Contacts and next steps

The calls, in order

1. Amwins — (877) 422-4170 · Mon–Fri, 7am–7pm CST
   The Valero retiree benefits administrator. The most important call, because Option 2 is the realistic path.
   • What do the United American supplement plans cost — Basic, Enhanced, and Premium?
   • Is medical underwriting required to move from the MA plan to a supplement plan? This is the pivotal question.
   • Send the Express Scripts formulary — check every current medication against it before deciding anything.
   • Does the Valero subsidy apply to the supplement plans, or only to the MA plan?
   • Is there any plan to terminate or restructure the retiree plan? (A termination would likely trigger guaranteed-issue rights.)
   • If one of us leaves and the other stays, does that affect the other's eligibility?
   • If we drop Valero coverage entirely, can we ever re-enroll? Get the answer in writing.
   • Send the 2026 Evidence of Coverage and the current prior authorization list.
   • Confirm the 2026 out-of-pocket maximum, premium, and Valero contribution.
2. Texas HICAP — 1-800-252-9240
   The state's free Medicare counseling program. No commissions, nothing to sell, and counselors will actually sit with you and file appeals.
   • Ask for hands-on help filing the current appeals. Lead with this — it's the most valuable thing they do and almost nobody asks.
   • Map exactly which Medigap underwriting questions block us today, and when each one clears.
   • Does voluntarily leaving an employer group MA plan create a guaranteed issue right in Texas? (Probably not — get it confirmed.)
   • Which Texas carriers, if any, honor loss of employer group MA coverage as guaranteed issue as a matter of business practice?
   • Confirm each of our Part B start dates.
   • Ask them to compare total annual cost, not premiums alone.
3. The auto insurer — check the declarations page
   See The car crash. Confirm whether PIP and MedPay are on the policy and at what limits. If PIP exists, file the claim immediately — proof-of-loss deadlines can be as short as six months, and it can fund rehab the plan is denying.
4. The prescribing offices — four specific asks
   • Ask the osteoporosis prescriber to check the diagnosis code on denied claims, and to file Tymlos as an on-label prior authorization rather than an exception request.
   • Ask the ophthalmologist which diagnosis code was on the denied eye drop claims — dry eye versus neurotrophic keratitis changes which policy applies — and whether Part B alternatives like amniotic membrane or scleral lenses are appropriate.
   • Ask the physical therapist to document the maintenance-therapy standard language rather than framing notes around improvement.
   • For every office: get the name of the person who handles prior authorizations, and work with that person directly from now on.
5. File complaints in parallel — 1-800-633-4227 or medicare.gov/my/medicare-complaint
   Logged against the plan's contract record; feeds Star Ratings and CMS audits. Note that the Texas Department of Insurance does not regulate Medicare Advantage, so a state complaint accomplishes nothing here. A complaint never gets care covered — only an appeal does. File both.

Everyone worth having in the phone

Worksheet — map the denials

Filling this in before the calls is worth an hour. The pattern that emerges points to the right option far better than any general comparison, and it's exactly what a HICAP counselor will ask for first.

The 2026 numbers

Enrollment windows