WHY WE NEED A CHOICE BETWEEN
TRADITIONAL MEDICARE AND
AETNA MEDICARE ADVANTAGE
In 2017 the State of Connecticut, to save money, shifted from a public Medicare + Supplemental Insurance plan to a privatized United Healthcare Medicare Advantage plan for state employee retirees. Aetna now has the contract. Both carriers have been heavily criticized for lack of choice of providers and excessive required preauthorizations and denials of services.
“98 percent of providers–doctors, hospitals, nursing homes, and others–participate in traditional Medicare.” The much lower proportion of providers nationwide that accept Aetna Medicare Advantage is unknown or unpublished.
Members of the traditional Medicare plan that was replaced had access to 98 percent of doctors and hospitals in the country. In its Health Care Options Planner, the state has consistently claimed since 2018 for its Medicare Advantage plan that replaced it that “you can see any doctor, hospital or other health care provider you choose, as long as they accept Medicare.” That is not true. You can only see a provider who accepts Medicare if that provider also accepts the Medicare Advantage plan, currently sponsored by Aetna. Many do not. That can cause serious problems for retirees
who have serious illnesses, such as cancer, that require specialized providers. There have been experiences of Connecticut retirees not being able to get chemotherapy from a hospital because it did not accept the Aetna Medicare Advantage plan while it would have taken the traditional Medicare plan that we formerly had.
Connecticut retirees have also had needed services denied through rejects of required preauthorizations for serious issues that would not have been denied by traditional Medicare.
The Guardian newspaper recently reported on a particularly egregious example that occurred with our plan to a retired member of the UConn Physics Department. That abuse was the subject of How Corporations Raided Medicare, a video with 193 thousand views on YouTube.
Reduced choices of providers and high rates of rejection of required preauthorizations for medical provider ordered procedures are nationwide problems with privatized Medicare Advantage plans as their corporate owners seek to maximize profits.
Connecticut is one of only thirteen states that do not allow its state employee retirees a choice between health insurance plans.
According to a Kaiser Family Foundation study, Connecticut in one of only thirteen states that does not offer a choice of health care plans for retirees. Their only option is an Aetna Medicare Advantage plan. Like with the great majority of states, Connecticut should be offering its retirees a choice between traditional Medicare and Aetna.
In 2025, the state and the State Employees Bargaining Agent Coalition (SEBAC) will renegotiate the retiree health insurance benefit. All members of SEBAC unions who are retiring or looking forward to it should advocate that their unions convince SEBAC to pursue us having a choice between traditional Medicare and a Medicare Advantage plan such as Aetna.
Members of Connecticut State Employees Association/Service Employees International Union, Council 400, the state retirees union, and members of those unions, such as AFSCME, that have their own retiree units should urge their union to encourage SEBAC to support the reform.
If you are not yet a member and would like to join CSEA, Council 400, you can write to organizer Kevin Sullivan (ksullivan@csea760.com) for information on how to join. Dues–$5/month–come out of pension checks.
You should also write to your state legislator urging support for the reform. Remember, many state legislators have or will have the Aetna Medicare Advantage insurance and do not know the issues with it. Even if they like their Aetna plan, they should not be opposed to retirees who need the traditional Medicare plan being able to choose it.
____________________________________________________________________________________________
To subscribe to free Updates–Send an email to info@csemedicarechoice.com with SUBSCRIBE in the Subject.
8 responses to “”
-
-
Good to have you in the group, Jaime. Be sure to subscribe to the Updates to keep informed on the issue.
-
-
-
Think of it like this:
Traditional Medicare is like a PPO.
Medicare Advantage is like an HMO.
Say you start with a Medicare Advantage plan when you’re healthy. As you age you might develop type 2 diabetes or high blood pressure. You decide to “upgrade” to a traditional Medicare plan. You will be allowed to switch to the traditional plan, which is accepted by virtually all doctors and hospitals. When you go to switch, you will find out that your now “pre-existing conditions” won’t be covered. Almost nobody understands this until it happens to them.-
To clarify, the problem with preexisting conditions won’t be with the traditional Medicare plan. It will be with the supplemental commercial Medicap insurance to cover what Medicare does not. That is, if it is an indivdually purchased Medigap plan. What we had until 2017 was a group supplemental plan that did not charge us more if we had preexisting conditions. That is what we would get–a group supplemental plan with traditional Medicare–if we get to have the choice we are advocating.
-
-
-
Thank you for this information. I couldn’t quite figure out what was going on. Now I know! Appreciate it!
Leave a Reply