Importance of Medicare Guaranteed Issue Rights - Avaya

[vernlarson]

Below has been sent to all NRLN Avaya Chapter members, Vern Larson

Importance of Medicare Guaranteed Issue Rights for Avaya Retirees

Vern Larson, President, Avaya Retirees Chapter - NRLN, and his wife Rose, a former IBEW member, serve as an example for the importance of Medicare Guaranteed Issue Rights (GIRs) for Avaya and other retirees.

In 2023, after several years of collective bargaining attempts by two international unions and Avaya management, approximately 12,000 Avaya retirees were notified that the parties reached a final impasse and that the union contract had been terminated.

Effective 2024, Rose and Vern lost their annual Avaya bargained for Medicare Supplement plan G benefit (Medigap) along with their Healthcare Reimbursement Account (HRA) of $2,200 for Rose (over age 75) and $2,000 for her spouse Vern (over age 75). Neither Rose, Vern or others of the 12,000 affected have been notified by Avaya or either of the two unions or insurance companies that they were GIR eligible.

Rose and Vern both have chronic Illnesses and still pay Humana a combined premium of $574 a month, $6,888 annually (out-of-pocket) for the same plan available from Physician Select Services for $3,289 or 47% less than they would pay if they had been notified, they were GIR eligible.

When an original Medicare beneficiary or Medicare Advantage (MA) enrollee qualifies for a GIR, insurers must accept their eligibility without regard to medical history and be allowed to shop for the best premium deal on the market. GIRs are a protection for those who are most vulnerable.

The NRLN is finalizing documents to use in meetings with members of Congress, there staff, Committee staffs and the Centers for Medicare and Medicaid to advocate that retirees from Avaya, AT&T, IBM and TVA were not provided the full measure of a federal law when their Medigap plans were discontinued. and this must be rectified.

There is another important issue that will soon impact more than 1 million seniors who have a Medicare Advantage plan. Here again having a GIR will be important.

Humana has told investors that the company expects to lose about 560,000, about 10% of its MA enrollees next year after it exits 13 unprofitable markets and trims its plan options. CVS Health Aetna will force 420,000 members to find other coverage. Centene - Wellcare announced in August it will be ending plans which will impact roughly 37,000 enrollees. Up to 5,395 Cigna beneficiaries will have to find new plans. UnitedHealthcare has not announced whether it will drop MA enrollees.

There have been news reports that MA insurers will be adding or raising premiums and increasing the out-of-pocket amounts due to higher expenses and lower profits as MA plan enrollees get older and have more healthcare costs. If your plan is discontinued, it is an opportunity to give thought to whether you want to continue in an MA plan (Part C) or enroll in original Medicare (Parts A and B) and a Medigap plan.

If you have not heard from your MA insurer about the status of your plan for next year, you should immediately contact your MA plan provider or your insurance agent to learn whether your plan will be continued.

If your plan is going to end on December 31, 2024, you should be sure to obtain a letter or email from your MA plan provider that states, as federal law requires, that you have a Guaranteed Issue Right (GIR) to get another MA plan or go into Original Medicare.

With a GIR you can acquire an MA plan or enroll in an Original Medicare, and if you choose, buy a supplement policy (Medigap) to cover the 20% that Medicare does not pay. The GIR provides you 63 days after your current MA Plan coverage ends to obtain other healthcare coverage. The upcoming Medicare Open Enrollment period October 15 – December 7 will be available to enroll in a new plan.
During the 63-day window, you cannot be denied for an MA plan or Original Medicare with a Medigap plan due to a pre-existing medical condition or face underwriting due to your medical history.

If your MA plan ends and you do not take action to acquire a different MA plan or enroll in Original Medicare you will be automatically enrolled in Original Medicare, but without a Medigap plan. Your MA plan that may be ending could have included Medicare Part D for prescription drugs. If so, it would be wise to shop for and purchase a Medicare Part D plan or an MA plan that includes Part D coverage.

Keep any letters, notices, or emails from your MA plan stating that your plan will be discontinued. You may need the information to prove your coverage ended to gain a GIR.

If your MA plan provider is discontinuing your plan and has not notified you about your GIR, the NRLN encourages to you let us know at contact@nrln.org your city, state, the name of your MA plan insurance company and whether it is an HMO or PPO.

The NRLN website at http://www.nrln.org has video to assist anyone who wants to shop for a Medigap plan on http://www.medicare.gov. Another video will be created and posted in early October on how to search for Medicare Advantage plans on http://www.medicare.gov.

The NRLN wants to help you get the healthcare coverage that is right for you at the best price. Ask your friends to sign up at https://nrln.org/2021/01/email-sign-up/ to receive NRLN emails. We will keep you informed on this MA issue and other issues important to retirees.

Bill Kadereit, President
National Retiree Legislative Network