Toni:
My wife is a retired teacher and we are both on her TRS-Care Plan. I also have retirement benefits from Dow Chemical where I worked for 30+ years. I have just found out that I’ve lost my Dow retiree health benefits because TRS enrolled us in the TRS Medicare Advantage plan.
My wife, Mary, has tried to call TRS, but cannot get anyone to talk to because of the long wait on the phone. She has waited over an hour and when you call the message says leave your name and number, TRS will call you back in 5 days…no returned call YET!!! What should I do?? Please give us some guidance. I am sure others are having the same problem. Thank you, Jack from Lake Jackson, TX
Good Morning, Jack:
TRS Care is definitely having its share of challenges because of the changes to more than 10,000 TRS retired teachers that have both Medicare Parts A and B.
In the TRS Care marketing material that was mailed out last fall it states that your wife should have contacted TRS Care at 1/866-217-2409 last November,2012 to opt out of the new Aetna Medicare Advantage plan to remain on the Original TRS Care plan. If she had not notified TRS last year, then both of you are in the new TRS Care Medicare Advantage plan as of January 1, 2013.
Many company retiree plans are like Dow’s plan and if you enroll in Medicare’s Part D, then you can lose your company benefits, which is stated in company benefit letters that go out every October. I do not know why TRS was able to enroll you in that Medicare Advantage plan; they should have not been able to.
The Texas Retired Teachers Assoc. 3rd quarter 2012 newsletter on page 3 discuss how to “opt” out of the TRS Medicare Advantage plan at your own discretion with the TRS Care’s “opt-out provision”. There is no waiting period to get back into your “old” TRS-Care plan beginning the first of the following month.
You should call TRS-Care at either 1/800-367-3636 or 866/217-2409 to disenroll from the TRS Medicare Advantage plan and return to the Original TRS-Care plan with Original Medicare.
Good Luck fighting your battle…I pray that the phone lines aren’t busy, so you can get your answers.
Confused about TRS Retiree Plan and how the changes affect your Medicare Decision Workshop will be… Wednesday, February 27th or Thursday, February 28th 6:00PM both days at El Jarrito’s Mexican Restaurant, 21724 Highland Knolls, Katy, TX 77450. RSVP: 832/800-4674 as seating is limited. Join me on either the 27th or 28th to get your TRS Medicare & Retirement questions answered.
Hello Toni:
I found your article on the internet about Medicare’s 3 day rule for a skilled nursing stay and would like you to clarify does the 3 midnight rule for a skilled nursing apply to when the Dr actually writes the order for inpatient or when the patient actually leaves the ER and goes to their bed. I feel that it should be based on when the order was written and many patients stay in the ER for many hours waiting on beds to open up on the floors. Concerned and want to get the information correct! Thanks for your help. Joe from Louisiana
Good question Joe:
On page 31 of the 2013 Medicare & You handbook it states that an inpatient hospital stay begins the day you’re formally admitted with a doctor’s order. You must have 3 full days past midnight stay “formally admitted” and doesn’t include the day you are discharged. So that makes 4 days. I would determine the stay begins when the doctor has “formally” written the order not when you are in the ER waiting for a room. Don’t confuse signing papers when you arrive at the hospital with being formally admitted. Your doctor has to do sign that order.
Toni King, author of the Medicare Survival Guide which is on sale at www.tonisays.com. Toni is an advocate/consultant for those “Confused about Medicare”. Email questions to toni@tonisays.com or call 832/519-TONI (8664).
1 comment
Toni King
February 23, 2013 at 2:38 pm (UTC -5) Link to this comment
TRS Aetna Advantage Insurance Travesty
Hello Toni:
If ever there was a name that was misinformation, Aetna Advantage is it. Last fall my husband was covered by Medicare A&B and Aetna for C&D. I followed up on the communication dispersed by Aetna about the new Advantage program. I did the phone conference for which the “press this number” after the conference didn’t work. I called and personally spoke to customer service reps twice. Superficial, vague, and lackluster responses descibes the reps who obviously didn’t seem to know what all the program entailed since it was so new. Decided to default and kept in mind the option to get out of it anytime in 2013.
Fast forward to February and a misfiled bill for a fall medical charge. Spoke to my internist’s business office manager and in the course of the conversation she related how she had researched a bill for a patient who went to a specialist and was charged far more than she felt she should be. The business manager spent four hours on the phone to discover that the Aetna Advantage card sent to the patient says PPO, but payment is HMO based. I was stunned at this bait and switch tactic.
In my dismay, I checked further to verify. I spoke to the Aetna Advantage rep, Mohammad, who told me that they were a PPO on an HMO platform. When I referenced what I was told last fall about being able to get out of the Advantage program, he said the opt out period was November and December (I knew this), and now it would require unenrolling. He gave a number to call and/or the option to receive a form that would take 7-10 business days to mail and would not activate until it was received and processed. The unenrollment would activate the first of the month after it was processed. From what I was told last fall, you only have the year of 2013 to unenroll. Ichose the form to get hard copy documentation.
Furthermore I spoke to a family friend, a recently retired doctor, who worked in an outpatient surgical clinic. He said that oftentimes a patient who had coverage under an “Advantage” plan wouldn’t be covered for procedures in a regular hospital setting even if the patient had other serious health problems that could lead to complications and would be better served in a hospital. He also said that many quality physicians cannot afford to be in the “Advantage” programs due to the minimal reimbursement they receive from “Advantage” programs. Case in point, a man in our Sunday School Class was diagnosed with melanoma. He went to MD Anderson for treatment and was told they didn’t take “Advantage” insurance plans.
Having served as a public school educator for 30 years, I feel this is an travesty to provide such inferior coverage via Aetna Advantage while publicizing it as a cost cutting measure that will provide quality care…like a magician’s trick, an illusion.
You have such an excellent rapport and a variety of venues to address the public’s concerns regarding Medicare. Would you please address the drawbacks of “Advantage” programs and in doing so, honor the service of educators and others in the work force who deserve to receive the best medical care?
Retired Texas Teacher