TRS-Care plan changes will not occur until Jan. 1, 2018. If, after you carefully compare TRS coverage with plans available in the individual market and you choose not to enroll in TRS-Care Medicare Advantage and TRS-Care Medicare Rx coverage for 2018, you may have options available to you, depending on your current TRS-Care plan. Please be aware that if you leave TRS-Care, you will not be able to re-enter the program if you are already age 65 or older unless you have a special enrollment event, which is rare.
Please note that these options assume you have both Medicare Part A and Part B. If you only have Medicare Part B, and don’t want TRS-Care Medicare Advantage, contact TRS. Individual Medicare Advantage and Medigap plans require people to have both Medicare Part A and Part B. The 2018 TRS-Care Medicare Advantage plan only requires that you enroll in Medicare Part B, so if you drop TRS-Care and get an individual Medicare Advantage or Medigap plan, you’d have to also purchase Medicare Part A. Read more about the options below:
You may have the option to purchase an individual Medicare Advantage plan on the open market without risk of underwriting or preexisting condition exclusions (except for restrictions on Medicare Advantage eligibility for Medicare beneficiaries with ESRD). Medicare holds an annual open enrollment period from Oct. 15 to Dec. 7. During this time, you can sign up for an individual Medicare Advantage plan if you have Medicare Part A and Part B or if you already have a Medicare Advantage plan. If you miss this open enrollment period and you disenroll from TRS-Care, you’ll get another chance to sign up for an individual Medicare Advantage plan.
If you disenroll from the TRS-Care Medicare Advantage plan – an employer-sponsored group health plan – you’ll be entitled to a "special" election period for an individual Medicare Advantage plan. That special enrollment window begins on Dec. 8, 2017 and ends on Feb. 28, 2018. Individual Medicare Advantage plan coverage under this special enrollment can take effect as early as Jan. 1, 2018 if you apply before Jan. 1, 2018. However, if you don’t purchase an individual Medicare Advantage plan before Jan. 1, 2018, it will take effect later and you might experience a gap in plan coverage. You would still have Medicare A and Part B on Jan. 1, you simply wouldn’t have additional benefits that come with a Medigap policy, Medicare Advantage, or Part D drug coverage.
If you opt out of TRS-Care Medicare Advantage and return to original Medicare and you do not enroll in a Medicare Prescription Drug Plan—or Medicare Part D—you will likely later face an enrollment penalty. Because original Medicare doesn’t cover all medical expenses, you may also choose to enroll in a Medicare Supplement plan, often called a Medigap policy, if you’re eligible for one. Different rules will apply to you if you want to sign up for Medigap coverage if you ever leave the TRS-Care Medicare Advantage plan.
You may purchase a Medicare Part D prescription drug plan on the open market without risk of underwriting or preexisting condition exclusions. Medicare administers an annual open enrollment period from Oct. 15 to Dec. 7, during which Medicare participants with Medicare Part A and Part B can sign up for a Part D prescription drug plan. If you miss the open enrollment period, you will also have another chance to sign up for a Medicare Part D prescription drug plan.
If you are disenrolling from TRS-Care – an employer-sponsored group health plan – you may be entitled to a "special" election period for a Medicare Part D prescription drug plan. That special enrollment window begins on Dec. 8, 2017 and ends on Feb. 28, 2018. Medicare Part D prescription drug coverage under this special enrollment can take effect as early as Jan. 1, 2018 if you apply before that date. However, if you don’t purchase Medicare Part D prescription drug coverage before Jan. 1, 2018, it will take effect later and you might experience a gap in coverage. In addition, if you fail to sign up for Part D coverage when initially available, you may experience a late enrollment penalty that will increase your premium for as long as you have your plan.
You may be eligible to purchase a Medigap policy on the open market. However, as explained below, your TRS-Care plan may affect your ability to do this.
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.
It’s to your advantage to keep your current coverage through the end of 2017. If you’re in a TRS-Care Standard plan, your plan has been extended for an additional four months through the end of this calendar year without any change to premiums, and your deductible and out-of-pocket maximum won’t reset until Jan. 1, 2018. This is an added benefit for this year only so that TRS can move plan participants into TRS-Care Medicare Advantage and TRS-Care Medicare prescription drug plans on Jan. 1, 2018. As a result, you can continue your coverage through Dec. 31, 2017 and take advantage of any available enrollment periods to begin your new coverage on Jan. 1, 2018, whether you choose to stay with TRS-Care or purchase individual Medicare coverage.
TRS will continue to work to ensure that everyone is aware of the coming TRS-Care plan changes through a number of communications channels so that retirees and surviving spouses and their families will have time to consider the changes and shop around for alternatives, if they choose. Your rights to enroll in Medicare and Medigap coverage can be highly dependent on your personal situation. We have tried to provide information that will be applicable in most situations; however, your personal situation may be different.
Medicare provides a number of very useful and informative resources that may help you understand your Medicare rights and enrollment periods. Here are just a few:
We encourage retirees, surviving spouses and their families to consider premium cost, benefit design, out-of-pocket costs, and access to providers in making their health coverage decisions. As always, we stand ready to assist retirees and surviving spouses, as they need it.