As a result of legislation passed in July 2017 by the 85th Texas Legislature, beginning Jan. 1, 2018, TRS-Care will offer a single TRS-Care Medicare Advantage plan. The plan will be available to Medicare-eligible retirees and their Medicare-eligible dependents, and is similar to the current TRS-Care Medicare Advantage 2 plan.
Participants with Medicare will still have access to a Medicare prescription drug plan — an option similar to the current level 2 Medicare prescription drug plan through TRS-Care. In addition, beginning Jan. 1, 2018, SilverScript, an affiliate of CVS Caremark will begin administering the prescription drug plan. What’s not changing is your access to a broad choice of quality doctors across the state. Unlike many Medicare Advantage plans, TRS-Care Medicare Advantage allows you to go to any doctor you choose, as long as they accept Medicare and agree to bill Humana.
The TRS’ Board of Trustees also passed a motion in September to apply additional funding from the special legislative session to reduce deductibles from $3,000 to $1,500 for TRS-Care non-Medicare participants and decrease premiums for TRS-Care Medicare-eligible participants. In addition, premiums for retirees with disabled children were reduced by $200.
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
- Primary care physician visit: $5*
- Specialist visit: $10*
- Urgent care: $35
- Emergency room: $65
- Outpatient hospital stay: $250*
- 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.