We know that open enrollment for Medicare in 2011 is now underway, and we want to clarify Piedmont’s participation in certain 2011 Medicare plans. We hope this information will help you in making your decision on which Medicare plan to choose for 2011.
REGARDING MEDICARE ADVANTAGE PLANS FOR 2011
for those who are NOT enrolled in the State Health Benefit Plan as a State retiree
These Medicare plans are offered and managed by insurance companies on behalf of the government. They are basically managed care Medicare plans, which can be in the form of an HMO, PPO, POS or Private Fee-for-Service (PFFS) plan. They are offered in replacement of traditional Medicare.
Piedmont does not have contracts with most of the Medicare Advantage HMO and PPO plans and therefore may be considered an out-of-network provider by some plans. If you have traditional Medicare coverage, you can utilize all Piedmont hospitals and facilities and those physicians who accept Medicare. If you are considering enrollment in one of the Medicare Advantage plans, we encourage you to consult with the insurance company before enrolling to inquire about out-of-network coverage for your Piedmont providers. This will enable you to ask about out-of-network benefits and understand any potential out-of-pocket cost differences, if applicable.
If you choose a plan that offers out-of-network benefits, access to your Piedmont providers would be covered with out-of-network benefits. However, there may be changes in your co-payments or out-of-pocket costs. For the Medicare Advantage HMO plans, there are no out-of-network benefits for members. This may also be a factor in your enrollment decision.
“Piedmont providers” as referenced in this letter include both your Piedmont Physicians Group physician who accepts Medicare and/or one of the Piedmont hospitals.
REGARDING THE STATE HEALTH BENEFIT PLAN (SHBP) AND COVERAGE FOR RETIREES
We understand that many State retirees contacted their insurance providers, after receiving a notice for annual benefits reenrollment, and were told that they would not have access to Piedmont providers (hospitals and PPG physicians).
However, this information is inaccurate. If you choose the Humana GA SHBP Medicare Advantage Plan (for CIGNA) or the United Healthcare Georgia SHBP Medicare Advantage Plan, you will continue to have access to Piedmont providers, and your out-of-pocket expenses should be no different.
Should you have any other questions about these matters, we suggest you contact your insurance company first and ask if your plan will enable you to continue to see your Piedmont providers. You may also call our dedicated phone line at 770-803-5533 for further information.
Thank you for entrusting us with your care. We look forward to the continued privilege of working with you to fulfill your healthcare needs.
Chief Executive Officer