Who does this apply to?

The changes to retiree healthcare plans only apply to people that are enrolled in Medicare Parts A&B and reside in the United States.

What happens if my doctor/clinic is saying that they don’t take my new health plan?

If you select the United Healthcare PPO:

Under the United Healthcare PPO (UHC) you can see any willing provider as long as the provider is in the Medicare program. That means that even if your provider does not have a contract with UHC, you will still be able to see them and UHC will still pay the provider. Even if the provider does not accept Medicare, UHC will still pay them the Medicare rate and your co-pays will still contribute to the same annual out-of-pocket maximum. If you find a provider that is unwilling to accept UHC or Medicare payments in any form, the UHC PPO will still cover your medical expenses up to the Medicare allowable rate- but you will need to submit your provider’s bill to UHC and they will reimburse you or your provider for the costs of the visit. While this process was troublesome in the past due to late payment by the state, under the new plans the carrier (United Healthcare) will pay you or the provider within ten (10) days.

If you select the Aetna or Humana HMO’s:

HMO plans come with a rigid network of specific providers. Care within these networks is sometimes cheaper than the PPO option, but going out-of-network can involve huge penalties. Also, the maximum out-of-pocket for the HMO plans is much higher than for the PPO ($1,300 versus $3,000). Basically, this option is a good choice if members rarely need medical care and all the doctors they prefer are in network.

What if I am Medicare eligible, but my spouse is not; or vice-versa?

In order for you in your dependents to transition into the new Medicare Advantage plans, both you and all of your dependents must be Medicare eligible. For example, this means that if you are 65 (and therefore Medicare eligible) and your spouse is 62 years old (and Medicare ineligible), then neither of you will transition into the new plans. You will both stay on the plans you currently hold until both of you are Medicare eligible. The same applies for dependent children.

What is the timeline?

The Open Enrollment Period for the new Medicare Advantage plans will begin November 12, 2013 and conclude December 13, 2013. The Medicare Advantage plans will go into effect on February 1, 2014. That means that the state insurance plan you are currently on will continue to be effective until January 31, 2014.

Many people are also receiving information from insurance companies and the media about a December 7^th deadline. This refers to the enrollment deadline for Medicare benefits. If you are already on Medicare Parts A&B, then you do not have to concern yourself with this deadline. If you are turning 65, or want to make changes to your Medicare (remember, you must be enrolled in both Medicare A&B to be eligible for the new Medicare Advantage plans) then this deadline applies to you for those purposes. The biggest deadline for state retirees going on the new plans is December 13^th, the date you have to turn your enrollment forms in.

What if I am not Medicare eligible?

If you are not Medicare eligible, then you will stay on the plan you have now and no action is required on your part.

I’m getting a lot of mail, how do I know which is official and which is just junk mail?

Many insurance agents are sending out advertisements in the mail which have led to widespread confusion. If the letter is not from CMS, AFSCME, another labor union (IFT or IEA, for example) or another retirement group (RSEA or IRTA, for example), then you should feel safe in disregarding the information contained therein. When CMS sends out the enrollment packet, it will contain a logo that says: “Total Retiree Advantage Illinois.” Any deadlines that advertisers may be referring to likely refer to Medicare enrollment for people not yet enrolled and don’t apply to the vast majority of retirees.

Are these plans comparable?

We at AFSCME are still conducting an analysis of the comparability of the plans. If our initial analysis determines that the plans are comparable we will reserve the right to take action against the state in defense of our members’ rights if it is later determined that plans are not comparable in practice.

What about drugs?

All of these plans are what are known as MA-PD plans, which is short for Medicare Advantage Plan with Prescription Drug Coverage. Under both the HMO and PPO plans, drug coverage costs the same, both for copay and deductible, as the current HMO and PPO plans respectively.

What about dental and vision?

Your dental and vision coverage will remain the same as it is now. However, if you opt-out of the state insurance plans during the enrollment period then you will not be able to keep your vision coverage, but you may elect to keep your dental.

What plan options will be available to me?

This is dependent on what county you live in. Most counties will have the choice between the United Healthcare PPO and one or more HMO plans. However, 48 counties, mostly in the South-East and Southern regions of the state, will only be able to select the United Healthcare PPO option since the state did not award a bid to any insurance company that has HMO networks in those counties. While we anticipate the PPO option being far-and-away the most popular choice for members, we are concerned that many counties will only have that as their option. We are monitoring any developments in this issue closely, including what implications this has on the comparability issue.

How does the Affordable Care Act (“Obamacare”) affect me?

In short, it doesn’t. There is a lot of misinformation being perpetuated about the Affordable Care Act (ACA) to seniors. The bottom line is: the Affordable Care Act is designed to set up health insurance exchanges for people that are uninsured. By that definition, people on Medicare and people receiving health insurance benefits through a state retirement system are not affected.