A group of Connecticut state retirees and family members who experienced barriers to care under the Connecticut state retiree Medicare Advantage (MA) plan have succeeded in creating a path for some state retirees to opt out of the MA plan and choose traditional Medicare. Connecticut State Employees for Medicare Choice was created by James Russel and Gloria Bent due to barriers Mr. Russel and Ms. Bent’s late husband, Gary Bent, experienced with obtaining access to care through the state’s requisite MA plan for state retirees. Mr. Bent died in 2022 after the retiree MA plan, then administered by United Healthcare, repeatedly denied rehabilitation care that Mr. Bent needed to recover from brain surgery. Mr. Russell was unable to obtain chemotherapy for lung cancer from a cancer center near his home in Oregon that would have been available to him in traditional Medicare due to the retiree MA plan’s network restrictions.
Roughly one in five Medicare beneficiaries enrolled in a Medicare Advantage (MA) plan are enrolled automatically through their former employer or union, usually without a choice in the matter. These group retiree plans, known as Employer Group Waiver Plans (EGWPs), have received approval from the Center for Medicare and Medicaid Services (CMS) to waive certain Medicare enrollment rules, including the option to automatically enroll their members into a group MA plan when they enroll in Medicare.
Some large employers provide both a Medicare Advantage and stand-alone prescription drug plan EGWP option to retirees, thus allowing them to choose between traditional Medicare and Medicare Advantage. From 2018 until last year, however, Connecticut state retirees have only had a Medicare Advantage option.
Connecticut state retirees who wish to opt for traditional Medicare in lieu of the MA retiree plan still have an uphill battle – they must demonstrate they are unable to access the care they need through the state’s MA option in order to opt out. The process includes completing an exemption application, signed by the applicant’s healthcare provider, attesting to one of the following:
- There is no hospital within a 25-mile radius accepting their retiree MA plan;
- They are receiving treatment for a chronic condition from a provider who will not accept the retiree MA plan; or
- The only specialist available within a 25-mile radius to treat their ongoing condition will not accept the retiree MA plan.
The narrow restrictions of the exemption qualifications are concerning, as delays in necessary medical care can have grave consequences. Care delayed is care denied.
The Center recently published an Issue Brief on the impact of automatic enrollment of retirees into EGWPs, including denials or delays in care, sometimes with grave consequences. As the Issue Brief points out, these automatic enrollments are antithetical to the stated intention at the inception of the Medicare Advantage program as a method to enhance beneficiary choice. CMA supports beneficiary choice for all Medicare enrollees, including those in retiree plans.
June 4, 2026 – M. Lambert