Medicare Advantage: A Health Coverage Solution for Retired Educators of Kentucky

Jane Cheshire Gilbert, Director of Retiree Health Care, Kentucky Teachers’ Retirement System

My name is Jane

Medicare has always been the model of health security for Americans, as well as a laboratory for change and progress in the U.S. health care industry.  One great example of this kind of innovation in Medicare is Medicare Advantage (MA), as it fosters many of the principles of health care reform.  MA has lead the way in treatment of chronic disease and care coordination, in provision of preventive screening services with no cost share, and it aligns Medicare reimbursement with quality and value, unlike fee-for-service Medicare. Incentives and innovations are achieved because MA plans bear a portion of the risk of treating enrollees and therefore use dollars wisely to get health care right for the people they cover.

We have seen Medicare Advantage and its care coordination work for retired teachers in Kentucky. Medicare fee-for-service system was often neither effective or affordable care for senior retired teachers.  Here in Kentucky, a retired educator does not fare well in Medicare fee-for-service when a senior gets only fifteen minutes with their primary care physician, with little time to fully explain or consider the complexity of their medical and social needs. For the Kentucky Teachers’ Retirement System (KTRS), MA provides higher quality care at a lower cost for a KTRS Medicare eligible retiree since 2007.

In addition to satisfied retirees, with Medicare Advantage, KTRS has experienced stability of health benefits, coupled with value-added benefits, all for a lower premium.  Now in our ninth year, with 29,000 Medicare eligible retirees, the KTRS MA premium is still $30 lower per person, per month than the Medicare Supplement Plan we had in 2006. By utilizing a combined Medicare Part D drug plan and the Medicare Advantage Passive PPO, KTRS has eliminated $1.9B in future liability obligation from the KTRS Other Post Employee Benefit (OPEB)!

These savings are critical. Health insurance is not a guaranteed benefit for a retired Kentucky educator who does not have the financial safety net of Social Security.  Average age of our 29,000 Medicare eligible retirees is 76 years old, with over 5,600 above the age of 80, and more than 50 over the age of 100. 

These retired educators of Kentucky deserve a valuable health benefit.  With the Medicare Advantage, KTRS has added valuable benefits including hearing aids, incentives for preventive care, and gym memberships--all without materially changing our Medicare plan design since 2006.

Our KTRS retired educators deserve the highest quality affordable care, and we are committed to providing it through MA. KTRS looks forward to working with the Better Medicare Alliance to build support for MA and to demonstrate the value it offers to our retirees and over 17 million seniors nationwide.