Wednesday, February 9, 2011

Seven Questions And Answers About Medicare And TRS Care

                            Texas teachers were ‘‘ present at the creation” of Medicare. President Lyndon Johnson who, signed the Medicare bill into law  in 1965 ,was a Texan and a former Texas teacher. Another bit of historical info is that the first Medicare card was given to  former president Harry Truman who was present at the signing ceremony and had been a committed supporter of the idea of health insurance for the elderly. The purpose of Medicare was to provide health insurance to the elderly( senior citizens was not yet widely used ,so we were still just ‘‘the elderly”)  Most  retired Texas teachers will, at least at some point in their lives, be a beneficiary of Medicare; so the purpose of  today’s bog is to look at some questions tra retirees might have about Medicare and it’s relationship to TRS Care, and hopefully provide some answers.

                               1. W hat Are Medicare Part A B C And D ? The bill signed into law in 1965 created Medicare part A and then Medicare part B; the two together are sometimes called “original Medicare”. Medicare part A is called hospital insurance and covers inpatient hospital care,  inpatient care in a skilled nursing facility, hospice care and some home health care. Long term custodial care or nursing home care were not provided  for in the original  Medicare nor or they covered today. Medicare part B is called medical insurance and covers doctor’s bills , outpatient care, and some home health care. Notice that doctor’s bills are paid separately  in part A and B , so if you go into a hospital your care in the hospital , nurse care, tests, food etc., will be paid by part A while any doctor visits while you are there may be paid by Part B. Part C is often referred to as Medicare Advantage and though paid for by Medicare is administered by private insurance companies , usually as HMO’S or PPO’S. Medicare Part D IS The Medicare prescription plan enacted in the 2003 Medicare Reform Act. This program is again paid for by Medicare but administered by private companies. TRS Care already has a prescription drug program  administered by Caremark and advises their retirees on Medicare that they are usually better off staying with the TRS prescription drug plan.  

                          2. Should Someone With TRS As His Primary Medical  Insurance Enroll In Medicare?  Absolutely. W hen a retiree reaches 65, TRS assumes that the retiree has Medicare and pays accordingly. So for example if you go in the hospital or to a doctor TRS will assume that Medicare is paying 80 per cent of your expenses and TRS will pay the other 20 per cent minus the deductible. A person with a total doctor bill of $ 40,000  but who had not applied for Medicare when she became eligible  would find TRS assumed Medicare had paid 80 percent and would pay only $8000 leaving the retiree to pay the other $32,000!

                      3. How Do I Apply For Medicare?  If you are already on Social Security you will be contacted 90 days before your 65th birthday. However if you are not on social security ,but only on TRS , you will need to contact Medicare or Social Security yourself  to enroll. I found this out the hard way as I am not on social security but only retired on TRS. I waited to hear from Medicare and finally 30 days before my 65th birthday I called Medicare and found out that I was the one responsible for calling and enrolling. ( Another lesson I learned from my call was that the folks at Medicare are very nice, but  you should have something to read, perhaps Gone With The Wind ,because you will wait a long time on the line)  So unless you enjoy trying last minute heroics, I suggest calling Medicare at least 90 days before your 65th birthday. Medicare will then send you the appropriate enrollment forms.    

                    4. Is Medicare Free?  The Noble Prize winning economist Milton Friedman wrote a book called There’s’ No Such Thing As A Free Lunch. This is certainly true of  Medicare. Start off with the fact that Medicare will pay only 80 percent of your total medical bill. In addition Medicare has premiums ;  most  Medicare recipients will not pay a premium for part A because they have paid into the system for their 40 quarters, but the premium for part B is currently $110.50. Medicare part A has a deductible of  $1,100
and Medicare part B has a deductible of $155 per year. Oh well, who expected a free lunch anyway?

                 5. What About Medigap? Medigap policies are private insurance policies that pay most or all of the amount not paid by Medicare. Since Medicare only pays 80 percent and medical bills today can quickly run to $ 50,000 or more, most retirees could quickly fine their savings vanished “ without a trace” . So though Medigap policies can be expensive they are certainly worth the expense if you have a large medical bill, an eventuality none of us can be sure we can avoid.  If you choose a private Medicare part C  plan mentioned above  you will not need a Medigap policy.

              6. Is TRS a Medigap Policy? Although TRS does not consider themselves a Medigap policy they act much like one as they pay most of the 20 per cent Medicare does not pay. I have found TRS to be a good secondary plan, though fortunately I have not yet had any serious medical bills.

             7. Should I Get A Medigap  Advantage PlanTRS Care. Many Medicare Advantage plans provide dental and vision coverage which traditional medicare does not. None the less, if you are on Medicare and your spouse is still using  TRS Care as the primary insurance: beware! This is true in my personal case. I could actually get some better options price wise by using a Medicare Advantage plan. However when I called TRS the person I talked with said that since my wife was eligible for TRS Care only because  she was my spouse, that if I chose a Medicare Advantage plan I would no longer be on TRS Care and therefore my wife would no longer be eligible.                                              

                                            Your Turn

                                 I thank you for reading this far. Now I would appreciate your thoughts. If you have any Medicare TRS questions you would like to discuss or if you would like to add anything or correct any of my answers please feel more than free to do so.

                                       How To Comment

                                     To comment, just scroll to the bottom of this page, find the orange “comment’’, click and then a new screen will appear with a square for your comments. Thanks in advance.


sam said...

Hello, Rich

I am currently trying to make my way through the Medicare?TRS-Care maze. As a retiree with only TRS Benefits, I'm trying to compare plans. Since I have no chronic illnesses, TRS-Care 1 has served my needs for years. However, upon "coming of age", it seems I have less choices and more mandates. I am looking for some objective, reliable assistance.
What do you think?

Anonymous said...

I hope more Texas teacher retirees find your blog. I found it by searching for info abt whether or not I need to bolster Medicare insurance & TRS-Care2 with a medigap policy once I reach 65 later in the year. Thanks for the effort you're putting out. Why don't you contact TRS & see if you can get a bit of publicity in the newsletter (maybe AARP, too).

James said...

I appreciate your blog. I will be 66 when I retire this August. I will have A and B. The end of September my wife will retire, but she will be 61. By your experience do I need any other insurance? Have you found a good dental plan?

James said...

I will retire this August with Part A & B. Do you think I need anything else? Have you found a good dental plan? My wife will retire this Sept, but she will be 60 without A and B.

rich said...


Thanks for checking in on my blog. I agree the Medicare TRS care decisions can sometimes seem like a maze. If you have turned 65, Sam, you would most likely need to sign up for Medicare part B because TRS will pay only29 per cent of your medical costs after you turn 65 because they assume you are on Medicare Hope you'll visit the blog again.


rich said...

Thanks so much for checking in to my blog and excuse me for the delay in replying. James, are you a retired Texas teacher; if you are TRS Care will continue with your drug coverage. If you are not a retired teacher you should probably look into Medicare part D drug coverage. Is your wife a retired teacher If so she can sign up for TRS Care which will cover her until 65 when she becomes eligible for Medicare. I hope this helps and you'll visit my blog again.


Anonymous said...

Appreciate your help as I'm about to access Medicare. I have TRS-2. I have not been happy with Caremark for prescriptions - for one thing, the price of particular drugs - even in small amounts - unless they are generic. Plus, if they can figure out a way to send me less for the same amount of money, they will contact my doctor to do so without even contacting me about it! Bad bad bad. Anyway, from what I read here, I'm thinking that your advice would be to keep TRS-2 prescription coverage instead of looking for another through Medicare Part D.
Thanks so much for your helpful blog.

Tonya said...

Hi my mom is retiring at the end June and she just made 65 in May.

She received a letter from TRS stating to attach her medicare card and send it in to the TRS.

Based on your above post, she should definitely go ahead and apply for medicare, but what if she does not have the correct amount of quarters (40 quarters) paid in to social security?

Don said...

My wife took early TRS retirement and we're both covered by her plan which is TRS-Care-3. I turn 65 in just under a year whereas she is 62. Are you still actively discussing these issues?

Anonymous said...

I don't quite understand the difference between Medicare Part C, Medigap and trs care. I have retired friends who have Part C, some have Medigap and they ask why do I need trs care? I called Austin and the rep said trs care pays the excess over 80%, etc. But, as I undeerrstand it, Part C and/or Medigap does same thing at possibly a lower cost. Am I missing something.

Anonymous said...

I am still empolyed as a secretary for a Texas school district. I have paid into Social Security/medicare prior to going to work for a Texas School Dist. I have not accumulated enough credits in SS to draw benefits. Can I still apply for medicare when I retire? I am married and my spouse does have enough to draw ss and medicare - can I get medicare because of him? I am worried about being able to have medicare when I retire.

rich said...

Anonymous, Thanks for visiting my blog. You do not have to have the quarters needed for social security as long as you have the 40 quarters needed for Medicare. Are you currently paying into Medicare through your school district? You will also be eligible for Medicare through your spouse if he is eligible. Take care and I hope you visit my blog again

Anonymous said...

I am a retiree with TRS care and will be 65 in April. I have been trying to enroll in medicare, part B; however when I called Soc. Sec., I was told I am not eligble. I explained that I knew I did not have enough Soc. Sec. credits, but that TRS Care explained that I should apply for Medicare Part B in the enrollment window starting 3 months prior to my birthday, since TRS Care would assume that I would have Medicare Part B at age 65. I was again told that I was not eligble. What should I do?


rich said...


Thanks for visiting my blog. I believe you are receiving inaccurate information from SSA. If you paid your 40 quarters into Medicare through your school district or some other employment you are eligible for part B even if you do not qualify for social security. I would suggest you call Medicare and check to see if their records show you qualify for part B. Good luck and I hope you'll keep visiting my blog.

Nona said...

I am a retiree with TRS Care 2. I received a letter from Kelsey Seybold Advantage (my husband & I both have Medicare thru Kelsey) that Aetna was no longer going to work with Kelsey after April 21, 2012. What are our options?

Nona said...

I am a retiree with TRS Care 2. I received a letter from Kelsey Seybold Advantage (my husband & I both have Medicare thru Kelsey) that Aetna was no longer going to work with Kelsey after April 21, 2012. What are our options?

rich said...

Nona, Thanks for visiting my blog. I also went on TRS Care 2 when I retired. When one goes on regular Medicare, TRS Care becomes a backup to Medicare and pays what ever Medicare does not pay, minus the deduction. In other words TRS Care acts much like a Medigap policy to pay the 20% of costs Medicare does not pay. However since you are in a medicare advantage plan I do not believe you will need a Medigap program as the advantage plans such as Kelsey Seybold pay all costs, unlike " regular Medicare". So you may not even need TRS Care. However for what my advice is worth, actually it's free, I would call or visit the websites of both Kelsey Seybold and TRS Care. Take care.

Miguel A. Contreras said...

I want to retire from SS, but not from TRS. Is it possible?

Anonymous said...

You have answered the question about medicare for individuals who have 40 credits but what about those who don't?

rich said...

anonymous, To receive medicare an individual must have 40 quarters of paying into the medicare system. One can actually get 40 quarters of medicare without 40 quarters os social security , as in my case because I taught in the Texas public schools most of my life and did not pay into social security but did pay into medicare. thanks for reading

Elaine Erback said...

I have recently found out about Medicare being taken out starting in 1986. I did not change jobs after that so Medicare was not taken out. I was never informed about this. I sure would have liked to contribute to Medicare but was not allowed to. Now I read that TRS (Texas) is considering reducing teacher's insurance if they have no Medicare. I feel really cheated.

Schelle said...

I am the daughter of a TRS/Aetna retiree. My mother retired at age 60 in 1980. She recently passed away in the fall of 2012 at age 92. Neither she,nor my father were ever eligible for Social Security nor Medicare due to my father's military retirement and pension from Civil Service.He was a retired Postmaster. They NEVER had medicare or Social Security benefits. I have no idea if medicare was taken out of her check or not. There has never been any problem with their medical benefits until now. TRS/Aetna is prmiary to the Tri-Care/CHampus insurance my father had. TRS/Aetna is saying that "Everyone" who is a US citizen received Medicare Part A free of charge and that it is not their fault that my mother did not purchase Medicare Part B. They will only pay what is left after what Medicare should have paid, leaving the balance to us. Why should my parents have purchased Part B when they already had Tri-Care? Through the years, Aetna has not been filed on for any of Mother's medical bills - only Tri-Care. Now- evidently Tri-Care realized the Aetna was OHI. I have also been unaware of the Aetna option since I am just now trying to get all of this straightened out. So after over 32 years of Aetna/TRS NOT having been filed on - they are now not wanting to pay on these medical expenses that Tri-Care is sending back for just these last few months of her life!!!I cannot get a straight answer from Aetna. It looks to me like they are just trying to dodge paying the benefits that are due. I guess we could go back 32+ years and have Aetna pay their part of those, but I think they would find that is not advantageous to them either. I am very frustrated. Help

Anonymous said...

if my district did not take out medicare deductions
and my medical ins. is TRS, and i do not have 40
quarters, and i am approaching 65 you are saying
that i should begin medicare enrollment process
and expect to pay monthly premium because my
TRS insurance will only be covering what they
assume medicare won't pay?

many thanks

Anonymous said...

Is this blog still active? I will be 65 soon and am a retired teacher. I currently have TRS 2 as my insurance. I have my 40 quarters and will be eligible for Medicare A and B. Do I keep TRS 2 or go down to TRS 1 since I will have to now pay an extra 105.00+ dollars for Medicare Part B?

Anonymous said...

Sister retired at 61, and has health insurance provided by TSR. Before she turns 65, can she apply for medicare and cancel TSR health insurance?

Jennifer Smith said...

Hey, This was an excellent post and was very insightful.your question and answers are more informative. i am agree with Medicare police but i have a question why TRS is not agree with it? Thanks.Texas jobs

Anonymous said...

I have TRS-2 and will turn 65 in 3 months. At that time, when I switch to Medicare, will TRS allow me to switch from TRS-2 to TRS-3? Also, have you explored supplemental prescription plans at all? I take compounded medications, and I'm getting no coverage on TRS-2. Thanks!

rich said...

Dear anonymous,

Thanks for visiting my blog. As I understand it, you may change your level of coverage when you go on medicare. This is a direct quote from the TRS website "When you reach age 65, you may add dependents
and/or increase your level of coverage". I am on the level 2 prescription plan myself and have found it quite good. I'm afraid I can't answer your questions about your particular medications but perhaps you should check with TRS and find out why they won't cover you. Thanks for visiting my blog and I hope you will return. Good luck.

Anonymous said...

I am a retired 56 year old teacher now. My wife is 47 and continues to teach and probably will continue for another 10 years. I have a number of health issues. For example I just got an ankle replacement. I take a lot of prescription drugs too. Should I get my insurance from her district policy or take out TRS Care 2?

rich said...

John, Thanks for visiting my blog. Have you just retired this year or are you already on TRS Care? As you may already know, under TRS Care you can choose either level 2 or 3. Under level two, you pay a lower premium, but have a $1000 deductible. Under level three your premium is higher but your deductible is only $300. I personally chose level 2. I think your best approach would be to see what your premiums, co pays and deductibles would be under your wife's school plan and then compare them to the two TRS plans. God luck andI hope you will visit my blog again.

american4ever said...

My husband will receive Social Security benefits while I receive TRS. I have 27 quarters under social security, but not the complete 40. I am currently retired, but deferred my TRS insurance because I am still covered under my husband's plan with his employer. I have never subscribed to the insurance.

1) When my husband retires, do I need to activate my TRS insurance to serve as my primary and his secondary?

2) Will I receive medicare as a spousal benefit under his SSI while he is living?

3) If so, will I continue to receive medicare as a spousal benefit should he pass away first?

I'm very confused.

Thanks, Liz

rich said...

Thanks for visiting my blog. When your husband retires, will he be eleigible for medicare? If he is eligible for medicare, then Medicare will be his primary and Trs Care will be supplemental. When he retires, you will need to contact TRS to start your TRS Care benefits and his. Yes, in most cases you will be eligible for Medicare due to your spouses' social security coverage. Also you should continue to be eligible for Medicare should your spouse predecease you. I think it would be worthwhile for you to contact TRS or even make the trip to Austin to clarify all these questions. Hope this has helped some.