The Teacher Retirement System Board of Trustees adopted TRS-Care plan changes and new premium rates resulting from the $212 million in increased funding approved by the legislature during the recent special session. TCTA testified to ask TRS to continue working on permanent and more beneficial solutions to the ongoing problems that TRS-Care and retirees are facing.

As expected, the board approved the following final premium rates and plan specifications:

Pre-65/non-Medicare-eligible retirees

MAJOR BENEFITS FOR HIGH DEDUCTIBLE HEALTH PLAN

Benefits 2018 Plan Year
In-Network

Individual Deductible

$1,500

Family Deductible

$3,000

Individual Out-of-Pocket Maximum

$5,650

Family Out-of-Pocket Maximum

$11,300

Coinsurance

80% / 20%

Out-of-Network

Individual Deductible

$3,000

Family Deductible

$6,000

Individual Out-of-Pocket Maximum

$11,300

Family Out-of-Pocket Maximum

$22,600

Coinsurance

60% / 40%

Retail Pharmacy 80% / 20%
Retail Pharmacy Maintenance Drugs 80% / 20%
($0 copay for certain generic preventive maintenance medications)
Mail Order / Retail 90 Pharmacy

MONTHLY PREMIUM RATES

Coverage Tier Non-Medicare
Retiree Premiums
Non-Medicare
Disability Retiree Premiums*
Non-Medicare Retiree with Disabled Child(ren) Premiums**
Retiree Only $200 $0 N/A
Surviving Spouse Only $200 N/A N/A
Retiree and Spouse $689 $489 N/A
Retiree and Child(ren) $408 $208 $208
Surviving Spouse and Child(ren) $408 N/A $208
Retiree and Family $999 $799 $799
Surviving Child(ren) $208 N/A $8

* No monthly premium is due for a retiree himself or herself who has taken a disability retirement under the TRS pension on or before Jan. 1, 2017, is receiving disability retirement benefits from the TRS pension, and is not eligible to enroll in Medicare.

** To qualify for this premium, the retiree or surviving spouse must have an enrolled child with a mental disability or a physical incapacity, as determined by TRS.

Medicare-eligible retirees 

NEW MEDICARE ADVANTAGE PLAN

Benefits 2018 Plan Year
Individual Deductible $500
Individual Out-of-Pocket Maximum $3,500
Coinsurance 95% / 5%
In Patient Hospital Copay per Stay $500
Out Patient Hospital Copay per Stay $250
ER Copay $65
Urgent Care Copay $35
Primary Care Physician Office Visit Copay $5
Specialist Office Visit Copay $10
Preventive Services Copay $0

NEW MEDICARE PRESCRIPTION DRUG PLAN

Benefits 2018 Plan Year
Retail Pharmacy Copay
Generic $5
Preferred Brand $25
Non-Preferred Brand $50
Specialty $50
Mail Order Pharmacy Copay
Generic $15
Preferred Brand $70
Non-Preferred Brand $125
Specialty $125

PREMIUM RATES

Coverage Tier Medicare Retiree Premiums

Medicare Retiree
with Disabled
Child(ren) Premiums*

Retiree / Surviving Spouse Only $135 N/A
Retiree and Spouse $529 N/A
Retiree / Surviving Spouse and Child(ren) $468 $268
Retiree and Family $1,020 $820
Surviving Child(ren) $208 $8

* To qualify for this premium, the retiree or surviving spouse must have an enrolled child with a mental disability or a physical incapacity, as determined by TRS.

Alternative plan

The board also approved an alternative plan for Medicare-eligible retirees in certain hardship situations, such as those with inadequate access to providers who will accept a Medicare Advantage plan, and those for whom Medicare Part B coverage would be cost prohibitive. The criteria for determining who will be eligible for the alternative plan will be finalized by the board in rules later this fall.

TRS staff to conduct TRS-Care information sessions for retirees

TRS is planning a series of information sessions to help retirees understand and make decisions regarding their TRS-Care coverage before the new plan is implemented in January 2018. Nearly 90 sessions are planned across the state beginning Oct. 9 and running through Nov. 2, with online webinars held during the week of Nov. 6 for those who are not able to attend a session in person.

When times, dates and locations are finalized, TCTA will publicize those details.