Medigap Plans in Texas (Medicare Supplements)
Medigap Made Easy
Ashford Insurance offers a selection of Medigap Plans in Texas (Medicare Supplements) from many top carriers including UnitedHealthcare® Medicare Solutions.
Also called Medicare Supplement Insurance, Medigap is health insurance coverage provided by private companies designed to cover excess costs not covered by original Medicare.
Depending on the Medigap 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.
Original Medicare, defined as parts A, B, and D, will not cover all expenses associated with an illness. Under original Medicare you would pay 20% of the cost of doctor visits and medical procedures regardless of the amount, a significant portion of your prescription medications, and at least $1,200 if admitted to a hospital.
Medigap covers all or a portion of those extra charges depending on the coverage type. Although private insurance companies offer the coverage, the federal government requires companies to offer standardized policies. Your choices are Plans A, B, C, D, F, G, K, L, M and N.
Open Enrollment for Texas Medigap Supplemental 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 Medigap. Doing so may save premium costs but it is important to compare the 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.
According to Medicare.gov, “You pay the private insurance company a monthly premium 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.
Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
To be eligible for a Medicare Supplement plan in Texas, you must have Original Medicare, Part A and Part B. In general, the best time to enroll is during your Medigap Open Enrollment Period, which starts the first month you’re 65 or older and have Part B. During this six-month time frame, you have a “guaranteed-issue right” to any Medicare Supplement plan offered in your location, regardless of pre-existing conditions. Insurance companies can’t turn you down for coverage or charge you higher premiums because of your health issues. The insurance company might delay coverage for a pre-existing health condition for up to six months, in some cases. It can be harder to switch Medicare Supplement plans or enroll for the first time without a guaranteed-issue right if you have medical issues.
Find affordable Medicare plans in your area
Although not all states require insurance companies to sell Medicare Supplement plans to qualified Medicare beneficiaries under 65, Texas does. If you have Medicare through disability or because of certain health conditions, Texas requires companies that sell Medicare Supplement plans to offer Plan A. If you’re under 65, you have a Medigap Open Enrollment Period that starts once you enroll in Medicare Part B; during this six-month period, you have a guaranteed-issue right to get Medicare Supplement Plan A only. You’ll also typically get another six-month Medigap Open Enrollment Period to enroll in or switch Medicare Supplement plans when you turn 65, and you may have more choices at this point.
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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