1.) I am hearing that the TRB medical plan is changing. Is it true and why is this happening?
Yes, there will be changes effective July 1, 2018. But you will not need to make any decision until the last week in April, so you have sufficient time to explore your options. This change is necessary because the amount that the State is supposed to appropriate to the retired teachers’ health fund has been underfunded by almost $200 million over the last 8 years. Legislators have cited the budget crisis as the reason for this underfunding. This results in increased costs for members and a constant search for more cost effective mechanisms to deliver services.
2.) So what exactly will the change be?
The TRB will now be offering two options for your medical plan – (1) a Medicare Advantage (MA) plan through Anthem and (2) the current plan through Stirling Benefits. Beginning July 1, 2018, the Anthem MA plan will be the base plan with a premium cost of $134 per month per person for the total package that includes drugs, dental, vision, and hearing. Stirling will remain as a “buy-up” option and the premium will be $259 per month per person. In April, you will have to choose which plan you wish to have.
4.) What is an MA Plan?
A Medicare Advantage plan is a Medicare plan that is run by an insurer – in this case Anthem. Rather than having “Regular Medicare” plus a supplement to pay expenses beyond what Medicare covers (in the current plan Stirling is the supplement), under a Medicare Advantage plan everything is provided in the same package with the same vendor. Please refer to our website for additional information on both plans, including a video prepared by each vendor on the benefits of the respective plan.
5.) Are the medical services between the two plans the same?
Yes, the plans are similar in nature. The federal government requires that the Medicare Advantage plans offer medical coverage at least as good as the traditional Medicare program. Premiums and deductibles may vary.
6.) What is difference?
The coverage for out-of- country is basically full coverage under Anthem, and 20% under Stirling for the regular medical portion of the claim. For the hospital portion under the current plan the coverage is very similar. The catastrophic coverage under Anthem is unlimited; while under Stirling plan is. Please review the plan documents to better understand these differences. Generally, Stirling has lower out-of-pocket costs, but is most cases the lower out-of- pocket costs are offset by the additional costs to “buy up” to the Stirling plan. The wellness coverage is better under the MA plan. The therapy coverages do not have dollar limits under the Medicare Advantage plan as they do under the regular Medicare program. There is an exercise program included with the MA plan. The Medicare Advantage plans (Anthem) tends to have more “process” involved to obtain some of the benefits such as therapy services.
7.) Is there a gatekeeper under the Anthem MA?
No, there is no gatekeeper, so you do not need permission from Anthem to see a specialist.
8.) Are there prior approvals under the plans?
Yes, both plans have approval processes for going into the hospital or using certain other services (e.g., physical therapy and durable medical equipment). As mentioned under questions #6, the Medicare Advantage plan tends to have more process involved to obtain some of the benefits.
9.) Are the other coverages the same?
The vision and hearing coverage will be handled by Stirling Benefits, the dental coverage will be handled by Cigna and the Prescription coverage will still be handled by Express Scripts.
10.) What is the outlook for the plan future?
The TRB medical plan is flat funded by the State for next year. As a result there is an expected $8 million shortfall in the budget. Costs have increased and the number of retired members in the plan has risen dramatically, thus more change are expected.
11.) I heard we get free gym membership with the Medicare Advantage Plan, is this true?
Yes, Silver Sneakers is automatically included in the Medicare Advantage Plan.
12.) If we join the Medicare Advantage Plan, do we have to pay for Medicare Part B?
Yes, participation in Medicare Part B is required to participate in a Medicare Advantage Plan.
13.) Do we have to pay the Medicare Part B deductible if we join the Medicare Advantage plan, like we do under the TRB Stirling Plan?
No, you do not pay the Medicare Part B deductible if you join the Medicare Advantage Plan. The cost shares in the MA plan come in the form of copays $5 for sick doctor visits and $200 for hospital stays, etc.
14.) Is the Medicare Advantage Plan only valid in Connecticut?
The Medicare Advantage plan operates in all 50 states and provides coverage for emergency services outside of the country.
15.) I heard that the contract for Stirling Benefits is expiring the end of the year. Will I be able to join the Anthem plan?
Yes, if the Stirling plan is not available after January 1 st , you will be given the option to enroll in the Medicare Advantage plan. You will not lose coverage.
16.) If I live in an area that is not serviced by Anthem, what options do I have?
You can seek services from any Medicare participating provider. The provider is paid 90% of the Medicare approved rate. The member then pays 10% of the approved rate until the sum of in and out of network costs equals $2000. The plan would cover 100% of Medicare approved amounts for the remainder of the calendar year. Effective January 1, 2019, the out of network services are subject to a $250 calendar year deductible.
17.) Why did TRB go with a Medicare Advantage Plan rather than a Medicare Supplemental Plan?
The health plan has higher claims than revenue, and almost no health fund balance. We are on the verge of running out of money to pay the claims. Therefore, the TRB felt it our responsibility to bridge the gap between revenue and expenses. One way of doing so was by offering a Medicare Advantage Plan.
18.) What happens to the state and active teacher contribution towards my plan if I get my insurance other than from the TRB?
You would be ineligible for the subsidy paid towards your health plan coverage.
19.) As I understand it, if I enroll in the Medicare Advantage Plan I will get my prescription coverage through Anthem, is that correct?
No, you would only get your medical coverage through Anthem. All other coverage remains with the vendor it is currently with, unless and until we bid those services and another vendor is selected.
20.) Do my spouse and I have to participate in the same plan?
No, you do not. You are allowed to participate in different plans.
21.) I heard that once I make my election as to what plan I want for July 1 st , I am locked in for two years. Is that correct?
As long as we have more than one medical plan you can change your election during our annual open enrollment, which is currently scheduled for this coming fall. However, if you leave the TRB plans entirely, you cannot reenroll in a TRB plan for two years.
22.) Why were the TRB health plan members not allowed to vote on this change?
This is not a collectively bargained plan. The teachers elect members to represent you on the Board, who participate in the decisions regarding the TRB health plans. Economics are driving many of the difficult decisions the Board is faced with these days.
23.) We were told that the Medicare Advantage plan for the state employees is the same as the plan being offered to the teachers. Is this true?
The plan being offered to the teachers is with Anthem, the plan with the state employees is with United Health Care. It is our understanding the MA copays are very different from each other with the office visit and emergency room copays being higher under the State plan but the hospital copay being higher under the TRB plan.
24.) If the Legislators provide additional funding, will any of those funds be used to reduce the cost of the current plan administered by Stirling Benefits?
Yes, if the State were to provide additional funding it would lower the cost of the plan Administered by Stirling Benefits. This would be done in proportion to the amount of state contributions applied towards each plan (the current plan and the MA plan). As long as there is more than one medical plan the state contributions would be applied equally in terms of dollars.
25.) Has the TRB moved open enrollment from the traditional January 1 to July 1st?
The move to July of 2018 is expected to be a one-time change. It became necessary because the State did not establish a budget during the normal time frame and when it did provide a budget the amount was less than originally indicated. It is expected that the TRB will continue to hold open enrollment in Oct/Nov for coverage effective January 1st in the future.
26.) I am enrolled in the current plan without the dental, vision and hearing plans. If I move to Anthem, will I be required to enroll in the dental vision hearing coverage?
No as you are a current TRB plan member, you will not be required to enroll in the dental, vision and hearing coverage for July 1 of 2018.