Medicare Hotline Complaints Detailed at this website (Sept. 3, 2015): Click Here.
Total Retiree Advantage Illinois (TRAIL) Program
Members of the following group insurance programs must be enrolled in Medicare Parts A and B in order to be eligible for the Total Retiree Advantage Illinois (TRAIL) Program. In addition, any covered dependent must also be enrolled in Medicare Parts A and B in order to be eligible for TRAIL coverage. If either the member or any dependent on the member’s insurance through the State is not enrolled in Medicare Parts A and B, neither will be eligible for TRAIL Medicare Advantage plans. Members and dependents of non-Medicare households must seek benefits under the non-Medicare programs offered by the State, which are described on the Benefits website at www.benefitschoice.il.gov.
2014 TRAIL Seminar Schedule
Since the Open Enrollment for the 2015 Medicare Advantage program (TRAIL) is October 15 through November 15, I have been getting many questions about the 2015 program – who is eligible, when will I get my packet, what options do I have, etc.
CMS has told us that during the first full week in October (hopefully October 6), CMS will be posting information on their web site about the 2015 Medicare Advantage Program. In addition, CMS will be holding informational seminars in October explaining the 2015 Medicare Advantage program. Attached is a listing of these seminars.
Remember, check out the CMS web site after October 6 -- http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/default.aspx
Rich Frankenfeld, TRS Director of Outreach, 2815 W. Washington St., PO Box 19253, Springfield, IL 62794-9253 (217-753-0973)
Updated June 24th:
There has been a change in the catastrophic prescription coverage with United Healthcare. This level is reached when a total of $4500.00 has been spent on prescriptions. Some members reached this level very quickly and were being charged very high prices for some of their medications. The policy was changed so that the highest copay for any approved medication is $50.00. This is retroactive to the start of the program. Everyone should have received a letter explaining this. If you have paid more than $50.00 for any covered medication and have not been reimbursed, call United Healthcare to see if you are eligible for a refund -- from the IRTA
Updated June 12th:
In this stage you no longer pay the plan's standard copayment; instead, how much you pay depends on which State-sponsored MA-PD plan you have enrolled in. The table below provides the benefit offered by each MA-PD plan in 2014 and by a standard Part D plan. The benefit for a standard Part D plan has been established by the federal government for 2014.
Coventry MA-PD HMO
Humana MA-PD HMO Plan
UnitedHealthcare MA-PD PPO Plan
Standard Part D Plan
Generic: $2.55 copayment per 30-day supply
Nongeneric: $6.35 copayment per 30-day supply
Generic: Greater of 5% of the retail cost or $2.55 copayment, not to exceed amounts below:
Nongeneric: Greater of 5% of the retail cost or $6.35 copayment, not to exceed amounts below:
1-30 day supply: $40
31-60 day supply: $80
61-90 day supply: $120
(90-day supply: $80 if purchased through Mail Order)
Generic (up to 90-day supply): Greater of 5% of the retail cost or $2.55 copayment, not to exceed $50
Nongeneric (up to 90-day supply): Greater of 5% of the retail cost or $6.35 copayment, not to exceed $50
Generic (up to 90-day supply): Greater of 5% of the retail cost or $2.55 copayment
Nongeneric (up to 90-day supply): Greater of 5% of the retail cost or $6.35 copayment
When a member enters the prescription Medicare Part D 'coverage gap' (the amount between $2,850 and $4,550), the amounts that the member pays for their prescriptions is still the copayment amount; however, the amount the member pays (i.e., the copayment) is added to any manufacturer's discount given to the plan for brand name drugs the member filled.
Humera (brand name drug was discounted 50%; total cost of the drug is not on the EOB, but in this case was $5,130.36); Plan Paid - $2,735.09; Member Paid - $50.00 (copayment); Discount - $2,345.27.
The Department of Central Management Services continues to work with United Health Care (UHC) to negotiate a fair alternative. IRTA will continue to keep our members updated on any future changes.
Updated April 24, 2015:
This email only pertains to those members who are on Medicare.
Updated November 21st:
Bachman also stressed that unlike all other Advantage Plans which have negotiated reduced fees with providers, the State of IL plan pays doctors and institutions the same exact amount as Medicare. He also explained that providers need to understand how the State of IL plans work; thus, retirees are urged to contact United Healthcare (UHC) and ask that they contact their doctor or hospital to provide them with plan information: 888-223-1092 (Group #12809).
A few members, who believe they qualify for the new Medicare Advantage plans, have personally told me that they had not received the Medicare Advantage Enrollment kit from CMS. If they don’t receive it by next Monday, November 25, please call TRS 800-877-7896 and request a form.
While they may also print one from the CMS web site, we ask that they wait a few days to see if the official one arrives. The official one has a bar code which would make it easier for processing.
Also, any member who believes they are qualified for the new Medicare Advantage program and has not previously enrolled in TRIP can contact our office and ask that an Enrollment Form and materials be sent.
If members need help completing the Enrollment form, please watch our enrollment video, posted on the TRS home page at trs.illinois.gov.
—Rich Frankenfeld, TRS Director of Outreach
Updated November 19th:
For those who have not attended an Illinois CMS Advantage Seminar, it is now available online: http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/TRAILSeminar.aspx
From TRS web site – a short PowerPoint presentation about how to complete the Medicare Advantage Enrollment Form – www.trs.illinois.gov
Updated November 18th:
“…For those who are concerned about the insurance companies drastically raising their fees next year, that has not been where their profits have been gained. But as recent news stories have shown, the Federal government hopes to reduce their costs for Medicare going forward. These companies make their profits not only from the amount they collect from the government, but also from what they can keep of those funds. We should all understand that insurance companies are in business to make money. For example: United Health Group Incorporated is a diversified managed healthcare company headquartered in Minnetonka, Minnesota. It is No. 17 on Fortune magazine’s top 500 companies in the United States. They are doing well.”
Updated November 17th:
CMS is pleading with retirees to help them reach out to those who have infirmities and/or live out of state. The fear is that some elderly will not attend to their mail or understand the necessity of returning the CMS form in order to continue insurance coverage.
TRS will accept and provide certification for CMS forms hand delivered to their offices. They will also sign for registered mail delivery. Retirees are reminded to use the CMS form received in the mail with an imprinted barcode. Forms sent through regular mail require extra postage: two stamps, not one. The application form can be downloaded from the CMS Website if necessary, but using the form with the barcode will expedite processing.
CMS reports it continues to experience great success in having hospitals/doctors accept the IL Advantage PPO plan. Again, retirees are urged to request United Healthcare or CMS to contact any doctor who requires information about the plan. By law, all hospitals and doctors who accept Medicare can be used by participants of the IL Advantage PPO plan. It is reported that in only very rare instances will it be necessary for retirees to pay at time of service for medical fees and submit the insurance form to United Healthcare for rapid reimbursement - this procedure is necessary only when a doctor or institution refuses to bill United Healthcare directly.
Updated November 16th:
* Insurance giant Health Alliance claims it seriously under bid all of its competitors to provide Medicare Advantage for thousands of Downstate public employee retirees…
* So, why was the company disqualified? State experience requirements…
Health Alliance spokeswoman Jane Hayes said the contract selections are puzzling, “because we’re often seen as too expensive.”
“Of course, they probably didn’t even look at the pricing, because we were thrown out on a technicality that the (state) chief procurement officer could have waived,” Hayes said.
The technical requirement Health Alliance didn’t meet pertained to experience administering large-member Medicare Advantage contracts.
The state required insurance vendors seeking the Medicare Advantage contracts to show they have at least five years’ experience administering Medicare Advantage plans — plus at least three years’ experience administering Medicare Advantage plans for at least one employer with a minimum 1,000 participants enrolled. Bidders also needed to show they had at least one year’s experience administering a Medicare Advantage plan for a government employer with at least 500 participants.
On Tuesday, Nov. 12, you received an email alert from Teachers' Retirement System regarding a new Illinois Medicare Advantage program that most TRIP members in Medicare will have to participate in under state law. This message is a clarification of that email. Eligible TRIP members must enroll in the new Medicare Advantage unless they decide voluntarily to drop their participation in TRIP. If you drop TRIP, you will not have to participate in the state's new Medicare Advantage program. If you decide to end your participation in TRIP, you must complete and sign that section of the Medicare Advantage enrollment form and return the form to TRS.
Member Services Division
Teachers' Retirement System of the State of Illinois
“…received my enrollment forms from CMS. Not complicated, but the daunting part is the unspoken part. United Healthcare manages your Medicare A and B, but nowhere announces that it is actually acting as a supplemental... (previously known as C in some groups). It will offer drug, but again the lack of a specific note that it will pick up what A and B doesn't is NOT clearly stated. I will need to check now with my own medical people to see if they take or are considering taking United Healthcare and the new program, then make a call to CMS for clarifications. Not a lot of time...” --John Dillon
On or before Dec. 13, 2013, all TRIP members covered by Medicare will be required by the Department of Central Management Services to enroll in a state-sponsored Medicare Advantage health insurance plan. Click here for a direct link to information from CMS on this change.
Member Services Division
Teachers' Retirement System of the State of Illinois
from Ed Wollet:
Can prescriptions be written for 90 days instead of just 30 days? Is there a price savings for a 90 day prescription over a 30 or 60 day prescription?
Prescriptions can be written for 90 days. The cost savings are available only through the mail order companies associated with each Medicare Advantage plan. Using the mail order company will give you a 90 day supply for the 60 day price. No discount exists for a brick-and-mortar pharmacy (i.e., CVS, Walgreen).
Do the deductibles and co-pays for medical treatment begin fresh on February 1, 2014?
Yes. From February 1, 2014-December 31, 2014 the $250 deductible and the $1000 total out-of-pocket will apply. The following benefit period will begin January 1, 2015 and run through December 31, 2015.
If I sign up for one of the state MA plans and it doesn't work for me, can I get my traditional Medicare back and buy my own supplement?
Yes, you never lose your traditional Medicare. However, you would only be able to switch back during the Medicare enrollment period each year (Oct 15-Dec 6).
Updated November 11th:
The following are Sanders’ observations, recognizing that over the next few weeks more information is likely to be forthcoming based upon questions that others will bring forward…
Janice Bonneville, Deputy Director of Benefits for Illinois’ Central Management Services (CMS), presented the information. Accompanying Ms. Bonneville were Leslie Booth, CMS Medicare Unit, and Dan Riewder from CMS.
Updated November 9th:
Updated November 7th:
Updated November 2nd:
IRTA is advising that members stay with the state program for this year and evaluate it. On first inspection, it appears to be a good program, with premiums lower than what we have had in the past and a number of extra promised benefits. Until we know how it will work, it is not advisable to sever the connection to TRIP and be in the position of having to obtain insurance privately.
Updated October 31st:
Which doctors are in the plan?
No, but approximately 98% of providers nationwide do accept MA PPOs
CMS: Yes, the rule under the PPO plan is the provider must be a Medicare provider. They can access the provider regardless of whether they are in the PPO network. If they are not in the PPO network, the provider can bill United Healthcare. If the medical provider does not want to bill United Healthcare, a member can pay the cost upfront and receive reimbursement from United Healthcare.
CMS: That is correct. Members will be told to reach out to United Healthcare and they will reach out to their providers. If a provider will not accept payment from United Healthcare, then United Healthcare will reach out to the provider and figure out the problem.
CMS: United Healthcare has indicated members will be reimbursed within 10 days.
“Under the Illinois UHC-PPO, you can continue to use your Medicare-approved out-of-state primary-care physicians whether they accept payment from United Healthcare PPO or not. If that primary care physician will not bill UHC-PPO, you can pay the doctor’s bill and submit the claim directly to UHC-PPO. You will be reimbursed just as the doctor would have been under the PPO plan. All doctors who accept Medicare are considered in-network for purposes of reimbursement. The portion of the bill that is residual (the part of the bill not reimbursed) will be applied to your annual deductible and your out-of-pocket maximum (reported to be $1250). This is the same information you should find in the benefit sign-up packets being mailed out from CMS” (Ed Wollet).
Updated October 29th:
Updated October 28th:
“THIS IS UNACCEPTABLE! Retirees must make a decision about insurance by December 13 (or December 7 in the event you opt to take a private drug plan), but this is not possible if the information is not to doctors until mid-December” –Robert Zahniser.
Customer Service Phone Numbers
UnitedHealthcare Group Medicare Advantage PPO
Coventry Advantra HMO
The Humana Benefit Plan HMO and
the Humana Health Plan HMO
Updates on October 25th:
Read more: http://www.sj-r.com/breaking/x450313318/State-to-retirees-Don-t-make-hasty-insurance-decisions#ixzz2imaXdxsj
Updated October 24th:
Updated October 23rd:
3. The UHC PPO policy is specifically designed for eligible state of Illinois retirees; it is not available to the general public.
4. You can choose any doctor anywhere in the United State who accepts Medicare.
5. The drug plan is similar to the current one (tier 1 drugs have a $10 co-pay, tier 2 drugs $20, tier 3 drugs $40); however, if the drug is a generic and is on the UHC preferred drug list, the co-pay is only $2.
6. This is nationwide insurance protection with the only requirement being that you go to a doctor who accepts Medicare.
Our understanding right now is that you will still pay for Medicare, and that premium will be deducted as usual from your Social Security check if you receive SS. The UHC premium will deduct from your pension. The Medicare Advantage plan pays both the Medicare portion of a medical bill and then pays the residual amount based on the MA contract (in other words, there is an 80-20 split between UHC and insured). Any applicable deductibles and co-pays come first for the insured to pay up to a maximum out-of-pocket of $1250 annually. You can drop out of the plan if you don't like it and return to traditional Medicare and purchase your own supplement.
If you have met your TCHP deductible, it will not roll over into the new plan. On February 1, you will be rolled into the new plan if you elect to take it. If you are not 65 yet, you will stay in CIGNA until you turn 65. Then at the next enrollment period in October, you can make the change. Forty-three counties will not have HMO's.
Updated October 21st:
CMS has posted on its web site the initial letter that gives more information, including rates, about the new Medicare Advantage plans that are being offered to members enrolled in Medicare Parts A and B will be mailed the week of October 21, 2013.
Currently, CMS is waiting for approval of the letter which will be sent to all qualifying participants. To receive the letter members must meet BOTH of the following criteria:
The member must be enrolled in Medicare Parts A and B, AND
CMS is expecting final approval of the letter today therefore the letter should be mailed by the beginning of next week. The letter will be delivered in a CMS envelope. The letter should be printed on yellow paper. Included in the letter will be general information about the plans, enrollment period dates, and premium rates.