Bay to Bay News | by Joseph Edelen
At the Statewide Employee Benefits Committee’s monthly meeting on Monday, the panel provided updates on the implementation of Medicare Advantage ahead of next month’s Medicare Open Enrollment period.
As many state of Delaware pensioners continue to express their uncertainty about the state’s move to a Medicare Advantage Plan, state officials and State Employee Benefits Committee members have made an immediate effort to inform pensioners of the change.
While Statewide Benefits and Insurance Coverage Director Faith Rentz has assisted in providing pensioners with as much information as possible, she said she wanted to “strongly caution pensioners to be fully aware of the implications of opting out of the plan,” during the open enrollment period from Oct. 3 through 24.
Beginning Jan. 1, 2023, Highmark Delaware’s Freedom Blue PPO Medicare Advantage Plan will be the only health plan available for pensioners. If pensioners choose to opt out, they will have no additional coverage beyond Medicare Part B medical insurance, Ms. Rentz said.
Those who opt out will not receive the value of the premium for the state’s new Medicare Advantage Plan with Part D prescription drug coverage should they purchase a plan on the individual market, according to Ms. Rentz, and if pensioners who opt out currently cover spouses or dependents, they will also lose coverage.
“This is not the same as the Medicare Advantage Plans that pensioners read about, hear about, see on television, or receive information through the mail about, it is not the same as our Medicare Advantage Plan,” Ms. Rentz said. “This is a specially designed Medicare Advantage Plan. As I said it’s designed to mirror the current Special Medicfill Plan’s insurance coverage and out-of-pocket costs to the pensioners. So, it’s very much different as other plans that would be available on the marketplace, as the plan includes the Medicare Part D drug plan that is available to pensioners today.”
Statewide Employee Benefits Committee Co-Chair and Director of the Office of Management and Budget Cerron Cade said Ms. Rentz’s comments were important to emphasize as many state pensioners have expressed their concerns to the committee but have referred to Medicare Advantage Plans that differ from the state’s new plan in doing so. He said the confusion has led to a lot of “miscommunication” and “misinformation” about the plan.
Ms. Rentz also clarified the requirement of prior authorization for non-emergency services. While the current plan does not include prior authorization, Ms. Rentz emphasized the new plan’s 92% approval rate, under two-day turnaround for expedited services, and under five-day turnaround for standard services.
However, in attempt to alleviate pensioners’ concerns, the state of Delaware and Highmark Delaware have agreed to postpone prior authorization processing until May 1. In addition to the agreement, the three-year contract between the state of Delaware and Highmark Delaware for the new plan has been renegotiated to include built-in performance guarantees regarding prior authorization. This will include strict reporting regarding prior authorization approvals, denials, and processing according to Ms. Rentz, who said the contract would be made available once finalized.
Ahead of the Medicare Open Enrollment period from Oct. 3 through 24, state pensioners will receive a mailed open enrollment packet including a summary of benefits under the new Medicare Advantage Plan and a medical benefits chart. The information is available on the Department of Human Resources website, Ms. Rentz said, and to further supplement the information, numerous open enrollment sessions will be held throughout the state.
“We encourage pensioners with questions to come out and attend these sessions. There will be representatives from the Office of Pensions, Statewide Benefits Office, and Highmark Delaware available to assist with enrollment, with disenrollment, with specific questions regarding providers, network, and prior authorization,” Ms. Rentz said.
There will be no question-and-answer portion at the open enrollment sessions according to Ms. Rentz, though pensioners with questions will be directed to representatives for individual assistance.
Members of the public were allowed to provide public comment and state retirees expressed their concern with the change. Retiring Rep. John Kowalko, D-Newark, was of those in attendance to provide public comment and recently co-founded Retirees Investing in Social Equity Delaware, or RiseDelaware, to fight the change.
“Not only do you not have the unilateral authority to impose these horrific changes to health care access that State retirees have earned and paid for and expect but you have consistently displayed a disregard for the truth and an arrogant attitude toward open government transparency,” Rep. Kowalko said.
“You all should be ashamed of what you are doing and enabling and how you are doing it. You should be especially ashamed of your disregard for open government and the truth and the welfare of all of these retirees who earned and expected better from Delaware.”
The next Statewide Employee Benefits Committee will take place on Oct. 24, the final day of Medicare Open Enrollment.