Medicare Advantage Concerns

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MedPageToday | 12/8/22: Should Doctors Warn Patients About the Downsides of Medicare Advantage Plans?

New York Times | 10/9/22: How Insurers Exploited Medicare for Billions

Q: What is Medicare Advantage?

Medicare Advantage plans are offered by private insurance companies. These plans bundle Original Medicare Part A (hospital insurance), Part B (medical insurance), and usually Part D (drug coverage) as an alternative to Original Medicare options.

Click to review Medicare basics and see comparisons between Original Medicare and Medicare Advantage plans.

Q: How does Delaware's proposed Highmark Medical Advantage plan differ from Original Medicare and our current Medicfill and SilverScripts supplement coverage?

State of Delaware retirees currently have Original Medicare coverage for Parts A and B plus a Medigap supplement (Medicfill) and a separate Part D Prescription plan (SilverScripts).

The Medical Advantage (MA) plan proposed by the state gives the Medicare premiums that are deducted from our Social Security accounts to a private company, Highmark BCBS, which then manages Parts A, B, and D in place of the federal Medicare system.

Q: What happens to Part D Prescription coverage under this Medicare Advantage plan?

The contract with Highmark BCBS proposed adding the Part D SilverScripts plan to their management package. This means that the state would no longer offer SilverScripts as a separate option to retirees.

Q: What are some of the retiree's chief concerns with this proposed change to Medicare Advantage?
  • The Medicare Advantage plan requires prior authorizations from Highmark for many medical services, procedures, and medicines that were not required under our current plan.
  • Providers such as doctors, medical practices, and hospitals that do not agree to accept Medicare Advantage plans will not be considered “in network” by Highmark, so there may be additional costs to retirees and families.
  • This new plan would give a private company, Highmark BCBS, authority to manage and make decisions about all our healthcare needs.
Q: What options was the state planning to offer?
  • All retirees would automatically be opted into the Highmark Medicare Advantage Plan. Retirees who decided to opt out would then have to find their own Medigap and Part D coverage on the open marketplace with all premiums out of their own pocket
  • The state DID NOT OFFER any other choices, and they were not willing to give those who opted out the same funds they planned to spend on the Medicare Advantage and the Part D drug plans to help offset some of their premium costs.
Q: What does RISE Delaware want the State Benefits and Pension Offices to do?

RISE Delaware wants the State to keep the healthcare option promised to Medicare-eligible retirees in their pension contracts. This means retirees will continue to have Original Medicare Parts A and B and the State provides a Medigap supplement such as the current Medicfil plan that covers the retiree's remaining healthcare costs.

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RISE Delaware

P.O. Box 7262

Newark, DE 19714