Government Retirees Facing Shifts to Medicare Advantage Plans Must Consider Bigger Picture
by Rick Kaplan
In the dynamic landscape of retiree healthcare plans, Medicare Advantage (MA) and Medicare Advantage Prescription Drug (MAPD) enrollment is rapidly gaining momentum, particularly in group retiree plans. Amidst the shifting landscape of retiree healthcare plans, the growth of Medicare Advantage often represents an affordable solution for employers to provide comprehensive coverage for retirees. As economic pressures mount and group retiree healthcare plan coverage faces potential cutbacks or discontinuation, MA can offer cost-saving opportunities that enable employers to continue providing plans, and potentially even broaden their scope.
The Rise of Medicare Advantage
There has been an increase in media coverage as several government entities – New York City, Delaware, Connecticut, and Vermont – have decided to move retiree coverage under MA. In some cases, these initiatives have become embroiled in politics, litigation and retiree opposition. As more groups transition their retirees’ healthcare plans to MA, it is not uncommon to encounter apprehension among retirees. Concerns arise regarding doctors being out of network, prior authorizations, and medication coverage. Change, in any form, can be intimidating, and retirees may face certain obstacles during the transition. However, it is important to recognize that there are pros and cons to every healthcare option.
Navigating the Transition Journey
Transitioning retirees into the MA plan requires careful consideration and support from plan sponsors. Given that Medicare Advantage operates on a different model, plan sponsors can play a pivotal role in helping retirees understand the plan, its rules, and network. By providing guidance and resources, plan sponsors can ease retirees’ anxieties and foster a seamless transition.
Exploring the Benefits of Medicare Advantage
While acclimating to a new policy can be challenging, transitioning to a Medicare Advantage plan enables retirees to maintain the coverage they need while often gaining additional benefits not offered by other Medicare eligible employer sponsored plans. These enhanced benefits can include lower copays, access to 90-day supplies of medication through mail-order or retail pharmacies, and ancillary benefits such as dental, vision, and health and wellness programs. When plan members actively engage with these programs, their overall health can improve, potentially resulting in fewer doctors’ visits, hospital stays, and emergencies.
Empowering Retirees through Education
Given the complexity of Medicare, it is essential for retirees to have a thorough understanding of their new MA plan before it becomes effective. In this endeavor, plan sponsors play a crucial role in easing retirees’ minds and preparing them for the transition to Medicare Advantage.
“Dealing with change can be tough, especially when it comes to retiree benefits. When we first joined forces with RetireeFirst, retirees were skeptical about the changes, and worried about their benefits. But the way RetireeFirst handled the transition was impressive. They didn’t just roll out the new plan; they came down to meet us in person. These meetings eased the retirees’ concerns because together we educated them about their benefits, assured them that they weren’t going away, and letting them know that this was an enhancement,” said Joey Lopez, Director of Human Resources for the City of Baytown.
Effective communication is key, as plan sponsors provide retirees with clear and accessible communications, resources, and educational materials to ensure they are well-versed in the upcoming changes and know what to expect.
Plan sponsors can also partner with an outside retiree benefits management provider with advocacy and concierge services to help members navigate the complex retiree healthcare landscape and troubleshoot issues with their insurance carrier, provider office, and/or pharmacy. Additionally, plan sponsors should make sure retirees are aware of additional resources and encourage them to look into reputable online websites, call the toll-free 1-800-MEDICARE number to request assistance, or contact a federally funded State Health Insurance Assistance Program, where trained volunteers and staff members can help consumers.
Achieving Cost Savings, Benefit Preservation, and Peace of Mind
As long as plans are designed the right way and have adequate support in place, the perceived hurdles are not insurmountable. By considering the bigger picture, it becomes possible to save money, preserve benefits, lower other post employment benefits (OPEB) liabilities, and facilitate a win-win experience for both plan sponsors and retirees. In learning that their healthcare is not in jeopardy, retirees can rest a bit easier, aligning with the essence of what retirement is all about.
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