I am writing to bring to light a current situation that is devastating for our community. 

As you know several years ago, Hendricks Hospital became a monopoly in the Abilene area. From time to time they go through contracting battles with insurance companies and because they are a monopoly they ultimately have the upper hand. 

More recently they have decided they want to be a public hospital that does not network with any Medicare Advantage plans. As each Medicare Advantage plan’s contract comes up for negotiations they let the contract expire. Last year Humana and Aetna were dropped and this year United Health Care (UHC) is on the chopping block. They are currently going through negotiations and have not reached an agreement and from the sounds of it – they do not intend to. Hendricks has shown they wish to be able to bill 100% with no oversight. Greed very clearly plays a role here, as they are expanding rapidly in Abilene and surrounding communities. 

I want educate you on how Medicare works and why this is devastating for many local community members. First and foremost, Medicare alone is $185/mo for the beneficiary. Typically Medicare by itself is not enough. Medicare pays about 80% and the beneficiary is responsible for the other 20%. However there is NO maximum out of pocket. Meaning if $100,000 is billed to Original Medicare, the beneficiary is then responsible for $20,000. A Medicare Beneficiary has the option to add a Medigap/Medicare Supplement to assist with their portion. The most common Medigap is a plan G or a plan N. They range in cost from $100-170 per month, when a beneficiary turns 65. Please keep in mind – these premiums increase annually and someone has to remain in good health to be able to change or obtain these plans past the age of 65. Furthermore, those on Medicare due to a disability DO NOT  have the option in the state of Texas of choosing a Medigap. So without a Medicare Advantage plan they are exposed infinitely to 20% of all charges accrued under Original Medicare. 

A Medicare Advantage plan is a private alternative that does not have an additional premium most often and allows the beneficiary to have copays on most services rather than pay 20%. Most importantly it allows them to have a maximum out of pocket if they cannot qualify for or afford a Medigap. 

In more simplified terms, if someone has preexisting conditions and is on a Medicare Advantage plan and wants to switch to Original Medicare and obtain a supplement so they can remain in network with the hospital they would have to go through medical underwriting and most likely be declined. Meaning their only option to cap their financial medical exposure would be an Advantage plan. The hospital is acting as if it is no big deal for these beneficiaries to just change to Original Medicare. But in all actuality for many it is not even a possibility. 

For a public hospital to decide they do not want to contract with any Medicare Advantage plans is a huge disservice to the community and comes down to nothing more than greed. This does not just have an immediate affect on our community but can also have long term affects. For example, CMS (Centers of Medicare and Medicaid) can come in and deny the ability for these plans to continue to offer coverage in this area because they no longer have in-network suitability. If this happens, it would be devastating for many beneficiaries that cannot afford to have other coverage. 

I would like to give you an example of a woman that I recently sat with. She lives on her $1200 monthly Social Security check. She has $12,000 in a 401K, which disqualifies her for any help with her Medicare premium from a Medicare Savings Program. This means her Medicare will cost her $185 monthly off the top of her check, bringing her monthly check to about $1000. This is what she lives on; groceries, gas, utilities and her beloved pet expenses. If this woman was to pick up a Medigap and a drug plan she adds about another $200 to her healthcare expense monthly. I’d like to ask, do you think that nearly $400 a month is a reasonable healthcare expense for someone living on $1200 monthly? Or do you think it would be better suited for this woman to take an Advantage Plan (MA) that allows her NO additional premiums. She can see her Primary Care doctor and complete her annual preventative services all for $0. If she has a surgery she pays a $300 copay. If she has a ER visit she pays a $125 copay. She gets some extra benefits like an OTC allowance which allows her to pick up her vitamins that she cannot afford for no additional cost. This plan also allows her to cap her financial expenses with a Maximum Out of Pocket Limit, which Traditional Medicare does not have without a Medigap.

Another example; I have a gentleman that is in his thirties and was injured in a motorcycle accident rendering him paraplegic. He is in a motorized wheelchair for the rest of his life. Because he is not 65, his only option to cap his medical financial exposure it to take a MA plan. Because he is on Medicare, even though he is under the age of 65, he does not have access to any other type of Health Insurance such as the healthcare marketplace plans. Is it fair to tell this gentleman “Sorry for your luck?” Your only hospital option is Hendricks. And the hospital that our state and local government officials allowed to become a monopoly is choosing not to network with the only health plans you have access to? Do you think this gentleman can just pick up and drive on down the road to San Angelo to get his surgeries or hospital services?

I understand that MA plans require prior authorizations and can be more restrictive than Traditional Medicare, however there is a place for them such as the two beneficiaries I just described; one a senior on a fixed income of $1000 and one a young man with a a life changing disability. We also have many folks in our community that are Dual Beneficiaries. Meaning that they qualify for both Medicare and Medicaid. If Hendricks is out of network with all MAs then these beneficiaries may accrue expenses that they did not have prior. And traveling out of the area to San Angelo the next nearest hospital is a luxury at best. Most in this situation don't have that as an option. 

In the United Healthcare plan alone, which is the current MA being hacked from the hospital network, there is about 10,000 beneficiaries in Taylor and surrounding counties that depend on this hospital to remain in network. Some of those same beneficiaries are the ones that lost their Humana or Aetna plan last year and moved to UHC to maintain in-network status and keep their cost out of pocket low. Now, UHC is the only $0 MA plan in Taylor county.  

State and local representatives allowed Hendricks to become a MONOPOLY rather than protecting our communities, which is supposed to be their main priority. So now Hendricks can do whatever they want with their insurance networks. If they want to be able to bill the maximum amount with no oversight, they can do it because they have no competitors. And like I said before, this not only has an immediate impact but could have a long term impact when it comes to CMS allowing these MA plans to remain in a county with no other options. I am sure the board members and government officials alike have the luxury of hospital choice and travel for medical services, because money is no issue. However, most of those that rely on Medicare Advantage, whether its the coverage you would choose for yourself - it is the health coverage that serves them best. We need our hospital system to understand the impact this will have if they do not change their minds. 

I am reaching out to advocate for our community of seniors! I am asking for your help to push the hospital to do the right thing. Our seniors already have very limited community programs and most live on a fixed income and cannot afford for Hendricks to put bottom dollar over their health and livelihood