The Teachers’ Retirement Board has approved an additional retiree health plan, giving retirees who have Medicare Part A and Part B a choice of two plans. The new plan will be the “base plan” with the current plan, administered by Stirling Benefits, a “buy-up” option. All current plan members will be moved into the new base plan on July 1st, unless the retiree re-enrolls with the current Medicare Supplement program (the Stirling plan). The new “base” plan will be a Medicare Advantage (MA) program insured by Anthem. Anthem is the for-profit insurer that purchased the assets of the non-profit Blue Cross Blue Shield of Connecticut. Dr. Joseph Fields, the consultant to the TRB, announced that the new Anthem program will have a $5.00 copayment for most office visits, specialist visits, chiropractic, mental health, physical therapy and other common medical services and no copayment for wellness visits. There is a $100 copayment for emergency room visits and ambulance services and a $200 copayment for hospitalizations. The maximum out of pocket costs for any retiree is capped at $2,000 per year.
The new program has both in-network and out-of-network benefits and is a Medicare Advantage PPO. The network is broad, with 95% of Connecticut’s physicians and all CT hospitals in-network. There is coverage across the United States. This plan has better network coverage and benefits than most individual Medicare Advantage programs and will offer Silver Sneakers. Express Scripts will continue to administer the prescription drug portion of the program for either the Stirling or Anthem option. Stirling will continue to administer the vision/hearing benefit and Cigna will continue as the dental plan administer. Members who do not re-enroll with Stirling will see their July premium decrease $22 per month for the complete TRB package (medical, Rx, dental and vision/hearing). Those who re-enroll to stay with Stirling will see their July premium increase $103 per month for the complete package. The difference in cost between the two programs (for the full package) is $125 per person per month.
As with all contracted health programs, the details are important. More information, including a complete benefit summary and the full Medicare Advantage policy, will be available from the TRB at some future date. Various retiree associations will also post information about the two plans. We will update our site with links to these resources as they become available.
Here are our answers to some questions we are getting from TRB members:
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Why is the TRB doing this?
Dr. Fields stated that the State of Connecticut has underpaid the TRB claims fund approximately $190 Million over the last fifteen years. Instead of funding 33% of the expected contribution, the state is contributing only 11% over the next two years. Without changes, the health plan account could run out of money by this September.
We understand that the increased cost to stay on the Stirling plan offsets the decrease in state funding and will help stabilize the TRB health fund. We believe that the changes adopted by the TRB are a measured and appropriate response to a difficult situation that the TRB did not create.
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Why is there such a price difference?
The Anthem plan and Stirling plan operate in fundamentally different ways.
With the Stirling plan, Medicare pays first; then the Stirling plan pays the doctor the remainder, usually up to 100% of the allowed amount. Most members report having no out-of-pocket costs after paying the annual Medicare Part B deductible. Members can see any doctor that accepts Medicare, anytime. To administer the medical program, Stirling receives a fixed fee of $4.69 per member per month and does not earn any more or any less regardless of the claims submitted by members. While Stirling Benefits is a for profit company, the TRB plan itself is a not-for-profit program. All claims are paid from the TRB health fund.
The new “base” plan is an insured program. The federal government will pay Anthem an amount that Medicare would expect to pay for TRB members. According to Dr. Fields, Anthem will receive approximately $11,000 per member per year. Anthem uses these funds to pay your claims. As an insured program, Anthem takes a risk: if claims are higher than expected, they will lose money. Alternatively, if claims are lower than $11,000, they will make a profit. And, because the program is rated with 4.5 stars, a high quality rating, Anthem will also expect to receive a $500 per member per year quality bonus from the federal government. The new Medicare Advantage (MA) plan is not a gatekeeper program. This means that members can see a specialist without a referral from their primary care physician. Both Medicare and Insurance companies use pre-certification and authorizations to help control unnecessary over-utilization of care. However, most industry experts agree that insurance company authorizations are typically more stringent than traditional Medicare.
The different financial model allows Anthem to offer an insured program at a lower rate than the current plan. Aside from these differences, the additional $103 to stay with Stirling reflects the amount the state is not contributing to the TRB health fund.
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How do I re-enroll to Stay with Stirling?
We understand that there will be a two week period to re-enroll with Stirling at the end of April to the beginning of May. We have heard that there will be a telephone option, an electronic option and a paper option. We will post re-enrollment information as soon as we have it.
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How can I learn more?
Until the TRB publishes more information about the details of the plan, you may find more information from the Association of Retired Teachers of Connecticut (ARTC), American Federation of Teachers (AFT) or the Connecticut Education Association – Retired websites. Meanwhile, to make an informed decision, you can research how Medicare Advantage plans work. A lot of information on these plans are available from unbiased sites, including Medicare.gov, AARP, and Consumer Reports. Most major news sites also contain articles about how Medicare Advantage programs work, and how they differ from Medicare Supplement plans (the Stirling plan is a group Medicare Supplement). Please be aware that much of the online information applies to plans purchased by individuals. The TRB Anthem and Stirling plans are both “group” programs, so the individual enrollment rules may not apply to you.
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Stirling Benefits encourages all members to learn more about their health plan options and make a well informed choice. There is more to choosing your plan then the benefits design and the cost. How care is accessed and how you are serviced are also important considerations. We understand that the TRB does not have a preference – financially, one way or the other – which plan you choose. We believe that TRB members are being offered two good choices at a fair price. Would we like the Stirling Plan to cost less? Certainly. Is it worth the difference in price? That’s for each member to decide.
Finally, Stirling staff are thankful and humbled to have served TRB members from our offices in Connecticut for 25 years. We are grateful to have helped so many retirees over these years and look forward to serving you in the future if you decide that staying with Stirling, despite the extra $103 per month, is worth it.
Wishing you good health!
James (Jamie) Stirling
Stirling Benefits, Inc.
You may have recently been notified of upcoming changes to the Teacher Retirement Board’s Medicare supplemental health insurance. While all of the details are not yet finalized, we wanted to provide you with an objective review of the facts to date.
· The current Supplemental Plan offered through Stirling (with Rx, Dental and Hearing & Vision) will still be available. The premium to continue with this coverage is increasing to $259 per month effective July 1, 2018. (The current premium is $156 per month.)
· The new Medicare Advantage plan through Anthem (with current Rx, Dental and Hearing & Vision) will cost $134 per month, which will be $125 less per month than the increased cost for the Stirling plan.
Please expect to receive an enrollment packet from the TRB and Anthem sometime in late April. Effective this July, the Anthem plan will become the default coverage for all eligible retired teachers and spouses currently enrolled in TRB supplemental coverage. This means that even if you take no action, you will be automatically moved from the Stirling Supplemental plan into the Anthem Medicare Advantage plan effective July 1. There will be an opt-out form for retirees who would like to stay in Stirling instead of shifting to Anthem. As far as we know, these elections will not be permanent, and retirees will be able to change their plan selection during open enrollment each January.
If you’d like to learn more: