FAQs: TRS-Care Eligibility and Enrollment

​Enrollment in the TRS-Care program is only available during specific windows of opportunity:

First and foremost, you have an initial enrollment opportunity to join the TRS-Care program upon retirement.

If you decide not to enroll in the TRS-Care program at retirement, there are only two other potential opportunities for you to enroll in the TRS-Care program:

• If you experience a special enrollment event. Generally, special enrollment events may arise from an involuntary loss of comparable coverage or upon the acquisition of a new dependent through marriage, birth, adoption, or being placed for adoption.
• If you turn 65 years of age. Visit the TRS-Care Eligibility and Enrollment​ webpage for details about special enrollment opportunities.
  

If a retiree or surviving spouse leaves TRS-Care, he or she will only have the following, limited opportunities to re-enter the program: 1) at age 65, or 2) with a special enrollment event.

In most situations, retirees and surviving spouses can’t re-enroll in TRS-Care. However, retirees and surviving spouses may re-enroll in TRS-Care when they turn 65 or if they have a special enrollment event, which are rare. There are two types or areas of special enrollment: 1) an individual becomes a new dependent; and 2) an involuntary loss of comprehensive coverage.

Aside from your initial enrollment opportunity, here are the opportunities when you can re-enroll in TRS-Care or enroll for the first time in TRS-Care:

• You have an enrollment opportunity when you turn 65

  If you’re a retiree or surviving spouse who isn’t 65 yet, and you either dropped TRS-Care or didn’t enroll during your initial enrollment opportunity, you can enroll in the program when you turn 65. You may also add dependents at that time. Prior to your 65th birthday, TRS will send retirees a postcard with instructions on how to enroll. You must submit your application for coverage no later than 31 days from the end of the month in which you turned 65 to re-enter TRS-Care.

  TRS does not always have information about surviving spouses in its records. Surviving spouses are responsible for requesting and submitting their application for coverage no later than 31 days from the end of the month in which they turned 65.

  Please note: This enrollment opportunity is not available to dependent spouses or children when they turn 65.

  You will be enrolled in both the TRS-Care Medicare Advantage medical plan and the TRS-Care Medicare Rx plan so long as you are enrolled in Medicare Part B. Your dependents will be enrolled in the appropriate plan based on their own Medicare status. If they’re eligible for Medicare, they’ll also be enrolled in the TRS-Care Medicare Advantage medical plan and the TRS-Care Medicare Rx plan. If they’re not eligible for Medicare, they’ll be enrolled in the TRS-Care Standard plan, which features a combined medical and prescription deductible. They will stay enrolled in the TRS-Care Standard plan until they become eligible for Medicare.

  You must maintain Medicare coverage, including Medicare Part B coverage, to participate in the TRS-Care Medicare Advantage plan. You risk losing all TRS-Care coverage if you do not have Medicare Part B coverage.

• If you have a special enrollment event, you can re-enter, but these are rare

  You can enroll in TRS-Care if you have a special enrollment event, which can arise in two areas.

  The first area is when there is the addition of a new dependent through:

  • Marriage
  • Birth
  • adoption, or
  • being placed for adoption.

  The second area is when there is an involuntary loss of comprehensive coverage. Comprehensive coverage may include Medicare supplements (e.g., Medigap) and individual Medicare Advantage plans.  Examples include:

  • Divorce or legal separation results in you losing coverage under your spouse's health insurance;
  • A dependent is no longer considered a "covered" dependent under a parent's plan;
  • Your spouse's death leaves you without coverage under his or her plan;
  • Your employment ends along with coverage under your employer’s health plan, or your spouse’s employment ends along with your coverage under your spouse’s employer’s health plan;
  • Your employer reduces your work hours to the point where you are no longer covered by the health plan;
  • Your plan decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time);
  • An individual loses coverage under a State Children’s Health Insurance Program (CHIP) or Medicaid, or becomes eligible to receive premium assistance under those programs for group health plan coverage;
  • An individual involuntarily loses coverage under a Medicare supplement plan (e.g., Medigap) or an individual Medicare Advantage plan; and
  • You no longer live or work in an HMO’s service area.

  However, an increase in premiums or a change in benefits for coverage that you purchased outside of TRS-Care is not considered a loss of coverage that allows you to re-enter TRS-Care.

  Please note: The vast majority of participants who are past age 65 do not experience another enrollment opportunity. You can find current requirements related to special enrollment events in the TRS-Care Benefits Booklets.
  

• You may add a new spouse by sending TRS a written request with the spouse’s name, date of birth, social security number and gender. The request must also include your signature and a copy of the marriage license. TRS must receive the request within 31 days from the marriage date. The coverage would take effect the first of the month after TRS receives the request.
  NOTE: A surviving spouse cannot add a new spouse.

• If a dependent who previously waived TRS-Care coverage loses other health coverage through no fault of their own, the dependent has a Special Enrollment Event and may enroll in TRS-Care within 31 days from the date of the coverage loss. Contact TRS to receive a Special Enrollment packet.

​You can remove dependents from your coverage at any time. Send a written request to TRS, with TRS retiree’s or surviving spouse's signature, requesting to remove the dependent. Please specify which dependent you would like to remove from coverage. If the retiree or surviving spouse doesn’t sign the request, TRS cannot process it. The termination will take effect the first of the month after TRS receives the request.

• Keep in mind, once you remove a dependent from your coverage, you may not have an opportunity to add him or her back later. Find more information on dependent eligibility and enrollment in the TRS-Care Standard Guide for Participants without Medicare​.
  

You must send a written request to TRS Care with the legal proof of the change. For example, changing a name requires a marriage license or ID.

​Contact Social Security at 1-800-772-1213, apply on SSA.gov or contact your local office. TRS has a web page called Turning 65 that will walk you through the steps of applying for Medicare and enrolling in the TRS-Care Medicare Advantage ​plans.

Dental and vision benefits for TRS retirees and their families are coming to TRS-Care in 2025! The 88th Texas Legislature passed Senate Bill 1854, which allows TRS to offer optional dental and vision care coverage for TRS retirees. This includes their dependents, surviving spouses and surviving dependent children. TRS retirees will be able to enroll in Fall 2024 and coverage will start on Jan. 1, 2025.​

If you would like to extend TRS-Care benefits to your dependent after he or she turns 26, you may send a written request to TRS requesting a COBRA packet. You must submit the request to TRS within 60 days after the month your dependent turns 26. The packet will contain information about the premiums. If your child is mentally disabled or physically incapacitated, please contact TRS for the correct forms to extend coverage.

• Contact TRS for a cancellation form (700B).  You must sign and notarize the form.  Once TRS cancels your TRS-Care coverage, you cannot re-enroll in the TRS-Care program unless you experience a special enrollment event or you turn 65 years of age.
• Cancellations will be effective the first day of the month after TRS receives the notarized 700B form.
• If you are a surviving spouse of a TRS retiree and are enrolled in the TRS-Care program, send in a written request to cancel your TRS-Care coverage. The request must have your signature.

Call TRS’ Telephone Counseling Center toll-free at 1-800-223-8778.

Call 1-800-223-8778.