Happy Winter
Social Security Fairness
At the time this issue is being written, we do not know the outcome of the efforts to repeal the unfair WEP and GPO provisions that penalize many public employees across the country by reducing or eliminating benefits. The intense efforts of Reps. Graves and Spanberger brought HR82 to the floor of the House of Representatives and it passed! Their remarkable efforts led to a discharge petition so the bill could come up for a vote. Along the way, a competing, far less attractive alternative bill was offered, so there were last minute efforts to derail the bill, but it survived and passed the House! The next step is for SB 597, sponsored by Sen. Sherrod Brown to come up for a vote and pass in the Senate. We have been called on to write to Sen. Schumer to bring the bill to the floor for a vote and to other Senators to vote for passage. The success so far is exciting and it is critical for these efforts to succeed now. The three champions, Graves, Spanberger, and Brown will not be in Congress next year. Graves declined to run again when his district in Louisiana was distorted through redistricting. Spanberger has chosen to focus on running for Governor of Virginia in 2025, and Brown was defeated in his Ohio election. It seems critical to have these provisions repealed before efforts begin to reform Social Security. Stay informed and stay involved.
Health Insurance
By this time, you have made the decision about which TRB UHC Medicare plan to use for 2025, the Supplement or the Advantage choice. The 2025 plan is a one-year extension of our previous insurance, meaning that an RFP will be issued and new plan proposals will be reviewed by the TRB Insurance Committee during 2025. Stay tuned.
What we are reading about health insurance.
Newspapers and magazines have included articles that report some medical providers are opting to no longer accept Medicare Advantage insurance. This could be because Medicare has given insurers permission to reimburse providers less for these services. Our Advantage plan has two requirements- that the provider accept Medicare and our plan, so this development is one to monitor. Our Advantage plan is a PPO, which is more desirable than many Advantage plans. For example, some Advantage plans have no monthly cost to the insured person. Ours does, for which we expect more comprehensive coverage. It is important for us to monitor how comprehensive the coverage is for our members. Medicare premiums are increasing for 2025.
We are reading concerns about how Advantage plan insurers, including UHC, have misused house call visits to identify additional medical conditions so that they can bill Medicare for more money. Several members have reported all being given the identical diagnosis after such visits, only to have their physicians dispute the diagnosis. Be advised.
What we are hearing about health insurance
Advantage coverage requires prior authorization for some services to be covered. During the November TRB meeting, it was reported that the prior authorization rate for our plan has been 95%. This figure is slightly lower than previous reports. The reasons for denial are generally stated to be more information is needed, but any service that would be covered by Medicare is to be covered by the Advantage plan.
Hearing aid coverage- This is one benefit where the coverage is different between the two plans, but even the amounts covered are not the whole story. ARTC recently sponsored a webinar with detailed information about how this coverage actually works, with some surprising information.
First, one question that always arises when hearing aids are discussed in relation to our insurance is whether Costco can be included as a provider. During the ARTC webinar, it was explained that UHC has a number of subsidiaries, including the United Hearing Center that we are required to use for hearing aid coverage. Having these subsidiaries allows UHC to recapture some profits generated by the subsidiaries. OptumRx, the provider for mailed prescriptions is owned by UHC, for example. Once you understand this relationship, you can see it is unlikely that UHC would include Costco as a provider, but read carefully to the end of this section for something to watch.
Members’ experience uncovered even more information about how the hearing aid benefit
orks. Two people had experience using hearing aids that had been purchased through our previous provider, Anthem, and were looking to replace them, using the more generous benefit that is part of the Medicare Supplement plan- $5000 once every two years. Hearing aids have many different features such as Bluetooth, the number of channels to enhance different aspects of hearing, etc. When one member went to a United Hearing Center provider, he learned that for our TRB plan with United Hearing Center, the best model they were allowed to offer cost $3800 and included three visits related to the hearing aids. In addition, the person was expected to purchase a 3-year warranty plan that included additional visits, out-of-pocket. The model offered was of lesser quality than what he was replacing. Given, the stated $5000 benefit, and dissatisfied with the model suggested, the person related his experience to the Connecticut Insurance Commissioner and Healthcare Advocate for Connecticut. After extensive investigation, lasting from January through September, he found he should have been able to purchase a more expensive model and file for reimbursement. He reported buying a different set of hearing aids, from the same United Hearing Center provider for $5200 that included a 3-year warranty and service. He then filed for the $5000 reimbursement, spending less out-of-pocket than he would have done for the designated, lesser model. Note that it was essential that he used the United Hearing Center person to access these services. Another member reported that she surveyed several friends using the TRB Supplement plan for hearing aids and found everyone had been offered the identical $3800 model from Starkey, the best available on our plan, but not necessarily the best model. A third person talked about accessing hearing aid services with the Supplement plan. His experience was similar in that the United Hearing Center provider presented him with the best model to which he was entitled by our plan. It was stated that the process of buying more expensive hearing aids and filing for the reimbursement does not apply for the Advantage plan.
The point here is not to suggest that everyone needs a $5000 hearing aid, but to explain that our coverage is not as straightforward as we might think, and to help understand why it is. unlikely that UHC will cover hearing aids sold at Costco or other providers who are not in their network. As of this year, our benefit has not been portable, or an amount that could be applied to whichever model was selected. Our plan required using United Hearing Center who determined which hearing aids were offered and encouraged out-of-pocket costs for warranties and follow-up visits. That is, UNTIL one member pursued a claim through Connecticut’s Commissioner of Insurance. After his efforts, the coverage allowed on the Supplement plan broadened, but it was stated that the wider benefit did not extend to the Advantage Plan hearing coverage. Although the change of benefits notice for 2025 does not mention any changes to coverage for hearing aids, a careful reading of the plan summary information does! The Advantage Plan coverage says in-network only, but that requirement has been removed from the Supplement plan. It reads: Hearing aids: $5000 maximum benefit; once every 2 years; includes digital hearing aids. Might that provision in the Supplement plan let you buy hearing aids from Costco? We shall see. It does seem to offer more flexibility.
For important information from the Center for Medicare Advocacy about access to skilled nursing and therapy. See this explanation:
Know Jimmo
As CMS Reiterates, Jimmo is the Law
Skilled Nursing and therapy to maintain an individual's condition are covered by Medicare. Improvement is not required. This applies to Medicare Advantage as well as traditional Medicare.
A CMS wrote on February 13, 2024:
“The Centers for Medicare & Medicaid Services (CMS) reminds MAOs [Medicare Advantage Organizations] of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or prevent or slow decline or deterioration (provided all other criteria are met).”
See the resources at cms.gov/medicare/settlements/jimmo
A valuable resource for Senior Citizens
The recent SFCRTA Board meeting featured a presentation from Kathleen (Katie) Regan, Director of Aging Answers from SW CT Agency on Aging. This agency is supported by State and Federal funding and provides services without charge. While many services are income-tested, other resource are available to all Seniors and their caregivers. They are extremely knowledgeable about what is available and can offer help in filling out forms for services that can be confusing or connecting people to resources such as Wheel it Forward, a lending library of durable medical equipment. Contact Aging Answers at 1-800-994-9422 or learn more via their website at www.secaa.org Look at this site today to see what they can offer.
Our pension
The Actuary’s report at the most recent TRB meeting indicated our pension gained 11.5%, which surpasses the standard needed to provide COLAs.
Check your credit information
Each calendar year, you are able to get a free credit report from each of the three credit-reporting agencies. If you have not done that yet this year, plan to do so before the end of December. Here is why- to make certain no one has managed to get credit coverage through your name. Here is how- www.usa.gov/credit-reports
You may also make a request by calling 1-877-322-8228
Membership
Help support SFCRTA so we can continue to provide this Newsletter, to offer scholarships for future educators, to offer meetings for our members and more. Please join or renew your membership for 2025.
SFCRTA Membership Renewal Information
Our membership goes from – January to December. If you have not yet joined, click here for our membership renewal information for 2025. Remember: Numbers matter and we still face many important issues regarding our pension and health insurance.