Transitioning to Medicare While Using the TRIP Medical Insurance Plan
If you are a teacher (or employee) retiring from a State of Illinois school district, you’ll likely have some questions about Medicare and how your TRS retiree medical insurance (TRIP) coverage works. Your benefits are unique in that TRIP will transition over to your Medicare and TRIP after age 65.
Let’s look at some of the basics you’ll want to know.
What is TRIP?
TRIP stands for Teachers’ Retirement Insurance Program. Retirees who enroll in this coverage get their health benefits, medications and behavioral health coverage from the plan. You can select your benefits through the State of Illinois’ MyBenefits website.
At age 65, TRIP members who are eligible for Medicare Parts A and B must enroll in one of the Medicare Advantage plans offered via the Total Retiree Advantage Illinois program. There are annual Benefits Choice Periods during which new retirees will transition from TRIP into a TRAIL Medicare Advantage plan.
What is a Medicare Advantage Plan?
A Medicare Advantage plan is a Medicare-approved plan that incorporates your Part A, B, and D into one health plan. You will seek your healthcare services from providers that are in the plan’s network and pay copays or coinsurance for services as you go along.
Medicare Advantage plans must include all the same inpatient and outpatient benefits that you would normally get under Original Medicare. Unlike Original Medicare though, many Medicare Advantage plans also have built in Part D drug coverage.
To join any Medicare Advantage plan, including the TRAIL plans, Medicare beneficiaries must first enroll in both Medicare Parts A and B.
How and When to Enroll in Medicare
Your initial enrollment period for Medicare begins three months before your 65th birthday month. It ends 3 months after your 65th birthday month. It’s important to enroll in both Parts A and B during this window to avoid any late penalties down the road.
Also, enrolling in the three months prior to your birthday month will ensure your benefits begin by the 1st of the month in which you turn 65.
The easiest way to apply for Medicare is online at the Social Security website. However, you can also call them for an application in the mail or go down to your local office in person. You must stay enrolled in Part B the entire time that you are enrolled in the plan because your Part B premiums help to subsidize the cost of this plan.
You will not need to enroll in Medicare Part D because your TRAIL Medicare Advantage plan already includes this coverage.
What Original Medicare Costs
Most people pay nothing for Part A. As long as you or a spouse has worked at least 10 years in your life here in the U.S and paid FICA taxes during those years, your Part A is already paid up. It will cost you nothing at 65.
Part B, however, has monthly premiums. The standard base premium in 2019 is $135.50/month. However, some people pay more – called an Income Related Monthly Adjustment Amount - based on their modified, adjusted household gross income.
You will not pay any separate Part D premiums. However, if you are in one of the high-income brackets, you will be charged a monthly adjustment amount on Part D as well since Part D benefits are built into the plan.
You can find a chart that details Part B and D premiums by income here.
Choosing Your TRAIL Plan
TRIP offers a number of different Medicare Advantage plans based on the county in which you live. Some are HMO-based plans while others have a PPO network.
HMO plans often require you to choose a primary care provider and you may need to see that provider for a referral before you can see a specialist. Since the insurance company has greater control over your medical usage in this style of network, you will often find that the premiums are lower than for the PPO plan.
HMO plans also must use the plan’s network providers in all circumstances except emergencies.
PPO plans are typically a bit more flexible. You may or may not have to choose a primary care physician, but referrals usually aren’t necessary. You also have some coverage (at a higher cost to you) if you want to see a provider who is not in the network.
Before you select a plan, be sure to check the plan’s directory to see if your preferred providers are in the network for the plan that you intend to choose.
You can find the 2019 plan summaries here.
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