Over the last few days, you may have received a notice from Aetna indicating that they now provide a choice of two different ways of receiving your retiree healthcare. The first is through the current Aetna Medicare Advantage plan and the second is through a new Medicare Wrap.

This is better understood as a single plan, the State Employee Retiree Plan. That Plan does what it has always done: provide the core state employee health plan to Medicare-covered retirees by covering those services that state employees have that Medicare doesn’t cover, and the additional deductibles and costs for covered services that Medicare includes that are not imposed by the State Employee plan.

There is now a choice of two different ways of receiving that core coverage. It can be received through the current Medicare Advantage structure or through the new Medicare Wrap. While core benefits of both choices are identical, the Medicare Advantage choice provides significant supplemental benefits not available under the Medicare Wrap choice.

And even though the Medicare Advantage plan provides these supplemental benefits, the alternative Medicare Wrap choice costs $379 a month more per person.

This Medicare Wrap choice came about because some retirees have expressed a simple preference for it, and SEBAC was able to negotiate that option in the SEBAC 2026 Agreement we reached earlier this year, to go into effect on January 1, 2027.

The vast majority of retirees have given positive feedback about the current Medicare Advantage plan for delivering state retiree benefits.

The Medicare Wrap is not an upgrade or premium plan. It is simply a different way of receiving State retiree health benefits at a cost of $379/month per person. In this case, more expensive doesn’t necessarily mean better.

Why are there two different ways of delivering the same core benefits?

Medicare Advantage is the result of a trade off reached in the 1990s. Progressive legislators wanted to pay medical providers more when they care for more seriously ill patients to encourage them to treat such patients and spend the additional time with them that they need. So, they wanted Medicare to subsidize that care with higher reimbursements for those patients.

Conservative legislators wanted to expand the presence of private insurance carriers in providing Medicare. These legislators blocked the ability to create Medicare Advantage unless it was provided by private carriers.

So the compromise is a Medicare Advantage with the upside of providing incentives for sicker patients, which means the federal government is providing much higher subsidies overall for Medicare Advantage than it does for traditional Medicare, and the downside of including private insurance.

In 2017, when CSEA through SEBAC made the choice to move to the Medicare Advantage vehicle for providing State Retiree Benefits, we were confident that the size of our Plan and power of our membership would enable us to make sure that the private insurance companies behaved themselves. So we have the upside of Medicare Advantage with little downside, and that has been the experience of the vast majority of our retirees.

Why does the Medicare Wrap cost more?

The above-mentioned trade off is why the Medicare Wrap choice is so much more expensive for retirees. The State is expected to make the same basic contribution towards either choice, but since the federal government subsidizes the Medicare Wrap choice much less, the retiree making that choice pays more. The $379 is based upon the Plan’s actuaries’ estimates of likely claims with the lower federal reimbursement.

In addition to the $379 per person, per month premium, the Medicare Advantage choice provides some supplemental benefits not available under the Medicare Wrap. These include:

Up to $200 in Healthy Rewards per person per year

Silver Sneakers

24 one-way non-emergency transportation trips per year

Care and disease-management/nurse support

Coverage for naturopath providers under the existing copay structure

28 post-discharge meals after an inpatient hospital stay

What about provider access?

By law, Medicare participating providers must treat all traditional Medicare patients, regardless of their other insurance. That law does not apply to Medicare Advantage patients.

However, the law does require that Medicare Advantage providers offer to all Medicare providers at least the full Medicare rate for their services. This means that nearly all providers have agreed to treat State of Connecticut retirees regardless of whether the provider is in the Aetna Medicare Advantage network.

For those few circumstances where needed providers are unwilling to accept payment through Aetna, the Medicare Advantage choice already contains a free opt out provision for affected retirees that is unconnected to the new Medicare Wrap option.

It is important to note that such provider access challenges are extremely rare and almost exclusively relating to out-of-state doctors or medical facilities. If you experience a provider issue, it’s important to contact Aetna to try and resolve it before making the switch.

If you are one of the few retirees having issues receiving coverage under the current option, this is the process in place to help resolve that issue that begins with the Aetna Retiree Member Services unit and, if necessary, goes through the Comptroller’s Retiree Health Insurance Unit.

Aetna Retiree Member Services:

855-648-0391 (TTY: 711)
Monday–Friday, 8:00 a.m.–9:00 p.m. ET

For enrollment and eligibility questions, you may also contact the:

Office of the State Comptroller
Retiree Health Insurance Unit:
860-702-3533
Monday–Friday, 8:00 a.m.–4:30 p.m. ET

If your current Aetna Medicare Advantage plan is working for you, do nothing. Your coverage continues automatically and your premium co-share remains $0, while the premium co-share for the new Medicare Wrap is $379 per month.

Before switching, make sure you fully understand what you are gaining and what you are giving up. If you have any questions, call us before you act. If your current plan works for you, you can stay right where you are.