As of Jan. 1, all Teacher Retirement System of Texas (TRS) retirees who are eligible for Medicare (as well as their Medicare-eligible dependents) have been transitioned to the TRS-Care Medicare Advantage (MA) plan, which is administered through Humana.
If you were contracted with Humana MA, you will be paid your contracted rates. If you were not contracted with Humana and you elect to see patients covered under the new TRS-Care MA plan, Humana is required to pay you the Medicare-allowed amount.
Some of your patients may have given you a flyer similar to the one on the Humana website.
Out-of-network physicians are required to comply with all MA plan rules regarding appeals and other guidelines. Also, TMA recommends physicians verify patients’ benefits and eligibility as these plans may have deductibles and cost-share amounts different from traditional Medicare as well as the previous plan.
In addition, the pharmacy benefit manager for TRS retirees eligible for Medicare is changing to CVS Caremark.
Contact Humana if you have questions about the plan and coverage guidelines.
Last Updated On
January 03, 2018