School board approves change to Humana-based post-65 retiree health plan after steep renewal

The West Allis-West Milwaukee School Board on Oct. 13 approved a renewal for the district’s post-65 retiree medical and prescription drug program that moves medical and pharmacy coverage under a Humana Medicare Advantage (MAPD) offering and preserves the district’s buy-up option for retirees who wish to keep richer benefits.

District staff told the board the change responds to unusually large renewal filings from the district’s existing carriers and to federal policy changes that took effect in 2025. Dawn Marking of Innovative Benefit Solutions and consultants from Brown & Brown and Humana presented cost comparisons and plan options during the meeting; assistant superintendent Aaron Norris introduced the item.

Why it matters: carriers’ renewal proposals reflected multiple cost drivers, staff said — higher hospital/provider pricing, rising specialty-drug use among retirees, increased behavioral-health utilization and regulatory changes tied to Medicare that shifted costs into carriers’ books. Presenters said one major federal change from the Inflation Reduction Act, implemented in January 2025, reduced the pharmacy catastrophic threshold and created an effective $2,000 incurred-cost cap that increased plan liabilities. Staff told the board that those factors produced unusually large renewal rates from the incumbent medical carrier and pharmacy partner.

What the board approved: staff recommended, and trustees approved, a consolidated Humana option in which Humana would provide both medical and pharmacy. Under the district’s preferred alternative, the base combined premium would be approximately $145 per member per month (district pays roughly half). The district would keep a buy-up tier that preserves the higher-cost benefits retirees selected previously; retirees who choose that tier will pay the added difference. Staff said the proposed Humana base option required some benefit changes to hold the district contribution roughly steady (examples cited included specified inpatient copays and a higher calendar-year out-of-pocket cap compared with the current program). The board approved the item by voice vote; the meeting record does not report a roll-call tally.

Implementation and retiree outreach: staff said existing retiree enrollments would transfer automatically to like-for-like coverage where possible; retirees who wish to switch tiers or opt out must complete a form. All retirees will receive new ID cards and welcome packets; Humana and district staff will hold an informational session on Nov. 4 at Nathan Hale High School. Staff noted some network changes to be aware of: the district was notified that Mayo Clinic (Rochester) facilities will not participate in Humana’s Medicare Advantage network beginning Jan. 1, and ancillary networks (dental, vision, hearing) would change from Anthem providers to Humana providers under the consolidated plan.

Board discussion: trustees asked about the vendor search and negotiation process and whether the 2026 renewal quoted by Anthem left room for negotiation. Presenters said staff solicited market bids, that Anthem’s initial renewal represented a 63% increase and that Humana’s proposals were more competitive once the district assessed combined medical/pharmacy pricing and plan design tradeoffs. Board members also asked whether the enrollment pattern (many retirees choose the buy-up) would change; presenters said past experience suggested most retirees would remain on the buy-up despite higher monthly costs.

Next steps and costs: staff recommended approval of the Humana consolidation and the alternative base plan that limits the district’s exposure while preserving the buy-up option. The board approved the motion without a roll-call tally recorded in the public transcript; staff will proceed with retiree mailings and the Nov. 4 information session.