CSR urges CalPERS to extend open enrollment for Medicare members
The California State Retirees Health Benefits Committee is calling for CalPERS to extend open enrollment for retirees this year because changes in Medicare health plan offerings were not adequately explained in time for members to make informed decisions by the Oct. 9 enrollment deadline.
“We are getting many calls from retirees who didn’t understand the different ramifications they face this year with some CalPERS Medicare plans no longer being available,” said Stephanie Hueg, chair of the CSR Health Benefits Committee. “Members who didn’t closely read their open enrollment materials may not realize that some seniors are automatically being switched to UnitedHealthcare (UHC) if their provider is one that CalPERS dropped and they didn’t make another choice. There are many other complications that can occur in specific cases. We believe our people need more time to figure this all out.”
As of Jan. 1, 2016, CalPERS will no longer offer the following Medicare plans: Anthem Blue Cross HMO Plans, Blue Shield of California HMO Plans, Blue Shield of California EPO Plan, Health Net HMO Plan and Sharp HMO Plan.
Major Medicare premium hikes in 2014 spurred the CalPERS Board of Administration to request a review of insurance plans for the 2015 open enrollment. In June, the board voted to eliminate the Medicare plans listed above and offer:
Medicare Supplemental Plans: PERS Select, PERS Choice and PERSCare
Medicare Advantage Plans: Kaiser Senior Medicare Advantage and United HealthCare Medicare Advantage PPO. All other Medicare Advantage HMO Plans were eliminated and replaced by UMC, which can be billed directly by other Medicare providers and facilities that are not in the UHC network.
About 40,000 Medicare members and dependents are affected by these changes. Members in the affected plans who did not sign up for another Medicare plan offered by CalPERS will automatically be enrolled in UHC Medicare Advantage PPO plan, which is available in all 58 California counties and all 50 states. The large majority of doctors who accept Medicare will accept UHC insurance.
But UHC basic health plans are not available in all counties, which can cause a glitch for “combination families,” who have one participant who is eligible for Medicare and one or more dependent(s) who are ineligible for Medicare. About 1,400 people in combination families without access to UHC basic plans would have to choose between Kaiser Medicare Advantage plan (if available) or PERSCare, PERS Choice or PERS Select. Those who choose one of the PPOs will usually see higher premium costs, CalPERS officials acknowledged.
The Blue Shield Access Medicare Advantage plan and its associated basic plan was the most popular plan in the past for retiree members in combination plans. But Blue Shield is no longer available under the new CalPERS Medicare offerings.
Another wrinkle is that the UHC provider list varies from the lists used by Blue Shield and some of the HMOs that were cut, so some retirees will need to change doctors, notes Larry Woodson, a Chapter 2 member, who is also calling for an extended open enrollment period for retirees.
Still another concern is that the “basic” UHC plan is an HMO, not a PPO plan. This means that while the CSR Medicare subscriber may be able to go to non-network Medicare providers and facilities, his or her dependent(s) in the “basic plan” will be limited to UHC in-network providers and facilities.
Earlier this year, members of the CSR Health Benefits Committee successfully convinced CalPERS and UHC officials to clarify, and in some cases, rewrite several communications to members. At the committee’s suggestion, the websites at CalPERS and UHC were also updated and enhanced.
But the board rejected the committee’s suggestion to put the UHC plan on a one-year trial basis.
CalPERS officials have said they will deal with special cases and help people who may be confused about their coverage, but they stopped short of extending the open enrollment period for all retirees.
Several mailings from CalPERS and UHC have been mailed to members’ homes over the last several months. At the request of retirees, another letter is expected before year’s end to confirm the health care status of each member.
The CSR Health Benefits Committee has the following recommendations for CalPERS Medicare members during open enrollment and during a possible extended open enrollment:
Do not take your health care insurance election for granted this year!
If you are changing your health care plan this year, make sure that your current providers and facilities are covered in the new health insurance plan. Contact your medical providers, hospital facilities, pharmacies and labs directly and ask them if they will be taking the plan you are considering for 2016.
Contact the new insurance plan, and make sure that your medications will be covered and what their cost will be under the plan’s formulary.
The “combo plan” member families should be especially careful in making a decision. Access to providers and hospitals that the Medicare member will have could be very different from that your dependents will have.
If you have questions, phone CalPERS customer service at (888) 225-7377 and ask for a health benefits specialist. Also contact by telephone health insurance representatives. Make sure your questions are answered.
Health Care Resources:
√ CalPERS: (888) 225-7377 or www.calpers.ca.gov Letters may also be sent to: Member Account Management Division, P.O. Box 942715, Sacramento, CA 94229-2715
√ Kaiser Senior Advantage HMO: (800) 464-4000 or http://kp.org/calpers
√ Anthem PERS Select, Choice or Care: (888) 225-7377 or www.calpers.ca.gov
√ UnitedHealthcare Medicare Advantage PPO and UHC Signature Value Alliance HMO plan for non-Medicare dependents,(888) 867-5581(Tell the operator you are a CalPERS “combo” member.) or calpers.welcometouhc.com
√ UnitedHealthcare Signature Value Alliance HMO Plan Basic Member Services: (877) 359-3714 or www.uhc.com/calpers
√ UnitedHealthcare Group Medicare Advantage
Medicare Retiree Member Services: (888)867-5581 or
√ To find approved medical providers for the UHC HMO plan for dependents, visit www.calpers.welcometouhc.com
and select “Find a doctor or hospital” in the Signature Value Alliance network under the first plan option.