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Mike Smith By Mike Smith • December 29, 2017

The 2018 TRS Care Enrollment Debacle: Your Pathway to New Clients

The new TRS Care Plan for Medicare Advantage plans scheduled to go into effect on January 1, 2018 may have a huge impact on your clients. Be sure to keep up with all the new information, dates, and challenges presented to your clients and applicants during the first few weeks of this transition. If you have assisted a TRS Care member or a dependent in disenrolling from the 2018 TRS Care Plan, please read this message carefully. Our office has been inundated with calls from concerned brokers like you alerting us to the fact that PDP or MAPD applications that were submitted have been cancelled. This email is to define the problem and offer a solution the problem.


The Problem

TRS sent a file of the current TRS Care members to CMS/Silverscript so that they could be enrolled in the new TRS Care plan with a 1/1/2018 effective date. Unfortunately, this file also included TRS members who had disenrolled. Because of this, any previously submitted PDP or MAPD applications with a 1/1/2018 effective date may have been cancelled. Even if the TRS member properly disenrolled using Form 700B, the disenrollment may or may not have been processed prior to the 11/9/2017 deadline imposed by TRS. We highly recommend checking status on all TRS Care members that you have assisted.

An Example

The following is a hypothetical situation that mirrors some of our agents' experiences. Let's say a TRS member sent in the signed, notarized Form 700B on 10/24/2017. The disenrollment was acknowledged by TRS as being received. You, as the writing agent, write a PDP or MAPD on 10/29/2017 for a 1/1/2018 effective date. On 11/27/2017, you get a phone call from your client stating that they have received a notification from their new plan's carrier telling the member that the application has been cancelled.

The Solution

It is important that you follow the specific carrier's instructions to get the cancelled application back in good order. In many scenarios, the PDP or MAPD application that has been cancelled should be rewritten to the respective carrier to acquire the 1/1/2018 effective date. In such scenarios, the rewritten application should use the "SEP-Loss of Group Coverage" code. Also, keep in mind that the SEP-Loss of Group Coverage may be used at any point during 2018.

Possible Outcomes

Here's what may happen to your client if they choose to remain on the 2018 TRS Care plan. Let's assume a TRS Care member develops a chest cold in January and goes to the doctor. The charges are $200 for an examination and diagnosis - plus costs for the administration of a shot and a prescription. The member will be required to pay the first $500 as a deductible. The member is also being charged $135 for the 2018 health plan, which may be taken from a 403(b) account (the member's retirement plan). At this point, the member is finally realizing the real impact of the 2018 TRS Care Medicare plan changes. They are not happy, and they call you for advice. You may inform the member that their options are to (a) stay on the TRS Care plan, or (b) notify TRS Care that they wish to disenroll. If the member disenrolls using Form 700B), and TRS receives the signed, notarized Form 700B by January 31, 2018, the member may exercise their right to secure a new health and drug plan on February 1, 2018. The member has a period of two months to select a new Medicare health and drug plan (February 1, 2018 through March 31, 2018). The member may acquire a 2/1/2018, a 3/1/2018, or a 4/1/2018 effective date - but their TRS Care plan ends the last day of the month in which TRS received the signed, notarized Form 700B.

Important Note: TRS is declaring a 2/2/2018 deadline to disenroll. Some carriers are interpreting this to mean after 2/28/2018, any TRS member enrolled will not be able to disenroll until 1/1/2019.

Other Possible Scenarios (and the Importance of Being Proactive)

Let's return to the scenario where your client receives a notice from the carrier saying that their new PDP or MAPD application has been cancelled. If the client replies to the carrier to have the application approved for the 1/1/2018 effective date, the carrier may employ a direct-to-consumer option -- meaning that the member is rewritten over the phone and the original agent is removed as the agent of record. To prevent this scenario from occurring, we recommend (a) you - the agent - check status on all TRS Care members that you have assisted, and (b) take the appropriate action to rewrite their PDP and MAPD application as needed.