FAQs for Health Insurance

Health Coverage with my CTRB Sponsored Plan

Do I need Medicare Part A and Part B to participate in CTRB’s Sponsored Medicare Supplement with Prescriptions Plan?
Yes. Participation in Medicare Part A and Part B is required to participate in the TRB sponsored health plan effective July 1, 2006. Premiums for Medicare Part A and/or Part B are not covered by the CTRB.

When I reach age 65, I will participate in Medicare Part A and Part B. Can I stay with my former employer’s plan?
Your former employer is not required by law to offer coverage to a member and/or spouse participating in Medicare Part A and Part B. If your former employer offers you a Supplemental Plan, you may elect to stay with them and the subsidy payment will continue, provided you do not enroll in any CTRB sponsored plan.

When I reach age 65, I will participate in Medicare Part A and Part B. What health care coverage is available through CTRB?
The CTTRB offers plan options: The Anthem Medicare Advantage PPO plan or The Anthem Medicare Supplement Plan. Each plan is offered as a single package which includes Medicare Hospital, Medical, Major Medical, Express Scripts Prescriptions, Cigna Dental, Vision & Hearing Coverage.

What are the difference in Network Services between the Anthem Advantage PPO plan and the Anthem Supplement Plan?
Both plans include a national passive network, which is seamless to the members and provides access to any provider who accepts Medicare assignment at the same cost share level of those providers who are considered in network. The provider does not have to participate with Anthem so long as they are a Medicare approved provider who accepts assignment.

What is the difference between a Medicare Advantage Plan and a Medicare Supplement Plan?
Services covered by Medicare Part A or B must be covered by either plan. Medicare has contracted with Anthem Advantage to administer covered services. Medicare Advantage plans offer preventive care and ancillary benefits not offered under original Medicare, for example Silver Sneakers. Because the Anthem Advantage plan is managed by Anthem, they have additional plan guidelines including some prior authorizations. The Medicare Supplement Plan follows original Medicare guidelines. Original Medicare will be primary, and the Medicare Supplement will be secondary.

Why does the Anthem Medicare Supplement have deductible and cost shares?
The benefit plan changes were designed as an alternative for those members who would prefer the option to remain on traditional Medicare with secondary coverage provided by a Medicare Supplement plan. This makes the overall cost of the plans more similar.

What is the difference between the Anthem Medicare Advantage Plan and the Anthem Medicare Supplement Plan?
The Anthem Medicare Advantage plan has a lower monthly premium with no deductible, but members are subject to more copays under this plan. You have a $10 copay for all non-preventative Part B services and some services require prior authorization such as surgeries, MRI's and physical therapy.

The Anthem Medicare Supplement plan has a higher monthly premium and a Part B deductible of $198 but there are no prior authorizations on this plan and members are subject to fewer copays. The Anthem Medicare Supplement plan has an enhanced hearing aid benefit.

The plans benefit each member differently and the choice is ultimately yours when deciding which plan you are most comfortable using. Members can switch between the plans each year during open enrollment.

Is my current coverage through the TRB’s prescription plan equivalent to or better than the Medicare Part D prescription coverage?
Yes. The TRB has determined that the prescription drug coverage offered to you by the TRB’s prescription drug plan is “on average”, expected to pay out at least as much as the standard Medicare prescription drug coverage will pay. Because your existing TRB coverage is “on average” as good as standard Medicare Part D prescription coverage, you can stay with your TRB coverage. If you decide later you want to enroll in Medicare Part D prescription coverage and drop the TRB plan, you will NOT incur a permanent lifetime penalty in your Medicare Part D premium, PROVIDED there is no lapse in prescription coverage.

What are the consequences if I choose to enroll in the Medicare Part D prescription coverage?
The federal government will only subsidize one prescription plan for you at a time. If we are notified that you are participating in another prescription plan subsidized and/or paid for by the federal government, your health care coverage and dental coverage through the TRB will be terminated.

How will I decide whether to remain in the TRB prescription plan or choose Medicare Part D prescription coverage?
Medicare Part D prescription coverage is different from the health coverage available under Medicare Parts A and B. To obtain prescription coverage under Medicare Part D, you will have to choose a plan from a private company. While there is standard coverage required by Medicare Part D prescription coverage, each private plan is likely to have unique attributes, including which drugs are covered, the level of co-pays, and which pharmacies you can use. Accordingly, you should compare your current coverage and cost with the coverage and cost of the plans offering Medicare Part D prescription drug coverage in your area.

Is there a penalty if my TRB coverage lapses and I enroll in the new Medicare Part D Plan late?
Yes. If you drop or lose your coverage with TRB and do not enroll within 63 days in a Medicare prescription drug plan, you will be subject to a permanent lifetime penalty by enrolling in a Medicare prescription drug plan after the May 15, 2006 (the initial Medicare Plan D enrollment deadline). Your Medicare Part D monthly premium will increase at least 1% per month for every month after May 15, 2006 that you did not have prescription coverage. For example, if you are without prescription coverage for nineteen months, your premium will always be at least 19% higher than normal cost.

What is the difference between the out of pocket (OOP) maximum and the true out of pocket cost (TROOP) on Express Scripts?
The Prescription Drug plan provided by Express Scripts is a Medicare Part D Prescription Drug plan with an employer group wrap sponsored by the Teachers Retirement Board.

What does that mean?
The TRB provides an enhanced version of a Medicare Part D drug program enabling lower costs for a higher level of benefits. In addition, the TRB plan includes prescriptions not covered under traditional Part D plans such as ED drugs.

What is Out of Pocket Maximum (MOOP)?
The sum of the deductible and coinsurance under the program, this equals the maximum cost members are required to pay under the plan for covered drugs.

What is the True Out of Pocket Cost (TROOP)?
The sum of the member cost and costs paid on behalf of the member by manufacturers in the donut hole or coverage gap. For 2019 the maximum TROOP is $5,100.00 Beyond the TROOP members are charged 5% of the cost of the drugs which is referred to as the catastrophic phase (subject to the plan maximum out of pocket costs)

Why have the out of pocket costs for prescription drugs increased so much for 2019?
The issue The TRB is keenly aware that the increase in out-of-pocket maximums for prescription drugs from $1,400 to $3,500, is substantial. The reality is that the cost of specialty drugs (also called biotech drugs) has dramatically increased the cost of many drug therapies. For example, just a few years ago, the highest cost cancer drugs were approximately $120,000 for a course of treatment. This cost has now increased to approximately $250,000. Thus, providing the necessary drug coverage to these critically ill individuals is simply not financially sustainable and in fact, at the current rates, threatens the long-term solvency of the plan.
Consequently, costs beyond approximately $8,500 in annual drug spend on behalf of an individual will have a 5% copay until the of pocket costs reach $3,500. This change is driven in large part by the fact that the federal government will provide $16 for each dollar of member cost share above the approximate $8,500 of drug spend. In fact, these 5% cost share plans are becoming increasingly common in other drug plans as well because the cost of new drugs are simply unaffordable, but the federal government will pay a large part of the cost if the plan requires the member to pay the 5%.

Who will be affected by this change?
The average TRB plan member pays about $2,000 per year for prescription drugs. Therefore, the average TRB member will not be affected by the cost share increase.
Those affected by the cost share increase will be the 3-4% of TRB plan members that spend over $8,500 per year on Part D drugs (note: in-hospital Part B drugs are not affected). We estimate that only about 1% of the membership will pay the $3,500 out of pocket, and those who are likely to be affected are members taking biotech drugs for multiple sclerosis, rheumatoid arthritis, and a number of types of cancer.
We also expect that any TRB plan member who will have to pay $3,500 towards drug costs will be receiving drugs annually costing over $40,000. Thus, this member will be paying less than 10% of the cost of the therapy.
In short, the TRB remains concerned about member costs (both premium and cost share) but unless there is a deep pocket to shoulder these dramatically increasing costs, cost shares will continue to increase. By charging the 5% coinsurance charge above the $8,500 in drug costs, we are able to obtain matching funds from the federal government which in turn will allow the plan to be able to pay for the continuing cost of these very expensive but very critical services.

How do I pay the premium for the CTRB sponsored plan coverage?
Monthly premiums for coverage for member and/or spouse must be deducted from the monthly benefit payment. In the event of a member’s death, a surviving spouse who does not receive monthly benefit payment can choose to have CTRB deduct the monthly premiums for coverage directly out of the surviving spouse’s checking account.

How do I enroll in a CTRB sponsored plan?
Obtain a TRB Sponsored Health Insurance Application and a Health & Prescription Drug Benefits Plan Summary from our website www.ct.gov/trb. All coverage takes effect on the 1st day of the month. Enrollment forms must be received by the 25th day of the second month preceding the effective date of coverage. For example, for coverage to become effective as of December 1st, CTRB must receive your form no later than October 25th. The premium will be deducted from the benefit payment dated November 30th. If you are a new retiree or the spouse of a new retiree, contact this office for a determination of the earliest enrollment effective date available.

When enrolling, please be aware that the $200 (effective 1/1/2020) annual prescription deductible is based on the calendar year, January to December, and is not pro-ratable. If you are enrolling in our plan at the end of the year, you would be subject to a $200 deductible for the remainder of that year and a new $200 deductible would begin in January.

How often can I make changes?
Once you enroll in our plan, you may not make any changes until the next open enrollment period. You may cancel at any time provided you notify CTRB in writing 30 days prior to the requested cancellation date.

When is the next open enrollment period?
The next open enrollment period will be held in the fall of the current year. In October, you will have the opportunity to re-enroll or change your form of coverage to be effective January 1st of the following year.

Do my spouse and I have to be on the same plan?
No, spouses and eligible dependents are treated as their own members with insurance. Your spouse can choose one plan while you choose the other. Premiums will be deducted from your pension accordingly.

Can my spouse enroll when they are 65 even if I am not eligible for Part B yet?
Yes. Spouses can enroll in TRB health insurance so long as you are receiving a retirement benefit from TRB. You do not need to be enrolled in our health insurance for your spouse to enroll.

When I die, is my spouse eligible for health insurance coverage through CTRB?
A surviving spouse who is participating in Medicare Part A and Part B may participate in a CTRB sponsored plan as long as he/she does not remarry. This is applicable regardless of whether or not your spouse is receiving a monthly beneficiary payment from this system.

If I travel outside the United States or live outside the United States, will the CTRB health insurance cover me?
The Teachers’ Retirement health plans will pay for emergency and acute care that occurs while traveling outside of the United States. The plan does not cover routine care or care for chronic conditions while a person lives outside the United States, even if their stay is for less than one half the year. The Out of Country benefit may not be used to obtain care that is not available within the United States.

When will I receive my insurance cards?
Cards are typically received the last week of the month prior to your enrollment date. For example: June 1st enrollees will typically receive their cards the last week of May. You will receive a card from the Anthem plan you selected, Express Scripts and Cigna.