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Toni:
I am a retired teacher and my Medicare began March 1st. I chose to go with TRS 2 and Original Medicare. I need the flexibility of picking my own medical providers since I am having bypass surgery in a few weeks.
The Toni Says team enrolled me in a Medicare Supplement with a March 1st effective date so that I have very low medical out of pocket and control on my side.
Major surprise for me when I went to the doctor on Wednesday, March 1st and discovered that TRS had enrolled me in the TRS 2 Humana Medicare Advantage plan without my permission.
With Toni’s guidance, I was able to have TRS advise Humana to release me to return back to Original Medicare and have my cardiologist, who does not accept TRS’s Humana Medicare Advantage PPO plan, schedule the pre-surgery appointment.
I want the Toni Says Houston Chronicle readers to be aware of the importance of documenting in writing that you don’t want the TRS Humana Medicare Advantage plan to avoid having the serious issues that I have had.
Thank You,
Marcy from Sugar Land, Texas
Hello, Marcy:
Last week, I wrote about the value to enrolling in Part B for the first time because you receive your Medicare Supplement Open enrollment and do not have to answer one question for your Medicare Supplement to be issued, no matter what your health issues.
TRS has certain rules about their retiree Medicare plans and putting in writing that you do not want to be enrolled in the Humana Medicare Advantage PPO plan. You had never received the TRS opt out form, thus not knowing that you needed to put in writing that you wanted the TRS Original Medicare plan.
Houston Chronicle readers need to know that TRS will automatically enroll retirees and/or their spouses into TRS Humana Medicare Advantage PPO plan when they first enroll in Medicare Parts A and B, whether turning 65 or older.
Let’s discuss the differences of TRS’s 2 Medicare plans; then you can make an informed choice for your Medicare needs:
- TRS Humana PPO Medicare Advantage Care 2 or 3 plan:Humana (not Medicare) will pay claims with a Medicare Advantage plan. Medicare pays a fixed amount for your care every month to Humana. TRS 2 has more out of pocket than TRS 3. The plan’s calendar year deductible is either $250 (TRS 3) or $500 (TRS 2), PCP co pay, specialist co pay, and inpatient and outpatient hospital per stay co pays ranging from $150 to $500 with each plan having a maximum out of pocket of either $3150(TRS 3) or $3500 (TRS 2). A separate Part D prescription drug plan from Express scripts is included.
- TRS-Care 2 or 3 with “Original Medicare”: TRS 2 (with a $1300 deductible and $5,800 out of pocket maximum) or TRS 3 (with $400 deductible and $4,900 out of pocket maximum) which can change your monthly premium. With Original Medicare, you have control over choosing which doctor, hospital, or healthcare professional to use instead of an insurance company advising you what to do. A separate Part D prescription drug plan with Express scripts that is exactly like the TRS Humana Medicare Advantage plan is included.
Always talk with your doctor’s office about what Medicare option meets your specific medical needs because that provider may not accept that Medicare Advantage plan.
