Molly Janczyk: Healthy Retirees

From Molly Janczyk, August 30, 2007
Subject: Healthy Retirees

I respond to the blog on Medicare and STRS HC. Insurance is just that: insurance in case you become ill. I understand that some feel they pay too much even at $67 or $40 a month to guarantee health care coverage in case they become ill next week, next month, next year, in 2, 5 or 10 years. None of us know but it is a risk few wish to take by not being covered.

Adverse selection is a balancing of healthy and ill recipients. All insurance plans count on it to keep costs down so that the healthier offset some of the costs for the more ill recipients. This is true of all insurance coverage: automobile, house, etc.

For those less fortunate who easily meet their deductible in the first month or two of each year, (my husband, for example, who must endure treatments to stay functional. Each treatment costs is approved at approx. $2500-3500. Our portion is $400-500. That is just one cost among the many that keep him out of bed. He is among the less fortunate among us.

I confess I fail to see the logic of comparing Soc. Sec. Medicare with STRS Supplemental Ins. for Medicare recipients. IF you had Soc. Sec. Part A only, you would pay the first $992 for EACH hospital visit if more than so many days apart. Forget the exact number. Then Medicare would pay for a limited number of days, after which you would pick up daily costs until you were paying 100%. This does not happen to most as they are discharged before this occurs.

With STRS Supplemental, after this initial $500 of that $992, your supplemental would kick in with STRS paying 80% of $492. So, you would pay the first $500 (Plus PLans) and then 20% of the $492 or $98.40 totalling $598.40 vs. $992 Soc. Sec. only. IF you should have another hospital visit, you would not have to again pay the $992 because STRS would pay 80% of it leaving you with $198.40 vs. $793.60 if you were Soc. Sec. only.

Also, thes costs to you go towards a stop gap of $1500 for the year: easy to meet if you are ill. My husband met his months ago. So, we now are on 100% pay by STRS for all medical costs until 12/31/07. WITH SOC SEC ONLY: THERE IS NO STOP GAP AND YOU WOULD PAY 20% TO INFINITY EACH YEAR.

Treatments: Again, the writer bases their scenario on the healthy: One treatment at $131 deductible. Then Soc. Sec. steps in at 80%. Remember, the patient pays 20% WITH NO STOP GAPS while the costs all go toward the STRS patient's deduc. and yearly stop gap of $1500. For the ill, many and mulitple types of treatments are usually necessary and without STRS stop gaps we'd be lost and broke.

We pay the same premium for Part B, I believe, at 65, that Soc. Sec. only recipients pay but with the added advantage of stop gap/ limits of what we have to pay insurance. Part A is free.

We pay insurance to ensure that we have it should we become ill. One can count on not becoming ill and drop it, seek other supplemental carriers, (all of which I have found to be costlier than STRS either with higher deductibles, less coinsurance (70/30 or 60/40) or fewer benefits. Some go with the lesser premiuims for monthly cost and offset that with higher deductible and paying more of the coinsurance. I would ask you to research other carriers against STRS.

I am not condoning what I feel was the lack of longterm planning and determination to seek legislation long ago to secure funding for HC by the former Board and Exec. Direc. who wanted out of the HC business. This resulted in retirees being overwhelming burdened with saving the HC system for retirees until a resolution could be found. I doubt current retirees will ever enjoy the benefits of such except by saving having HC at all.

We petition legislators to hear us in our plight. We were not at fault and did all we were advised to do while serving our communities for the betterment of its children and future. New potential quality educators will seek other professions with no promise of secure retirements with HC. There is no retirement without HC as no educator could possible save enough for their HC.

Ohio has never properly funded education. If districts were properly funded with higher priorities for aid towards education as is constitually mandated, the school boards could transfer some funds towards contribution increases. Ohio has always ranked low in priority to education putting this burden on the school districts to raise funds largely through taxation further burdening home owners.

Legislators can find other ways to address what they feel is early retirement for a group of people who experience job related stress induced health conditions second to air traffic controllers according to a Newsweek Article some time ago. But, taking away any possibility of a secure retirement will only degrade education further in a state historically troubled in this area. Ohio is losing more potential residents when once it attracted new population. Several of our main cities are high in poverty ratings. Serve the educators by approving increased contributions, secure HC, and draw the brightest and best to turn around this state and attract and retain those who can contributor to Ohio's future.

Please, all: Remember, to look at the total picture and not just what is happening to a few who are so very fortunate as to not have to use their HC plan. The rest should be so lucky. The healthy, no claim individuals, will always feel they pay too much until and unless they actually have to use their 'insurance.' I pay monthly for Long Term Care insurance. I hope never to use it. But, in case I do, it is there. My husband cannot get this type of insurance because of preexisting conditions. Aetna banks on me never having a claim to offset all those who end up in nursing homes.

That is how insurance works and can stay in business. We have so much to do. Fighting how insurance works so that only ill people pay, will result in all insurance going bankrupt.

Molly J.