Concerns About Private Medicare Exchanges

Dan Pitts, the new President of the Tennessee Valley Authority Retirees Coalition (TVARC), an NRLN Chapter, has brought to my attention an issue that has affected TVA retirees’ selection of their Medigap (Medicare supplement) plans offered through a Private Medicare Exchange (PME). Companies use PMEs to move retirees from their group plan and into the individual Medicare market. This has caused me to wonder whether other NRLN grassroots advocates many have been similarly impacted by a PME.

Dan is requesting that you sign his online petition on this issue that will be sent to Congressional leaders and the administrator of the Centers for Medicare and Medicaid Services. Click here to see the petition.

The NRLN has a brief survey for anyone who has had dealings with a PME to purchase their Medicare coverage and/or has a Medicare Advantage plan. The NRLN survey is at: https://www.surveymonkey.com/r/NRLNMED. Your input will help the NRLN determine whether there is a need to take action.

Dan has been trained and certified as a member of the Senior Medicare Patrol (SMP), a federally funded program administered by each state. Dan is empowered to assist Medicare beneficiaries to prevent, detect and report health care fraud, errors and abuse. Because Dan’s goal as a SMP volunteer is to ensure that all seniors receive accurate and complete information to make their Medicare choices and to report any cases of impropriety to Medicare, I take seriously his concerns about PMEs.

First, a little background about the PME situation with TVA retirees. TVA terminated retirees’ health coverage effective January 1, 2017 and contracted with a PME to help retirees find new Medicare insurance. In the fall of 2016, TVA retirees started looking at the Medicare Supplement (Medigap) plans offered during transition to the PME. It turned out the most popular Medigap plan (Plan G) and the two insurers offered by the PME were 35-67% more expensive than buying coverage directly the insurers.

Retirees complained to TVA about the PME’s higher rates and TVA executives were surprised about the higher rates and challenged the PME about its high rates. The PME eventually admitted to TVA that many of its high-priced plans may carry the look and brand of major, well-established insurers, but the plans are really "separate legal entities" with rates based on different cost structures, resulting in much higher rates. The names of those insurers, their logos, plan descriptors, and plan benefits were used in the marketing and promotions material presented to TVA retirees.

Dan sent an email on December 6 to TVARC members whose email addresses are in the NRLN’s database. He cited an example of how much more expensive the two Medicare Plan G offerings were versus eight other plans

Dan noted that another issue relates to a very basic, but a very important, option available to retirees who have no serious pre-existing conditions. Healthier retirees have absolutely no need for the PME's high-priced "guaranteed issue" plans. Because of their better health, they would qualify to purchase any plan, not just guaranteed issue plans, from any insurer in their local market, many at very low rates. Some insurers will allow switching to a Medigap plan at any time, not just during open enrollment. Before changing plans, retirees should always make sure they will not be giving up any significant benefits such as healthcare subsidies or insurance for their under 65 spouses.

He said it is unclear why the PME chose not to disclose this information to TVA retirees. Also, it is troubling that the PME restricted its offerings for the highly popular Medigap Plan G to just two insurers and did not bring more competition into the offerings.

Dan made other good points that apply to anyone age 65 and older.

Medicare eligible seniors should not be afraid to inquire about changing plans, especially if they have no serious pre-existing condition,” Pitts said. For example, even if you have been treated for cancer and the disease has been in remission for a certain period, some insurers may be willing to provide you a new Medigap plan without imposing higher rates or waiting periods. As always, before changing plans, retirees should make sure they will not be giving up any benefits such as healthcare subsidies or insurance for their under age 65 spouses.

Dan pointed out the Medicare website at https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/switching-medigap-policies provides information about Medigap plans. Another excellent source for advice on Medicare plans is offered by the State Health Insurance Assistance Program (SHIP) that provides local, in-depth, and objective insurance counseling and assistance to Medicare-eligible individuals, their families, and caregivers. The national SHIP website can be accessed at https://www.shiptacenter.org/.

Please take a few minutes to review and sign Dan’s petition. Also, please respond to the NRLN’s brief survey if you have had experience dealing with a PME and/or have a Medicare Advantage plan. It is voluntary whether you submit your name, email address and home address on the NRLN survey.

Bill Kadereit, President
National Retiree Legislative Network

PHARMA CONTRIBUTIONS TO CONGRESS

Learn About the Dollars Members of Congress Have Been Receiving from Pharma since the 2012 election cycle . How much did your U.S. Representatives and Senators and newly elected members take as campaign contributions from the Pharmaceutical and Health Products Industry for the 2018 election ? Could these be a reason why bills to reduce the price of prescription drugs are not being passed? Click here to see data that the NRLN has compiled from OpenSecrets.Org, Center for Responsive Politics. The contributions are for each 2-year election cycle. Note that Representatives run every cycle; Senators every 6 years (3 cycles), one third every 2 years.

Invitation to View NRLN Photos on Instagram

You are invited to visit the new NRLN Instagram page at www.instagram.com/photosnrlnorg/. The page has photos from the NRLN’s September 2018 Fly-In and March 2018 Leadership Conference in Washington, DC. Click on each photo to read about who is in the photo and what is happening.

You do not need an Instagram account to visit the NRLN’s page. Instagram can be accessed with an electronic tablet, smartphone or computer. If you have an Instagram account, I encourage you click on the “Follow” button.