Five paths, assessed honestly — including the two that don't work and the one that is probably closed for now. The underwriting reality that shapes all of this is at the bottom.
Not really an alternative to the others — the thing to do while deciding, since every other option takes months to execute. And the arguments here are unusually strong: the Tymlos on-label argument, the diagnosis-coding fix, the Jimmo maintenance-therapy standard, the step-therapy lookback rule, the transition fill right, the eye-drop diagnosis code question.
Valero's retiree program offers United American Medicare Supplement plans in Basic, Enhanced, and Premium tiers, alongside Express Scripts pharmacy coverage. A Medicare Supplement means Original Medicare underneath — no network, no medical prior authorization, no PT authorization, no rehab gatekeeping, no surveillance-imaging approvals.
Given that individual Medigap is likely unavailable to you, this is probably the only realistic route to unrestricted medical access — and it stays inside the Valero program, so it doesn't put the retiree benefit permanently at risk. This is the single most important call to make.
This is the clean version of what you want on the medical side. Based on the actual underwriting questions Texas carriers use, the realistic probability of approval today is very low for either of you. Active rehab, ongoing cancer surveillance, and osteoporosis each independently trip standard knockout questions. Details in the underwriting section below.
As employer-group plan members you have a special enrollment period letting you leave the Valero plan almost any time. That is a Medicare right, not a Medigap right. Nothing about leaving obligates a Texas insurer to sell you a supplement — and Texas has no birthday rule and no year-round guaranteed issue.
The failure mode is: drop the Valero plan → land on Original Medicare → get declined by every carrier → end up with no supplement, no cap on the 20% coinsurance, and very likely no way back into the Valero plan. Never disenroll before a Medigap policy is approved in writing.
A better way to hold this: treat it as a destination, not a current option. The blocking questions do expire. Finishing therapy and waiting out a 12-month look-back opens some carriers. Two to three years past the last cancer treatment with no recurrence opens others. It's worth asking HICAP to map exactly which questions block you today and when each one clears.
Ask Amwins, in writing, whether Valero has any plan to terminate or restructure the retiree plan. If Valero ends the plan, that is an involuntary loss of coverage and would likely trigger guaranteed-issue rights — meaning no underwriting at all. That single fact would flip this option from closed to open, so it's worth asking even though the answer is probably no.
Medigap underwriting is assessed individually, so you don't have to move together. If one of you would clearly pass while the other wouldn't, that's a real option.
In practice, though, both profiles here have knockout triggers, and the person with the greatest need tends to be the least likely to be approved. Worth having a broker pre-screen both of you, but don't expect much today. Two other things to check: this forfeits the household discount (typically 10–12% on two policies), and you should confirm with Amwins whether one spouse leaving affects the other's eligibility.
Listed to rule it out. This would almost certainly be a downgrade: a regional network instead of a national PPO, several thousand dollars of out-of-pocket exposure instead of $0, no Valero subsidy, and the same prior authorization apparatus. The only reason to look is if a specific plan's formulary happens to cover your exact medications without restriction — check on the Medicare Plan Finder, but this won't solve the problem.
| Stay + appeal | Valero supplement | Original + Medigap | |
|---|---|---|---|
| Physical therapy authorization | Required, recurring | None exists | None exists |
| Medical prior authorization generally | Continues | Essentially gone | Essentially gone |
| Drug prior authorization | Continues | Different formulary, same rules | Different formulary, same rules |
| Post-acute / rehab access | Winnable, but a fight each time | Medicare rules apply | Medicare rules apply |
| Risk of being refused coverage | None | Verify with Amwins | Very high for you |
| Can you undo it later? | Yes | Verify with Amwins | Probably not |
| Keeps the Valero subsidy | Yes | Likely — verify | No |
| Monthly cost | Lowest | Moderate | Highest |
| Dental / vision / hearing | Included | Verify | Not covered |
This deserves specifics, because it's the constraint that shapes everything else. The questions below are drawn from actual Texas Medigap applications, not from summaries or general guidance.
| The question carriers ask | Look-back | What trips it here |
|---|---|---|
| "Have you received physical, occupational, or speech therapy?" | Last 12 months | Post-crash rehab — and note it says received, not currently receiving |
| "Have you been advised by a physician to have treatment, follow-up visits, further diagnostic evaluation, diagnostic testing or therapy?" | No time limit at all | Ongoing bladder cancer surveillance answers yes indefinitely |
| "Any cancer, excluding skin cancer" | 2–3 years from last treatment | Bladder cancer. The clock runs from treatment, not diagnosis, and a recurrence restarts it |
| "Osteoporosis with fractures" | 2 years | Appears on multiple carriers' outright decline lists |
| "Is surgery anticipated in the next twelve months?" | Forward-looking | Any planned procedure |
| Prescription database check | Ongoing | Injectable osteoporosis drugs and anticonvulsants both draw scrutiny |
Carbamazepine and oxcarbazepine are anticonvulsants, and a carrier's prescription report shows the drug, not the indication. An underwriter may infer epilepsy or bipolar disorder — and if the application says "no seizures," that reads as a discrepancy and triggers a records request. It's usually resolvable with a physician letter, not an automatic decline. Disclose the indication proactively in a cover letter rather than letting the prescription report raise it.
Pull your own consumer reports first. Both the Medical Information Bureau (mib.com, 866-692-6901) and Milliman IntelliScript provide free consumer disclosures and have dispute rights under federal law. Errors are common, and correcting them before applying is far easier than after.
Never let a broker submit speculatively. Have them pre-screen against each carrier's current underwriting guide first. The differences between carriers are entirely in question wording and look-back length — "currently receiving PT" versus "received PT within 12 months" is where whatever daylight exists will be found. A declined application also raises a question on future applications ("have you previously been declined?"), which is where a careless submission actually bites.