A Superior Court Judge has issued a stay that halts a Highmark Medicare Advantage plan for state retirees slated to go into effect next year.
A group known as Rise argues that the program will harm retirees by forcing them to join a network of providers rather than using traditional Medicare. They further claim that the system will reject treatments that would have otherwise gone forward under Medicare.
Rise was organized by retiring State Rep. John Kowalko, D-Newark and New Castle County Council member Dee Durham, a state retiree.
Advocates of Medicare Advantage say the program gives retirees additional services that aid in dealing with chronic diseases such as diabetes and heart conditions. Benefits can also include dental and fitness programs and no co-pays on prescriptions.
Delaware struggles with health issues that include higher rates of cancer, diabetes and obesity that add to healthcare costs in both the government and private sectors.
Medicare Advantage aims to cut health care costs that now account for a large percentage of the state budget.
The program was developed in consultation with groups that included the Delaware Education Association and other retiree groups.
Kowako and Durham claim that retirees were shut out of the process and left in the dark about the program.
Changes have been made to the program that includes state retirees keeping their current physicians who accept Medicare.
Delaware House leadership issued the following response:
“State pensioners deserve the benefits they worked for and were promised. Since learning the details of the planned transition, legislators engaged the administration in negotiations and secured several concessions to the original agreement. The House and Senate also drafted legislation to further protect our retirees and add more oversight, including giving retirees a seat at the table.
“Throughout this process, we have closely followed the court case regarding the move to the new healthcare system. The Superior Court ordering a pause injects uncertainty into this situation for our retirees, but we are committed to supporting them throughout this process. Legislators will re-engage the administration and our retirees on next steps and how to ensure that current and future pensioners are protected and receive the best possible care.”
Medicare Advantage programs have been controversial for reasons that include possible rejection of treatments not deemed to be necessary and allegations that providers are ordering unnecessary treatments and driving up costs.
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