TRS Retired Medical Insurance..it's changed!

[bullhead44]

I thought this was an interesting quote from the TRS website

The Texas Legislature determines the funding of benefits and has no continuing obligation to provide benefits beyond each fiscal year.
(Required disclosure by House Bill 2365)

This one is on the ERS website

*Notice about Insurance - Health and other insurance benefits for employees and retirees are subject to change based on available State funding. The Texas Legislature determines the level of funding for such benefits and has no continuing obligation to provide those benefits beyond each fiscal year.

I

[Razrbk89]

The root of nearly all of this is people not taking care of themselves & our system keeping people alive too long.

Our obesity rate is like 35%. It’s a no brainer that Healthcare costs are going to continue to increase.

There’s no telling how much it costs us all.

[cehorn]

So if they notify me and I don't like the change --- I can just say no thanks-- I'll just stick with my OLD plan. If your retired on a pension you worked for 30 plus years they shouldn't be able to just decide to change it.

Bingo! Sorry to any and all going thru this.

And if you don't think insurance, etc is all a scam I don't know what to tell you. The medical industry and insurance are in bed together and the consumer is the one suffering with no real alternative thanks to obamacare.

A few years ago I had tennis elbow and went to the doctor. He gave me a band to wear and I paid the doctor on my way out. A few weeks later I received a bill for the band. It was from a 3rd party (never mentioned in dr office) and not part of the doctors office visit. The bill was for over $100 dollars. I called them to discuss and they said that was the "negotiated rate" with the insurance company and that was it. I did a quick internet search for the band and WalMart had it online for $18 (SAME BAND). I called back to discuss and they said they didn't care what price WalMart was selling it for, that was the "negotiated rate". I hung up and called back a 3rd time but this time I asked for their sales department and didn't mention any previous conversations. Within a minute, the sales lady said I could buy the band from her for $25. Same company, same band. I said thank you and asked to be transferred to billing immediately. This time, I didn't let them talk. I told them their sales department just informed me the cost of the band was $25 and that is ALL I was paying. They ended up accepting the $25. If this sounds like a fair business model, I don't know what to tell you and this is just one of the smallest examples.

So once again, IN. BED. TOGETHER!! Pure scam and we are the ones getting screwed. I have more examples of friends without insurance paying 1/3 of the cost I pay as the insurance "negotiated rate" for the exact same services.

[meltingfeather]

TRS Retired Medical Insurance..it's changed!

I do not disagree with that statement. But are you saying banning pre-existing conditions, covering preventive care without co-pays or a deductible, allowing adult children to stay on parents’ policies until age 26, increasing annual coverage limits, etc... didn't affect our premiums?

I didn’t say any of that.
I am interested how you reconcile the data with your hypothesized Obama effect.

[Huntsman27]

Bingo! Sorry to any and all going thru this.

And if you don't think insurance, etc is all a scam I don't know what to tell you. The medical industry and insurance are in bed together and the consumer is the one suffering with no real alternative thanks to obamacare.

A few years ago I had tennis elbow and went to the doctor. He gave me a band to wear and I paid the doctor on my way out. A few weeks later I received a bill for the band. It was from a 3rd party (never mentioned in dr office) and not part of the doctors office visit. The bill was for over $100 dollars. I called them to discuss and they said that was the "negotiated rate" with the insurance company and that was it. I did a quick internet search for the band and WalMart had it online for $18 (SAME BAND). I called back to discuss and they said they didn't care what price WalMart was selling it for, that was the "negotiated rate". I hung up and called back a 3rd time but this time I asked for their sales department and didn't mention any previous conversations. Within a minute, the sales lady said I could buy the band from her for $25. Same company, same band. I said thank you and asked to be transferred to billing immediately. This time, I didn't let them talk. I told them their sales department just informed me the cost of the band was $25 and that is ALL I was paying. They ended up accepting the $25. If this sounds like a fair business model, I don't know what to tell you and this is just one of the smallest examples.

So once again, IN. BED. TOGETHER!! Pure scam and we are the ones getting screwed. I have more examples of friends without insurance paying 1/3 of the cost I pay as the insurance "negotiated rate" for the exact same services.

This is a huge problem with medical cost, the insurance/PPO's are in bed together. There is nothing else we as consumers buy without knowing the cost and have no way to determine the costs but simply get billed weeks later. PPO negotiated reimbursements have no relationship to actual costs and until that is fixed we will always have this problem. I have seen many examples of items hospitals charge extremely high prices for and it just get paid by the insurance company because it is the negotiated rate. Things like $10 - $15 for Tylenol or tooth brushes or $1,000.00 for a screw (not that kind) or MRI's in the same city costing between $1500 - $6000 or more. Until there is some basis for what is being charged instead of a discount off billed charges this will continue to be an issue.

[BigWes]

I still can't imagine that with the previous TRS healthcare plan, participants paid copays BEFORE they reached the deductible? That may be correct, but that just doesn't seem to correlate to most insurance policies I have had...but I am not familiar with TRS insurance.

I think the way it works is that the patient pays the co-pay when they walked into the doctors office, then the doctor submits the charges to the insurance company. The insurance company adjusts the bill with the doctors office, accounting for whatever discounts or unallowable charges to the patient are applicable. At that point, the insurance company applies the adjusted amount to the patients deductible and the doctors office bills the patient for the adjusted amount minus the co-pay.

Edit for clarification: Your statement seems completely correct. It's that most people don't understand health insurance. Add on to that the fact that some people think insurance companies exist to pay claims but not collect premiums just complicates the matter even further.

The co-pay essentially worked as a down payment against the final charges at the doctors office.

That's my basic understanding of it.

[cehorn]

I didn’t say any of that.
I am interested how you reconcile the data with your hypothesized Obama effect.

Can you give the deductibles along with coverage/services with that as well? How about the doctors that are still accepting insurance (remember we were supposed to be able to keep our doctors with the same coverage if we liked them, obama lie number 625,348)? Deductibles have gone up and coverage has gone down from everything I've seen. Bottom line is with obamacare I'm sitting at ~$1k a month in premiums on a high deductible plan with a ~$6k deductible, so $18k before I receive any benefit at all. The system is fubar and obama had more to do with it than anybody. Prior to obama care I was in the same industry with fairly standard insurance and while you are right the premiums weren't that much lower the coverage and out of pocket were drastically better before obamacare.

[HogHunter34]

My sister & her husband were on Otraumacare for awhile and they had issues finding doctors that would accept the insurance in the Corpus Christi area. They’ve since switched to other insurance options

[Shane]

I still can't imagine that with the previous TRS healthcare plan, participants paid copays BEFORE they reached the deductible? That may be correct, but that just doesn't seem to correlate to most insurance policies I have had...but I am not familiar with TRS insurance.

The previous TRS health insurance was not a high deductible HSA plan, like most of us in the private sector have had for the last several years. It was an older, more expensive (for whoever was paying the premiums - TRS), PPO type plan that had lower deductibles and low co-pays for office visits, etc... It was similar to what I had 25 years ago when I worked for State Farm. Great coverage for the insured participants, but as healthcare costs have risen astronomically over the last decade, those types of plans are just flat out unaffordable and unsustainable nowadays.

TRS retirees are now experiencing the kind of sticker shock that the rest of us experienced whenever Obamacare first came into being 10 years ago. Even before Obamacare, most of the private sector plans had already gotten away from PPO low deductible low co-pay plans and gone to high deductible HSA plans.

I'm sorry that all my family and friends who teach or are retired teachers are experiencing the same thing as the rest of us. But welcome to the "party".

[Wall_Hanger]

The previous TRS health insurance was not a high deductible HSA plan, like most of us in the private sector have had for the last several years. It was an older, more expensive (for whoever was paying the premiums - TRS), PPO type plan that had lower deductibles and low co-pays for office visits, etc... It was similar to what I had 25 years ago when I worked for State Farm. Great coverage for the insured participants, but as healthcare costs have risen astronomically over the last decade, those types of plans are just flat out unaffordable and unsustainable nowadays.

TRS retirees are now experiencing the kind of sticker shock that the rest of us experienced whenever Obamacare first came into being 10 years ago. Even before Obamacare, most of the private sector plans had already gotten away from PPO low deductible low co-pay plans and gone to high deductible HSA plans.

I'm sorry that all my family and friends who teach or are retired teachers are experiencing the same thing as the rest of us. But welcome to the "party".

This is correct. The only thing I would say is that those outside of teaching typically have a higher total compensation package and can stomach the cost a bit easier than teachers. My wife teaches and there is no way that she and my son could afford any of the insurance packages offered last year if something were to happen to me (which is why I have a healthy life insurance policy). The single teacher plan is actually very reasonable, but the jump to family plans is absolutely crazy....which is by design.

[Dusty Britches]

Now is the time to get onto your rep and senator in Austin. They were just talking about this yesterday. Some are waffling on adding a cost of living increase in the pension.

Call them!
Hound them!

[awry]

this is correct.


This is correct. ERS is for all state employees excluding teachers. My wife is in ERS and I’m in TRS. I’m thinking about dropping mine and being added to hers. I think it Would save us money when we retire

The legislature can make the same changes for ERS as well. Think the chances are slightly less, there more people in ERS which translates into more ticked off voters at the polls.

[LWC]

I didn’t say any of that.
I am interested how you reconcile the data with your hypothesized Obama effect.

Your graph only shows the premium cost. You also have to factor in that since Obamacare, you get a lot less coverage and a lot higher deductibles.

[Jason Fry]

You must be an outlier for some reason. to pretend that there were good ole days prior to Obama with the mountains of healthcare cost data we have is head-in-the-sand, partisan, revisionist history. The rate of healthcare cost increase has actually been decreasing, but it is still astronomical.
Note that the y axis is rate of increase.

That's a tricky graph. Shows a decline, but that's only a decline in the RATE of INCREASE. What it shows is a huge cumulative increase in cost over the entire time period.

It's like "I will kill you slower, see, here's a graph."

[jmeghunts]

What I'm taking away from this thread: Keep staying in good shape because I cannot afford to get sick.