Many members of the Texas Retired Teachers Association (TRTA) have contacted us regarding information that appeared in a recent The Inside Line article about opting out of TRS-Care. We have also received many calls about a letter sent out recently by TRS to all Medicare-eligible retirees who currently are not in the TRS-Care Humana Medicare Advantage Level 2 program. The letter is meant as a “guaranteed issue” letter for a participant who needs to purchase a private Medigap supplemental insurance policy. Click here to read an explanation of the letter from the TRS website.
Per the TRS website:
- “If you’re currently enrolled in TRS-Care Standard 1, 2, or 3 or TRS-Care Medicare Advantage 3, both Federal and Texas law provide a ‘guaranteed issue’ right for individuals whose coverage (that is supplemental to Medicare) has terminated or ceased to provide benefits. TRS will provide you with a letter in October 2017 indicating that your current coverage is ending. You may be eligible to purchase a new Medigap policy without underwriting or preexisting condition exclusions anytime from the date you receive the October 2017 letter from TRS until March 4, 2018. You must provide the insurer with the letter that TRS issues to you in October 2017 in order to enroll in the Medigap policy on a guaranteed issue basis. If you don’t qualify for the guaranteed issue right or you purchase Medigap coverage after March 4, 2018, you may be denied coverage or be subject to underwriting and preexisting condition exclusions.
- If you’re currently enrolled in the TRS-Care Medicare Advantage 2 plan, you may apply for a Medigap policy at any time. However, the Medigap insurance carrier may decline to cover you or you may be subject to underwriting and preexisting condition exclusions because the 2018 TRS-Care Medicare Advantage plan is similar to your current TRS-Care Medicare Advantage 2 and Medicare doesn’t provide for a guaranteed issue period for Medigap policies if you remain eligible for similar coverage after Jan. 1, 2018.”
Facts for Medicare-Eligible Participants
Health care is a complicated business, especially for Medicare-eligible participants. TRTA understands that many of these insurance changes are confusing, as are all the rules and regulations regarding Medicare insurance options. We want to provide as much clarity as possible. Please read a few facts TRTA has compiled regarding Medicare below.
- TRS-Care is still a great deal for the majority of Texas retired educators. TRS-Care is a group plan with a relatively rich benefit package, and the price is reasonable when considering the level of benefits. However, as with any insurance program or changes to health care, especially when choices are being limited and costs are increasing, some retirees will look for other options for themselves and their dependents. Many choices are available for Medicare-eligible retirees, while fewer choices are available for retirees under age 65. As with any complicated purchase, please take the time to compare all the benefits and costs on an apples-to-apples basis if you decide to look for other options. Use this TRS document to help you when asking questions.
- The rule regarding TRS-Care has always been that if you leave the program after the age of 65, you cannot re-enroll in the program. This is common practice with many group insurance plans and is meant to prevent “adverse selection.” Adverse selection is when the healthiest and least expensive participants in a program leave to pursue less costly insurance options and participants who are less healthy and need expensive care and treatment stay in the program, causing overall program costs to rise quickly. By keeping a large, diverse group in TRS-Care, the plan is better able to provide financial stability for the group of participants as a whole.
- If you choose to leave TRS-Care, and you are eligible for Medicare, you may need the “guaranteed issue” letter mentioned above if you choose a Medigap insurance supplement. The letter confirms that your current coverage is ending. You should not need the letter if you choose a private Medicare Advantage plan, as these have annual open enrollment periods. Again, please be very cautious when comparing benefits and costs between TRS-Care and alternative programs. Ask yourself if the deal offered in the alternative plan is worth leaving TRS-Care permanently. If you select a private insurance plan, ensure that your new plan begins on January 1, 2018 so you can maximize your current year insurance benefits.
- If you are staying with TRS-Care, you will be auto-enrolled and sent a new insurance card in November or December of this year. TRS asks that you inform them by November 9, 2017 if you are leaving the program. This request is related to the auto-enrollment process if you are not in the TRS-Care Medicare Advantage 2 plan currently. You may still exit the TRS-Care program after November 9, but you may receive health care cards and mailings from TRS because of the auto-enrollment process.
- In order to leave TRS-Care officially, you must contact them at 888.237.6762 ext. 6 and request a form to be sent to you by mail (no electronic copy is available). The form must be signed, notarized and sent back to TRS to decline the coverage and must be received before December 31, 2017 to avoid possible gaps in coverage or double-billing for insurance premiums.
TRS is attempting to make the auto-enrollment process as seamless as possible and deliver information to all affected members in a timely manner. TRTA will help facilitate information and help TRS in any way we can to provide TRTA members with answers to their most asked questions. Remember, there are still several TRS-Care seminars occurring across the state. To view the seminars schedule and to RSVP, please click this link.
TRTA is cognizant that its members have a wide-ranging interest in many subject areas, including TRS-Care and other issues such as cost-of-living-adjustments and the Windfall Elimination Provision. While many of the recent The Inside Line updates have focused on the plight of retirees affected by the TRS-Care changes, rest assured that TRTA is working to create positive change in all areas concerning retiree benefits.
Thank You
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