In January, she would have had to get approval for most small and all large medical procedures and pay for a much higher percentage of all medical fees.
This is a testament to the power of a few smart protestors.
Superior Court judge orders state to pause switch to Medicare Advantage Plan for retirees
Superior Court judge orders state to pause switch to
Medicare Advantage Plan for retirees
Delaware
Public Media | By Paul
Kiefer
Published October
19, 2022 at 6:06 PM EDT
Roman Battaglia
/
Delaware Public Media
A Superior Court judge sided with
retired state employees in a Wednesday ruling ordering Delaware to pause plans
to transfer 30,000 retirees from standard Medicare plans to Medicare Advantage.
The ruling comes after the retiree
advocacy group RISE Delaware sued the state’s State Employee Benefits
Commission (SEBC) and other state officials for allegedly violating open
government and public administration laws when planning and executing the
change in health insurance plans.
A Medicare Advantage plan gives a
private insurer – in this case, Highmark Delaware – greater control over
coverage decisions in exchange for assuming financial risks previously borne by
the state.
Judge Calvin Scott's ruling points
out the state assured retirees their benefits would not change before
finalizing a contract with Highmark Delaware. The SEBC issued a letter to
retirees in June promising that the new plans would offer "the same level
of medical plan benefits"; however, Scott noted, the SEBC seemingly didn't
become aware that the new plans would include pre-authorization requirements
for more than 1,000 procedures and would require retirees to use in-network
doctors – primary causes for concern among opponents — until August. The state
did not finalize its contract with Highmark Delaware until September 28.
"This court cannot agree that
the need for prior authorizations for over 1,000 procedures and the use of only
in-network doctors is the same level of benefits retirees obtained with the
current policy," Scott wrote.
Plaintiff and former state senator
Karen Peterson says the interim ruling gives retirees more time to consider
their options; the state originally planned to transfer retirees to new plans
on January 1, and the deadline for open enrollment ends on October 24.
“For now, they can’t do anything
with regards to moving retirees into a Medicare Advantage Plan," she said.
"There could be a trial, there could be an appeal by the state – the ball
is kind of in their court.”
Meanwhile, the General Assembly is
planning to reconvene on October 26 to discuss the proposed shift to Medicare
Advantage plans. Lawmakers will consider a bill that would increase the state's
oversight of the transition — including any increases in coverage denial rates
resulting from the new pre-authorization rules — but Speaker of the House Pete
Schwartzkopf and House Majority Leader Valerie Longhurst wrote on Wednesday
that the ruling could overshadow their original plan.
"The Superior Court ordering a
pause injects uncertainty into this situation for our retirees, but we are
committed to supporting them throughout this process," they wrote.
"Legislators will re-engage the administration and our retirees on next
steps and how to ensure that current and future pensioners are protected and
receive the best possible care."
If the state cancels its contract
with Highmark, it may have to refund to $600,000 to the insurance provider for
marketing costs.
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