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31 Aug 2012
0

Important Announcement about Medicare Advantage

by in Medicare, TRS-Care, Update

TRTA Working to Help You!

The Texas Retired Teachers Association (TRTA) has coordinated with the Teacher Retirement System of Texas (TRS) and Aetna to assist TRS members eligible for the new TRS Medicare Advantage plan. We have heard from many of our members concerned about whether or not their doctors will take the new plan. 

Some of you have experienced difficulty in determining if your doctor is in the network or have been told by your doctor(s) that they are not participating.

TRTA wants to help.
We have created a new email address that you can use to send us the names of your doctors. In order to make the process of determining which doctors are accepting the plan easier for retirees, TRS and Aetna have agreed to review the list of doctors generated through your feedback. 
Please send an email to doctorcheck@trta.org that includes the name of your doctor(s), as well as his or her office phone number and office address. Please also include in the email your name and your contact information. It is important that all of this information is included in the email in order to determine accurately if your doctor is a participant.
TRTA will compile a master list and send it to TRS and Aetna. You will receive a response regarding your inquiry within one to two weeks.
TRTA is doing everything possible to answer your questions about Medicare Advantage. Please continue to contact us with your concerns. We do ask, however, that you use the doctorcheck@trta.org email only to provide us with your doctor’s information. 
We continue to receive numerous emails from members who have questions about plan coverage, whether or not they qualify for the Medicare Advantage plan, and what the differences are between standard Medicare and the Advantage plan. 
If you have a question about the TRS-Care Aetna Medicare Advantage plan, please send an email to plancheck@trta.org.
Utilizing these two email addresses will help TRTA better manage the vast amount of emails we receive and organize them into the appropriate categories.  
We continue to encourage our members to call the Aetna customer service line at 1-866-217-2409 (TDD: 711). TRTA staff members tested the number and were able to speak with a representative in less than one minute (our customer service rep was located in the Dallas area, not out of state). If you are experiencing long hold times, please let us know and provide us with details such as the time of day.
Exciting News about Official Aetna Slides
TRTA attended the very first Aetna TRS-Care Medicare Advantage meeting a couple of weeks ago in Austin. Since then, we have been working with TRS and Aetna to provide all of our TRTA members with the presentation slides and special video used during these presentations.
We have great news. TRTA now has the slides and the video is on the way! Below is a link to the official Aetna presentation slides. In addition, there is another link to a video presentation produced by TRS featuring Mr. Brian Guthrie, TRS Executive Director. Next week, we should have the official Aetna video used during the TRS-Care Medicare Advantage seminars.
Official Aetna Medicare Advantage Video—Coming Soon!
TRTA members that have attended a seminar already can now go back and review the information at their own leisure. TRTA members preparing for an upcoming seminar can be better prepared to ask their questions.
We are very grateful to Aetna for providing these materials. Please note, while we are providing these materials now, it is still in your best interest to participate in a workshop (where they are available) or listen to an Aetna conference call.
Many TRTA members now live out-of-state, and these materials will help you receive the same information we are hearing here in Texas!
Aetna Response to Two Very Involved Questions
More than a few TRTA members want to know how this Medicare Advantage plan can offer a better benefit at a lower premium, and still provide savings to the TRS-Care health care plan.
Additionally, some of you have asked TRTA about a Medicare Advantage video that is circling the internet talking about how the move to MA plans is more than a political “coincidence.”
The real issue with these questions and the internet video seems to be long-term sustainability.
We asked Aetna these questions and this is their response:
Maintaining sustainable Medicare Advantage plans
How is Aetna planning to execute in areas of sustainability?
Aetna has planned and is executing actions in several areas to mitigate these funding cuts:
·         Star Ratings:  Focused efforts to improve performance across the spectrum of clinical, operational, and member satisfaction measures that drive star ratings and quality bonuses.
·         Risk Adjustment:  Focused efforts to ensure complete and accurate data that drives member-level risk adjustments to CMS revenue.
·         Care Advocacy:  Enhanced advocacy and programs for improved plan participant well-being, ensuring the appropriate care at the appropriate place & time, reducing costs to plan participants, their plan sponsors if applicable, and the plan.
·         Provider Contracts:  Collaborative, performance-based relationships coupled with analytics and data sharing to further improve cost, quality, and utilization outcomes.
·         Administrative Expenses:  Stable margins coupled with modest efficiency gains will drive stable loss ratios.
·         Network Strategy: Continue to enhance our relationships with key, high-volume providers, utilizing our collaborative model and thereby enhance the effectiveness of care management. 
 
Overall, we expect Aetna’s action plans to effective in limiting the impact of CMS funding cuts.  This will allow Aetna to maintain stable pricing of rates and benefits, and sustain the Medicare Advantage program’s value proposition.
If the government is cutting back on how much it pays health plans for Medicare Advantage, what will happen to my Medicare Advantage plan?
We know how important it is that our members have affordable, high quality health plans. We’ve been working hard to keep our costs down.  Our efforts will help keep your costs down, even if government payments don’t keep up with rising medical costs.
We’re doing a lot of different things. A few important ones are:
·         First, we focus on providing you with excellent service and clinical programs. We know how important that is to you. It’s also important to the government. Plans that score well in the government’s ratings also get paid a little bit more.  So you win on a few fronts. You are happier with your plan, and you get a little more value for your dollar.
·         We work with you and your doctors so you get the care you need, at the right place and at the right time.  We help our members understand and deal with chronic conditions like diabetes and heart disease.  Our efforts are focused on helping you get the right health care, keeping you healthy, saving you money and keeping your plan costs low.
·         We’re working with doctors and hospitals in new and exciting ways.  We’re starting to pay more of them according to the quality of care they give – not just how many services they provide.  We’re helping them use new tools to make your care more efficient and effective.
·         And, of course, we’re always looking for ways to reduce our cost of doing business.
Those are just a few of the things we’re doing.  We’re working to keep premiums from rising, even while the government is planning to cut back on funding for Medicare Advantage.
–End of Aetna’s response
TRTA will continue to work with TRS, the Texas Legislature, and Congress to protect your health care plans under Medicare and TRS-Care.

The next TRTA update will provide more information about a recently released TRS benefit study. Look for this update later this weekend!

As always, thank you for being a member of TRTA. Your membership matters to us, and we hope to represent YOUR voice on these issues.

If you are not a member and want to join, please contact TRTA at 1.800.880.1650.

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30 Aug 2012
0

TRS Makes Budget Pitch

by in TRS, Update

TRTA to Legislature…Now is the time to adequately fund programs!

Today, the Teacher Retirement System of Texas (TRS) presented its 2014-2015 budget request to the Legislative Budget Board (LBB) and the Governor’s Office of Budget Planning and Policy (GOBPP). The LBB is a permanent joint committee of the Texas Legislature that develops budget and policy recommendations for legislative appropriations for all agencies of state government, as well as completes fiscal analyses for proposed legislation. The LBB also conducts evaluations and reviews for the purpose of identifying and recommending changes that improve the efficiency and performance of state and local operations and finances.

Brian Guthrie, Executive Director of TRS, provided a summary of the system’s budget needs for the 2014-2015 biennium. Mr. Guthrie stated that the TRS baseline budget calls for a state contribution of 6.4% to the pension trust fund for both years of the biennium. Mr. Guthrie also requested that an exceptional item be considered to help move the fund towards actuarial soundness. He stated that if the state contributed 8.13% to the fund today, the fund would become sound.

Understanding the current budget environment, Mr. Guthrie noted that this request may not be reasonable and recommended that instead, the Texas Legislature consider making incremental increases to the fund. Under exceptional items TRS is requesting that the state make a 6.9% contribution in 2014 and 7.4% contribution in 2015, an increase of half a percent each year.

Mr. Guthrie also discussed the results of the pension benefit design study that was mandated at the end of the last legislative session. The final report is due to the Legislature on Saturday, September 1 and will also be posted on the TRS website at that time. Mr. Guthrie discussed eight key findings from the study, including that the system can continue to pay benefits to all of its members without making any changes until the year 2075.

The study looked at a variety of possible methods for reducing the trust’s unfunded liability, which is presently $24 billion. Some options that would have a significant impact on the fund include raising the minimum retirement age from 60 to 62 or changing the multiplier. TRS will make no recommendations to the Legislature about what options should be used to address funding issues; the study was done as an objective means of reviewing all possible options. TRTA will report more about this study after it has been released officially.

Mr. Guthrie also presented the budget request for TRS-Care. Mr. Guthrie asked that the 1% (of the aggregate active teacher payroll) state contribution be restored in both years of the upcoming biennium. During the previous legislative session, the state contribution was 1.0% in the first year of the biennium and 0.5% in the other. TRS-Care has more immediate funding issues than the pension fund, which has resulted in TRS taking action over the past several months.

As you know, TRS is implementing an optional Medicare Advantage plan for retirees who are Medicare A and B eligible. Mr. Guthrie discussed that with the cost savings from this plan, combined with the restored state contribution, TRS-Care will remain solvent through 2015. Without the restored contribution, TRS- Care may experience a shortfall in 2016 or 2017. Funding for the healthcare plan is a long-term problem that was also addressed in the legislatively mandated study.

TRTA provided public testimony at today’s hearing. We stressed that TRTA fully supports the TRS budget plan to gradually increase the state contribution to the pension fund and to restore full funding to the TRS-Care program. Retirees need to be reassured by the state’s commitment to the 1% contribution for their healthcare. Members of the LBB were reminded that retirees have not received a cost-of-living increase since 2001, and that members can receive one only if the fund is actuarially sound.

Many TRTA members did receive a much needed supplemental payment in 2008, and this benefit increase provided vital short-term financial relief. Since that time, inflation continues to erode our members’ ability to maintain a reasonable standard of living and pay for medical care, basic goods and services.

TRTA believes that higher state contribution rates are reasonable and appropriate given that 95% of the public school employees in Texas are not covered by Social Security. By not participating in Social Security, state and local taxpayers save billions of dollars that would otherwise be sent to Washington, D.C. For the last 15 years, state and local taxpayers (as a percentage of payroll) have been paying less for TRS retirement and Social Security combined than private sector employers pay.

TRS members are being asked to make changes by participating in the new TRS Medicare Advantage plan in order to help save money and extend the life of TRS-Care. TRTA’s expectation is that the state will honor its statutory commitment to extend the life of the health care fund by contributing 1% each year.

That being said, significant changes are being considered to make it viable in the future. TRTA’s concern is that retirees are already paying a significant share of the total health care costs.

Absent additional TRS-Care funding sources in the future, retirees may no longer be able to afford adequate health care(this is a key fact legislators need to know).

TRTA believes it is critical to address the long-term funding needs for TRS-Care NOW, rather than taking action when the fund runs out of money.

TRTA is committed to working with the Legislature to devise long-term solutions for TRS-Care that are fair and equitable.

We will need your help in the coming session to work with the Legislature and help bring much needed action on this vital issue.

Membership Matters

Thank you for being a member of TRTA. Our network of informed and involved education retirees continues to grow. If you are not a member and need more information on how to join, please contact our office at 1.800.880.1650.

Final Note: TRTA will provide an important update on new Medicare Advantage information tomorrow!

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24 Aug 2012
0

Medicare Advantage Explained

by in Medicare, Update

TRTA is Live at the first Aetna Presentation on Medicare Advantage Plans

The Teacher Retirement System of Texas (TRS) is preparing to enroll thousands of TRS-Care 2 and 3 participants into the new Medicare Advantage plan. TRS-Care participants that are Medicare A and B eligible will be automatically enrolled in the new Medicare Advantage plan.

This additional plan option is presented as a solid program of benefit coverage and reduced costs. There are good indications that the TRS-Care Aetna Medicare Advantage plan will benefit many TRS-Care participants. There are, though, many questions about how the new Medicare Advantage plan option is different than current coverage through Medicare and TRS-Care 2 or 3 (Medicare is primary coverage with TRS-Care being secondary coverage).

To answer these questions, TRS and Aetna are conducting a series of meetings around the state. The goal of these meetings is to inform TRS-Care participants about the Medicare Advantage plan, how it works, how the plan saves the participants money, and how to decide to stay in the new Medicare Advantage plan or opt-out and return to traditional Medicare and TRS-Care 2 or 3.

The first of these statewide meetings occurred this morning (August 23, 2012) in Austin. TRTA attended this meeting and we have some answers to some of the most commonly asked questions.

In addition, TRTA is working to link you directly to the Aetna materials presented at the meeting. These materials include a video overview and the presentation slides that will be shared at these meetings. At the time of this email, those video and slide presentations were not yet available. We hope to have that information from TRS and Aetna very soon.

TRS and Aetna will be making dozens of presentations around the state and many of you are already signed up to attend one of these meetings (click here for the presentation schedule). Please use the information presented in this update to prepare your questions in advance. If you are not able to attend and ask your questions directly to an Aetna representative, please send TRTA your questions and we will provide them directly to Aetna officials to get answers.

If you have provider participation questions, please call 1-866-217-2409 (TDD: 711). These Aetna customer service agents have the most up to date list and can contact providers directly about participating in the TRS-Care Medicare Advantage plan if they are not yet in the network.

TRTA is working to get as much information as possible for you on this important topic. It is our purpose to provide you the information needed to make informed decisions about your health care choices.

Please note, TRTA does not endorse any one of these programs over the other. For some, the new TRS-Care Medicare Advantage program will be a great option. For others, remaining with traditional Medicare and TRS-Care 2 or 3 will be the better option. Knowing what option is best for you is a very personal decision and one that should be made after reading the information and talking with an Aetna customer service agent and/or TRS.

TRTA does endorse the TRS-Care plan! This is a great benefit for Texas public education retirees and one that we are working hard to protect. While not everyone may like these new plan options, we must all work together to let legislators know we value the TRS-Care plan and will work to restore funding and protect the health care benefit.

TRTA can also say that TRS has worked hard to provide you a very benefit-rich Medicare Advantage plan that is far better than any individual plan available in the general market. In addition, TRS and Aetna have a strong working relationship and a solid national network for your plan. The ability to learn about the plan, work with your medical providers, and try it after the first of the year with a guaranteed no-penalty opt-out is a strong indicator that TRS believes this plan will fit many participant situations.

We are working closely with TRS. In the event that our members are not satisfied for any reason, we will address those issues with TRS and with you. Thank you for your continued support and ongoing feedback.

Meeting Overview (Read this section if you plan to attend a future TRS-Care meeting):

  • Meeting started around 10 AM. Parking at the meeting location was very challenging and delayed the start time by about 10 minutes.
  • If you are planning on attending a future meeting location in your area, make sure you arrive at least 20 minutes early.
  • There were well over 250 attendees in this morning’s session. The room was full to standing-room-only capacity.
  • The actual Aetna presentation lasted about 45 minutes.
  • A short video was shown (about 11 minutes) and then Aetna representatives provided additional content through a slide presentation (links provided in this update).
  • The video and the slide presentation flow very quickly, so be sure to write down your questions as all questions are held to the end of the presentation.
  • Additional materials were provided at the meeting, BUT copies of the slide presentation were not distributed.
  • The question and answer time was moderated by Aetna staff.
  • Aetna representatives responded to dozens of questions being asked by the group, but also remained after the session to answer more personal or individualized questions.
  • Aetna is not allowed to answer questions about the prescription benefit program administered through the new pharmaceutical benefit manage Express Scripts International (also known as Merc Medco for a few more months).

Meeting Highlights (Key points from the Aetna presentation):

  • TRS-Care Medicare Advantage PPO plan (hereafter TRS-Care MA) is NOT an individual Medicare Advantage plan. It is a specific group plan with better benefits for participants and physicians compared to other individual Medicare Advantage plans;
  • TRS-Care MA does not act as a “gatekeeper” and cannot deny medical service that is Medicare eligible (in other words, the insurance provider is not overriding a doctor’s discretion on your behalf);
  • TRS-Care MA does not cover procedures that are not already Medicare eligible (meaning that if Medicare is not covering a procedure, such as an experimental procedure or a cosmetic procedure, it is not likely that the TRS-Care MA plan will, either);
  • TRS-Care participants CAN opt-out starting in November of 2012. The number to opt-out is 1-866-217-2409 (TDD: 711);
  • If a TRS-Care participant opts out, though, they cannot get back into the TRS-Care MA plan until at least January 2014;
  • If the TRS-Care participant is the least bit interested in trying this new option, they should not opt-out in November. After January 1, 2013, a participant will be able to opt-out at any time;
  • The Aetna doctor and hospital network is very large in Texas and in the nation. This is a national network;
  • If your doctor is telling you they will not take this plan, Aetna will contact that doctor and verify they have the information on this TRS-Care MA plan and how it is different from individual MA plans already in the market;
  • Aetna has a very high success rate (90 percent!!) in convincing doctors to accept the Medicare Advantage plan if they can communicate directly with them;
  • The number to check if your doctor(s) are in the plan is 1-866-217-2409 (TDD: 711);
  • The benefit levels with the TRS-Care MA plans are higher than traditional Medicare and TRS-Care;
  • Cost savings are a combination of health advocates working with you and on your behalf, and;
  • Better medical care planning, follow-through, and follow-up with the many additional services offered through the TRS-Care MA plan (many of these additional services are FREE to TRS-Care MA plan enrollees);
  • These costs savings are being passed on to you and to the TRS-Care plan.

Participant questions asked during the Q&A:

  • Can Aetna deny me the care that my doctor is saying I need? Aetna response: No, the Aetna TRS-Care MA plan does not deny services provided by medical professionals that are already Medicare eligible.
  • Aetna and TRS are lowering my premiums in this plan, but they are saying my benefits are richer. How is this advantageous to TRS and Aetna and less costly for me with better benefits? Aetna response: Traditional Medicare does not engage in health advocacy and does not have the extensive effort for coordination of care for all your health questions and concerns. The TRS-Care Aetna MA plans work together to coordinate and engage with you directly for better, faster, more comprehensive care. These efforts, with you at the center of this care plan, saves everyone time and money in the long run as it keeps you healthier and helps get you well more quickly.
  • I have called various hotlines and the people are hard to understand or communicate with. Can we get a better group of people to communicate with?! (much applause with this question) Aetna Response: People from Aetna are here in America. We are building teams all over Texas with additional call centers in San Antonio and Arlington. More agents are coming online all the time.
  • How many customer service reps will their be? Aetna response: We do not have that answer, but we will get it to you (TRTA will follow-up).
  • Is “health advocate” just another term for “services gatekeeper?” Aetna response: No, your health care is a collaborative effort with you at the center and Aetna and your care providers all working together. Many Aetna care advocates are registered nurses who are there to ensure you are getting quality care, making sure your questions are answered, and providing you tips on healthy living. In addition, TRS-Care Aetna MA plan has many FREE services built into this plan including special wellness discounts, quarterly communications on healthy living, and lots of hands-on feedback through the customer service hotline.
  • Is this plan tied to Affordable Care Act? What happens if it is repealed? Aetna Response: No, this plan is not tied to the Affordable Care Act. Medicare Advantage plans have been around for a long time. About 1 out of 3 Medicare eligible participants around the country are in a Medicare Advantage plan. The future trends are suggesting those numbers may increase to 1 out of 2. No, these plans are not tied to the Affordable Care Act (reemphasized by the speaker).
  • Is the copay associated with the TRS-Care Aetna MA plan in effect a substitute for the 80/20 rule we now have through traditional Medicare and TRS-Care (80 percent of the usual and customary claim covered by Medicare with the other 20 percent covered by TRS-Care)? Aetna response: Yes. Under the current plan Medicare pays first, then TRS. With the new plan Medicare is no longer involved. One payment is processed. You pay the copay for the office visit (which may be $5 or $10). After that, you pay nothing else for that visit, unless some other service is required (such as labs, tests, etc.). Those services are covered under the plan depending on what they may be.
  • My spouse is deceased and I have Med through him. Will I qualify? Aetna Response: This is a more individualized question, and we will help answer it before you leave.
  • No info being given on the Med D plan. Aetna response: I am sorry that we are unable to answer questions about Medicare D and the new TRS prescription drug benefit program. Contact TRS or Express Scripts with these questions.
  • Is this network nationwide? Aetna Response: Our TRS-Care Aetna MA network is a nationwide preferred provider network. Same benefit regardless of where you live.
  • Can I really opt-out any time? Aetna response: Yes. November 2012 is the start of the opt-out, but if you want to at least try the new plan and all the enhanced benefits at a lower cost, then wait until the plan begins in January and evaluate it for yourself. You will be able to opt-out any time after that and you will have the experience to know how the plan is working for you and with your medical care providers. You will not be able to opt back in until January 2014 if you opt out in November. People who opt out after January 1 will revert back to traditional Medicare and TRS-Care 2 or 3 (whichever one you had before the new plan started).
  • I called 4 of my primary doctors and they all said “no” to Medicare Advantage plans. Is that common?Aetna response: No, it is not common. Contact our Aetna service representatives at 1-866-217-2409 and have the retiree advocates call the doctors directly to see if they understand how the plan works and make sure they will not accept payment. When doctors learn more about this plan and how it is a special group Medicare Advantage plan, many accept the plan with no problem. The key is getting Aetna involved in this process and do not accept the first “no” without letting us talk to your care providers. It may really help you save a lot of money.
  • I want to ask about the opt-out one more time. Is it really a no penalty opt out at any time for any reason?Aetna response: Yes. First opt out is in November. Try it first and then opt-out if you are not satisfied, but satisfaction rates for these group Medicare Advantage plans are very high. Yes, you can opt out and then revert back to the original plan.
  • Aren’t medical services approved by Medicare? Aetna response: Yes, the Feds regulate Medicare services eligibility and these provisions also govern Medicare Advantage plans. Doctor’s must determine care and Aetna cannot deny those services so long as the services are Medicare eligible. If it is experimental and or cosmetic (which Medicare does not pay now), these claims may not be paid. Remember to engage your health care advocates in the Medicare Advantage program through our customer service phone number–1-866-217-2409.

The session broke into individualized Q&A after this discussion.

If you did not see the question asked here that you want answered, please email me and I will work to get that question to Aetna.

Again, today was only the first of over 20 scheduled statewide meetings. TRTA will continue to update you on the meetings, the questions, and the answers provided to our TRTA members. Additional meetings are being planned and added for your convenience.

If you have questions, please send them to tim@trta.org or to trta@trta.org. We are recording these questions and will use them to update you in the future.

Thank you for your membership in TRTA. As you know, these are challenging times and we need your support and membership to effectively represent you! If you are not a member, but want information on joining TRTA, please contact us at 1.800.880.1650.

One final thought…the implementation of the new TRS-Care MA plan will impact hundreds of thousands of TRS retirees. Out of these hundreds of thousands of TRS retirees that will be impacted, only about 16,000 are signed up for seminars around the state. Now is a great time to talk to you friends and family about joining TRTA to get as much information on these plans as possible.

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