Summary of Jamie Stirling’s Comments
Oct 23, 2016
Norwalk Motor Inn
2016 TRB plan and Changes to Medicare
Health Insurance Premium Account-Currently, the funding from the State budget for 2016 is at 25% (originally was to be 33 1/3%). Active teachers account pay 1.25% of their salary to this account, retired teachers pay 1/3.
The plan is still solvent.
The 25% is there, as opposed to less or zero, because of people contacting the Legislators.
Eligibility of participants– no change (those who are eligible for Medicare Part A and B, retired, or their spouse/surviving spouse).
NB- Spouses who reach 65 before the actual TRB member can apply for the TRB program before the retirement of the TRB member. (and vice versa)
Medicare B cost will not go up for most. When there is no COLA, part B premium cannot increase.
Unfortunately, Fairfield County teachers, whose pensions tend to be higher than those in other parts of the State, may see a rise in costs as we have to offset what those with lower pensions don’t pay. Those with higher incomes or those not having the full amount deducted from Social Security will see an increase. It could be as much as 52%.
Stirling’s role is to provide service, not establish policies. Stirling manages the Medicare Supplement plan, vision and hearing. Send eye exam bills to them. As of 2015, those coming on to the plan will have the total program- Supplemental, Vision/Hearing, Dental. There will be no choice. If you currently have a plan without dental and/or vision/hearing, you can maintain that, but, if you ever change to the full program, you must continue that. You cannot opt in and out.
- Stirling Benefits did not determine the change to Express Scripts. It was determined by the TRB, with consultants.
- By going to Express Scripts, the Government will cover 95% of the costs after the maximum out of pocket cost has been reached. That is a plus. The problem is that some of the hard to get drugs now become part of Medicare Part B. Many have seen increased costs. We are now in an EGWP (Employee Group Wrap Plan)
- Dental is covered by Aetna, also not managed by Stirling.
For the TRB plan- The deductible will go up $40. The out of pocket will be $1100.
Dental- implants are not covered. With the cost of implants, more people would reach $2000 of benefits, so premiums for all would go up.
If there are things you think should be covered, send letters. One example- Silver Sneakers (or similar programs)
Because of the Affordable Care act, we can purchase an individual plan if we are not on Medicare and finding the district’s plan too costly. You can check this out at accesshealth.ct. There is no gender rating, is it based on age and zip, no medical underwriting. There is also no one but you to negotiate, and you may have to change each year. A commissioned insurance agent can help.
Some towns “nudge” retirees to buy Medicare B rather than have them pay and stay on the district’s plan. It depends on the language that is used in the contract. There are new accounting and funding requirements for municipalities. They have to identify and cover unfunded liabilities (extreme doctor bills which retirees may encounter).(Per GASB 45)
Remember– if you are eligible for Medicare B and you wait to enroll, there is a penalty of 10% per year e.g. If you wait five years after your eligibility for Medicare B, you would pay an extra 50% of the premium.
Medicare Advantage plans are available from many companies. They sometimes cover things that Medicare does not cover. They usually involve networks.
You need to do the research to determine if it’s a better deal for you.
Remember- if Medicare doesn’t cover something, the TRB doesn’t cover it either.
Some are finding that doctors do not take new or any Medicare patients, or the doctor will submit, but not accept Medicare’s reimbursement rate. If the doctor’s office submits, they are only supposed to charge 15% above the Medicare reimbursement for a procedure.
With the change in demographics, the Medicare landscape is changing. As one example, doctors are encouraged to use PA’s, Nurse Practitioners, and Clinical Nurses rather than refer us to other doctors.
We may see a time when we have to weigh increased benefits to Medicare against investments in Education and Infrastructure.
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