TRS-Care and Medicare for Texas Retired School Employees

What Happens to TRS-Care When You Turn 65?

For most TRS retirees, becoming eligible for Medicare changes the type of TRS-Care coverage available to you.

TRS-Care Standard generally covers retirees who are not yet eligible for Medicare. Once a TRS-Care retiree becomes Medicare-eligible, the Medicare-based TRS-Care option is generally TRS-Care Medicare Advantage, along with TRS-Care Medicare Rx prescription drug coverage.

This means turning 65 isn’t simply a matter of getting a Medicare card. You need to understand how Medicare enrollment affects your TRS-Care benefits and what steps must be completed before your Medicare coverage begins.

Medicare Part B Is Required for TRS-Care

Your Medicare Part B premium is separate from your TRS-Care premium. You pay the Part B premium through Medicare, usually through your Social Security benefit or directly to Medicare if it is not deducted from a federal benefit.

The amount you pay for Medicare Part B can also be higher for people whose income exceeds Medicare’s income-related premium thresholds.

Do TRS Retirees Have to Enroll in Medicare Part A?

If you qualify for premium-free Medicare Part A, TRS generally requires you to enroll in it when you become Medicare-eligible.

Some retired Texas school employees do not qualify for premium-free Medicare Part A because they did not pay Medicare taxes for enough of their working career.

If you do not qualify for premium-free Part A, TRS does not require you to purchase Part A. Medicare Part B, however, is required for Medicare-eligible TRS-Care participants.

What Is TRS-Care Medicare Advantage?

TRS-Care Medicare Advantage is a Medicare Advantage plan designed specifically for eligible participants in the Teacher Retirement System of Texas retiree health program.

It is not the same as simply selecting an individual Medicare Advantage plan from the general Medicare market.

Medicare Part A and Part B provide the Medicare foundation, while TRS-Care Medicare Advantage provides your medical benefits through the TRS retiree program.

TRS-Care Medicare Rx provides prescription drug coverage for eligible Medicare participants and is bundled with the TRS-Care Medicare Advantage coverage.

TRS-Care Medicare Advantage Premiums for 2027

TRS has announced lower Medicare Advantage premiums for the 2027 plan year beginning January 1, 2027.

For a retiree-only participant, that means the TRS-Care Medicare Advantage premium decreases from $75 per month in 2026 to $50 per month beginning January 1, 2027.

Remember that this TRS-Care premium is separate from your Medicare Part B premium.

TRS-Care Premium vs. Medicare Part B Premium

One of the most common sources of confusion for Texas school retirees is that there are two separate premiums involved.

Your TRS-Care premium pays for participation in the TRS-Care Medicare program.

Your Medicare Part B premium is paid separately to Medicare.

For example, a retiree enrolled in retiree-only TRS-Care Medicare Advantage in 2027 would pay the $50 TRS-Care monthly premium in addition to whatever Medicare Part B premium applies to that individual.

Does TRS-Care Include Prescription Drug Coverage?

Yes. Medicare-eligible TRS-Care participants are generally enrolled in TRS-Care Medicare Rx along with TRS-Care Medicare Advantage.

TRS-Care Medicare Rx is the prescription drug component of the program. Its cost is included as part of the TRS-Care Medicare Advantage premium rather than requiring a separate standard prescription plan premium from TRS.

Higher-income Medicare beneficiaries may still be subject to Medicare’s income-related prescription drug adjustment.

What If My Spouse Isn’t 65 Yet?

Married couples don’t necessarily move into Medicare at the same time.

If the TRS retiree becomes Medicare-eligible before a covered spouse, the retiree can transition to the Medicare-based TRS-Care coverage while the younger, non-Medicare-eligible spouse remains in the appropriate TRS-Care coverage for non-Medicare participants.

The premium is determined by the applicable TRS-Care coverage tier, so couples should review both the medical coverage and the premium before the retiree’s Medicare effective date.

When Should a TRS Retiree Start the Medicare Process?

Don’t wait until the month you turn 65.

TRS recommends beginning the Medicare enrollment process approximately 90 days before your 65th birthday.

If you’re already over 65 and still working, begin planning well before your retirement date so that Medicare and your retiree health coverage can begin at the appropriate time.

You may need your Medicare Beneficiary Identifier (MBI), Medicare enrollment information, and TRS-Care enrollment documentation before your transition can be completed.

I’m Still Working at 65. Do I Have to Start Medicare?

Not every person turning 65 has the same Medicare enrollment situation.

If you’re still actively employed and covered by an employer group health plan, Medicare enrollment rules can depend on the type of employer coverage you have.

Retiring after age 65 can also create a Special Enrollment Period for Medicare Part B when the requirements are met.

This is an area where it’s important to evaluate your individual situation rather than assuming the Medicare rules that applied to a coworker automatically apply to you.

Do You Have to Stay With TRS-Care After 65?

Medicare-eligible Texas school retirees may want to compare TRS-Care with other Medicare coverage available to them.

Depending on your situation, other Medicare arrangements might include Original Medicare with Medicare Supplement insurance and prescription drug coverage, or an individual Medicare Advantage plan available in your county.

But comparing premiums alone is not enough.

Consider your doctors, hospitals, prescriptions, expected healthcare use, travel, maximum out-of-pocket exposure, provider access, and the rules governing your ability to return to TRS-Care later.

TRS-Care Medicare Advantage vs. Medicare Supplement

This is one of the most common comparisons we discuss with retired Texas educators.

TRS-Care Medicare Advantage and Original Medicare with a Medicare Supplement are fundamentally different ways of receiving Medicare coverage.

TRS-Care Medicare Advantage

• Designed specifically for eligible TRS-Care participants
• Requires Medicare Part B
• Includes TRS-Care Medicare Rx prescription coverage
• Has its own deductibles, copays and maximum out-of-pocket rules
• 2027 retiree-only TRS-Care premium is $50 per month

Original Medicare + Medicare Supplement

• Uses Original Medicare as the primary coverage
• Medicare Supplement insurance helps pay certain Medicare cost sharing
• A separate Medicare Part D plan is generally needed for prescriptions
• Medigap premiums vary by company, plan, age and location
• Medical provider access follows Original Medicare rules rather than a Medicare Advantage network

Neither approach is automatically right for everyone. The better choice depends on your healthcare needs, budget, doctors, prescriptions and personal priorities.

Can I Get a Medicare Supplement After Leaving TRS-Care?

Medicare Supplement enrollment rules deserve particular attention before leaving TRS-Care.

Having Medicare does not necessarily guarantee that you can purchase any Medicare Supplement plan at any future time without medical underwriting.

Certain federal or state protections may provide guaranteed-issue rights in specific circumstances, but those protections depend on the facts of the situation.

Before leaving TRS-Care for Medicare Supplement coverage, determine whether you qualify for the coverage you want and understand its enrollment requirements.

TRS Retirees Who Don’t Qualify for Premium-Free Medicare Part A

Texas public school employees can have a Medicare situation that differs from many private-sector retirees.

Some educators worked for school districts that did not participate in Social Security or did not accumulate enough Medicare-covered employment to qualify for premium-free Medicare Part A on their own work record.

Eligibility can sometimes also be based on a spouse’s work record.

If you don’t qualify for premium-free Part A, don’t assume that means you can simply skip Medicare altogether. Medicare Part B remains particularly important because Medicare-eligible TRS-Care participants must maintain Part B to keep TRS-Care.

Questions to Ask Before Making a TRS-Care Medicare Decision

• When should I enroll in Medicare Part A and Part B?
• Do I qualify for premium-free Medicare Part A?
• What will my Medicare Part B premium be?
• What will my TRS-Care premium be?
• How are my prescriptions covered?
• Are my doctors and preferred hospitals accessible under the coverage?
• What is my maximum potential out-of-pocket cost?
• How will my spouse’s coverage be affected?
• What happens if I leave TRS-Care?
• Would I be able to return to TRS-Care later?
• If considering Medigap, do I have guaranteed-issue rights or could underwriting apply?

Local Medicare Help for Texas School Retirees

Medicare decisions for TRS retirees can be more complicated than a typical turning-65 Medicare situation because TRS-Care, Medicare eligibility, retirement timing, spouse coverage, and future enrollment rights can all interact.

MediWhat.Info helps Texas retirees understand those moving pieces in plain language.

We can help you understand Medicare, compare the options available to you, and identify the questions you should answer before changing your coverage.