At the November Teachers Retirement Board (TRB) meeting, the Board voted to obtain bids for an alternative health plan. This new plan will be a Medicare Advantage Plan.
All retirees will be automatically dis-enrolled from the plan that Stirling Benefits administers and moved to the new Medicare Advantage Plan July 1st unless she or he re-enrolls in the current Stirling Benefits program.
"My husband retired from IBM. His retirement package offered insurance, but we chose Stirling Benefits over that. The customer service is wonderful and I can see any doctor I want to. I have doctors that cater to me and my husband that don’t accept any Medicare Advantage plan. I would pay an additional $60 a month or any amount of additional premium necessary to stay with Stirling Benefits!"
– Jane Sachs, TRB/Stirling Benefits - Member since August 2004
With the current plan, almost all doctor visits, all lab tests and hospitalizations are covered at 100% with no copayments. There is no network of preferred vs non-preferred doctors and no required referrals. Members can see any doctor or facility that accepts Medicare, anywhere in the United States.
Most Medicare Advantage (MA) have a network of providers, and member typically pay more for non-network services. We won’t know the details until the bids are in, but most MA plans have copayments for doctor visits, physical therapy or hospital services. MA plans sometimes require a referral to see a specialist, have surgery, or obtain coordinated care.
Frequently Asked Questions
Despite the TRB board and administration tirelessly advocating for full funding, the new two year CT budget underfunds the TRB health plan by around $50M. This comes on top of almost $100M underfunding by the over the last decade. The current plan is not sustainable without additional funding from other sources.
The TRB cannot just raise the retiree contribution to make up the difference. There is language that prohibits the TRB from raising retiree contributions above one third of the cost of the medical “base plan.” Since CT is not paying its share, the only way to maintain the current program is to charge the retirees that choose the traditional plan more. To do that, the TRB has to offer a new, less expensive, “base Plan” with the current Stirling plan being a “buy up” option.
New rates will not be known until the bids are in. This information should be available in late December or early January.
Medicare Advantage programs are typically operated by a large, for-profit insurance company. Members of an MA plan “trade-in” traditional Medicare, and the government pays the insurance company a percentage of what Medicare would to pay for that member. The insurance company makes a profit when the carrier spends less on claims then they receive in premiums.
Under traditional Medicare, members can generally see any provider, anywhere, anytime. The member choses what medical service to get and when. Under MA plans, there is typically a network of providers and visits to a specialist sometimes require a referral by a primary care gatekeeper or upon approval by the insurance company. By controlling care access, timing, the network and reimbursement rates, the insurance company is able to lower costs. MA plans argue that their coordinated approach produces better outcomes and that lowers costs.
Stirling Benefits is not an insurance company. We do not make more money if we deny or delay claims. Our goal is the prompt, accurate, courteous and cost effective administration of the TRB plan.
At this point, we do know you will have to re-enroll to "Stay with Stirling." The details of the re-enrollment process will be decided over the next month or so.
Spread the word. Please share this with your retiree friends and keep checking back to Stirling for updates on the new plan and re-enrollment. Please like us at Facebook and share our links with other retirees.
Our goal is to provide you with information about your plan options, and of course, to help make it easy for you to Stay with Stirling!
We look forward to serving you.
James (Jamie) Stirling,
CEO, Stirling Benefits, Inc.