Sarah was ready to be back in the classroom this fall, teaching middle school science in Amarillo. The rhythm of school years feels familiar, but open enrollment for benefit elections was hitting differently this time around. She sat at her kitchen table after dinner, flipping through her district’s benefits packet. She was feeling completely overwhelmed.
As her two kids were in the next room playing video games, she stared at charts and medical plan names that might as well have been written in Greek. The costs looked steep. The options were confusing. And all she wanted was to pick a smart health care plan that didn’t wreck her budget.
Every Fall Brings the Same Confusion for Texas Teachers
If you are currently in Sarah’s shoes starting back for the year, you know the feeling. School starts, the really boring guy gives the open enrollment talk, and the pressure is on to make a big decision with very little clear guidance. Most teachers are handed an employee benefits packet and told to pick the plan that works best for them.
But what does that even mean? How are you supposed to know if the more expensive one is really any better?
The "health benefit solutions" always seem to cost more than they did last year. Deductibles creep up. Copays change. And for some reason, no one ever really explains how all this fits together. That’s what Sarah was dealing with. She wanted a succinct way to compare. Here are three items that explain health insurance coverage no matter who is offering it.
Three Keys Ways Texas Teachers Evaluate Health Plans
1. Understand What the Deductible Actually Covers
Sarah noticed her district offered three different plan options, each with a very different individual deductible. One was over $6,000. Another sat at $2,500. A third hovered around $1,000. Her first instinct was to run from the big number. But after talking with an agent at Insurance For Texans, she realized she needed to look deeper.
Deductibles represent the amount you must pay before your insurance company starts covering a portion of your bills. That part’s simple. What catches most people off guard is that you may not be done paying for medical claims.
Preventive care should be fully covered. But doctor visits might be a copay. Labs and prescriptions will likely have copays as well. Those copays will always have to be paid, even if you meet your deductible.
But there is one more dirty secret the health insurance company doesn't want you to know. When your deductible is met, you may still have to pay additional costs up to your maximum out of pocket costs. This is usually a big number they don't talk about, but can hit hard if you have a surgery or other big event. This number is vastly more important than your deductible because you can be on the hook for a lot more than you realize.
Sarah was able to see how the plans broke down once real medical events started happening. She didn’t like the idea of a high deductible. But when she saw what it saved on monthly premiums, and what services were still covered without needing to meet that amount, it made more sense.
2. Compare the Total Cost of Risk, Not Just Monthly Premiums
This part was the eye-opener for Sarah. Remember the maximum out of pocket amounts we mentioned? When Sarah looked at these amounts on the various health care plans offered, she realized that she could be on the hook for $10,000 if she had a major health event during the school year.
She is a math teacher, so doing the math on this was easy. Annual premiums plus the plan’s out-of-pocket maximum give you your total cost of risk for a school year. As a single mom of two kiddos, she just couldn't afford what she was seeing.
The family premiums for her and the kids were going to be almost $2,000 per month for the plan with the most advantageous health care and pharmacy benefits. When she considered that plus the maximum out of pocket costs she could be out over $30,000 this year. That was too big of a portion of her salary for her to be able to sleep at night.
3. Make Sure You Understand Your Options Beyond TRS ActiveCare
Sarah had heard the name before. TRS ActiveCare. That’s the health plan system run by the Teacher Retirement System of Texas. Her district was part of it, and the benefit packet was built around it. What she didn’t know was that she was not locked into that program.
A growing number of Texas teachers in school districts that use TRS ActiveCare are seeking alternative coverage instead. There are many teachers that are exploring private health insurance options instead. Most teacher in Texas don't realize they can seek health care coverage not provided by their school districts or the TRS. Sarah wanted to know more when shared this with her.
We helped Sarah compare her TRS ActiveCare options to what she might find through private insurance or with a catastrophic health policy. It helped her see what her money was buying. She could compare the Total cost of risk for each of the plans and decided that she needed a different path given how crazy health insurance costs have become.
Working With Insurance For Texans
Our goal is simple. Help people like Sarah understand what the heck they're signing up for so they don’t end up stuck with a policy that eats their paycheck or leaves them exposed when something happens.
After walking through all of her options, Sarah picked the plan that gave her the best mix of affordable monthly premiums and the most manageable total cost of risk.
She stopped guessing. She stopped feeling paralyzed. She finally had the peace of mind that she made the best choice for her and her kids.
That’s what we do every single day at Insurance For Texans. We help Texas Educators see what they’re really paying for, how plans work in real life, and what their options look like when things change. You don’t have to become a health insurance expert. You just have to talk to someone who already is. That's us!
Click the button below to get help choosing your benefits plan with clarity and confidence. Don’t settle for confusion this year.
FAQs - Frequently Asked Questions