Ben Moore and his wife, Jane, (not real names) are both retired teachers in Texas. Since becoming age 65, they have obtained health insurance through the Medicare Advantage program offered by the Teacher Retirement System (TRS). Last year the premium for the Medicare Advantage was $209 a month for both of them. In addition, they each paid the premium for Medicare Part B. The deductible for their insurance was $150 each. 

Ben and Jane received notice that their premiums for 2018 will be raised to $529 a month and that each of them will have to pay $500 deductible before receiving any insurance benefits. Adding together the increases in premium and deductible, Ben and Jane will have to pay $4,540 more in 2018 for medical coverage than they paid in 2017, if they stay with the TRS-sponsored plan. The notice stated if they drop the plan, they will not be able to return to that plan except under limited circumstances.

Ben and Jane were outraged when they received this information. They called Humana to find out why their premiums were more than doubling. The Humana representative said she wasn’t even privy to what their premiums were. They would have to call TRS for that information. The TRS representative told Ben they were not responsible because the Texas legislature controls this matter. Ben wanted to know why TRS couldn’t have negotiated a better deal with the legislature. The TRS representative said they didn’t negotiate with the legislature. It was the legislature’s decision.

Frustrated Ben researched to see if he and Jane could get a better deal with regular Medicare, Parts A and Part with a Medicare Supplement or Medigap plan. He found that he and Jane could obtain the Medicare Supplement, plan G, for a total premium of $224.91 a month. This plan would have a deductible for each of them of $183.00 a month. In addition, he and Jane would have to purchase a Part D drug coverage plan, which was included in the Medicare Advantage Plan. They found the Humana Walmart Plan at $20.40 a month each suited their needs.

If Ben and Jane switched from the Humana Medicare Advantage Plan to these plans, instead of paying a total of $6,348, they would pay premiums of $3,188.50, meaning they would save $3,159.48 in premiums over the TRS-sponsored Medicare Advantage plan. In addition, they would save an additional $634.00 in their combined deductibles, for a total savings of $3,793.48 over the TRS Medicare Advantage plan.

Ben thought there must be something the Humana Plan covered that the Medicare supplement did not cover to make the difference in premiums. He reviewed the summary provided him and couldn’t find it. He called Humana and asked what the plan covered that Medicare did not. Nothing, he was told. They use Medicare guidelines.

Jane was furious that, what had been touted her whole teaching career as a benefit to offset her low salary, was not as good a deal as one obtainable on the open market. She called the Texas Retired Teachers Association (TRTA). Surely, this organization, to which they had paid dues should have advocated for teachers more effectively. Jane was told they had advocated or it would have been worse. Both TRS and TRTA leveled the cause of the increases in the premiums and deductibles on increased health care costs.

Jane did not buy this explanation. Increased health care costs would apply to all insurance companies. Something was wrong here. She and Ben determined they would do all they could to rouse their former colleagues to protest what their own organizations and the Texas legislature had done in abandoning them after longstanding service to the children of Texas.

Ben and Jane have made the decision to drop the Humana Medicare Advantage plan with TRS for 2018. They plan to work toward getting TRS and the Texas legislature to correct the abominable actions taken and restore the affordable insurance teachers were promised as they served the children of Texas. They are determined to urge everyone they know to do the same.

According to the Houston Chronicle, there are 207,000 retirees and 54,000 of their dependents facing the decision Ben and Jane have had to make. Researching the plans that are best suited to the individual is a complex and time-consuming process. However, assistance is available at no cost to the consumer. Ben and Jane used an entity called Boomer Benefits to help them locate the best plans for them. This entity can be located online at http://boomerbenefits.com. Ben and Jane spoke with Cynthia Guittierez by telephone at (817) 717.3380.  Similar private resources provide help in navigating the differences in the offered plans. A governmental source can be found at  https://www.medicare.gov/find-a-plan.

Sandra W. Reed is an attorney with Katten & Benson, an Elder Law firm in Fort Worth. She lives and practices in beautiful Somervell County, near Chalk Mountain.