Medicare Benefits & Plan Types


The Medicare Advantage (MA) PPO plan is the primary plan for Medicare-enrolled Trust member (over age 65, or on Medicare because of a disability). Medicare-enrolled members are automatically enrolled in the MA PPO plan on January 1, following the year they qualify for Medicare. Certain Medicare members, such as Protected Status members and those enrolled in an HMO plan may not be automatically enrolled in the MA PPO plan but have the option to select the plan, if they meet all other eligibility criteria.

More Benefits

MA PPO plans provide Medicare members with greater value than other plan offerings while preserving coverage levels and access to doctors and hospitals. These plans also have lower cost share than the Traditional Care Network (TCN) plan so Medicare members can save up to $374 per member per year! Click here to see the savings detail.

Learn More About Your MA PPO Plan Option

For specific health plan information such as coverage details, participating providers, and covered preventive services, contact your health plan carrier.

Members currently enrolled in the MA PPO Plan:
Aetna: (800) 663-0885 For all states excluding MI
BCBS: (888) 322-5616 For states of AL, FL, IN, MI, MO & TN

Members NOT currently enrolled in the MA PPO Plan:
Aetna: (855) 406-4062 For all states excluding MI 
BCBS: (877) 336-0377 For states of AL, FL, IN, MI, MO & TN

Your Health, Your Choice

While we believe you will enjoy the MA PPO plan and its programs and lower out-of-pocket costs, in some instances the MA PPO plan may not be right for everyone. You still have a choice in health care. If you are enrolled in the MA PPO plan but prefer the TCN plan (or another available option in your area), simply contact Retiree Health Care Connect (RHCC) at 866-637-7555. Please note, if you make a mid-year change, any cost amount applied toward your deductible and out-of-pocket maximum will not carry-over to your new plan selection.

- Plan Types -

It’s important to understand that the plan options available to you depend on where you live and can vary based on your Medicare enrollment. Also, keep in mind that plan options are reviewed annually to determine if they will be renewed. Often times there are yearly changes that are communicated to you in the Benefit Highlights newsletter mailed every fall.

MA PPO 

TCN

HMO 

Medicare Advantage

Traditional Care Network

 Health Maintenance Organization

Eligibility

Medicare members enrolled in Part A and Part B

Must be enrolled in Medicare Parts A and B and living in one of the states where an MA PPO plan is offered*

Eligibility

Medicare members. 

For Medicare members in this plan, Medicare is primary and TCN coverage is secondary

Eligibility

Medicare (and Non-Medicare members) living in regions within these states: California, Colorado, Georgia, Maryland, Michigan, Minnesota, Oregon, Washington D.C., Washington (state), and Virginia where an HMO is offered. 
 
Must be living in areas where an HMO plan is offered

About the Plan

This is the primary plan for Medicare members. An MA PPO plan type is approved by Medicare and administered by a private company (such as Blue Cross Blue Shield or Aetna). These plans provide your Original Medicare, Part A (hospital) and Part B (medical) benefits, and include additional benefits. MA plans are based on a nationwide network of providers and allow services to be performed both in-network and out-of-network.


About the Plan

This is a nationwide plan option available to Medicare members.  Based on a nationwide network of providers, the TCN plan allows services to be performed both in-network and out-of-network.

About the Plan

While HMO plans have been a popular choice among members, they are only offered in limited areas where they are able to be competitive with the Traditional Care Network (TCN) plan. HMO plan options are based on a regional network of providers and do not offer out-of-network benefits (although emergency services may be covered out-of-network).


Cost

See cost share

May have copays, deductibles, coinsurance and out-of-pocket maximums.

In order to receive the highest level of benefits with the lowest out-of-pocket cost, you should receive services from an in-network provider.

Cost

See cost share

May have copays, deductibles, coinsurance and out-of-pocket maximums.

In order to receive the highest level of benefits with the lowest out-of-pocket cost, you need to receive services from an in-network provider.

Cost

See cost share

May have copays and deductibles but do not have coinsurance or out-of-pocket maximums.

For More Info

Refer to the Summary Plan Description (SPD).Contact your health plan carrier for information about your specific medical benefits at the number on the back of your medical ID card.

For More Info

Refer to your evidence of coverage or contact your MA PPO plan carrier at the number on the back of your medical ID card.

 

For More Info

Refer to your certificate of coverage or contact your HMO plan carrier at the number on the back of your medical ID card.

 

*To stay eligible for this plan, you must continue to pay your monthly Medicare Part B premium.

Cost Share

Before reviewing more details on your available plan options, it’s important to understand all Trust provided plans have copay and cost share elements. As a member of the Trust, you are responsible for paying certain health care coverage costs including a monthly contribution, annual deductible, coinsurance, copayment and annual out-of-pocket maximum. Understanding how these work will help you know when they apply and how much you will have to pay for care, click to view coverage costs.

Copay elements are fixed dollar amounts for services such as Primary Care Physician (PCP) office visits, specialist visits, urgent care visits and emergency room visits. Cost share elements can include deductibles, coinsurance and out-of-pocket maximums. Want more detail on what these terms mean? Visit the Health Care Glossary

 

- Benefit Materials for Download -

Below are the four main documents you will need to understand and utilize your benefits - click on the links below the images to download copies.

2019

Benefit Highlights

2019

Health Care
Benefits Summary
(Schedule of Benefits)

2015-Present

Summary Plan Description
(SPD)

2019

Plan Document

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Learn about your 2019 cost share and benefit coverage updates. An addendum to the SPD that includes year-to-year changes in cost share and benefit coverage. This is mailed to members every fall. Para español, haga clic aquí.

An addendum to SPD including current cost share and detailed coverage information on health plans, physical therapy, vision, hearing aid, dental, health programs and additional plan provisions (Benefit Highlights information is included). This is mailed to participants by request and is available online.

A summary of the Plan Document. This is written to be more easily understood and is typically updated and mailed to Trust members every five years (the current version was published in 2015). Because of this, changes made in the years between are detailed in the annual Benefit Highlights and Health Care Benefits Summary (Schedule of Benefits).Para español, haga clic aquí.

The legally required comprehensive document describing the operation and administration of the Plan. This is written using legal language and is mailed to participants by request and is available online.

Videos

Watch a video about your 2018 Medicare Advantage plan option