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A look at the latest CMS health insurance memo

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Illinois

* From a CMS memo to state employees last Friday that was forwarded to me a kabillion times…

In recent weeks, there has been considerable misinformation directed to state employees about the future of our state employee group health insurance. I can assure you that employee premiums will remain at their current levels from now until June 30, 2016 (Fiscal Year 2016). Put simply, your existing plan, with the same carrier and the same costs, will remain in place throughout Fiscal Year 2016.

* But as Doug Finke reports, the state really had no choice…

“It’s extremely misleading and disingenuous,” AFSCME deputy director Mike Newman said. “They had proposed until our last bargaining session to double employees costs in (the current) fiscal year. That proposal is now off the table because the state insisted on such outrageous demands for so long that it is now too late to be able to implement changes in this fiscal year.”

And according to Newman, the state is now demanding a doubling of employee costs starting July 1, 2016.

* Back to the memo…

You must be aware, however, that many of our current plans are considered Platinum Plus plans and are so expensive that they will likely be subject to federal penalties on luxury plans in future years. Premiums for these expensive Platinum Plus, Cadillac plans are likely to double after July 1, 2016. But here again, recent misinformation provided to some employees omitted a key fact. Starting July 1, 2016, under the completed contracts and in our current proposals, we will offer less expensive plans with the same carriers and the same services for substantially the same premium costs that we offer today. Said otherwise, you would have the option to pay the same premium you pay today even after July 1, 2016.

* Finke…

“They’re not less expensive plans,” Newman said. “What they’re saying is that if somebody wants to pay less in premiums, they can sign up for a plan that will have higher copays and deductibles and higher maximum out-of-pocket costs. Either way, the state’s proposal is for employee costs to double.”

* CMS…

Finally, despite the national trends that show massive increases in healthcare spending and costs in the next few years, we are implementing several cost-saving measures, including identifying and removing those individuals who are defrauding the system, that will allow us to contain costs going forward. Overall, we’re shifting towards a consumer-focused model and away from a “one-size-fits-all” approach, a strategy that mirrors what is happening in other states and is long overdue here in Illinois. Due to these cost-saving measures, the State has proposed a cap on any increases to employee premiums for 2018 and 2019. We would cap all annual increases in employee premiums for 2018 and 2019 at 10%, even if the State’s actual costs increase by an amount greater than 10%.

* Finke…

They’re talking about capping them at 10 percent after they’ve already doubled,” Newman said. “It’s not like that’s a good deal.”

posted by Rich Miller
Monday, Dec 14, 15 @ 11:08 am

Comments

I like that line about working towards a consumer focused model. How about paying the claims for the employees.

Comment by Huh? Monday, Dec 14, 15 @ 11:15 am
Looking better for Reps. Bourne and Jimenez every day!

Comment by Willie Stark Monday, Dec 14, 15 @ 11:22 am
So if I’m reading all of this correctly, the State is proposing that starting next year, all employees either pay a lot more to keep the same level of coverage, or pay the same amount to get significantly less coverage. That’s actually a step back from the administration’s previous position, which was (according to AFSCME) simply demanding that everyone pay a lot more for less coverage across the board.

Comment by Secret Square Monday, Dec 14, 15 @ 11:22 am
All I can say is that you can’t believe anything CMS is saying. I know several older retirees who were switched into a Medicare Advantage Plan. CMS marketed these plans as actually being better than their existing plans but they are all paying more out of pocket than they were before.
I don’t have a problem with occasional modest increases in such things co pays. I think at some point if retiree out of pocket expenses triple or quadruple over the course of several years it could end up in court.

Comment by The Dude Abides Monday, Dec 14, 15 @ 11:28 am
we are implementing several cost-saving measures, including identifying and removing those individuals who are defrauding the system

CMS hired folks out of Texas to demand a list of personal information found in every HR department personnel file, or lose coverage. Every employee was guilty of fraud, until these anonymous Texas cleared you. How much did this cost us? What did they do with the personal data collected? How many state employees were exposed of fraud? How much did we end up saving with this program?

No one is telling us. The whole thing was based upon unproven assumptions. 35,000 civil servants were treated like they were getting free welfare by a private corporation located a thousand miles from Illinois.

Now they are touting imaginary results, as though they have saved us billions.

Groups of people who do things like this, aren’t interested in providing earned benefits - they are only interested in saving a buck and don’t care who they screw to get it.

Comment by VanillaMan Monday, Dec 14, 15 @ 11:28 am
The only people who haven’t seen this coming are Republican state workers.

Comment by Liberty Monday, Dec 14, 15 @ 11:28 am
What exactly would doubling the contribution cost the employee?

Comment by phocion Monday, Dec 14, 15 @ 11:30 am
Good news, after we double premiums, we’ll cap future increases at 10% per year! Like the premium you have now? Then, accept our lovely “get sick, get bankrupt” catastropic plan.

Once you remove the added language (consumer focused?) this sounds identical to information AFSCME has released. The only thing missing is a reminder that management also wants to remove seniority and end bumping rights in layoffs which would allow them to eliminate state employees altogether. Sure, the state would pay more in total to private vendors, but at least they’d save money on health insurance.

Comment by AC Monday, Dec 14, 15 @ 11:31 am
The downside of an extreme opening offer in negotiations is that you inevitably start to negotiate against yourself because there is no reason for the other side to engage in fantasy. Rich, how about we negotiate a sale of your blog to me. My starting offer is that I will take it off your hands if you pay me $1,000. Your move…

Comment by Abe the Babe Monday, Dec 14, 15 @ 11:31 am
Will this affect retirees insurance cost too?

Comment by Mama Monday, Dec 14, 15 @ 11:32 am
I don’t like the idea of anyone paying more, but in the Obamacare world that’s the reality. State employees have substantially better benefits than those of the taxpayers who are paying for them. Those same taxpayers are dealing with these same realities or are losing coverage.

It sucks, but it’s the reality of a broke state in our current healthcare insurance environment.

Comment by Reme Monday, Dec 14, 15 @ 11:32 am
George Orwell was prescient in 1984.

Comment by PublicServant Monday, Dec 14, 15 @ 11:33 am
How does this trend differ from national trends. I’m under the impression that those participating in insurance plans through the ACA sites are also seeing higher costs, not sure how that is affecting the level of benefits received. If health costs are going up in the country, though, should certain groups be exempt from paying more?
Which groups? Who decided that?

Comment by Cassandra Monday, Dec 14, 15 @ 11:36 am
==Dude==… Agree… In addition, non Medicare retirees get the same insurance as current workers. They lost in the attempt to charge premiums but I suspect they will try again through reducing the level of the plan. Also, I thought States were exempt from ACA penalties for not offering insurance. Are they not exempt from “luxury” value tax ?

Comment by Anotherretiree Monday, Dec 14, 15 @ 11:36 am
Welcome to the wonderful world of the Affordable Care Act. If your healthcare plan falls into the classification of being a “Platinum”, there’s an additional 40% penalty applied to the employer (State of Illinois, in this case) starting January 1, 2018.

“The “Cadillac tax” is to impose a 40% excise tax on the portion of group health care plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage starting in 2018.”

Link is: http://www.businessinsurance.com/article/20151206/NEWS03/151209867/vote-puts-cadillac-tax-on-the-bubble

Question: Why should taxpayers in the State of Illinois be asked to fund state employee healthcare (and pay a substantial penalty to do so) when that healthcare is substantially superior to what is going to be available to them as taxpayers?

Sounds to me like a case of “Many pay but few will benefit”.

Comment by Judgment Day (on the road) Monday, Dec 14, 15 @ 11:39 am
It all comes down to one thing - Rauner’s obsession with destroying unions, nothing more.

Comment by Anon Monday, Dec 14, 15 @ 11:39 am
==” We would cap all annual increases in employee premiums for 2018 and 2019 at 10%,”

Given CMS’ track record in “explaining” benefits changes, I have to ask: Will the 10% percent annual increases be 10% of the then-current employee share of the premium or 10% of the TOTAL premium paid by employees and the State to the insurers?

Comment by Curmudgeon Monday, Dec 14, 15 @ 11:39 am
=== The only people who haven’t seen this coming are Republican state workers. ===

Don’t delude yourself, there are a large number of GOP and former GOP state workers who’ve seen this coming.

Comment by Norseman Monday, Dec 14, 15 @ 11:46 am
I have often pondered the reason why the State’s COBRA payment was more expensive than the comparable plan I was able to purchase on the private market. Just because the state plan is expensive does not mean it necessarily has platinum coverage.

Comment by Natalie Monday, Dec 14, 15 @ 11:48 am
The US now spends 17% of GDP on health care expenses. Medicare premiums will increase next year as will most other health care insurance premiums.

Comment by Enviro Monday, Dec 14, 15 @ 11:49 am
No one knows health care and insurance like our governor. Just ask hundred of satisfied nursing home residents.

Comment by Name Withheld Monday, Dec 14, 15 @ 11:54 am
Welcome to the Affordable Care Act, where offering good healthcare benefits are penalized. We are also raising deductibles and limits to avoid being penalized with a tax we cannot afford.

Comment by Shemp Monday, Dec 14, 15 @ 11:55 am
==- VanillaMan - Monday, Dec 14, 15 @ 11:28 am:==

Vanilla, thanks for the wake-up call.
Do you know the name of the company in Texas which CMS contracted with to go thru every state employees’ files to collect personal information, & then call everyone an insurance fraud? Whoa…
Does it include retirees insurance files too?

Comment by Mama Monday, Dec 14, 15 @ 11:56 am
If anyONE or anyTHING is to blame for this, it is Obamacare. Worst. Law. Ever. Let’s keep it going with Hillary! Yea for us. After a lifetime of working to make sure I had health insurance, this is what it comes down to, so that non-workers can have the coverage that I, again, worked all my life to have. Again, hurrah for us, the state workers and retirees.

Comment by Gone, but not forgotten Monday, Dec 14, 15 @ 11:56 am
Hey- since the advent of the ACA- unless you are on either Medicare or Medicaid- everyone has been hosed with both huge premium and copayment increases- l have no sympathy for folks who are being told to face the realities under Obamacare

Comment by Sue Monday, Dec 14, 15 @ 11:58 am
I have more than 30 years with the state - and just found my medical bllls sent to medicare instead of my state plan - which I had met the deductible on — and now?

Comment by tweedle Monday, Dec 14, 15 @ 11:59 am
If any one thing is to blame for this it might be the high cost of prescription drugs and Big Pharma.

Comment by Enviro Monday, Dec 14, 15 @ 11:59 am
“State employees have substantially better benefits than those of the taxpayers who are paying for them.”
Dear Clueless, State-workers pay taxes just like everyone else! Geesh…

Comment by Mama Monday, Dec 14, 15 @ 12:02 pm
I currently pay $216/month for me and my child. Just for fun I filled out the Healthcare forms to find out what insurance I could get if I was a private sector worker. For $249 I could get the Gold plan with a $1000 deductible for me, and I make little enough that my child would be covered under AllKids. Much better deal than what the state doubling my costs would be.

Comment by HangingOn Monday, Dec 14, 15 @ 12:02 pm
Is any of this ACTUALLY related to Obamacare, or are we just being bombarded with buzzwords here? My employer faced the same challenge with the cadillac tax, and simply reworked the coverage to avoid the penalty. All we saw was a slight rise in premiums and a slight tick up in an already low deductible. Nothing close to double

Comment by Johnny Pyle Driver Monday, Dec 14, 15 @ 12:02 pm
My current family medical plan through the state costs a combined premium of $18,638, not that close to Cadillac status touted in the memo. Of that premium, I pay $3900 or 21% of the cost. Coverage is very similar to what I had in the private sector.

Comment by Johnnie F. Monday, Dec 14, 15 @ 12:03 pm
I know that our HMO and OAP plans are considered Platinum Plus… And I don’t believe that the Quality Care plan is either… I know it wasn’t six years ago, when I worked in H/R…again they’re misleading the general public by being vague. How many is the ‘many of our plans’ and how ‘likely’ is it that they will be considered Cadillac plans? It even appears that the Cadillac tax is poised to be done away with by Congress in a bipartisan manner… Let’s worry about something when it applies to us. Not if it may apply to us! Sheesh!!!

Comment by Triple fat Monday, Dec 14, 15 @ 12:09 pm
I meant to say that Hmos and OAPs are NOT considered Platinum.

Comment by Triple fat Monday, Dec 14, 15 @ 12:11 pm
“Welcome to the wonderful world of the Affordable Care Act. If your healthcare plan falls into the classification of being a “Platinum”, there’s an additional 40% penalty applied to the employer (State of Illinois, in this case) starting January 1, 2018.”
JD, State-workers are not insured under the “Affordable Care Act”(otherwise called Obamacare) so there is no 40% penalty. The State is mostly self-insured.

Comment by Mama Monday, Dec 14, 15 @ 12:11 pm
Mama - Health Management Systems out of Irving TX. AuditOS is a branch of it. HMS is a huge firm that is contracted by state governments to conduct “efficiency” reviews. HMS is filled with people who are low paid with poor benefits who leave after discovering that there are no promotions. HMS operates like a data factory, many employees have no idea what they are going to do until they arrive. Have no idea how long they will be on a project. Are shuttled between projects that are deemed similar enough for their cookie-cutter, cog data approach to operation and have no interest in developing employees since they view all college graduates as corporate fodder for their data processing.

Whenever you wonder how Rauner sees the government he is head of - take a look at an operation like this. People are to today’s corporate leaders what pigs were to Swift and Armour a hundred years ago - sausage and profit potential.

Comment by VanillaMan Monday, Dec 14, 15 @ 12:19 pm
== Will this affect retirees insurance cost too? ==

-Mama-,

The answer to that is most likely yes, but it just depends on your situation.

If you are a State retiree with “premium free” health insurance (mostly likely SERS and some SURS), then you will still have the “free” insurance. But …

a) if you are paying for a spouse / dependent, that premium will go up

b) if you (and any/all dependents) are Medicare age (65), you end up in your choice of a State sponsored Medicare Advantage program that has currently increased deductibles and co-pays (compared to previous Medicare/Quality Care combination), and you can expect to see the out of pocket expenses to increase some. If they go too far, there will be another Kanerva type lawsuit because the IL SC did question that exact scenario. Note: you can opt out of the State’s Medicare Advantage Program and just go with original Medicare, but then you have to buy your own supplemental policy to cover the gaps / drugs / vision because the only “supported” choice the State offers 65+ retirees is an Advantage program.

c) if you (and any/all dependents) are UNDER Medicare age (65), you end up in your choice of one of the State’s employee insurance plans which will most likely have higher co-pays / deductibles than the current plan.

That’s the best I can project at the moment until the State actually publishes the information and schedules for next FY’s health insurance options.

Comment by RNUG Monday, Dec 14, 15 @ 12:21 pm
Are the Medicare Advantage plans a part of the “Affordable Care Act”? Are the Medicare Advantage plans considered Cadillac plans?

Comment by Mama Monday, Dec 14, 15 @ 12:22 pm
If the unions had pushed Single Payer and made it part of the ACA, they would not have to bargain health insurance.

Comment by old guy 2 Monday, Dec 14, 15 @ 12:31 pm
== Is any of this ACTUALLY related to Obamacare, or are we just being bombarded with buzzwords here? ==

- Johnny Pyle Driver - ,

Yes, it is somewhat related because when ACA first took effect, the State requested and was granted a temporary exemption to to the “Cadillac tax” provision of the law. I believe we are approaching the end of that exemption period. So, as you stated, the State either has to pay the fine or rework things to avoid it.

The big problem with the State’s group health insurance plans, IMO, is that the bids have not been structured to be as competitive as they could have been. Or, to put it in other terms, the bid specs were rigged to try to reward certain companies over others (see Blago, 1st health insurance contract for one of the more blatant examples or the bid under Quinn that had such narrow requirements Health Alliance was locked out of some portions).

Comment by RNUG Monday, Dec 14, 15 @ 12:31 pm
“JD, State-workers are not insured under the “Affordable Care Act”(otherwise called Obamacare) so there is no 40% penalty. The State is mostly self-insured.”
———————-

Mama, don’t think that is correct. Was told that the ‘Cadillac Tax’ provisions are subject to every group health plan unless specially exempted (like healthcare for the Administration and the ‘Congress Critters’). Self insured - doesn’t matter.

Btw, the Administration has taken the position (to date) that they are not willing to repeal the ‘Cadillac Tax’ because that will blow up the numbers on the Affordable Care Act.

Interesting times…..

Comment by Judgment Day (on the road) Monday, Dec 14, 15 @ 12:31 pm
Some taxpayers in Illinois have plans better than what the state issues and some taxpayers have worse plans and some taxpayers have similar plans. Health care is not one size fits all so trying to compare state employees health coverage to others is like trying to compare vegetables to fruit. They are both good for you but they are different. Quit blaming ACA for all this since health care has been changing for years including the share of the cost between the employer and the employee. The change was occurring before ACA and at a faster pace than now. The reality of insurance is the insurance company will design the plan to maximize their profits. Employers will design plans based on what they want to pay and their bottom line. Any cost over what the employer pays is transferred to the employee via higher premiums, co-pays and deductibles.

Comment by illinifan Monday, Dec 14, 15 @ 12:33 pm
Thanks for the info RNUG. I guess what I’m asking is whether the costs of these plans are actually enough to trigger the cadillac tax? And if so, are the recommended changes simply to bring those plans under the threshold, or are there other things at play?

Comment by Johnny Pyle Driver Monday, Dec 14, 15 @ 12:33 pm
I am a current state worker. My single coverage costs 10754.88 of which I pay 2232.00 if you believe the benefit statement available from CMS. I pay a little over 20%. I believe the average for other states is less than that

Comment by ANONIME Monday, Dec 14, 15 @ 12:33 pm
By the way my brother works in the private sector and his company’s Benefits Manager was fired leading up to Thanksgiving. He was fired after the employees were able to establish that the large shift in healthcare costs that they were experiencing had nothing to do with the Affordable Care Act… His employer was just blaming their desired shift in cost to the ACA. What’s a little lie to your employees when it suits the bottom line?

Comment by Triple fat Monday, Dec 14, 15 @ 12:37 pm
== Are the Medicare Advantage plans a part of the “Affordable Care Act”? ==

The MA plans existed before ACA. They were an opportunity for the private insurers to get a portion of the Medicare business. The early ones were generally a pretty decent deal for a lot of people in that you could get a MA plan for less than Medicare plus a supplement and they provided the same or better coverage. The problem with the early ones is the companies over promised and mostly lost money, so they had to raise premiums and cut back coverage by increasing co-pays and deductibles.

== Are the Medicare Advantage plans considered Cadillac plans? ==

The ones that State offers are pretty decent ones; not sure if they fall into the “Platinum” level but they are still in the “Gold” range.

Comment by RNUG Monday, Dec 14, 15 @ 12:38 pm
retirees with 20 years or more of service pays zero premium. Suspect if given a choice, retiree would elect best plan possible since premium would not be effected. Dependent premiums could be another matter.

Comment by Facts are Stubborn Things Monday, Dec 14, 15 @ 12:40 pm
== I guess what I’m asking is whether the costs of these plans are actually enough to trigger the cadillac tax? ==

- Johnny Pyle Driver -

I believe they are, otherwise why would the State have asked for the temporary exemption that expires in either 2017 or 2018?

== And if so, are the recommended changes simply to bring those plans under the threshold, or are there other things at play? ==

I’m not that well informed to say exactly what changes would be required to avoid the “Cadillac” tax.

Comment by RNUG Monday, Dec 14, 15 @ 12:45 pm
Universal health care is looking pretty good right now. It certainly would provide a lot of debt relief to states and local units of government.

Comment by Tempo Monday, Dec 14, 15 @ 12:50 pm
One business I know changed their employees plan deductible from $250 to $500 to avoid the Cadillac tax. That is all that was needed. Either deductible I thought was pretty sweet. The change needed for any plan to avoid this tax will be different based on the deal available through the insurance company. I personally think that the insurance companies that are managing the state plans are generating a nice profit for themselves and this is what contributes to a good potion of the cost to the state. We need less politics involved in the decision of which insurance companies win bids for the state insurance program.

Comment by illinifan Monday, Dec 14, 15 @ 12:52 pm
The threshold for the Cadillac tax for individuals is $10,200 currently. Note that this total applies to both employee and employer contributions. For HMO Illinois in Sangamon county, the total is $7878. Premiums would need to go up by about 30% before the tax would apply. Why is there all this talk about the Cadillac tax if it doesn’t and realistically wouldn’t apply? Is there something I don’t understand?

Comment by AC Monday, Dec 14, 15 @ 1:01 pm
I’m not understanding how someone can make an educated comment on here without having more information such as what does doubling the premium payment even mean? What we need is a deal that is fair to both employees and taxpayers (something AFSME is never going to argue for). Since we don’t know the starting point and are not comparing it to what most taxpayers have to pay for, it seems inappropriate to comment on the fairness of it either way.

Comment by Ahoy! Monday, Dec 14, 15 @ 1:02 pm
Ahoy! - employee contributions are listed here:

https://www.illinois.gov/cms/Employees/benefits/StateEmployee/Pages/FY2016Rates.aspx

Comment by AC Monday, Dec 14, 15 @ 1:05 pm
==such as what does doubling the premium payment even mean==

What kind of question is that? It’s double. What else do you need to know?

==need is a deal that is fair to both employees==

Do you think doubling is fair?

==not comparing it to what most taxpayers have to pay for==

Why does that even matter to the discussion?

Comment by Demoralized Monday, Dec 14, 15 @ 1:11 pm
== The threshold for the Cadillac tax for individuals is $10,200 currently. Note that this total applies to both employee and employer contributions. ==

-AC-,

I can’t find my 2015 Comptrollers statement, but my 2014 statement shows the State claiming to pay $11,239.92 for my health insurance. At that time, under 65 retiree, Sangamon County, Health Alliance HMO.

Comment by RNUG Monday, Dec 14, 15 @ 1:14 pm
Ummmm. JD - did you forget that Republicans control congress. Any bill sent to the President doing away with the tax will require a pay for. I like the idea of an additional 1% on income over a million dollars.

Comment by Triple fat Monday, Dec 14, 15 @ 1:18 pm
Thanks RNUG, I suspect this may highly variable and dependent on geographic location, situation and the health plan chosen. Or, the differences between HMO Illinois and Health Alliance in Sangamon county are huge.

Comment by AC Monday, Dec 14, 15 @ 1:23 pm
RNUG - Do you happen to know if that $11,249.92 includes CMS’ administrative costs? No snark intended.

Comment by Triple fat Monday, Dec 14, 15 @ 1:27 pm
Rauner administration may be trying to trick folks with their language, but state and state university employees paying far more for less has always been part of their game plan.
http://www.rrstar.com/article/20150221/NEWS/150229843

Comment by Joe M Monday, Dec 14, 15 @ 1:37 pm
Vanilla Man -
Don’t forget that for CMS’ Texas hirees if your dependent was a handicapped child the front page of your 1040 was fine, but if the kids weren’t a birth certificate was required.

Comment by Smitty Irving Monday, Dec 14, 15 @ 1:38 pm
consumer focused model…. the States health insurance is currently comporable to State Farms; which is a comporable size private company.

compared t google, apple and microsoft the States policies are lower coverage at higher employee cost….

so the plans seem in line. lot of medical practices in the State and the capital that would be impacted if we reduced healthcare utilization.

not t mention all the missed time and lost productivity when people stip going to doctors for care to save money… which then causes higher costs down the road when their medical consitions progress to much worse states before the person seeks treatment. lot of data shows you reduce health care costs with prophylactic well visits and getting people in early to catch problems before they progress.

penny wise pound foolish when tou drive people away from medical care and catching diseases at early onset

Comment by Ghost Monday, Dec 14, 15 @ 2:02 pm
== RNUG - Do you happen to know if that $11,249.92 includes CMS’ administrative costs? No snark intended. ==

No idea, but your comment made me laugh!

Comment by RNUG Monday, Dec 14, 15 @ 2:04 pm
==The threshold for the Cadillac tax for individuals is $10,200 currently.

… my 2014 statement shows the State claiming to pay $11,239.92 for my health insurance. ==

You should know that the 40% tax is imposed on the difference between the premium paid and the threshold amount. In this case, the additional tax would be 40% x $1,039.92 = $415.97.

Comment by Dilemma Monday, Dec 14, 15 @ 2:27 pm
Did someone mention vision insurance? Last time I got glasses it would have cost me more to use the vision plan than to get the glasses on sale. Only $20 more if I used my Cadillac Insurance. What a deal!

Comment by Niblets Monday, Dec 14, 15 @ 2:58 pm
cadillac designation is made without reference to dental and vision, I believe

Comment by Johnny Pyle Driver Monday, Dec 14, 15 @ 3:05 pm
==Did someone mention vision insurance? Last time I got glasses it would have cost me more to use the vision plan than to get the glasses on sale.==

The vision insurance is really separate from the health insurance, but CMS seems to lump their costs together. Last time I got glasses, I paid about 40% out of pocket, about 40% of the cost was charged to group discount, and the insurance paid only about 20%.

Comment by Curmudgeon Monday, Dec 14, 15 @ 3:57 pm
“Some taxpayers in Illinois have plans better than what the state issues and some taxpayers have worse plans and some taxpayers have similar plans. ”

I doubt that anyone in the private sector over the age of 65 can buy health insurance for $1000 a year which offers the same coverage provided to state retirees. That is approximately what spouses of retirees pay for coverage.

“The early [Medicare Advantage plans] were generally a pretty decent deal for a lot of people in that you could get a MA plan for less than Medicare plus a supplement ….”

But not a good deal for State retirees. Prior to the switch to Medicare Advantage Medicare acted as the primary insurer and the State acted as the supplemental insurer. By switching retirees to Medicare Advantage the State saves money(In April 2014 CMS forecast savings of $75 million in FY 2016). Guess where the savings come from.

” I personally think that the insurance companies that are managing the state plans are generating a nice profit for themselves and this is what contributes to a good potion of the cost to the state.”

You do realize that the State switched eligible retirees to Medicare Advantage plans to save money. If you are a retiree covered by Medicare Advantage you know where the savings are coming from.

Comment by CapnCrunch Monday, Dec 14, 15 @ 4:31 pm
Can’t believe the switch to Medicare advantage has not been challenged in court

Comment by Anonymous Monday, Dec 14, 15 @ 5:16 pm
“Defraud” is a specific legal term of an illegal act. I wish the administration wouldn’t throw such words around, especially when there are other reasons to cull people from the system. Yes, I know she said “including… defrauding.” But it comes off sounding like a threat.

Other than that, I do wish the whole country could go on a single payer/single policy type thing.

Comment by Cheswick Monday, Dec 14, 15 @ 6:12 pm
Capt Crunch What I was discussing was employee not retiree insurance. Different types of plans and costs.

The retiree coverage is totally different. The state is saving money on us.

Comment by illlinifan Monday, Dec 14, 15 @ 6:37 pm
== I doubt that anyone in the private sector over the age of 65 can buy health insurance for $1000 a year which offers the same coverage provided to state retirees. ==

I think you’re off on that number. My 2014 dependent health insurance (one person over 65) was shown as a bit over $2400, again Health Alliance HMO.

Comment by RNUG Monday, Dec 14, 15 @ 7:02 pm
Adding … that does not include the money being paid to the Feds for original Medicare. That $2,400+ amount is the (retiree) dependent cost of having the HA HMO as a Medicare supplement.

Comment by RNUG Monday, Dec 14, 15 @ 7:05 pm
“I think you’re off on that number. My 2014 dependent health insurance (one person over 65) was shown as a bit over $2400, again Health Alliance HMO.”

Most recent CMS manual, Oct 2014, quotes dependent cost as $89.91 per month for HMO plan, $110 for PPO plan ($1080 - $1320 per year). Not sure why yours is so high.

“Adding … that does not include the money being paid to the Feds for original Medicare. That $2,400+ amount is the (retiree) dependent cost of having the HA HMO as a Medicare supplement”

Not sure what you are referring to here. All Americans over age 65 must pay Medicare Part B regardless of Social Security eligibility.

Comment by CapnCrunch Tuesday, Dec 15, 15 @ 8:20 am