Experience with Texas Teacher Retirement Medicare Plan

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lucastx
Posts: 13
Joined: Tue Mar 21, 2023 6:04 am

Experience with Texas Teacher Retirement Medicare Plan

Post by lucastx »

My Spouse is retired and has Texas Teacher Retirement System (TRS) pension. Currently has the TRS care insurance. Several years ago, they completely upended their health insurance benefits, put the younger people on a high deductible and the Medicare eligible ones on a Medicare Advantage plan.

65th birthday is next year so we are trying to figure out whether he gets on that MA plan or not.

Because it is a group issued plan, it appears to avoid some of the issues with MA plans in general, however one is still at the mercy of them making changes any time they feel like it, as they did a few year ago.

He takes an expensive biologic drug (several thousand dollars/month), so drug coverage is as important as medical care.

Pros of this plan are:
  • Group plan - lots of retired teachers from Texas, you hope that someone out there is looking out for that group as a whole and that "retiree health benefits" are better than what's on the open market
  • Does not require pre-authorization
  • Allows you to see any Medicare accepting doctor
  • Includes drug coverage that somehow "skips the donut hole"
  • $135/month for the retiree (spouse is another $400ish, so not really interested in that)
Cons of the MA Plan
  • They can't tell me what his drug cost would be on the plan. When I call TRS, they refer me to the prescription provider, when I call the prescription advisor, they tell me other plans have a way for them to login as a fake patient and get the costs but TRS doesn't provide that function, so I should call TRS. That part has been super frustrating.
  • It's an MA plan and subject to change at any time. Because TRS retirees don't get COLAs, I guess they try to manage the health care with no annual increase which is nice until one day they wake up and say, oh wait, we're spending way too much money on this, so let's rip out all the coverage and start over. Seems like small annual increases would have been a better plan, but that's not the way they handled it and they have not had an increase yet since the last rip and replace. Fear of the unknown is a factor here.
This decision we have to make next year is going to be a permanent one, he would not pass any underwriting if he ever wanted to move to a Medigap plan, and you must pick their MA plan when you reach Medicare age, or you are permanently out of TRS health care, no coming back at a later date.

I understand no one on here can predict the future but I'm hoping maybe someone here has the current TRS Medicare Advantage plan and could provide some feedback on your experience. Have you had to fight them to get any Medicare approved coverage like happens sometimes in other MA plans? (Hopefully, no pre-auth stops that from being an issue) How has the drug coverage been? and so forth.

All feedback appreciated.
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