Where can I find out more information about my healthcare benefits as a state or university retiree?

The state of Illinois offeres retirees, annuitants and survivors a healthcare program called Total Retiree Advantage Illinois (TRAIL). This program provides Medicare-eligible members and their covered dependents comprehensive medical and prescription drug coverage through TRAIL Medicare Advantage Prescription Drug (commonly referred to as ‘MAPD’) plan. For more information on the TRAIL MAPD, including important details on eligibility, enrollment, plan rules and coverage, visit the CMS TRAIL webpage.

What is a Medicare Advantage Prescription Drug (MAPD) Plan?

Medicare Advantage plans (sometimes referred to as ‘Part C’ plans) are Medicare approved plans offered by private companies for your health and drug coverage. These ‘bundled’ plans include all of your Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, as well as Part D (Prescription Drug). These plans must cover all medically necessary services and supplies that Original Medicare covers. Medicare Advantage plans often have lower out-of-pocket costs than Original Medicare, and in many cases the plans offer extra benefits that Original Medicare doesn’t offer. 

To whom does the state’s TRAIL MAPD coverage apply?

The state’s Medicare Advantage program applies to SERS and SURS annuitants and their covered dependents who are enrolled in Medicare Parts A and B and reside in the United States.  In order to be enrolled in the Medicare Advantage plan, all covered dependents must be enrolled in Medicare. So if you are 66 and your spouse is 60, neither of you will transition onto the Medicare Advantage plan until your spouse is 65.

Do I have to move to the MAPD plan when eligbile?

Yes. If you are Medicare-eligible and wish to remain on the state’s health plan, you must move to the Medicare Advantage plan.  At your choice you may opt out of the state health plan and purchase your own Medicare Supplement. You can only only be enrolled in one Medicare porgram at a time.

When do I enroll in the MAPD plan?

You will enroll in the MAPD plan when you first become Medicare eligible, or at a date when both you and your spouse both become Medicare eligible.  You may terminate coverage at any time by contacting the plan administrator in writing. 

You may re-enroll throughtout the plan year and coverage will be effective the first of the month following your enrollment request or during your annual Trail MAPD Enrollment.

What are my healthcare costs under the Medicare Advantage plan?

The copays and deductibles for the MAPD plan are consistent with, if not more favorable, then the coverage under other health plans offered to state and university employees and retirees under age 65. The annual deductible is $110 and the annual out of pocket maximum is $1,300. As part of the most recent contract settlement reached with the state, there shall be no cost increases in any provisions of the Medicare Advantage Plan through 2027.

Retirees with 20 or more years of service continue to have premium-free coverage. The cost for dependent coverage is $2.46 per month ($5.05 per month if covering two or more dependents).

What happens if my doctor or clinic says they are not part of MAPD plan?

The state sponsored Medicare Advantage PPO plan is a ‘passive’ PPO plan, which means that you may see any provider as long as they participate in Medicare and accept the plan. Even though Aetna has its network, you do not have the restrictions of in and out of network providers.  If you receive care from a provider not in the Aenta network, the PPO plan pays those providers the same amount Medicare would have paid, and you pay the same out of pocket as if you had received in-network care.

The majority of poviders in Illinois and across the nation accept the state-sponsored MAPD plan or be willing to bill Aetna. If your provider still refuses to bill Aenta for your visit, you mus tpay the bill and submit a request for reimbursement to Aenta for payment. Aenta will then reimburse you the Medicare allowable amount, minus any deductible or coinsurance for which you are responsible.

If your medical provider is refusing to accept the MAPD plan, call Aetna or CMS directly and inform them of the issue:

• Aetna: 1-855-223-4807 from 8am to 8pm CT
• CMS: (217) 728-7007

Where can I find out more information about the extra benefits available under the MAPD plan?

Under the state’s MAPD plan, you have acess to extra benefits including the Aetna Healthy Rewards program and the Silvers Sneakers Fitness Program.  For a list of no-cost extras, visit here or go to the state's Aetna website.

What about coverage for prescription drugs?

The Medicare Advantage plan offered by the state includes prescription drug coverage. Unlike a standard Part D plan in which the enrollee is required to pay a percentage of the full retail cost of the drug, State members enrolled in the TRAIL MAPD Program pay only the plan’s standard copayment through the Initial Coverage and Coverage Gap stages. Paying only the standard copayment through the Coverage Gap is a valuable benefit for TRAIL MAPD members. Once a member reaches the Catastrophic Coverage stage (when the true out-of-pocket costs reach $7,400 for prescription drugs in 2023), the member will pay either a small copayment or 5% coinsurance that is capped to limit a member’s out-of-pocket costs.

Under Medicare Advantage plans, Medicare’s so-called prescription drug ‘donut hole’ does not exist. There is no gap in prescription drug coverage.  For more information on drug coverage or filling prescription drugs under the MAPD plan, please see this fact sheet.

I’m getting a lot of mail. How do I know what’s official and what’s just junk mail?

Insurance companies send out a large amount of advetisements in the mail, which can lead to widespread confusion, especially in the fall. If the material you receice is not from CMS or AFSCME then you should feel safe in disregardign the information contained therein. When CMS sends information about the MAPD plan, it will contain a logo that says: Total Retiree Advantage Illinois (TRAIL) or it will be on CMS letterhead.

What if I am Medicare eligible, but my spouse is not, or vice versa?

In order for you and your spouse to move onto the MAPD plan, both of you must be Medicare eligible. For example, this means that if you are 62 (Medicare ineligible) and your spouse is 65 (Medicare eligible), then neither of you will transition to the MAPD plan. Rather, you will both stay on the plan you currently have until both of you are Medicare eligible.  The same applies for dependent children.

Why did the State switch from United to Aetna as the provider of the Medicare Advantage Program?

On December 31, 2022 the contracts between the state and the Medicare Advantage carriers expired. Because of this the State of Illinois was legally required to enter into a request for proposal (RFP) process. During this process the state reviewed each bid and ultimately selected Aetna.

What about dental and vision coverage?

Your dental and vision coverage do not change when you become Medicare eligible. If you do not enroll in Medicare Advantage and instead decide to opt out of the state’s medical insurance plan, you will not be able to keep you vision coverage, but may elect to keep your dental insurance.

Further Questions?

If you have questions, contact:

• Aetna at 1-855-223-4807 from 8am to 8pm CT or by visiting the state's Aetna website to learn about plan benefits, find providers, and look up prescription drugs.

• MyBenefits Service Center at 1-844-251-1777 from 8am – 6pm CT or by visiting  MyBenefits Illinois to ask about eligibility, make changes to your coverage, or opt out of the Aetna MAPD PPO plan.

• Medicare at 1-800-633-4227 or by visiting www.medicare.gov to ask questions about Medicare Parts A and B.