Retirees rally against new Medicare plan

Opponents of a new Medicare plan for state retirees took to the steps of Legislative Hall Oct. 12, demanding the state stop a privatization plan they say will cost seniors more.

“We vote, our families vote, and our friends vote,” said John Kowalko, a former state representative and member of RiseDelaware, which is leading the charge to stop the new Highmark Medicare Advantage plan from going into effect. “We’re not going to be silenced.”

A lawsuit filed by RiseDelaware to halt changes to the state’s Medicare plan will be heard in New Castle County Superior Court Monday, Oct. 17. 

Karen Peterson, a former state senator and member of RiseDelaware, said retirees would like the existing Medicare plan to continue for another year so retiree concerns can be addressed. She said a review of the new Medicare Advantage plan shows more than 2,000 procedures that were covered under the previous plan will require pre-authorization.

“If your provider does not get the pre-authorization, you’re on the hook for the entire payment,” she said. “In one case, I read, a man was charged $300,000 for a hospital bill because they decided it wasn’t medically necessary after the fact.”

More than 100 people showed up to protest the new plan, including a bipartisan contingent of legislators. Republican Sens. Dave Wilson, Bryant Richardson and Dave Lawson were among the half dozen legislators in attendance.

Wilson said state officials presented the new plan to legislators at the end of session but failed to include the full picture.

“It was sold to me that this is the plan and we need to get on board,” he said.

After RiseDelaware filed its lawsuit, the state Legislature introduced a bill addressing Medicare Advantage accountability. Both the House and Senate will convene a special session Wednesday, Oct. 26, to consider legislation that will create an ombudsman at the Department of Human Resources who would be tasked with helping retirees navigate benefits under the new plan, and will also create a subcommittee with members to include state retirees, sitting legislators, union representatives and other state officials who will monitor Highmark’s performance during the three-year life of the current contract.

In a statement sent out when the special session was announced, Speaker of the House Rep. Pete Schwartzkopf, D-Rehoboth Beach, acknowledged retiree concerns raised during public hearings held over the summer.

“These teachers, secretaries, engineers, troopers, administrators and other dedicated workers put in their service to the state and want to ensure that the state fulfills its commitment to them in their golden years,” said Schwartzkopf, who retired from the Delaware State Police in 2002. “We were able to win several concessions that will improve the current deal for retirees. And after several conversations and negotiations, we have crafted a bill that will add several layers of oversight to the process to protect the current agreement and assist retirees during this transition.”

Kowalko said the first sentence of the bill says it all by specifically referring to the Medicare Advantage plan. “The plan’s in place. We’re done,” he said.

He also questioned whether the creation of an ombudsman position within the Department of Human Resources will have retirees' interests at heart. 

Secretary of the Department of Human Resources Claire DeMatteis and Secretary of the Office of Management and Budget Cerron Cade, both named in the lawsuit, have declined to comment on the pending lawsuit but recently released an explanation of changes that will occur under the new plan including the pre-authorization process under the Highmark Medicare plan.

“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,” DeMatteis and Cade said in the statement.

Emergency and urgent care do not require prior authorization, they said, and non-emergency prior authorizations take about a day while non-emergency pre-authorizations may take about four days.

Highmark will continue to administer the state Medicare plan with no co-pay for doctor visits, no deductible for medical services, and no cost for skilled nursing facility services, lab and imaging, or emergency or urgent care. There is also no cost for out-of-network coverage with out-of-network providers receiving 100% Medicare allowable reimbursement for services, they said.

Changes are needed to reduce the state’s $10 billion unfunded liability for retiree healthcare “that threatens the long-term sustainability of these very important benefits,” DeMatteis and Cade said.