CENTRAL ILLINOIS (WCIA) — The Illinois Department of Central Management Services (CMS) handed a contract to Aetna that will make it the primary health insurance option for retired state workers, a closely connected source verified.
This comes within a week of Target 3 reporting that patients in Champaign and surrounding counties on a state-run Aetna Medicare plan have been struggling for months to find a doctor.
CMS was still in the process of picking a handful of plans for state retirees from scratch last week for the first time in a decade, so there was a possibility that plan options could change and with them, doctor options.
Reporters learned Friday that Aetna was awarded the PPO contract for the entire state starting in 2023, a contract United Healthcare has held for ten years and the life of the state’s Medicare Advantage program, known as the Total Retiree Advantage Illinois Medicare Advantage Prescription Drug (TRAIL MAPD) program.
Aetna is poised to be at least one of two plan options in every county as opposed to the 50 counties its Medicare plans are offered in now.
The patient disruption reported on for months primarily affected people enrolled in Aetna’s Medicare HMO plan after they lost access to Carle Foundation Hospital and surrounding clinic doctors in January.
Aetna’s PPO plan also fell out of network with Carle, but until now, it’s not been an option for state retirees, so the impact is unclear.
United Healthcare’s PPO plan is not accepted at these Carle facilities either. The difference, according the Executive Director of the Illinois Retired Teachers Association (IRTA) Jim Bachman, is that those kinks in coverage were worked out years ago. He said the transition ten years ago was “bumpy” for a few years after the state moved retirees to a program separate from employees in 2014, and he says this will be another huge transition.
Reporters first caught wind of a contract of sorts awarded to Aetna after obtaining an internal memo sent to IRTA members Friday.
It remains unknown whether Aetna will be re-awarded an HMO contract come open enrollment in October, and so far, the statewide PPO contract is the only one verified.
United Healthcare appealed the decision earlier in the week, according to multiple sources, so nothing is final at this point. Reporters were told by multiple sources that the appeal should be decided in roughly 30 days.
Patients who enroll in PPO plans — which are pricier than HMO plans — typically live out of state or travel a lot because, unlike HMO plans, PPO plans provide access to a wider range of doctor and facility options even out of state.