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

TRS-Care Standard is a high-deductible health plan that TRS offers to retirees and their eligible family members under 65 and not eligible for Medicare. TRS-Care Standard includes medical and prescription drug benefits. 

TRS-Care Medicare Advantage is for retirees and their eligible family members (generally 65+) enrolled in traditional Medicare (Parts A/B, or Part B only). TRS-Care Medicare Advantage (medical plan) includes TRSCare Medicare Rx (prescription drug plan).

The TRS retiree’s Medicare eligibility status determines their premium, regardless of their dependents’ Medicare status. For example:

• If you’re the TRS retiree and not eligible for Medicare and you cover your spouse who is eligible for Medicare, you pay the 2025 TRS-Care Standard premium of $689 per month (for retiree + spouse) because you, as the retiree, are not eligible for Medicare.
• If you’re the TRS retiree and eligible for Medicare and you cover your spouse who is not eligible for Medicare, you pay the 2025 TRS-Care Medicare Advantage premium of $280 per month (for retiree + spouse) because you, as the retiree, are eligible for Medicare. 

When evaluating your health plan options, look beyond monthly premiums. Consider all key out-of-pocket costs, including doctor copays, inpatient hospital stays, out-of-pocket maximum amounts, and the cost of prescriptions and coverage. Be wary of plans with very low premiums and deductibles — the costs will come from somewhere, so it's important to compare all details. Visit the 2025 TRS-Care Plan Highlights to see all TRS-Care monthly premiums and Comparing TRS-Care to Other Medicare Plans to learn more.

For enrollment and eligibility questions, call TRS Health at 1-888-237-6762, 7 a.m.– 6 p.m. CT, Mon–Fri. or visit TRS-Care Eligibility and Enrollment. 

For medical benefits questions, call United Healthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri to speak with a dedicated TRS of Texas advocate, or visit TRS-Care Medicare Advantage by United Healthcare. 

For prescription drug benefits questions, call Express Scripts at 1-844-863-5324, TTY 711, 24 hours a day, seven days a week or visit TRS-Care Medicare Rx by Express Scripts.

The retiree’s Medicare status determines TRS-Care plan eligibility:

• TRS-Care Standard is for retirees without Medicare (people under 65).
• TRS-Care Medicare Advantage (which includes TRS-Care Medicare Rx) is for retirees with Medicare (people 65+ or with a disability). 

Visit TRS-Care Eligibility and Enrollment for more information.

Please visit Are you turning 65 soon?

Please visit TRS-Care Eligibility and Enrollment.

Enroll in Medicare Part A only if you can get it free. If you’re not eligible for premium-free Medicare Part A, you don't need to sign up for it. However, if you can get it free, we encourage you to sign up for this benefit that you worked for and earned during your career.

You qualify for premium-free Medicare Part A if you or a spouse paid 40 quarters (or 10 years) into Social Security during your career. The Social Security Administration (SSA) can tell you if you qualify. Call SSA at 1-800-772-1213. 

However, you must buy and maintain Medicare Part B to be eligible for TRS-Care Medicare.

Yes. You must buy and maintain Medicare Part B to enroll in TRS-Care Medicare Advantage.

You must buy Medicare Part B from Centers for Medicare and Medicaid Services (CMS) via the Social Security Administration (SSA). You don’t pay your Medicare Part B premium to TRS. You must buy and continue to pay for Medicare Part B to remain eligible for TRS-Care Medicare.

SSA deducts your Part B Medicare premium from your monthly social security check. If you don’t get a social security check or Railroad Retirement Board (RRB) benefits, you’ll get a quarterly bill for your Medicare premium. This bill comes from Medicare. The cost of your Medicare premium depends on your income.

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

For those whose income exceeds certain levels, the Medicare Income Related Monthly Adjustment Amount (IRMAA) is the amount they must pay in addition to their Medicare Part B premium (which pays for outpatient medical care) and Part D premium (which pays for pharmacy benefits).

The Social Security Administration sets four income brackets that determine whether a person (or a person and their spouse) is subject to IRMAA and the amount of the adjustment. If IRMAA applies to you, you must pay it directly to Medicare. To remain enrolled in Medicare Part B, you must pay your Part B premium, including IRMAA, if required.

IMPORTANT NOTE: You can stay enrolled in TRS-Care Medicare Advantage coverage even if you choose not to pay your Part D-IRMAA. However, if you don't pay Part D-IRMAA, you will lose Part D eligibility and your TRS-Care Medicare Rx coverage. Loss of Part D eligibility will jeopardize prescription coverage with ALL providers (including TRS-Care) and you risk not being able to get it back.

You pay your Medicare Part B premium to the Centers for Medicare and Medicaid Services (CMS) through Social Security. You pay your TRS-Care premium to TRS. In most cases, TRS will withhold your TRS-Care premium from your monthly annuity payment. You must pay both premiums to enroll in and remain enrolled in TRS-Care Medicare Advantage.

A deductible is the cost you pay out of pocket to your health care provider before TRS-Care starts to cover certain expenses. 

A maximum out of pocket, or MOOP, is the amount you must spend on eligible health care expenses through copays, coinsurance and deductibles before TRS-Care starts to cover all eligible expenses at 100%. TRS-Care Medicare Advantage participants have a $400 deductible and a $3,500 maximum out of pocket (in-network) per person. Deductibles and maximum-out-of-pocket amounts reset every Jan. 1

Some services don’t require that you meet your deductible before paying a copay or coinsurance, allowing you to access services at a low cost more quickly. An example is primary care visits when you’re sick. For those visits, you’ll pay a $5 copay, whether or not you met your deductible. This copay counts toward your maximum out of pocket (MOOP) but does not count toward your deductible.

For services that do apply to your deductible, you must pay the plan-allowed amount until you meet your $400 deductible. Once you meet your $400 deductible, you’ll pay only the copay for that service. Some examples are below. You don’t have to meet your $400 deductible for these services before paying only the copay amounts shown here:

• $5 copay for primary care sick visit
• $35 copay for urgent care visit
• $65 copay for emergency room

Your prescriptions are also not subject to the $400 deductible.

You must meet your $400 deductible for these services before paying the copay amounts shown here: 

• $10 copay for specialist visit
• $250 copay for outpatient procedure or service
• $500 copay for inpatient hospital stay

For a full breakdown of what does and does not apply to the $400 deductible, visit TRS-Care Medicare Advantage by United Healthcare (click Coverage and Benefits) to download a copy of your Evidence of Coverage.

Coinsurance is a percentage you pay for certain services such as an MRI. For example, on TRS-Care Medicare Advantage, MRIs are covered at 5% coinsurance after you meet your annual $400 deductible. This means that once you meet your $400 deductible, the plan pays 95% of the allowed amount for the service, and you pay the remaining 5% coinsurance.

If a retiree or surviving dependent (including a surviving spouse) leaves TRS-Care, they have limited chances to reenroll:

• When they have a special enrollment event. Special enrollment events may arise from an involuntary loss of comprehensive coverage or when you get a new dependent by marriage, birth, adoption, or placement for adoption. See the special enrollment events section at TRS-Care Eligibility and Enrollment for details.
• When they turn 65.
• NEW! See Back to Care: Limited-Time Enrollment Opportunity.

For questions on special enrollment events, call TRS Health at 1-888-237-6762, Mon–Fri, 7 a.m.–6 p.m. CT.

• You may add a new dependent only during your Initial Enrollment Period or a Special Enrollment Event.
• Call TRS Health at 1-888-237-6762 to get an enrollment application and complete information about adding new dependents (for example, marriage, adoption, guardianship, divorce).
• The coverage starts the first of the month after TRS gets your application.
• If a dependent who previously waived TRS-Care coverage loses other comprehensive health coverage through no fault of their own, the dependent may qualify for a special enrollment event. They may enroll in TRS-Care within 31 days from the date they lose their other health coverage. Call TRS Health at 1-888-237-6762 to get a Special Enrollment Event application.
• A surviving spouse cannot add a new spouse.

You can remove dependents from your coverage at any time. Call TRS Health at 1-888-237-6762 to ask for the form to remove dependents. You must complete, sign and return the form to TRS to remove your dependents. You must specify which dependent(s) you want to remove from coverage. If you don’t sign the request, TRS cannot process it. The termination starts on the first of the month after TRS gets your request. Once you remove a dependent from your coverage, you may not get a chance to add them back later

Call TRS Health at 1-888-237-6762 for a coverage termination form. You must sign and notarize the form. Once TRS cancels your TRS-Care coverage, you will have a 31-day grace period from the effective date of termination to contact TRS for a reinstatement form or to get instructions to submit a written reinstatement request. 

Reinstatement of coverage starts the first day of the following month assuming TRS gets your documentation in the 31-day grace period. Once TRS terminates your TRS-Care coverage, you cannot reenroll in TRS-Care unless you have a special enrollment event or reach age 65. 

Cancellations take effect the first day of the month after TRS gets your notarized coverage termination form. 

If you’re the surviving spouse of a TRS retiree and enrolled in TRS-Care, you can send a notarized coverage termination form or you can send TRS a written request to terminate your TRS-Care coverage. The request must have your signature. TRS accepts scanned copies.

You’ll see the change at the end of the month you terminate coverage. For example, if you terminate coverage starting Jan. 1, your last day of coverage would be Dec. 31 and will be paid from your Dec. 31 annuity check. Your Jan. 31 annuity check will reflect the change that became effective Jan. 1.

If you’re enrolled in TRS-Care Medicare Advantage, you must continue paying your Medicare Part B premium to Social Security and your TRS-Care Medicare Advantage premium to TRS. If you don’t, you risk losing your TRS-Care coverage for you and your covered dependents.

The TRS-Care Medicare Advantage plan is a National Preferred Provider Organization (PPO) plan. That means you may see providers in- and out-of-network for the same cost if the provider accepts Medicare and will bill UnitedHealthcare. To find out if your provider is in the UnitedHealthcare network, visit TRS-Care Medicare Advantage by UnitedHealthcare (click Find a Provider).

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. They can reach out to your provider to educate them on how TRSCare Medicare Advantage works.

Covered ambulance services include fixed wing, rotary wing, and ground ambulance services, to the nearest appropriate facility that can provide care only if the services are furnished to a member whose medical condition is such that other means of transportation could endanger the person’s health or if authorized by the plan. 

Nonemergency transportation by ambulance is appropriate if it is documented that the member’s condition is such that other means of transportation could endanger the person’s health and that transportation by ambulance is medically required.

Find the closest in-network facilities at TRS-Care Medicare Advantage by UnitedHealthcare (click Find a Provider) or call UnitedHealthcare Customer Service at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri.

TRS-Care Medicare Advantage does not require a referral to see a specialist. You pay a $10 copay after you meet your $400 annual deductible.

No. Prior authorization is not required if the out-of-network provider accepts Medicare and will bill UnitedHealthcare.

To learn more about plan deductibles, coinsurance and maximum out-of-pocket limits, visit TRS-Care Medicare Advantage by UnitedHealthcare (click Coverage and Benefits) to download copies of the plan guide and Evidence of Coverage.

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 one exam every 12 months.

As a TRS-Care Medicare Advantage participant, an important protection for you is that after you meet any deductibles, you pay only your cost-sharing amount when you get services covered by our plan.

Providers may not add additional separate charges, called “balance billing.” This protection applies even if we pay the provider less than the provider charges for a service and even if there is a dispute and we don’t pay certain provider charges.

Here’s how this protection works: 

• If your cost-sharing is a copayment (a set amount of dollars, for example, $15) then you pay only that amount for covered services from a network provider.
• If your cost-sharing is coinsurance (a percentage of the total charges), then you never pay more than that percentage. However, your cost depends on which type of provider you see:
  • If you get the covered services from a network provider, you pay the coinsurance percentage multiplied by the plan’s reimbursement rate (as determined in the contract between the provider and the plan).
  • If you get the covered services from an out-of-network provider who participates with Medicare, you pay the coinsurance percentage multiplied by the Medicare payment rate for participating providers.
  • If you get the covered services from an out-of-network provider who does not participate with Medicare, you pay the coinsurance percentage multiplied by the Medicare payment rate for non-participating providers.

TRS-Care Medicare Advantage is not a supplemental plan. It gives you original Medicare coverage, plus added benefits Medicare does not cover. If you’re enrolled in TRS-Care Medicare Advantage, you don’t need to buy a separate medical supplemental plan

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.

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