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    Should I Put My Family On My School District Health Plan This Year?

    Posted by Kevin Hall on Jul 23, 2025 4:10:13 PM
    Kevin Hall

    While the kids are trying to milk the last days of summer for everything they can get, the teachers are already back preparing for that first day of school. Mary is one of the teachers that is an institution at the local elementary school.

    Mary is a third-grade teacher in Abilene who has been back in the classroom for over a decade. She started teaching again after her youngest kiddo was old enough to be in school too.

    She is a master of juggling lesson plans, parent conferences, and the occasional science fair volcano. But this year, she’s facing a different kind of decision.

    Every year during in service days, the teachers have their enrollment opportunity for the TRS health plans. She has caught herself staring at the form asking whether she wants to add her kids to her district health plan.

    This year, her husband has access to insurance through his job. His plan isn’t amazing, but it’s not terrible either. So now she’s wondering… which plan is better for the kids?

    The problem is, none of the options feel affordable, and it’s hard to tell what you’re actually getting until it’s too late.

    Mary called us wanting an easy to understand way to compare which is the better option. And we realize that any Texas teacher in the same boat needs this as well. So what should Mary consider before putting her family on her district-offered Teachers' Choice health plan?

     

    Click To Get Help With Health Insurance


    The Three Big Things You Need To Know

    1. Network Coverage
    2. Flexibility & Portability
    3. Total Cost Of Coverage

    For those of you who love a down and dirty, our FAQs are at the bottom!

     

    Should I Put My Family On My School District Health Plan This Year?

    What Kind of Network Are You Really Getting?

    This is the piece many people overlook when they stare at an enrollment packet.

    Most teachers start by looking at that big premium you’re paying no matter which of the two plans you're looking at.

    Premiums are important, but they don't always give you access to the doctors, labs, or facilities you want or need. In fact, many plans have limited networks to help them control health care claim costs.

    That means you may not be able to see your preferred pediatrician. You might have to drive too far to find a specialist who takes your plan.

    And if you live in a more rural part of Texas, like Abilene, those options can get even thinner.

    The first step in comparing two plans is looking at how you can use them. You need to understand which providers you need are in-network. You need to understand which prescription drugs are on your formulary. You need to understand that paying monthly premiums should get you the ability to actually use your coverage.

    This is where an independent health agent can help you compare networks. Because once you’re locked in during that initial enrollment opportunity, you’re riding that policy until next fall unless you have a lot of money or a special enrollment event.

    Mary easily understood this concept. She had been burned before.

    Flexibility and Probability: What Will You Actually Use?

    Mary’s youngest son has asthma. Not a big deal most of the year, but he tends to flare up around October when the weather shifts. They usually have a few urgent care visits and a prescription drug refill or two.

    So when she compares plans, she isn’t just looking at premiums or networks. She’s looking at how easy it is to get care and how much it’ll cost when they need it.

    1. Does the plan require referrals before seeing a specialist like in an HMO?
    2. Does it offer telehealth visits?
    3. What’s the copay for urgent care or a primary care visit?

    Flexibility of use is more important than monthly price when your kid has been sick for days on end. Teachers have gone bankrupt because they could not be reimbursed for using care out of network.

    Mary understood that our concern went far beyond just the network issues we had mentioned previously. She liked that we were thinking beyond the enrollment window and trying to find her the best bang for the buck.

    Total Cost of Coverage: Premium + Out-of-Pocket + Chaos

    Mary’s district plan would cost her around $1,300 a month to add the whole family. That’s over fifteen grand a year in premiums alone.

    Her husband’s job offers a family plan for about $900 a month. But it’s a higher deductible, the network is a little tighter, and the maximum out of pocket for a family member is also higher.

    Which one is the better deal?

    It depends.

    Let’s say their son ends up in the ER for a broken arm from soccer practice. On Mary’s plan, the visit might only cost $1,000. On her husband’s plan, it could be $3,000 or more due to the out of pocket maximum.

    But over the course of the year, that premium difference is almost $5,000.

    If they only use the plan for checkups and a couple of visits, her husband’s plan might actually be cheaper overall. But in the event of a major health scare, that out of pocket maximum is going blow away any premium savings.

    That’s why you have to think in terms of total cost of risk – not just the monthly premium payment.

    1. How much are you paying in premiums?
    2. How much will you pay if someone gets sick or hurt?
    3. How much does a major health event cost even after the deductible is met?
    4. And what would that total look like over the entire year?

    The math changes depending on how often you use it, what kind of care you expect to need, and then what happens if you have a major health event.

    The Bottom Line for Texas Teachers Like Mary

    Health insurance is no longer just a form you fill out during in-service week. It’s one of the most expensive and most misunderstood decisions you’ll make for your family this year.

    Before you check the box that adds your kids to your plan during the initial enrollment period, stop and take a breath.

    You have options.

    The district plan provided through the Teacher Retirement System might be the right one for you and your children. But it also might not.

    Having an unbiased advisor help you determine how you will use the plan and what the total cost of risk is can make all the difference in the world for you. Just like it did for Mary.

    Experienced independent health insurance agents like us at Insurance For Texans help teachers and their families compare every angle: network access, flexibility of care, total cost of coverage, and whether there are private plans that offer more for the same or less.

    You don’t have to figure it all out alone.

    Click the button below and let’s walk through your options together before open enrollment ends.

     

    Click To Get Help With Health Insurance

    FAQs - Frequently Asked Questions

    What should I compare when deciding between my school district’s health plan and my spouse’s plan?

    When comparing health plans, don’t stop at just the monthly premium. Look at the total cost of coverage, including deductibles, out-of-pocket maximums, and how care is accessed. Ask:

    • Are your preferred doctors and hospitals in-network?

    • How much will urgent care or ER visits actually cost?

    • What’s covered when your kids need care most?

    Plans with lower monthly premiums might have tighter networks or higher deductibles—meaning they could cost more if someone gets sick.

    Why does network coverage matter so much in a Texas health plan?

    Because it determines whether your family can actually use the care you’re paying for. In places like Abilene and other parts of Texas, limited networks can mean long drives, fewer pediatricians, or being stuck with out-of-network costs. Always check if your doctors, hospitals, and pharmacies are considered “in-network” before choosing a plan.

    How can I calculate the true cost of risk for a health insurance plan for my family?

    Look at the total cost of risk, which includes:

    • Monthly premiums

    • Copays and deductibles

    • The out-of-pocket maximum for the year

    Also factor in expected medical use (like prescriptions or regular visits) and potential emergencies. A plan with a cheaper monthly premium might cost thousands more if one kid ends up in the ER. That’s why working with an independent agent—who knows how to run the numbers based on your real-world needs—can make all the difference.

    Topics: health insurance, teacher, group health