Retirees Facing Insurer Tangles

Jan. 9--Some retired Georgia government workers and teachers are finding themselves in Medicare limbo because of confusion over a change in coverage options.

The problem has arisen because some retirees switched from basic Medicare to a Medicare Advantage Plan to save money when the state eliminated its contributions to premiums.

The confusion is over what the different plans cover, where they overlap and a Medicare prohibition on having duplicate coverage because of the overlap.

While the programs that went into effect Jan. 1 have caused confusion that administrators are trying to straighten out, no one should lose coverage because of it, said Lisa Marie Shekell, director of communications for the Georgia Department of Community Health, which administers retirees' benefits.

The journey into health insurance limbo for some began when the state adopted cost-cutting measures for its state-funded retirees' insurance plans and many retirees decided to move to a Medicare Advantage Plan, said B.J. Bennett, president of the Georgia State Retirees Association and former commissioner of the Georgia State Merit System of Personnel Administration,.

A Medicare Advantage Plan, in effect, is comprehensive coverage for medical expenses that, generally, includes prescription drug coverage.

Basic Medicare coverage, on the other hand, is administered through multiple "parts." Medicare Part B is the part of Medicare that covers doctors' services, outpatient hospital care and other medical services. Part D covers prescription drugs.

Retirees were essentially forced into a Medicare Advance Plan, or MAP, because of enormous increases in their premiums when the state cut its contributions, Bennett said.

In some cases, monthly premiums jumped to $300 from $30 for those who chose to retain traditional coverage..

The state discontinued its subsidies for any retiree insurance plan other than a Medicare Advantage Plan because of $16.4 billion in unfunded liability for retiree health care.

Bennett said the Department of Community Health was told to reduce its financial liability, so one step it took was to eliminate state subsidies on Medicare-eligible retiree coverage other than for those in a MAP.

"The state is saving $770 per retiree per year," Bennett said. At 70,000 retirees, that amounts to $53.9 million annually.

When some retirees made the move to a Medicare Advantage Plan, they did not realize that it included prescription drug coverage they previously had to obtain separately under Medicare Part D and enrolled for it, as well .

"This member enrollment error causes the (federal) Centers for Medicare and Medicaid Services to automatically dis-enroll the member from their earlier selection (or the MAP)," Shekell said. "(The state) is currently working with both CIGNA and United HealthCare (the insurers providing MAPs) to reinstate any members that made this mistake."

While unintentional, the dual enrollment amounts to double coverage.

"When (the state) notified Medicare that retirees had been enrolled in MAPs, Medicare took the liberty of cancelling Part D (prescription coverage), because MAP members weren't supposed to need it," Bennett said.

Under the new rules, retirees are also prohibited from having Medigap policies, which pay for gaps in traditional Medicare coverage.

The Department of Community Health maintains that retirees were notified of the changes to the plans and that 188 meetings to explain them were held around the state from this past August through October.

In Brunswick, two meetings were held Oct. 7 at College of Coastal Georgia.

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