TRS-Care Medicare Advantage FAQs

Your TRS-Care Medicare Advantage ID card, or UCard, combines all cards in one, including your Medical ID card, over the counter (OTC) benefits, and all earned rewards. Use your UCard when you visit your doctor and buy over-the-counter items.

A network doctor or health care provider is one who contracts with the TRS-Care Medicare Advantage medical insurer, UnitedHealthcare, to provide services to TRS-Care Medicare Advantage participants. You pay your copay or coinsurance according to your TRS-Care Medicare Advantage benefits. Your provider will bill UnitedHealthcare for the rest. 

An out-of-network provider does not have a contract with UnitedHealthcare. With TRS-Care Medicare Advantage (PPO), you can see any out-of-network provider that accepts Medicare and will bill UnitedHealthcare. 

You pay the TRS-Care Medicare Advantage copay or coinsurance. UnitedHealthcare will pay for the rest of the cost of your covered service(s), including any charges up to the limit set by Medicare. If your provider tells you they do not accept TRS-Care Medicare Advantage, call UnitedHealthcare. They will contact the provider on your behalf to explain how the plan works.​​

TRS-Care Medicare Advantage is a National Preferred Provider Organization (PPO) plan. This means you may see providers both in- and out-of-network for the same cost if the provider accepts Medicare and will bill UnitedHealthcare. 

Ask your provider if they accept the plan or call UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri. They can reach out to your provider to explain how TRS-Care Medicare Advantage works. 

No. Prior authorization is not required if the out-of-network provider accepts Medicare and will bill UnitedHealthcare. 

To learn more about plan deductibles, coinsurance and maximum out-of-pocket limits, visit TRS-Care Medicare Advantage by UnitedHealthcare (select Coverage and Benefits) to download copies of the plan guide and Evidence of Coverage.

When you reach your maximum out of pocket, there is no dollar amount limit for TRS-Care Medicare Advantage covered medical expenses. However, certain benefits may have visit limits such as your routine eye exam, which is limited to one exam every 12 months.

As a TRS-Care Medicare Advantage participant, an important protection for you is that after you meet any deductibles, you pay only your cost-sharing amount when you get services covered by our plan.

Providers may not add additional separate charges, called “balance billing.” This protection applies even if we pay the provider less than the provider charges for a service and even if there is a dispute and we don’t pay certain provider charges.

Here’s how this protection works:

• If your cost-sharing is a copayment (a set amount of dollars, for example, $15) then you pay only that amount for covered services from a network provider.
• If your cost-sharing is coinsurance (a percentage of the total charges), then you never pay more than that percentage. However, your cost depends on which type of provider you see:
  • If you get the covered services from a network provider, you pay the coinsurance percentage multiplied by the plan’s reimbursement rate (as determined in the contract between the provider and the plan).
  • If you get the covered services from an out-of-network provider who participates with Medicare, you pay the coinsurance percentage multiplied by the Medicare payment rate for participating providers.
  • If you get the covered services from an out-of-network provider who does not participate with Medicare, you pay the coinsurance percentage multiplied by the Medicare payment rate for non-participating providers.

​​TRS-Care Medicare Advantage is not a supplemental plan. It gives you original Medicare coverage, plus added benefits Medicare does not cover. If you’re enrolled in TRS-Care Medicare Advantage, you don’t need to buy a separate medical supplemental plan.

As a member, you are encouraged to read your plan’s Evidence of Coverage (EOC), including appeals and grievance rights, which you can find by logging into the member portal at retiree.uhc.com/TRS-CareMA. Your EOC also covers specific plan benefits, copays, exclusions, limitations and other terms.

Select Coverage and Benefits on the member portal to find covered benefits information or call UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri.

Call the 24/7 Nurseline at no cost to you at 1-833-968-1770. A registered nurse can help you decide if you should go to an emergency room, urgent care center or make an appointment with your doctor.

TRS-Care Medicare Advantage does not require a referral to see a specialist. 

You pay a $0 copay for an annual routine eye exam (one exam every 12 months). The plan pays up to a $70 eyewear allowance every 12 months or up to a $105 contact lens allowance in lieu of eyewear allowances every 12 months.

Before you make your routine eye exam appointment, ask your vision provider if they will bill TRS-Care Medicare Advantage for the exam and eyewear. If they won’t, call UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri. Contact the number on your member ID Card to find a participating vision provider in the UHC network.

Yes. Through UnitedHealthcare Hearing, you can get a broad selection of name-brand and private-labeled hearing aids custom-programmed for your hearing loss. A select number of brands are available over the counter. Hearing aids can be fit in person or delivered to your home (select products only).

To access your hearing aid benefits, you must call UnitedHealthcare Hearing at 1-888-547-1374, TTY 711. The plan pays up to a $500 allowance for hearing aids (combined both ears) every three years. You must use a UnitedHealthcare Hearing provider. Some hearing aids come with warranties for repairs.

If you’re enrolled in TRS-Care Medicare Advantage, read Comparing TRS-Care Medicare Advantage (UHC) and TRS-Care Vision (MetLife) Benefits to help you decide to also enroll in TRS-Care Vision by MetLife, which includes hearing benefits.

TRS-Care offers dental and vision plans to eligible retirees and their families. See TRS-Care Dental and TRS-Care Vision to learn more.

Your TRS-Care Medicare Advantage medical plan covers only Medicare-covered nonroutine dental services, which are services from a physician or dental professional for treatment of primary medical conditions such as jaw surgery due to radiation treatments.

TRS-Care Medicare Advantage plan does not cover routine dental services or services that are dental in nature, such as cleanings, exams or x-rays.

The plan covers Medicare-covered chiropractic services at 5% coinsurance after you meet the $400 deductible. Coverage is limited to manual manipulation of the spine to correct subluxation.

The plan covers routine chiropractic services at 5% coinsurance after you meet the $400 deductible. The plan limits the number of visits to a chiropractor to 20 visits per year. This plan provides more chiropractic coverage than typical Medicare coverage.

Yes. For more information on preventive care services, visit TRS-Care Medicare Advantage at UnitedHealthcare (select Coverage and Benefits) to download a copy of your plan guide or Evidence of Coverage.

For more information on your covered benefits, visit TRS-Care Medicare Advantage by UnitedHealthcare (select Coverage and Benefits) to download a copy of your Evidence of Coverage. If you have more questions, call UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri.

The purpose of a preventive care service is to prevent certain illnesses and diseases. The purpose of a diagnostic service is to identify the nature and cause of an illness or other medical concern, along with the method of treatment. 

Your Annual Physical is your yearly chance to get labs and tests that measure your health. Your Annual Wellness Visit is your chance to talk with your primary care physician about options for preventive care, screenings and exams. You can schedule your Annual Wellness Visit anytime in the year. But many people choose to combine their Annual Physical and Annual Wellness Visit to allow for a longer visit with their doctor. This visit is free — but a copay or coinsurance may apply if you get services that are not part of the Annual Wellness Visit or Routine Physical. 

You can get your Annual Wellness Visit anytime during the calendar year. You don’t have to wait 365 days for your next Annual Wellness Visit. For example, if your last visit was in November this year, you can have your next visit in April next year. 

Yes. Eligible members can earn a reward by completing a specific health-related activity, such as an Annual Physical or Annual Wellness Visit. You must self-report that you completed the health activity by the end of the calendar year in which you completed the activity.

Yes. You’ll get a $40 credit each quarter to order over the counter (OTC) supplies from the Healthy Benefits+ catalog. You can shop online, on the app, and from network retail locations.

You can shop for toothpaste, pain relief, vitamins, cough drops and more. Credits roll over each quarter but don’t roll over annually. To find participating stores or check your balance:

• Call 1-833-818-8694 (TTY 711);
• Visit healthybenefitsplus.com/TRSCareMA; or
• Download the Healthy Benefits+ app at Healthy Benefits+ App (Apple Store) or Healthy Benefits+ App (Google Store).

Yes. Enrolling in SilverSneakers gives you a standard monthly gym membership to over 15,000 fitness locations across the country at no added cost to you. You have access to exercise equipment, classes and more. And you can use more than one location. Go to SilverSneakers to search for participating locations near you.

HouseCalls is an optional program that includes a yearly home visit to support the care you get from your primary care provider. 

HouseCalls work in conjunction with your primary care visit. It’s a great chance to ask questions you didn’t ask your primary care physician (PCP). The HouseCalls practitioner will help create a checklist of topics you can discuss with your PCP, which allows you to get more holistic care in your home and at your doctor’s office. 

To schedule a HouseCalls visit, call UnitedHealthcare and one of our Advocates will help you set up a visit. Call 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Mon–Fri. HouseCalls may not be available in all areas.

Yes. Your plan includes a Personal Emergency Response System (PERS), which is a medical alert device. The PERS in‐home monitoring device provides fast, simple access to help 24 hours per day, 365 days per year, with the simple push of a button. Members choose the product that best fits their lifestyle and get their device at no added cost. 

The routine transportation program helps you travel to health-related appointments easier at no added cost to you. If you don’t have a way to get to your health care appointments, we can help.

You have 24 one-way rides each year to and from medically related appointments and the pharmacy for a $0 copayment. For more information and to schedule your trips, call SafeRide at 1-844-876-6177.  Some restrictions apply.

Yes. You’re eligible to get services from CareLinx®, an in-home caregiver service, at no added cost. CareLinx has a network of over 300,000 background-checked professional caregivers. The plan matches you with a caregiver who meets your needs and schedule.

Once matched, your caregiver can provide services such as companionship, preparing meals, bathing, medication reminders, providing transportation around your community and more.

We know that an inpatient stay can cause a lot of stress and worry. The Healthy at Home program gives you support that goes beyond traditional medical care to help you successfully recover at home after inpatient admission or a skilled nursing facility stay. Benefits include:

• 28 home-delivered meals when a UnitedHealthcare Engagement Specialist refers you;
• 12 one-way rides to medically related appointments and to the pharmacy when a UnitedHealthcare Engagement Specialist refers you; and
• Six hours of in-home personal care from a CareLinx professional caregiver to perform tasks like preparing meals, bathing, medication reminders and more. A referral is not required for in-home personal care.

You’re eligible for the benefits up to 30 days following inpatient and skilled nursing facility discharges. The plan requires a referral after every discharge to provide your meal and transportation benefit through the Healthy at Home program.

Evernorth Health Services is the pharmacy benefit manager for the TRS-Care Medicare Rx prescription drug plan. We updated our logo and branding to reflect that Express Scripts is part of Evernorth Health Services. New branding, same Express Scripts promise. The service you know and trust won't change.

If you have questions or need an ID card, call Evernorth at 1-844-863-5324, 24 hours a day, seven days a week or visit TRS-Care Medicare Rx by Express Scripts for more information.

You may use any pharmacy in the Evernorth retail network. You can fill long-term supplies (up to a 90-day supply) of maintenance medications at Retail-Maintenance pharmacies.

You can get certain preventive generic drugs at no added cost through TRS-Care Standard. We encourage you to ask your doctor about switching to a generic. Check our prescription drug list (formulary) to see if your plan covers your medication at no added cost:

1. Go to TRS-Care Standard by Express Scripts.
2. Select Explore your Plan.
3. Select the PDF links to download the latest versions of:

• TRS-Care Standard Prescription Drug Benefits Overview
• TRS-Care Standard Preferred Drug List
• TRS-Care Standard Preventive Drug List

If you get your medications from the Evernorth Mail Order Pharmacy, you can split the payments for a 90-day supply into three payments over three months. Call Evernorth at 1-855-778-1459 for more information.

A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. It is also called a drug list.

Participants enjoy:

• No convenience fees on maintenance medications with less than a 90-day supply
• No high out-of-pocket costs due to elimination of the “donut hole.” Instead, enjoy predictable, flat copays.
• Lower copays

Find more information at TRS-Care Medicare Rx by Express Scripts.

No. Your prescription drug plan is part of your TRS-Care Medicare Advantage Plan. You don’t need to pay an additional TRS-Care premium for prescription drug coverage.

If you enroll in TRS-Care Medicare Rx, you must also enroll in TRS-Care Medicare Advantage (medical plan). No other Medicare medical plans are allowed.

Likewise, if you opt out of TRS-Care Medicare Rx but keep TRS-Care Medicare Advantage, your premium will not decrease, and you cannot join an individual Medicare prescription drug plan.

CMS rules prohibit mixing group and individual Medicare Advantage or Part D plans. If you try to enroll in an individual plan, you will lose all TRS-Care coverage.

View your drug formulary and search your medication cost at TRS-Care Medicare Rx by Express Scripts. Use the explore your plan and price medication tool "Check Drug Costs." You can also call Evernorth at 1-844-863-5324 to confirm your medication cost.

No. TRS-Care Medicare Rx does not have a deductible.

Call Evernorth at 1-844-863-5324 or visit TRS-Care Medicare Rx by Express Scripts and select View Order Status.

Your prescriptions will automatically transfer to your TRS-Care Medicare Rx plan. Any prior authorizations you currently have under your TRS-Care Standard plan will not transfer to your TRS-Care Medicare Rx plan when you turn 65. You need to reapply for your prior authorization(s) when you enroll in TRS-Care Medicare Rx.

Call Evernorth at 1-844-863-5324 to request prior authorization.

It depends on when your current PA expires. Some PAs run calendar year to calendar year, while others are based on plan year and/or date of approval. 

When your PA expires, you need a new one. Call Evernorth at 1-844-863-5324, to request your prior authorization status and renewal.

Yes. Select Go Paperless when you sign in to your personal TRS-Care Medicare Rx online account with Evernorth.

No. Starting January 1, 2026, CVS is out of network for TRS-Care Medicare Rx. TRS-Care Medicare Rx participants can access a broad network of pharmacies, including all the large pharmacy chains (Walgreens, Walmart, Target, HEB, Kroger and others). You must use a network pharmacy to get full benefit coverage on your prescriptions.

Yes. Medications not on the formulary are "nonformulary drugs." If you learn that TRS-Care Medicare Rx does not cover your drug, Evernorth can help you find a generic or lower cost equivalent.

Generic drugs are listed as Tier 1 in the formulary. Preferred brand drugs are Tier 2. No-preferred drugs, or brand name drugs, are Tier 3 and Specialty medications are Tier 4. Visit the TRS Formulary (drug list) at TRS-Care Medicare Rx by Express Scripts or call Evernorth at 1-844-863-5324.