Medicare Advantage Q & A


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Medicare Advantage Q & A

  1. 1. State employee/retiree/teacher health plan update ILLINOIS SENATE DEMOCRATIC CAUCUS Q & A UPDATED 10/30/13
  2. 2. What is Medicare Advantage? Medicare Advantage is a type of health insurance plan designed only for people who are Medicare-eligible. One of the provisions of the new AFSCME contract requires certain retirees to enroll in a Medicare Advantage plan. This group consists of people who meet all of the following conditions: Retired Eligible for Medicare Prime (Medicare A and B, with Medicare listed as the person’s primary or secondary payor) All dependents are also eligible for Medicare Prime Do not maintain a residence outside the United States Do not have end-stage renal disease
  3. 3. People who do not meet one of these conditions may not enroll in a Medicare Advantage plan. So, if a constituent has a minor dependent or a disabled dependent, or if her spouse is on her insurance but is still working or not Medicareeligible, the member will maintain her current state insurance.
  4. 4. Do I have to switch to Medicare Advantage? What happens if I don’t enroll in a plan? It’s important for people who fit all of the above criteria to understand that they must either enroll in a Medicare Advantage plan or opt out of state health insurance altogether. A person who fails to enroll in a Medicare Advantage plan will eventually have his or her existing policy terminated. There is no “default” insurance plan for this group and no automatic enrollment. CMS does have some flexibility when it comes to terminating individuals’ health insurance. The agency will send multiple notices and will work with people who may not have received a notice or, due to advanced age or poor health, may not have been able to understand their options. More information is available at the CMS website:
  5. 5. When is the enrollment period, and when does coverage begin? The enrollment period is Nov. 12 through Dec. 13. Coverage takes effect Feb. 1.
  6. 6. If I have to switch to Medicare Advantage, what options do I have? Options vary across the state. CMS has produced the following map showing which plans are available in your area.
  7. 7. Why isn’t Health Alliance included in the Medicare Advantage plan? At a recent government hearing, CMS testified that Health Alliance didn’t meet the requirements that were set out to be a provider.
  8. 8. How will Medicare Advantage affect my premiums and benefits? People who are 65 or older and qualify for Medicare Advantage don’t need full-service insurance plans; for instance, they don’t need obstetric or pediatric care. By switching many retirees to more precisely targeted plans, CMS and AFSCME hope to reduce costs, both for the state and for retirees. The estimated savings to the state are $325 million per year. Additional and detailed information about the plans can be found here:
  9. 9. How can I get more information? CMS recently added a new website to post information about Medicare Advantage. Additionally, in the coming weeks, CMS personnel will be giving presentations and providing information throughout the state on Medicare Advantage.
  10. 10. Why am I being asked to verify my dependents’ eligibility? If I don’t reply to the letter I received, could my dependents lose their coverage? CMS is currently conducting a Dependent Eligibility Verification Audit, or DEVA. Starting with retirees and moving to active employees, state employees and TRIP members are being mailed requests for verification that the people they claim as dependents for health insurance purposes are actually eligible to receive state health benefits. For most minor dependents, only a copy of a birth certificate is necessary to prove eligibility. Tax records are usually required for spouses, step-children and some other types of dependents.
  11. 11. Constituents with some special situations, particularly those for whom a civil union or domestic partnership is the basis for claiming someone as a dependent, may need to contact CMS directly to determine what kind of documentation they need to provide.
  12. 12. It is important to provide the information because If CMS never receives documentation of a dependent’s eligibility, the dependent’s coverage could be terminated. For more detailed information, see the CMS webpage and FAQ on the DEVA process.
  13. 13. Why did I get a dependent eligibility verification request from a company called HMS, and why does it have an Indiana postmark? CMS is using a vendor to complete this audit, and the vendor is mailing the letters from an Indiana address.
  14. 14. Q&A provided by Illinois Senate Democratic Caucus updated October 30, 2013