The change won’t have an impact on the actual coverage network. The village of Tupper Lake currently has a direct Medicare Advantage plan with Excellus Blue Cross Blue Shield, and the potential new plan remains with Excellus. Rather than a direct plan, however, it would be through a healthcare consortium organized by Broome County that Excellus won through a request for proposal.

As part of a state Shared Services Initiative, the village of Tupper Lake is eligible to join the consortium, which is expected to yield a slightly cheaper premium with greater benefits for enrollees than the village’s current direct plan with Excellus.

The vote came after a presentation by Ian Coryea, who is the president of marketing at Burnham Benefit Advisors, a brokerage group based out of Lake Placid. The group advises numerous municipalities and organizations throughout the North Country on healthcare and other benefit options.

Coryea said he had no skin in the game in terms of what the village of Tupper Lake ultimately decided to do, but as a broker working on behalf of the village, his job is to research different plans and help the municipality navigate the complex world of benefit offerings for employees and retired employees.

The Tupper Lake Village Board listens as Ian Coryea of Burnham Benefit Advisors presents on health insurance options for retired municipal employees during the board’s regular meeting on Sept. 15. From left, village Trustee and Deputy Mayor Eric Shaheen, village Trustee David “Haji” Maroun, village Mayor Mary Fontana and village Trustee Rick Pickering. Village Trustee Leon LeBlanc was absent from the meeting. (Enterprise photo — Chris Gaige)

“My job is to make sure the village of Tupper Lake has the best plan for the best rate,” he said.

In his presentation, Coryea emphasized that there would be no change in the providers that enrollees are currently seeing.

“We’re going from Excellus network to the same Excellus network,” he said. “So there’s no disruption from a provider’s standpoint.”

Coryea works with several other local municipalities, such as the towns of Tupper Lake and Long Lake; the villages of Saranac Lake, Lake Placid and Malone and local organizations such as the Wild Center. Coryea said not all municipalities offer the same type of Medicare plans, and this potential savings under the Broome County consortium mostly applies to Medicare Advantage Plans — which the village of Tupper Lake has.

“A lot of our municipalities have Medicare supplement plans,” he said, adding that for those municipalities, the incentives to switch from a direct plan to one through this consortium weren’t as clear. “There’s not as much savings (with the supplement plans) and there’s big benefit changes. But you’re already in that Medicare Advantage world.”

Medicare Advantage, also known as Medicare Part C, are health insurance plans provided to individual beneficiaries by private companies that are then reimbursed by the government. Medicare Advantage plans are an alternative option to traditional Medicare Part A and Part B, which provide coverage for inpatient and outpatient services, respectively, for Americans 65 or older, or have an otherwise qualifying condition.

The intent of Part C plans is to render more efficient healthcare coverage, both by bundling parts A and B into one plan and introducing private sector competition for beneficiaries, who in turn would have more options for what to include in their health insurance plans.

“Very rarely (while) doing my job do I get to come to clients and say, ‘Hey, we could save money and enhance a majority of your benefits,'” Coryea said. “Usually, it’s the other way around — rates are going up and the benefits are going down.”

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Cost and benefits comparison

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Under the village of Tupper Lake’s current plan, its monthly premium is $415 per enrollee. This is the 2025 rate. The 2026 rates for the current direct have not yet been announced. Coryea said those would be expected around the end of October, and estimated that they would be around a 10% increase, which would hypothetically amount to $456.50.

On the contrary, the 2026 rates for the Broome County plans have been announced and would be guaranteed. The plan that the village of Tupper Lake is considering would be $408 per enrollee per month. Coryea added that while the 2027 official rates are not yet announced, Excellus has a maximum increase cap of 7.5%, meaning those monthly premiums would, at most, go up to $438.60.

Things get more uncertain after that, Coryea noted.

“What I want to make sure we know is that we know we’ll save money for 2026,” he said. “We know for 2027 we’ll save money. We don’t know what’s going to happen in 2028.”

Coryea said that Broome County could put out another RFP. If Excellus were to lose out at that point, the village of Tupper Lake could always revert to the current direct plan it has to keep the provider network.

Under the village’s current direct plan, enrollees have a $0 in-network deductible and a $500 out-of-network deductible. The Broome County plan has $0 for both in-network and out-of-network care. The current direct plan has an out-of-pocket maximum of $4,000 in-network and $8,000 out-of-network. The Broome County plan has $1,250 out-of-pocket maximums for both in-network and out-of-network care.

Prescription prices, for 30-day supplies, under the current direct plan have $10/$30/$50 tiers and would fall to $5/$20/$40 under the potential new plan. In-network office visits would increase from $20 to $25 under the new plan, while out-of-network office visit prices are $25 under both plans.

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Village board reacts

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Village Mayor Mary Fontana approached the plan skeptically at first, noting that when things appear too good to be true, they often are. After looking into it further, she figured it just happened to be the right confluence of circumstances on this go around.

Fontana noted that the savings from switching, while beneficial, weren’t astronomical in the context of the village’s $3.3 million annual budget — roughly $17,000 next year, assuming the direct plan increases 10% and the number of enrollees remains at or around 29.

“So we’re not saving bookoo bucks, but the (bigger) benefit is for the participants,” she said. “They’re going to see lower out-of-pocket expenses for in-network and out-of-network, certain visits, prescription costs, those types of things. It’s a better benefit plan, but it also came with a more finite picture of what rate structures might look like in the next two years.”

Fontana said that a clearer picture would allow for better budgeting calculations, at least in the short-term future, whereas the current Excellus direct plan is even harder to account for, as the next year’s premiums aren’t known until a month or two before the new year.

At the meeting, village Trustees David “Haji” Maroun and Eric Shaheen each voiced support for submitting a letter of intent prior to the vote. The board reviewed the above cost and benefit comparisons before moving forward.

“It’s a no-brainer moving to that Broome County plan,” Maroun said. “I like the plan.”

Village Trustee Rick Pickering joined Fontana, Maroun and Shaheen in voting in the affirmative. Village Trustee Leon LeBlanc was absent from the meeting.