Upcoming health care shift for N.H. state retirees, explained

  • Kathleen Zaso of Concord is facing a followup surgery on Jan. 7 and she is worried about her new health plan. GEOFF FORESTER / Monitor staff

Monitor staff
Published: 12/20/2018 6:07:57 PM

On Jan. 1, nearly 10,000 state retirees face a transition: a mandatory change from their present state-funded health care plan to a new one. For Kathleen Zaso, it’s been a process easier said than done.

In September, the Concord retiree began working to schedule a surgery under her present plan, Medicomp, available to retirees through the end of December. But with the coming Jan. 1 transfer to the “Medicare Advantage” plan, Zaso wanted to make sure the same hospitals and providers would be continuously covered in the new year.

The search proved frustrating. After dozens of phone calls with representatives of Anthem, the insurer that will administer Medicare Advantage in New Hampshire, and the state Department of Administrative Services, Zaso struggled to get clear answers on which hospitals would be covered in 2019. A representative from Indiana said Dartmouth-Hitchcock Medical Center in Lebanon was not covered; a manager in Alabama later said it was. A Wisconsin representative gave a list of hundreds of providers covered, but it was disorganized “gobbledygook,” Zaso says.

Two months later, Zaso received a card for the new system, and after still more difficulties finally got the confirmation that her coverage would continue with the same hospitals and doctors. Her surgery took place last Friday. But her experience was a trial, she said. And for Zaso, who worked as a bureau chief in the state’s Department of Health and Human Services and is intimately familiar with health care administration, the past month’s experience is a lesson in how not to do a rollout.

“Everyone made a big deal about the Obamacare rollout, ‘Oh, terrible.’ ” she said. “Well I don’t think the state of New Hampshire for the retirees has been very good.”

While declining to comment on Zaso’s direct case, officials from Anthem and the Department of Administrative Services have stressed that the transition is designed to be a smooth handover of the same care for all 9,800 Medicare state retirees. But that message may not be reaching the rest of the state’s now-retired state employees.

So here’s a short recap of what’s about to happen.

What exactly is changing?

Substantively, not much, officials say. Anthem will cover the same services, doctors, hospitals and providers under the new Medicare Advantage program as under the present Medicomp system. That means retirees should see no disruption in their care.

The main difference lies in how those services will be paid for. Rather than splitting coverage into three parts of Medicare (Medicare A, B and D), the new program runs all bills through one part – Part C. Doing that gives Anthem more control over the way the health care is paid for and unlocks greater federal funds to relieve state coffers.

Importantly, however, that change does not affect the price tag of care for consumers. It’s simply a new way for the state to handle administration and payment and for Anthem to oversee its coverage.

The bottom line: Any provider that was in network in December will stay in network in January. And any provider that is out of network but accepts Medicare will be available for care as well.

“For the retiree it’s going to feel just like it did in 2018,” said Joyce Pittman, director of Risks and Benefits at DAS, which oversees retirees’ health care. “It’ll feel the same.”

What should retirees prepare for?

All retirees are set to receive a new card in the mail, if they haven’t already. This will replace the Medicomp card, but recipients are advised not to throw out the old card in case the state ever transitions back.

Participants should reach out to their doctors and providers to alert them of the new program, administrators say.

Why is this happening?

The Medicomp system, while appreciated by many retirees, has taken some severe financial hits in recent years – mostly due to claims surpassing available funds and the Legislature’s failure to fund the program adequately. By transitioning to a Medicare Part C program, the state offloads the risk it was taking on before by self-insuring and passes it on to Anthem. The new federal funds the move unlocks will also save the state an estimated $11.8 million a year.

(Ethan DeWitt can be reached at edewitt@cmonitor.com, at 369-3307, or on Twitter at @edewittNH.)




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