Medicare Supplements Made Easy
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
Medicare Supplements are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M, and N. However, Medicare Plans C & F are no longer available to those who are eligible for Medicare after January 1, 2020.
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 Medsup plan. No one should try to sell you an additional Medsup plan unless you decide you need to switch policies.
Medicare Supplement insurance plan basic benefits:
Each Medicare Supplement insurance plan offers a different level of basic benefits, but each lettered plan must include the same standardized basic benefits regardless of insurance company and location. For example, Medicare Supplement Plan G in Florida includes the same basic benefits as Plan G in North Dakota. Please note that if you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement insurance plan options are different than in the rest of the country. Medicare Supplement insurance plans do not have to cover vision, dental, long-term care, or hearing aids, but all plans must cover at least a portion of the following basic benefits:
Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits are exhausted
Medicare Part A hospice care coinsurance or copayments
Medicare Part B coinsurance or copayments
First three pints of blood used in a medical procedure
Some plans include additional basic benefits. For example, Medicare Supplement Plan F, the most comprehensive standardized Medigap insurance plan, carries the following additional benefits:
Medicare Part A deductible
Medicare Part B deductible
Part B excess charges
Part B preventive care coinsurance
Skilled Nursing Facility (SNF) care coinsurance
Foreign travel emergency care (80% of Medicare-approved costs, up to plan limits)
Some plans may include additional innovative benefits.
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.
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, if you leave an employer plan you may not be able to go back on it.
- 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.
Do not forget about your prescription drug coverage.
There are two ways to get Medicare prescription drug coverage, either through a Medicare Prescription Drug Plan (Part D), or through a 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.
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Sarah began working in the healthcare industry in 2001, where she worked for many years with elderly Alzheimer and Dementia patients. From there she worked as a Group Benefits Administrator with a local healthcare company in the Human Resource Department for a period of 10 years. Since then, she has decided to work in the Medicare insurance industry full time and has joined the family business, Ashford Insurance, as a Medicare Insurance Agent.
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