Molly Janczyk, Gary Russell & Jim Kimmel re: Medicare supplemental (Med Mutual ) deductible

From Gary Russell, August 28, 2007
Subject: RE: Medicare supplemental (Med Mutual ) deductible

Molly, You are correct that a considerable exposure that the STRS Ohio Health Care program is covering for individuals with Medicare is the lack of any out-of-pocket maximums in the Medicare plan. (Meaning STRS picks up all which is not >covered by Medicare after deduc. at 80% with the patient at 20% UP TO $1500 and then STRS >PAYS AT 100% and we pay nothing. With Soc. Sec. Medicare alone, we would pay 20% to >infinity. This is what supplemental coverage by STRS provides).

Prescription medication is, of course, the other significant exposure. (STRS DOES NOT have the donut hole that Soc. Sec. Medicare demands).Decreasing or eliminating the deductible to provide first dollar coverage would be a very expensive enhancement to the program that would increase the premiums for everyone and shorten the solvency of the your health care plan.

I hope this helps, Gary

From Molly Janczyk, August 26, 2007
Subject: RE: Medicare supplemental (Med Mutual ) deductible

Maybe Gary Russell can help explain. I do know that while Medicare with Soc Sec deduc may be lower, they also

have NO stop gaps and you pay 20% of all bills all year with no out of pocket max. If you have big bills, you would pay huge amounts. With STRS being our supplemental, there is a stop gap of $1500 after $500 deduc. So that is $2000 a yr.: costly if you are healthy; less costly for the ill patient such as my husband and many others.

From Jim Kimmel, August 26, 2007
Subject: Medicare supplemental (Med Mutual ) deductible

I just got an EOB which told me I got nothing in benefits because I had not yet fulfilled my $500.00 deductible. I began to think: Before I was on Medicare there was a $500.00 deductible but then I would more quickly reach it because ALL my medical bills went through. It was my Primary insurer. Now that I am on Medicare and Med Mutual is only supplemental paying only 80% or the 20% Medicare doesn't pay I am STILL required to accumulate $500.00 before the coverage kicks in. Medicare's deductible in less than half that. That seems like a rigged game to me. You get less coverage and yet you still have to meet the same$500.00 deductible! I bet many retirees over 65 with Medicare never reach the supplemental $500.00 deductible because pays out such a smaller amount. And the pharmacy bills do not count for deductible, of course. Since it pays less it should require a smaller deductible. And the supplemental premiums are certainly high enough.

it would be interesting to know what percent of retirees never hit the Med Mutual supplemental in a given year. Or over the past few years? Shouldn't that be helping the Healthcare Stabilization Fund? could the deductible be lowered to match Medicare's which it supposedy "shadows".

Jim Kimmel