Medicare Supplements Texas
Texas Medicare Supplement Made Easy
Medicare Supplements Texas
While Medicare Parts A and B, also known as Original Medicare, cover some health care costs, they don’t pay for everything. That’s where a Medicare Supplement insurance plan may help. Medicare Supplement insurance plans, also known as Medigap, from private insurers help you pay for the costs not covered under your Original Medicare benefits.
Medicare Supplement plans are set by the federal government which means that the basic benefit structure is the same from one insurance company to the next. However, some plans do offer additional benefits.
A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like:
Medigap policies are sold by private companies.
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
- Medicare will pay its share of the
for covered health care costs.
- Then, your Medigap policy pays its share.
Texas Medicare Supplements are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M, and N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add more benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. You can only have one Med Sup plan. No one should try to sell you an additional Medigap plan unless you decide you need to switch policies.
Open Enrollment for Texas Medicare Supplement Insurance is at age 65 for all consumers, including those already receiving Medicare due to disability. The Open Enrollment period is a six-month period, beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover and how much they will charge based on your health—if you have an individual or “bank group” insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding which will work best.
As our Texas population ages, individuals inevitably encounter more medical problems that require additional, costly healthcare services. A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like care when you travel outside the United States. Medigap policies only supplement your Original Medicare benefits and shouldn’t be confused with Medicare Advantage Plans.
If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Also, it is important to remember that if you leave an employer plan you may not be able to go back on it.
Depending on the Medicare supplement plan you choose, the plan may provide a benefit for (Benefits and cost vary depending on the plan you choose.):
- Part A coinsurance (and most plans provide a benefit for the Part A deductible)
- Some of the out-of-pocket costs not paid by Part B (some plans also cover the Part B deductible)
- Cost of blood transfusions (first 3 pints)
- Cost of up to 365 extra hospital days after you’ve used up your Part A benefits
- Skilled nursing facility coinsurance or copayment
- Part A hospice/respite care coinsurance or copayment
You pay a monthly premium and some out-of-pocket costs.
Some Texas residents are eligible to enroll in approved Part C Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. Several include vision, dental, hearing, and wellness programs not covered by original Medicare. As noted earlier many Medicare Advantage Plans also offer prescription drug coverage. There are several Medicare Advantage plans available in Dallas, Tarrant, and surrounding counties. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services. Most importantly, with Medicare Supplements, Medicare Advantage, and stand-alone Part D Prescription Drug Plans, you must continue to pay your Part A (if any) and part B Medicare premiums.
Don’t forget your prescription drug coverage.
There are two ways to get Medicare prescription drug coverage, either through a Texas Medicare Prescription Drug Plan (Part D) or through a Texas Medicare Advantage Plan with prescription drug coverage (MA-PD). Let the sales agents at Ashford Insurance help you discover the most affordable Medicare plans available to you, and to understand when your coverage starts, what’s covered, and what to expect.
8 things to know about Medigap policies
- You must have Medicare Part A and Part B.
- A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
- You pay the private insurance company a monthly
for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan unless you’re switching back to Original Medicare.
Need help? Call us for an appointment at (817) 952-3153
Ashford Insurance is an independent health insurance agency specializing in Texas Medicare insurance and has been helping seniors since 2005. Ashford Insurance is here to help you understand Medicare and health insurance in simple, plain terms that anyone can grasp. We specialize in assisting folks who are Medicare eligible to learn about the coverage options available through the Medicare Health Insurance Program.
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* A licensed sales agent may call or e-mail as a result of completing the information to discuss Medicare Advantage, Prescription Drug Plans or Medicare Supplement Insurance.
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