Delaware state pensioners will get the same Medicare and premium health coverage | Opinion

We want to share more on the latest developments on Medicare coverage for state pensioners to ensure our state retirees understand they will continue to have the best, most comprehensive Medicare coverage.

We know the healthcare system can be complex, and it can be made even more daunting when you or a family member are dealing with health issues or an emergency. That is why we continue to partner with one of our state’s leading nonprofit healthcare companies to protect state pensioners’ Medicare coverage for years to come.

For several years, Delaware’s State Employee Benefits Committee and the Retirement Benefit Study Committee have worked to identify options that assure that retired State employees retain access to high quality and affordable health care while also making progress toward reducing the State’s $10 billion unfunded liability for retiree healthcare that threatens the long-term sustainability of these very important benefits.

What you should know:Delaware is changing its Medicare plan for state workers, here's what it means for retirees

To protect our state pensioners, in June, the Delaware General Assembly approved language in the State’s Fiscal Year 2023 budget placing 1% of the prior year’s budget into a Trust Fund for retiree healthcare.  In February, the SEBC approved a plan that was included in the Fiscal Year 2023 budget assuring that retirees and their dependents continue to receive premium health care services through a customized Medicare Advantage plan specifically designed by Highmark Blue Cross Blue Shield Delaware.

The coverage for Medicare services and prescription drugs remains the same as the past Medicare Supplement plan. State pensioners and their dependents have the same access to doctors and hospitals who accept Medicare.

Highmark Blue Cross Blue Shield Delaware will continue to administer the State Medicare health plan, just as it has for many years with:

• $0 co-pay for visits with your doctor.

• $0 deductible for medical services.

• $0 cost for skilled nursing facility services.

• $0 cost for nationwide in and out-of-network coverage with out-of-network providers receiving the 100% Medicare allowable reimbursement for services provided.

• $0 cost for lab and imaging.

• $0 cost for emergency room and urgent care services.

• Full and immediate coverage for pensioners with pre-existing conditions.

In addition, the new plan adds:

• The Silver Sneakers® fitness program membership

• Help managing your health and wellness; and,

• Home meal service after a hospital discharge.

The SEBC went through an extensive public process over the past year on the transition to a Medicare Advantage plan.  Coverage will remain employer-sponsored and state-funded; it is not privatizing state retirees’ health care.  The new plan takes effect on January 1, 2023, with open enrollment Oct. 3 through Oct. 24.

We understand any change can be met with concern.  If you are a state pensioner with questions about the plan, please contact Highmark Concierge Service: available 7 days a week from 8 a.m. to 8 p.m. at 1-888-328-2960 (TTY call 711).

When compared with retiree health plans in other states, Delaware’s Medicare Advantage plan remains among the most elite, with the best and most comprehensive Medicare coverage. And like the health coverage available to State employees and pensioners not yet eligible for Medicare, the Medicare Advantage plan will require prior approval for some non-emergency services.

Say you were sent to a specialist because you had intense back pain and needed an MRI. Your doctor would contact Highmark to request an authorization for this test.  The request will then be reviewed by the Highmark clinical team of nurses and physicians to make sure that it was the most appropriate test for your symptoms. By doing this, Highmark can ensure you get the best access to care and both you and your doctor are not burdened by extra paperwork on the backend.  Highmark BCBS Delaware approves about 93% of all prior authorizations, with 92% approved on the initial submission. Expedited, non-emergency prior authorizations are approved within an average of a day and a half, with standard, non-emergency pre-authorizations approved within about 4 days. Emergency and urgent care services do not require prior authorization.

There are other benefits too. The fact is that State pensioners who retired prior to July 1, 2012, and earned 100% of state share coverage, continue to pay no monthly premium, and for those retired after this date with 20 years of service, their premium is reduced to $10.80 per month.

For State pensioners who retired after June 30, 2012 with less than 20 years of service and are responsible for some or all of the cost of their Medicare coverage, the monthly fee is reduced by more than half to $216.18 per month.  This significant reduction makes the plan affordable and gives retirees access to exceptional medical and prescription coverage that simply is not available in the individual healthcare market.

While it is true that the State’s ability to absorb growing healthcare costs has limits, by partnering with Highmark BCBS Delaware, our State pensioners will have access to medical professionals and a concierge service team dedicated to ensuring they receive medically necessary health services and exceptional support in navigating their health and wellness needs.

Over the past month, we have held several education sessions to inform and engage our State Medicare pensioners. We will hold additional sessions in September and October. We also encourage Medicare pensioners and their dependents to visit our website to stay informed: Highmark Delaware Medicare Advantage webpage(https://dhr.delaware.gov/benefits/medicare/medicare-advantage.shtml).

Claire DeMatteis is secretary of the Delaware Department of Human Resources. Cerron Cade is director of the state Office of Management & Budget. DeMatteis and Cade co-chair the State Employee Benefits Committee.

This article originally appeared on Delaware News Journal: Delaware pensioners will get same Medicare, premium health coverage