Changes in the State Retiree Health Care Plan Causing Concern for Some Downstate
There is concern that thousands of University of Illinois retirees could be impacted if Aetna and Carle Foundation Hospital don’t come to an agreement when a new contract for retiree health care kicks in January 1.
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A change in providers impacting some 160,000 thousand state retirees has raised a lot of questions, and more than a little concern, among many downstate retirees. But it appears some potential changes to Medicare supplemental plans from the state won’t make much difference in the health care they receive.
The state has seemingly granted a new contract for the state retiree health care plan that supplements Medicare known as the Total Retiree Advantage Illinois (TRAIL) plan to Aetna, the nation’s third largest health care provider when the state’s contract with United Healthcare expires at the end of the year.
While the state’s Department of Central Management Services (CMS) apparently awarded the contract to Aetna in July, though it hasn’t been formally announced while United is appealing the decision. That formal announcement could come shortly after Labor Day.
Central Management Services Spokesperson Cathy Kwiatkowski said CMS is simply following the law regarding the awarding of a contract.
“CMS remains committed to administering health care coverage programs for State employees, their dependents and retirees in accordance with all federal regulations and requirements,” she said in a statement. “Provider network adequacy requirements are governed by the Federal Centers for Medicare & Medicaid Services, part of the U.S. Department of Health and Human Services. CMS relies on this regulatory authority to ensure that the plan is in compliance, and to date, CMS has received no notification from the regulatory entity regarding a change in provider network adequacy, which serves a combined total enrollment in the program.”
But in some corners of the state, there is concern over what it means for retirees as open enrollment is scheduled to begin next month.
A PPO does not require a referral from a doctor, but usually costs more than a traditional HMO plan. Furthermore, Aetna does not have a contract in place with Carle Foundation Hospital in Urbana and Carle BroMenn Medical Center in Bloomington, which serve thousands of retirees downstate.
But, industry sources tell The Illinoize Carle already accepts payment on claims to Aetna PPO plans. A Carle spokesperson wouldn’t confirm the information independently, but pointed us to a page on the hospital website which appears to corroborate that Carle does, in fact, accept Aetna’s PPO claims.
Linda Brookhart, Executive Director of the State University Annuitants Association (SUAA), which advocates on behalf of community college and university employees and retirees, says she doesn’t expect many changes for retirees.
“It is my understanding that Aetna will provide a PPO just as United Healthcare does currently,” Brookhart said. “I have heard that there will not be an HMO offered, but I have heard that the copays and deductibles stay the same.”
Brookhart says she’s been contacted by retirees, mostly former University of Illinois employees, that Carle doctors may not take their new Aetna PPO.
“People are worried that the networks will be disrupted,” Brookhart said. “I have no idea. But, according to law, the networks have to be in place.”
Sen. Chapin Rose (R-Mahomet) told WCIA-TV last month he’s been stonewalled by the state looking for more information.
“We’ve been fielding these calls, we’ve got a bunch of angry people, honestly, almost on a daily basis,” Rose said last month. “In fact, our office can’t even get a word out of CMS at all when we call, other than to say that they’re not going to tell us anything.”
Rick Frommeyer, a Senior Vice President for Aetna Group Retiree Solutions said in a statement the company will be sure retirees “receive affordable care.”
“As the second largest group Medicare Advantage provider in the nation with over 1.1 million members, we are firmly committed to ensuring the long-term sustainability of retiree benefits for the State of Illinois so that the State’s Medicare-eligible retirees can continue to prioritize their health, receive affordable care from high-quality providers and drive better health outcomes,” he said. “We are confident our experience with providing group Medicare Advantage plans to other large State Retirement Systems, like the State of Illinois, will guide us through the thoughtful implementation and delivery of a sustainable plan to State of Illinois retirees for years to come.”
Carle, meanwhile, isn’t saying much about its relationship with Aetna.
“As a healthcare system that is mindful of the dynamic needs of this region, payor contracts are continually evaluated and regularly negotiated to assess the most holistic support possible for those we serve,” said Carle Foundation Hospital spokesperson Brittany Simon. ”Once a formal announcement from the State of Illinois is made, Carle will evaluate how this may impact its patients.”
Carle’s in-house insurance carrier Health Alliance lost the state contract in 2011, leading to a similar frenzy as United took over the coverage.
Industry sources say Carle does not have a contract with United, much like with Aetna, but has continued to accept payment on PPO claims for the past decade. So even if the state forces current HMO employees into a PPO, it appears Carle will take payment on claims to Aetna.
“These retirees are just switching from a United Healthcare plan to the Aetna plan through the member’s [Medicare Advantage] benefits, just as they do today,” the source said.
We’re told about 20,000 of the state's 160,000 active retirees would potentially make the switch from an HMO to a PPO.
But, Brookhart is concerned fewer Carle doctors will be available under the change.
“My bigger concern is [if] there will be enough doctors at Carle, or anywhere else for that matter, to accept Medicare patients,” Brookhart said. “People keep talking about Aetna’s limited network throughout the state. Maybe all that has been worked through.”
But industry sources say Carle has no incentive to stop seeing Aetna patients.
“[It’s] certainly a decision for Carle to make,” the source said. “If there is no contract, Carle can decide if it wants to accept payment [from Aetna] or not. They’re seeing the members today, why would they want to stop seeing them? [Carle] already gets paid the same amount.”
Meanwhile, the source says while Carle and Aetna have not made a deal on a contract for the PPO, the two sides are talking.
“There’s discussion that has taken place,” the source said, but couldn’t say if the two sides are near an agreement. “Those conversations may pick up once the state announces [the new deal.]”
Industry sources say Aetna already has a working relationship or contracts with almost every large provider in the state, including in the Chicago and Springfield areas and Brookhart says she’s heard very little concern from retirees in those areas.
While the state attempts to finalize the agreement, Aetna’s Frommeyer urges patience.
“We understand changing to a new health plan can create fear and uncertainty. We know retirees want reassurance they can continue to see their doctors and can go to their hospital of choice,” he said in a statement. “We know retirees want simplicity instead of complexity, and finally, after giving so much of themselves in service to others during their careers, we know retirees want to feel respected in their retirement. At Aetna, we get that and are committed to delivering reassurance, simplicity and respect in every interaction we have with our members.”
Reassurance may not quell the concerns of thousands of retirees in the meantime.
“I would just like to see everyone calm down until the facts are available,” Brookhart said.
The hope remains that the facts are available before open enrollment begins just six weeks from now.