The Texas Retired Teachers Association’s (TRTA) Executive Director Tim Lee continued his video series this week with a conversation about TRS-Care, the state-run health insurance program for retired educators. Lee held the video call with Katrina Daniel, who has been the Chief Health Care Officer for the Teacher Retirement System of Texas (TRS) for five years.

Daniel’s responsibilities include overseeing the implementation of TRS-Care as well as working with providers to ensure the best possible benefits for retirees.

TRS is the largest purchaser of health care in Texas except for Medicaid. Daniel said during the interview that TRS’s goal with TRS-Care is to “get the most value to our members.” She said that she defined value as the combination of “quality and cost,” and that she tries to help members by “extract(ing) every bit of value out of every dollar that we spend.”

TRS-Care is the changing providers for both the pre-65 retiree plan, TRS-Care Standard, and the plan for over-65 retirees, TRS-Care Medicare Advantage. TRS-Care Standard is switching to BlueCross BlueShield. TRS-Care Medicare Advantage is switching to United Healthcare. The change to the new vendors for retirees takes place on Jan. 1, 2021!

The TRS-Care MA plan is specially designed to help retirees. Unlike HMO health care plans, TRS-Care MA is structured as a PPO plan, which makes its in-network and out-of-network benefits the same. “You can go to any doctor, any hospital that takes Medicare, and you can be seen,” Daniel said.

When deciding to switch to United Healthcare, TRS closely examined the providers that were offered, and Daniel said they found a “very broad overlap” between United’s providers and what’s currently provided.

Daniel presented a useful graphic during the conversation that describes the benefits that TRS-Care MA participants receive. The document is located here.

A common question that retirees have whenever TRS-Care switches providers is how to explain to their doctor that TRS-Care Medicare Advantage plan is a group plan and operates differently than plans in the “individual market.”

When asked about a specific example that many TRS retirees are concerned with, that being UHC and Houston Methodist, Katrina said that members will be able to go to Houston Methodist and see their medical providers.

The real issue is helping medical providers in any medical system understand that TRS-Care is a group and operates different than individual market Medicare Advantage plans.

Daniel said the process to resolve this scenario will be very similar with United Healthcare as it has been with Humana and Aetna in past years. She said there will be a flyer on trs.texas.gov for retirees to take to their doctor’s office, and the doctor’s office can also call United or TRS.

TRS has developed a number of programs to help inform retirees about the transition to the new providers. A popular program has been the in-person seminars during the fall. However, due to the pandemic, these in-person seminars are up in the air. Daniel said that the seminars will occur in the fall, even if they have to happen in a virtual environment. In the past, TRS has done webinars in addition to the seminars.

Additionally, Daniel said that the SilverSneakers brand will continue providing gym benefits with the new plan. She said that Go365, which is a Humana brand, won’t be a part of the United Healthcare structure, but there will be a similar program called Rally Health. TRS will have more information about Rally Health as the transition approaches.

If you’d like to learn more about the transition to the new providers, please visit TRS’s health care site.