Medicare plan for State of Delaware Retirees is Changing in January

Posted on 08-31-2022

      Medicare plan for State of Delaware retirees is changing in January  

Beginning January 1, 2023, the State of Delaware will be changing the Medicare plan offered to state retirees.   After a year of consideration, the State Employee Benefits Committee (SEBC) in February signed a three-year contract with Highmark BCBS Delaware to provide state pensioners with a new Medicare Advantage Plan (Freedom Blue PPO) that will replace their existing health care coverage at the start of the New Year. The change was reportedly made to maintain the high level of state retiree health care services while keeping the system financially sound.   According to information provided by the Delaware Department of Human Resources, the new Highmark BCBS Delaware Freedom Blue PPO plan matches the benefits and out-of-pocket costs for care offered under the current Special Medicfill plan.    The Delaware Freedom Blue PPO will also include a fitness program, an after-hospital discharge home meal service benefit, and patient access to a clinical team of experts to help them manage their care. When compared with retiree health plans in other states, Delaware’s Medicare Advantage plan will remain among the most comprehensive.    Medicare Part D prescription drug coverage will continue to be offered through SilverScript (administered by CVS Caremark).    After sending a series of mailings to retirees beginning on June 1, state officials held 18 public meetings earlier this month to discuss the change of plans.   One aspect of the new plan that has raised concern is that it will require prior approval for some non-emergency services. It should be noted that limited prior authorization is already required under the health coverage provided to active state employees.   Authorization requests will be reviewed by a Highmark clinical team of nurses and physicians to verify the requested test is appropriate to the situation.  Highmark BCBS Delaware approves about 93% of all prior authorizations, with 92% approved on the initial submission. Expedited, non-emergency prior authorizations are approved within an average of a day and a half, with standard, non-emergency pre-authorizations approved within about 4 days. Emergency and urgent care services do not require prior authorization.   At the urging of state legislators regarding the need to address ongoing concerns raised by retirees about how the switch could potentially impact them, Director of the Office of Management & Budget Cerron Cade has agreed to hold additional meetings in October. These events will be part of the open enrollment process (October 3 – 24) and will include an option to participate virtually.  All State of Delaware Medicare-eligible pensioners and dependents will receive more information from the Office of Pensions and Highmark BCBS Delaware next month.  

In the interim, the resource links posted below will help retirees answer some of their questions:  
Click here to view answers to Frequently Asked Questions about the Highmark Delaware Freedom Blue PPO plan. Click here to review the material presented at the public meetings.
Click here to see the Medicare Advantage Rates that will be effective throughout 2023.
Click here to access the Department of Human Resources’ webpage on the Highmark BCBS Delaware Freedom Blue PPO plan.  
If you have questions about Medicare or how your new Freedom Blue PPO Medicare Advantage plan works, call 1-888-328-2960, 8 a.m.- 8 p.m., seven days a week (TTY call 711).            
To contact Tim:

State Rep. Tim Dukes: http://Visit Tim’s Website