Medicare Advantage For Retired Teachers In Texas
Texas has worked closely with the TRS (Teacher Retirement System) to provide healthcare for retired teachers and their dependents for many decades. Which has led educators to believe that TRS may be their only option as a healthcare plan, but that is the furthest from the truth. We will do an overview on TRS and explore other options such as the Medicare supplement plan and the Medicare Advantage Plan.
WHAT DOES TRS COVER?
TRS has 100% coverage for the recipient minus co-pays and monthly premiums for retirees starting from $135 to $1020 (if on a family plan). It sounds like a good deal, but co-pays and monthly premiums play a role in why many retirees have been opting out of their TRS-Care Medicare Advantage plan.
HOW MUCH DOES IT COST?
This plan is the most expensive retirement plan in the state of Texas. The premium for being enrolled in Medicare is $170.10 in the year 2022, and on top of the initial premium cost previously mentioned, you have to pay a TRS-Care premium as well. The prices for the monthly premium vary on who will be covered. Such as a retiree alone will pay $135 a month, resulting in paying approximately $1,800 a year without including co-pays and deductibles that may be utilized during the year. In comparison, that price is not including if the retiree has a spouse and family who wishes to be covered as well, which can result in paying over $12,300 yearly without including co-pays and deductibles that may have been utilized throughout that year.
WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF TRS-CARE MEDICARE ADVANTAGE PLAN?
An advantage that TRS Medicare Advantage offers, as previously stated, is the recipient will be 100% covered minus the co-pays. Deductibles do not apply for sick visits (co-pay $5), urgent care visits (co-pay $35), and emergency room visits(co-pay $65).
A disadvantage of this health plan is that a deductible applies for specialist visits (co-pay $10), inpatient hospital stays (co-pay $500), and outpatient hospital stays (co-pay $250). How much is the deductible for TRS? The deductible is $500, and what does that mean for the services that require the deductible to be met in order to pay a small co-pay? It means that you first have to pay the $500 deductible then pay the co-pay for the service you utilized, which includes specialist visits and in/outpatient hospital stays.
WHAT OTHER OPTIONS DO TRS-CARE MEDICARE ADVANTAGE MEMBERS HAVE?
Since TRS is very pricy many individuals have opted out of it and explored other Medicare plans that are best suited for them. There are many options a person could have, but there are two that will be focused on in this article, such as the Medicare supplement plan or the Medicare Advantage Plan.
WHY SWITCH TO A MEDICARE SUPPLEMENT PLAN?
Medigap is best suited for people who want a stress-free health insurance. You won’t need to worry about any co-pays, unexpected costs, high deductibles, and networks. You can see any Physician in the nation who takes Medicare and the best part is that if there was a medical emergency in another country, you will be covered.
HOW MUCH DOES IT COST?
Medigap is not free, and it will cost between $90- $180, depending on your age and gender. Assuming you are a 65-year-old female, it will cost approximately $90. In comparison, a 65-year-old male will cost roughly $110. A requirement for this plan is purchasing a prescription drug plan in Medicare which covers medications. That will cost you anywhere from $20-$60. Assuming you already have Medicare parts A and B, Medigap will cover the remaining 20% of coverage of those two parts, leaving you at 100% coverage. Joining a Medigap plan will automatically cover part B co-insurance, leave out part A deductibles but will leave you paying for Part B deductible costing $233. In the scenario of a recipient of this health plan has cancer and needs to go to a hospital such as MD Anderson cancer center in Houston, Texas, they can. Whereas if you were still enrolled in TRS, it is not guaranteed you could do the same. The recipient will pay roughly $270 a month total if enrolled.
WHY SWITCH TO A MEDICARE ADVANTAGE PLAN?
There are many advantages to enrolling in this type of Medicare health plan, including the extra benefits recipients have. Such as dental, vision, transportation, over-the-counter RX, free gym membership, and with most plans have already included a prescription drug coverage.
HOW DOES THE MEDICARE ADVANTAGE WORK?
To get into a Medicare Advantage plan, your part B premium cost of $170.10 will go into the advantage plan of your choice. This tells the insurance company that you want them to cover 100% of your insurance, but it will not cover any co-pays. The advantage plan falls under two types of plan, which are known as HMO or PPO.
WHAT IS THE DIFFERENCE BETWEEN THE TWO?
HMO and PPO are the complete opposite of each other.
HMO needs you to have a Primary Care Physician (PCP) and a referral to see any specialists. While under this type of plan, you can’t see a doctor outside of the network and they have a limited network which is mostly regional. The benefit of this is that they have a lower cost and more benefits than a PPO.
In contrast, a PPO does not require a PCP nor a referral. You may see a doctor outside of the network, and their network providers is bigger than an HMO network. Lastly, it has fewer benefits and is more costly than an HMO. But you have more freedom than an HMO plan.
HOW TO UNENROLL FROM TRS-CARE MEDICARE ADVANTAGE & WHAT YOU NEED TO KNOW?
First and foremost, you would have to call the number 1-888-237-6762 to disenroll. Once you have contacted TRS, you will be receiving a 700B form in the mail. After receiving this, you would have to sign and notarize the form. The cancellation will be in effect the 1st day of the month after TRS receives your form back. You can opt out at any time during the year, but once you do, you cant re-enroll unless you meet special circumstances. Such as adoption, marriage, special enrollment event, or the involuntary loss of coverage.
ANYTHING POSITIVE ABOUT TRS MEDICARE?
Yes. You do not have a donut hole if you are on the plan. This only applies for people who are taking a lot of medications or who take expensive medications. If this does not apply to you…then I would suggest to shop around.
WANT TO KNOW MY HONEST OPINION ABOUT TRS MEDICARE?
TRS-Care – Retired Teachers with Medicare. This plan is the most expensive Medicare Advantage plan in the state of Texas.
Right now, the monthly premium is $135 a month with a $500 deductible. Fees this high can put a dent on all retired teachers wallets with fixed income. Because TRS members have had TRS insurance for most of their lives, they are not aware of other available options. For example, most HMOs have $0 premiums and PPOs are available in almost every area of the state with $0 or small monthly premiums. Even Medigap plans could be less expensive with more advantages than those offered by TRS- Care.
Many TRS recipients are afraid that once they leave TRS they will never be allowed to go back, but we have helped hundreds of TRS members switch from TRS into an independent plan and not one of them has ever asked to return to TRS.
“The TRS system is broken and it is continuing to get worse.”
I recommend you to look for other plans available in your county and compare the benefits. You can even give me a call and I will help you find a much better plan than TRS. If you are a TRS retiree, you owe it to yourself, your family, and your financial future to learn all your options as soon as possible.
Need an Overview of what TRS Medicare Covers?
The video below will cover the basics of TRS Medicare.
Want Further Proof?
You can visit the TRS site to further investigate what TRS has to offer. Then you can meet with an agent (or me!) to see what plans are being offered in your area.
You can also quickly download the 2021 TRS-Care Medicare Advantage Plan.
WHAT INSURANCE IS BEST FOR YOU?
The best insurance for you is dependent on your needs. Some insurance plans are better than others for you, but how do you find out what’s your best option? I am here to guide you and help you find out what works best for you! You can book an appointment or call me and text me for further information at (956-455-1313).