Medigap Plans in Texas (Medicare Supplements)

Medigap, also known as Medicare Supplement Insurance, is a type of health insurance coverage provided by private companies to help cover some of the out-of-pocket costs that are not covered by Original Medicare, such as deductibles, coinsurance, and copayments. The coverage and cost of Medigap plans vary depending on the plan you choose, and there are ten standardized Medigap policies available, labeled Plans A, B, C, D, F, G, K, L, M, and N.

Original Medicare, which includes Parts A, B, and D, does not cover all expenses associated with an illness, leaving beneficiaries with substantial out-of-pocket costs, including 20% of the cost of doctor visits and medical procedures, a significant portion of prescription medications, and at least $1,200 if admitted to a hospital. Medigap plans help cover these extra charges, depending on the coverage type.

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 Medigap plan in Texas, you must have Original Medicare, Part A, and Part B. The best time to enroll in a Medigap plan is during the Medigap Open Enrollment Period, which starts the first month you are 65 or older and have Part B. During this six-month period, you have a guaranteed issue right to any Medicare Supplement plan offered in your location, regardless of pre-existing conditions. Insurance companies cannot turn you down for coverage or charge you higher premiums because of your health issues. However, the insurance company may delay coverage for a pre-existing health condition for up to six months in some cases.

Medigap policies require a monthly premium in addition to the monthly Part B premium that is paid to Medicare. It’s important to note that Medigap policies only cover one person, and if both spouses want Medigap coverage, they must each buy separate policies. Medigap policies sold after January 1, 2006, do not include prescription drug coverage. If you want prescription drug coverage, you can enroll in a Medicare Prescription Drug Plan (Part D).

In Texas, Medicare Supplement plans are available to qualified beneficiaries under 65 who have Medicare due to a disability or certain health conditions. Texas requires companies that sell Medigap plans to offer Plan A to beneficiaries under 65, and they have a six-month Medigap Open Enrollment Period to enroll in Plan A only. Once they turn 65, they will typically have another six-month Medigap Open Enrollment Period to enroll in or switch to other Medigap plans.

It’s essential to review employer retirement insurance plans carefully to understand what benefits are available and how they work with Medicare. Employer plans are not standardized and are not subject to the requirements governing standardized Medigap policies. It’s also crucial to remember that if you leave an employer plan, you may not be able to go back on it.

In summary, Medigap is a private health insurance coverage designed to cover excess costs not covered by Original Medicare. The coverage and cost of Medigap plans vary depending on the plan you choose. The best time to enroll in a Medigap plan is during the Medigap Open Enrollment Period, and it’s important to review employer retirement insurance plans carefully.