Illinois state retirees facing a health insurance switch.

The problem with privatized healthcare.

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The first I heard about the switch was yesterday when Bob sent me the email that the Illinois Retired Teachers Association’s executive director Jim Bachman sent out.

September 14, 2022

IRTA Members,

The Illinois Retired Teachers Association would like to make our members aware that according to a recent article, Aetna Medicare Advantage PPO will be the sole insurer offered to Illinois retired state workers and retired teachers. This means that, in addition to removing United Healthcare, the State is also removing all HMO options from retired teachers. IRTA understands that in some areas, members will not be able to continue to see their current healthcare providers at the same cost. 

The attached article makes it clear that this will be true in the Champaign area, but your area could be impacted as well. You may want to check with your healthcare providers about how the State’s decision to contract Aetna as the sole provider could impact your benefit.

Open enrollment for retirees has been pushed back to November 1st from the typical October 1ststart date. The new plan will go into effect for enrollees January 1, 2023. Communication regarding the change will begin within the next couple of weeks. To read the full article, please click here.

Sincerely,

Jim Bachman

IRTA Executive Director

I’m a retired teacher with Medicare and a subsidized Medicare Advantage plan through United Healthcare.

Illinois’ Central Management Services which has the power to do these things has moved all the 140,000 state retirees to Aetna’s Medicare Advantage.

The first thing I did this morning was call Northwestern Memorial Hospital, home to most of my medical care, to check that they accept Aetna. And they do.

But I don’t really understand the switch since United Healthcare is reported to have matched the Aetna offer.

And bigger medical system issues aside, I have had pretty good experiences with the folks I have had to talk to at United Healthcare.

So, as another fellow retiree explained it, “Somebody must have had lunch with somebody.”

Previous to the new deal with Aetna, retirees around the state had some options.

No longer. It’s Aetna or the highway.

Downstate retirees are expressing concern.

The decision by CMS was made despite protests by retirees in and around Champaign over apparent inaccuracies in the list of providers and hospitals that Aetna submitted to CMS in its April application.

For many state worker and teacher retirees the switch to just Aetna is coming as a surprise and suddenly, even though enrollment has been pushed back from October to November. The switch becomes effective January 1st.

All this change is a stressful thing for retirees.

“My wife and I were having lunch with friends of ours, both of whom are retired physicians, and when the topic turned to health coverage and the possibility of having Aetna, both of them just grimaced at Aetna’s reputation,” he said.

“You don’t have to say you’re rationing health care if, in fact, you offer health care with so few providers that people can’t get in or can’t get in for months and months.”

Carle Physician Group, a network of at least 550 eastern-central Illinois doctors, and Carle Foundation Hospital are no longer in-network for seniors on all Aetna Medicare plans, state retiree or otherwise, HMO or PPO.

The list of providers Aetna submitted to the state in its application for the PPO plan still included these doctors and the Urbana hospital. Both are accurately marked as out-of-network, but in the next column on the spreadsheet reporters obtained, the insurer claimed Carle is willing to accept the plan. (WCIA.com)

Reports are that as of a few weeks ago CMS hadn’t responded to questions about the bidding process, only saying “CMS remains committed to administering health care coverage programs for State employees, their dependents and retirees in accordance with all federal regulations and requirements.”

The statement came in after nearly a month of silence from the state agency on reporters’ questions.

This isn’t good.

Of course, at the root of it all is the privatized insurance driven system of healthcare for everyone, including retirees.

It’s a mess.

And it wouldn’t have this mess if we took profit-based insurance companies out of the process and replaced it with a system of national healthcare.