Frequently Asked Questions (FAQs) – TRS-Care Medicare Advantage

The TRS-Care Medicare Advantage plans are for retirees and their family members who are enrolled in Medicare. TRS-Care Medicare Advantage is the medical plan and TRS-Care Medicare Advantage Rx is the prescription drug plan. It features copays, plus a low medical deductible and out-of-pocket maximum.

TRS-Care Standard is a high-deductible health plan offered to retirees and their family members under 65 and not eligible for Medicare.

TRS-Care benefits and premiums have stayed the same since 2018. The premium you pay is determined by the TRS retiree’s Medicare eligibility, regardless of their dependents’ Medicare status. For example, if you are the TRS retiree and you are not yet eligible for Medicare and you cover your spouse who is eligible for Medicare, you would pay $689 per month because, you, the retiree are not yet eligible for Medicare. (Refer to TRS-Care Plan Highlights (pdf).)

A number of factors contribute to the $3 Billion projection in 2023:

• Following the 2018 health care changes, around 30,000 participants left the program. As a result, TRS-Care has fewer claims each year.
• During the 86th legislative session, the Legislature appropriated $231 million to keep TRS-Care premiums and benefits same.
• In 2020, TRS underwent one of its largest health care procurements ever. This decision to select BCBSTX and UnitedHealthcare as the new medical plan administrators is projected to save an estimated $454 million dollars. Together with the elimination of a federally required health insurer fee (tax) that TRS-Care was required to pay every year, TRS-Care has a positive balance.

It's important to note that any positive balance could neutralize as TRS-Care spends $1.5-$2 billion a year on health care claims and health care funding continues.

TRS for Enrollment and Eligibility related questions: 1-888-237-6762, 7 a.m.– 6 p.m. CT, Monday–Friday

www.trs.texas.gov

UnitedHealthcare for Medical Benefits related questions: 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday,

www.UHCRetiree.com/TRSCare-MA

SilverScript for prescription drug related questions: 1-844-345-4577, TTY 711, 24 hours a day, 7 days a week

Info.caremark.com/trscaremedicarerx

TRS-Care plan options are based on your Medicare status: the TRS-Care Standard plan for those without Medicare (generally, those individuals younger than 65); and the TRS-Care Medicare Advantage plan for those eligible for Medicare.

First, you need to sign up for Medicare. Everyone needs to purchase Medicare Part B, which is the medical coverage.

If you're eligible for premium-free Part A, go ahead and enroll in it. If not, just make sure you get Part B. TRS needs your Medicare Beneficiary Identifier (MBI) to enroll you in coverage. If we do not receive this information, we will not be able to enroll you.

• Attend a TRS-Care Medicare Advantage and You webinar to learn more about the enrollment process
• Visit the Turning 65 page on our website for more detailed steps

Contact Social Security at 1-800-772-1213. You can also apply on SSA.gov or contact your local office. Once you’re enrolled in Medicare, TRS will need that information to sign you up for the TRS-Care Medicare Advantage plans.

TRS has a web page called Turning 65 that will walk you through the steps of applying for Medicare and enrolling in the TRS-Care Medicare Advantage plans.

You may qualify for premium-free Part A if you paid enough quarters into Social Security. The Social Security Administration can tell you if you qualify. You may reach them at 1-800-772-1213.

If you’re not eligible for premium-free Medicare Part A, you don't need to sign up for it. However, you must purchase and maintain Part B to be eligible for the TRS-Care Medicare Advantage.

No, you purchase Medicare Part B separately through Medicare. You do not pay this premium to TRS. You must purchase and continue paying for Medicare Part B to be eligible for the TRS-Care Medicare Advantage medical plan.

Your Part B premium is deducted from your monthly federal benefit. If you aren't receiving SSA or Railroad Retirement Board (RRB) benefits, you'll receive a bill from Medicare. The cost of your Medicare premium will depend on your income.

If you have questions about how much you may have to pay for your Medicare benefits, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.

The Medicare Income Related Monthly Adjustment Amount (IRMAA) is the amount a member may pay in addition to their Part B or Part D premium if their income is at a certain level.

The Social Security Administration sets four income brackets that are determined by either the member (or the member and their spouse's) IRMAA.

If this situation applies to you, you pay your Part D-IRMAA directly to Medicare, not to TRS or SilverScript. You're required to pay the Part D-IRMAA. If you don't pay the Part D-IRMAA and become disenrolled, you may also lose your TRS-Care coverage and you risk not being able to get it back.

When evaluating your health plan options, look beyond monthly premiums, and consider all key out-of-pocket costs, including:

• doctor copays
• inpatient hospital stays
• copays
• out-of-pocket maximum amounts

If a plan sounds too good to be true, it probably is. 

Be wary of plans with unusually low premiums and deductibles – the costs will come from somewhere so it's important to compare all the details.

See our Medicare comparison page for more information.

You must maintain Medicare Part B by paying that premium to Medicare. You pay your TRS-Care Medicare Advantage premium to TRS.
 

• Find more information about Special Enrollment Events here.
• Find more information about our Limited-Time Enrollment Opportunity here.

You get your annuity payment at the end of the month, so if you terminate coverage effective Jan. 1, 2022, you'll see this reflected on your Jan. 31, 2022 annuity check. Your last day of coverage would be Dec. 31, 2022. Insurance is due at the end of the month.

• Contact TRS for a cancellation form (700B). You must sign and notarize the form. Once TRS cancels your TRS-Care coverage, you cannot re-enroll in the TRS-Care program unless you experience a special enrollment event or you turn 65 years of age.
• Cancellations will be effective the first day of the month after TRS receives the notarized 700B form.
• If you are a surviving spouse of a TRS retiree and are enrolled in TRS-Care, send in a written request to cancel your TRS-Care coverage. The request must have your signature.

A network doctor or health care provider is one who contracts with our medical insurer i.e., UnitedHealthcare, to provide services to TRS-Care Medicare Advantage participants. You pay your copay or coinsurance according to your TRS-Care Medicare plan benefits. Your provider will bill UnitedHealthcare for the rest.

An out-of-network provider does not have a contract with UnitedHealthcare. With the TRS-Care Medicare Advantage (PPO) plan, you can see any out-of-network provider that accepts Medicare and will bill UnitedHealthcare.

You pay the TRS-Care Medicare plan’s copay or coinsurance. UnitedHealthcare will pay for the rest of the cost of your covered service(s), including any charges up to the limit set by Medicare. If your provider says they won’t accept the plan, call UnitedHealthcare. They will contact them on your behalf and explain how the plan works.

The TRS-Care Medicare Advantage plan is a National Preferred Provider Organization (PPO) plan. This means you may see providers both in and out of network for the same cost, as long as the provider accepts Medicare and is willing to bill UnitedHealthcare.

If your doctor has questions about the plan, you can reach out to the UnitedHealthcare Customer Service team at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday.

You can locate and find the closest network facility by visiting www.UHCRetiree.com/TRS-CareMA or contacting the UnitedHealthcare Customer Service team at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday.

The TRS-Care Medicare Advantage plan does not require a referral to see a specialist. You will pay a $10 copay after the $500 annual deductible has been met.

No, prior authorization is not required, as long as the out-of-network provider accepts Medicare and is willing to bill UnitedHealthcare.

Deductibles, coinsurance and maximum out-of-pocket: For more detailed information, you can visit www.UHCRetiree.com/TRS-CareMA to download a copy of the plan guide (pdf) and Evidence of Coverage (pdf).

A deductible is the cost you pay on health care before the TRS-Care plan starts covering any expenses. The maximum out-of-pocket is the amount you must spend on eligible health care expenses through copays, coinsurance or deductibles before the plan starts covering all covered expenses at 100%. TRS-Care Medicare Advantage participants have a $500 deductible and a $3,500 maximum out-of-pocket per person.

Services that do not apply to the deductible such as primary care visits mean that when visiting your primary care provider (PCP) for a sick visit, you only pay your $5 copay. That only counts toward your out-of-pocket maximum.

For services that do apply to your deductible such as specialist office visits, you would be responsible for the allowed amount until you meet your $500 deductible. Once the deductible is met, you only pay your $10 copay. Deductibles reset every Jan. 1.

For more information about what does not apply to the deductible, you can visit www.UHCRetiree.com/TRS-CareMA to download a copy of your Evidence of Coverage.

Coinsurance is a percentage you would pay for certain services such as an MRI. For example, on your TRS-Care Medicare Advantage plan, MRIs are covered at 5% coinsurance after you meet your annual deductible. This means that once your deductible is met, the plan will pay 95% of the allowed amount and you will be responsible for the remaining 5% coinsurance.

Frequently asked benefit questions: For more information on your covered benefits, please visit www.UHCRetiree.com/TRS-CareMA to download a copy of your Evidence of Coverage (pdf). If you have further questions, contact our UnitedHealthcare Customer Service team at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday.

There is no dollar amount limit in your TRS-Care Medicare Advantage plan. However, certain benefits may have visit limits such as your routine eye exam, which is limited to 1 exam every 12 months.

The TRS-Care Medicare Advantage plan is not considered a supplement. It provides coverage that would be covered by original Medicare as well as added benefits not covered by Medicare.

The TRS-Care Medicare Advantage plan’s service area includes the 50 United States, the District of Columbia and all U.S. territories. However, under this plan, you have worldwide emergency and urgent care services.

TRS-Care Medicare Advantage plan will pay its share first. The claim then goes to TRICARE, and TRICARE will reimburse TRS beneficiaries’ copayments for services covered by TRICARE. TRICARE will not pay for Medicare Advantage plan premiums, routine dental care, eyeglasses, hearing aids or any other services not covered by TRICARE.

• A PCP office visit is a $5 copay
• A specialist office visit is a $10 copay after you meet your $500 deductible
• A Virtual Doctor Visit for providers in and out of network is a $5 copay. If you use Doctor On Demand™, Amwell® or Teladoc®, the copay will be $0.

• Vision: Are there any dental and vision benefits under this plan?
  • Vision –$0 copay for routine eye exams (1 exam every 12 months)
  • Vision – Plan pays up to $70 eyewear allowance every 2 years or up to $105 contact lens allowance in lieu of eyewear allowances every 2 year
• Dental: Your TRS-Care Medicare Advantage plan only covers Medicare-covered dental services, which are services rendered by a physician or dental professional for treatment of primary medical conditions such as jaw surgery due to radiation treatments

Inpatient hospital stays are covered at a $500 copay per stay after you meet the $500 deductible. The copay along with the deductible accrue toward your $3,500 out-of-pocket maximum.

Outpatient surgeries are covered at a $250 copay after a $500 deductible. The copay along with the deductible accrue toward your $3,500 out-of-pocket maximum.

• Outpatient surgery includes services such as:
  • Cataract surgery
  • Diagnostic colonoscopy

Medicare-covered chiropractic services are covered at 5% coinsurance once after you meet the $500 deductible. Coverage is limited to manual manipulation of the spine to correct subluxation.

Routine chiropractic services are covered at 5% coinsurance once you meet the $500 deductible. The number of visits to a chiropractor are limited to 20 visits per year. This plan provides additional chiropractic coverage beyond what is typically covered by Medicare.

Acupuncture services are covered at 5% coinsurance after you meet the $500 deductible. Coverage is limited to acupuncture for chronic lower back pain up to 12 visits in 90 days. An additional 8 sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually.

Some of the preventive services covered on your plan at a $0 copay are:

• Annual Physical
• Annual Wellness Visit
• Immunizations
• Breast cancer screenings
• Colon cancer screenings
• Cardiovascular screening
• Diabetes screenings

A preventive care service is intended to prevent certain illnesses and diseases. A diagnostic service is intended to identify the nature and cause of an illness or other medical concerns, along with the method of treatment.

Your Annual Physical is your opportunity to have labs and test done to measure your health. Your Annual Wellness Visit is your opportunity to set time aside for a conversation with your primary care physician to discuss options for preventive care and screenings and exams. While your Annual Wellness Visit can be scheduled for anytime throughout the year, many people choose to combine their Annual Physical and Annual Wellness Visit to allow for a longer visit with their doctor. There is no charge for this visit.¹

¹A copay or coinsurance may apply if you receive services that are not part of the Annual Physical/Wellness Visit. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply. © 2021 United HealthCare Services, Inc. All Rights Reserved.

You can get your Annual Wellness Visit anytime during the calendar year. You do not have to wait a full 365 days for your next Annual Wellness Visit.

For example, if you’ve had your visit in August of 2021, you are eligible to have your next visit in January of 2022.

Screening colonoscopies are covered as a preventive service at a $0 copay. If you have a prior history of colon cancer, or have had polyps removed during a previous colonoscopy, ongoing colonoscopies are considered diagnostic and are covered as an outpatient surgery.

Additional benefits: Take advantage of these additional benefits available to you at no cost through your TRS-Care Medicare Advantage plan. These programs are available to you once you are enrolled in the plan. To learn more, visit www.UHCRetiree.com/TRS-CareMA.

Through UnitedHealthcare Hearing, you can receive a broad selection of name-brand and private-labeled hearing aids custom-programmed for your hearing loss. Hearing aids can be fit in person or delivered directly to your home (select products only).

To access your hearing aid benefits, you must contact UnitedHealthcare Hearing at 1-888-547-1374, TTY 711. The plan pays up to a $500 allowance for hearing aids (combined both ears) every 3 years, and you must utilize a UnitedHealthcare Hearing provider.

Renew by UnitedHealthcare® is an exclusive program that guides and inspires members to take charge of their health and wellness every day.

Renew provides a comprehensive suite of activities and resources members can engage with daily. They include fitness activities, a program for cognitive health, useful information, healthy recipes, Renew magazine and more, all at no additional cost.

Under the Renew Rewards program, you may also be eligible to earn rewards by completing certain health care activities such as your Annual Physical or Wellness Visit.

FirstLine Essentials+ is an over-the-counter benefit that gives you credits each quarter so you can order supplies from the Health Products benefit catalog. Shop toothpaste, pain relief, vitamins, cough drops and more.

FirstLine Essentials+ is an over-the-counter benefit that gives you credits each quarter so you can order supplies from the Health Products benefit catalog. Shop toothpaste, pain relief, vitamins, cough drops and more.

You have access to 3 unique programs that provide online and telephonic coaching support designed to support your health and wellness goals.

1. Real Appeal® is a simple, step-by-step online program that helps make losing weight fun. The program offers tools that may help you lose weight, reduce your risk of developing serious health conditions, gain energy and achieve your long-term health goals, at no additional cost to members with a body mass index, or BMI, of 19 or higher.
   • When you enroll in Real Appeal, you receive:
   • Access to a Transformation Coach who leads weekly online group sessions
   • Online tools to help you track your food, activity and weight-loss progress
   • A Success Kit with food and weight scales, recipes, workout DVDs and more — shipped directly to your door
2. Rally® Wellness Coaching provides personal coaching, online learning, and support for a variety of topics that promote whole-person health. Wellness Coaching offers a comprehensive solution to address your physical, mental, social, and emotional needs.
   Wellness Coaching includes the option to select a program topic of interest, work with a coach, set an action plan and engage with online learning modules and digital tools at your own pace.
3. With the Quit For Life® tobacco cessation program, you will have 24/7 access to tools and resources to help you quit all types of tobacco use.

Yes, SilverSneakers gets you a free membership to over 16,000 fitness locations across the country. You’ll have access to exercise equipment, classes and more! And you can use more than one location. Just go online to www.SilverSneakers.com to search for participating locations near you!

HouseCalls is an optional UnitedHealthcare program that includes a yearly visit that is meant to support the care you receive from your primary care provider.

HouseCalls are designed to work in conjunction with your primary care visit. It’s a great opportunity to ask questions you may not have had a chance to address with your primary care physician. The HouseCalls practitioner will even help create a checklist of topics you can discuss with your PCP, which allows you to experience more holistic care in your home and at your doctor’s office.

To schedule a HouseCalls visit, you can call UnitedHealthcare and one of our Advocates will assist you in scheduling. Call us at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday. HouseCalls may not be available in all areas.

Yes, your plan includes a Personal Emergency Response System (PERS), which is a medical alert device. The PERS in‐home monitoring device provides fast, simple access to help 24 hours per day, 365 days per year, with the simple push of a button. Members choose the product that best fits their lifestyle and receive their device at no additional cost.

The routine transportation program will help you get to health-related appointments easier at no cost to you. If you don’t have a way to get to your health care appointments, UnitedHealthcare’s transportation program can help. You are eligible for 24 one-way trips or 12 round trips per year up to 50 miles.

You’re eligible to receive services from CareLinx®, an in-home caregiver service, at no additional cost. CareLinx has a network of over 300,000 background-checked, professional caregivers. You’re matched with a caregiver who meets your needs and schedule.

Once matched, your caregiver is able to provide services such as grocery shopping, meal preparation, light housekeeping, personal care, medication reminders and even respite care for families and caregivers. This benefit includes 8 hours of in-home, non-medical care per month, and unused hours do not roll over.

We know that an inpatient stay can cause a lot of stress and worry. The Healthy at Home program gives you support that goes beyond traditional medical care to help you successfully recover at home after an inpatient admission or a stay at a skilled nursing facility.

• Your benefits include:
  • 28 home-delivered meals through Mom’s Meals® when referred by a UnitedHealthcare Advocate*
  • 12 one-way rides to medically related appointments and to the pharmacy when referred by a UnitedHealthcare Advocate*
  • 6 hours of in-home personal care provided through a CareLinx professional caregiver to perform tasks such as preparing meals, bathing, medication reminders and more. A referral is not required for the in-home personal care.

You’re eligible for the benefits up to 30 days following all inpatient and skilled nursing facility discharges. A n referral is required after every discharge to access your meal and transportation benefit provided through the Healthy at Home program.

SilverScript, an affiliate of CVS Caremark, administers the TRS-Care Medicare Rx prescription drug plan.

If you have questions or need an ID card, you can contact SilverScript at 1-844-345-4577 or visit the TRS-Care Medicare Rx website at https://info.caremark.com/oe/trscaremedicarerx.

Participants enjoy:

• No convenience fees on maintenance medications with less than a 90-day supply,
• No coverage gap, commonly known as the "donut hole,"
• Lower copays,
• No cost difference between brand-name and generic drugs, and

Find more information on the TRS-Care Medicare Rx website.

No, your prescription drug plan is coupled with your TRS-Care Medicare Advantage Plan. You don’t need to pay an additional TRS-Care premium for prescription drug coverage.

While you have the option of opting out of TRS-Care Medicare Rx, CMS prohibits people enrolled in a Medicare Advantage plan through their group retiree benefits from joining an individual Medicare prescription drug plan.

The reverse is true as well—a person with group Medicare prescription drug plan cannot have an individual Medicare Advantage plan. Keep this in mind if you are considering opting out of TRS-Care Medicare Rx.

Be aware that if you do opt out of the TRS-Care Medicare Rx plan and maintain your medical coverage through the TRS-Care Medicare Advantage plan, your premium will not be reduced.

No, you won't experience a donut hole with this plan. The TRS-Care Medicare Rx prescription drug plan provides continuous coverage in the coverage gap stage commonly known as the "donut hole." That's when you've paid $4,430 in out-of-pocket prescription drugs.

Instead of the plan not paying anything, you pay your normal copays. Once you have paid $7,050, you may see a reduction in your copays. You will pay the higher of 5% coinsurance OR a $3.35 copay for covered generic drugs (including brand-name drugs treated as generics) and an $8.35 copay for all other covered drugs.

The most you'll pay is your current TRS-Care copay.

You can only enroll in the TRS-Care Medicare Advantage medical plan. You cannot be enrolled in a Medicare medical plan outside of TRS.

The Centers for Medicare and Medicaid Services (CMS), prohibits people enrolled in a Medicare Advantage plan through their group retiree benefits from joining an individual Medicare prescription drug plan.

The reverse is true as well—a person with group Medicare prescription drug coverage cannot have an individual Medicare Advantage plan.

This means that if you are enrolled in TRS-Care Medicare Advantage—a group plan—and you opt out of the TRS-Care Medicare Rx prescription drug plan and buy an individual Medicare Part D plan, you will lose all TRS-Care coverage.

If you need a replacement ID card, you can request one by calling our Customer Care Team: 1-844-345-4577, press option #2, and they will be able to mail it to you.

You can access your drug formulary on the TRS Rx site and search what your medication will cost by using the Check Drug Cost Tool that is also located on the TRS Caremark site under "Check Drug Costs." Please visit the TRS-Care Medicare Rx website.

TRS-Care Medicare Rx participants do not have a deductible.

You can call our Customer Care Team: 1-844-345-4577, press option #2, or you can login to Caremark.com; from the top menu, hover over Prescriptions and click on View Order Status.

It depends on when your current PA expires. Some PAs run calendar year to calendar year, while others are based off plan year and/or date of approval.

So, whenever the PA expires is when you would need a new one. You can call our Customer Care Team: 1-844-345-4577 and press option #2 to request your prior authorization.

Any prior authorizations you currently have under your TRS-Care Standard plan will not transfer to your TRS-Care Medicare Rx plan when you turn 65. You will need to be re-apply for your prior auth once you have enrolled in the TRS-Care Medicare Rx plan.

You can request your prior authorization by calling SilverScript Customer Care at 1-844-345-4577, press option #2.

Yes, you can select to go paperless when you sign into your personal TRS-Care Medicare Rx online account with CVS Caremark.

**Keep in mind, EOBs only generate after filling a prescription. EOBs will become available a month after you fill a prescription. If you do not fill a prescription within a month, you will not see an EOB for that month.

A retail pharmacy that chooses to participate in the Retail-Plus network and can dispense up to a 90-day supply of maintenance medication. You can find a list of your Retail-Plus pharmacies here: TRS-Care Medicare Rx website (click Retail Plus Pharmacy Locator).

No, Walgreens is limited to a 31- day supply because they are not part of the Retail Plus Pharmacy network.

Yes, TRS participants have access to a broad network of pharmacies which include all the large pharmacy chains: Wal-Mart, Kroger, Target, HEB and others. Please note, you must use a network pharmacy in order to receive full benefit coverage on your prescriptions.

You will receive a Welcome Kit from SilverScript 30 days before your enrollment in the TRS-Care Medicare Rx plan. This Welcome Kit will include your Formulary, or covered drug list. You can also contact our Customer Care Team at 1-844-345-4577 (press option #2) for further coverage information.

Most diabetic supplies will require a prescription. However, your test strips will be covered under your Part B medical coverage. You will want to present your UnitedHealthcare card at the pharmacy when filling these supplies.

Yes, flu shots are covered under your TRS-Care Medicare Rx Plan.

Yes, medications that are not listed on the formulary are considered "non-formulary drugs". If you learn that TRS-Care Medicare Rx does not cover your drug, you have two options:

• You can ask TRS-Care Medicare Rx Customer Care team for a list of similar drugs that are covered by our plan. When you receive the list, show it to your doctor and ask them to prescribe a similar drug that is covered by your plan.
• You can also apply for a non-formulary exception. Our Customer Care Team will be happy to assist you with this process. You can contact them at 1-844-345-4577, press option #2.
  **Please note that non-formulary exceptions do not guarantee you coverage for a non-form