Fight against Medicare Advantage plan for retirees has only just begun

State retirees are now receiving a mailing from the state Pensions Office notifying us that there will be no changes to our coverage through Dec. 31, 2023. It seems like a victory - no Medicare Advantage plan, no loss of our funds if we opt out.

The key word is "seems." The fight to stop this Medicare Advantage mandate, protect your insurance funds and to prevent this from happening again has just begun.

The State Employee Benefits Committee was compelled to comply with the Superior Court order to delay implementation of Medicare Advantage in 2023. The decision had nothing to do with a change of heart or public outcry against the Medicare Advantage plan.

As a consequence of the committee's vote to continue to offer the Highmark Blue Cross Blue Shield Special Medicfill Supplement plan for 2023, a scheduled state legislature special session to discuss two bills concerning the Medicare Advantage issue was canceled.

The first of these bills (Senate Bill 348) was to have created oversight to protect seniors from delays in treatment and denials of services, one major concern of managed health care plans, such as the Medicare Advantage plan. It also proposed creating an ombudsman role to ensure that retirees were aware of and using the plan's added benefits, such as the preventive care, gym membership and so forth.

The second, and in my eyes most important, bill was proposed by retiring state Rep.

John Kowalko, D-Newark. This bill was to have mandated that state retirees have options - Medicare Advantage and Medicare supplemental insurance until 2025, preventing the "take it or leave it" scenario of this year. In other words, our hard-earned health benefits couldn't be taken from us if we opted out of Medicare Advantage. It also noted that there were other health care options under consideration by the state committee, so that this shift to Medicare Advantage was not necessarily the only or best option.

By opting to delay implementation of Medicare Advantage, these bills never came into consideration - and state retirees now have less protection from Medicare Advantage.

How can that be?

The state's Superior Court ruling granted an interim stay based on irreputable harm if Medicare Advantage was implemented this year without adequate notification to seniors. Given a ton of mailings and meetings and other "ample notice," the court might rule quite differently next year.

Legislators have pledged to take up the matter in the 2023 session, but Rep. Kowalko will not be there.

Why is Medicare Advantage bad? The bill Rep. Kowalko planned to introduce said it well: Many of our retirees live out of state and would have difficulty finding in-network care; many major hospitals do not accept Medicare Advantage plans; delays and denials of service are common and can impact your health care outcome; and more. AARP has reported on negative issues with these plans.

The December 2022 issue of Consumer Reports concluded, "Advantage plans can carry hidden risks, especially for people with major health issues. 'Some people in Medicare Advantage end up paying unexpectedly high costs when they become ill or find their network lacks the providers they need,' says Tricia Neuman, senior vice president at Kaiser (Family Foundation). (But) if you have chronic conditions or significant health needs, you may want to think twice. For one thing, with Original Medicare you can see any provider that accepts Medicare, which is most of them. But Medicare Advantage plans typically require that you get care from a more limited network of providers, and you may need pre-authorization to see specialists." The article added, "A recent Kaiser study found that about half of all Medicare Advantage enrollees would end up paying more than those in traditional Medicare for a seven-day hospital stay." We'd all like to have the "free" benefits touted by those TV ads - but not if the Medicare Advantage plan increases our costs unpredictably and makes it far more difficult to get care.

A different approach, a health reimbursement arrangement, is an option that a state committee was studying as a solution to the multibillion-dollar retiree health care liability and would be an excellent alternative to Medicare Advantage, but the Department of Human Resources' Statewide Benefits Office did not pursue the option. Under this approach, the state would not provide health care coverage directly; instead, Medicare-eligible retirees would stay under Medicare and pick their own Medicare supplemental or Part D plans and pay for them. The Human Resources/Statewide Benefits Office would set up a health reimbursement arrangement account containing several thousand dollars that would be used to reimburse the retirees for their monthly premiums and other qualifying out-of-pocket expenses like copays. I believe I could support this.

I also would support an investigation to find why the Statewide Benefits Office did not consider the health reimbursement arrangement, how the office and other participants came into their contract with Highmark and how they rationalized the decision to keep benefit funds of retirees who opted out. I feel that they breached their contract with retirees and failed in their duty to serve us, and were negligent, deceitful and possibly criminally culpable.

What to do?

The legislature is out of session until the second Tuesday of January. Please keep sending your letters and emails to your state senators and representatives. The issue needs to remain front and center from day one of the coming session.

If you'd like to read more about health reimbursement arrangements and all other options studied by the benefits committee, including estimated costs of each, here's the link to the governor's committee - the Retirement Benefit Study Committee: finance.delaware.gov/financial-reports/committee-reports/retirement-benefit-study-committee.

Of particular note are the the Nov. 1, 2021, report (financefiles.delaware.gov/Reports/Committee/RBSC%20 Initial%20Report%20-%20November%202021.pdf) and the July 26, 2021, presentation packet (financefiles.delaware. gov/Reports/Committee/State%20of%20DE%20RBSC%20 meeting%207.26.21.pdf).

The first linkexplains the huge reduction of the health care/other postemployment benefits liability under the health reimbursement arrangement approach in the tables of findings (item 8 shown on pages 9 and 11). The report's recommendation II (Page 14) notably says not to make any changes until after Jan. 1, 2024, and to fully evaluate the Medicare Advantage plan and the health reimbursement arrangement approach. The presentation packet, starting on Page 13, explains this approach and the huge reduction it would have on the unfunded liability.

The tables on pages 15 and 18 are interesting, as they illustrate the relatively small reduction other changes would have. Also, the section on modeling of the health reimbursement arrangement approach shows a simple graphic on Page 28 of how it would work, including enrolling in any available Medicare plan. Finally, the appendix (starting on Page 33) explains the methodology used to develop the graphic on Page 28. (Thank you, Ken Steck of Delaware Coalition for Open Government, for this detailed information.)

You can also join, support or follow Retirees Investing in Social Equity Delaware, the group formed by Rep. Kowalko to fight the Medicare Advantage plan. RiseDelaware initiated the court filings that temporarily halted the implementation of the mandate, and help with the legal costs in the past and future is needed.

Retirees and all state employees deserve better, as does the state of Delaware. Honesty and integrity are, I believe, important to all of us. Please make your opinions known!

Terry Kansak

Georgetown