Teachers Retirement Insurance Program

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1 Comparison of Illinois State Retiree Health Insurance Options with Traditional Medicare and Medicare Supplement (Medigap) Insurance Teachers Retirement Insurance Program Insuraprise, Inc. (C) Copyright (2013) All Rights Reserved 1

2 Introduction We have thoroughly reviewed the health insurance options given through the State of Illinois Teachers Retirement Insurance Program. We then compared these options to what is otherwise available to each of its members through their entitlements to Medicare and private insurance. The details of our findings are highlighted and tabulated below. Summary of Findings 1 In general, the work of the state of Illinois to secure good and affordable health insurance coverage for their retirees has been less than effective. When compared against a scenario where they would have approached all Medicare based options, the State of Illinois has dramatically decreased its own and its retiree s savings for what is, in the end, a more restrictive and less comprehensive set of coverage options. These options may reduce access to healthcare and increase out of pocket costs for Illinois retirees- all at an additional cost to the taxpayers of Illinois. The claim of the State of saving hundreds of millions of dollars is only valid when compared to the outdated coverage s they provided in the previous years. Unfortunately, our analysis concludes that due to the State s decision to pursue only Medicare Advantage Plans as a solution they have exposed the State and retiree s to higher costs and additional bureaucratic processes to contend with than other options on the market. In many cases retirees would have better coverage, less restrictions and more options for less money under the Medicare and private insurance programs they are already entitled to. The State Sponsored Plans The State of Illinois is attempting to force all of its retirees to give up their coverage from Medicare Part A and B and instead accept private insurance coverage from either Humana, Coventry or United Healthcare through the Medicare Insuraprise, Advantage Inc. (C) program. Copyright (2013) All Rights Reserved 2

3 These private insurance companies have succeeded in eliminating traditional options within the State program at a severe cost to taxpayers and to those who depend on them for pension benefits. In turn, the federal Medicare program will pay these insurance companies money based upon who enrolls in each company s plan. These Medicare Advantage Plans, offered as either Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), will replace traditional Medicare with their own bureaucratic process for claims, referrals, patient cost-sharing and provider payments and open the door to possible complications and restrictions on retirees and their physicians. On the other hand, traditional Medicare, especially when combined with Medigap Insurance, are both widely accepted without restriction and have automated claims processes in place. Conclusion Most Illinois State Retirees are already eligible for Medicare and free to purchase Medigap Insurance without assistance of any sort from the State. Medicare coverage by itself is, in many instances, comparable to the plans offered through the Medicare Advantage Programs but without the added restrictions. Furthermore, traditional Medicare allows for the purchase of Medigap insurance to close any coverage gaps, whereas there is no supplemental insurance for gaps in Medicare Advantage. These Advantage Plans when compared to Medigap Plans impose more restrictions, less coverage and fewer options on State Retirees at a total cost of $111- $205 per retiree or $222-$410 per retiree and dependent. These costs will be shared between the State and the retiree as shown in the table below. It is the opinion of Insuraprise that the State of Illinois and its retirees would have all been better off using traditional Medicare and using the savings to purchase Medigap Insurance for its retirees. As it is, those who want this option will be able to do so by opting out of the State Program altogether, though this option is not being publicized by CMS. Those who choose to stay on Medicare and attain Medigap insurance and a Medicare Part D Drug Plan may possibly pay more in premium but much less for out of pocket medical expenses for individual retirees, resulting in a net gain in most cases. For retirees who will also cover their dependents, costs will generally be less all the way around. Everyone s situation is different and no major changes should be taken lightly or done without knowing all the facts and how they are affected by them. Detailed plan and price comparisons for sponsored plans compared with Medicare and Medigap Plan G are shown in the chart below. Insuraprise, Inc. (C) Copyright (2013) All Rights Reserved 3

4 Comparison of Health Care Costs per Person by Plan Options Teachers Retirement Insurance Program United Healthcare PPO Coventry Advantra HMO Humana HMO Annual medical deductible $250 None None $147 Annual out-of-pocket $1,000 $3,000 $3,000 $147 maximum Doctor office visit 20% after deductible $20 copay per visit $20 copay per visit $0 Specialist office visit 20% after deductible $20 copay per visit $20 copay per visit $0 Preventive services $0 $0 $0 $0 Emergency $65 copay $65 copay $65 copay $0 Traditional Medicare with Medigap Plan G and Part D Drug Plan* Inpatient hospital 20% after deductible $250 copay (per admission) $250 copay (per admission) Outpatient surgery 20% after deductible $150 copay $150 copay $0 $0 Diagnostic tests (lab, x-ray, radiology) 20% after deductible $0 $0 $0 Prescription Drug Co-Pay Tiers $10/ $25/ $50 $10/ $20/ $40 $10/ $20/ $40 Your choice of a drug plan that suits you best from over 1000 plans from all companies. Coverage in Donut Hole Yes Yes Yes Available Formulary Details Released Available from Available from Available from Yes Carrier Carrier Carrier Formulary Options No No No Choose from thousands of formularies based on your exact situation Automatic Claims Filing No No No Yes Appeals Process for Denied Yes Yes Yes N/A** Health Claims Doctor Restrictions Yes Yes Yes No Restrictions Hospital Restrictions Yes Yes Yes No Restrictions Insuraprise, Inc. (C) Copyright (2013) All Rights Reserved 4

5 Individual Premium Rates Total Premium Individual $ $ $ Average $175*** State Contribution Individual Only Member Contribution Individual $ $ $0 $47.56 $35.36 $ % Individual and Dependent nt Premium Rates Total Premium Individual and Dependent Sate Contribution Individual and Dependent Member Contribution Individual & Dependent $ $ $ Average $350*** $ $ $ $0 $ $ $ % * Analysis has shown that in general on an annual basis Medigap Plan G has the lowest total out of pocket cost, including premium, of all of the Medicare Supplement options. Please be aware that you will also need to purchase a stand-alone Part D Drug Plan to accompany it and those costs are averaged in with the premium rates within the above chart. **All Medicare Approved Procedures automatically covered by Medicare and Medigap Insurance *** Your price will vary depending on Medicare Supplement and Medigap Part D Plan Selected. Averages based on statewide averages of Medigap Plan G plus average of all Medicare Part D Plans. Get individualized Medicare Supplement Rates by clicking on links above. 1 As of the last published reports the monthly State contribution to Medicare eligible retirees was approximately $41,433,000. The projected amount awarded for the new Medicare Advantage plans is forecasted at approximately $4,186,927,000 or approximately $34,891,000 monthly (ref: Medicare Plans RFP Notice Addendum ). At the time of the original RFP the average market price of a private Medicare Supplement plan F and the average part D drug plan the State s cost would have been approximately $17,900,000 monthly. Disclaimer: This report is the product of Insuraprise Inc. Insuraprise is an independent third party and as such, the content contained in this document does not reflect official opinions or policies of any organization that may be utilizing it. Any decision regarding an individual s healthcare options must be made carefully and are ultimately the responsibility of the individual consumer. Insuraprise, Inc. (C) Copyright (2013) All Rights Reserved 5

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