The state's new supplemental Medicare coverage: meetings and questions

PEORIA, IL -- The politicians that have forced state retirees to pay 1 percent of their pensions for supplemental Medicare coverage, a rate which will double to 2 percent on July 1, will finally have to face their victims. (This coverage was previously free, part of their retirement benefits, a situation now in litigation.)

Meetings are now being scheduled throughout the state on the Medicare Advantage plans the state is offering.  There's one in Peoria on Thus., Nov. 14, 9:30 a.m. and 1:30 p.m. at the Peoria Civic Center, 201 SW Jefferson. It's said to be sponsored by Reps.David Leitch, R-Peoria, and Jehan Gordon-Booth,D- Peoria,  Mike Unes, R-East Peoria, Sens. David Koehler, D-Peoria and Darrin LaHood, R-Peoria.  Will they show up to face the music?

 No details of the plans have been released yet -- vital information such as deductibles, co-pays, coverage.  Hopefully retirees will get this information in the mail before the meetings. 

But there are many, many questions that must be asked.  Here's a list, from Fred Klonsky's blog:

• If your doctor accepts Medicare but chooses not to participate in the PPO Advantage Plan, can you pay his charges at time of service and submit a claim to United Healthcare for reimbursement?  If so, what is the time period for reimbursement?
• State of IL is a notoriously slow pay, so much so that some doctors have refused to take public employees as patients.  While TRIP was a “slow pay”, the State Insurance Program for other State employees was “appalling slow.”  Will these plans be any better?
• If one leaves traditional Medicare for an advantage plan, can you go back to traditional Medicare at any point?
• If someone accepts the Advantage PPO Plan, but after two months is dissatisfied, can they leave the State plan and purchase a Medigap policy and Drug plan without penalty from the State OR penalty in purchasing the alternative healthcare and drug plans?
• If a doctor accepts Medicare, is he required to accept the Medicare Advantage PPO?
• Doctors are reporting that CMS has stated the details of the Advantage PPO will NOT be available to them until mid-December.  Since retirees must make a decision with regard to any private Drug plan by December 7 (Open Enrollment deadline), the timeline for doctors to receive and evaluate the Advantage Plan does not appear to work.  Please advise how doctors and retirees can make intelligent decisions under the present timeline.
• Why can some State retirees leave the State insurance program and return at a later date, but TRIP retirees can’t?  Are there other differences between the three State group plans (College Insurance Program, TRIP and State Insurance Program)?
• Is the paperwork required of doctors in the Advantage plans more or less difficult than for Medicare and is payment to them as prompt, more prompt or less so?
• Why is CMS scheduling meetings to explain “TRAIL” that are after the time that retirees must make a decision about a private drug plan - DECEMBER 7?  Why are not more meetings scheduled in the Chicago suburban area?
• Will the co- pays for prescriptions covered be limited to only generic? Will brand name prescriptions cost 20% or more of the retail price as exists under some plans?
• It has been reported that in many states, the UnitedHealthcare PPO offered to retirees is very restrictive, having fired many specialists, such as in cardiology, ophthalmology, dermatology, orthopedics.  These, of course, are specialties especially needed by retirees.!!! Will these restrictions also be applied in TRAIL?
• What about hospitals that do not accept Medicare Advantage ?  Is it right to expect retirees to pay those bills & wait to be re-imbursed.
• People have been in a situation where the doctor & hospital accepted their insurance, but the anesthesiologist group did not.  What kind of safeguards will be in place to prevent this kind of problem?  Include radiologists, pathologists, & blood labs in this question.

Note to politicians:  stop asking retirees for political contributions -- their disposable income will be going to pay for these plans instead.

  -- Elaine Hopkins

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