Your health insurance to-do list, regardless of which plan you choose, Advantage or Supplement.
As of January 1, 2022, we will all have new health insurance coverage with United Health Care (UHC). There are notifications and other steps to take so that all works smoothly for the transition. Here are some suggestions:
Notify all of your medical providers that as of January 1, 2022, you have a change of health insurance, except dental, which stays the same. You may do this at the start of the new year or the first time you see each medical provider.
Monitor your prescriptions. See where you are in the series of refills, paying careful attention to prescriptions where you have no refills left at the end of the calendar year. Those prescriptions will not be rolled over to UHC. You will need to provide new prescriptions directly to UHC’s OptumRx. You can begin now by looking through your order history with Express Scripts. Pay special attention to any orders that should come to you in January, and, once you have selected a plan and your account is set up, be sure that the new pharmacy plan has all of your prescriptions on file and is ready to dispense the prescriptions to you. Once you have your Quick Start Guide, you can learn how to check on prescriptions.
If you occasionally use a local pharmacy as opposed to mail order, let them know of your pharmacy plan change, too.
Do you have a durable medical equipment provider? Inform them of your new health insurance.
Set up your online account with UHC so that you can check the status of claims.
Sign up for Renew Active to access those benefits, including health club membership, brain games, and other resources.
Ask yourself if there are any medical services you want/need to use before leaving Anthem at the end of December.
Opinion- It’s not just you
The new TRB health insurance plans for 2022 seem to have generated many more questions than past changes. Apparently, attendance at meetings has been high and members have been vocal, at least when the presenter would allow for questions from attendees, which is reported to not always have been the case. Why is there so much discussion this time around? It appears to be because the changes in the two plans have been so discrepant. The Advantage plan benefited from a large price reduction while the Supplement plan experienced an even larger price increase, without any supporting information given to explain those changes. Even members who have been happy with the Advantage plan in the past have become suspicious about what sort of coverage will come from the new, very inexpensive Advantage plan. Perhaps the pharmacy coverage is different and the more expensive plan has more comprehensive pharmacy coverage? We are told no, they are identical.
Why are the costs so different between the Advantage and Supplement plans, especially since the Supplement plan is only responsible for picking up what Medicare does not cover? Why
would anyone choose the expensive Supplement plan? Variations of these questions were asked at several of the presentation sessions and here are a few of the responses we heard were offered.
- For peace of mind; so you can sleep better.
- It’s because the Advantage plan is managed care. We manage your care. There are these extra programs for you to use and that results in lower bills for your care.
- Look online, you will see that Advantage plans are always less expensive than Supplement plans.
- (Unintelligible because the audio was so poor.) Zoom
- Often, people who are healthier choose the Advantage program and people who are older or who have more health needs choose the Supplement.
- Ask the TRB; they negotiated these deals.
Perhaps the last explanation was the most accurate. The TRB has been encouraged to move everyone to Advantage plans, something that has already happened for retired State employees. The State contributes equally to each of our plans, calculated on their one-third share of the base plan, which is the Advantage plan. The monthly premium for the base plan is funded one-third by the State, one-third from the contributions of teachers who are presently working and one-third by each individual. With the dramatically reduced monthly premium of $30 per month, the State and TRB contribution is then $60 a month to each person’s cost, regardless of the plan chosen. This reflects a dramatic reduction from the 2021 TRB contribution of $130 per month to each person’s monthly premium. The TRB’s costs for health insurance in 2022 will be far less because the Advantage plan rates were slashed. If you are interested in knowing more about the TRB, you can read transcripts of past meetings and even listen to meetings. Click here to gain access.
It is true that Medicare Supplement plans are more expensive than Medicare Advantage plans. Why is this so? To begin, for each participant who chooses to leave Medicare and transfer their care to a managed care Medicare Advantage plan, Medicare gives the health insurance company money to use in covering their medical expenses. Advantage plans say they are required to cover what Medicare does and they call attention to enhancements like the ones described by UHC. Medicare Supplement plans say they cover what Medicare doesn’t. Medicare pays 80% of the agreed-upon cost and then the Supplement covers the additional 20%. Of course, there are some procedures even Medicare does not cover, regardless of your plan. The Advantage plan works most successfully when you see physicians who are part of the UHC Network, so it is important for you to check with each of your medical providers about participation in the UHC Network. Medical providers in Southern Fairfield County have been slower to join these networks, but that seems to be changing. What happens if your medical provider does not participate in the UHC Network or does not accept the plan? If they accept Medicare, but won’t bill UHC on your behalf, you can see the provider and pay out of pocket. Then you submit the statement to UHC. Most likely the reimbursement will be for the Medicare allowed amount, which may be less than what you paid up front, but represents covering what Medicare does. Here is what UHC explains: You pay your plan’s copay or coinsurance. UnitedHealthcare will pay for the rest of the cost of your covered service(s) including any excess charges up to the limit set by Medicare.
Another difference between the plans is that Medicare does not require prior approval, so that is not a concern for the Supplement plan. The Advantage plan does sometimes require prior approval. How are we to know? If you are using a medical provider who is part of the UHC Network, they know and will seek necessary approvals. This is another reason to know about your provider’s participation in the UHC Network or acceptance of the plan. With the Advantage plan, when in doubt, seek prior approval.
If you plan to stay with the same type of plan as you have this year with Anthem, there is nothing to do except for the items on the To Do List. If you plan to switch, you must do so by following the instructions in the open enrollment materials before November 22. In the meantime, keep checking the Open Enrollment site on the TRB pages. New information continues to be posted.
Barbara Oppedisano, VP Newsletter
More information about Medicare’s services
We are fortunate that Stephanie Aston from the Center for Medicare Advocacy provides us with information to share about Medicare’s services. These services are available with Medicare and the Supplement plan, but the Advantage plan is bound to cover what Medicare does, so having this information from Medicare can help you seek the comparable services, if needed. The services described in these booklets are Medicare Coverage for Home Health Aide Care and Medical Coverage for Durable Medical Equipment (DME). Medicare coverage can help older adults and people with disabilities obtain necessary home care. As defined by federal law, home health aides provide hands-on personal care, including assistance with the activities of daily living. This care is often critical to beneficiaries’ health, safety, and ability to remain at home.
Medicare Coverage for Home Health Aide Care Fact Sheet
Medicare Coverage for Durable Medical Equipment
And now for something completely different
COLA Increases are on the agenda for approval at the November 3rd TRB meeting. They are based on the higher than typical amount Social Security is granting for 2022, but the assumption is that they continue to be dependent upon the performance return of the Retirement Fund, now at 6.9% instead of 8.5% growth.
Social Security Fairness- Connecticut U.S. Representative John Larson has introduced a bill aimed at making changes to Social Security. At present it includes repealing the WEP and GPO provisions that penalize many of our members. There is ample reason to be cynical, but please stay tuned and be ready to offer your support in educating members of Congress just why these provisions are unfair. More to follow. If you have not already, join the mailing list of Social Security Fairness at https://ssfairness.org
SFCRTA Book Grants are awarded to deserving high school seniors from the high schools in Southern Fairfield County who plan a career in education. The Leadership Team approved an increase in the amounts for our five 2022 grants to $2000 each. Book grant awards are particularly helpful because they do not impact a student’s status for financial aid. Please help spread the word about these grants. Information about how to apply will go to the schools in the spring.
SFCRTA Donations to causes we have supported in the past. When we have met in person, individuals have been able to contribute, but once again, we have made the following donations on behalf of SFCRTA:
Glenn Moon Scholarship: $2000
Henry Barnard Fund: $1000
Kathleen Flynn Scholarship (Brien McMahon HS): $1500
Food Bank of Southern Fairfield County:$1000
Toys for Tots: $1000
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.