UNITED STATES—Dear Toni: I read an article from the Statesman which stated that 36,000 TRS retired teachers have left TRS Care and this troubles me.   I am a 68-year-old retired high school principal with a wife who turns 65 in January and needs to enroll in Medicare.

I have a liver condition that requires a liver transplant soon. My doctor says I will receive better care thru Original Medicare due to the amount of time needed for skilled/rehab care. I’m concerned I will have problems with the TRS Retiree plan.

I talked with an insurance agent who told me that I now must answer health questions and will not qualify for a Medicare Supplement because of my health conditions. HELP!!

Thanks, Bob from Beaumont, TX.

Hello, Bob: You were given wrong information from that agent. Since TRS is an employer group plan you should be able to disenroll from TRS and enroll me a Medicare Supplement without having to answer health questions.

Your time is ticking because the TRS plan is a Medicare Advantage plan and there are special rules for that type of plan when returning to Original Medicare. This will take time to explore.

Every day at the Toni Says® office, we help confused Americans understand what their proper Medicare options are, especially when there is a serious health issue such as yours.

You are applying for a Medicare Supplement will be a completely different experience than your wife’s Medicare enrollment because she is new to Medicare.

Your wife is in her “Medigap Open Enrollment Period” which is explained in the Medicare & You Handbook. The handbook states, “The best time to buy a Medigap policy is during your Medigap Open Enrollment Period which is a 6-month period that begins on the first day of the month in which you’re 65 or older and enrolled in Part B.  At this time, an insurance company can’t use medical underwriting to approve a plan.  She is issued automatically.

Bob, your Medicare saving grace that you have, is a special right because you were included in a group Medicare health plan and can receive a 63-day guaranteed issue period for applying for a Medicare Supplement/Medigap plan. Keep your TRS/company benefit termination letter to show the Medicare Supplement insurance company that you are in a guaranteed issue period.

The special Medicare Guarantee rule is explained below:

With guaranteed issue an insurance company must:

  • Sell you a Medigap/Medicare Supplement policy. “You have the right to buy Medigap/Medicare Supplement Plan A, B, C, F, K or L that’s sold in your state by any insurance company, as stated in the 2017 choosing a Medigap Policy by Medicare.
  • Cover all your pre-existing health conditions.
  • Cannot charge you more for a Medigap/Medicare Supplement policy, regardless of past or present health problems, as stated in the 2017 Choosing a Medigap Policy by Medicare.

Medicare enrollment rules are explained in the ABBS (American Baby Boomer Society) website at www.abbs4u.com.

Bob, with 36,000 TRS Retirees leaving the TRS system little changes were made to the TRS plan this year…who knows what the future holds!

Toni King the author of Medicare Survival Guide® Advanced, is offering a Medicare Open Enrollment book package special at www.tonisays.com. For questions about Medicare, email info@tonisays.com or call 844-250-8664.