Molly Janczyk and Greg Nickell re: Medicare Advantage

(Best read from bottom up)

From Molly Janczyk, August 31, 2009
Subject: RE: Greg Nickell: STRS: A GAO document that should be read by every STRS retiree who soon (if they're 65) will be defaulted into a Medicare Advantage program:

Thank you Greg. I very much appreciate your timely explanations.

From Greg Nickell, August 31, 2009
Subject: RE: Greg Nickell: STRS: A GAO document that should be read by every STRS retiree who soon (if they're 65) will be defaulted into a Medicare Advantage program:

Ms. Jancyzk:

I can tell you that:

· A higher percentage of premium dollars will be paid toward claims expense than what is expressed in this article as it is guaranteed through the contract we hold with Aetna;

· This plan has an annual out-of-pocket maximum which traditional Medicare does not offer and many of the plans discussed in the article did not offer. By plan design, no person could pay higher maximum annual out-of-pocket expenses for covered services under the Medicare Advantage Aetna Medicare Plan (PPO) than they would under the Plus Plan as the Aetna Medicare Plan (PPO) has a $500 lower total out-of-pocket annual maximum -- $1,500 Aetna Medicare Plan (PPO) versus $2,000 under the Plus Plan. This is the amount when you add the medical deductible, copayments and coinsurance together applicable to each plan);

· Everyone will pay less for preventive services than the Plus Plan because they are covered at 100% not subject to deductible under the Aetna Medicare Plan (PPO);

· Access to fitness centers is covered under the Aetna Medicare Plan (PPO) and are not covered under the current Plus or Basic Plans;

· There will be care management services available that do not exist under the Plus Plan like disease management, depression case management, dementia care management and management for social service issues;

· Every person who enrolls in the Aetna Medicare Plan (PPO) will save premium dollars every month over what they would pay otherwise under the Plus Plan; and,

· There is no difference in coverage for someone using a PPO provider versus a non-PPO provider so long as the provider accepts Medicare assignment. A provider accepting Medicare assignment is the same criteria used currently under today’s Medicare Plus and Basic Plans.

(I provided much of the list above to Mr. Curry to hopefully reduce some of the time it will take him to develop his questions.)

The report does not distinguish between individual plans and a group plan like the STRS Ohio Plan. This is an important difference in my mind. STRS Ohio had Aetna construct the plan based upon the current Plus Plan as opposed to an individual purchasing a plan based upon something the individual read or as a result of speaking to someone “selling” the individual plan. When someone purchases an individual plan it is likely they do not fully understand how the plan works in any great detail compared to the time and effort STRS Ohio staff puts toward building this plan to be based around the current Plus Plan. Aetna also totally understands the provisions in the Plus Plan as they are currently administering this program.

Ms. Janczyk, your last point regarding the impact of changes being discussed in Washington and President Obama’s talk of reducing funding to the Medicare Advantage program is also an important point. STRS Ohio staff discussed this at some length with Aetna during the contracting phase. Aetna provided their plan on how they believe this change in funding will develop along with how they intend to remain competitive to arrangements like our current Plus and Basic Plans even with the reduction in funding.

If this does not address your questions or concerns, please let me know what remains unanswered.

Sincerely,
Greg Nickell
Director, Health Care Services
State Teachers Retirement System of Ohio

From Molly Janczyk, August 31, 2009
Subject: FW: Greg Nickell: STRS: A GAO document that should be read by every STRS retiree who soon (if they're 65) will be defaulted into a Medicare Advantage program:

Greg,

1. I would like you to address any negatives in the report as to how it relates to STRS Medicare Advantage.

I think you understand the general concerns. So us reading this report doesn't make a case for the Medicare Adv. plus

2. The impact to us with Obama wanting to discontinue/reduce funding to Medicare Advantage Plans

From Greg Nickell, August 31, 2009
NickellG@strsoh.org
Subject: RE: Greg Nickell: STRS: A GAO document that should be read by every STRS retiree who soon (if they're 65) will be defaulted into a Medicare Advantage program:

Ms. Jancyzk:

Do you have specific concerns about this report so I make sure I address them in my response?

From Molly Janczyk, August 30, 2009
Subject: Greg Nickell: STRS: A GAO document that should be read by every STRS retiree who soon (if they're 65) will be defaulted into a Medicare Advantage program:

Greg,

Please read and respond. Thank you.

Molly J.

http://www.gao.gov/new.items/d08522t.pdf