Blog

28 Jul
0

TRS Releases More Information on Medicare Advantage Programs

(Your next packet of information is in the mail, or you may read it now by clicking on the links provided by TRTA)

TRS-Care 2 Enrollees ||| TRS-Care 3 Enrollees

The incorporation of the new TRS Medicare Advantage Plan is a big change for many TRS-Care participants. Some TRTA members eagerly are awaiting the cost savings associated with these plans. Others want nothing to do with the plan and want to opt out at the earliest opportunity.

Nearly all TRTA members contacting our office want more information. There are some common questions that many members are asking:

  • Will my doctor(s) and medical provider(s) accept the Medicare Advantage plan?
  • Am I able to opt out?
  • When will TRS be able to answer direct questions about provider networks in all areas of the state?
  • Does TRTA think it is a good idea for me to be on the Medicare Advantage plan?

Let me answer the last question first. The answer is one that many people will not want to hear. The fact is that this is a very diverse state. An individual’s health care options vary widely by location. Some areas are losing doctors and hospital networks that are willing to accept Medicare. Other areas are full of medical provider options; but some are saying they are not accepting Medicare Advantage plans. Many people just want to know if this is a good program or one that could force them potentially into situations with their health care they cannot afford (either financially or personally).

We know this is not going to be an easy decision. The good news is that there is still plenty of time to have ALL of your questions answered before it impacts your insurance options. The program will NOT auto enroll anyone until January 1, 2013. Over the next five months, TRS will provide many opportunities to address your questions.

TRTA is not endorsing or condemning the TRS-Care Medicare Advantage plan. We do, however, have tremendous confidence in the people working on your behalf at TRS. These dedicated employees are doing everything they can to make the TRS-Care Medicare Advantage plan beneficial for those choosing to utilize it.

Please remember the Teacher Retirement System of Texas is providing you with a 100% guarantee opt-out provision. If you review the Medicare Advantage plan over the next few months and decide to stay in the plan in 2013 as many TRS retirees will, you can opt out at any time for any reason—even if you have been in the plan for six months.

It is also important to know that if TRTA did not think that TRS was doing everything in their power to provide a comparable plan that is beneficial to our members, we would oppose its implementation. We are not opposed to TRS officials working on plan design options that provide equal or better benefits, and savings to the member and the plan. The TRS Medicare Advantage plan is NOT the average, off-the-shelf Medicare Advantage plan available in the open market. It has been tailored to serve TRS retirees and is based largely on the Medicare supplement programs already available through TRS-Care 2 and 3.

TRTA is trying to learn more about medical provider networks. We have been told by TRS and Aetna that even though a medical provider (doctor or hospital) may have a policy against taking Medicare Advantage, they may not have a problem taking the TRS Medicare Advantage plan and/or payment from the plan because it is different than the standard general market plan.

What this means is that if you have already started checking with your medical providers and have been told that they do not take Medicare Advantage, it is worth the effort to verify with Aetna as their plan and payment allowances may be acceptable to the provider. This may seem like extra legwork on your part, but it could open doors for you and many TRS retirees in your area. TRS and Aetna have the ability to make changes, and your role simply is to check with your medical providers and provide feedback.

TRS and Aetna are preparing to go on the road and visit with TRS-Care plan participants directly. These meetings should be announced soon. TRTA will post the schedule on the Inside Line and on our web site as soon as it is received.

We understand that many of you have questions and concerns. We are also concerned. TRTA is confident that TRS is working for you on this plan implementation. They want you to know what is or is not possible in your region, and they are very appreciative for your feedback.

Finally, TRTA is working with TRS to develop a “checklist” that you can use to make a better, more informed decision about whether the TRS-Care Medicare Advantage Plan is a good option for you. As we continue to receive your comments, we will relay them to TRS and provide answers back to you.

We have the next five months to work together and get as much information as possible. We are focused on helping you have the information necessary to make a good decision for you and your family. Remember to click on the links above to see a PDF version of the information packet that TRS is sending. Pages 4-8 provide details on how these plans may save a TRS-Care participant out-of-pocket costs. Please continue to provide your questions and feedback.

Friendly Voting Reminder

Today is the end of early voting in the Texas primary runoff elections, but that does not mean this is your last opportunity to go to the polls! Remember that Tuesday, July 31 will be your final opportunity to vote. There are MANY VERY CLOSE ELECTIONS STILL TO BE DECIDED. TRTA members vote in high percentages, so we need you to get to the polls and vote for the candidate(s) you believe are the most interested in protecting your TRS defined benefit plan and your health care benefits. TRTA does not endorse candidates, but if you have a question about a legislative voting record please let us know. More information about candidates can be found by asking your friends and fellow TRTA retirees. If you want to contact one of our local units in your area, please click the link below for more information about our statewide TRTA local unit network : http://LocalUnits.org/LocalUnitDirectory/

TRTA Membership

Thank you to everyone who has already taken the time to renew your TRTA membership. As you all know, we are in a major fight to protect your TRS defined benefit plan and health care benefits. Your membership is helping us work for you. If you are not yet a TRTA member, or would like more information about our growing retiree network that exceeds 73,000 members, please call us at 1.800.880.1650 or send your questions to trta@trta.org.

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06 Jul
0

TRS Posts Official Information on New Prescription and Medicare Advantage Plans

The Teacher Retirement System of Texas (TRS) has posted the official information resource about the new prescription drug and Medicare Advantage plans on their web site. You can see this document by clicking here.

TRS retirees will be receiving this information brochure in the mail very soon. In addition, TRS is working on a schedule of statewide information sessions that you can attend where TRS and Aetna will be available to talk about this optional TRS-Care coverage. TRTA will post that schedule when it is available.

Also, TRTA has mailed the second quarter issue of The VOICE (our member news bulletin). We cover many details of the new prescription drug and TRS-Care Medicare Advantage options. This information will help answer many of your questions and prepare you to make a decision about what options fit your needs the best.

We know that many of you want to know more about what is covered by the plans. TRS, Aetna, and Express Scripts are diligently working to answer your questions about coverage options, doctor and hospital network acceptance, and more.

TRS has established two special toll-free numbers.

For Questions Regarding Current TRS-Care Coverage—1.800.367.3636, press # 1 at the prompt to connect directly to an Aetna representative;

for Questions Regarding Express Scripts Medicare plan—1.800.367-3636, press # 2 at the prompt to connect directly to Express Scripts Customer Service; and

for Questions Regarding Aetna Medicare Advantage Care 2 and Care 3 plans—1.866.217.2409 to Connect to the TRS-Care Medicare Advantage Hotline.

More Information

The Teacher Retirement System of Texas (TRS) is your best resource to ask provider and benefit related questions. TRTA wants to know what your thoughts are on these plan choices after you receive the information from both TRS and TRTA. As you consider these options, feel free to email us your questions and comments. We want your feedback.

Please remember, these are OPTIONS. Ultimately, you will need to decide to stay in the new plans or opt out. You may want to know more before making a final decision; we are here to help as much as possible.

Let us know how we can help you. Remember to watch your mailbox for the The VOICE, as well as for the TRS official information guide.

Final Word

Thank you for your support of the Texas Retired Teachers Association. TRTA is working hard to win the war that is being waged against the TRS defined benefit plan. We need everyone interested in preserving TRS to be engaged in this fight.

If you are a member, we appreciate your steadfast support. If you want to learn more about joining TRTA in the battle to protect TRS retiree benefits (and the benefits of future retirees), please contact our office at 1.800.880.1650.

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08 Jun
0

TRS Meeting Underway: Pension Benefit Study, TRS-Care Among Many Issues Being Discussed

Update on TRS-Care Medicare Advantage Option
Many TRTA members expressed concern and shared questions with us regarding the potential changes to the TRS-Care health insurance program. Betsey Jones, Director of Health Care Policy for TRS, was kind enough to review a list of those questions compiled by TRTA and respond to them.
What are the changes being discussed?
  • Medicare Advantage—A health insurance product that takes the place of Medicare and TRS-Care. This plan, while taking the place of these two options, does not remove an individual from the TRS health care program. A TRS-Care Medicare Advantage option is different in benefit coverage and doctor networks than what may be available in the individual market.
  • Employer Group Waiver Program—A prescription drug option that moves a retiree into the Medicare D Prescription Drug plan. This plan has been enhanced significantly from the time of its introduction almost 5 years ago. The overall benefit and cost savings is far more advantageous to the plan member (a TRS-Care participant) and plan sponsor (TRS-Care).
Are these plans linked to the Affordable Care Act (ACA)?
  • The Medicare Advantage Plan is NOT linked to the Affordable Care Act.
  • The Employer Group Waiver Program (EGWP), the prescription drug component, is linked to the Affordable Care Act. The original Medicare D provided a “donut hole” in the prescription drug coverage where participants picked up more of the overall cost. The Affordable Care Act has a provision that reduces the cost of prescription drugs in the donut hole by 50%. This change allows TRS to save millions of dollars by using this plan in lieu of receiving a reimbursement from the federal government, as has been the case for the last few years.
  • If the Affordable Care Act is declared unconstitutional, TRS will reevaluate their decision on EGWP and adjust their decisions accordingly.
What did the TRS Board recommend for the Medicare Advantage Plan?
  • TRS-Care will incorporate a Medicare Advantage Plan as a choice for retirees eligible for this option.
  • The plan provider will be Aetna. Aetna was picked for their large network, current relationship with TRS-Care, strong pricing, and ability to communicate with and advocate for TRS retirees in their Advantage plan.
  • As an additional incentive for retirees participating in the Medicare Advantage plan, retirees will receive a $15 per month reduction in their premiums.
  • In addition, Medicare Advantage deductibles will be reduced by 50%.
    • If you are in TRS-Care 3 and choose Medicare Advantage, your deductible will be reduced from $300 to $150.
    • If you are in TRS-Care 2 and choose Medicare Advantage, your deductible will be reduced from $1,000 to $500.
  • A retiree participating in the Medicare D plan will have a $5 reduction in copays for generic and preferred brand drugs.
  • The Medicare D plan will also:
    • Eliminate the requirement that participants pay the difference in cost between brand and generic drugs when a generic is available;
    • Offer premium and copay assistance for certain low income individuals;
    • Improve benefits for participants faced with catastrophic pharmacy costs.
  • TRS-Care participants eligible for the Medicare Advantage plan and the Medicare D plan will be automatically enrolled. Members need to know that plan participation is voluntary. Though you will be auto-enrolled, you can withdraw from Medicare Advantage, Medicare D, or both. Those who withdraw will revert back to the plan they are already using.
  • The more people that participate in the plans, the more that TRS-Care will save. The incorporation of the Medicare Advantage and Medicare D plans could save TRS-Care as much as $385 million or more. This will help extend the solvency of the TRS-Care plan to at least 2016.
  • The Medicare Advantage Plan is designed to provide coverage as good, and in many cases, better than the current TRS-Care plans 2 or 3.
  • TRS will offer direct member informational sessions through the state’s regional service center network, establish a toll-free information line and provide written materials explaining TRS-Care participant options.
 
TRTA Executive Director Tim Lee addressed the TRS Board of Trustees at today’s meeting regarding the TRS-Care Medicare Advantage proposal. “This plan design option is one that offers many benefits to both the member and the TRS-Care plan. Clearly, the success of these options is based on members understanding them, allowing members to receive care from the health care providers of their choice, and the plan not acting as a ‘gatekeeper’ to those services.
Mr. Lee presented a list of concerns that must be addressed and satisfied for retirees to consider this option one they can be comfortable participating in. This list of concerns was a culmination of questions expressed by TRTA members.
In response, the TRS Board invited the Aetna representative (the selected provider) to answer many questions at today’s meeting. Some of those answers included:
  • The Medicare Advantage product is designed to be as good or better than current options;
  • The plan is NOT the same product as may be available in the private market–this is a product designed for TRS-Care participants;
  • Aetna will not act as a “gatekeeper.” Aetna describes this plan as an “open access program” that allows you to utilize their health advocate network as much or as little as you wish;
  • There are no referrals needed for service; Aetna and TRS believe that a referral system with this plan design is not helpful as many TRS members may need to see more than one doctor every month;
  • There may be some instances when a doctor may take Medicare and not Medicare Advantage. TRS expects Aetna to work with the provider and reach out to the provider community to resolve any issues to the fullest extent possible. Those TRS-Care participants who feel it is more beneficial to remain in their current TRS-Care 2 or TRS-Care 3 plan may choose to do so;
  • For those interested in trying the Medicare Advantage plan, but concerned you will have difficulty switching back to TRS-Care if you decide to opt out, TRS explains that you will go back into your original plan (TRS-Care 2 or TRS-Care 3);
  • If you are not eligible for Medicare A and B, you will not be auto-enrolled in this plan and you will remain on TRS-Care 2 or 3 (depending on your coverage);
  • Non-Medicare Advantage participants will not see premium reductions or benefit enhancements that are available in the Advantage plan, but premiums and benefits for TRS-Care 2 and 3 are unchanged for the coming year.
TRTA believes that the Teacher Retirement System staff and Board of Trustees are providing the best Medicare Advantage plan that is possible for our TRS-Care participants. This option provides a richer benefit, a provider network that is already used for the current TRS-Care plan, lower premium cost and deductibles, assistance through professional health care advocates, plan savings for the TRS-Care plan, and the ability to opt out of the plan without penalty even after the plan is launched in January 2013. TRS-Care will also extend the plan year through December 31, so that retiree deductibles and out of pocket maximum thresholds will not reset at the start of next year.
Many people will still have many questions about plan coverage, doctor choice, and out-of-pocket costs. TRS will launch a broad communications program to answer your questions. TRTA will continue to follow this issue and provide regular information.
The bottom line is that this Medicare Advantage proposal may be very beneficial for those who qualify for it. The proof, though, will be in Aetna educating members, answering questions, and working with doctors and medical providers to ensure their participation in the plan.
Thank you for all your questions about this issue. We are working hard to get the answers you need. A copy of Tim Lee’s letter to the TRS Board of Trustees will be posted to the TRTA web site for your review. Please feel free to send more questions and feedback, and we will address these issues with TRS.
We appreciate your membership in the Texas Retired Teachers Association. Your membership is what helps this organization represent your interests’ with TRS, the Texas Legislature, and to help protect and improve your retirement benefits. If you are not a member and would like to know more about joining TRTA, please contact our office at 1.800.880.1650.
TRTA will provide an additional update on other TRS business issues in the coming days.

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