Toni:
I suspect you have had a number of questions regarding what is the best course for a Texas retired teacher (with expensive medical costs) and spouse to select between two alternatives; a new PPO Medicare Advantage plan or keeping the old plan at a slight increase in cost. Have talked with a lot of retired teachers and they all are confused since the TRS is promoting the PPO Advantage plan alternative and TRS hasn’t really made a definitive recommendation as to what is the wisest.
The literature that I have seen is mostly promotional stuff written by Aetna in order to sell the new program Medicare Advantage plan. They claim the PPO is cheaper and better, I question this since the costs are going up and I fear there is a hidden reduction of benefits. Hope you have some knowledge on this problem. Nick, a confused retired Texas teacher with Medicare.
Hello Nick:
For the past 2 weeks, I have researched the changes with TRS retiree benefits and as mentioned in the second quarter 2012 TRS newsletter, “The Voice”, TRS seems to be having a “little” problem. On page 2 it states, “TRS-Care has developed compromises to keep TRS-Care premiums from skyrocketing”. “The TRS-Care fund is nearly gone” so says the newsletter and TRS has responded by implementing new Part D prescription drug option with Express Scripts (the EGWP) and the Aetna PPO Medicare Advantage options. The newsletter also states, “TRS-Care hopes to save as much as $385 millions. This of course depends on how many TRTA members enroll in the new Medicare Advantage options.” Nick, my guess would be that is why the marketing material is slanted more to the Aetna Medicare Advantage plan to help save the TRS-Care fund.
There are 2 options to pick from:
1) TRS-Care 2 or 3 with “Original Medicare”: TRTA members have used for years. Depending on which plan you elect TRS 2 or 3, there is a calendar year deductible of either $300 or $1,000 and a maximum out of pocket limit of $3,300 or $4,000. There may be a little more out of pocket and the premium is $15.00 higher, but you use “Original Medicare” with you having control over choosing which doctor, hospital or healthcare professional to use not an insurance company telling you what to do. With you having serious medical problems, this way you will have less worry with fewer headaches.
2) Aetna Medicare Advantage Care 2 or 3 Plan: Aetna not Medicare will pay claims because with a Medicare Advantage plan, Medicare pays a fixed amount for you care every month to the companies offering Medicare Advantage Plans. There is less out of pocket, but only if you stay in network and going out of network will cost you more. Read the last paragraph from pg. 25 under How Aetna Pays Out-of Network Providers of the TRS-Care Aetna “Get more, Save More” handbook which states, “When we pay less than what your provider charges, your provider may require you to pay the difference.” In other words, when out of network, you will have to pay more. With this plan, your monthly premiums are reduced $15.00
The new TRS Express Scripts Medicare Prescription Drug plan is one of the better Medicare Part D plans I have reviewed. TRTA members are lucky to have this option. The co pays are reasonable and there is no “donut hole” with the plan. This is such a blessing!!
Nick, I hope this brief overview can help you make an informed decision. I will be discussing this at my future “Confused about Medicare” workshops. Visit my website at www.tonisays.com for a complete list or watch Fox 26 every Monday at 9:00 am.
Toni King is advocate/consultant for those “Confused about Medicare” send Toni an email at toni@tonisays.com or call 832/519-TONI (8664)
