The Teacher Retirement System of Texas (TRS) Board has approved revised TRS-Care rates and benefits with increased funding as a result of actions by the Texas Legislature in the recent Special Session.

The best information is on the TRS website at these links:

https://www.trs.texas.gov/TRS%20Documents/trscare_changes_retiree_flyer.pdf

https://www.trs.texas.gov/Pages/healthcare_news_update_nonmedicare_eligible.aspx

https://www.trs.texas.gov/Pages/healthcare_trs_care_medicare.aspx

Below is a brief summary of the new rates and benefits from the TRS-Care website.

 

Non-Medicare Retirees (Under Age 65):

Plan details In-network Out-of-network
Deductible for medical and prescription expenses $1,500 individual
$3,000 family
$3,000 individual
$6,000 family
Maximum out-of-pocket for medical and prescription expenses $5,650 individual
$11,300 family
$11,300 individual
$22,600 family
Coinsurance for medical and prescription expenses You pay 20% after meeting your deductible You pay 40% after meeting your deductible
Teladoc ​– Board-certified doctors diagnose, treat and write prescriptions via phone or video, available 24/7 $40 consultation
Coverage for certain generic drugs No cost for certain maintenance medications taken to prevent or treat chronic conditions. The list is available on the CVS Caremark website.

 

Monthly premiums for non-Medicare retirees in 2018
Retiree/Surviving Spouse Only: $200*
Retiree + Spouse: $689
Retiree/Surviving Spouse + Child(ren): $408**
Retiree + Family: $999

*TRS-Care will no longer offer a $0 premium health plan option for retiree-only coverage. Retirees will pay $200 for retiree-only coverage beginning Jan. 1, 2018.

**Retirees without Medicare who cover disabled children will have their monthly premiums reduced by $200. Their monthly premium for the Non-Medicare Retiree + Children tier will be $208. For the Non-Medicare Retiree + Family tier, their monthly premium will be $799.

 

Medicare Retirees (Age 65 and Over):

  TRS-Care Medicare Advantage Plan
How the 2018 TRS-Care Medicare Advantage plan works
Deductible: $500 Maximum out-of-pocket: $3,500 Coinsurance: You pay 5% or a copay after meeting your deductible
Copays:
Primary care physician visit: $5* Urgent care: $35 Outpatient hospital stay: $250*
Specialist visit: $10* Emergency room: $65 Inpatient hospital stay: $500*
Preventive care benefits are still covered at 100%.

*After you meet the deductible.

In most cases, you must also purchase and maintain Medicare Part B in order to have benefits through TRS-Care.

Prescription drug plan details
  Retail copays Mail order or Retail-Plus copays (up to 90-day supply)
Generic $5 $15
Preferred brand $25 $70
Non-preferred brand $50 $125

 

Monthly premiums for Medicare retirees in 2018
Retiree/Surviving Spouse Only: $135
Retiree + Spouse: $529
Retiree/Surviving Spouse + Child(ren): $468**
Retiree + Family: $1,020**

**Medicare retirees with disabled children will have their monthly premiums reduced by $200. Their monthly premium for the Medicare Retiree + Children tier will be $268. For the Medicare Retiree + Family tier, their monthly premium will be $820.

 

TCG’s assessment is that the TRS Medicare Advantage Plan provides excellent benefits, as is the drug coverage.

 

The biggest issue with the Advantage plan is that some medical providers are reluctant to accept these plans.  They often have to be in a network for each Advantage plan.  The TRS plan does not have a network.  According to TRS, their Advantage plan should be accepted by any provider that accepts Medicare.  According to retired TRS members with whom we have spoken, it may take some pushing of your provider to accept the plan and you may have to call TRS-Care for assistance.  But in the end, most providers will accept the plan when they understand how the TRS plan works.  You have to be diligent.  You also have to start working on this very soon – before your coverage under the plan starts on January 1, 2018 (if you are not already under the Advantage plan now), so that you do not have problems with your providers then or you have time to change to a different provider before then.

The steps we suggested for getting ready for these changes in our previous publication and blog on this subject are still the same and are reprinted below.  Please review our recommendations for preparing for the new benefits and rates.  We are happy to answer questions.

 

 

 

TCG’s recommended actions for retirees under TRS-Care.

 

1. If you will be under age 65 on January 1, 2018 you will need to do the following:

  • Review your current medical expenses and determine what your estimated out of pocket costs of medical care will be under the new plan. Be sure to review the new prescription drug coverage in making this estimate.
  • Determine how much your premiums for TRS Care will increase. This should include your spouse and any family members covered.
  • Change your monthly budget for 2018 and beyond to accommodate these new costs. Be sure to project these costs to increase with inflation each year. It is wise to use an increase rate of at least 3.00%.

 

2. If you will be age 65 or older on January 1, 2018 you will need to do the following:

A. If you are currently under the TRS Medicare Advantage Plan:

  • Determine how much your premiums for TRS Care will increase. This should include your spouse and any family members covered.
  • Change your monthly budget for 2018 and beyond to accommodate these new costs. Be sure to project these costs to increase with inflation each year. It is wise to use an increase rate of at least 3.00%.

 

B. If you are currently not under the TRS Medicare Advantage Plan:

  • Review your current medical expenses and determine what your estimated out of pocket costs of medical care will be under the Medicare Advantage Plan. We have found the TRS Medicare Advantage Plan to offer excellent benefits so there may not be much of a change.  You will have to compare your current TRS Care to the Advantage Plan to make this determination.
  • If you are not currently enrolled in Medicare A and B you will have to do this. You can estimate your premiums for this, if any, by going to the Medicare website at:   https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html. A Medicare Advantage Plan requires that you be enrolled in Medicare A and B, then the Advantage Plan takes over your medical plan needs in place of traditional Medicare.
  • Contact your medical providers (e.g., doctors, pharmacy, etc.) to see if they accept Medicare. If they do not you will need to find a provider that does accept Medicare. The TRS Medicare Advantage Plan does not have a network – it should be accepted by any provider that accepts Medicare. If you have difficulty with any of your providers who do accept Medicare and do not want to accept the TRS plan, contact TRS Care for assistance.
  • Determine how much your premiums for TRS Care will increase. This should include your spouse and any family members covered.
  • Determine how much to add to your budget for the cost of Medicare A and B, if any.
  • Change your monthly budget for 2018 and beyond to accommodate these new costs. Be sure to project these costs to increase with inflation each year. It is wise to use an increase rate of at least 3.00%.

 

We at TCG would be happy to help you with these issues.  Please contact us at info@tcgservices.com or by calling (512) 306-9939. You can also go to our past blogs on this subject for more background on our website at http://tcgservices.com/2017/06/23/trs-care-update/.


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