regular Medicare, but it is unclear if you quit Trail, if you can get back on to Trail later.
      Call TRS, call the phone numbers in your book and also watch the online presentation. Do so ASAP because the deadline is only a couple weeks away, and you need that information so you can make an informed decision. Please take Fred’s advice and call TRS TODAY.
      Anon

  19. I talked to someone at SURS about why there is a different policy on state retirees and CIP (and TRIP) regarding re-enrollment in the TRAIL program. I was told this was NOT something SURS or TRS had any choice in doing, they have to follow the letter of the law. It appeared part of the law adding CIP and TRIP to the TRAIL program has an error of omission. Roughly, the part in the law for the state retirees says “if you withdraw from TRAIL you can not re-enroll UNTILL THE NEXT OPEN ENROLLMENT PERIOD”. The CIP and TRIP versions left out the “UNTILL THE NEXT OPEN ENROLLMENT PERIOD”.
    SURS said they can not correct this, but the legislature could easily do so. They suggested we call our representatives to correct this situation. NO better time to remind candidates of this awful discrimination against retired teachers and community college employees then RIGHT NOW, before an election! Fred, please post phone numbers of representatives that we could call about this small, technical correction needed to this law.

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