Shirlee Zerkel to John Curry, August 11, 2007
Subject: Interesting tidbits concerning a chart SERS has in their newsletter
John, I hope this is not the plan that STRS staff proposes to the Board next week. In the July SERS Focus newsletter, they explain their new Medicare Health Plans. They are forcing all of their members who have both Medicare A and B to go into their Advantage Plan. In the newsletter, they explain improved benefits and, on the first look, it seems good. Upon closer scrutiny, in my opinion, there are problems and members may not have such a good deal after all. Their chart is divided into 2 columns Current 2007 Plan and 2008 Medicare Private Fee for Service Plan. Under their Current 2007 column, they list only the coverage their supplement pays, NOT WHAT REGULAR MEDICARE PAYS thus making it look like you are getting a lot more in 2008 than you did in 2007. I don't, in all cases, think that is true. The news letter does NOT state the cost to the member for premiums for this plan (imagine that)!
Their chart mentions that in their Advantage Plan there will be no yearly deductible ($340 for 2007); then further down the chart, it is listed that there will be a fee of $250 called hospital admit deductible. It is a one time charge or each time a member is admitted?
The #340 deductible is reduced to 0, but the Out-of-Pocket max ($1,500) has been removed. So if you have some expensive medical situations, your co-pays could really add up.
Let's look at regular doctor office visits, which is what the majority of us use the most. SERS says that members are covered at 80% in 2007. What we are looking at is the fact that Medicare pays 80% of what they call customary and that leaves 20% for SERS and the member to pay. We will say that Medicare approved a $50. office visit and so Medicare pays $40, leaving SERS and the member to divide the remaining$10. Under the new SERS ADVANTAGE PLAN the member will PAY A $25. CO-PAY each time a $50 office visit is needed. For the members that is far more than they are presently paying. Is this a better plan than what the SERS member had now under the regular Medicare plan with SERS supplement? But the SERS supplement will be NO MORE, all in the SERS plan will be FORCED to take the Advantage plan or leave SERS. A note, this plan does not cover prescription drugs. Separate plan!
Their chart also states some preventive Care as not covered. Many of the items listed are covered by regular Medicare in 2007; some examples are: Immunizations, colorectal cancer screening, PSA, Annual Pap and Mammogram.
If an Advantage plan is presented to the members of STRS, we must look very carefully at what it offers us. We must educate ourselves as what we already have with Medicare A and B plus the present STRS supplement. The only members this will affect are those who have the regular Medicare A and B.
These are the personal opinions of