Guest Commentary: State retiree opposes ‘inferior’ Medicare proposal
Joan DelFattore is a retired University of Delaware professor. She lives in Newark.
At its Monday meeting, the Retiree Healthcare Benefits Advisory Subcommittee considered including Medicare Advantage as an option for state retirees who retired on or after July 1, 2012. The stated purpose was primarily to assist individuals who do not qualify for full state benefits and thus pay most or all of their own premiums.
There are three reasons to oppose this attempt to use the buzzword “choice” to mislead as many retirees as possible into accepting inferior health care coverage so that the state will not have to pay for the Medicare supplement that all current state retirees earned and were promised.
First, the retirement date has nothing to do with identifying retirees who pay most or all of their own premiums. That is determined by how long they worked for the state, not by when they retired.
Second, it is not true that retirees who pay all or most of their own premiums will lack affordable insurance unless the state offers Medicare Advantage. Relatively few state retirees do not qualify for full benefits, and some have insurance from spouses or from other jobs. If the rest are willing to settle for Medicare Advantage, any differences between the plans available on the open market and the state’s proposed plan are nowhere near significant enough to drive policy affecting thousands of other retirees.
Third, among retirees who qualify for full state benefits, the difference between those who retired before or after July 1, 2012, is a mere 5%. The state pays 100% of the cost of a Medicare supplement for pre-2012 retirees and 95% for the rest. In 2024, that 5% will cost retirees only $24.10 per month, including supplement and prescription coverage. Based on last year’s Medicare Advantage proposal, the retirees’ cost for Medicare Advantage would be about half — a savings of a whopping $12 a month in return for accepting far inferior coverage.
Retirees who oppose including Medicare Advantage as an option have been accused of wanting to force our own choice on everyone else. That is a red herring — clever but inaccurate. We are not obstructionists but whistleblowers.
Decades ago, when immigrants were arriving in large numbers from Eastern Europe, con men sometimes offered them cheap fedoras in exchange for their big fur hats. Of course, the fur hats were worth much more, but the immigrants didn’t know that. Rather, they were assured that their fur hats would be laughed at, whereas this nice fedora would make them look like real Americans. True, it was their choice, but the way the choice was framed made it a mask for exploitation.
For people of retirement age who have no employer-sponsored insurance benefit and cannot afford a Medicare supplement, it might make sense to consider going on Medicare Advantage, paying a low premium or none at all. But state retirees who retired after July 1, 2012, are owed a Medicare supplement for only $24 a month, with a guarantee that they will never pay more than 5% of the total cost. Going on Medicare Advantage would save them almost nothing — but it would save the state a great deal, and it is the state that will decide how to describe the choice to them.
The Medicare Advantage contract that the state signed with Highmark in 2022 warns that out-of-network providers may not accept this plan. It lists more than 2,000 items that require preapproval, including tests and treatments for cancer.
According to the contract, delays of up to two weeks are acceptable and may run longer if the request is denied and has to be appealed. Care may be denied even if Medicare would have covered it. If retirees are treated out of network, where providers do not have to do the preapproval paperwork, retirees must either do it themselves or risk having the claim denied, leaving them with the whole bill.
All that is in the contract. By contrast, the slick, glossy marketing materials sent to state retirees last summer and the (mis)information provided in public sessions said that we could keep all our own doctors, said nothing about denials of care and barely mentioned preapprovals or the risk of catastrophic out-of-network bills.
If the best predictor of future behavior is past behavior, it is likely that information about the “choice” offered to retirees going forward would be no more comprehensive than what we were told last summer. Retirees who rely on what the state tells them might easily opt for Medicare Advantage, only to discover later that the specialists they desperately want to see don’t take this insurance or that they can’t get cancer testing as quickly as they used to or that payment for out-of-network treatment has been denied. But, by then, it’s too late. They “chose” to trade their valuable fur hat for a cheap fedora, and they’re stuck with it.
What could possibly be wrong with choice? That’s what’s wrong with this particular choice.
