Shirlee Zerkel: Concerns about health care deductibles

From Shirlee Zerkel, August 29, 2007
Subject: Concerns about Health Care Deductibles

Sunday after reading an email by a fellow CORE and STRS member, I did some thinking about what he said about our coverage of health benefits. It is almost September and yet the STRS MM. Plan is paying nothing on his health care. That is probably true of most Medicare recipients. I verbally polled 6 people in my area who are on Medicare A and B and STRS supplemental. They also have received no compensation from MM or Aetna yet this year.

STRS states that they spend over 1.3 million a day on member health care. Who is that for? It certainly is not spent on the Medicare A and B group! STRS is saving money on us because Medicare picks up most of the bills and sets the reasonable and customary cost. So it would take a hospital or emergency room visit or even a very expensive diagnostic tests like a PET scan to reach the deductible. Then if the member is only in the hospital once during a year period, STRS may have to pay some of the Medicare up-front charge of $992. Medicare pays the rest of that hospital stay. Medicare B has a $131. deductible for doctors, etc.and then B coverage starts. A member would have to have an office visit every two weeks and pay $20. a visit after Medicare pays to reach the STRS deductible in order for the supplemental to pay anything on our health care.

I asked STRS how many retirees used STRS Health plans and the answer was 66,816. 57,337 members with the Plus plan and 6,072 with the Basic Plan. Let's assume that all of these recipients taught for 30 years (many haven't and some in the plans are spouses) If each recipient paid the monthly $67 for Plus or the $40 for Basic, we pay to STRS in premiums a minimum of $4,094,399 a month. Where is that money used? Not for us!

I did not teach for a full 30 years and my plus plan costs me in 2007 $94. a month and if my husband were in the program, his would be $301. a month. That would be a total of $395. a month for no medicare services. I retired 5 years ago at age 60 and only one year did I meet the deductible and have Medical Mutual pay any tests, doctors, etc. Then I was not on Medicare. So I know that I will probably not meet the deductible most years in the future since I now have Medicare A and B. I am thinking of finding another supplemental where I do get some benefits.

I agree with my fellow CORE and STRS member when he suggests that our deductible be lowered since we save you money by having Part A Medicare.

Shirlee Zerkel