WHY WE NEED AN AFFORDABLE 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 The much lower proportion of providers nationwide that accept Aetna Medicare Advantage is unknown or unpublished.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 “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 medical
conditions that require specialized providers, such as at The Mayo Clinic that stopped taking our Aetna Medicare Advantage insurance in 2026. There has been the experience of a Connecticut retiree 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 rejections of required preauthorizations, preauthorizations that were not required 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 259 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.
According to a Kaiser Family Foundation study, until 2026 Connecticut was one of only thirteen states that did not offer a choice of health care plans for retirees. In 2027, as a result of the SEBAC 2026 agreement, Connecticut will begin offering a choice. But it will
Connecticut still needs an affordable Medicare option for its retirees.
not be an affordable choice for most state employee retirees. They will have pay a monthly premium of $379 for the tradItional Medicare option, while the Aetna Medicare Advantage plan will be free, as was the traditional Medicare plan we had in 2017. The extra cost of the
Medicare secondary insurance will be the highest in the country for states that offer their retirees choices between plans.
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 work to secure an affordable traditional Medicare option.
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 action to develop an affordable traditional Medicare option.eform. Remember, many state legislators have or will have the same retirement health insurance we have and do not know the issues with the Aetna Medicare Advantage plan. 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 at an affodable cost.
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12 responses to “”
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Good to have you in the group, Jaime. Be sure to subscribe to the Updates to keep informed on the issue.
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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.
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So is the intent to allow an existing retiree to switch to the traditional Medicare. If so how can we do that if we did not signup for it at the start of retirement? The social security states once you’ve signed up for a Medicare advantage plan, you cannot switch later to traditional Medicare. Or are the retirees doomed to a Medicare advantage plan for the rest of our lives.
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No – it is possible to switch back to Medicare. For an extra cost, we will be able to do that. See https://csemedicarechoice.com/Updates#update20
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Thank you for this information. I couldn’t quite figure out what was going on. Now I know! Appreciate it!
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Hello
I am also now a victim of the Aetna and state of CT poor health care.I require critical care and hospitals inform me they need extra approvals becasue of Aetna. Care that could
Be covered with Medicare.
I would like to join this group and donate for legal actions that call out state representative lbs who vote againt ending Aetna coverage.-
Dennis – Sorry for the delay in responding. See https://csemedicarechoice.com/Updates#update20. We will be able to switch to Medicare + supplement from Aetna Medicare Advantage for an extra cost to be determined, probably starting next Jan. 1.
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