Medicare Eligible Retiree Plan Comparison: Horizon BCBS Medicare NJ Direct vs. Aetna Educators Medicare Advantage

We would like to start off by saying thank you for your patronage to our clinic and entrusting us with your physical therapy needs over the past few years.

Over the past few weeks we have received many questions and concerns regarding the changes to the New Jersey School Employees Health Benefits Program (SEHBP). As many of you are aware, you have the option as a retired school employee to maintain your current plan with Horizon BCBS or switch to the Aetna Educators Medicare plan.  

Presently, most of you have traditional Medicare as a primary insurance till the end of 2018.  This will change. While salesmen do not emphasize it, you need to understand that traditional Medicare and Aetna Medicare Advantage plans are very different.

The letter that many of you have received from the NJ SEHBP is ambiguous, and after speaking to many retired educators, there seems to much confusion and almost purposeful deception regarding these plans.  Our office cannot even receive clear answers from Aetna regarding these changes.  Here is a Screenshot below from the NJPSA wesbite demonstrating the Medicare Eligible Retiree Plan Comparison: Horizon BCBS Medicare NJ Direct vs. Aetna Educators Medicare Advantage

Eligible Retiree Plan

The plan comparisons are listed HERE.  While co-pays and deductibles are increasing marginally under your BCBS plan, the access to providers and lack of a true secondary insurance might limit your options for utilization of medical professionals with the Aetna Medicare Advantage plan. 

Many services under the Aetna Medicare Advantage plan will require pre-authorization, including your physical therapy benefits.  Currently you have Medicare as primary coverage and BCBS as secondary coverage, which does not require pre-authorization allowing you greater access to physical therapy.  Under the new Aetna Medicare Advantage plan, you will only have the Aetna plan, and Medicare will be eliminated.

For example, Medicare currently pays as primary, and BCBS picks up the additional amount.  When you exhaust Medicare, BCBS provides additional physical therapy services as a ‘True’ secondary, allowing additional visits.  Under the new Aetna Medicare Advantage plan, you would no longer have a secondary insurance and could have limitations to physical therapy visits, dependent upon pre-authorization and medical necessity.

We hope by giving you this information, you will have an opportunity to make an educated decision and if possible, continue care with Specialized Physical Therapy. 

Thanks for the trust you place in us allowing to provide your physical therapy needs and we look forward to helping you meet your goals for many years to come.

Wishing you a happy and healthy holiday season!


Daniel Ryan PT & Michael Ryan PT