Medicare Advantage in Illinois. Don’t try selling the Brooklyn Bridge to a retiree.

Since the letter from CMS regarding the Medicare Advantage details came out I have received lots of comments and emails.

We are a suspicious bunch.

Why on earth would that be?

Experience!

The wording from IRTA Executive Director Jim Bachman that was passed along today was that any doctor who takes Medicare must take Medicare Advantage.

Right away I received messages from retirees who had called their Medicare doctors. They were told that they did not take Medicare Advantage.

Here is what I understand:

The Medicare Advantage plan worked out between the vendors and CMS is a unique plan, customized for Illinois state retirees. Not all doctors who take Medicare patients are aware of it as yet.

But according to what I have been told, doctors who take Medicare patients must take members from this Medicare Advantage plan.

Just as information still needs to get out to all members, doctors may not yet be aware of it.

The plan is called Total Retiree Advantage Illinois.

Trust, but verify.

But also know that the meetings about the coverage options are still to be scheduled and held. And most doctors are not yet aware of the new plan.

That’s not to say we shouldn’t read the small print.

Once again, here is the letter from CMS.

CMS letter on Illinois retiree Medicare supplemental.

Illinois state retirees have been holding their breath and many were fearing the worst these past weeks.

Today Central Management Services released some of the information that retirees who are Medicare eligible and using the state health care system have been waiting for.

For most the news will be good for a change.

Although every individual has different needs, the news of the plan produced an audible sigh of relief among the nearly 400 hundred delegates of the Illinois Retired Teachers Association meeting today and tomorrow in Springfield.

The cost of premiums is available here.

Individual premiums will be 75% subsidized.

Dependent coverage will be 25% subsidized.

Any doctor that accepts Medicare will accept users of Medicare Advantage.

All Medicare benefits that are currently provided will continue to be provided.

The deductible is reduced from the current Cigna plan from $500 to $250.

Out-of-pocket is reduced from $1250 to $1000.

A drug plan is included.

Many people will still have questions. But those meeting here were pleased at the news.

Finally it appears Illinois state retirees are hearing something good.

I am looking forward to hearing the reaction from readers.

Retiree health care and verification good news? Not enough fruit.

You all must have been making lots of phone calls and sending lots of emails about the switch to Medicare Advantage and the issue of verification of dependent eligiblity. IEA President Cinda Klickna has sent out a message to IEA members saying as much.

She says that as a result of her fighting to get information, our efforts have gained fruit.

What fruit?

The timeline for dependent eligibility has been pushed back and we will get another letter containing explanations.

As for the switch to Medicare Advantage? It may be good news for those getting hired as CMS trainers.

She says letters will be sent out explaining enrollment timelines and a plan for seminars. That is a good thing.

But it addresses only a very small portion of the concerns retirees have been raising about the switch to Medicare Advantage.

For example, nothing has changed about the short timeline that seniors have been given to make the choice before being tossed out of the system.

Many of us remain concerned about keeping our doctors and continuity of coverage.

(Message from IEA President Cinda Klickna)

Colleagues,
As we told you a few days ago, we’ve been fighting to get information about the impending changes to retiree health insurance by the state’s Department of Central Management Services (CMS).

The good news is that it appears the calls by IEA leaders and members to Gov. Quinn are bearing fruit. This afternoon CMS, at the direction of the governor’s office, called me today to make sure IEA members had the latest update on this important issue.

What’s new

CMS’s trainers have been trained to deal with questions about the insurance changes, allowing the agency to send out the definitive information.

What we know

Letters will be sent from CMS next week to retirees outlining the enrollment timeline, rates and product information.

  • Each retiree will also receive a reminder postcard informing them of the enrollment timeline, kits from each vendor that apply to a person’s area of residence and a final follow-up reminder postcard.
  • Seminars will be conducted across the state.
  • On a separate issue, for those people concerned about verification requirements for dependents, a separate letter will be sent from CMS.

What you should do

Visit the CMS web site.

Please continue to check the IEA website for the latest updates.

The in box. What is the root of the current health insurance issue? SB1313 under the radar.

A reader writes:

Despite the denials of many organizations at the time, Senate Bill 1313 is the reason we are in the mess we are in with retiree insurance.

Many groups said SB 1313 affected ONLY State employees, and not teachers.

SB 1313 passed the Illinois House on May 9,2012, by a vote of 74 yes, 43 no; and the Illinois Senate the very next day, May 10, 2012, by a vote of 31 yes, 20 no.

On May 11, 2012, the education newsletter of Jim Broadway stated:

“We recently observed how quickly dramatic changes in state policy can be made and advised vigilance. In some cases, the action comes in such a rapid blur that vigilance does no good. When SB 1313 passed both chambers by the morning after its language surfaced, the question was: What did they do?

“SSNS has received other questions. Who is affected? Are the legislators cutting their own health benefits too? How about the judges? I pay my health premium, so how does this affect me?

“The answers: Members of all five state-administered retirement systems, active and retired, are affected. That includes legislators, state employees, judges, university employees and downstate educators. 

“The ‘free’ health care enjoyed by 78,000 retirees is ended. (My note: Teachers did not receive free health care.)  Others should expect their premiums to rise.”

Please find below the wording of the relevant part of SB 1313 as signed into law on June 21, 2012, by Governor Pat Quinn:

“Beginning on the effective date of this amendatory Act of the 97th General Assembly, the Director of Central Management Services shall, on an annual basis, determine the amount that the State shall contribute toward the basic program of group health benefits on 
behalf of annuitants (including individuals who (i) participated in the General Assembly Retirement System, the State Employees’ Retirement System of Illinois, the State Universities Retirement System, the Teachers’ Retirement System of the State of Illinois, 
or the Judges Retirement System of Illinois and (ii) qualify as annuitants, survivors (including individuals who (i) receive an annuity as a survivor of an individual who participated in the General Assembly Retirement system, the State Employees’ Retirement 
system of Illinois, the State Universities Retirement System, the Teachers’ Retirement system of the State of Illinois, or the Judges Retirement System of Illinois and qualify as survivors and retired employees.  The remainder of the cost of coverage for each 
annuitant, survivor, or retired employee, as determined by the Director of Central Management Services, shall be the responsibility of that annuitant, survivor, or retired employee.

“Contributions required of annuitants, survivors, and retired employees shall be the same for all retirement systems and shall also be based on whether an individual has made an election under the Illinois Pension Code.  Contribution may be based on annuitants’, survivors’, or retired employees’ Medicare eligibility, but may not be based on Social Security eligibility.”

A federal government shut-down means nothing to the jerks who run the Illinois teacher retirement health insurance program.

Bev Johns sent me this remarkable letter from CMS, the management firm that runs the Teacher Retirement Insurance Program (TRIP).

Letter, 4 pages printed on both sides of two legal size pieces
of paper, is from CMS and HMS Employer Solutions
in Jeffersonville, Indiana.

“FAILURE TO RESPOND TO THIS VERIFICATION
LETTER WILL RESULT IN THE REMOVAL
OF YOUR DEPENDENT(S) FROM THE TEACHERS’
RETIREMENT INSURANCE PROGRAM.”

The first paragraph:
“To ensure that only eligible dependents are covered
under Teachers’ Retirement Insurance Program (TRIP),
the Illinois Department of Central Management Services
(CMS) has retained the services of HMS Employer
Solutions (HMS), an independent firm, to conduct a
dependent eligibility verification audit.”

REQUIRED DOCUMENTS by October 25, 2013:

“REQUIRED DOCUMENTS – All Required Documents
MUST [underlined] include date and/or year, employee
name, and dependent’s name.
“A copy of the front page of your 2012 federal tax return
transcript** identifying this dependent as your spouse; AND
a document dated within the last 60 days showing current
relationship status such as a bank, mortgage or credit
card statement listing both names, or a Property Tax
Statement issued within the past 12 months listing both names.”

**NOTE: Review FAQ #13 for information on how to obtain a
federal tax return transcript at no cost to you.”

“Q13: How do I get a federal tax return transcript?
You must provide a copy of the front page of your federal tax
return TRANSCRIPT [emphasis added] ….” Then it states
how to contact IRS to get the transcript in 7 to 10 days.

Enclosed is prepaid postage “Business Reply Mail” to HMS
in Jeffersonville, Indiana.

Apparently CMS has hired HMS to make sure us old folks aren’t trying to pull some stuff.

First of all, your spouse better be living with you. None of that she’s painting in Paris and I’m writing a novel in Kankakee. And your bank accounts better be joint ones. And if you women teachers think you can have your own private credit card. Think again.

But the amazing thing about receiving this letter on September 30 is that you have 7 to 10 days to get a federal tax transcript from the IRS.

There’s a probable federal government shut-down midnight tonight.

Good luck with that.

The insurance companies are happy. And so am I. I guess.

In the summer of 2009, Anne and I drove to Wakarusa, Indiana to support Obama’s plan for health care with a public option.

Great. The Supreme Court decided people without health insurance shouldn’t die.

What a country.

Don’t get me wrong. I’m glad Obamacare got past the crazies like Scalia, Alioto and Thomas on the Supreme Court. Millions of people are better off because of the decision. I don’t treat that lightly.

I’ve read a lot of articles in the last 24 hours that tried to explain the Roberts’ vote. I now know more about the Commerce Clause than I ever thought I would.

I’ve decided that Roberts’ change of heart was a Roger Sterling thing.

Of all the jerk guys on Mad Men, Roger is the biggest pig of them all. But this season he dropped some acid and he mellowed out. A little.

I think Roberts dropped some acid and had a vision.

He saw poor people.

In a couple of days, he’ll crash and realize what he’s done and be really pissed off.

That’s my theory, anyway.

Meanwhile, they  put the final nail in the coffin of single-payer health care in my life time. Which given the power of money in elections as a result of Citizens United (why didn’t Roberts do some acid on that one?) was probably true either way.

A little reported story coming out of the court decision is that the part of Obamacare that guaranteed Medicaid for all poor people in the United States was thrown out. Millions of people in poverty that were going to be covered now won’t be.

Poor people.

Even Obama’s appointed Justice Kagan voted against that one. I don’t think she does acid.

The in box. Candy in the classroom.

When I wrote about candy in the classroom the other day, I was targeting the bureaucratic and dishonest way in which some administrators deal with issues. The issue of food allergies and the issue of childhood obesity, on the other hand, are real.

A friend writes:

Hi Fred,
I live in fear that the school will give a peanut type candy to my child. It already happened once. In a “nut free” classroom, my boy was given candy with nuts to put in his backpack. While driving the couple of blocks home, he got to it, ate it and had a severe allergic reaction. His lips started cracking, throat started closing and his eyes bulged huge. In the emergency room, I watched as he was given epinephrine  and monitored his breathing. This has to be one of the most frightening experiences of my life, to watch and wait to see if my child was going to be okay from a stupid candy bar. I had to watch him for days, as the severe reaction could return at any time, until the peanuts were completely out of his system. Did the school know about their allergy? Yes! Did the teacher know about their allergy? Yes! Was the teacher too busy to check to see what candy came into the classroom? Yes! Did she look to see if they put it in their backpacks? No! Could it have cost them their lives? Yes! I should be able to go to work and not live in fear that the school will accidentally kill my children with candy. It could have been a funeral all because we don’t want to take the fun out of a school party. Believe it or not, there are other ways of having fun at a school party that don’t include food. He is now learning to read the allergens on all food products. But let’s face it. He is impulsive like any other child, and loves candy. He trusts friends, family and teachers, no matter how often I tell him how severe their allergy is and the fact that he could die from it. Everyone makes mistakes. Life and death mistakes for a classroom party are not necessary.

Pritzker poisons NATO officials.

Penny Pritzker. Hyatt owner. Pal of Obama and Emanuel. Member of CPS Board of Ed.

The McCormick Hyatt is where most of the NATO delegates were staying this weekend. It is attached to the gigantic McCormick Convention Center and was in the Green Zone.

As readers of this blog know, Hyatt is owned by the Pritzker family. The Pritzkers are close friends and financial supporters of President Obama and Mayor Emanuel. Members of the Pritzker family are major backers of the anti-teacher union group, Stand for Children.

Penny Pritzker was appointed by Emanuel to the Chicago Board of Education.

The Pritzker’s have refused to come to a labor agreement with UNITE HERE, the union that represents their hotel employees. The dispute has gone on for over two years.

UNiTE HERE has asked folks not to stay at Hyatt Hotels.

Did NATO officials listen?

No.

They got food poisoning.

Where I come from, that’s called justice.

What if Senator Mark Kirk had worked at Wal-Mart?

Phil Kadner in the Southtown:

Kirk’s facing a difficult recovery process. But he’s a lucky guy.

Millions of Americans have no health insurance. No job security.

Millions of other workers would discover that their health insurance didn’t cover the costs of the Rehabilitation Institute of Chicago when they needed it.

But instead of using his emotional video to talk about that, instead of saying that every one of his constituents deserves the same opportunity to resurrect their lives in a medical emergency, Kirk talks about cutting budgets and taxes.

Is that really the top priority of this country? Is that really what people want?

I would like to know why Kirk hasn’t told his doctors, “You know, this country is facing a dire budget crisis, I don’t want to waste federal tax dollars on my medical care. I want to make a point about what’s really important.”

No. He wants to get well. He wants to get back to work. And he wants the best treatment money can buy.

I don’t blame him.

But I think every American — each housewife, every child, every person who works at a fast-food restaurant — deserves the same thing.