http://www.statejournal.com/story.cfm?func=viewstory&storyid=30917
“The State Journal
Angry Retirees Question PEIA Changes
Posted Thursday, November 1, 2007 ; 06:00 AM
Updated Thursday, November 1, 2007 ; 12:12 AM
Some PEIA subscribers are unhappy with changes in the state-run health insurance program.
Story by Beth Gorczyca Ryan
Email | Bio | Other Stories by Beth Gorczyca Ryan
HUNTINGTON — Hundreds of retired state workers are lashing out at the Public Employees Insurance Agency after the insurance provider changed carriers.
Between 175 and 200 retired and soon-to-be retired state workers and teachers gathered Oct. 29 at Huntington High School to learn why PEIA decided earlier this year to allow Kentucky-based Advantra to provide health care coverage for retirees who are eligible for Medicare.
One of the biggest complaints the retirees had is that the new card and provider are not accepted in some other states, including parts of Florida, North Carolina, South Carolina and Georgia. They also complained the new system was costing them a whole lot more and providing worse coverage than what they had before.
“I feel like PEIA sold us out,” said Imogene Parrish, a retired Cabell County Schools worker.
The group was so bothered by the changes that attendees began bombarding the PEIA representative with questions as soon as the meeting started. And the questions continued, one after another, sometimes being asked directly over another, for two hours. PEIA’s representative, Gloria Long, deputy director for insurance programs and services, tried to answer questions and calm people. But by the end of the meeting, people were just getting madder and blaming everyone from Gov. Joe Manchin to President Bush for the health insurance changes.
“The intention was never to stick you out there without insurance or to make you feel uneasy about your insurance,” Long said.
She told the group the PEIA board decided a while ago to allow Advantra to handle insurance for all PEIA members who were eligible for Medicare. Advantra then set up a plan based on PEIA’s requirements, as well as specifications Medicare demands. PEIA’s board accepted the proposal, and the new benefits went into effect July 1.
She said PEIA has heard about problems, particularly with finding providers in other states.
“There are some pockets of the U.S. that don’t accept Advantra,” she said. “We are calling providers to ask them to start accepting (it). We are trying to help out.”
She said every doctor or health care provider that accepts Medicare payments should be accepting Advantra as well. But some areas just aren’t willing to accept the new carrier. She said that has caused lots of problems for retirees who travel a lot or spend several months in warmer climates. As a remedy, she said PEIA has agreed to let some retirees who do spend a lot of time out of state rejoin the old plan for the time being.
Another common complaint was that some retirees under the new carrier were losing the supplemental insurance they had purchased for themselves and their spouses over the years.
“I’m just wondering if you are aware how this is impacting other plans,” one man called out from the audience.
“Painfully aware,” Long said. “The issue there is Medicare considers any plan with a Plan D (or prescription drug coverage) as double dipping, and they kick you out.”
That was not the answer the man wanted to hear.
“I paid for this insurance while I was working, and now I have less than before,” he said.
Long told him one solution would be for him to maintain his PEIA life insurance but drop his PEIA health insurance and sign up under his wife’s plan. She said if he did that, he could rejoin PEIA at any time.
The new coverage also is limiting where some people can go to the hospital. Long said she’s heard of cases where hospitals have turned away patients with Advantra. Her recommendation to those in the group was to call the hospital before any planned procedures to make sure they accept that carrier.
Some of the biggest complaints, however, were about retirees having to pay co-pays, co-insurance and deductibles, something they didn’t have to pay under the old system. That’s a big change for some former state workers. And it’s a bitter pill for them to swallow.
Long said while many people are blaming Advantra for the problems, she said Advantra designed a program to meet PEIA’s requirements and specifications.
“The plan design we have to take credit for at PEIA,” she said.
The plus side of the changes, Long said, is that it won’t raise premiums. In addition, retirees will have a maximum out-of-pocket expense for health care per fiscal year of $500. However, she said retirees who make less than 250 percent of the federal poverty rate are eligible to have that maximum out-of-pocket amount reduced.
Money spent on prescriptions is not included in that maximum out-of-pocket amount.
She said despite the retirees’ complaints, she believes the program is good and provides retirements with the same excellent level of health care. But she admitted that it’s different, a bit confusing and that adjusting to the new system could take some time.
“I believe you have a good health plan; if I didn’t, I wouldn’t be here,” she said.
Cabell County Delegates Kelli Sobonya and Carol Miller, both of whom are Republicans, called the meeting, which was attended by the county’s two senators, Robert Plymale and Evan Jenkins, both of whom are Democrats. All four not only listened to complaints but also tried to answer questions, or at least help them find someone who could answer their questions.
“There were so many questions we couldn’t answer, so we figured we’d bring PEIA here to answer them for you,” Sobonya told the audience. “
