Effective July 1, 2018 The Teachers’ Retirement Board offers two health plan options giving retirees who have Medicare Part A and Part B a choice of plans. The Medicare Advantage Plan through Anthem is the “base plan” with the traditional supplemental plan, administered by Stirling Benefits, a “buy-up” option.
Anthem is the for-profit insurer that purchased the assets of the non-profit Blue Cross Blue Shield of Connecticut. The new program has both in-network and out-of-network benefits and is a Medicare Advantage PPO. The network is broad, with 95% of Connecticut’s physicians and all CT hospitals in-network. There is coverage across the United States.
Stirling Benefits is not an insurance company. We are a service company that administers the claims of members once they have reached their Medicare deductible.
As with all contracted health programs, the details are important. More information on the Medicare Advantage Plan, including a complete benefit summary, are available on the TRB website. The traditional Medicare Supplement Plan will continue to be administered by Stirling Benefits, and may be elected by completing the application on our website, or by contacting the TRB for an enrollment form.
Here are our answers to some questions we are getting from TRB members:
In January of this year, Dr. Joe Fields announced at a Board Meeting that the State of Connecticut had underpaid the TRB claims fund approximately $190 Million over the last fifteen years. Instead of funding 33% of the expected contribution, the state would contribute only 11% over the next two years. The higher premium to stay with the traditional Medicare supplement plan administered by Stirling Benefits reflected the amount that the state had not contributed to the TRB health fund.
In early May, after the TRB announced the change in plans and premiums, the CT Legislature voted to appropriate the required funding for the TRB Health Plan. The TRB's responsibility is to provide the best medical plan available within their financial constraints. The state is appropriating their 33% for this year, but this still leaves a gap due to several years of not funding their share. Therefore, the premium increase will remain for the rest of 2018.
With the newly approved funding of the plan, the TRB is able to examine plan options moving forward into 2019. Decisions on what plan(s) are offered, along with premiums, are expected to be announced by the TRB in early fall.
The Anthem plan and Stirling plan operate in fundamentally different ways.
With the Stirling plan, Medicare pays first; then the Stirling plan pays the doctor the remainder, usually up to 100% of the allowed amount. Most members report having no out-of-pocket costs after paying the annual Medicare Part B deductible. Members can see any doctor that accepts Medicare, anytime. To administer the medical program, Stirling receives a fixed fee of $4.69 per member per month and does not earn any more or any less regardless of the claims submitted by members. While Stirling Benefits is a for profit company, the TRB plan itself is a not-for-profit program. All claims are paid from the TRB health fund.
The new base plan is an insured program. The federal government will pay Anthem an amount that Medicare would expect to pay for TRB members. According to Dr. Fields, Anthem will receive approximately $11,000 per member per year. Anthem uses these funds to pay your claims. As an insured program, Anthem takes a risk: if claims are higher than expected, they will lose money. Alternatively, if claims are lower than $11,000, they will make a profit. And, because the program is rated with 4.5 stars, a high quality rating, Anthem will also expect to receive a $500 per member per year quality bonus from the federal government.
The new Medicare Advantage (MA) plan is not a gatekeeper program. This means that members can see a specialist without a referral from their primary care physician. Both Medicare and Insurance companies use pre-certification and authorizations to help control unnecessary over-utilization of care. However, most industry experts agree that insurance company authorizations are typically more stringent than traditional Medicare.
The different financial model allows Anthem to offer an insured program at a lower rate than the current plan. Aside from these differences, the additional $103 to stay with Stirling reflects the amount the state had not contributed to the TRB health fund.
To enroll with Stirling Benefits, you may contact the TRB to request an enrollment packet or you may click on the "Learn More" link under General TRB Information on the right hand side of this page. Under "useful links" please click on "TRB enrollment form"
The TRB has posted information on both plans on their website. You may also find more information from the Association of Retired Teachers of Connecticut (ARTC), American Federation of Teachers (AFT) or the Connecticut Education Association - Retired websites.
Meanwhile, to make an informed decision, you can research how Medicare Advantage plans work. A lot of information on these plans are available from unbiased sites, including Medicare.gov, AARP, and Consumer Reports. Most major news sites also contain articles about how Medicare Advantage programs work, and how they differ from Medicare Supplement plans (the Stirling plan is a group Medicare Supplement). Please be aware that much of the online information applies to plans purchased by individuals. The TRB Anthem and Stirling plans are both “group” programs, so the individual enrollment rules may not apply to you.
Stirling Benefits encourages all members to learn more about their health plan options and make a well informed choice. There is more to choosing your plan then the benefits design and the cost. How care is accessed and how you are serviced are also important considerations.
We understand that the TRB does not have a preference – financially, one way or the other - which plan you choose. We believe that TRB members are being offered two good choices at a fair price. Would we like the Stirling Plan to cost less? Certainly. Is it worth the difference in price? That’s for each member to decide.
Finally, Stirling staff are thankful and humbled to have served TRB members from our offices in Connecticut for 25 years. We are grateful to have helped so many retirees over these years and look forward to serving you in the future, if you decide that staying with Stirling, despite the extra $103 per month, is worth it.
Wishing you good health!
James (Jamie) Stirling