Town hall: Attendees vent frustrations over insurance premiums, coverage

Published 12:34 am Wednesday, January 4, 2017

Representatives from some of the state’s key agencies that affect state employees, retired state employees, and local municipal employees were on hand Tuesday night in Opp at a town hall meeting to answer the public’s burning questions about health care and retirement benefits.

Dave Wells, assistant director of PEEHIP, spoke to the crowd about the new Medicare Advantage program PEEHIP partnered with United Healthcare to offer Medicare-eligible retirees and Medicare-eligible dependents in 2017.

The change replaces the previous PEEHIP Blue Cross Blue Shield hospital plan and their Medicare Generation RX Prescription Drug plan.

Wells said that under the new plan, members have their Medicare Part A coverage, Part B coverage and Part D coverage in one plan.

Audience members were concerned about co-pays increasing with the new plan or prescription drugs not being covered.

Wells said for those on the Medicare Advantage plan, primary care physician office visits are $13 per visit, a specialist will cost $18 and annual preventative care is free.

He said under the previous plan it typically costs 20 percent for the office visits.

Wells said under the new plan customers will only pay a set fee rather than having balance billing.

Former Opp City Schools Superintendent Allen Miller said he recently received a letter from UnitedHealthcare informing him that they would not cover two prescriptions for which he has been paying a $20 copay.

Wells explained that the new coverage was supposed to be a replica of the previous insurance, but that sometimes insurance companies prefer Lilly over Novo or vice versa.

“Basically the prescriptions are the exact same thing, they just come from different manufacturers,” he said. “A lot of insurance companies have different financial arrangements with the companies.”

Wells said that if a consumer’s physician was adamant that it must be a certain drug, they do have exceptions to get the medicine for the consumers.

The Medicare Advantage wasn’t the only part of PEEHIP audience members were annoyed by.

Several in the audience was frustrated that they are now paying a $100 surcharge for their spouse on top of family coverage.

“We are paying $1.5 billion in claims each year,” Wells said. “Our membership is going up. We have some 340,000 plus members. As you know, health care costs are increasing, largely due to pharmaceuticals.”

Wells called it a national crisis.

Another PEEHIP subscriber was disturbed that though the Affordable Care Act allows for dependents to continue on their parents’ insurance until 26 regardless of school status or marriage, that her daughter, who is 23, would not be covered for her pregnancy.

“Under Alabama law, we are not allow to have maternity benefits for dependents,” Wells said.

Wells said he was familiar with her daughter’s case and that they were looking into what could possibly be done to help.

Sen. Jimmy Holley asked Wells if they had any idea what President-Elect Donald Trump’s efforts to modify and improve Medicare and Obamacare would have on PEEHIP.

“We don’t really know yet,” he said. “There is a lot of talk and analysis.”

Wells said that it is predicted that a lot will be taken back.

Currently birth control and preventative screenings are covered for free as mandated by the Affordable Care Act.

Wells said that it’s possible that some of the administrative oversight will also be taken back, such as the requirement to send two to three pages notifying subscribers that are not being discriminated upon.

“We are certainly monitoring the impact of Trump’s repeal or reform of ACA.”

Until then, Wells said they will continue to operate under ACA.

“There are some things from ACA that a lot of people like, such as dependents up until age 26,” he said. “We would have to decide do we want to take that away, as well as pre-existing conditions.”

Tonya Campbell, marketing director for the state employees’ insurance board, said there was no premium increase in 2017 for Medicare eligible retirees.

However, non-Medicare eligible retirees saw a $23 per month increase.

She said they were required to re-enroll as well as active state employees.

“Medicare retirees were not required,” she said.

Campbell said there is also a new benefit called tele-doc.

For state employees and non-Medicare eligible retirees, they are able to call in and schedule by phone, Skype or FaceTime a tele-doctor’s visit.

“The doctor may diagnose minor illnesses such as sore throats or sinus infections,” she said. “There is no copay and it is free. It’s a great way to avoid co-pay and have your meds called in.”

Medicare-eligible retirees also were switched to the Blue Advantage program.

“Everything is all in one now,” she said. “Federal law required that your coverage is equal or better than what you had before,” she said. “So, they are receiving some better benefits.”