State Merit - Georgia

[North American]

I've recently spoken with a handful of retired teachers telling me they have the Sate Merit plan. They don't seem to know the details "but everybody says it's great insurance". Does anyone hear in Georgia know about or understand this plan? Is it Medicare Advantage? What does it cost? What are the copays, deductibles? Has anyone here gotten a retired teacher to choose a supplement instead?

Thanks!!

 

[sman]

They have a couple of options with the MA plan being the cheapest. I don't recall the specifics but do recall it being a plan that we can't touch with anything we have. If memory serves me correctly, the premium is minimal and the plan has a $1,000 MOOP. Additionally, if they ever opt out, they can't go back. Unless the plan changes next year or any year after that, we likely won't be replacing any teachers on the state program.

If there is someone who has gotten a teacher to choose a supplement instead, they have done them a disservice unless their doctor just doesn't participate in the plan they have.

 

[somarco]

georgia.gov - State Health Benefit Plan (SHBP)

 

[sman]

Well there you go. Thanks Bob. Here are the Summary of Benefits for the two Cigna plans:

http://www.cigna.com/sites/stateofga/pdf/SummaryofBenefits_Standard.pdf

http://www.cigna.com/sites/stateofga/pdf/SummaryofBenefits_Premium.pdf

Just as I remembered, the standard plan has a MOOP of $1,000. The premium plan has a MOOP of $500. Neither plan has a coverage gap for Rx. Both plans are pretty rich in benefit.

Like I said, if someone has "gotten" a teacher to choose a Medicare Supplement over this plan, they have likely done them a disservice.

 

[North American]

I'm not advodating that anyone choose a MedSupp over the State Merit options; I'm just trying to understand it. As I look at the plan info, it does look like these are PFFS plans. Would there be any value to someone paying a few dollars more each month to have more options? The max out of pocket is nice, but not if you can't see the doctor you want.

(Again, this really is a question. I want to understand.)

 

[sman]

As I stated in my first reply, the only reason to switch would be due to the fact that the insured wants to see a doctor who won't accept their plan.

Additionally, I don't believe that the MA plans are their only choice. They have the standard HMO/PPO type plans available to them at a higher cost than the MA plans. Of course, these usually aren't a good option for those on Medicare since they have deductibles and copays.

The retired teacher market in Georgia isn't really one to go after for Med Supp business. They usually have some nice 403b accounts that you can roll though.

 

[North American]

That's really helpful. Thanks.

(I wouldn't say I'm "going after it", it's just who's been picking up the phone.)

 

[dandan]

2016 would you still not change someone from Georgia State Merit to another plan?

 

[sman]

2016 would you still not change someone from State Merit to another plan?

If it's from MA to MA then probably not. They have two options. One has a max out of pocket of $2,500 and the other is $3,500. There's no MA plan available in Georgia that can compete with what they have. However, the $2,500 MOOP plan has a premium of a little over $88 per month. Personally I think a Plan G or N is a better value. The challenge is that most teachers have been with the school system for 30-40 years and they have a tough time giving up their benefits. They believe it's something they've earned and feel as if they are losing out by not going with it.

It's a battle I choose not to accept. There is lower hanging fruit out there to grab.

 

[dandan]

Thank you, I didn't know if I had missed anything, I have a neighbor that called me and said that her doctors were out of network with State Merit and she wanted something different, she went with a zero premium plan and was happy. Yesterday a friend of hers convinced her that she had lost some golden State benefits.