Medicare Advantage Concerns
ProPublica | 2/2/23: "We're Still Gonna Say No": Inside UnitedHealthcare's Effort to Deny Coverage to Chronically Ill Patient
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
Click to review Medicare basics and see comparisons between Original Medicare and Medicare Advantage
Q: How does Delaware's proposed Highmark Medical Advantage plan differ from
Original Medicare and our current Medicfill and SilverScripts supplement
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
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
Q: What are some of the retiree's chief concerns with this proposed change to
- The Medicare Advantage plan
requires prior authorizations from Highmark for many medical services,
procedures, and medicines that were not required under our current
- 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.