A Guide to DFW Metroplex School Districts’ 2015 Health Insurance

The cover of the 2015 Scott & White Health HMO Plan’s Summary of Benefits asks ‘Who thinks school employees should get lower health insurance deductibles?’ To put it bluntly – not I.

Please don’t think me cruel, but I happen to know that deductibles are just marketing tools used by health insurers to sell lucrative policies to folks. A lot of them.

Don’t believe me? I can prove it. Let’s say you just need the Employee option and you’re comparing the ActiveCare-1 HD (Bronze) plan to the ActiveCare 2 (Gold). The Bronze plan has a $2,500 deductible, while the Gold is only $1,000. That’s a difference of $1,500, and sounds like a bargain, right? The trick is, it’ll cost you a cool $3,276 more in premiums to Go For The Gold – and get that $1,500 off the deductible.

It’s even worse if you need to insure yourself and your spouse – by Going For The Gold you’ll have to pay $6,768 more in premiums, just to save $2,000 off the deductible. 

There’s just no way anyone in their right mind would ever do that though, right?

Wrong. It happens every day, and I would wager it’s happening right now, too because once again, hundreds of thousands of school district (ISD) employees across Texas are shopping for new health insurance that will take effect on September 1.

And I predict that many of these folks, just like most other Americans who fear the “costs” of health care, will look to buy the policies that offer them the – you guessed it – lowest deductible.

If they can afford it that is, because over the past few years the price of health insurance has skyrocketed – so much so that salary increases for educators and employees have barely kept up with the increased premiums.

But the question remains: does spending thousands more on a higher-priced, low deductible plan really amount to better coverage?

The answer is a most definite, hardly ever. As I proved last year, when I analyzed health insurance plans for five local school districts in the Dallas/Fort Worth area (see To pay, or not to pay, that is the Question?), and found that any time an employee bought anything other than the high deductible (we’ll call it the Bronze level) plan, they were losing thousands of dollars. And not just in premiums, but also if they got really, really sick and had to maximize their health insurance benefits.

At this point, I want to add an exception to this general rule. And that is, if an insured takes one (or more) of the outrageously priced, “specialty” drugs that cost thousands of dollars per year. In those cases, having the prescription coverage offered by the upgraded plans may result in an economic advantage. However, given that Medicare data shows that < 1% of prescriptions consistently fall into this category, for the vast majority of people who are NOT taking these very expensive drugs, it doesn’t make much sense to purchase the more expensive plans.

This year, I wanted to see if the general pattern still held, so I decided to compare the health insurance policies offered by every school district in Tarrant, Dallas, Denton, and Collin Counties. All 65 of them, in fact (NOTE: I only included school districts where the majority of the district’s geographic area was found within the particular county; I did not include those adjacent districts that only have a slight overlap).

Lo and behold, when I applied the Dr. Wacasey’s Equation to the different available levels (think Bronze, Silver, and Gold), I wasn’t really surprised to see that, as I’ve shown time and again, when it comes to health insurance, less is more. Because in almost every single case, all that glitters is not Gold.

NOTE: Other than links to external websites, the following analysis and all documentation is my work product only. I did not receive any endorsement, acknowledgement, advice, or cooperation from any of the districts involved or their administrative staff, and in no way do the results reflect their opinions. I have tried to be as accurate as possible, and have included links to each district’s benefits page where I got this information; however should any errors or omissions be found please email me.

 

So, without further ado, I present the:

 

Guide to DFW Metroplex School Districts’

2015 Health Insurance

Fifty nine of the school districts analyzed provide the Teachers Retirement System of Texas (TRS) health insurance, which offers one HMO and three PPO plans: ActiveCare 1-HD (Bronze level), ActiveCare Select (Silver level), and ActiveCare 2 (Gold level). State guidelines mandate that each district contribute a minimum of $225 per month toward each premium, but many districts subsidize even more. 

Interestingly though, despite the differing subsidies paid between the districts, almost all of the TRS PPO plans shared one characteristic – the higher the level of insurance bought, the more money spent (mostly on the premiums), with no return on the back end. For example, if insured employees and/or their dependents are involved in a catastrophic illness or injury then compared to the lower-cost, ActiveCare 1-HD plan:

By “upgrading” to the ActiveCare Select plan:

  • The Employee could pay $1,734 more for their total health insurance and health care costs for the year
  • The Employee + Spouse could pay $2,796 more for their total health insurance and health care costs for the year
  • The Employee + Child(ren) could pay $2,064 more for their total health insurance and health care costs for the year
  • The Employee + Family could pay $1,500 more for their total health insurance and health care costs for the year

And by choosing the ActiveCare 2 plan:

  • The Employee could pay $3,426 more for their total health insurance and health care costs for the year
  • The Employee + Spouse could pay $7,068 more for their total health insurance and health care costs for the year
  • The Employee + Child(ren) could pay $4,824 more for their total health insurance and health care costs for the year
  • The Employee + Family could pay $3,780 more for their total health insurance and health care costs for the year

I should note that I did not include policies that involved Both Employees, or Split premiums between family members who work for different ISD’s. If you’d like to do the comparisons for crosschecking or to compare a plan that I left out, feel free to use the Wacasey Equation to do so.

So let’s begin with Tarrant county, which is where I was born, raised, and schooled in the Birdville ISD. There are 20 school districts within Tarrant county, and all but Keller and Northwest participate in the TRS health insurance plans:

 

TARRANT COUNTY SCHOOL DISTRICTS

(Click on the district to see a comparison of plans)

Aledo Crowley Keller
Arlington Eagle Mountain/Saginaw Kennedale
Azle Everman Lake Worth
Birdville Fort Worth Mansfield
Burleson Godley Northwest
Carroll Grapevine/Colleyville White Settlement
Castleberry Hurst/Euless/Bedford

 

Dallas County has 15 school districts:

DALLAS COUNTY SCHOOL DISTRICTS

(Click on the district to see a comparison of plans)

Carrollton/Farmers Branch Duncanville Irving
Cedar Hill Ferris Lancaster
Coppell Garland Mesquite
Dallas Grand Prairie Richardson
DeSoto Highland Park Sunnyvale

 

Denton County has 10 school districts:

DENTON COUNTY SCHOOL DISTRICTS

(Click on the district to see a comparison of plans)

Argyle Lake Dallas Ponder
Aubrey    Lewisville Sanger
Denton    Little Elm  
Krum     Pilot Point  

 

And last but not least, Collin County has 20 different districts:

COLLIN COUNTY SCHOOL DISTRICTS

(Click on the district to see a comparison of plans)

Allen Frisco  Prosper
Anna Gunter Royse City
Bland Lovejoy Trenton
Blue Ridge McKinney Van Alstyne
Celina Melissa Whitewright
Community  Plano Wylie
Farmersville Princeton  

 

So, which policy makes the most sense? Well, it’s high time we stop falling for the same old gimmicks about deductibles and co-pays, and instead start comparing the ultimate value of health insurance plans. And by using The Wacasey Equation to help decide, you can come out ahead.

Every time!

Remember, It’s not the COSTS of healthcare that are outrageous…it’s the CHARGES.

Physician. Health Insurance Agent. Author. Health care humorist. Medical satirist. Disruptor. At your service.

My name is Kevin Wacasey, and I’ve been practicing medicine since 1994. When I graduated from medical school, I took an oath to do no harm to my patients. To me, that includes financial harm. But since health insurance took over health care over 40 years ago, health care prices have skyrocketed. And despite what we’re told by the media every day, it isn’t the costs of health care that are outrageous; it’s the charges. So if you’ve ever wondered why we spend so much on health insurance and health care, then come along and join me as I explore the crazy world of Healthcareonomics. Health care doesn’t have to be expensive. Let me show you how. For speaking opportunities and to pass along your questions/comments, please email me at drw@healthcareonomics.com.

Leave a Reply

Next ArticleTouché!