health plan update
ILLINOIS SENATE DEMOCRATIC CAUCUS
Q & A
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
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
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
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
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
More information is available at the CMS website:
When is the enrollment period,
and when does coverage begin?
The enrollment period is
Nov. 12 through Dec. 13.
Coverage takes effect Feb. 1.
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.
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.
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:
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
Why am I being asked to verify my
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.
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.
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.
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.
Q&A provided by Illinois Senate Democratic Caucus
updated October 30, 2013