The Pennsylvania Employees Benefit Trust Fund (PEBTF) recently announced changes in its health care coverage for retirees. These changes are causing confusion for many individuals who have retired from employment with the State of Pennsylvania and receive their health care through the Medicare program with supplemental coverage from the PEBTF.
AARP Pennsylvania is providing the following information about these changes in the hopes it will help to make them more understandable.
PEBTF has decided that the primary form of health coverage for state retirees will be a Medicare Advantage private fee-for-service plan offered by Advantra Freedom. Retirees will also have the option of enrolling in another Medicare Advantage private fee-for-service plan, a Medicare HMO (Health Maintenance Organization) or a Medicare PPO (Preferred Provider Organization).
Many people are confused about Medicare Advantage plans. It is important to note that coverage under any Medicare Advantage plan means that retirees are still enrolled in Medicare. Many employers are now choosing Medicare Advantage plans for their retirees because it saves the employer money. In the past, retirees were most often covered by “traditional” Medicare and a Medicare supplemental plan. A Medicare Advantage plan combines the coverage under “traditional” Medicare and a Medicare supplemental plan. Employers save money by covering their retirees under a Medicare Advantage plan because the federal government pays for a higher percentage of the total coverage under the combined plan.
In most cases a retiree will see little change in their health insurance under a Medicare Advantage plan, but it is important to check the details of the plans you are considering. The biggest concern is that some physicians or hospitals may not initially accept coverage under a Medicare Advantage plan. It should be emphasized that the vast majority of physicians and hospitals will accept this coverage, but retirees should check to be sure the first time they visit a physician or hospital after this change. A Medicare fee-for-service plan does not have a “network” of physicians and hospitals. Instead, physicians and hospitals must accept the payment schedule that the fee-for-service insurance company offers. Pennsylvania officials claim the Advantra Freedom plan offers the same payment schedule that “traditional” Medicare and Medicare supplemental insurance does, so physicians and hospitals are likely to accept coverage once they learn the details about Advantra Freedom.
Retirees should also investigate the other options for health coverage, which include other Medicare private fee-for-service plans, Medicare HMOs, and Medicare PPOs. Different plans will have different deductibles, and may cover additional services. If retirees do not make a choice of plans by March 22, they will automatically be enrolled in the Advantra Freedom plan. PEBTF will continue to offer seminars about the upcoming change. Local Area Agencies on Aging also have health insurance counselors available through their APPRISE program to discuss insurance options. APPRISE is available weekdays from 9a-4p, call 1-800-783-7067.
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