In 2024, A Majority of States Offer Medicare Advantage Plans to Their State Retirees, with 12 Offering Medicare Advantage Exclusively

The share of enormous employers providing well being advantages to retirees has been declining over time, dropping to 21 % in 2023 in accordance with KFF’s Employer Well being Advantages Survey, although with considerably greater provide charges amongst public employers, akin to state and municipal governments, than amongst non-public employers. In 2024, practically all states and the District of Columbia (DC) present some well being advantages to their Medicare-age retirees.

Till pretty lately, employer-sponsored well being advantages for Medicare-age retirees have been sometimes designed to complement, wrap round or coordinate with conventional Medicare. These plans usually cowl some or all of Medicare’s coinsurance and deductibles, and generally cowl different advantages not lined by Medicare, akin to dental and imaginative and prescient. Over the previous few years, many states have shifted their strategy and at the moment are fulfilling their retiree well being obligations by providing protection by way of Medicare Benefit plans, mirroring the same pattern noticed amongst giant employers who’ve been shifting their retiree protection to Medicare Benefit. Medicare Benefit plans are non-public plans – akin to PPOs or HMOs – that present all Medicare-covered advantages, sometimes embody further advantages akin to dental, imaginative and prescient, listening to, and Half D drug protection, and sometimes present all advantages for no further premium (apart from the Half B premium).

Beneath this strategy, states sometimes contract with a Medicare Benefit non-public insurer to supply all Medicare-covered advantages in addition to further advantages for his or her Medicare-eligible retirees (and sometimes spouses). The federal authorities (Medicare) supplies a fee per retiree to cowl all Medicare advantages, together with a bundle of additional advantages for retirees within the group. The additional advantages can also be backed by the employer or worker premiums. Whereas some states provide their Medicare-age retirees a alternative between a Medicare Benefit plan and a plan that dietary supplements conventional Medicare, others solely provide Medicare Benefit. This shift to Medicare Benefit could assist states scale back their retiree well being legal responsibility and simplify administration, however presents tradeoffs for beneficiaries, significantly those that want protection below conventional Medicare.

This information word examines the extent to which states are offering well being advantages to their Medicare-eligible retirees by way of Medicare Benefit preparations in 2024, based mostly on KFF’s evaluation of states’ worker retirement system web sites (Determine 1, Desk 1). This evaluation doesn’t concentrate on well being advantages for pre-65 retirees, lively staff, municipal- or county-granted retiree well being advantages, teams of retirees which have separate retirement techniques in some states, akin to regulation enforcement or lecturers, nor does it embody Puerto Rico or the territories. Key findings for 2024 embody:

Nearly all states, 48 states and DC, provide retiree well being advantages to their Medicare-age retirees. Simply two states, Idaho and Nebraska, provide no retiree well being advantages to state retirees ages 65 or older.
In 12 states, Medicare Benefit is the one choice for retiree well being protection for Medicare-age retirees. In a few of these states, retirees forfeit their retiree well being advantages in perpetuity in the event that they select protection below conventional Medicare. This is a rise from eight states in 2016, as famous in a previous Pew report.
In 22 states and DC, Medicare-age retirees are supplied each Medicare Benefit plans and supplemental plans that wrap round conventional Medicare, a rise from 13 states in 2016. Amongst these states, 18 states and DC provide Medicare Benefit and supplemental plan choices on to their retirees whereas 3 of those states provide retiree well being advantages by way of a non-public alternate, giving their retirees the choice to buy both a Medicare Benefit plan or a plan that dietary supplements Medicare – sometimes Medigap. In Louisiana, Medicare-age retirees have the choice of getting protection by way of a non-public alternate or immediately from the state, together with each Medicare Benefit plans and dietary supplements to conventional Medicare.
In 14 states, Medicare-age retirees are supplied protection by way of plans that complement conventional Medicare, however will not be supplied protection by way of a Medicare Benefit plan, a lower from 25 states in 2016.

For states, as with employers and unions that provide retiree well being advantages, this shift in the direction of Medicare Benefit could also be an efficient technique to keep up advantages whereas decreasing spending on retiree well being prices. For instance, in 2022, Connecticut estimated the state would save $400 million over the next three years by switching retirees to a distinct Medicare Benefit administrator, which might additionally scale back the state’s unfunded legal responsibility by about $7.5 billion. Equally, in 2023, New York Metropolis estimated that it will save $600 million yearly by switching its metropolis retirees to Medicare Benefit.

Shifting retiree advantages to Medicare Benefit from different protection preparations could current tradeoffs for retirees. On the one hand, Medicare Benefit could provide decrease premiums and extra complete advantages than different retiree protection choices. Alternatively, Medicare Benefit plans could have a extra restricted community of hospitals, physicians and different suppliers, which may require retirees to pay extra out-of-pocket or pay the complete value of their care in the event that they go out-of-network. (Some states with Medicare Benefit contracts stipulate that retirees won’t be required to pay extra for out-of-network care; nonetheless, retirees in these states could must cowl the complete value of their out-of-network care upfront if the supplier doesn’t take their Medicare Benefit plan, and submit a declare for reimbursement to cowl their prices.) Retirees with conventional Medicare and supplemental retiree advantages can see any supplier who accepts Medicare, however supplemental plans range on the extent to which they cowl value sharing.

Along with usually having a extra restricted community of suppliers, Medicare Benefit plans sometimes make use of utilization administration instruments, akin to prior authorization. These limitations are, partly, why public sector retirees in each Delaware and New York Metropolis sued to cease being moved right into a Medicare Benefit plan. In New York Metropolis, a Manhattan Supreme Court docket Decide prohibited the implementation of this plan (although it’s nonetheless attainable that the mayoral Administration could attempt to attraction the ruling). In Delaware, the Supreme Court docket lately overruled the decrease courtroom’s determination, stating that it incorrectly halted the state’s transfer to a Medicare Benefit plan.

Of the 12 states that present well being advantages to Medicare-age retirees solely by way of Medicare Benefit plans, simply three provide plans with $0 (or fully-subsidized) plan premiums. Whereas many states provide premium subsidies or reductions based mostly on particular person elements akin to family revenue, years of employment, or work in hazardous roles, premiums should still be pricey. In Missouri, as an illustration, a retiree with no dependents receiving the utmost state contribution of 65% nonetheless pays a premium of $82 per thirty days, elevating questions on whether or not some retirees are paying extra for his or her protection than they might in the event that they enrolled in one other Medicare Benefit plan supplied to enrollees of their space. Almost all Medicare beneficiaries (99%) have entry to a Medicare Benefit plan with drug protection for no further month-to-month premium in 2024 (apart from the Half B premium), together with 100% of beneficiaries within the state of Missouri.

It’s attainable that employer-sponsored Medicare Benefit plans cost further premiums as a result of they provide extra beneficiant advantages and broader supplier networks than plans supplied to different Medicare beneficiaries in the identical space, however profit, community, and cost-sharing info for employer plans will not be required to be reported to the Facilities for Medicare and Medicaid Companies (CMS), making it troublesome to match the generosity of advantages in these state retiree plans to plans obtainable to all Medicare beneficiaries.

For Medicare, the transfer to Medicare Benefit raises questions on whether or not states are shifting liabilities to the Medicare program. On common, Medicare pays extra for enrollees in Medicare Benefit plans than for enrollees in conventional Medicare, together with for group plans. In 2024, MedPAC estimates that the Medicare program will spend 22% extra per Medicare Benefit enrollee ($83 billion) than for related beneficiaries in conventional Medicare, together with employer plans. As well as, employer plans (which embody states) can even obtain bonuses below the Medicare Benefit program. These bonus funds to employer and union-sponsored plans reached $2.5 billion in 2023, or practically $10 billion over the past 5 years (2019-2023).