Gov't retirees bewildered by gov't-run healthcare

As many as 1,000 retired state employees from a six-county area could attend a briefing today at the Blair County (PA) Convention Center on changes the state is making to their Medicare coverage. The forced shift from traditional Medicare to privately run "Medicare advantage" plans has generated "unbelievable" confusion, said Dan Mazus, president of the Retired Public Employees of Pennsylvania.

Retirees can choose between Coventry Advantra Freedom "private fee for service" and health maintenance organization-style or preferred provider-style plans, but many aren’t capable of making a sensible choice because of the complexities, officials said.

The default Advantra plan provides the same level of coverage as traditional Medicare, Medicare Supplemental and Major Medical, according to a fact sheet issued by the Office of Administration, which is overseeing the change.

Complicating matters, the Advantra plan doesn’t provide a list of participating hospitals and doctors, so retirees must call around to find out who does, Mazus said.

Former Pennsylvania state employees living in Florida are ‘‘sweating it out’’ because many hospitals and doctors there don’t participate, he said.

The Advantra plan doesn’t provide a list because hospitals and doctors don’t sign a contract, like they would for HMOs or PPOs, said Mia DeVane, spokeswoman for the Office of Administration.

They can accept or refuse a patient at will and on a visit-by-visit basis, she said.

Providers will get the same reimbursements for procedures as from traditional Medicare, DeVane said.

The office that administers the plan will track participation and provide policy holders a list of providers who are unwilling to participate, she said.

Contrary to the belief of some retirees, the governor has the right to make the changes unilaterally, DeVane said.

“It’s an administrative decision” made to ensure that the current benefits, among the most generous in the country, continue, she said.

Mazus did not question the governor’s authority to make changes, saying retiree benefits are not a contractual matter.

But he resents that Rendell didn’t consult with his group or the American Federation of State, County and Municipal Employees union before acting.

Retirees also are complaining that the changes violate promises made by Rendell to leave retiree health care alone.

Dorothy Herman, regional vice president for the Retired Public Employees, says she heard the governor tell a small group that pre-2001 retiree benefits ‘‘would not be affected.’’

Mazus said he saw him make a similar claim in a campaign video.

DeVane said the change is ‘‘administrative,’’ and the benefits will remain nearly the same.


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