If you are a Texas teacher, you are likely familiar with TRS-Care, the self-funded program established in 1985. TRS stands for the Teacher Retirement System. TRS-Care works with the Medicare program to provide healthcare benefits to retired Texas teachers. Funding for the program was only set to last for about 15 years, and there was no program in place to replace TRS-Care or offer additional funding. For this reason, TRS-Care has quickly become unaffordable for most beneficiaries.
Benefits Provided by TRS-Care
TRS-Care offered coverage to retired Texas teachers and their dependents – that’s one huge difference between it and Medicare. (You must be 65 or older to join Medicare, and each type of coverage only applies to one individual.) The option to add a dependent is a great benefit for retirees whose spouse may not yet be 65 but relies on them for insurance coverage.
TRS-Care started with several different plan options but is now down to just one, a Medicare Advantage PPO plan run by UnitedHealthcare. Medicare Advantage plans are known for low monthly premiums, but that is certainly not the case for TRS-Care. A subscriber and their spouse can expect to pay around $530 each month. If you have dependents and need a family plan, you’re looking at a premium of over $1000.
The TRS-Care plan has a $500 deductible and requires its members to see in-network providers for the most coverage.
For these reasons, and because we know that premiums will continue to increase, many retired Texas teachers are choosing to enroll in Medicare plans instead of TRS-Care.
Medicare Options Outside of TRS-Care
Individuals who elect to enroll in Medicare instead of TRS-Care will need to pay the Part B premium, assuming they have qualified for premium-free Part A. In 2022, the standard Part B premium is $170.10. After they enroll in Medicare Parts A and B, they have two options: Medigap or Medicare Advantage.
Let’s review the Medigap option first. Medigap Plan G has the most comprehensive benefits available to newly eligible Medicare beneficiaries. In Texas, the premium for Plan G runs about $110. (The premiums increase with age.) With the Part B and Plan G premiums, your total monthly cost is about $280. If you have Plan G, the only cost you will have outside of the premiums is the Part B deductible, which is $233 in 2022. After that deductible has been met, you have $0 out-of-pocket expenses. Plus, Medigap Plan G is accepted all over the United States. There are no networks, so as long as your provider accepts Medicare, they will accept Plan G.
Another option for Medicare beneficiaries is Medicare Advantage, similar to what TRS-Care offers. However, individuals will have more than just one plan to choose from and will often find a much lower premium than what we’ve seen in TRS-Care. You will, however, still be limited to a network of providers. It’s hard to say what your premiums and coinsurance expenses will be with a Medicare Advantage plan since there are so many to choose from. Generally speaking, your premiums will be lower than a Medigap plan, but your coverage will not be as comprehensive.
In addition to one of these two types of coverage, you’ll also need a Part D prescription drug plan. A Part D plan won’t add much to your total monthly premiums. If you are relatively healthy and don’t take many prescriptions, you may pay around $15 each month for prescription drug coverage.
Find Help Making Medicare Decisions
If you choose to pursue Medicare instead of TRS-Care, we’re here to help. While we have given you a little information here, there is quite a bit to dissect when it comes to your healthcare. One of our lichened Medicare advisors can help you weigh the pros and cons of each avenue so that you can make the best decision.