TOTAL RETIREE ADVANTAGE ILLINOIS health insurance plan
I attended Monday’s (11/11/13) informational meeting at Rock Island High School for the roll out of the new state health insurance program. There were about 375 attendees, most of whom were members of the Teacher Retirement System (TRS). The meeting lasted about 90 minutes. Following are my observations as of today, recognizing that over the next few weeks more information is likely to be forthcoming based upon questions that folks bring forward.
Janice Bonneville, Deputy Director of Benefits for Illinois’ Central Management Services (CMS) presented the information. Accompanying Ms. Bonneville were Leslie Booth, CNS Medicare Unit, and Dan Riewder from CMS.
TRIP-THE TRAIL, as it is called on the CMS web site, provides the “latest news” for TRS members:
http://www2.illinois.gov/cms/Employees/benefits/trail/trip/Pages/default.aspx. No, I didn’t make up “TRIP-THE TRAIL.”
An introductory decision guide for TRS members can be found online at the CMS web site:
I strongly encourage you to read this guide before attending your local informational meeting. It will give you good background information to formulate your own questions.
• You must be medicare eligible to qualify for the new TRIP-THE TRAIL program. You must be age 65 and enrolled in Medicare Part A and Part B before September 30, 2013. If you are not medicare eligible, then your current state health insurance plan stays in effect with no change. There will be another open enrollment time in the fall of 2014 for those turning age 65 after Sept. 30, 2013.
• There are three options within TRAIL. All three are Medicare Advantage plans with Prescription Drug coverage (MA-PD) that fall within the approved national Medicare Part C program, i.e. a private insurance plan that meets federal medicare coverage standards. MA-PD plans are private insurance plans not administered by the federal government. Plan benefits and claims processing are determined by the contract between Illinois and the private insurance company. Claims for services are not submitted to Medicare.
Medicare Part A (hospital insurance) + Part B (medical insurance) + Part D ( prescription drug coverage) = Medicare Advantage-Prescription Drug (MA-PD)
The three MA-PD options available are:
1) A Preferred Provider Organization (PPO) administered by UnitedHealthcare (UHC) that is available to members nationwide.
2) Coventry Advantra HMO (available to residents of certain Illinois counties)
3) Humana HMO (available to residents of certain Illinois counties)
HMO plans are for state coverage only unless there is a medical emergency when you are out-of-state.
A map of Illinois showing available plans by county is included in the CMS decision guide.
The MA-PD program consolidates Medicare Part A, B and D into one private insured plan with one ID card. However, DO NOT THROW AWAY YOUR MEDICARE RED/WHITE/BLUE CARD.
Healthcare providers must be a provider under Medicare in order to qualify for each of the three programs (PPO or HMO). For example, if a doctor does not accept Medicare, then they do not qualify under the state plan.
• Current TRIP members who are medicare eligible have until December 13 to enroll in one of the new MA-PD plans. There is no default coverage. If you are medicare eligible and don’t submit an enrollment form by the Dec. 13 deadline your state health insurance coverage will terminate on Feb. 1, 2014. ALL individuals covered MUST sign the enrollment form. Your enrollment form must be returned to TRS and postmarked by Dec. 13, 2013.
For TRS members, if you opt out you can not enroll in the state MA-PD plan in the future. This is governed by Illinois statute. You do not have to enroll in this new program. If you opt out you can join the original federal Medicare program and purchase Medicare supplement insurance if you wish. Just remember, if you opt out you can not enroll in the state plan in the future.
If you enroll in the TRAIL program and decide that it is not a good plan for you, then you can drop the plan at the next Medicare open enrollment period and enroll in the “original” Medicare program administered by the federal government.
• Plan benefits and premium amounts are described in the retiree healthcare decision guide. Your premium cost is the amount you pay for Medicare Part A and Part B, plus the premium for the state plan. There is no additional cost for Medicare Part D (prescription drug) because it is included in your state plan premium. If you enroll in the state MA-PD plan you do not need nor can you have an additional Medicare supplement plan. Premiums for the PPO are substantially less than under the current TRIP plan. Also, the deductible and out-of-pocket maximum are less under this MA-PD PPO plan compared to the current TRIP PPO plan.
Most of the information presented at the Rock Island meeting dealt with the UnitedHealthCare MA-PD (PPO) since there are no approved HMO providers in that immediate area.
One confusing point relative to the UnitedHealthCare MA-PD deals with approved providers. There is a UnitedHealthCare network of doctors and hospitals. However, any doctor or hospital that accepts Medicare patients qualifies as an approved provider by UnitedHealthCare. But, health care providers that do not have a contract directly with UnitedHealthCare TRAIL have the choice to accept the PPO plan or not, except in the case of emergency treatment. So, it is advisable to check with your own doctor and/or hospital to make sure they will bill UnitedHealthCare for services if they are not a part of the UnitedHealthCare network. If they will not, you can pay for medical services received and request reimbursement from UnitedHealthCare yourself. Obviously, this could be a problem. You can also ask UnitedHealthCare and CMS to reach out to your doctor or hospital to become a network member and/or to ensure that they will bill UnitedHealthCare directly. You can search for UnitedHealthCare network providers on their web site at www.UHCRetiree.com/soi.
UnitedHealthCare has a national network of pharmacies as well as a mail order program. You should check to see if your pharmacy is in the network and check on the actual cost of your prescriptions. Fox example, you may be only able to get a 30 day supply from a retail pharmacy under this plan when you have been able to get a 60 day supply under the existing TRIP plan, thus your prescription costs could increase substantially.
ONLINE SITES WITH VALUABLE INFORMATION
UnitedHealthCare site specifically for the Illionis TRAIL program
1-888-223-1092 UnitedHealthcare Customer Service
Illinois Central Management Services
1-800-442-1300 CMS Bureau of Benefits
PLAN TO ATTEND AT LEAST ONE INFORMATIONAL MEETING
A SCHEDULE OF MEETINGS CAN BE FOUND ON THE CMS-TRAIL WEB SITE.