Retiree plan promises might have been “too good to be true”

Above: A Town retiree says she was told that that single health plan option they were offered doesn’t include the SilverSneakers benefit — one of two promises allegedly not kept. (image)

According to a retired Southborough employee, the single Medicare Advantage Plan offered by the Town is not delivering on promises made this fall.

As I previously covered, the Select Board voted in October to shift from offering retired Town employees 5 medicare supplement/advantage health plan options to just one plan. Now one retiree is publicly asserting that it hasn’t been the “win-win” that was pitched.

According to resident retiree Cynthia Foster, two specific promises made haven’t panned out. And because she opted out to instead choose a plan that does cover what she was promised, starting in January, her costs will skyrocket.

The two issue are related to SilverSneakers and Doctor coverage/networks.

SilverSneakers

Retirees were pitched that the Aetna Medicare Advantage Plan through the Mass Strategic Health Group would include the SilverSneakers program, that covers membership to certain fitness programs. That meant many retirees would have a new benefit and cost savings, and those in the one plan that already covered it would retain the benefit.

Foster was previously on the Town’s Fallon plan, the one plan that had included the SilverSneakers. She told the Select Board on Tuesday night that the “concierge” assigned to answer questions and navigate issues with the plan informed her that the plan the Town purchased didn’t cover that program. 

Doctor coverage

In the October meeting and presentations/promotions to retirees, the Town’s benefit plan advisors (NFP) had assured the retirees that their providers should accept the new plan.

In public comments at the November 7th Select Board meeting, Foster raised concerns that her primary care doctor wasn’t covered. She was promised follow up. On December 19th, she returned to the Town House to update the Select Board that she was correct and ask what they would do to offset her costs.

Foster told the board that her doctor said he wouldn’t take the insurance. She was promised that the Town would follow up. This week, she described the back and forth with the town’s independent “Concierge Service (RetireeFirst) and the doctor’s office since then. It purportedly culminated in a representative visiting the office unannounced to question the doctor’s office to request more detailed information, frustrating the doctor and angering the former town employee.

As to why her physician won’t take Aetna, Foster said that based on her research,  the insurance company’s reimbursement fees are far lower than other plans. Doctors who are out of network can at least get the Medicare minimum reimbursement. Foster referred to Aetna as the “Walmart of health plans”.

In the October meeting, NFP representatives Rusty Short and Ken Lombardi claimed that doctors offices that had told retirees they don’t take Aetna must have misunderstood what the plan was. They said a concierge would walk offices through how to submit bills under Medicare Part B. They defended that the retirees’ doctors must take Medicare or they wouldn’t be their current doctors, therefore they would also accept the Town’s version of the Aetna plan.

Cost impacts

The Select Board’s October vote to change health plan options wasn’t just driven by cost savings to the Town. They had been pitched that the change would also save money for retirees and offer improved benefits for some.

Under the new plan, Foster would have had to pay the monthly membership fee to the YMCA she uses, $62/month. She said retirees are only reimbursed $300 per year for those kinds of services (which leaves $444 as her responsibility).

According to Foster, in November, she told RetireeFirst to stop contacting her doctor’s office. (It appeared that she felt the doctor was feeling badgered.)  She was then contacted by NFP. She was asked if she would like to see if they could get Fallon to keep her as a customer on an “exception” basis.

When she followed up, she discovered the plan closest to her current one would cost $200/month and the Town wouldn’t subsidize any of it. She still made the choice but was now asking the Select Board what to do to be “reimbursed”.

Looking at the presentation made in October, if the Town had renewed its Fallon plan option for retirees, the cost to Southborough retirees would have been $82 per month. That is a difference of over $1,400 per year over what Foster will now pay. (The Town would have footed $246 per member/month.)

Employees had been warned in October that they would be on their own if they opted out of the Town’s plan. But, they had also been made promises about what taking the plan would cover that allegedly aren’t being met.

Select Board discussions & looking forward

In October, some retirees had publicly worried that promises were too good to be true. Retiree and former Select Board member Bonnie Phaneuf argued that the board’s vote was premature with more study needed on the doctor coverage issue. Member Kathy Cook rebutted that the Town had spent a lot of time looking into it and the decision wasn’t premature.

Upon questioning about the SilverSneakers this week, Select Board member Marguerite Landry voiced that she hadn’t known that the benefit wasn’t being included.

In October and November, member Al Hamilton made clear that if promises made by NFP didn’t prove out, he would want to see the representatives back in front of the board to answer questions.

Because the item was on the agenda for this week’s meeting, Select Board Chair Andrew Dennington told Foster they couldn’t get into the issues but would stay on top of it.

Foster pressed for an answer on whether the Town would pay for anything, or she would have to pay completely out of pocket. Dennington said he couldn’t answer. He advised the retiree to follow up with them.

With the effective date for plans changing on January 1st, the window has passed for switching Medicare supplement plans for 2024.

Phaneuf also commented at this week’s meeting. She told the board that she had adopted the new plan and paid the premium, but she still was unsure whether her rehab services would be covered when the switchover is made.

The new consolidated plan under Aetna was just for a one year commitment. In October, Insurance Advisory Committee member Ryan Donovan said they would follow up on plan members’ actual experiences next year before making a recommendation on whether to renew or make changes for 2025.