Jun. 24—MASSENA — Town of Massena retirees say they’re happy with a new health insurance plan that will kick in on Jan. 1.
Zachary Zuckerman, a group benefits consultant at USI Insurance Services in Syracuse, outlined the new plan for the Massena Town Board, with several retirees in attendance. Among them were some who had served on a town committee that examined potential retirement health insurance plans.
Mr. Zuckerman said he was no stranger to Massena, having worked with village officials as well as current Deputy Town Supervisor Patrick M. Facteau when he was the chief financial officer for the former Massena Memorial Hospital and now as a member of the town’s retiree health insurance committee .
“The village has been a client of ours for decades,” he said.
Mr. Zuckerman said the key to saving the town and retirees money on their health insurance plans was to enroll in Medicare Part C, the Medicare Advantage Program rather than Medicare A, B and D offered by the federal government. Part A covers hospitalization, Part B covers major medical, and Part D covers prescription drugs.
“C is a privatization of those federal programs. What happens is the insurance companies — Blue Cross Blue Shield, MVP, United Healthcare, Aetna, Humana — they get paid by the federal government to provide health insurance to Medicare-eligible retirees,” he said. “There are a number of companies who do it on a group basis. They’ll come to an employer and say, ‘Hey, how many retirees do you cover? Here’s our range to cover those retirees.'”
The more members, the better “star rating” the company receives from Medicare, Mr. Zuckerman said. And the better star rating, the more reimbursement they receive from the federal government.
“Therefore, the lower they can charge. There are a number of carriers who are four or five star rated, United Healthcare and Aetna being two of them,” he said. “Two years ago, Broome County, who has like 1,000 retirees that they cover, said, ‘Why are we shopping for our retirees on our own? Why don’t we do an RFP (Request for Proposal) and ask all of our peers to participate?'”
Mr. Zuckerman said Broome County put together an association called the Broome County Healthcare Alliance, which has 6,000 retirees covered by the program.
“They put it out to bid. The winner of that bid was United Healthcare. So, United Healthcare has put together a proposal to Broome County, and there are four plans that are offered through the Broome County Alliance. The one that I have used most frequently is Plan One. It is very, very competitive from a price perspective and very competitive from a benefits perspective. In fact, the major medical part of it has been paid in full. There’s no co-payments from the members. Prescription drugs have a $0 co-payment for generics, $5 for preferred brand name drugs, and $20 for non-preferred brand name drugs,” he said.
He said, because the plan is written on a group basis, retirees don’t have a “donut hole” when it comes to prescription coverage.
“You pay $0, $5 or $20,” Mr. Zuckerman said. “Based on the research that I’ve done on what is being done now, I believe that the town will save a considerable amount of money in premiums. More importantly, almost everyone will get better health insurance.”
He said United Healthcare offers a Preferred Provider Organization program with a list of doctors who accept their reimbursement. However, he said, United Healthcare will reimburse others who aren’t part of the program as long as they accept Medicare.
“I don’t believe we’ve had any issues in Massena or any of the surrounding communities that we work with that are on United Healthcare,” he said. “It might happen. It could happen. It’s unlikely. My experience is that it hasn’t happened.”
Mr. Zuckerman said the town had been approved to join the Broome County Healthcare Alliance. The premium is $260 per person in 2023, which will increase by 5% in 2024. It includes hospitalization, major medical and prescription drugs, which he said would save the town $43,000. Once individuals sign up for the United Healthcare program, it automatically terminates them from other coverage they might have.
“The benefits are going to be unreal, paid in full for everything except for prescription drugs,” he said.
In addition, retiree Nancy Fregoe said, “You get one bill. You send the check and you don’t have the problems that we have currently where each person is individually covered. You have to send two checks, one for prescription and one for medical. This is one check for all the coverage.”
Elaine A. Dunne, who’s retiring at the end of June, said retirees will also only need one card to cover all of their visits and expenses.
“One card for everything,” she said. “You’re not pulling out two or three cards for one visit. One card and you’re done.”
“It’s good for the town and it’s good for the retirees,” Ms. Fregoe said.