It is Health Insurance Season
Each year in the fall, there is a chance to consider different health plan options and make a decision to stay or change plans. This year, the decision is based on a new health care provider chosen by the TRB, UnitedHealthcare (UHC). They will carry our coverage for the next three years. You will now make a decision for 2022, and then during open enrollment each year you have the opportunity to once again choose between the plans offered.
The Facts
A provider has been selected, rates have been approved, and informational meetings have been set. The best source of information for these decisions is the TRB website– where you click the box labeled health insurance.
The provider? UnitedHealthcare will oversee both the Medicare Advantage program and the Medicare Supplement program. Both plans will include prescription coverage by UnitedHealthcare, which means you will have a single card for medical and pharmacy coverage. Both UHC plans include medical, prescription drug, vision, and hearing coverage.
There are some enhancements announced. For the Advantage plan, there will be no copays for labs, X-rays, and diagnostic testing. For everyone, coverage for diabetic medications is improved. There will not be a deductible for diabetic medications and the maximum co-pay will be $25 for a 30-day supply of Preferred Diabetic Medication or $50 for a 90-day supply. Perhaps these savings come from the use of the new medication that can replace insulin as discussed in our previous newsletter, which is something to be followed.
Many members have enjoyed the Silver Sneakers program opportunities. The new plan does not include Silver Sneakers but does include UHC’s Renew Active. You can see the facilities and programs included by clicking here. If you enter your zip code, they will list the currently participating programs within a 20-mile radius.
The premium costs? For both plans, the dental costs are decreased by $3 a month from $53 to $50. For the medical, prescription, vision, and hearing, the Advantage plan cost is $30 per month and for the Supplement plan the monthly cost is $269 per month.
The informational meetings? The schedule is online, but there are two meetings closest to our area. October 21, in Trumbull (Trumbull Marriott Shelton) there will be a morning and afternoon meeting opportunity. October 22 in Stamford (Serafina at the Italian Club) there will only be a morning meeting. A reservation is required, with the statement that if attendance is full, you may need to select a different meeting, and that meetings are on a first come first seated basis. It is assumed that informational slides will be used in the meetings. The audio-only attendance will mean you have to use whatever materials are sent in advance to be able to follow along with the presentation. The latest information now indicates an online option for joining the meeting. The instructions are lengthy, so please find them at the bottom of the meeting page by clicking here.
To reserve a spot to attend a meeting in person, call UHC at 1-844-368-5650, TTY 711, 8 AM-8 PM ET, seven days a week.
The Observations
How does insurance work? Health insurance, like homeowners, auto, life, or other types of insurance works by collecting premiums that the insurance company feels will cover the payout costs they have for whatever type of policy is issued. They assess risk and put together groups that spread the risk to an amount that will let them cover their costs and make a profit. Risk isn’t always easy to predict. Look at the storm costs, or COVID hospitalization costs, for example. Has UnitedHealthcare been profitable? A quick search turns up this information for the year 2020.
- UnitedHealth Group annual gross profit for 2020 was $67B, a 16.32% increase from 2019.
So, we understand that health insurance is a for-profit business.
What is the difference between Medicare Advantage and Medicare Supplement and why are the costs so different? A Medicare Advantage program is inclusive and exclusive. What is excluded is Medicare; the Advantage plan completely replaces Medicare. Medicare gives an insurance company a lump sum of money for each person who enrolls in a Medicare Advantage plan and then Medicare is not responsible for that individual’s coverage, the Advantage plan is. The amount Medicare pays to the private insurance company may be different each year, but the most recent amount was said to be $12,000 per individual per year. The inclusive part is that UHC will then provide all medical, prescription, vision, and hearing coverage. Keeping within the money it receives from Medicare and from the TRB, UHC will cover the costs for all of the Advantage plan participants.
We are often told that our plan is not to be confused with other Advantage plans, and in one important aspect, that appears to be the case. Both the Medicare Advantage plan and the Medicare Supplement plan have the same network- “any provider participating with Medicare and accepts the plan.” Perhaps it is important to check with your medical providers to see they accept the plan you select. The Advantage program does require prior approval for many services. How has that worked? We have no history yet with UHC, but TRB meeting minutes from April include this information that gives a picture of how prior authorization worked with Anthem during the first quarter of 2021:
The Medicare Advantage prior authorization approved first contact rate for inpatient is 92.6%, outpatient authorization approvals are at 97.2% and diagnostic tests is averaging 94.2%. There are cases in which additional information may be required for the approval process.
The Medicare Supplement plan is designed to pay supplementary costs beyond what Medicare pays for an individual. It also includes prescription, vision, and hearing services. Prior authorization is not required. Depending on your household income, you may have to pay an income-based surcharge to Medicare.
It is important to note that both plans work to encourage wellness. The Renew Active program in offered to encourage participants to stay active, for example.
How is the selection made for the TRB health insurance plans? This may be a case of not wanting to know how the sausage is made. The process begins with an RFP or request for proposals. Discussions in the TRB meeting explained that there were three proposals for the Advantage plan and two proposals for the Supplement plan, all of which proposed combining the pharmacy and medical plans. It is not necessary to have the same company administer both plans and it has been suggested that there may be a competitive advantage for us to having two companies administer the different plans.
Some information on how the selection was made is available through the TRB website. A three-person Insurance Review Committee reviewed the proposals and recommended UHC for both plans. A newer TRB member asked for more information and was told the usual action is to accept the recommendation of the Insurance Review Committee since they spent time reviewing the proposals. At the April 2021 meeting, the TRB was asked to approve the choice of recommended plans, both from UHC, and that happened. Once the provider was selected, then the Insurance Review Committee and legal representatives began negotiations on the rates and offerings. At the June meeting, the committee came back with the rates and plan offerings. The only discussion on that information was held in an approximately 30-minute Executive session, the contents of which remain private. The plans and rates were then approved.
The outcome? Members who choose the Advantage plan will be thrilled that their monthly cost for the medical part will be reduced by $42 per month. Apparently, close to 80% of the retirees who participate in TRB health insurance have chosen the Advantage plan this year. Members who choose the Supplement plan will be unhappy and confused by the $94 per month increase for their medical coverage. For comparison’s sake, an opinion piece in the September 14, 2021, Greenwich Time stated,
The state Department of Insurance approved last week an average rate hike of 5.6 percent for individual health plans in 2022, which is less than the carriers had asked for, at 8.6percent.
Those figures are quite different from the increase or decrease found in our new plans. In fact, the $42 reduction for the Advantage plan is a 58 percent decrease, while the $94 increase to the Supplement plan is a 53 percent increase. Both plans include pharmacy coverage, which is said to produce cost savings.
How did this incredible discrepancy in rates come about? Two factors seem to be at play. First, a retired teacher member of the insurance committee explained in the April meeting that people who choose the Supplement plan know they will have to pay more. Next, it appears that the TRB pushed to shift the costs this way to be able to greatly lower the TRB contribution to our health insurance from the fund we paid into while working, but to which the State has been negligent in making its required contribution. Here is the impact. For 2021, the TRB contributed a little more than $130 per person to every person’s insurance, regardless of plan choice. Under the new plan for 2022, the TRB’s contribution will be just $60 per person, regardless of plan. Keep in mind that teachers who have to purchase their insurance through their last employing school district receive $110 per month from the TRB out of the health insurance fund.
Now what? Go to the meetings and speak up, but that route is not likely to have an impact. A better plan is being devised by the ARTC Insurance Committee. They are collecting information about the huge cost discrepancies and plan to seek meetings with the state Comptroller Kevin Lembo, the Attorney General William Tong, and the state Insurance Commission. Whether changes can be made is unknown, but at least it will be clear that our organizations are watching these decisions.
Here are some topics to consider as you select the plan that is best for you. These considerations are provided by Rick Follman the SFCRTA Vice President- Insurance.
- Remember there is open enrollment each year.
- Evaluate your need for medical and pharmacy use.
- Do you travel to a different geographical area of the country during the year?
- Have you had problems receiving medical care in different states?
- Are you willing to pay more for a Medicare Supplement plan because it offers you peace of mind?
- Does your personal philosophy regarding medical insurance question privatization of medical insurance, specifically Medicare?
Do you still want to think further about the decision? The Center for Medicare Advocacy has a decision tree that can alert you to some of the differences between traditional Medicare and Medicare Advantage programs. Two warnings- the Traditional Medicare section doesn’t include the Supplement aspects of a plan that provide additional coverage, and the traditional Medicare Advantage plans may not be as generous as the TRB plan. The decision trees can be found by clicking here. Once this newsletter is posted on our SFCRTA.com site, you can access it there and click on any links provided.
If you have any problems with our present insurance carrier, Anthem, you are asked to call the phone number on your card to speak with the person who is dedicated to our TRB plan.
In the meantime? Stay healthy!
Other News
Income tax- You might want to consider changing the amount you have withheld from your pension income. Why? From this point, only 50 percent of the income you receive from the TRB, including pension and any annuity you have chosen to arrange, will be taxed for state income tax. This decision is completely individual. Some people prefer to not pay more than necessary in advance and others prefer to be pleased at year end to owe less than they expected or receive a refund. If you are interested in making a change to the amount you have withheld from your monthly TRB income, Form CT-W4P can be found on the TRB website under Retired Teacher Forms or click here.
Retirement Options- This provision does not apply to already retired teachers, but the TRB was able to reinstate the opportunity for active teachers to purchase an annuity by rolling over certain pre-tax money.
Plan N payouts- Stay alert. There was mention of changes in how much money is deducted from the member’s account during Plan N payouts or reverting back to the way the payouts were to happen. No information can be found yet on the TRB site, to clarify the conversation, but this is a topic we will continue to follow.
Membership
It is time to see about renewing your SFCRTA membership for 2022. The membership year is based on a calendar year, so the membership you renew now will run through December 2022. Southern Fairfield County Retired Teachers’ Association (SFCRTA) is a nonprofit organization whose membership includes retired educators from eight Southern Fairfield County school systems. Our $15 annual membership cost is reasonable and includes periodic newsletters and in-person meeting events when it is safe for us to do so. We strive to keep you informed about topics that impact retired Connecticut educators and we support aspiring educators from these towns through monetary book grant awards. We are also an affiliate of the Association of Retired Teachers of Connecticut (ARTC), a group that represents all retired educators from Connecticut.
Our membership goes from – January to December. If you have not yet joined, click here for our membership renewal information for 2022. Remember: Numbers matter and we still face many important issues regarding our pension and health insurance.