Shirlee explains more about Medicare A & B to a retiree; some good info for all of us

From Shirlee Zerkel

May 17, 2006

I would like to address your comments to my information. I agree that Gary Russell can, if he would, explain the benefits through STRS, but what gives him the authority to speak about what the real Medicare has in benefits?

I would like to give this little example of a hospitalization. If a retiree has the Government Part A Medicare and NO other coverage and has a $10,000 necessary hospital bill. In 2006 that retiree will pay $952 and Medicare will pay the rest. If a retiree has STRS or OPERS equal coverage to Part A, that retiree will pay the deductible of the STRS policy which is either $500 for Plus or $1500 for Basic coverage and then 20% of what ever the hospital bill was.

Let's use the $500 deductible policy,for example, and figure what a retiree pays on a $10,000 hospital bill with STRS Part A coverage: The retiree will pay the $500 deductible and then 20% of the $9,500 that is left. That comes to $1,900. The STRS out-of-pocket max says that a retiree only has to pay $1,500 after the deductible. So we will add the $1,500 and the $500 deductible together and the retiree on STRS Part A will pay $2,000 for his hospital stay, but the retiree on real Medicare Part A has only paid the $952 for the same services. For that particular hospital bill a person on real Medicare would have $1,048 in his own wallet that the person covered by STRS Part A would have to pay out to the hospital.

I agree with you that Medicare A covers hospital, skilled nursing home stays up to 10 days and Medicare B covers doctors, test, and outpatient.

Your quote: "STRS is your primary payor for Part A: overnights in hospitals and convalescent and nursing homes with Medicare as your secondary." I do not agree. Medicare will pay no part of a person's Part A expenses if they do not have Part A listed on their Medicare card. This is listed in Medicare books and I have talked to Medicare persons also on this issue. Medicare is never secondary!

I agree with your comments about Medicare B: "Medicare is your primary for Part B...with STRS as your secondary. Yes, everyone has Part B.

I believe that you may have added to the confusion by stating that "STRS is your primary payor for Part A. There are many of us out there that have or will have the real Medicare so STRS is not our main source of benefits. We are not all the same but we do all pay the same premium to STRS after reaching 65. Some of us have real Medicare coverage and some have STRS coverage.

Molly, I guess according to you I did lay out the differences. But evidently they were not clear enough. You had to clarify and in the process change some of my points. I also did not ask you to call in Gary Russell on this issue. If I had depended on him in the past, this couple that I was helping would have had to pay over $20,000 in Medicare Expenses and they had STRS Part A. STRS was willing to let them pay the hospital!

I also have a spouse on Medicare, other relatives who are, and I took care of my mother's medical things until she passed away. I also from my own experiences have some knowledge of how health insurance works. In one 5 year recent period of time I had seven surgeries -- 5 of them major. I also have 3 chronic conditions I think I know of what I speak.

Do you still say there are no differences between real Medicare and STRS Medicare, except the precert. and in network providers?

Shirlee